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Florida Academic Cancer Center Alliance
About Overview

FACCA White Paper
As of July 18, 2013

Policy Issue Summary – Health and Human Services

Topic: Florida as a Destination for Cancer Treatment and Research

Problem Statement

Sound investment in cancer care and research offers great potential to improve the quality of life for Floridians and positively contribute to the state’s economic competitiveness. Major cancer centers, through the patient, provider, and research communities they attract to the state represent significant opportunities to have a significantly positive statewide economic impact, enhance the quality of higher education at our universities and instigate the proliferation of high-paying jobs and educational opportunities in science, technology, engineering and math (STEM) degree programs.

Goals

  1. Create an attractive and competitive climate within the State of Florida for nationally recognized cancer treatment and research institutions
  2. Establish a strong link between state funding of cancer centers and Florida’s universities and colleges
  3. Establish a consistent source of funding to assist existing Florida cancer centers in becoming NCI-designated cancer centers
  4. Establish a consistent source of state funding for NCI-designated cancer centers located within the state

Overview

While modern medicine allows for more common types of cancer to be diagnosed and treated in virtually any community setting, including small towns, major cancer centers, especially those recognized by the National Cancer Institute (NCI), remain a rich resource for patients who are dealing with relatively uncommon or complex forms of cancer, searching for sound second opinions, or attempting to access experimental treatments through participation in clinical trials.1

A rapidly increasing emphasis on translational research2 in the medical domain is bringing treatment and research closer together than ever before, but this is especially the case with cancer, which was one of the original principal targets of translational research more than a decade ago. Indeed, some even argue that translational research came out of cancer treatment out of necessity due to the unique difficulty3 in understanding and treating this increasingly common4 host of diseases. Also, the Chair of Florida’s Biomedical Research Advisory Council has noted: “In a number of important scientific and healthcare delivery respects, cancer can provide a model5 by which we can work to address other preventable disease, including cardiovascular disease, lung disease, and stroke.”

Background on Florida’s one NCI center:

Moffitt Cancer Center was created by the Florida Legislature6 and opened in 1986 to address the state’s burden of cancer by contributing to the prevention and cure of cancer. Moffitt has consistently received funding from the state over the years and today is one of 41 NCI-designated comprehensive cancer centers.7 With Moffitt, Florida has only one NCI-designated cancer center, compared to the following large states:8

  • California-10
  • New York-6
  • Pennsylvania-5
  • Texas-4

Moffitt shares important characteristics to major cancer centers in these other states, including the following:

  • Receiving financial assistance from state government;
  • Offering the full range of diagnostic and treatment services on site;
  • Participating in cancer-related clinical research by enrolling patients in cancer-related clinical trials;
  • Offering degree-granting programs and/or affiliating with universities through degree-granting programs; and9
  • Providing internship, residency, and fellowship training opportunities to Ph.D.s and medical professionals.10

Strategy for developing major cancer centers statewide:

Establishing more major cancer centers is integral to Florida being competitive in the cancer treatment and research fields, since the competition in this area is primarily centered around attracting patients with more challenging and complex cases.

A fair and balanced playing field for all organizations is essential to maintaining a robust and competitive environment in cancer care and research, which ensures maximum return on investment of Florida taxpayer dollars. At the same time, such competition must not come at the expense of the network integrations and collaborative efforts that enhance cancer treatment and research. To achieve this balance, state funding must be open to all institutions, but institutions must meet a very high set of standards in order to receive such funding.

A very high set of standards:

Open competition for funding does not need to come at the expense of collaborative efforts, so long as the competition is structured around which institutions can best provide a comprehensive set of services. Such a system might require institutions to meet a minimum set of standards before being eligible to receive state funding, including all of the following measurable items:

  • Offering and providing the full range of diagnostic and treatment services on site;
  • Participating in cancer-related clinical research by enrolling patients in cancer-related clinical trials;
  • Offering degree-granting programs and/or affiliating with universities through degree-granting programs; and
  • Providing internship, residency, and fellowship training opportunities to Ph.D.s and medical professionals.

Open state funding:

Rather than providing direct appropriations to institutions explicitly named in statute, the state can provide support by designating and funding institutions according to tiers, with each tier assigned a portion of the overall funding. Such a system might look like the following:

Tier 1: NCI-Designated Comprehensive Cancer Centers
Tier 2: NCI-Designated Centers
Tier 3: University affiliated cancer centers with comprehensive programs in place looking to achieve NCI cancer center designation

Conclusion:

Development of More NCI Centers in Florida

NCI designation for more Florida cancer centers is the obvious first and most essential step toward making the state a destination for cancer research and care. The prestigious designation is the first and most apparent thing patients(or the physicians searching on their behalf) look for when dealing with relatively uncommon or complex forms of cancer, searching for sound second opinions, or attempting to access experimental treatments through participation in clinical trials. Given the unique difficulty in treating cancer, particularly with the most challenging cases, these patients will continue to look for treatment where some of the most cutting-edge research in science and medicine are taking place. Making Florida a leader in this field will prove valuable both to the state and the field, since cancer is the leading cause of death in the state and the size, diversity, and age of its population11 are tremendous resources for greatly improving proper representation in clinical trials and, in turn, advancing science and medicine.

Affiliation with Florida Colleges and Universities

Science is often advanced through world-class colleges and universities. The needs of patients and science presented by cancer and the potential Florida has to offer the field present significant educational and future job opportunities for its students, particularly in the areas of science, technology, engineering, and math (STEM). The majority of NCI-designated Cancer Centers in the United States are affiliated with major universities, and it is noteworthy that the two cancer centers in Florida closest to achieving NCI designation are both affiliated with two of the state’s most well known universities.

Establishment of a Consortium of NCI Centers in Florida

Market competition in industries on the cutting edge of scientific insights and technologies tends to be among networks of innovators. That is, such industries are largely defined by collaborative competition and competitive collaboration, or “coopetition.” In addition to developing more NCI centers in the state, a dedicated source of funding for these centers will help them to maintain their designation and remain part of the prestigious NCI network. Additionally tying this funding to participation in a consortium where members congenially compete on caseloads, peer-review research, and educational offerings, but also must collaboratively research, exchange knowledge, and report back to state policymakers on progress measures relating to improvements in cancer treatment and research in the state will further help and encourage Florida’s leading cancer centers to be competitive nationally and internationally.12

Footnotes

  1. http://www.webmd.com/cancer/features/how-to-find-the-best-cancer-treatment and http://health.usnews.com/health-news/managing-your-healthcare/cancer/articles/2009/11/30/how-to-get-thevery-best-cancer-care
  2. Also termed “translational medicine”
  3. Cancer was famously described as “the emperor of all maladies,” by a 19th century English surgeon. This phrase became the title of a Pulitzer Prize winning book in 2011.
  4. In recent years, cancer has become the leading cause of death in Florida, and second leading cause of death nationwide.
  5. bold his
  6. s. 1004.43, F.S.
  7. Of the 68 NCI-designated cancer centers in the U.S., 41 are comprehensive cancer centers. http://cancercenters.cancer.gov/cancer_centers/index.html
  8. http://cancercenters.cancer.gov/cancer_centers/cancer-centers-list2.html
  9. Some of the bachelor’s degree, master’s degrees and Ph.D.s offered through MD Anderson in Texas include: immunology, cancer biology, genes and development, molecular carcinogenesis, medical physics, biomathematics, biostatistics, experimental therapeutics, virology, gene therapy, clinical laboratory science, histotechnology, medical dosimetry, molecular genetic technology, radiation therapy, and diagnostic imaging.
  10. Moffitt is training more students in the field of oncology than all other Florida institutions combined.
  11. Nearly two-thirds of all cancer patients are 65 or older, but only one quarter of the people in cancer studies have reached the age of 65. This is largely attributable to the fact that the elderly population finds it more difficult to travel and spend time away from home.
  12. “Business is cooperation when it comes to creating a pie and competition when it comes to dividing it up.” – Brandenburger, A. & Nalebuff, B. (1996). Co-opetition. Currency Doubleday. p.4
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