Some day in the future, when University of Kentucky Markey Cancer Center (Markey) Director Mark Evers, MD, reflects on his time leading the UK institution, he expects to see that “Markey had a hand in changing the culture of Kentucky,” in relation to cancer treatment and cancer-promoting behaviors. Recently, that vision became much more likely. Markey’s long-standing commitment to regional health – through cancer treatment and prevention – has been substantially bolstered by its July designation as a National Cancer Institute (NCI) center.
With the NCI designation comes increased funding for research and clinical trials and a mandate to address the regional phenomena contributing to high incidences of certain cancers. The people of the Commonwealth, long among the nation’s most cancer-prone, will find increased resources right at home to help them fight their cancers and change the behaviors that lead to them. Evers says, “Folks don’t have to cross the border to get top-notch cancer care. They won’t have to go to Vanderbilt or Ohio State.” And the physicians of the Commonwealth will find they have a “destination center of excellence, a nationally recognized cancer center nearby, so they need not send their patients elsewhere,” says Evers. The boon for research will empower Kentucky physicians with increased access to newly developed and very large clinical trials reserved for NCI designated facilities and subsequent new standards of care.
Markey’s Commitment and Journey
For Evers, “A cancer center needs to stay true to its catchment population. We have a mandate to understand and take care of our population.” Markey is a textbook example of this. Founded in 1983 with money bestowed by Lucille Markey, matron of Lexington’s Calumet Farm family, its charge was to focus on the most common cancers of the region: lung, colorectal, gastrointestinal, and head and neck. Outreach to the cancer prone populations of Appalachia was always a focus, with hallmarks such as the community-focused “Faith Moves Mountains” program, in which local churches help with pre-cancer screenings and the establishment in 1990 of the Kentucky Cancer Registry (KCR). In 2005, UK’s NCI-funded five-state Appalachia Community Cancer Network (ACCN) was awarded.
The 2009 arrival of Evers, a surgical oncologist and nationally recognized physician-scientist who had served as director of the University of Texas Medical Branch (UTMB) Cancer Center in Galveston, was the result of an exhaustive search and the beginning of a new era at Markey: the push to build a cancer center worthy of National Cancer Institute designation.
Several key components of the effort had long been in place. Tom Tucker, PhD, associate director for Cancer Prevention and Control, had been with Markey from the start, and his work in cancer prevention and control in central Appalachia had been going on for several decades. Data from the KCR, which he helped develop, was used to focus resources on colorectal cancer screening. Using this data to guide the implementation of interventions, a statewide initiative was conducted resulting in a 22 percent decrease in both the incidence and mortality of colorectal cancer in Kentucky.
Susanne Arnold, MD, associate director for Clinic Translations, an eighth-generation Kentuckian, arrived at Markey in 1998 and has overseen hundreds of participants in clinical trials. Her work is infused with her Kentucky and medical lineage. “I learned a very valuable lesson from my father, who was also a physician and a Kentuckian — that we can’t make progress in the treatment of diseases without being invested in the research that we do,” says Arnold.
Daret St. Clair, PhD, associate director for Basic Research, has been receiving NCI research funding since she began at UK in 1991; she went full-time at Markey in 2009. Her team’s efforts toward reducing the side effects of chemotherapy-induced normal tissue injury, including cognitive impairment (aka “chemo-brain”), has been groundbreaking. She now spends much of her time coordinating Markey research projects and mentoring their scientists.
While at UTMB-Galveston for 20 years, five as Cancer Center director, Evers nurtured a committed group of cancer professionals, including administrators, post-docs, graduate students, and research staff, 34 of whom sought to come to Markey with him. Evers notes that, “It is not typical to bring so many people with you, but a major institutional commitment by Dr. Michael Karpf, (UK’s executive vice president for Health Affairs) and former UK President Lee Todd was really what it took to make it happen. This has allowed us to jump-start many of the programs key to earning the NCI designation.”
Arriving with Evers was Heidi Weiss, PhD, biostatistician and associate director of Shared Resources and a veteran of 20 years in the field, many at other NCI designated cancer centers. Under her direction, Markey’s six shared resource facilities are coordinated to maximize the value of the research conducted, from laboratory to clinical trials. Simplified, her job is two-fold: “To ensure that Markey’s shared facilities – which are funded by the NCI – deliver high quality, state-of-the art, and cost-effective services that will enhance the entire spectrum of cancer research; and as a biostatistician, to help Markey’s researchers design clinical trials and find the story in the data produced from those trials,” says Weiss.
Dave Gosky, MBA, associate director for Administration, was another eager transplant. He has an MA in Classics from the University of Pennsylvania to go with his MBA, and he and Evers led the program together in Galveston. An impression left on him by a mentor committed to cancer patient care directed his career as a young man, and he has stayed in oncology because “I feel that, as an administrator, my job is to ensure that all of the cancer physicians and researchers have the tools, equipment, and staffing they need to do their job successfully and serve more patients thoroughly.”
Fertile Ground for NCI Designation
The team that Karpf assembled at Markey in 2009 immediately began working towards the NCI designation. All NIH funded NCI-designated cancer centers are institutions dedicated to research in the development of more effective approaches to prevention, diagnosis, and treatment of cancer – and committed to reach out to underserved populations. Markey had all of these attributes, but it took Evers’ leadership – and $119 million dollars from multiple sources including UK HealthCare, the Commonwealth, and generous philanthropic and community support – to coordinate the effort and presentation that would earn the designation.
NCI-designated cancer centers experience a typical suite of benefits. Access to funding increases, high profile researchers are drawn in, and broader scientific collaborations and information sharing with other NCI centers are enabled. Ultimately, research-giving data and clinical trials abound, and a better use of statistics supplies valuable information. The resulting new standards of care are what doctors in the region benefit from most. Cancer patients find access to multidisciplinary, state-of-the-art treatment; expertise in rare cancers; and outreach, education, and cancer control programs. The coattail effect extends to the local communities as medical professionals relocate, drug companies arrive, and high tech jobs increase.
Value Added at Markey
This pattern is already manifesting itself at Markey. Evers notes that, “Our number of physician referrals has already increased, and several hospitals who were watching us in the NCI process are now wanting to talk to us about affiliations.” The face of the research is being affected also. “We have already taken advantage of grant supplements of $100,000 and $125,000, which are only available to NCI designated cancer centers,” he continues. “And we just announced a group of fully-funded metabolic investigators who have chosen to relocate with us.”
The evolution in standards of care that the average Kentucky physician will experience is gradual, but it is underway. St. Clair began mobilizing for the future of research at Markey two years before the designation was awarded. Now that it is in place, she has increased funding for multiple projects already underway and received abundant input about her program’s strengths and weaknesses. She says her teams are primed to “put the basic research and the clinicians together and increase the rate of applying the research to our clinical trials.” With NCI’s mandate to focus on Markey’s catchment population, she plans “even more focus on developing new treatments that are effective in these Appalachian populations.” Specifically, they are developing more effective treatments to reduce incident rates of multi-factor lung and GI cancers in these populations. “The NCI designation will really boost our ability to do this,” she says.
Weiss’ focus on “developing better clinical trials around the novel therapies that will serve our catchment populations” will be bolstered in several ways. Designation will help her increase the multidisciplinary nature of Markey studies to maximize what can be learned from the clinical trials. Multidisciplinary grants that can come with the NCI designation, some of which are $8 to $10 million grants to be used over five years, are anticipated. She also will have access to open clinical trials that involve other NCI-designated cancer centers. “This collaboration will enrich the quality of our trials,” she says. Together, these will produce more compelling and convincing “stories” from the data that will in turn bring better treatments to the cancer patients of the Commonwealth. She sees a “comprehensive attack on the whole continuum of cancer in Kentucky.” Arnold concurs: “We know that the best way to erase the huge cancer burden in our state is through research and advocacy, and the NCI designation brings both to our people.”
Tucker, the sage of the center and its man in the field, says “The last phase of translational research is broad-based implementation. This is where the products of the clinical trials are disseminated to the medical practitioners of the region.” He is energized by the work of Evers’ committed team, noting that in the last four years, “This cancer center came together the way a true cancer center should.”
Gosky’s job, while larger, will only be made easier by the NCI designation because, “It allows us to do more of what we have been committed to all along: recruiting grant-funded faculty, getting more science into the outreach of the cancer prevention and control program, increasing the number of patients in clinical trials, and replacing seasoned faculty.” For him, the “halo effect” of the NCI designation is simple: “When you are successful, people want to be part of that success.”
For his part, Evers will continue to work his 80-hour weeks. He has been blessed with great philanthropic support, especially from Markey Cancer Foundation Chair Sally Humphrey, her board, and the equine community of the region who continue to support Evers and the Markey Cancer Center. But he will use the NCI designation to fuel his push to increase annual grant funding from $30 to $50 million, grow his patient referral base, and establish Markey as the cancer treatment provider for all of central Appalachia.
Value Added for Physicians and their Patients
Physicians of the region should be aware that this designation establishes Markey as their resource for all things cancer. Evers wants them to know that, “For the complicated cases, for the tertiary cases, for the interesting clinical trials, folks don’t have to leave our borders. We are in the same league as MD Anderson and The Cleveland Clinic; that’s the kind of rigorous review we have had to go through to get this designation.”
The population of the region can in turn expect to become healthier. “A cancer center’s mission should be on the people that it serves,” says Evers. “We’ve got to really focus on our patient population and cancers that are prevalent there, and the NCI designation provides the mandate for doing this into the future.” The collaborative team of highly competent and congenial individuals who have coalesced under his energetic and insightful leadership is poised to deliver on this.
Tucker concludes with his patent optimism: “If we continue to push collectively like this, as a community, as a state, we will be able to reduce the cancer burden and move ourselves out of that awful position of highest cancer mortality rate in the country.”
WE KNOW THAT THE BEST WAY TO ERASE THE HUGE CANCER BURDEN IN OUR STATE IS THROUGH RESEARCH AND ADVOCACY, AND THE NCI DESIGNATION BRINGS BOTH TO OUR PEOPLE. – Dr. Susanne Arnold
WE ARE IN THE SAME LEAGUE AS MD ANDERSON AND THE CLEVELAND CLINIC; THAT’S THE KIND OF RIGOROUS REVIEW WE HAVE HAD TO GO THROUGH TO GET THIS DESIGNATION. – Dr. Mark Evers