Lum and Dr. Gerald Elfenbein.
After six years without a nationally recognized cancer center in Rhode Island, the independent Roger Williams Hospital and Lifespan’s Miriam and Rhode Island hospitals are each preparing to launch centers that would not only provide cutting-edge research and treatment and earn recognition but also are expected to produce funds from the National Cancer Institute (NCI).
At Roger Williams Hospital, Gerald J. Elfenbein, M.D., himself a bone marrow specialist,
has been working the past two years to rebuild the hospital’s reputation in cancer
treatment and research.
After about 20 years as an NCI center, Roger Williams Cancer Center, which was then affiliated with Brown University, lost that status in 1994 after federal reviewers ruled it no longer met its standards because of administrative problems.
The National Cancer Institute, a federal agency that funds cancer research, currently has about 60 such designated cancer centers in the United States.
“Lifespan happened,” said Dr. Elfenbein, referring to the 1994 partnership of
Rhode Island and Miriam hospitals into a system that now includes Newport and
Bradley hospitals in Rhode Island and New England Medical Center in Boston.
“It really came down to the institutions could not cooperate, not the doctors, not the scientists,” Dr. Elfenbein said. “There was no question about the quality of care.”
Losing NCI status meant not only a major loss of prestige for Rhode Island cancer researchers in general but the loss for Roger Williams of $1 million in annual funding and in-state access to NCI trials and support, Dr. Elfenbein said.
;The number of new cancer patients being treated for cancer at Roger Williams dropped from a high of 784 in 1992 to 615 in 1998, but in 1999 it rebounded to 726, he said, with 746 new patients projected for 2000.
But this past year the hospital has been recruiting a multidisciplinary team of physicians, surgeons, radiologists, researchers and nurse specialists, which now includes world-renowned leaders in breast and lung cancers and immunotherapy, “some major players,” said Roger Williams President and chief executive officer Robert A. Urciuoli.
And as an affiliate now of Boston University School of Medicine, which has already received an NIH program-planning grant, the first step in gaining NCI center status, Roger Williams is close, Urciuoli said, to regaining its status as a regional cancer treatment leader.
“We were known for cancer, we want to be known for cancer again,” Dr. Elfenbein said. “I’m not competing with Miriam Hospital or Rhode Island Hospital My competition is the world.”
Roger Williams’ cancer team includes veterans Dr. Harold Wanebo in surgery and
Dr. Kathy Radie-Keane in radiation oncology. Newly recruited specialists are Dr.
Denise Fraser for breast health, Dr. Lawrence Lum for cancer immunotherapy research,
Dr. Gary Strauss for lung cancer and cancer control and Dr. Peter Quesenberry,
who will lead programs in hematologic and stem cell applications and research.
Dr. Elfenbein said Roger Williams’ cancer center will focus on the most common and top-killing cancers such as breast, prostate and lung, and will also increase the number of bone marrow transplants, which currently number about 23 a year. “There are real advantages to being in a smaller, stand-alone institution,” Dr. Elfenbein said. “What we do, we do well.”
At Lifespan, Dr. Fred Schiffman, vice chairman of the Department of Medicine at Brown was hired this year as clinical director for their cancer center. He said within a year they anticipate hiring “a world-class researcher” to serve as overall director and to accelerate work toward gaining NCI status.
Lifespan’s treatment focus is on being “patient friendly” and accessible, and “capitalizing on the fact that already we are the largest” deliverers of cancer care in Rhode Island, he said. He also said Lifespan is promoting its technologically advanced tools such as the “gamma knife” for brain tumors, available nowhere else in the state, and its affiliation with Brown and Tufts universities and New England Medical Center.
“We will treat all cancers,” malignancies both common and rare, Dr. Schiffman said. “We have had meetings with representatives of the NCI who feel our chances are good.”
Lifespan President and CEO George Vecchione said that group plans to spend $2.6 million at Miriam and $8 million at Rhode Island hospitals in the next one to two years to upgrade its cancer facilities.
Lifespan spokesperson Linda Shelton said according to the national health care database HCIA, in 1999 Lifespan affiliates provided 39 percent of the state’s adult cancer care, 26 percent at Rhode Island Hospital, 10 percent at Miriam and 3 percent at Newport.
According to the HCIA, Women and Infants Hospital provided 11 percent, Kent Hospital 10 percent and Roger Williams 7 percent, Shelton said.
Rhode Island’s Hasbro Children’s Hospital provides 86 percent of the inpatient pediatric cancer service in the state, and Newport Hospital and New England Medical Center each provides slightly over 1 percent, Shelton said, adding that pediatrics is “something that Roger Williams doesn’t have.”
She said Lifespan spends approximately $35 million a year for inpatient cancer services and about $23 million each year in cancer research, with $20 million of that coming from external funds, primarily the National Institutes of Health.
Margaret Holmes, chief of the cancer centers branch of the NCI, said while “geographic representation is a concern” in granting cancer center status, “proximity of an institution to other centers does not preclude the possibility of establishing another center in that geographic area,” and a number of states already have multiple cancer centers.
And while “if two closely co-located institutions compete for the same patient population then there might be a problem, since the quality of any clinical research program is dependent on the availability and accessibility of patients,” Holmes said. He added that the most important factor in competition is “the quality and breadth of the institution’s cancer research program.”
Robert J. Marshall, health department assistant director of community affairs,
said there are four criteria in a hospital expansion that would trigger a health
department review — if the hospital wants to establish an entirely new service,
if it wants to buy a new piece of equipment (they don’t already have) that costs
$1 million or more, if it wants to spend $2 million or more in capital expenditures,
or if the hospital wants to implement any kind of transplant services.
“I don’t think there’s a problem” with Rhode Island having two NCI cancer centers, “I think there’s room,” Dr. Schiffman said.
“We will both evolve as cancer centers. I think that what we would want is to collaborate,” Dr. Schiffman said, primarily for the benefit of the patients, “and not be competitive and have advertising wars.”
Urciuoli said he is “guardedly optimistic” that advanced treatment options and
drug therapies could be shared among the state’s cancer centers, whether partnered
in a network or not.
While the incidence of cancer per 1,000 population is about the same in Rhode Island as the national average, “mortality is significantly higher,” Urciuoli said.
According to the National Cancer Registry there are approximately 5,500 new cases of cancer every year in Rhode Island, Shelton said.
