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The Honolulu Advertiser
Posted on: Sunday, January 17, 2010

Together, UH center, hospitals can better target cancer

By Jeanne Mariani-Belding

Hawaii news photo - The Honolulu Advertiser
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Dorothy Coleman: How will the UH Cancer Research Center's partnership with the hospitals benefit cancer patients and the community? Do you think this will increase enrollment in clinical trials?

Dr. Michele Carbone: The partnership is critical to provide a cancer center that can serve Hawai'i, first to prevent cancer and then to take care of those who develop cancer. By joining resources, we will be able to afford what each one of us could not afford individually. Moreover, each hospital can devote more resources to a particular theme rather than trying to compete on everything. The results should be that the overall quality of care will improve, because resources can be targeted.

For example, Kapi'olani can focus on pediatric malignancies, another hospital on liver cancer and so on.

Coordination among hospitals should also result in more clinical trials available to our Hawai'i cancer patients, increase the enrollment of patients in Hawai'i and decrease the need for them to travel to the Mainland to find a clinical trial that matches their needs.

ULU: It's been charged that you did not meet the minimum requirements for the position of director in terms of supervisory experience. Could you address this and put the issue to rest?

Carbone: Those who did not want me as director tried to argue that I was too young actually, I am almost 50 and that I had not been a cancer center director before. It is and please forgive me for the comparison a very similar argument to the one that was expressed against President Obama during the recent election. I respect experience, and I agreed that McCain had much more experience than Obama. I still voted for Obama.

I have been the chair of pathology at the UH medical school for the past two years and have led an international team of asbestos researchers for the past 10 years. I would like to be judged on the results.

Emily: What is the main obstacle that could prevent the cancer research center from being successful?

Carbone: Fear. That we are in Hawai'i, and for some reason, we cannot compete with the Mainland and settle on a lower standard. In fact, Honolulu is one of the best cities in the U.S. and certainly the most beautiful, and there is no reason that we shouldn't have the best hotels, the No. 1 shopping mall in the country and a first-class cancer center to serve those who develop cancer in Hawai'i.

Emily: I don't understand how the community hospitals, which all are competing for the same patients, can benefit from collaboration with one another. Doesn't that mean each hospital gets less of the "patient pie?"

What kind of researchers are you trying to bring into the cancer center, and how much do they cost Hawai'i taxpayers?

Carbone: The consortium allows each hospital to keep its current clinical volume under the matrix model, so the pool of patients will remain the same.

We are trying to recruit investigators that will bring us a lot of grant funding, and their grant funding will provide jobs to many people in Hawai'i. The key is to hire the best and most talented investigators. They are in high demand, and we need to be competitive to convince them to come here.

In short, we already are a very good economic investment for Hawai'i, and as we recruit new well-funded investigators, we will become an even better investment.

Nancy Lewis: Are there other cancer centers which are utilizing this collaborative model? Is there a track record for success? Will this new cancer center result in an increase in clinical trials here in Hawai'i which cancer patients may benefit from?

Carbone: Yes, the New Jersey Cancer Center and the Kansas Cancer Center are both consortium cancer centers like the one we are establishing here in Hawai'i.

That is one of the main goals of the consortium. In addition, we want to focus our research efforts on types of cancer that disproportionately strike residents of Hawai'i as a result of our ethnic diversity. For example, we have just hired Dr. Linda Wong, a surgeon who specializes in liver cancer, because Hawai'i has the highest incidence of this type of cancer in the U.S. We are building a research team to address liver cancer.

Nancy Lewis: Are there centers of excellence on the Mainland or abroad that you are also collaborating with in any way, such as UCLA, Stanford, UCSF, etc? How do you see the future of this cancer institute in 10 years?

Carbone: Of course. For example: the New York University Cancer Center, the Fox Chase Cancer Center in Philadelphia, the University of Iowa Cancer Center and many more. I see a cancer center that can compete with any other cancer center in the U.S., that attracts the best researchers and physicians, that has successfully reduced the cancer burden in Hawai'i and that has decreased and possibly eliminated the need for any patient (in Hawai'i) to travel to the Mainland to enroll in a clinical trial because it will be available here.

Nancy N.: You've been talking about this expanded center for a long time. Why do it now? How much will it cost?

Carbone: It is a top priority for Hawai'i because as we know, one in four people die of cancer. Additionally, it is a top priority of $12.5 million per each million you invest.

A. Newman: I understand that the cancer center is spending significant amounts of state tax money to rent office space and pay for parking in the Gold Bond building, nearly a million dollars a year, and that the existing UH-owned cancer center building at Queen's hospital (which apparently has no rental fee) is half empty. Also, the center has vacated free space on the UH-Mānoa campus for the Gold Bond rented space. In these tight economic times of cutbacks in social services, pay cuts, furloughs, etc., how does the cancer center morally and ethically justify this?

Carbone: You have incorrect information, and we are very conscious of the current economic climate. In fact, we would not be proceeding with this project if this were not the right thing to do now for the health of the people of Hawai'i.

First, it is impossible to recruit successful researchers to our facility near The Queen's Medical Center at Lauhala because it has poor and very old research facilities. Secondly, even if it were possible to recruit an investigator with a lot of funding, it would not be economical to keep him or her there. Here's why: For every million dollars of grant funding that a researcher receives at Kaka'ako, including the Gold Bond building, the federal government gives us an additional $500,000 in what is called indirect costs. Of this, $250,000 comes to the center and $250,000 goes to the university. At the center, we use our portion of indirect cost to pay the salaries of the staff, and of the center researchers who do not have grant funding. Instead, the indirect cost rate at the Lauhala facility gives us $360,000 of indirect cost for every million dollars in grants. This is because the indirect cost is related to the university's investment in the infrastructure, and the Lauhala facility is old and outdated compared to Kaka'ako. Because it is old, the maintenance costs at Lauhala are exceedingly high. For example, the electricity bill there exceeds $400,000 per year. This means that we need $3 million in grants just to pay for electricity. Clearly, it is not economical to keep well-funded investigators at Lauhala, and I am encouraging them to move to the Gold Bond building. We will continue to keep those investigators who do not have grant funding at Lauhala because they do not generate direct cost and do not help pay the costs of running the center, including salaries.

The UH-Mānoa space we vacated is now being renovated to accommodate other researchers as we build the new cancer center. By investing in renovation, the university expects to increase the direct cost presently at 36 percent at UH-Mānoa. You see how critical it is to invest in the infrastructure because well-funded investigators and the rate of indirect cost drives the economy and well-being of the university.