publication date: Jul. 31, 2020

Conversation with The Cancer Letter

Raymond DuBois discusses his plans to navigate past the pandemic and take Hollings to comprehensive designation

RaymondDuBois

Raymond N. (Ray) DuBois, MD, PhD

Dean of the College of Medicine at the Medical University of South Carolina,

Distinguished University Professor,

Director MUSC Hollings Cancer Center

 

Raymond N. DuBois was named director of MUSC Hollings Cancer Center effective Aug. 17.

This is an additional role for DuBois, who will continue his other job as the dean of the MUSC College of Medicine. He has held that position since March 2016.

“Our cancer center was established in 1993, and it has evolved over time. It was established to help support the vision of Sen. Fritz Hollings and his legacy of public service, serving our culturally and socio-economically diverse state,” DuBois said to The Cancer Letter. “My vision for the next five to ten years is to take our enterprise to a higher level and to try to integrate our activities more across the state, interfacing better with our statewide clinical enterprise.

“We have several underserved populations in this state. We really want to have a major impact in approaching and solving many of our health disparity issues.”

DuBois, whose research is focused on elucidating the role of inflammation and inflammatory mediators in the progression of cancer, replaces the interim director, Denis C. Guttridge, who has served in the role since mid-January. Guttridge was appointed to the interim position when the previous Hollings director, Gustavo Leone, announced his intention to become director of the Medical College of Wisconsin Cancer Center.

Guttridge will continue his dual role as director of the Charles P. Darby Children’s Research Institute in the MUSC College of Medicine, and associate director of translational sciences for Hollings.

“Ray is a great choice for the Director of the Hollings Cancer Center at the Medical University of South Carolina in Charleston,” NCI Director Ned Sharpless said in a statement. “I have worked with him closely during his service as chair of the NCI Board of Scientific Counselors and as a member of the Frederick National Laboratory Advisory Committee. He recognizes and promotes research excellence, has a proven track record, and strongly supports patient-centered cancer care. He will certainly elevate the Hollings Cancer Center as well as the whole cancer effort in the State of South Carolina.”

DuBois serves as chair of the NCI Board of Scientific Counselors and is a member of the Scientific Advisory Board for the NCI Frederick National Laboratory. He is vice chair for the Stand Up To Cancer Scientific Advisory Board and chair of the SU2C Catalyst Program, where he oversees the selection and management of several early phase clinical cancer trials examining unique drug combinations in collaboration with the leadership from BMS, Genentech and Merck.

He serves as president of the AACR Foundation, chair of the AACR Foundation Board and is a past president of AACR, the Southern Society for Clinical Investigation, and the International Society for Gastrointestinal Cancer. He was named to the steering committee for the AACR Academy in 2018.

Before coming to MUSC, DuBois served as executive director of the Biodesign Institute in Arizona and as the Dalton Professor of Chemistry and Biochemistry with a joint appointment as professor of Medicine in the Mayo College of Medicine and Investigator at the Mayo Clinic Cancer Center.

From 2007 to 2012, he served as provost and executive vice president at MD Anderson Cancer Center and held the Ellen Knisely Distinguished Chair in Colon Cancer Research. He also oversaw their Global Academic Oncology Program.

Prior to that, DuBois spent 16 years at Vanderbilt University Medical Center, serving as director of Gastroenterology, Hepatology & Nutrition as well as director of the Vanderbilt-Ingram Cancer Center.

DuBois said his goals include setting Hollings on the path toward comprehensive designation.

Taking on the new role of cancer center director in addition to his duties as dean is not unique among academic medical centers today, DuBois said.

“There are currently over 150 deans of allopathic (MD granting) medical schools in the United States,” DuBois said. “And we looked at what all of their roles were at their respective institutions, in terms of duties and major administrative responsibilities.

“Over half of the deans are either CEOs of their health systems or serve as provosts, or, in some cases, even presidents of their institutions. Many also serve as VPs of clinical affairs for their health enterprise, and some serve as directors of research institutes or centers. I have not served in any of those roles here at MUSC.

“In serving both as cancer center director and dean, I believe that I will be in a position to help develop more synergy and closer ties between both of these organizational units, which will ultimately benefit both. However, the Hollings cancer center with remain a completely independent unit organizationally.”

As the Hollings director, DuBois will report to MUSC Provost and Executive Vice President Lisa Saladin and Patrick J. Cawley, CEO, of MUSC Health and vice president for Health Affairs, University.

 

DuBois spoke with Paul Goldberg, editor and publisher of The Cancer Letter.

 

Paul Goldberg:

First of all, congratulations.

Raymond DuBois:

Well, thanks. As you know, I’ve been interested in cancer for a long time, and I’ve been involved in major leadership roles in a couple of cancer centers and national cancer organizations. So, it’s exciting to be back in a position like this.

 

PG:

And you’re now a permanent cancer center director. You’re not stepping in temporarily?

RD:

Yes, this is a permanent role, in addition to my current duty as the dean of the College of Medicine. So, it’ll be an expansion of my role, to include leading the Hollings Cancer Center.

 

PG:

I don’t think I’ve ever seen the dean be a cancer center director. A dean is someone that a cancer center director fights against. How will you do that?

RD:

I agree that at some institutions there is friction between the school of medicine and the cancer center, but that won’t happen here. We’ve solved that problem.

There are currently over 150 deans of allopathic (MD granting) medical schools in the United States. And we looked at what all of their roles were at their respective institutions, in terms of duties and major administrative responsibilities.

Over half of the deans are either CEOs of their health systems or serve as provosts, or, in some cases, even presidents of their institutions. Many also serve as VPs of clinical affairs for their health enterprise, and some serve as directors of research institutes or centers. I have not served in any of those roles here at MUSC.

At Vanderbilt, for example, the president of the medical center and the dean are the same person. There are a few deans who also run major research centers, such as a cardiovascular research center, for example, and others. So, it’s not beyond the scope of what some deans do.

And many deans have a much broader scope of work as CEOs of their multi-hospital health systems that includes managing mergers and acquisitions as well as clinical network expansion. So, we didn’t think that it was something beyond what would be possible.

In serving both as cancer center director and dean, I believe that I will be in a position to help develop more synergy and closer ties between both of these organizational units, which will ultimately benefit both. However, the Hollings Cancer Center with remain a completely independent unit organizationally.

 

PG:

Being the CEO of a health system sounds like a bigger conflict, potentially.

RD:

Well, individuals in those positions take on the whole scope of the organization under one roof. There’s a number of places, Michigan, and Vanderbilt and others, where the dean and the leader of the health system are the same person, but that is a much, much bigger job than directing a single cancer center.

 

PG:

Did you apply for the job? Or did they say, “Dr. DuBois, we want you to do it.”

RD:

The administrative leadership for MUSC and MUSC Health knew that I was already engaged as a member of the Hollings Cancer Center and did ask me if I would be potentially interested.

And, obviously, having been here for almost five years, I had a pretty good feel for the cancer center, and scope of work, and some of the issues being addressed.

Also, I have a pretty well-developed leadership team in the College of Medicine. We have several associate and senior associate deans that take care of education, research and clinical activities.

The cancer center has a fairly robust senior executive committee that helps oversee programs and operations there.

It’s a matter of managing things and delegating appropriately to make sure all the work gets done. In fact, I am a strong believer in the team approach, because I have seen great things happen when a team of professionals with complementary skills and backgrounds work together toward common goals. Our common goal is the fight against cancer!

 

PG:

Because, I mean, most of us have 24 hours in a day. Did they give you more?

RD:

Well, there’s a lot that needs to be done. It’s a big job, but I think I’m up for the task, and with my current team in place we have things under reasonably good control in the college.

We still have all of the issues that we’re dealing with the COVID pandemic—and that has caused a lot of challenges.

 

PG:

Well, let’s get to that in a minute. You also have a lab, an active lab.

RD:

I do direct a research lab. I have pared it down quite a bit, and only maintain a group of about four to six individuals that I’m working with now so that when I work on those issues I can more easily focus on a smaller number of projects.

I meet regularly with the lab group, and am very involved in evaluating data, troubleshooting and deciding on future experiments needed. It’s worth noting that most members of my lab team have been with me for several years, so we are a well-oiled machine.

My research effort is a fraction of what it was at MD Anderson or at Vanderbilt. Thus, it is easier to manage, but very important for me to continue. I’ve given up my Program Project Grant and one of my R01s to make administrative time for managing the CCSG.

 

PG:

What about the cancer center itself? What is it like? I mean, every cancer center is different. What’s Hollings like, and what are your thoughts on what you want it to be?

RD:

It’s a matrix center, similar to several other institutions. Obviously, these matrix centers are much different from cancer centers like MD Anderson,  Memorial Sloan Kettering or the Fred Hutchinson Cancer Center in Seattle.

We currently have 110 to 150 members of the cancer center, so it’s one of the smaller of the NCI-designated centers. It encompasses the clinical care of patients, clinical research, basic science research and translational research.

Hollings has organized research programs with a clinical trials office. Hollings also supports a significant community outreach effort, because South Carolina has a large rural population with a huge underserved population.

Hollings has established a well-organized community outreach effort for cancer screening, cancer education, and other activities across the state, because there’s such a big underserved need.

The Hollings Cancer Center is the only NCI-designated cancer center in the state of South Carolina.

 

PG:

Is there anything you do that nobody else does? Anything about Hollings that’s just totally unique? And what are your goals for where you want to take it?

RD:

Paul, that is a great question. We have a very well-developed and sophisticated group working on health disparities, and we do have a lot of health disparities research underway.

The outcomes for some of the people in our state are much worse than for other citizens of the state in higher socio-economic brackets.

We’re constantly looking to try to solve some of those problems with outreach and other programs. There also are some unique populations that seem to have a higher incidence of cancer because of a variety of factors including gender, race, lifestyle or geographic differences.

We are trying to investigate that and understand what causes it: is it environmental, genetic, or what are the other etiologic factors that lead to such a susceptible population?

 

PG:

What happens five years from now? By the way, when is your grant renewal?

RD:

Well, I just came on board Friday, so, I’m working through that. We have three years to submit it, so that’s not a lot of time in terms of getting these things prepared. We’ll have to start working on it right away.

We do not currently have comprehensive status. Obviously, one of the big goals here is to work towards getting comprehensive status at some point, when it’s appropriate.

 

PG:

What needs to happen?

RD:

Well, we need to build and develop our clinical operation to a much greater extent.

Our health system has recently acquired four new hospitals in rural areas of the state. In order to step up and care for that increased need, we’re going to have to build the clinical enterprise to a greater extent, as well as our clinical research operation to reach out to these other areas in the MUSC network within the state.

And then, we will need to develop a broader group of investigator-initiated trials to go along with that.

 

PG:

I don’t think that many people who know more about how science and clinical operations overlap than you do. You’ve done this in so many places.

RD:

I think that’s one of the reasons why I was interested in this, because I have had a lot of experience with the areas of need for the cancer center. And I have a real passion and purpose in the cancer field. So, I’m very excited about rolling up my sleeves and getting to work on these issues.

I officially take over the directorship on Aug. 17, but we’ve already started having preliminary meetings and planning.

And, obviously, we’ll have to come up with a more tailored strategic plan to address the main issues that we want to focus on. I would like to hear from all members of the cancer center and solicit their input.

 

PG:

Is this a good time to be recruiting?

RD:

Well, COVID has slowed down recruiting across the whole nation, Paul, as you would suspect, people are hunkering down and trying to deal with the pandemic right now.  Although, folks are continuing to get trained and looking for jobs.

One of the advantages we have here in the Charleston area is that it’s a wonderful place to live. This region of the country offers a very nice lifestyle and quality of life for professionals and their families.

We’ve actually been doing quite well in recruiting faculty for the whole College of Medicine in general. And, there is a close link between the college and the cancer center, because almost all of the faculty and researchers in the cancer center have appointments in the College of Medicine.

So, I had already been involved in a lot of those recruitments prior to this and will continue to focus on that going forward.

 

PG:

But as far as COVID, how has the pandemic affected the institution on the cancer side and all around?

RD:

Like most other cancer centers, it has impacted our research operations overall and slowed things down a bit during the shutdown.

One of the biggest impacts on the institution has been the financial impact.  And, as you know, when we shut down all of our outpatient clinics and a lot of our inpatient surgical procedures, we lost a significant amount of revenue since the pandemic started.

Charleston was not hit that hard initially, so we were able to restart those activities fairly quickly. And we’re back up to almost 100% of our clinical activity that we had prior to the pandemic.

However, we have had a significant increase in the surge of cases over the past few weeks, which has taken quite a toll. It puts a lot of pressure on our intensive care units.

That’s put a strain on our operations and faculty, although we’ve been able to continue with our clinical activities over this time, and that’s really improved our financial situation and allowed continuity of care for our patients.

With regard to cancer, it’s had a big impact, Paul, and I think you’ve heard from Ned Sharpless and Otis Brawley and others about some of these issues. Some cancer patients are afraid of getting the virus and hesitate to come in and get treatment in order to avoid exposure.

For patients who must come for an in-person appointment, we are taking a lot of precautions, like social distancing, masking, and separating patients with COVID from those without.

We test all inpatients and people who come in for procedures, to make sure they’re negative for the virus and thus not spread it to our staff and faculty.

There’s data in many different medical areas: cardiovascular, diabetes, cancer—that regular exams and procedures are getting greatly delayed. So, there’s more and more data that’s coming out all the time.

I just saw a huge piece by the American Cardiology Association this morning about problems with women having more heart attacks and more severe heart damage after their heart attack, just because of the fear of getting COVID when they come to a clinical facility.

 

PG:

Are cancer patients coming in now, even despite the resurgence?

RD:

Yes. Because if you’re on a defined treatment regimen, it’s really important not to disrupt that. And so, within the cancer center, we’ve taken extra precautions, because many cancer patients are immunocompromised and need special attention.

 

PG:

It must be even more complex to be both a center director and the dean at this time, because of COVID.

RD:

Yes, it has complicated everybody’s lives. It has disrupted education of medical students and training of residents. And it’s been very difficult, because our third and fourth year medical students must be involved directly in patient care in order to achieve proper training.

And there has been some concern about getting the students back into the clinical setting, because of their potential exposure. But we’ve been able to accomplish that since May 18, and things are working reasonably well.

Everyone is trying to do the best they can given the current circumstances we are dealing with. Everyone’s situation is more complex now. And as mentioned before, we’re doing everything we can to provide a safe environment and continuity of care for our patients.

 

PG:

So third and fourth year medical students returned to campus on May 18th. And you were shut down when?

RD:

Well, it was from that initial date in March, when all the clinical activities were shut down in several states because of the stay-at-home order and that initial reaction to the pandemic.

 

PG:

So, it’s two months.

RD:

Yes. On the education side, we had to adjust our curriculum. We had to do a lot of our teaching online. We had to initiate virtual teaching for some subspecialties.

We have just tried to adapt the best we could. It’s just nothing that you’re ever really totally prepared for.

 

PG:

But you’re able to recruit, right? Even with the financial challenges?

RD:

Well, we’ve gotten our financial footing back on solid ground. We made up almost all of the loss that we had during the stay-at-home order.

I suspect that there will be future surges in the fall based on what is happening now in Australia and other times of the year, and that we will have to adjust our clinical activity based on the severity of the pandemic. We are now in hurricane season and that is always one of threats along the Atlantic coast. So, yes, we are in a position to recruit.

 

PG:

But if you’re able to even out the finances this at this time, with the element of surprise, at the next COVID spike it would be just a matter of managing it, applying what you have learned.

RD:

Yes. We have great faculty and very dedicated staff. We are extremely committed to delivering patient-centered care. So, we’ve been able to adjust, make it work, and continue to care for our patients. And we’re in a better position to do so if we experience another surge in the future.

 

PG:

Is there anything we’ve missed? Is there anything you want to address?

RD:

Our cancer center was established in 1993, and it’s evolved over time. We are well configured here and an ideal size to support team science and nurture the careers of young cancer scientists and we do promote innovation to a great extent.

And then there are underserved populations in the state, and we really want to try to have a major impact in approaching and solving some of these health disparity issues and increasing our community outreach and engagement efforts.

 

PG:

Well, thank you so much.

RD:

Thank you Paul and we do appreciate all you do to spread the cancer message across the country and keep everyone adequately informed.

I must give a shout-out to our physicians, nurses, staff, researchers and volunteers here at MUSC and at Hollings. They have been working days, nights, and weekends during the pandemic to try and resolve a myriad of problems and issues that unexpectedly crop up every day.

These people now have the hardest jobs in the world, yet they come in, roll up their sleeves and devote themselves to serving their patients and people all across the community with skill and compassion, despite the great risk to themselves and their families.

It makes me very proud to be a member of this medical community. It has been inspirational.

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