Michele Carbone points to a map on which Hawaiʻi is fixed at the center—tiny dots in a vast ocean-blue grid with the far-off land masses of Asia and North America framing much of the image’s east and west edges.
“This can be two things,” says Carbone, who heads the Cancer Research Center of Hawaiʻi. “Either we are at the center of the world or in the middle of nowhere.”
The dryly delivered quip elicits smiles and knowing laughter from scientists, physicians, educators and others gathered in July 2009 to hear Carbone articulate his vision for the University of Hawaiʻi research unit’s future.
CRCH is one of 65 National Cancer Institute centers across the United States, a designation that brings grant funding needed to further the center’s work in epidemiology, natural products and cancer biology, prevention and control and carcinogenesis.
One day—within a decade possibly, Carbone says—if a viable clinical component is added to CRCH’s operations, its status could be elevated to “comprehensive cancer center,” the top NCI tag.
That’s the vision. Anticipated groundbreaking for a new research facility in Kakaʻako adjacent to UH’s John A. Burns School of Medicine this summer is a step in that direction, as well as insurance for retaining the current designation.
The path has been bumpy at times, negotiating internal challenges and external pressures, but those pushing for the center’s future believe there is no more important battle.
Cancer is blamed for one in four deaths in the United States
One in three Americans will eventually develop some form of the disease, according to NCI, a federally funded research and development center housed within the U.S. Department of Health and Human Services.
Every year, about 6,700 people in Hawaiʻi are diagnosed with cancer. That’s more than a hundred Hawaiʻi residents a week, says UH Mānoa Chancellor Virginia Hinshaw, who counts herself a “cancer survivor and thriver” thanks to research advances.
In far-flung Hawaiʻi, NCI’s backing is key to upgrading cancer-related options for island residents, adds Gary Ostrander, vice chancellor for research and graduate education.
“Many patients head to the mainland for treatment, which can leave them with enormous bills tied to travel and extended care. We need to fix that,” Ostrander explains. “What we really need is a comprehensive cancer care facility.”
NCI’s 40 comprehensive cancer centers are known for depth and breadth in population-based (epidemiology) studies as well as laboratory and clinical activities. To join their rank, UH’s center must establish a program built around treating patients in clinical settings.
CRCH was first organized in 1971 as part of Mānoa’s Pacific Biosciences Research Center.
It conducts research on the causes, prevention and treatment of cancer, but does not treat patients at its facilities.
When a new CRCH facility was first envisioned, about five years ago, plans called for a self-contained patient treatment area. Director Carl-Wilhelm Vogel persuaded the Hawaiʻi Legislature to deposit 2 cents for every cigarette sold into a special tax fund to cover construction costs and researchers’ salaries, promoting a facility that combined research with a university-operated clinical program.
When Vogel stepped down at the end of 2008, Carbone, director of CRCH’s thoracic oncology program and chair of the medical school’s pathology department, was named interim director. Carbone, who joined CRCH in 2006, heads an interdisciplinary team that investigates thoracic malignancies and recently received an American Association for Cancer Research award for discovery of a unique mesothelioma in Turkish villages.
Believing the university should collaborate rather than compete in the clinical setting, Carbone courted cancer physicians and hospital executives with persuasive arguments for a different approach—a matrix-style model used by about two-thirds of U.S. cancer centers.
In a matrix model, center-based researchers work with the oncologists who provide patient care in community hospitals and clinics.
“Isolated in the mid-Pacific, like we are, I really don’t think you have any other option but teamwork, if you want to grow,” Carbone says. “Hawaiʻi’s 1.3-million population is too small to support healthy competition” among all the cancer-related entities.
Chief Executive Officers Art Ushijima, of The Queen’s Medical Center, and Chuck Sted, of Hawaiʻi Pacific Health (Kapiʻolani, Straub, Pali Momi and Wilcox hospitals) appeared at a UH Board of Regents meeting in August 2009 to endorse Carbone’s permanent appointment as director, and they sat together at a January 2010 legislative briefing to voice support for new CRCH facilities.
“We have come together as a community of healthcare providers and professionals with a unified purpose and goal to improve cancer care for the people of Hawaiʻi,” Ushijima told lawmakers. “Dr. Carbone’s leadership in promoting collaboration and inclusion has enabled the dialog so that we could focus our energies and resources toward the greater good of our patients and the community.”
Queen’s, Hawaiʻi Pacific Health and Kuakini Health System are committing up to $2.2 million a year to support the center, he added.
Sted described watching Hawaiʻi cancer patients seek treatment at Fred Hutchinson in Seattle, M. D. Anderson in Houston and Mayo Clinic sites…if they have the means.
What about those who do not have the ability, either financially or otherwise, to get to the mainland? he asks. “As a community, we long ago solved this problem in other areas of healthcare. Now we are solving that problem in cancer care,” he answers. “Everything is in place for reaching that goal.”
Legislators have been receptive.
Despite the state’s struggle to balance the budget, lawmakers have honored their commitment to use the cigarette tax fund to support development of the cancer center.
“We’d like to see shovels in the ground as soon as possible,” urged Sen. Jill Tokuda, chair of the Senate Committee on Higher Education.
“We have developed a strong, feasible business plan, one that will result in the opening of the research facility in fall 2013,” UH President M.R.C. Greenwood assured the committee.
She meets weekly with an advisory group of university and CRCH leaders to ensure the project moves forward.
Working with the Research Corporation of the University of Hawaiʻi, the university selected Shimokawa + Nakamura to design the new research facility. The Honolulu architectural firm leads a team that includes ZGF of Los Angeles and Jacobs Consultancy of New York, which designed research facilities at nine of the country’s top 10 research centers.
Honolulu firm Wilson Okamoto and Associates will handle planning, and development company Kobayashi Group will coordinate day-to-day project management. Negotiations were underway on a construction contract at press time; officials expect the matrix-style facility to be less costly to build than the initial model, which was nearly twice the size.
A Kobayashi executive says the project may be the pinnacle of the partner’s careers.
It is neither the most expensive nor luxurious, but “one of the most important things we could do for the state of Hawaiʻi,” says Chief Operating Officer Kathryn Inouye.
“Those of us involved in the project have a passion like we’ve never had before,” she adds, noting that she lost a sister-in-law to cancer at age 46.
Besides providing construction jobs now, the project creates future medical and research positions for Hawaiʻi youth, she adds.
And, as Greenwood noted in announcing the university’s “Renovate to Innovate” initiative during her historic February 2010 address to the Legislature, investment in UH’s research infrastructure translates into higher overhead rates on federal research grants, which returns more money to the state via the university.
State-of-the-art facilities also help recruit talented faculty.
That is vital in addressing criticisms that threatened renewal of the UH cancer center’s NCI designation.
Federal reviewers first raised concerns about the status, size and scope of CRCH, smallest of the 65 NCI-designated centers, at its last renewal about five years ago. It recommended the university build a new facility to consolidate researchers spread across multiple locations and accommodate new investigators.
In extending the center’s application deadline last summer, NCI told CRCH to quickly increase the size of its depleted research staff; make strides toward breaking ground on the new research facility; and further cultivate relationships with entities from the medical school to Queen’s to the Hawaiʻi chapter of the American Cancer Society.
After a visit in February, NCI officials extended CRCH’s designation and associated funding through 2011. That’s major, says Greenwood. “If you’re not in the center group, it’s hard to get access to funding opportunities. ”
Only NCI-designated centers were eligible for 30 recent stimulus grants; CRCH obtained two.
The grants allow CRCH to hire a pair of researchers with unique local perspective. Oncologist Clayton Chong has focused on cancer incidence and mortality among Native Hawaiians. Liver specialist Linda Wong has conducted more than 160 transplants in the state with the dubious distinction of leading the nation in incidence of liver cancer.
CRCH also recruited David Ward, former deputy director of the Nevada Cancer Institute and chair of the genetics department at Yale, and three scientists who bring medical training from both Asia and the U.S. mainland—valuable background in multicultural Hawaiʻi.
Carbone hopes to hire four more researchers by the end of the year.
“Some people might say, ‘You don’t need a cancer center in Hawaiʻi because anything you do in Hawaiʻi can be done elsewhere,’” observes Ostrander, quickly countering with an emphatic, “Not true.”
Drawing on Hawaiʻi’s ethnic diversity, CRCH’s historic strength in epidemiologic studies helped define the role of lifestyle factors, such as diet, and genetic factors that render certain ethnic groups more susceptible to specific cancers.
The center’s population-based research holds increasing relevance.
With continued migration and intermarriage, Ostrander says, “the rest of the United States, in 100 years, and the rest of the world, in 200 years, is going to resemble Hawaiʻi”.
The islands are also uniquely positioned for probing marine ecosystems, allowing cancer researchers to collaborate with marine biologists on topics ranging from species spawning to mechanisms that regulate growth.
Among the CRCH natural products program’s top achievements is identification of cryptophycin, a cytotoxin produced by blue-green algae that has yielded promising anti-cancer compounds.
Another advantage of Hawaiʻi’s position on the Pacific map is the opportunity to serve as a bridge connecting the U.S. mainland with Asia and Australia—a place where cancer researchers from different parts of the world meet to discuss research.
“If there is a place that needs a cancer center,” Carbone says, “that place is Hawaiʻi.”