On a chilly Saturday morning in March of 2016, dozens of doctors, nurses, researchers, and staff at Wilmot Cancer Institute gave up part of their weekend to talk about how to build a more cohesive and comprehensive cancer center. At that informal retreat, they set an ambitious goal to apply to the National Cancer Institute in 2021 for a P30 Cancer Center Support Grant (CCSG). This would require a restructuring of the cancer center, millions of dollars in investment from the University of Rochester and outside donors, and other herculean efforts. The retreat participants left wearing NCI buttons on their jackets and scrawled their signatures of commitment on a white board, which still sits in the office of Wilmot Director Jonathan Friedberg, M.D., M.M.Sc. It was a sign of good things to come.
If awarded, the NCI-CCSG grant would place Wilmot into a coveted club amid 71 NCI-designated cancer centers in the U.S., proving that it meets the most rigorous standards for research, prevention, and cancer care.
Remarkably — following the most hectic and exciting five years imaginable — Wilmot met its goal in September 2021 when the executive team uploaded the 1,100-page grant to the NCI. The review process is underway, and a decision is expected in the summer.
In the following question-and-answer story, which has been lightly edited, Friedberg offers his thoughts on the fundamental changes that carried Wilmot through the journey.
Going through the NCI designation process, he says, is the capstone since his appointment as Wilmot Director in 2013. “Whatever the outcome,” Friedberg notes, “I can say without hesitation that this process revitalized Wilmot, galvanized our faculty and staff toward a common goal, and made us better.”
Let’s start with this: After all of the hard work, what did it feel like when you hit ‘send’ to upload the NCI grant?
I would say a combination of relief and a little bit of intimidation. I also had a feeling of accomplishment. We actually did this in the timeframe that we had projected!
It was a personal goal; when I was hired I was not told that it was a mandate. So, it’s always been on my mind. For the first two years that I served as director, though, my focus was on building our regional network, which needed to be in place to serve our patients throughout western and central New York. We now have more than a dozen locations.
When we called the retreat in 2016 and made the commitment, I remember feeling a little concerned about putting the (2021) date out there. But, I think we all needed some motivation to rally around. I think we’ve really wowed everyone with what we’ve been able to achieve in such an accelerated fashion.
What does it mean to get NCI designation?
This is the blue ribbon. There’s really nothing better for a cancer center. And the designation has to be renewed every five years, so it’s not like you get it once and you’re done. There’s a constant evaluation process with changing levels of expectations — it really pushes you to become ever better.
At the core level, NCI designation comes with a research grant for infrastructure, salary support, new equipment that allows us to recruit the best and brightest, and support for clinical trials and education.
Patients want to be treated at an NCI-designated center. There’s a certain cachet to it. They want to know that the interaction between physicians and scientists is happening on a daily basis, and that the top doctors want to come here to work.
In addition to Wilmot, a number of other centers are pursuing designation as well. The NCI gives it out very sparingly. Over the last decade, only two or three new cancer centers have received this top designation.
What if the NCI does not designate Wilmot in 2022, as hoped?
I can’t pretend it wouldn’t be disappointing. But I take tremendous pride on behalf of our entire team on what we’ve accomplished, and I can go to bed every night knowing that Wilmot is much better in so many ways.
We have a deeper understanding of the region’s cancer burden. We have many important, new research collaborations in place, and two new programs for community outreach and for education. We’ve doubled down on our clinical trials efforts, which helps our patients and our research mission. All of these things will endure whether or not we get the blue ribbon. I firmly believe we belong in the NCI-designation group, and I’m going into the next stage of the review process with confidence.
You’ve brought in a lot of new talent during the past five years. What was it like to embark on the biggest strategic recruitment drive in the cancer center’s history?
“Strategic” is the key word. Historically, many of our recruitments of physicians and scientists were opportunistic. People were brought in to fill an important slot or expand a program. But with the NCI process in the background, we were able to leverage many positions all around the same goals and ensure that we were
bolstering our research programs in a very intentional way. I give (University of Rochester Medical Center CEO) Mark Taubman a lot of credit for ensuring that we had the funds and the ability to recruit in that way.
My pitch to incoming talent was: You have to have the enthusiasm to build something. We needed to harness universal appreciation for the NCI goal. The caliber of people that we wanted here were expecting us to be an NCI designated center, and many of them would not have come here if NCI designation was not reasonable. So, we just had to encourage people to take the leap and believe that what we were saying and doing was true.
Some of our recruitment efforts were very memorable. For example, when we were talking to Paula Cupertino about building our new Community Outreach and Engagement office, we put on the full-court press. She worked in New Jersey at the time and had been up here, but the deal wasn’t sealed. I flew down there
over Christmas break that year to take her out to lunch in her neighborhood. I think it was a Cuban restaurant. It was a long day in and out of Rochester, but I remember getting on the plane to go home and feeling like, ‘We’ve got this.’
Getting her to come to Wilmot was essential. Earlier, when we visited the NCI to outline our plans to achieve designation, they told us that for a new cancer center the most important aspect — in addition to everything else we needed to do — was to have a community engagement program with an experienced leader
from another NCI-designated center. Paula was the absolute right person for that. She came here quickly, started working as the pandemic struck, and despite that has done an enviable job.
I want to add that every single person we recruited was important. Some of the younger people we brought in, for example, are now starting to get their first grants here. We picked good candidates all around who have talent and drive.
Speaking of faculty and staff, what has this journey been like for them?
It’s very important to recognize that this has been selfless work. Let’s start with faculty. There are a lot of pressures on them. If you’re a physician, you have to do a certain amount of work to support your salary and those numbers get carefully tracked. If you’re an investigator, you need to obtain grants, publish, and keep
your laboratory running. Any time spent on cancer center work toward NCI designation is time away from other things that are mandates.
For me, it’s been humbling. Every day I’m grateful for the support of patients, community fundraisers, medical center leadership, and everyone at Wilmot who has toiled many long hours. People realize that this project is for the greater good. That’s an important statement. Five years is a long time, and getting ready for the next step has been constant. People rolled up their sleeves and did what they had to do. When it’s August and a beautiful day outside, do you really want to be working on the NCI grant? Is this worth it? It’s been so worth it when you reflect on how much we’ve gained and the transformation of Wilmot.
As part of the NCI process, Wilmot developed a homegrown data-tracking tool to investigate cancer incidence in this region. As data came to life, what struck you?
Seeing that we have one of the highest incidence rates of cancer in the entire country was surprising to me. We are right behind Kentucky. And the truth is, in many ways our rural demographics mimic that of Kentucky’s with health-care access problems, high rates of smoking, and other health issues. It caused us to pause
and realize that we’re the only institution in the region equipped to help solve the problem.
The tool is remarkable in many ways. We can look at the entire region, and we can also zoom in on hotspots, zip codes, even at the street level. Take pancreatic cancer, for example: We have a higher incidence than what you would expect in New York and in the U.S., but among certain populations, like Black men, it’s
significantly higher. That gives us a mandate to reach out and help that population.
When you look at the maps we’ve developed, quickly it becomes sobering. There’s a lot of suffering out there due to cancer.
That’s our strongest case for NCI designation: We have a problem and we’re committed to fixing it. The numbers ensure that we’re focused and grounded in a way that we’ve never been before. It’s a reminder of why we do what we do. And that urgency is particularly present here, as opposed to other places.
You’ve received a lot of support from civic leaders for NCI designation. And the new mayor of Rochester, Malik Evans, sits on the Wilmot Cancer Institute advisory board. Tell us about those partnerships.
Everybody fears a personal confrontation with cancer — and having top-quality care and the most advanced treatments accessible through clinical trials, close to home, is something that any politician would support. A thriving NCI-designated cancer center is an important asset for the city, and I think Malik realizes that.
We’ve enjoyed terrific bipartisan support. Every representative from the 27-county region, as well as our U.S. Senators, has provided letters to the NCI on our behalf. Even Congressman Brian Higgins of Buffalo supports us, and he’s not even in our direct area.
For Malik, what’s remarkable is how quickly he saw that our pursuit of NCI designation was aligned with his vision for improving Rochester. He’s been a terrific partner at so many levels, and is looking at us to overcome disparities in cancer outcomes. He participated in making a video with us for the NCI and I think he
really spoke from the heart. Both of his parents were treated at Wilmot, and he wants to see this thing through.
Top Ten Accomplishments Since 2016:
- Submitted grant to NCI seeking blue-ribbon designation; application is under final review with a decision expected in 2022.
- Doubled research funding; more than half comes from NCI.
- Defined a data-based, 27-county “catchment area” for patient care and research encompassing western and central New York, and includes 3 million residents who seek care at Wilmot.
- Buoyed team science approaches; assembled three broad research programs, five shared resource programs, and 100 scientific members, executive team.
- Completed a comprehensive five-year strategic plan with center-wide participation.
- Restructured Clinical Trials Office; 70% increase in patient participation in trials.
- Created a Community Outreach and Engagement office; connects patient needs with physicians, scientists and addresses disparities.
- Built an informatics team and data-mapping tool for cancer hotspots.
- Strategically recruited more than 20 top-flight physicians/scientists.
- Built a new education and training program; serves high school students to junior faculty and emphasizes diversity.