Substance with Style

Cancer survivor Sherry Stewart has extraordinarily high regard for the physicians and nurses at UofL’s James Graham Brown Cancer Center, where she began receiving treatments for breast cancer in 2005.

The center’s physical plant, however, once evoked very different feelings.

“The staff there is just fantastic — the very best you could ever ask for,” says Stewart, a Louisville homemaker whose cancer is now in remission. “But the building itself was so drab and gray, it was downright depressing.”

Indeed. The original design motif could charitably be described as “1970s Concrete” — broad spans of institutional cement, dull gray walls and dimly illuminated corridors, with little thought given to creating a comfortable environment for patients.

Donald Miller, M.D., Ph.D., who was recruited from the University of Alabama-Birmingham in 1999 to head the Brown Cancer Center, remembers it all too well.

“The patients always got good care here, but we had the ugliest clinical facility this side of South America,” he notes, somewhat ruefully.

Now, however, thanks to an expert $29 million renovation, the 30-year-old building has a stunning new look. The center’s public image is now dominated by bright, cheerful colors; warm, inviting light; and the soothing sounds of mountain streams, which emanate from waterfalls on the first and third floors.

The lobby features an iridescent sculpture, by Louisville artist Ken Von Roenn, that mimics the refraction of light through a rainbow, symbolizing hope and optimism. And a redesigned chemotherapy unit offers patients more space in which to receive treatments as warm rays of natural light flood the pastel walls through a bank of large windows. 

“It’s so much nicer now than it used to be,” Stewart says of the center’s marble floors, cherry-on-maple woodwork and framed art depicting natural elements like flowers and trees. “It’s just a very relaxing place now, which is important to people with cancer. The soothing atmosphere really does make you feel a lot better.”

As nice as the overhaul is, all of the $29 million tab wasn’t spent on aesthetics. Slightly more than half went to purchase new equipment for the center’s radiation oncology program, including five state-of-the-art linear accelerators, says Patty Melvin, vice president of administration. The center already boasts the region’s first tomotherapy accelerator, its first Trilogy linear accelerator and its first intra-operative radiotherapy unit, in addition to a host of leading-edge diagnostic imaging equipment like a 64-slice, high-resolution CT scanner.

“We are in the process of recruiting more faculty like radiation oncologists,” Melvin says, “and when those prospects see the level of technology we have, they are blown away.”

Officially unveiled May 1, the makeover is the most visible change yet to a cancer center that has been undergoing one form of renovation or another since Miller arrived in Louisville nine years ago to shape the facility into a nationally recognized center of excellence.

When Miller first took the helm, he was steering a ship with less than $300,000 in federal research grants, just two endowed faculty members and a clinical system that made it difficult for patients to get the best in coordinated care.

Today, the cancer center is in a vastly different place. Research funding now tops $45 million annually, more than 90 new faculty have joined the ranks, endowed chairs have skyrocketed to 23, and clinical care has been dramatically reconfigured to focus on multi-disciplinary, personalized treatment — a fact that helps account for a growth rate of 10 to 12 percent annually in the number of patients seeking care at the Brown Cancer Center.

Meanwhile, some of the nation’s leading investigational therapies are being provided to patients here, long before they’re available to the rest of America.

The center also is nearing the end of a record-breaking capital campaign that handily surpassed its original goal of collecting $41.5 million in private gifts in just two years. Officials now expect the campaign will garner $80 million, generating funds that will be used to establish more endowed chairs, recruit new faculty and build additional programs across the breadth of the cancer center’s clinical and scientific endeavors.

“When you look at everything that’s been done at this cancer center in the past few years, it just takes your breath away,” Melvin says. “These are huge accomplishments, and they’re making a real difference in the lives of our patients every day.”

One-stop shopping

The heart and soul of any cancer center is the care it provides to its patients, and the Brown Cancer Center offers some of the best in the nation, Melvin says.

That’s because UofL embraced the concept of multidisciplinary care several years ago, tossing out an old paradigm that treated each medical subspecialty as a kind of self-contained silo.

Traditionally, cancer patients were referred by their primary-care physicians to see a cancer specialist. That specialist — say, a surgical oncologist — would then make additional referrals to a medical oncologist, a radiation oncologist and any number of other practitioners like dieticians or psychologists. Each referral meant yet another appointment for the patient, often at different physical locations, resulting in care that was difficult to coordinate and sometimes contradictory.

In contrast, the Brown Cancer Center offers specialists from all three treatment modalities — surgery, chemotherapy and radiation therapy — under one roof, as well as a full spectrum of support services that are bound together to form eight different multidisciplinary cancer clinics.

Each of the clinics specializes in a particular area of care — breast cancer; gastrointestinal cancer; genito-urinary cancer; gynecologic oncology; head and neck cancer; lung cancer; melanoma; and the blood and marrow transplant program clinic.

Some have developed such an excellent reputation that they now are drawing patients from six different states around the region.

“People really like our multidisciplinary clinics because they offer one-stop shopping,” Melvin explains. “Patients don’t have to traipse all over town to see a multitude of a doctors on different days. But more importantly, the clinics allows our clinicians to collaborate very closely on patient care, so that everyone is on the same page with each patient’s treatment plan.”

Those plans are developed and later modified weekly during conferences that pull every member of a multidisciplinary team together in one room for consultations.

“This makes the management of each patient a little more complex because it requires a tremendous amount of coordination, but it also eliminates cases in which patient care is delayed because the various clinicians failed to get together and agree on a treatment plan up front,” Melvin notes.

“The conferences typically also include a social worker, a clinical trials specialist, a radiologist, a pathologist, a cancer nurse and any other staff who might be relevant, such as a speech therapist for patients with head and neck cancer or a thoracic surgeon and a pulmonologist for patients with lung cancer. The idea is that multiple resources from a very broad range of specialties will be brought to bear to ensure that appropriate clinical care and support services are provided and coordinated for each patient as needed.”

Non-traditional therapies also play a role in clinical care at the center, Melvin notes. These stress-relieving programs, offered through the Mint Jubilee Cancer Resource Center, include massage therapy, Reike therapy, art therapy and music therapy. There’s even a cooking class.

“The idea here is to offer a range of things that can help patients feel as though they’re taking more control over their lives,” Melvin says.

Promising discoveries

The cancer center also has been aggressively pursuing new areas of scientific discovery, says John Eaton, Ph.D., deputy director of the facility and UofL’s James Graham Brown Chair in Cancer Biology. The intent is to find unique cancer-fighting compounds that can be brought to market quickly and then safely administered to patients in a clinical setting.

Three compounds discovered by UofL scientists have already entered clinical trials, Eaton says, and more than a dozen additional candidates have been identified for further study.

“This is one aspect of our work at UofL that is pretty unique,” Eaton says. “Most cancer centers don’t have a coherent program to accomplish this kind of work. We do.”

To assist with the commercialization of effective discoveries, the university has partnered with a group of local investors to form Advanced Cancer Therapeutics, a business incubator that’s managed by professional staff who have expertise in guiding medical discoveries to success in the marketplace.

Feeding the pipeline with potential new therapies are the cancer center’s five main areas of research. They are:

• Molecular Targets Program — Headed by Eaton, this group works to identify aspects of cancer cells that aren’t present in normal cells. When a unique aspect is discovered, scientists determine if it can be exploited in some way, perhaps by targeting it with a designer drug or custom-made compound that harms only the cancer cells’ metabolism, while leaving healthy tissue intact.
• Structural Biology Program — Headed by Andrew Lane, Ph.D., this section studies the molecular structure and interactions of cancer cells, with the hope of creating drugs that target proteins essential to tumor growth. A unique capability of the program taps the processing power of about 3,500 desktop computers located at school districts across the state. When not being used for classroom instruction, the PCs carry out computerized screening of millions of small molecules to identify promising new drug candidates.
• Tumor Immunobiology Program — Headed by Haribabu Bodduluri, Ph.D., this cadre works to better understand the body’s own immune system, so it can be trained to stop or eliminate cancer cell development on its own. The group also is working to develop effective vaccines against all types of cancer.
• Stem Cell Biology Program — Headed by Mariusz Ratajczak, M.D., Ph.D., this effort focuses on cells, derived from adult bone marrow, that surprisingly behave like embryonic stem cells. Discovered by Ratajczak and his team of researchers, these cells appear to mimic the ability of embryonic stem cells to multiply and develop into other kinds of tissue. The discovery could lead to a renewable source of replacement cells and tissues for the treatment of illnesses ranging from cancer to heart disease.
• Cancer Prevention and Control Program — Headed by David Hein, Ph.D., this group investigates the reasons why some individuals are genetically susceptible to the development of cancer after exposure to certain chemicals. The team also focuses on pharmacogenetics and pharmacogenomics to better understand the genetic causes of drug failure or toxicity, and to help optimize drug dosing for individual patients. The Kentucky Cancer Program, which Eaton calls “the nation’s Cadillac program in terms of cancer awareness, education, screening and outreach,” also is housed under this section.

Overall, the cancer center’s research push has been so successful that UofL has literally run out of lab space in which to conduct investigative cancer work, Eaton says. A new, six-story research facility is slated to open on campus next summer, and about half of that space is expected to go to cancer researchers, but Eaton believes the site will be filled to capacity almost immediately, based on current needs and the rate of new faculty recruitment.

Additional space will be necessary if center officials hope to continue growth at the current pace, he says.

NCI designation

With all these advances, UofL’s James Graham Brown Cancer Center is now tantalizingly close to attaining one of its primary long-term goals: National Institutes of Health designation as a Comprehensive Cancer Center.

That designation, held by just 41 other facilities across the country, would certify UofL’s center as being in the top echelon of cancer treatment and research programs nationwide, opening the door for access to promising new treatment options and additional research dollars.

The designation is awarded based on performance in six key areas, including patient care, community outreach, and current NCI funding for advanced cancer research.

The center met none of these criteria in 1999. Today it meets all but one — NCI funding.

“We have about $5.5 million annually in NCI funding now, but we need about $9 million to meet the standard for a Comprehensive Cancer Center,” Miller explains. “We’re about 2/3s of the way there. The problem is that research funding is much tougher to secure now than it was a few years ago because of federal budget cuts. In 1999, approximately 30 percent of all new grant requests were funded by the NCI. Today, the figure is 9 percent.

“We’ve been lucky at UofL in that our people have been holding their own. That means we’re not growing much, but a lot of other institutions around the country have been losing ground in research funding.

“For UofL to take it to the next level, we need to continue to grow, so we can add more lab space, so we can recruit new faculty members who already have NCI funding, and so we can provide infrastructure that allows all of our researchers to do things here that they can’t do anywhere else.

“I think we’re right where we need to be, right now,” Miller adds. “We’ve built multidisciplinary clinics that are starting to attract patients from across the region, our clinical research has really taken off, and our young scientists and doctors are building top-flight reputations and practices.

“Kentucky deserves to have a cancer center that really makes a difference, and I think that the James Graham Brown Cancer Center does that. Every cancer patient in the state should have the very best care, and almost without exception, they can now get it here at UofL.”

And because of the new renovation, they can now get it in style.