THIS IS A PUBLIC MEETING BEING
VIDEOCAST AND RECORDED.
MEMBERS OF THE PUBLIC WHO MAY
EXPRESS VIEWS OF ANY ITEMS
DISCUSSED MAY DO SO BY WRITING
TO DR. GRAY, EXECUTIVE
SECRETARY OF THE NCAB WITHIN
TEN DAYS OF THE MEETING.
ANY WRITTEN STATEMENTS OR
QUESTIONS SUBMITTED BY MEMBERS
OF THE PUBLIC WILL RECEIVE
CAREFUL CONSIDERATION.
THE FOLLOWING SUBCOMMITTEE
MEMBERS ARE PARTICIPATING IN
TODAY'S MEETING, THE CHAIR
VADAPARAMPIL, DR. BOXER, DR.
HEIMBERGER, AND DR. KHATIBI.
THERE IS A QUORUM.
ANY QUESTIONS REGARDING PROCESS?
DR. VADAPARAMPIL, CAN YOU
BEGIN, THANK YOU.
>> THANK YOU SO MUCH, JOY, I
WOULD LIKE TO WELCOME EVERYBODY
TO OUR CANCER CENTER
SUBCOMMITTEE MEETING.
I KNOW IT'S BEEN A WHILE SINCE
WE MET AND AT OUR LAST MEETING
WE DISCUSSED WANTING TO GET
TOGETHER AS A GROUP, SO I
APPRECIATE EVERYONE COMING
TOGETHER.
SINCE WE HAVEN'T REALLY BEEN ON
TOGETHER FOR A WHILE, I KNOW IT
WILL JUST TAKE A FEW MINUTES
AND I'M COGNIZANT OF THE TIME
WE ONLY HAVE AN HOUR.
BUT I DO THINK IT WILL BE
HELPFUL FOR THE SUBCOMMITTEE
MEMBERS TO INTRODUCE THEMSELVES.
JUST HELLO AND YOUR NAME, YOUR
ORGANIZATION.
AND WE CAN GO FROM THERE.
IN THE INTEREST OF TRYING TO
MOVE THINGS, I'M JUST GOING TO
TRY TO CALL ON YOU AND IF I
LEFT ANYBODY WHO IS ON THE
COMMITTEE OFF, PLEASE JUMP IN
AFTER THAT.
AND I THINK DR. CIOLINO WILL DO
A BRIEF INTRODUCTION OF THE NCI
TEAM HERE PART OF THE CANCER
CENTER'S OFFICE.
WITH THAT, MAYBE START WITH DR.
BOXER?
>> DR. BOXER: HI, I'M DR.
BOXER, CLINICAL -- UCLA
MEDICAL CENTER.
>> DR. FRIESE.
>> NURSING POLICY ROGO CANCER
CENTER UNIVERSITY OF MICHIGAN.
>> DR. HEIMBERGER?
>> PROFESSOR OF NEUROSURGERY,
NORTHWESTERN UNIVERSITY.
>> DR. KHATIBI, ARE YOU ON?
>> YES, HI, THIS IS DR. KHATIBI
FROM SOUTHERN CALIFORNIA.
I'M A PHYSICIAN, CEO OF
HEALTHCARE IN THE PRIVATE
INDUSTRY.
>> I DON'T SEE DR. T --
DR. W --
>> HERE.
NO PROBLEM.
ASSISTANT PROFESSOR OHIO STATE
UNIVERSITY, COMPREHENSIVE
CANCER CENTER.
>> NICE TO SEE YOU.
DR. WEERARATNA AND DR.
WINKFIELD.
>> I'M DR. WINKFIELD AT
VANDERBILT UNIVERSITY AND
PROFESSOR OF MEDICINE AT
HARRIET MEDICAL COLLEGE.
>> A COUPLE OTHER NCAB MEMBERS
I SEE ON, DR. BARKER?
>> HI, ANN BARKER, ARIZONA
STATE UNIVERSITY,
TRANSFORMATIVE MEDICINE, USC.
>> AND DOES AZAD.
>> I'M PROFESSOR AT JOHNS
HOPKINS CANCER CENTER.
>> GREAT TO SEE ALL OF YOU, I
THINK THAT'S EVERYONE ON THE
SUBCOMMITTEE, WE WELCOME OUR
BSA COLLEAGUES AS WELL.
SO I WILL JUST WELCOME
EVERYONE, THANK YOU FOR ALL
YOUR INPUT ON THE AGENDA.
AND THE WAY WE HAVE STRUCTURED
TODAY'S MEETING IS THAT HENRY
IS GOING TO BE PRESENTING, DR.
CIOLINO WILL BE PRESENTING ON A
COUPLE OF THE TOPICS YOU ALL
HAD SUGGESTED.
I THINK YOU WANTED TO HEAR MORE
ABOUT.
AND THEN WE LEFT PLENTY OF TIME
FOR DISCUSSION AND THEN A
LITTLE BIT OF TIME TO WRAP UP
IN FUTURE DIRECTIONS.
AND BEFORE I GET STARTED, I SEE
DR. HAYES JOINED US.
HELLO.
>> ANDREA HAYES DICK ON, HOWARD
COLLEGE AZZEDINE.
-- AS DEAN.
I STUDY SARCOMA IN THE
MOLECULAR BIOLOGY LABORATORY.
>> DR. CARPTEN?
>> JOHN CARPTEN, CHAIR FOR
NCAB, I'M DIRECTOR FOR THE CITY
OF HOPE COMPREHENSIVE CANCER
CENTER.
>> ALL RIGHT.
THANK YOU, EVERYBODY.
SO WITH THAT, HENRY, I WILL
TURN IT OVER TO YOU FOR THE
NEXT COUPLE OF PRESENTATIONS
AND WE WILL GO FROM THERE.
>> THANK YOU, SUSAN.
THANK YOU EVERYONE WHO CAME
HERE.
THIS IS QUITE A TURN-OUT.
I WOULD LIKE THE PRINCIPLE
LEADERS OF NCI TO INTRODUCE
THEMSELVES.
STARTING WITH THE DEPUTIES.
DOUG?
>> DOUG LOWY, ACTING DIRECTOR
NCI.
>> JIM, JIM DOROSHOW OF CANCER
TREATMENT AND DIAGNOSIS.
>> DINA?
>> DEPUTY DIRECTOR OF NCI.
>> UNEXPECTEDLY DR. RATHWELL,
MY NEXT BOSS.
>> JUST A BSA -- TODAY.
GLAD TO BE HERE.
>> O'ER ALL RIGHT, FOLKS SINCE
IT'S BEEN SO LONG SINCE WE HAVE
MET, I THOUGHT I WOULD
INTRODUCE YOU TO THE STAFF OF
THE OFFICE OF CANCER CENTERS.
I'VE BEEN DIRECTOR SINCE 2015,
I SUCCEEDED LINDA WEISS WHO HAD
BEEN IN THE JOB SINCE 2001.
DR. CHRISTOFF.
WE HAVE FOUR PROGRAM DIRECTORS,
MAFIQ.
IN ADDITION TO HANDLING THE
NORMAL PORTFOLIO FOR PROGRAM
DIRECTOR OF ABOUT 15 CANCER
CENTERS ALSO RUNS AIDS
MALIGNANCIES P 30 SUPPLEMENT,
SHE SECURES FUNDING FROM OFFICE
HUMAN AIDS MALIGNANCIS.
DR. SONJA ROBERSON IS VERY
EXPERIENCED IN THE REVIEW SIDE
AND NOW THE PROGRAM SIDE OF THE
CCSG.
PRISCILLA CAME TO US FROM --
SHE WORKED ON THE P 30
SUPPLEMENT CURE PROGRAM.
AND ALSO HAS A REAL INTEREST IN
SURVIVEORSHIP ISSUES X DR. MINH
CAME FROM DIVISION OF CANCER
TREATMENT AND CONTROL WHERE SHE
DEVELOPED NEW MECHANISMS
PARTICULARLY AROUND DRUG
DEVELOPMENT AND TRAINING.
CHI DIN I.T. SPERKIST.
MARTINEZ IS PROGRAM SPECIALIST
AND MOLLIE MAYOR IS OUR NEWEST
RECRUIT ONBOARD A FEW MONTHS
AGO HANDLES ALL OUR BUDGET AND
SORT OF OUR PROGRAM DIRECTOR IN
TRAINING.
WE HAVE PROBABLY THE SMALLEST
DIVISION OFFICE OR CENTER IN
ALL OF NCI AND WE HAVE ONE OF
THE LARGEST BUDGETS.
I WOULD LIKE TO THINK WE ARE
VERY EFFICIENT MOVING NCI
DOLLARS OUT THE DOOR.
YOU CAN GIVE ME THE NEXT SLIDE,
PLEASE.
SO DR. RATHWELL WILL GET THESE
SLIDES TWICE, I ASKED THE
FORMAT WE WERE ASKED TO PREPARE
FOR HER BRIEFING AS THE FIRST
PART OF MY TALK.
SO WE HAVE A TOTAL BUDGET OF
$322.1 MILLION IN TOTAL COSTS
FOR THE CCSG, THAT DOES NOT
INCLUDE SUPPLEMENTS.
AND OUR MAIN MISSION IS TO
OVERSEE THAT PROGRAM.
WE PROVIDE PRE-APPLICATION
ADVICE TO NEW AND RENEWING
CANCER CENTERS.
THIS IS PARTICULARLY IMPORTANT
FOR THE EMERGING CANCER CENTERS.
WE OFTEN MEET WITH THEM ON A
YEARLY BASIS RUN-UP TO THEIR
INITIAL APPLICATION.
AND FOR RENEWING CANCER CENTERS
IT ALL DEPENDS HOW EXPERIENCED
THE DIRECTOR IS, WE CHANGED
SINCE THE LAST TIME HE OR SHE
WROTE THE APPLICATION AS TO HOW
EXTENSIVE THAT MEETING GOES.
WE PARTNER WITH OTHER NCI
DIVISION OFFICES AND CENTERS
FOR NEW INITIATIVES.
THE D43 WE DEVELOP WITH CENTER
FOR GLOBAL HEALTH.
THE CLINICAL SCIENTIST FOR
CLINICAL TRIALS.
P 30 SUPPLEMENT THAT TRAINS
EARLY SURGEON SCIENTISTS WE
DEVELOP WITH CENTER FOR CANCER
TRAINING AND INTRAMURAL
ONCOLOGY BRANCH.
AND WE ALSO HELP OTHER DOCS
DEVELOPING P 30 SUPPLEMENT
IDEAS.
THIS HAS LED TO QUITE A LARGE
AMOUNT OF FUNDING DIRECTED
TOWARD THE P 30 DESIGNATED
CANCER CENTERS FROM 20-30
MILLION A YEAR IN FUNDING.
IS DEVOTE TODAY P 30
SUPPLEMENTS RIGHT NOW.
THESE PROGRAM PRIORITIES.
I WILL GO THROUGH EACH ONE OF
THESE IN MORE DETAIL.
LET'S START WITH OUR MANDATE TO
REVISE AND IMPROVE THE CCSG
REQUIREMENTS.
NEXT SLIDE.
THIS IS THE MOST IMPORTANT
THING WE DO.
WHAT THE OFFICE OF CANCER
CENTERS LAYS OUT IS ESSENTIALLY
WHAT CANCER CENTERS ARE
REQUIRED TO DO AND WHAT THEY
ARE REQUIRED TO DISCUSS WITHIN
THEIR APPLICATION.
THIS HAS TO OCCUR EVERY THREE
YEARS UNDER THE NIH RULES.
AND WE THEORETICALLY COULD
PUBLISH THE EXACT SAME THING
THAT THE PREVIOUS CYCLE HAD.
WE LOOK AS AN OPPORTUNITY TO
IMPROVE THE CCSG AND ALIGN ARE
ALIGN WITH NIH PRIORITIES.
WE LOOKED AT REVIEW CRITERIA AND
ADDED CANCER RESEARCH TRAINING
AND COORDINATION, ADDED SHARED
RESOURCE MANAGEMENT AND RECENTLY
PUBLISHED AT THE END OF 21 AND
CAME ONLINE FOR 22, WE ADDED THE
PLAN TO ENHANCE DIVERSITY WHICH
WE'RE GOING TO TALK ABOUT IN THE
SECOND PART OF MY TALK.
WE'RE GOING TO PUBLISH AGAIN AT
THE END OF 24, SOMETIME AFTER
SEPTEMBER 25 THE LAST RECEIPT
DATE FOR THE CCSG DATE OF THAT
WE'RE COMING OUT WITH A NEW
REVISION, AND WE HAVE CLOSELY
MONITORED REVIEWERS'
EXPECTATIONS AND WE'RE GOING TO
BE REVISING DIVERSITY.
NEXT SLIDE.
ONE OF THE MAJOR EFFORTS IS
DEVICE STRATEGY FOR RENEWING
CANCER CENTERS.
NCI NEVER HAD THIS BEFORE.
AND LET ME GIVE -- SINCE THE
COMMITTEE HASN'T MET, IN 2010
WE WERE LIMITED TO 10% OVER THE
PREVIOUS CYCLE.
THAT LED TO A PROTEST ON THE
PART OF CENTERS WITH SMALLER
CCSGs, AND DR. VARMUS FORMED A
WORKING GROUP WHICH CONSISTEDDED
OF TEN NCI DESIGNATED DIRECTORS
AND CHAIR.
THEY MET OVER A PERIOD OF 18
MONTHS AND THEY ISSUED A REPORT
THAT WAS ACCEPTED BY THE NCAB
WITH RECOMMENDATIONS ON HOW TO
REALIGN CANCER CENTER FUNDING.
STAFF IN THE OFFICE OF CANCER
CENTERS AS WELL AS DR. VARMUS'
OFFICE BEGAN TO WORK ON THOSE
RECOMMENDATIONS AND AFTER
SEVERAL YEARS DEVELOPED A
THREE-PHASE FUNDING STRATEGY FOR
CANCER CENTERS.
PHASE 1 WAS IN 2016, WE CREATED
MINIMUM AWARDS FOR EACH TYPE OF
CANCER CENTER AND RAISED 21
CANCER CENTERS UP TO NEW LEVELS,
SPENDING HAVE A $10.1 MILLION IN
TOTAL COSTS.
PHASE 2 WAS TWO YEARS LATER.
WE DETERMINED THE MAXIMAL BUDGET
ELIGIBILITY OF CANCER CENTER
BASED ON ITS NIH CANCER RELEVANT
PORTFOLIO, AND THEN MADE A FINAL
FUNDING AWARD BASED ON THE
OVERALL IMPACT SCORE THAT THE
CENTER ACHIEVED IN ITS NEXT
REVIEW.
THAT COST EXTRA $33 MILLION, WE
HAVE ONE REMAINING CANCER CENTER
TO GO THROUGH PHASE 2,
UNIVERSITY OF MIAMI.
AND MY RECOMMENDATION TO NCI
LEADERSHIP IS EVERY NEW CANCER
CENTER IN ITS INITIAL RENEWAL
APPLICATION WILL HAVE A CHANCE
TO RAISE ITS FUNDING IN A MANNER
SIMILAR TO WHAT THE PHASE 2 HAS
DONE.
THAT'S WHAT WE'RE DOING WITH
MIAMI.
WE'RE IN THE MIDST OF PHASE 3
APPROVED BY DR. SHARPLESS WITH A
MORE TARGETED APPROACH.
WE LOOKED AT THE VARIOUS
COMPONENTS OF THE CCSG AND CAME
TO THE REALIZATION THAT THE MOST
UNDERFUNDED IS COMMUNITY
OUTREACH ENGAGEMENT.
THE CLINICAL PROTOCOL AND DATA
MANAGEMENT, WE'VE HAD THE NEW
COMPONENT, PLAN TO ENHANCE
DIVERSITY, SO WE'RE INSTRUCTING
CANCER CENTERS TO APPLY FOR
PREVIOUS AWARD PLUS $650,000
DIRECT COSTS IN THEIR NEXT
RENEWAL DIVIDED AMONGST THOSE
THREE COMPONENTS AND WE'LL MAKE
A FUNDING DECISION BASED ON
MERIT DESCRIPTOR EACH OF THE
COMPONENTS ACHIEVES IN REVIEW.
THIS MORE DIRECTED APPROACH WE
FELT LIKE WOULD SPREAD PHASE 3
FUNDING ACROSS MORE CANCER
CENTERS IN A MORE EQUITABLE
MANNER THAN PHASE 2 WHICH TENDED
TO BE FOCUSED ON LARGER CANCER
CENTERS AND CENTERS THAT MADE A
BIG MOVE IN OVERALL IMPACT
SCORE, MAYBE SHORT ON REWARDING
SMALLER CANCER CENTERS WHICH DID
BENEFIT GREATLY FROM PHASE 1.
AS FOR PHASE 2
IT COMMITS NCI TO A BUDGET
INCREASE IN THIS PROGRAM OVER
PERIOD OF YEARS WHEN WE DON'T
KNOW WHAT THE NCI BUDGET IS
GOING TO BE.
WE'RE GOING TO RUN INTO THAT
PROBLEM THIS YEAR IN 24 AND
PROBABLY 25 WHERE NCI IS
ANTICIPATED TO HAVE FLAT BUDGET
WHICH MEANS A NEGATIVE BUDGET
FOR US DUE TO RISING COSTS AND
RISING COSTS OF GRANTS, AND THIS
IS COMMITTING US TO INCREASING
THE CCSG FUNDING REQUIRING
REALIGNMENT OF FUNDING.
ARE WE GOING TO AWARD PHASE 3
FUNDING IN 24 AND 25?
WE'RE ADVISINGS THEM TO REQUEST
AND I PRESUME A DECISION IS
GOING TO BE MADE WHEN I GO
BEFORE THE SENIOR PROGRAMMATIC
LEADERSHIP, LEADER OF THE DOCS
AND PRESENT THE RENEWING
APPLICATIONS WHICH I DO THREE
TIMES A YEAR, AND DISCUSS THE
BUDGET INCREASES THAT WE'RE
PROPOSING FOR EACH CANCER
CENTER.
NEXT SLIDE PLEASE.
THE PROGRAM IS NOW 52 YEARS OLD.
WE'VE CREATED SIX NO CANCER
CENTERS OVER THE LAST 11 YEARS,
MOST RECENTLY THIS YEAR
UNIVERSITY OF FLORIDA.
WE HAVE A NUMBER OF EMERGING
CANCER CENTERS, CEDARS-SINAI
APPLICATION IS IN, UNIVERSITY OF
ROCHESTER PROBABLY COMING IN
JANUARY, UNIVERSITY OF ILLINOIS
URBANA HAS POSSIBLE SUBMISSION
IN 24 AS DOES THE MEDICAL
COLLEGE OF WISCONSIN UNIVERSITY
OF ILLINOIS AT CHICAGO.
WE EXPECT ALL OF THESE WITHIN
THE NEXT COUPLE OF YEARS AND
THERE'S ANOTHER SLATE INCLUDING
PENN STATE, SUNY STONY BROOK,
LSU, THREE TO FIVE TO SEVEN
YEARS OUT DEPENDING HOW WELL
THEY GET THEMSELVES ORGANIZED.
OUR CRITERIA COMES DOWN TO
IMPACT SCORE AND WHETHER THE
CATCHMENT AREA IS NOT COVERED OR
UNDERCOVERED.
A NEW CANCER CENTER COSTS
$2.2 MILLION IN TOTAL COSTS
BECAUSE NEW CENTERS COME IN AT
THAT MINIMUM AWARD THAT WE
ESTABLISHED THAT I DISCUSSED
EARLIER.
VARIES WITH INDIRECT COSTS AT
THE INSTITUTION.
WE'VE NEVER REDUCED THE EXISTING
CANCER CENTERS AWARDS IN ORDER
TO FUND A NEW CANCER CENTER.
IT'S ALWAYS BEEN NEW MONEY TO
FUND NEW CANCER CENTERS.
AGAIN, WITH THESE NEW CANCER
CENTERS COMING IN IN 24 AND
PERHAPS 25 IN THE FACE OF A FLAT
BUDGET REQUEST NCI ACCORD TO ADD
TOED THIS PROGRAM BY ADDING NEW
MONEY?
SHOULD WE CONSIDER SUBTRACTING A
SMALL PERCENTAGE AND IT COULD
COST .5% OF THE CCSG AWARDS TO
FUND A NEW CANCER CENTER.
THAT'S GOING TO DEPEND HOW
MERITORIOUS IT IS.
WHETHER THE CATCHMENT AREA IS
COMPELLING OR WHETHER WE FEEL
LIKE IT'S ALREADY COVERED
SOMEWHAT BY THE EXISTING CANCER
CENTERS.
AND ALSO GOING TO DEPEND ON
SENIOR LEADERSHIP AT NCI AND
WHETHER THEY WANT TO DEVOTE NEW
MONEY OR WHETHER THEY WANT TO
CONSIDER CUTTING EXISTING AWARDS
IN ORDER TO FUND THIS.
WE HAVE ROBUST SUPPLEMENT
PROGRAM, AND WE GENERALLY
COLLABORATE WITH OTHER DOCS.
IT'S THEY WHO HAVE THE SOURCES
OF MONEY, COMING PRIMARILY OUT
OF DIVISIONAL FUNDS.
WE WORK WITH THEM TO DEVELOP THE
CONCEPT AND THE PROGRAM
DIRECTORS IN THE OFFICE OF
CANCER CENTERS SERVE AS
REVIEWERS.
WE WOULD LOVE TO HAVE OUR OWN
SOURCE OF FUNDING FOB FOR
SUPPLEMENTS.
PROGRAM DIRECTORS IN OTHER
DIVISIONS, OFFICES, AND CENTERS
COME TO US WITH REALLY EXCITING
IDEAS AND I HAVE TO LET THEM
DOWN GENTLY AND TELL THEM WE
HAVE NEW SOURCE OF FUNDING TO DO
THIS.
IT'S INTERESTING THAT THE NCAB
WORKING GROUP RECOMMENDED IN
THEIR REPORT THAT WE WITHHOLD
10% OF THE CCSG BUDGET FOR
SUPPLEMENTS SO WE CAN REWARD
CANCER CENTERS BASED ON
ALIGNMENT WITH NCI PRIORITIES.
THAT WAS A RECOMMENDATION THAT
WE REJECTED.
WE DIDN'T FEEL LIKE WE WANTED TO
RESERVE THAT BUT IT'S BEEN A
DREAM OF OURS TO HAVE A
SUPPLEMENT PROGRAM.
OBVIOUSLY THIS IS GOING TO HAVE
TO WAIT UNTIL THE NCI BUDGET
IMPROVES, HOPEFULLY IN 26.
NEXT SLIDE.
SO, THAT'S THE UPDATE, WHAT THE
OFFICE OF CANCER CENTER DOES AND
I'LL STOP BEFORE WE GO TO THE
CCSG AND ANSWER ANY QUESTIONS
YOU MAY HAVE.
>> AS FAR AS THE DIVERSITY
PORTION EXPECTATIONS THAT ARE
CHANGING, HOW IS THAT GOING TO
BE MONITORED AND HOW FREQUENTLY?
>> WE WILL DISCUSS THAT IN THE
NEXT COMPONENT.
>> OKAY.
>> THANK YOU.
QUICK QUESTION.
IS THERE ANY DIFFERENCE IF A NEW
APPLICATION COMES FROM AN
ACADEMIC CENTER OR COMMUNITY
CENTER?
>> THERE'S NO DIFFERENCE IN
GENERAL, ONLY AN ACADEMIC CENTER
WOULD HAVE THE BASE OF RESEARCH
THAT WOULD MAKE THEM ELIGIBLE
FOR A CCSG AWARD.
>> CAN YOU TALK ABOUT NEW
INCOMING CANCER CENTERS AND THE
BUDGETING IN TERMS OF PHASE 3?
>> SO ALL NEW CANCER CENTERS
START AT BASE AWARDS.
IT WOULD BE $1.2 MILLION FOR
BASIC CENTER, $1.4 MILLION FOR
CLINICAL CENTER.
YOU'RE NOT ALLOWED TO REQUEST
COMPREHENSIVENESS NOTICE FIRST
CYCLE.
THEY I HOPE TO CONVINCE TO GET A
CRACK IN RENEWAL FIVE YEARS
LATER UNDER PHASE 3 AND FIVE
YEARS AFTER THAT WE'LL SEE WHERE
CENTER FUNDING IS AT THAT POINT.
>> SO NEW CENTERS WOULD BE
EXPECTED TO FUND THEIR COE, POD
AND SHARED RESOURCE PART OUT OF
$1.4 MILLION?
>> THAT'S CORRECT.
>> DR. ULRICH .
>> ARE THERE SPECIFIC DOMAINS
THAT YOU HAVE AN INTEREST IN
BECAUSE -- WOULD IT BE HELP
FOLLOW HAVE THIS LIKE MECHANISM
TO BE ABLE TO REACT MORE QUICKLY
TO OPPORTUNITIESES?
AND SECOND QUESTION, A LOT OF
DISCUSSION ABOUT DIFFERENT
CRITERIA FOR DIFFERENT CANCERS
TO KEEP IN MIND THE
INSTITUTIONAL FUND GZ AND
SUPPORT IS TIED TO THE FACT THIS
IS A SPECIAL DESIGNATION AND
COMES, AND IF THERE IS INFLATION
AND A LOT OF PEOPLE CAN HAVE IT
WITH DIFFERENT REQUIREMENTS IT
MAY ACTUALLY CAUSE SOME
CHALLENGES FOR THE EXISTING
CANCER CENTERS TO HAVE THAT
SUPPORT FROM INSTITUTIONS.
>> I UNDERSTAND EXACTLY WHAT
YOU'RE TALKING ABOUT, AND DON'T
WORRY ABOUT THAT.
WE'RE NOT GOING TO DILUTE THE
CCSG RIGOR OR IMPORTANCE.
IT'S ONE OF OUR MAIN FUNCTIONS
IN THAT SLIDE SET I HAD, I
DELETED FOR THIS PRESENTATION,
PROTECTING THE SANCTITY, SO
WE'VE DEVELOPED FOR EXAMPLE WE
DEVELOPED A SUPPLEMENT ON THE --
TO ENHANCE PO1 SUBMISSIONS, AN
IDEA FOR AIDS MALIGNANCY EVERY
YEAR, SOMETIMES TWO, VERY
EXCITING IN THEMSELVES BUT HELPS
NCI SPEND MAN DATED PORTION OF
FUNCTION.
A SUPPLEMENT PROPOSAL ENHANCES
MINORITY PARTICIPATION IN
CLINICAL TRIALS WHICH WE'RE NOT
BRINGING FORWARD NOW BECAUSE
OBVIOUSLY THERE'S NOT MONEY
UNDER THAT.
BUT I WOULD SAY THE MAIN FOCUS
IS GREAT IDEAS FOR P32s.
THE HPV VACCINE LED TO THE FIRST
PUBLIC SERVICE ANNOUNCEMENT ON
HPV VACCINATION THAT EVERY
CANCER CENTER SIGNED ON TO
LEADING TO A GENERATION OF
NETWORKS OF ANNUAL MEETINGS
HAPPENING EVERY YEAR, ALL AROUND
THE SUPPLEMENT PROGRAM WHICH
COSTS $3 MILLION TOTAL BECAUSE
WE DON'T GIVE A LOT OF MONEY.
IT'S SEED MONEY TO START THESE
THINGS.
IT'S FOLKS DCCPS, I WOULD LIKE
TO RESPOND WITH FUNDING TO
SUPPORT THIS SORT OF THING.
YES, WE'D LIKE TO DEVELOP OUR
OWN AND PARTNER WITH COLLEAGUES
A LITTLE MORE OFTEN TOO.
>> THANK YOU.
DR. HINEBERGER.
>> I'VE BEEN INVOLVED IN A
NUMBER OF THESE RENEWALS AT A
VARIETY OF CENTERS.
IT'S USUALLY A VERY SIGNIFICANT
EFFORT, USUALLY STARTS ALMOST
TWO YEARS BEFORE THE ACTUAL
SUBMISSION, AND INVOLVES A LOT
OF RESOURCES, SOMETIMES
SHUFFLING OF THE DECK, SO TO
SPEAK, VARIOUS INDIVIDUALS, HOW
YOU FRAME IT, HOW YOU DO ALL OF
THAT.
HAS THERE BEEN ANY THOUGHT WITH
REGARDS TO WAYS TO STREAMLINE
ASSESSMENT OF MERIT COMPONENT SO
THAT IT'S NOT A MASSIVE DOCUMENT
THAT INVOLVES SUCH A FOCUSED
EFFORT BY THE CANCER CENTER
DIRECTOR AS WELL AS ASSOCIATED
DEPUTY DIRECTORS AS WELL AS
SENIOR FACULTY IN ASSEMBLING
THIS DOCUMENT TO GET IT MORE
STREAMLINED SO YOU CAN MAKE
THOSE CRITICAL ASSESSMENTS
WITHOUT DISTRACTING THEM FROM
THE IMPORTANT WORK THEY ARE
DOING ON CLINICAL TRIALS AND
RESEARCH?
>> YOU'RE SPEAKING LIKE A CANCER
CENTER DIRECTOR.
THIS IS WHAT I HEAR FROM THEM
ALL THE TIME.
YES, AND NO.
SO, SEVERAL YEARS AGO WE
RESPONDED TO THAT NCAB WORKING
GROUP.
ONE OF THEIR RECOMMENDATIONS
WHICH WAS NOT ADOPTED, BY THE
WAY, BY THE NCAB, WAS THAT WE
WOULD ELIMINATE SITE VISITS AND
RELY ONLY ON THE APPLICATION.
THIS WAS ROUNDLY REJECTED BY THE
NCAB BASED ON FEEDBACK THAT WAS
GIVEN BOTH BY NCAB MEMBERS AND
CENTER DIRECTORS WHO SPOKE TO
THE IMPORTANCE OF THE PROCESS IN
GENERATING BOTH CENTEREDNESS
THAT SENSE OF BRINK THE MEMBERS
OUT OF THEIR LABORATORIES AND
GETTING THEM TO FOCUS ON THE
CENTER AS A WHOLE BUT ALSO
INSTITUTIONAL COMMITMENT, AS WAS
SAID, THE FACT THAT NCI BOTHERS
TO SEND FOLKS TO DESCEND ON YOUR
CANCER CENTER FOR WHAT IS A
THREE-DAY ORDEAL OF REVIEWING
YOUR CANCER CENTER CONCENTRATES
THE MIND OF INSTITUTIONAL
OFFICIALS.
I UNDERSTAND THE BURDEN OF THE
APPLICATION IS A CONSIDERATION,
YOU KNOW, I'VE LOOKED AT VARIOUS
CCSG.
IT'S AROUND 300 PAGES.
THE -- WE STARTED CUTTING BACK
ON THE SHARED RESOURCE WRITEUPS,
HAD VISIONS OF SHARING TO TRY TO
BALANCE WHAT WE WERE ADDING WITH
SUBTRACTING.
SO IT'S ALWAYS A CONSIDERATION.
THAT'S WHY SERTAC, AND ISLAND
TALK IN A FEW MINUTES, IS SIX
PAGES.
IT'S WHY ENHANCED DIVERSITY IS
SIX PAGES AND NOT TWELVE.
NIH HAS VERY SPECIFIC PAGE --
YOU DON'T JUST PICK OUT A PAGE
LIMIT, IT'S SIX OR TWELVE.
SO, YEAH, I'D LOVE TO REDUCE
FROM 300 DOWN TO 100 IF I COULD
BE GUARANTEED THAT THE REVIEWERS
WOULD HAVE EVERYTHING THEY NEED
TO EVALUATE A CANCER CENTER
RIGOROUSLY AND IT DIDN'T AFFECT
THE QUALITY OF THE CANCER CENTER
ITSELF.
WE'VE BEEN DOING THIS FOR 52
YEARS.
THE CENTERS ARE IN THE STRONGEST
POSITION THEY HAD EVER BEEN IN
TERMS OF SCIENTIFIC RESEARCH AND
ALIGNMENT WITH THE COMMUNITIES.
I DON'T WANT TO MESS WITH THAT.
SO, I UNDERSTAND IT'S ALWAYS ON
THE RADAR SCREEN, TO TRY TO
REDUCE THE BURDEN OF
APPLICATION.
>> LOOKING FORWARD TO TIME WITH
YOU AT THE CITY OF HOPE.
IT'S TIGHT ALL AROUND.
WE'LL HEAR MORE TOMORROW, FROM
M.K. AND OTHER --
[AUDIO DISTORTION]
FDA WHEN WE THINK ABOUT
INCREASING REPRESENTATION IN
CLINICAL TRIALS, ARE THERE
OPPORTUNITIES FOR PARTNERSHIPS
WITH OTHER AGENCIES CONSIDERING
THE CANCER CABINET AROUND THE
MOONSHOT, ARE THERE DISCUSSIONS
FLOATING AROUND NCI GIVEN THE
CRITICAL NATURE OF THE CANCER
CENTER PROGRAM.
>> WE NEED TO GET AGENCIES
WORKING TOGETHER ON THINGS.
THE OFFICE OF CANCER CENTERS HAD
EXTENSIVE DISCUSSIONS WITH HRSA
WHEN IT WAS DOING THE ACCESS
PROGRAM.
AND WE WERE PROPOSING TO FUND A
DATA COORDINATING CENTER FOR
THAT IF HRSA WOULD PUT UP THE
MONEY, WE WOULD PUT UP THE MONEY
FOR COORDINATING CENTER.
IN THE END THAT DIDN'T FLY
BECAUSE THE ACCESS PROGRAM WAS
CUT FROM $50 MILLION DOWN TO $5
MILLION AND WE DIDN'T FEEL LIKE
IT WAS WORTH OUR INVESTMENT.
BUT YES WE WOULD LOVE TO DISCUSS
THAT SORT OF THING.
AGAIN, UNDER A FLAT BUDGET.
ANYTIME WE HAVE AN IDEA, I GO TO
THE NCI DIRECTOR AND SAY, HEY,
TAKE A LOOK, WE'D LIKE TO DO
THAT.
THAT'S BEEN SUCCESSFUL WITH THE
PO1, BUT THAT IS A STEP THAT'S
GOING TO BE DIFFICULT FOR THE
NEXT COUPLE YEARS.
>> GREAT TO EXPLORE THOSE TYPES
OF OPPORTUNITIES.
THANK YOU.
>> PART 2.
>> WE'RE FACING A REVISION AFTER
SEPTEMBER 25 OF 24 WITH JANUARY
APPLICANTS.
THERE'S NO WAY AROUND THE SHORT
TIME LINE.
WE'RE NOT ALLOWED TO HAVE TWO
VERSIONS OF ANY MECHANISM ON THE
STREETS SO IT'S NOT LIKE WE CAN
GET THE JANUARY APPLICANTS A
HEADS-UP FORMALLY.
WE GENERALLY DO INFORMALLY EVEN
THOUGH WE'RE NOT SUPPOSED TO DO
THAT.
AND WHEN THE COE AND SIRTEC CAME
OUT WE GAVE EXTENSIONS THE FIRST
CYCLE TO GIVE MORE TIME TO
PREPARE.
WE'RE GOING TO SPEND TIME ON
PLAN TONE -- TO ENHANCE
DIVERSITY AND 2.0 VERSION.
YOU'RE PROBABLY FAMILIAR WITH
THIS BUT THIS IS THE PHILOSOPHY
STATEMENT.
I WANTED TO LEAD WITH THIS.
DIVERSIFYING MEMBERSHIP AND
LEADERSHIP AND EXTERNAL ADVISORY
BOARDS IS GOING TO RESULT IN
BETTER CANCER SCIENCE AND RESULT
IN ADDRESSING CANCER HEALTH
DISPARITIES IN UNIQUE WAYS.
THAT IS OUR VIEW.
THAT'S WHY WE PUT THE PLAN TO
ENHANCE DIVERSITY INTO THIS.
YOU PROBABLY HAVE NEVER HEARD ME
TELL THIS STORY, BUT THIS REALLY
AROSE OUT OF THE CENTER
DIRECTORS MEETING, WHICH IS
YEARLY THAT WE HOST AT NCI FOR
THE CENTER DIRECTORS.
WE HAD ROB WYNN PRESENT IN 2018,
ON HIS EXPERIENCES AS AFRICAN
AMERICAN AND AS A NEW -- THEN
NEW DIRECTOR.
I CONTACTED DR. SHARPLESS, WE
SHOULD DO SOMETHING ABOUT
DIVERSITY, HIS RESPONSE WAS YOU
MEAN YOU'RE NOT?
HE WAS SURPRISED.
I WAS UNDER THE IMPRESSION WE
WERE NOT ALLOWED BY NIH TO
ADDRESS THIS.
THAT WAS MY MISCONCEPTION
BECAUSE EVERY TIME DIVERSITY OF
LEADERSHIP CAME UP AT A REVIEW
IT WAS SQUELCHED BY THE REVIEW
OFFICIAL.
BECAUSE IT'S NOT A REVIEW
CRITERIA.
I THOUGHT IT WAS BECAUSE IT WAS
AN NIH RULE.
IT TOOK A FEW YEARS TO DEVELOP
THIS PLAN.
WE KNOW HOW IMPORTANT IT IS AND
HOW SENSITIVE AN ISSUE IT CAN
BE.
EVERY CANCER CENTER WE DECIDED
THE METRIC WAS NATIONAL
DIVERSITY, AFTER ALL EVERY
CANCER CENTER REGARDLESS OF
WHERE THEY WERE LOCATED RECRUIT
NATIONALLY.
BUT WE RECOGNIZE ALSO SOME
CANCER CENTERS WILL BE
CHALLENGED TO ADDRESS THE
DIVERSITY OF THE NATION WITHIN
THEIR AREA SEE WE WANTED TO MAKE
SURE THEY ARE ABLE TO EMPHASIZE
THE SPECIAL OPPORTUNITIES WITHIN
THEIR CATCHMENT AREA.
AS WITH THE COMMUNITY OUTREACH
AND ENGAGEMENT COMPONENT WE KNOW
THIS IS A LONG-TERM COMMITMENT
AND CAN'T EXPECT CANCER CENTERS
TO SATURN ON A -- TO TURN ON A
DIME.
WE HAVE TO NUDGE AND WATCH.
USUALLY REVIEWERS NUDGE HARDER.
WE WANT THEM BASED NOT ON WHAT
DIVERSITY IS NOW.
WE WANT THEM JUDGED ON WHAT
INFRASTRUCTURE THEY ARE
ESTABLISHING TO DIVERSIFY IN THE
FUTURE.
WE NOW ARE HAVING PROBLEMS OVER
THE WORD "DIVERSITY."
I'LL TALK ABOUT THAT.
NEXT SLIDE.
SO, WE'VE HAD 20 CANCER CENTERS
BE EVALUATED FOR THE PLAN TO
ENHANCE DIVERSITY.
IT GOT OFF TO A ROCKY START.
BY GOT OUR EXCEPTIONAL THOUGHTS
THE HIGHEST SCORE.
RECENTLY SCORES HAVE BEEN
PEAKING UP.
WE HAVE A BARE MAJORITY OF
CENTERS SCORING EXCELLENT OR
BETTER.
WE THINK REVIEWERS ARE STARTING
TO REALIZE THIS IS NOT SOMETHING
THAT CAN HAPPEN OVERNIGHT.
THAT'S NOT SOMETHING THAT WE'RE
ASKING FOR.
THIS IS A PLAN AND I THINK THEY
ARE STARTING TO ALIGN BETTER
WITH THE NOW CALLED NOTICE OF
FUNDING OPPORTUNITY.
I THOUGHT LEADERSHIP WAS
SOMETHING LEADERS COULD
EVALUATE.
DR. SHARPLESS SAID YOU HAVE TO
INCLUDE MEMBERSHIP BECAUSE
THAT'S WHERE THE SENIOR LEADERS
COME FROM, AND THEN WE HAD TO
MAKE SURE EABs WERE INCLUDED
BECAUSE WE NEED DIVERSIFIED
EABs TO MOVE THE NEEDLE.
THOSE ARE TARGET AUDIENCES FOR
THIS.
PATIENTS ARE COVERED UNDER CPDM
SECTION AND INCLUSIONS POLICY.
WE WANTED CANCER CENTERS TO
ESTABLISH AND WE WANTED TO FUND
INFRASTRUCTURE AND CALLED THESE
THINGS OUT IN THE CCSG WITH THE
THOUGHT THIS INFRASTRUCTURE
WOULD LEAD TO NEW APPROACHES AND
WE'VE BEEN SEEING NEW APPROACHES
PRESENTED.
WE REALIZE CENTERS HAVE BEEN
WORKING ON THIS, SOME CENTERS
WORKING ON THIS LONG BEFORE WE
INTRODUCED THIS IN THE CCSG,
INSTITUTIONS IN GENERAL HAD BEEN
WORKING LONG BEFORE WE
INTRODUCED THIS.
BUT IT IS A NEW COMPONENT TO THE
CSGG SO WE NEED TO BE JUDICIOUS
IN WHAT WE ASK FOR.
SOME WILL LEAD TO GOLD STANDARD
FOR DIVERSITY WHERE A CENTER IS
ABLE TO PRESENT HERE'S HOW WE
DIVERSIFIED OUR MEMBERSHIP AND
LEADERSHIP AND THIS IS THE NEW
SCIENCE THAT IT LED TO AND THIS
WAS THE NEW IMPACT ON PATIENTS
THAT IT LED TO.
THAT'S GOING TO BE EXAMPLES I
WILL BE VERY EXCITED TO SEE
SOMETIME IN THE FUTURE.
WE'RE NOT THERE YET.
BUT I EXPECT OVER THE NEXT
COUPLE CYCLES WE'LL START SEEING
CANCER CENTERS WITH EXAMPLES OF
THIS SORT OF THING.
NEXT SLIDE.
THIS IS ALL SWIMMING UPSTREAM AT
A LARGE NUMBER OF STATES.
SUSAN IS AWARE OF THIS.
WE'VE BEEN MONITORING THIS
CLOSELY.
I KNOW MONICA IN HER TIME TALKED
TO A NUMBER OF CANCER CENTERS
AND POLITICAL TYPES.
BUT IN SOME STATES THIS IS GOING
TO BE MUCH HARDER THAN OTHERS.
I FACETIOUSLY SAID THAT IN THE
EXAMPLE MAYBE WE SHOULD CHANGE
TO THE PLAN TO ELIMINATE
DIVERSITY, IT WOULD GO OVER MUCH
BETTER IN THAT STATE.
AND IN A PLACE LIKE TEXAS THEY
ARE NOT ALLOWED TO HIRE AN A.D.
FOR DIVERSITY.
THAT SO MANY CANCER CENTERS HAVE
ALREADY NOT ONLY HIRED BUT
INCLUDED IN SENIOR LEADERSHIP.
I DON'T KNOW THE ANSWER.
I'M GOING TO PROPOSE SOMETHING
THAT SEEMS TRIVIAL BUT MAYBE YOU
THINK IT'S A GOOD IDEA IN A
SUBSEQUENT SLIDE BUT I WANT YOU
TO BE AWARE WE KNOW THIS IS
PROBLEMATIC AT A LARGE NUMBER OF
OUR CANCER CENTERS.
I WAS ON THE PHONE WITH THE NEW
DIRECTOR OF NEBRASKA TODAY,
THAT'S ONE OF HER CONCERNS ALSO.
BECAUSE SHE KNOWS THEY NEED TO
DO CATCH-UP BUT THE WORD
"DIVERSITY" GETS PEOPLE BACK ON
THEIR HEELS WHEN SHE'S TALKING
TO STATE LEGISLATORS AND THAT
SORT OF THING.
NEXT SLIDE.
SO I JUST WANTED TO BRING THIS
UP TO DISCUSS HOW REVIEW
CRITERIA MIGHT BE ADJUSTED FOR
PED.
THIS APPLIED TO EVERY COMPONENT.
DO WE WANT TO FOCUS ON IMPACT AT
CANCER CENTERS OR FOCUS ON
PROCESS?
I HAVE GOTTEN THE COMPLAINT THAT
PROCESS IS OVEREMPHASIZED IN THE
CCSG.
IT'S AN INFRASTRUCTURE GRANT WE
NEED TO EVALUATE BOTH.
JUST BECAUSE A CANCER CENTER CAN
LIST A NUMBER OF ACCOMPLISHMENTS
OR IMPACT, DOESN'T MEAN THAT
THEIR PROCESS IS OPTIMIZED.
THEY MIGHT HAVE BEEN ABLE TO DO
BETTER.
AND THIS IS TRUE FOR COE.
WE NEED TO KNOW WHAT THE PROCESS
IS IN COE, NOT JUST EVALUATE
PEOPLE SCREENED OR NUMBER OF
COMMUNITIES THAT HAVE BEEN
DISCUSSED.
WE NEED TO KNOW THE PROCESS.
SO, MY MINDSET WE WANT TO
EVALUATE BOTH IN THE CCSG, IT'S
A BALANCE BETWEEN THE TWO.
NEXT SLIDE.
SO THIS IS THE CURRENT PLAN.
I'M NOT GOING THROUGH THIS.
WE DON'T HAVE TIME.
LET ME DISCUSS WITH YOU SOME
THOUGHTS ABOUT WHERE WE MAY BE
GOING.
MY UNDERSTANDING OF THIS
PROCESS, I'M GOING TO CLARIFY
WITH PAULETTE GRAY, I CAN'T ASK
YOU FOR RECOMMENDATIONS USING
SPECIFIC LANGUAGE FOR REVIEW
CRITERIA, THAT WOULD BE GIVING
YOU AN UNFAIR ADVANTAGE IN
APPLICATIONS IN THE FUTURE TO
LET YOU TAILOR.
BUT I CAN TALK IN GENERAL TERMS
ABOUT THIS.
I'LL CLARIFY WITH HER.
NEXT SLIDE.
SO, HOW ARE WE GOING TO CHANGE
IT?
HOW ARE WE NOT GOING TO CHANGE
ITS?
SHOULD WE REQUIRE CENTERS TO
PRESENT BASELINE DATA TO
REVIEWERS?
REVIEWERS HAVE BEEN ASKING FOR
THAT, FOR THE NOW OBVIOUS REASON
THEY NEED TO KNOW TO DECIDE WHAT
PROGRESS IS MADE IN THE FUTURE.
WE THINK YES WE'RE GOING TO CALL
THIS OUT.
SHOULD WE SPELL OUT IT MUST
INTERACT WITH THE CRTEC AND
COROE AND MAYBE THE PRNS DISEASE
GROUPS?
REVIEWERS ARE EXPECTING THIS.
THEY HAVE ASKED THIS QUESTION AS
IT'S IN THE CCSG.
WE'RE GOING TO UPDATE THE REVIEW
CRITERIA.
SHOULD WE ADD STAFF TO THE
TARGET LIST OF MEMBERSHIP
LEADERSHIP IN EAB?
A NUMBER OF CENTERS MADE
PROGRESS DIVERSIFYING STAFF.
YES, LET'S GIVE THEM CREDIT THEY
DESERVE FOR THAT.
NAME CHANGE, RATHER THAN SAY
CRITERIA FOR EVALUATING
PROGRESS, I I RATHER LIKE THOSE
TERMS.
IT'S THE PLAN TO ENHANCE
DIVERSITY, WE DIDN'T TALK ABOUT
EQUITY, INCLUSION, ACCESS.
THESE ARE VERY DIFFERENT.
THEY ARE DIFFERENT.
ALTHOUGH IN MY MIND NOT BEING AN
EXPERT IN THIS AREA THEY ALL FIT
UNDER DIVERSITY.
IT'S A SIX-PAGE WRITE-UP.
WE DIDN'T WANT A FRACTURED
NARRATIVE ON EACH COMPONENT.
WE AGAIN WANTED TO NUDGE THE
SHIP A LITTLE BIT OF THE TIME SO
WE STARTED WITH THIS.
BUT THERE'S A QUESTION AS TO
WHETHER WE SHOULD CHANGE THE
NAME OF THE COMPONENT OR AT
LEAST IN THE NARRATIVE
REQUIREMENTS TO COVER THESE
OTHER THINGS.
SO LET ME DISCUSS WITH YOU THE
TITLE.
PLAN TO ENHANCE DIVERSITY.
CAN WE HELP CANCER CENTERS IN
RED STATES MANAGE THIS BETTER BY
CHANGING THE NAME OF THE
COMPONENT AND ADJUSTING THE
LANGUAGE?
WOULD IT HELP THEM IN THEIR
DISCUSSIONS?
PLAN TO ENHANCE INCLUSIVE
EXCELLENCE, PLAN TO ASSURE EQUAL
ACCESS.
DOES THAT DILUTE WHAT WE'RE
TRYING TO DO AT ALL THE OTHER
CANCER CENTERS?
DOES IT REALLY HELP THE CENTERS
WHO ARE CHALLENGED BY STATE LAWS
AROUND DIVERSITY?
I'D LOVE TO HEAR FEEDBACK.
THIS IS SOMETHING I DON'T
UNDERSTAND SINCE I'M NOT ON THE
GROUND TALKING TO STATE
REPRESENTATIVES.
HOPEFULLY WE'LL HAVE TIME TO
DISCUSS THIS.
SHOULD WE REQUIRE DEIA IN
GENERAL BE PART OF THE STRATEGIC
PLAN?
THAT'S GOT TO MOVE OUT OF MAYBE
INTO YES.
IT'S ABSOLUTELY REQUIRED, SHOULD
BE PART OF THE CENTERS, NOT JUST
INSTITUTIONS' STRATEGIC PLAN,
THEY NEED TO THINK ABOUT THIS IN
THE FUTURE.
TWO NOs SHOULD WE EXPAND TO 12
PAGES, EVENTUALLY, IT'S THAT
IMPORTANT.
ONLY 20 OF 72 CANCER CENTERS
EVALUATED FOR THIS.
WE'RE STILL IN THE EARLY STAGES
SO WE THINK WE WANT TO KEEP IT
AT SIX FOR NOW.
SHOULD WE START EMPHASIZING
IMPACT OVER PROCESS?
AGAIN, I DON'T THINK SO.
WE DON'T WANT REVIEWERS GETTING
CONFUSED SAYING WAIT A MINUTE
YOU'RE ONLY 10% X.
WE WANT TO KNOW THAT THERE'S
INFRASTRUCTURE THAT'S GOING TO
IMPROVE THAT SOMETIME IN THE
FUTURE.
SO I THINK PRIMARILY IT'S A
PROCESS DRIVEN COMPONENT RIGHT
NOW.
BUT I THINK IT NEEDS TO STAY
THAT WAY FOR THE TIME BEING.
NEXT SLIDE.
I CONFESS I DON'T SEE A CLOCK.
I'M NOT SURE HOW WE'RE DOING ON
TIME.
IF I NEED TO MOVE UP --
>> WE'RE A LITTLE BIT OVER TIME
BECAUSE WE HAD SOME DISCUSSION
ALREADY SO WE WERE -- WE'RE AT
1:45.
IF YOU WANT TO WRAP UP IN FIVE
MINUTES.
>> I'M NOT GOING THE REST OF MY
SLIDES, I'LL TALK YOU THROUGH
IT.
MOST IMPORTANT THING OCC THINKS
ABOUT IS HOW WE CAN HELP COE.
IT'S BECOME INCREDIBLY IMPORTANT
PART OF CANCER CENTERS, AND IT'S
FAR MORE EXPANSIVE THAN A
RESEARCH PROGRAM.
AND IT'S UNDERFUNDED.
WE KNOW THAT.
WE DIRECTED PHASE 3 FUNDING
ORIGINALLY GOING TO OVERALL
IMPACT AT CANCER CENTERS AND DR.
LOWY GAVE PERMISSION TO CHANGE
THAT AFTER WE CAME BACK FROM A
CCCIF MEETING IN PHILADELPHIA,
THESE FOLKS HAVE TO GET HELP.
THERE WAS A SUGGESTION MOVING
GLOBAL HEALTH OUT.
WE HAVE TO FIT IT IN ELSEWHERE.
I LOVE THE IDEA, OUTREACH AND
ENGAGEMENT IS A BIT REPETITIVE.
WHAT ABOUT PARTNERSHIP?
IF YOU WERE TO TELL ME INCLUDING
PARTNERSHIP WOULD REALLY HELP
YOU TALK WITH YOUR COMMUNITIES,
WHETHER IT'S COMMUNITY
PARTNERSHIP OR COMMUNITY
OUTREACH AND PARTNERSHIP, WE'LL
CONSIDER THAT NAME CHANGE
BECAUSE I ACTUALLY REALLY LIKE
THAT.
I THINK THAT'S HOW COE HAS
GROWN.
IT'S BECOME A PARTNERSHIP WITH
THE COMMUNITY.
DATA TABLE 3 IS A PROBLEM AT THE
EAB LEVEL, A LIST OF NEW
ANALYTIC CASES, WE ELIMINATED
THE DENOMINATOR SEVERAL YEARS
AGO BECAUSE WE DON'T WANT THAT
RATIO BEING A REVIEW
CONSIDERATION ANYMORE AND IT'S
NOT.
REVIEWERS DON'T BRING IT UP.
IF THEY DO, THAT DISCUSSION IS
ELIMINATED BY THE SRO
IMMEDIATELY.
BUT EOBs STILL WORRY ABOUT.
SO CAN WE HELP CENTERS BY
ELIMINATING THAT?
WE WOULD STILL REQUEST THE
INFORMATION AS PART OF THE
NON-COMPETITIVE SO NCI HAS AN
IDEA OF HOW MANY PATIENTS BY
ANATOMIC SITE ARE SEEN AT OUR
CANCER CENTERS, THAT'S
IMPORTANT.
IN A TYPE 1 APPLICATION NEW
CANCER CENTER WOULD STILL
REQUIRE THAT INFORMATION.
IS IT TIME TO EXPAND CRTEC TO 12
PAGES IN THEY THINK SO.
I'M LEERY OF EXPANDING IN THAT
WAY.
BUT THAT'S SOMETHING I'D LOVE TO
HAIR BACK FROM YOU THERE'S
DISCUSSION AT NCAB A COUPLE
SESSIONS AGO ABOUT HOW CENTERS
INCLUDE INDIGENT AND MEDICAID
PATIENTS TO HAVE ACCESS TO
CLINICAL TRIALS.
THIS IS SOPPING THAT MY
IMPRESSION IS EVERY CANCER
CENTER DOES BUT I DON'T KNOW THE
DETAILS.
SHOULD WE ADD THIS TO THE CCSG
TO ALLOW THEM TO GET CREDIT FOR
WHAT THEY DO BUT ALSO TO
GENERATE LEVERAGE TO GET FURTHER
INSTITUTIONAL COMMITMENT BECAUSE
THIS IS AN EXPENSIVE PROPOSITION
AND MAYBE WOULD FIT UNDER
INSTITUTIONAL COMMITMENT.
AND WE HAVEN'T SINCE 2016
REVISION REALLY LOOKED AT EVERY
COMPONENT.
WE FOCUSED ON FOUR AND ON THE
PRMS SYSTEM HAVE BEEN THE MAJOR
CHANGES.
IT'S TIME FOR US TO GO BACK WORD
BY WORD THROUGH EVERYTHING RIGHT
FROM THE RESEARCH PROGRAMS,
THROUGH THE SHARED RESOURCES.
AND WE'RE GOING TO BE EVALUATING
THAT ON THIS IMPACT VERSUS
PROCESS SPECTRUM.
THE PROGRAM DIRECTORS ARE GOING
TO START DOING THAT.
WE'VE ALREADY STARTED ALTHOUGH I
PLANNED TO DO IT IN JANUARY.
WE'VE ALREADY STARTED ON THAT.
SO I THINK WE CAN END MY SLIDES
NOW.
ALL THE SLIDES WILL BE AVAILABLE
TO YOU.
THERE ARE SEVERAL OTHERS THAT
I'M NOT GOING TO SHARE SO WE
HAVE MORE TIME FOR DISCUSSION.
>> THANK YOU SO MUCH.
JEB CON -- GENERAL CONSENSUS IN
THE CHAT IS NO MORE PAGES, ASKED
AND ANSWERED, AND APPLAUSE FROM
SOME PEOPLE.
WITH THAT, I'LL OPEN IT UP AND
GET STARTED.
>> HENRY, WE APPRECIATE YOU
SPEAKING WITH US AND HOPE WE CAN
BE HELPFUL TO YOU AND YOUR TEAM.
THIS IS A GENERAL THING.
YOU'RE PROPOSING -- YOU'RE
RESPONSIVE, YOU'VE LISTENED, AND
THERE'S A LOT OF POTENTIAL
CHANGES.
I WONDERED IF YOU AND YOUR TEAM
THOUGHT ABOUT POSTING AN RFI
BEFORE YOU REVISE NEXT TIME.
THERE'S ALWAYS THE CHALLENGE OF
SHOWING DRAFTS TO US, THAT
CREATES SOME ISSUES.
BUT IF THERE WAS A PUBLIC RFI
THEN THE CANCER CENTERS AND
PARTICULARLY OUR STAFFS WHO DO
THIS WORK CAN GIVE US THE
FEEDBACK YOU NEED AND BRING THAT
TO YOUR TEAM IN A THOUGHTFUL WAY
AND YOU CAN WORK THROUGH THAT.
THAT'S JUST A SUGGESTION FOR YOU
AS YOU THINK ABOUT THESE
IMPORTANT CHANGES.
THANK YOU SO MUCH.
>> THANK YOU.
THAT'S NOT SOMETHING WE HAD
CONSIDERED.
I USUALLY TALK TO TWO GROUPS OF
PEOPLE, THE DIRECTORS AND
ADMINISTRATORS.
ONE OF THINGS ON AGENDA HOW THE
SUBCOMMITTEE CAN HELP.
YOU'RE SENIOR LEADERS.
I LOVE THE FACT THERE'S ANOTHER
GROUP I CAN TALK TO ABOUT THESE
CHANGES.
I'LL HAVE TO LOOK INTO THE RFI
AND SEE HOW IT WOULD NEED TO BE
TAILORED BECAUSE IT'S SUCH A
COMPLEX COMPONENT, I WONDER IF
WE COULD GET INUNDATED WITH
RANDOM SUGGESTIONS.
>> DR. HAYES-DIXON?
>> A COMMENT ABOUT MEDICARE AND
INDIGENT PATIENT INCLUSION,
CRITICAL IN NOT JUST HAVING
ACCOUNT OF CLINICAL TRIALS BUT
DAY-TO-DAY TREATMENT IN CANCER
CENTERS.
THERE ARE SOME CANCER CENTERS
THAT ARE TURNING AWAY PATIENTS
BASED ON INDIGENT OR MEDICARE OR
OTHER REASONS, WE WANT TO
INCLUDE THEM IN CLINICAL TRIALS
AND ALSO IN THEIR DAY-TO-DAY
PATIENT CARE AND HOW SOME WAY OF
THEM RECORDING IT SO IT CAN BE
REVIEWED BY YOUR COMMITTEE.
>> SO, I UNDERSTAND, I'M A
LITTLE LEERY OF MY ABILITY TO
MANDATE ACCEPTANCE OF UNINSURED
PATIENTS BY CANCER CENTERS INTO
BASIC CLINICAL CARE.
THIS IS A RESEARCH MECHANISM.
WE DON'T EVALUATE CARE IN THAT
WAY.
I CERTAINLY THINK WE CAN
CONSIDER FOR CLINICAL TRIALS HOW
THE CENTER SUPPORTS INCLUSION ON
CLINICAL TRIALS.
>> YES, AND HAVE A WAY TO ASK
FOR THAT DOCUMENTATION OF HOW
THAT'S DONE BECAUSE THE OTHER
THING I'M FINDING ON MY END AT
HOWARD, THERE ARE OTHER CENTERS
REACHING OUT TO INCLUDE THE
UNDERREPRESENTED MINORITY
PATIENTS WE TAKE CARE OF BUT ARE
NOT INCLUDING THEM -- BUT ARE
NOT -- NOT APPLYING RESOURCE TO
INCLUDE THEM IN CLINICAL TRIALS
EITHER SO THEY ARE ASKING FOR
ALL OF MY PATIENTS WITHOUT ANY
REAL PARTNERSHIP, SO IF THAT
COULD ALSO BE PART OF THE
EVALUATION THAT WOULD BE
HELPFUL.
>> OKAY.
>> THANK YOU.
DR. ULRICH?
>> WONDERFUL TO HEAR FROM YOU,
HAPPY TO GET MORE FEEDBACK.
THE BIG ONE HERE IS WHERE YOU
ASKED ABOUT WOULD IT HELP THE
RED STATES TO HAVE ACCESS IN THE
TITLE, I WOULD SAY ABSOLUTELY.
I THINK, YOU KNOW, WE DON'T KNOW
WHAT'S GOING TO COME DOWN THE
PIKE IN UTAH THIS YEAR.
WE WERE ABLE TO FEND OFF LAWS
LAST YEAR IN PART BY USING CCSG
REQUIREMENT BUT I THINK HAVING A
COMBINATION OF SAYING PLANS TO
ENHANCE DIVERSITY AND BROADEN
ACCESS OR SOMETHING LIKE THAT
WOULD ILLUSTRATE TO OUR
COMMUNITIES THAT THE NCI CARES
ALSO ABOUT THE RURAL POPULATIONS
AND THAT IS WHERE WE HAVE A LOT
OF FOCUS ON PROVIDING ACCESS.
AS LONG AS YOU HAVE AIMS OF
DIVERSITY, MINDFULNESS ABOUT
WOMEN AND UNDERREPRESENTED
MINORITIES IN LEADERSHIP, WE
TALKED ABOUT THAT, IT WOULDN'T
DETRACT BUT WOULD BROADEN AND
MAY HELP PROTECT IT SO I'M
LOOKING FORWARD TO HEARING FROM
OTHERS.
I DO WANT TO GIVE ONE SMALL
CONSIDERATION ABOUT THE MEDICAID
PATIENTS.
SO WE ABSOLUTELY WANT TO MAKE
SURE THOSE PATIENTS ARE SEEN, WE
HAVE A LOT OF CHARITY CARE WE DO
WHAT WE CAN DO INCLUDE THEM IN
TRIALS.
IT'S MAYBE A LITTLE BIT TRICKY
TO THEN MAKE SURE PEOPLE,
REVIEWERS DON'T SEE THIS AS
QUANTITATIVE BECAUSE WE HAVE
STATES THAT DON'T HAVE MEDICAID
EXPANSION IN OUR FIVE STATES
AREA WE SERVE, WE CALL IT AREA
WE SERVE.
IN ADDITION PARTNERSHIP WITH
FEDERALLY QUALIFIED HEALTH
CENTERS IT'S BECOME CLEAR THAT
FOR THEM THIS IS A MAJOR SOURCE
OF INCOME AND NOT GOOD IF WE
SOMETIMES DRAW THOSE PATIENTS IN
ESPECIALLY IF THEY DON'T HAVE
COMPLEX CASES OR DON'T END UP IN
CLINICAL TRIALS.
THERE'S A LOT OF CONSIDERATIONS
THAT MAY BE DIFFERENT ACROSS THE
COUNTRY, OF COURSE EVERYBODY
SHOULD SERVE AND WE DO.
>> IT FITS UNDER INSTITUTIONAL
COMMITMENT, NOT AS EVALUATION
FOR, SAY, THE CPDM COMPONENT OR
SOMETHING LIKE THAT BECAUSE
THERE ARE A LOT OF BUSINESS
CONSIDERATIONS HERE THAT I DON'T
UNDERSTAND HOW IT MIGHT BE
AFFECTED IF WE WERE TO EMPHASIZE
IT IN OTHER COMPONENTS.
>> AND JUST TO PIGGYBACK, THE
WORD ACCESS, IT SEEMED LIKE P.E.
D WAS FOCUSED ON TRAINING,
DIVERSITY, WORKFORCE, AND ACCESS
ISSUES ARE MORE PATIENT
CENTERED, I'M NOT SAYING IT
DOESN'T NEED TO GO SOMEWHERE BUT
THEN I FEEL LIKE THE
BEHIND-THE-SCENES OF NOW WHERE
DOES COE FIT IN AND CPDM BUT
YOUR POINT ABOUT ACCESS IS HUGE
AND WELL TAKEN.
WAS THERE ANOTHER HAND UP?
>> I HAD A QUESTION THAT WAS
ADDRESSED.
THANKS.
>> OKAY.
>> I THANK YOU FOR PRESENTING.
I WANT TO GIVE A LITTLE BIT OF
CONTRASTING OPINION ABOUT THE
CHANGE IN NAME.
PLAN TO ENHANCE DIVERSITY.
IN TEXAS THE LAW SPECIFICALLY
STATES THAT WE CAN'T CALL IT
SOMETHING ELSE WHILE WE'RE DOING
DIVERSITY, SO IT'S NOT --
>> OH REALLY?
>> YEAH.
>> TEXAS WAS ONE OF THE STATES I
WAS THINKING I COULD HELP.
>> I DON'T KNOW THAT IT HELPS.
BE HAPPY TO HAVE A CHAT WITH OUR
GOVERNMENTAL RELATIONS PERSON
AND SIGH IF HE THINKS THERE'S
WIGGLE ROOM BUT MY UNDERSTANDING
IS IT'S SPECIFIC LI WRITTEN INTO
THE LAW THAT YOU CAN'T CALL IT
SOMETHING ELSE AND STILL DO
DIVERSITY.
>> WE WOULD STILL HAVE THE WORD
"DIVERSITY" WITHIN THE
COMPONENT.
>> SURE.
>> IF WE COULD GET THE TITLE TO
BE UNOFFENSIVE TO ALL WITHOUT
DILUTING IT, THAT WAS MORE MY
THINKING.
>> YEAH, YEAH.
I DON'T KNOW THAT THAT WOULD
HELP US A LOT IN TEXAS.
>> OKAY.
>> WE ARE A STRANGE STATE
SOMETIMES.
>> FLORIDA STANDS WITH YOU IN
THAT.
>> I DON'T THINK CHANGING THE
NAME ITSELF IS A PROBLEM.
BROADENING THE TITLE WOULD BE
HELPFUL.
IF WE MAKE IT BROADER IN SUCH A
WAY IT COMPENSATES, NOT JUST A
RACE ISSUE, IT WILL HELP.
BUT I HAD A CHANCE TO LOOK AT
MANY OF THESE LAWS IN TEXAS FOR
SURE.
AND EVEN HERE, IF THE BILLS
PASS, JUST CHANGING THE NAME IS
NOT GOING TO MAKE A DIFFERENCE.
AS A MATTER OF FACT, IT WOULD
JUST CHANGE DISCOURSE TO
SOMETHING ELSE.
I THINK HAVING IT IN THE
COMPONENTS IS HELPFUL BECAUSE IT
DOES PROVIDE AVENUE TO WORK ON
THESE ISSUES SO I WOULD SAY JUST
TWEAK IT TO MAKE IT BROADER SO
IT CAN ENGAGE PEOPLE IN THE
PROCESS, BUT YOU WOULDN'T CHANGE
THE NAME OR DROP "DIVERSITY."
>> OKAY.
>> I THINK YOU MIGHT BE MUTED.
>> SO, I WANTED TO MENTION THAT
ALTHOUGH I SEE SOME POINT IN
ADDING THE WORD "DIVERSITY" I
MEAN ACCESS AROUND DIVERSITY
WITH THE TITLE, I DO HAVE REAL
CONCERNS ABOUT MUDDYING THE
WATER OVER EXACTLY WHAT THAT
ACCESS MEANS.
IT'S ALREADY COMPLICATED ENOUGH
WHEN WE'RE TRYING TO PUT THESE
THINGS TOGETHER AND MAKE SENSE
TO PEOPLE IN THE COMMUNITY.
WE TALK ABOUT ONE, WE TALK ABOUT
DIVERSITY, AND EQUITY AND
INCLUSION, AND PED, AND THEN WE
TALK ABOUT COE AND PATIENT
ACCRUALS.
AND SO THE WAY IT IS NOW IT
NICELY SEPARATES THAT, RIGHT?
AND THEY HAVE TWO VERY DIFFERENT
MISSIONS AND FOCI, AND, YOU
KNOW, TO ME I FEEL LIKE IF
YOU'RE GOING TO USE ACCESS MAYBE
WE NEED TO THINK OF A DIFFERENT
WORD, NOT ACCESS, BECAUSE I
THINK WE THINK OF PATIENT ACCESS
TO CARE, WE THINK OF PATIENT
ACCESS TO CLINICAL TRIALS, LIKE
PEOPLE ACROSS THE COUNTRY KNOW
THAT AND RECOGNIZE THAT.
IF YOU WANT TO DO SOMETHING
DIFFERENT WITH A TERM WE NEED TO
THINK OF SOMETHING ELSE.
>> I UNDERSTAND.
THE WHITE HOUSE USES DEIA BUT
THE ACCESS PART, THAT'S NOW
OFFICIAL AT NIH, WE'RE REFERRING
TO THE DISABLED, NOT PATIENTS,
TO ACCESS TO TRIALS AND THAT
SORT OF THING.
I AGREE, WE WON'T DO THAT.
>> IT'S CONFUSING TO PEOPLE OUT
THERE.
>> IT'S COMPLICATED ENOUGH.
>> TAKE US HOME.
>> I WANT TO ECHO BECAUSE I
THINK IT'S IMPORTANT NOT TO MAKE
THINGS MORE CONFUSING THANK WHAT
THEY ARE.
PEOPLE STRUGGLING WITH WHAT IS
CRTEC'S CONTROL VERSUS COE.
I WOULD LEAVE IT THAT WAY.
I WOULDN'T CHANGE IT AT ALL.
CAN I WOULD MAKE SURE THE WORK
WE'RE DOING IS BROADLY
APPLICABLE TO THE PEOPLE THAT
WE'RE SERVING, SO KEEPING THAT
FOCUS NEEDS TO RESONATE WITH
FOLKS VERSUS THE OUTREACH PIECE.
IT'S ALL ABOUT ENGAGEMENT.
>> IT SOUNDS LIKE YOU'RE GROUP
IS MOVING IN THE RIGHT
DIRECTION.
>> WE'RE A MINUTE OVER.
I JUST WANTED TO THANK THE TEAM
AND ALL OF YOU FOR SUCH AN
ENGAGED DISCUSSION.
WE'LL DO A SUMMARY AND READOUT
AND HOPEFULLY THAT'S AN
OPPORTUNITY FOR US TO THINK
ABOUT HOW WE CAN BE OF SERVICE
TO YOU, HENRY.