Matthew Oswald's trek around the University of Nebraska Medical Center campus helps explain why officials want to build a new cancer center there.
Matthew, a 15-year-old with T-cell lymphoma, has been coming from the family farm near Aurora, Neb., to the med center nearly every Friday since mid-April for treatment.
He and his parents, Deb and Mike, first ride the escalators just inside the Durham Outpatient Center doors to the third floor and walk to the University Tower Treatment Center to get Matthew's blood drawn. They then head to his doctor's office in the Lied Transplant Center, south of the treatment center.
After that, they often have to hike back north, past the University Tower and the Hixson-Lied Center to the Post-Anesthesia Care Unit in Clarkson Tower, so Matthew can get a spinal infusion of chemotherapy.
Their entire trip is more than two-thirds of a mile long.
“If everything was in one location,” said Deb Oswald, “it would sure make things a lot easier.”
Med center officials agree. The $323 million cancer center being planned on the Omaha campus is expected to make things more convenient for patients like Matthew.
“Every doctor they need to see will be in one facility: medical oncology, surgical oncology, radiation oncology, plus physical therapy, social workers,” said Dr. Ken Cowan, director of the Eppley Cancer Center.
The project has been in the public eye because of controversy over the use of public funding. The State of Nebraska, Douglas County and the City of Omaha have approved providing a total of $90 million for the center.
Private fundraising will cover the remainder, officials have said.
The new facility also will help integrate the science of cancer with the treatment of cancer by placing all the cancer doctors, cancer researchers and their labs, and inpatient beds for cancer patients in connected buildings.
Such consolidation is key, med center officials say, as they seek to build the facility into a comprehensive cancer center, a higher-level designation by the National Cancer Institute that brings with it greater stature and more research funds.
It isn't a requirement; many prominent centers aren't configured that way. For example, MD Anderson in Houston, the Mayo Clinic in Rochester, Minn., and Memorial Sloan-Kettering in New York City all are “spread out,” Cowan said.
“Very few (comprehensive) cancer centers had the opportunity to build a cancer research tower right next door to a cancer clinic,” Cowan said.
But research has found that consolidation gives clinicians and scientists more opportunities to discuss the cancer research and treatment each group is pursuing. Such discussions, officials say, can lead to improved treatment regimens and advances in cancer care.
Officials say the exchanges will be more likely because the two groups will cross paths more often if they are working near each other.
The cancer center project will move cancer researchers' offices to one building on campus and move the offices of researchers and cancer physicians next to each other. Those researchers now work in five buildings, often far from each other and from the physicians treating cancer patients.
Cowan said officials “want to shorten the distance — not only the physical distance, but the distance in time between a discovery in the laboratory and developing a new therapy. We need to have as much interaction as we can between these two groups.”
That's because of the movement toward a cancer treatment approach that seeks to rapidly apply discoveries in the lab to improvements in patient care, Cowan said.
Patients' tumors now can be evaluated at a genetic level, he said, allowing doctors to use new drugs that target specific genetic changes that lead to the spread of cancer.
“It really does take a scientist to help look at the information, to study it in laboratories,” Cowan said.
Officials at UNMC and its hospital partner, the Nebraska Medical Center, say the project will help address their need for more clinic space, outpatient treatment room space, rooms that can accommodate immunosuppressed cancer patients and research lab space.
“Our current facilities are too small for today, let alone tomorrow,” said Dr. Julie Vose, chief of oncology at UNMC.
The Eppley Cancer Center is a National Cancer Institute-designated cancer center, which means researchers and clinicians on the campus already are expected to interact, said Dr. Linda Weiss, director of the institute's Office of Cancer Centers.
Putting the two groups in close proximity is preferable, she said.
The integration of research and care has been standard for some time in academic medical centers such as UNMC, she said, and the approach is common for many other diseases besides cancer.
UNMC currently is a designated cancer center, meaning it focuses on laboratory research, research focusing on the general population and research that targets individuals, or some combination of the three, according to the National Cancer Institute.
A comprehensive cancer center, by contrast, must demonstrate depth and breadth of research in all three areas, with substantial research that bridges the three.
It also must provide professional and public education and outreach, including the dissemination of health advances in the communities it serves.
Of the 67 cancer institute-designated cancer centers in the country, 41 are comprehensive centers. UNMC has been a designated center since 1984.
UNMC lymphoma researcher John Chan said clinicians and researchers working near each other would have more opportunities to brainstorm and develop closer working relationships that can help get research findings to patients faster.
“That would be good and feasible if they are close together,” Chan said. “If they are multiple buildings apart, it is very unlikely that they will casually bump into each other and talk about things.”
A scientist might, for example, discover a protein in a tumor that could be used to predict how the tumor will respond to treatment, Chan said. He may run the finding by physicians, Chan said, to see whether the protein could be useful to the doctors as they work with patients and whether a test should be further developed.
Or, he said, a physician may identify a group of cancer patients who respond poorly to therapy and who seem to share certain characteristics. She may ask the scientists to come up with a good hypothesis to explain the patients' poor response and see if the hypothesis could be tested.
Chan, who also is a pathologist who analyzes patients' lab work, has his office in the Lied Transplant Center, a couple of floors up from the clinicians with whom he works. Being so close, he said, makes meeting with physicians more convenient.
“I interact with the clinicians a lot,” he said. “We have conferences together to discuss not only research but patient care.”
He contrasts that with most of the campus' researchers, who have offices in the Durham towers.
It's not that clinicians and researchers in different buildings don't ever talk or that collaboration is impossible unless the two groups are next-door neighbors.
The University of California-Davis Comprehensive Cancer Center is in Sacramento, 20 minutes from the main campus in Davis. It's also 45 minutes from researchers at Lawrence Livermore National Laboratory, which is part of the comprehensive cancer center, and about six miles from Jackson Laboratory-West, a research partner that grows cancer center patients' tumors in mice.
Researcher retreats, seminars and teleconferences allow the main players to discuss developments in cancer care, said Dorsey Griffith, a UC-Davis cancer center spokeswoman: “We do a lot of meetings.”
But where you work can make a difference.
Research has found that bringing people from different disciplines together in the same building increases the chances that they will collaborate, said Jon Crane, global director of translational health science for Omaha-based HDR Architecture. Translational health science refers to the process of moving scientific discovery to the clinic.
UNMC and Nebraska Medical Center officials were interested in housing the various disciplines in one center and contracted with HDR to provide programming and concept design for the project.
Crane cited a University of Michigan study that found the extent to which scientists share overlapping space significantly increases both the formation of new collaborations and the scientists' success in securing outside funding.
Funding organizations are likely to see the configuration as enhancing a project's chances of meeting its goals, said Bruce Carpenter, HDR Architecture's senior vice president.
“Just getting people together spurs innovation,” Crane said, “particularly people who wouldn't normally get together.”
The Michigan researchers found that when investigators with no prior history of collaboration move to the same building, they're 33 percent more likely to initiate a new collaboration than when they occupy different buildings.
When they're assigned to space on the same floor, the study found, the likelihood of a new project increases by 57 percent when compared with investigators working in different buildings.
The workspaces that the different groups use — the clinics and labs — don't need to intersect, Crane said, but it helps to put everyone's offices, conference rooms and casual work spaces in the same area.
“What we're trying to do is eliminate artificial barriers, if possible,” Crane said.
“The University of Nebraska has the potential to have the most highly integrated cancer center in the country and equal to any in the world.”
Cancer center project
The three-part center will be built next to the Durham Research Center towers on the west end of campus.
Swanson Hall will be demolished next spring, and officials are considering whether to remove a 767-stall parking garage to make way for the center. Construction is expected to begin in late summer and be completed in 2016. The facility will consist of three main parts:
|RESEARCH TOWER||10 stories; 250,000 square feet; 98 laboratories||$110 million|
|INPATIENT TREATMENT CENTER||Three stories; 125,000 square feet; 108 beds||$63 million|
|OUTPATIENT CLINIC||Four stories; 200,000 square feet||$150 million|
|ALSO PLANNED||20,000-square-foot clinic for nonemergency care that isn't cancer-related||$47 million|
|Total project cost||$370 million|
Possible magnet for funding, prestige
The new cancer center will help attract top U.S. scientists, who will bring their research teams, funding and prestige to Omaha, a University of Nebraska Medical Center cancer researcher says.
The researcher, Dr. Hamid Band, and his wife, Vimla Band, were the top scientists targeted for recruitment about five years ago. Dr. Ken Cowan, director of UNMC's Eppley Cancer Center, knew the breast cancer researchers from serving with them on national panels that review grant requests for research projects.
Cowan got the two to leave Northwestern University for Omaha. They brought with them $8 million in grants and 14 research team members.
When the Bands considered moving here, Hamid Band said, part of what attracted them was the first Durham Research Center tower, with its modern laboratories and new equipment. (The second tower still was being built.)
Other draws, he said, were the relatively low cost of living, good schools, short commuting times and the opportunity to work with researchers who already were at UNMC.
UNMC has recruited 100 cancer center faculty members over the past decade, quadrupling total outside funding, said Dr. Jennifer Larsen, UNMC's vice chancellor for research.
Just since 2008, total outside funding for Eppley Cancer Center researchers who do non-cancer-related research as well as cancer-related research has risen from $43.6 million to $65.3 million.
Cowan expects to recruit 50 more cancer researchers in the next several years.
Frequently diagnosed cancers
Some of the most frequently diagnosed cancers in Nebraska will be emphasized at the enhanced cancer center. In addition, cancer center researchers want to study pediatric cancers. Planned areas of emphasis are ALL CAPS.
|Type of cancer||Diagnoses, 2009|
|Kidney, renal pelvis||332|
|ORAL CAVITY, PHARNYX||209|
|BRAIN, NERVOUS SYSTEM||131|
Source: University of Nebraska Medical Center, Nebraska Department of Health and Human Services, Nebraska Cancer Registry
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