Karen Knudsen named CEO of the American Cancer Society

Karen E. Knudsen was named CEO of the American Cancer Society and its advocacy affiliate, the American Cancer Society Cancer Action Network.

Knudsen is the executive vice president of Oncology Services and enterprise director for Sidney Kimmel Cancer Center at Jefferson Health, a member of the NCI Board of Scientific Advisors, president of the Association of American Cancer Institutes, and a member of the board of directors for the American Association of Cancer Research.

She will take over as the ACS CEO on June 1, replacing Gary Reedy, who is leaving after having headed the society since 2015 (The Cancer Letter, Aug. 7, 2020). 

The appointment was announced April 12.

Knudsen is the first woman CEO to lead the 107-year-old organization. She is also the first basic scientist and the first director of a cancer center to hold this job. An NCI-funded investigator, Knudsen holds a PhD in biological sciences from the University of California at San Diego and an MBA from Temple University Fox School of Business.

Her immediate predecessor Reedy was a business executive at Johnson & Johnson. His predecessor, John Seffrin, was a professor of health education at Indiana University before rising through the ACS political structures.

“Dr. Knudsen is exactly what the American Cancer Society needs right now,” said John Alfonso, chair of the ACS board of directors, said in a statement. “She is an accomplished researcher, innovative healthcare executive, dynamic leader of a prestigious cancer center, and true thought leader in the fight against cancer nationwide.”

Gross receipts at ACS have been eroding steadily since 2007—when the society’s total public support exceeded $1 billion—and today, the society’s revenues are at about half of what they were at that time. ACS was hoping to raise $512 million in 2020 (The Cancer Letter, Feb. 7, June 19, 2020).

“I think ACS is ready for that next phase, to truly complete the journey of a single organization with new leadership to make strategic choices that are based with the patient at the center, and to use unique partnerships to really accelerate that mission,” Knudsen said to The Cancer Letter.

“I also think there’s a sense of urgency that’s going to help ACS in this next phase, as we start to emerge from the pandemic, we hope. We know that there are thousands of individuals in the U.S. who skipped screening that are going to present,” Knudsen said. “We’re starting to see this now—patients presenting with more advanced disease. ACS has a long history of promoting patient education as part of their support mission, and promoting screening events.”

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

A video recording of the conversation is available here. A transcript of the conversation follows:

Paul Goldberg: First of all, Karen, congratulations on your new job.

Karen Knudsen: Thank you. I have to say I’m very excited. I’m still here at Jefferson until June 1, and I’m very excited about joining ACS.

That’s amazing. This is a lot to process. Your career is in a really good place right now. You’re a cancer center director, you are the AACI president, you are on the BSA. Also, in your spare time you managed to get an MBA. Of course, you are also an NIH-funded investigator.

KK: That’s true.

ACS, on the other hand, is a place that has been losing its gross receipts. They’ve been eroding since 2007. Actually, other organizations that are comparable have been growing. So, why do you take the CEO position at a place that’s really going down while your career is at a really nice spot?

KK: Well, great question, as always. I think, probably, the most important aspect of what it is that I do that led me to ACS is, in fact, leading the cancer care and cancer discovery mission at Jefferson’s Sidney Kimmel Cancer Center. ACS has had an incredibly positive impact on the operation that I run in Philadelphia. So, my microcosm of experience with ACS has given me this incredible perspective, but also, incredible respect for the organization.

ACS exists because the burden of cancer in this country is unacceptably high. And they believe something I believe, which is that we can improve lives through cancer research, through advocacy, and through direct patient support mechanisms that enhance the lives of cancer patients and their families. All of those things are true in Philly. And, I’ve experienced that as the leader of this large cancer operation.

So, when ACS called and said that they had a vision for the future to further enhance what it is that they do, and take experiences like mine, in Philadelphia, and ensure that that is permeating optimally throughout the nation, I listened.

And the more that I met with the board, the more that I understood the impact of ACS and what the organization is, and what the organization can be, the more enthusiastic I became. So, in a nutshell, I looked at this seriously, because of what the impact of ACS can be and is in this nation.

And I fully believe that.

Well, Joe Simone used to say, “leadership matters.” And as you are leaving Thomas Jefferson, what have you accomplished there? You’ve brought it back from the brink, really. What have you accomplished there? What are you leaving behind?

KK: This is in fact the hardest part, without question, of going to the American Cancer Society–leaving behind the Sidney Kimmel Cancer Center. I love my team. And at the end of the day, the strength of what we’ve done at Jefferson is the team that we’ve built that’s allowed this expansion and greater impact on the community.

From the NCI perspective, we’ve really grown. We’ve more than doubled the research funding. Now, more than $80 million in research funding is coming in for cancer in any given year. We were ranked “outstanding” for the first time by the NCI in our last renewal. We are one of two nationally ranked cancer programs in the greater Philadelphia region.

That care delivery component of what it is that I do in leading the cancer center has given me an entirely new appreciation over the last almost seven years of the challenges of really delivering equitable cancer care.

But without question, our most important impact has been in shifting our focus so that decisions are guided and resources allocated by the needs of the patients whom we serve. That’s everything from how we distribute research funds to how we organize.

We went from a single hospital system in Philadelphia Center City, now to three advanced care hubs out in the region, all with clinical trials, all tailored toward those patients in the region, opened the first men’s genetic risk clinic in the US, and, continue to innovate, really inspired by my CEO, Steve Klasko, who has encouraged us to take creativity, innovation, and novel partnerships toward the greater good, and given us a real license in cancer to follow those dreams. And they’ve borne fruit.

We’ve more than tripled the number of cancer patients that we are serving. And the access to advanced care and clinical trials out in the community was a dream that we were able to realize, underneath Steve.

What I really came to appreciate at Jefferson is the impact through building this large multi-state service line, and seeing it integrated beautifully with research. Having all of our decisions guided by what’s right for the patient is a discipline and competency that I hope to bring as the CEO of the American Cancer Society.

But leaving the place behind like that, are they okay without you? Can it sail without you?

KK: I think they’re going to be terrific. The day that I spoke to Steve Klasko and said, “I’m making this transition.” I also said, “And, by the way, here’s my plan. Here’s the plan for SKCC from the research and from the service line side.” There will be a national search for my replacement.

I serve many roles, two of which are the director of the cancer center and the executive vice president of oncology services. So, I think it’s going to be a terrific position for someone to walk into because it’s doing so well. And, because of leaders like Steve Klasko and Bruce Meyer, who heads the health system, just really embracing what it is that that cancer center can be.

And so, the team, they’re fantastic. They’re going to be terrific.

What I’ve said to them is that we’ll be still partners. This is one of the things that ACS can and should take advantage of—greater partnerships with cancer centers.

Example: in the underserved areas that I have as part of my catchment area right now, here in Philadelphia, I have 16% of my patients who will miss chemo or radiation therapy in any given year because they don’t have transportation. We bend over backwards to find resources and ways to support patients to get them to treatment.

ACS has the same goal. They are one of our key partners in providing transportation for our patients. This is an area where we can really work together for creating new strategies, to build new alliances toward resourcing, how it is that we get patients to treatment, and improve access to care. 

At the end of the day, the cancer centers care deeply about achieving equity in cancer care. This is a passion of mine as well. ACS also holds this value. So, finding ways to work together with cancer centers, pharma, and other partners, I think has to be part of the strategy moving forward for ACS.

If I may opine, if anybody can make this happen, if anybody can turn ACS around, it’s you. But, what is ACS? What are the problems? How do you expect to address them?

KK: Yes. I’ll certainly learn more after June 1, when I walk in the door as CEO. But from my experience–what I know from learning from the outside– it appears to me that ACS has had some of the typical types of issues that happen, when organizations that have been around as long as ACS has, evolve and go through transformation.

Some of those challenges were internally generated. Some were due to external factors beyond their control that they are still in the process of adapting to.

But, one of the biggest challenges that I see in the history of ACS, which I feel empathy and sympathy for, is this move from a federated model (where ACS lived in a lot of different places with different missions and different strategies) to a single organization functioning under a single mission.

This is a journey I understand very well, given all of the consolidation in healthcare, and the growth of Jefferson from three hospitals to 14 and therefore, the cancer program and cancer research mission blooming out into those areas. It’s not simple. It’s not a journey that happens in one year.

I think ACS is ready for that next phase, to truly complete the journey of a single organization with new leadership to make strategic choices that are based with the patient at the center, and to use unique partnerships to really accelerate that mission.

I also think there’s a sense of urgency that’s going to help ACS in this next phase, as we start to emerge from the pandemic, we hope. We know that there are thousands of individuals in the US who skipped screening that are going to present. We’re starting to see this now–patients presenting with more advanced disease. ACS has a long history of promoting patient education as part of their support mission, and promoting screening events.

We are very thankful to them for partnering with us on screening events. They have to be part of the solution of reducing the cancer burden in the post-pandemic world. That sense of urgency I see throughout the leadership of ACS, and I’m sure it exists in all aspects of the organization. It’s just yet another reason that I think ACS is so critical in the current and future environment.

So, that’s a purpose?

KK: Yes.

That wasn’t there, and COVID has created that; right?

KK: I think it’s really heightened that sense of purpose on prevention and screening, which is part of the patient support component of ACS. But yes, I think having that sense of purpose that’s centered around the patient and their family to improve the lives of patients and their families through the three pillars that hold up ACS, discovery, advocacy, and patient support, that really differentiates this organization from similar organizations with whom they partner and share interests. For example, in cancer research funding.

Well, nothing is going to happen unless the board is on board. And hiring you was something that is probably a good omen, I’m opining again. But, do you think the board has the vision right now? It hasn’t always had the vision. At least, that’s kind of like I would hang most of the problems–or a lot of the problems–on the board, as it was meandering and changing in every which way. Is it now stable enough to actually give you direction and engage with you in the way one responsibly engages with a CEO? Is that happening now, the thing that wasn’t happening before?

KK: All I can say is what’s happening now at ACS. I looked at this, of course, very carefully. That relationship between management and governance is so important for the health of any organization, but ACS in particular. I’ve had quite a lot of interaction to date with the board, and it’s been I would say, uniformly positive.

I think I have a reputation for transparency and openness. And I’ve certainly shared with them my vision for ACS along the lines of what we just talked about, the patient-centricity and refining our focus on true patient impact.

What I found in the board was an enthusiastic group that shared the vision, that spoke to me in ways that really energized me, talked about the desire to bring new creativity, innovation, to spar with the board and come out with the greatest ideas. I’m used to this from the board at Jefferson and am very enthusiastic about working with them. As much as the time I’ve spent with the board, I’m anxious in the post-June-1 world to start to move beyond, and to spend the first several weeks and months in a listening tour.

ACS is everywhere; right? They have 3,500 employees, 1.5 million volunteers, they are in six regions. And I’m a believer that good ideas can come from anywhere.

As a many decades funded scientist with a phenomenal research staff to work with, I realize that good ideas can come from anywhere.  I’m really looking forward to speaking with everyone, from senior leadership to volunteers, to listening, and helping to shape that vision– that tentative vision that we’ve put together — and to set it into motion as quickly as possible for the next phase of ACS.

How long is the listening tour?

KK: I think the listening tour is certainly going to be however long it takes me to get out to these six regions in the world of COVID, but I do want to physically visit. But, the listening tour can’t last too long. I’d like to learn quickly, and then have those important conversations throughout the organization. I’d say, in the first three months, we would like to come out with a solid next strategic plan for the ACS.

I would think that the fact that you got the job… I cannot imagine that in your interviews with the board you would have been anything but blunt about what’s going on.

KK: That is my reputation. Yes.

And yet, they still hired you, which is a good thing.

KK: They did.

… that means they are probably onboard.

KK: I might be blushing, but I enjoyed it. Again, as a scientist by training, we thrive in peer review. We thrive from having objective feedback from each other. I tell my lab all the time, “The way that you show love to people that you work with is by challenging their concepts and really making sure that they’ve thought through it. Do they have a good strategy? Is there an alternative plan?”

As a scientist, that’s how we show the love, and as a leader, that’s how we’ve developed an effective team at the Sidney Kimmel Cancer Center.

This massive expansion that we’ve undergone, in consolidation of the organization from a federated to an organizational model came from having these kinds of transformative discussions with our leaders, all the way through to everyone on the staff. I really think that (the board) got the chance to know who I am. I’m optimistic about working with the senior leadership team and the board towards shaping these next few years. Creativity and innovation is part of what they were looking for, and I hope that’s one of the things I bring to the table.

I’m opining here again, I’m sorry, but this is probably the biggest change that place has had since Mary Lasker bought it, and took it over, from these crazy conservative surgeons who didn’t believe in government funding of research.

KK: Well, it is a change; right? In recent times, I am the one who is most connected to academic oncology. And I would like to think that that’s in part why it is that I was selected as CEO, and it’s certainly what gives me good competencies for leading the organization.

To your point, I still have a very active funded lab, which I will still keep my professorship at Jefferson, and, transition my lab out, and those grants and ideas to other investigators at Jefferson. But, we’ve been really fortunate in the way that we lead the lab, to focus on what are the current clinical problems.

We’re very tightly connected to the clinic. And in my case, for my lab, it’s advanced prostate cancer. We’ve been very fortunate to make discoveries that have contributed to new approvals and new understanding of disease. Our ability to translate into clinical trial is something that we’re very thankful for, because of the environment at Jefferson.

That care delivery component of what it is that I do in leading the cancer center has given me an entirely new appreciation over the last almost seven years of the challenges of really delivering equitable cancer care.

At the end of the day, the cancer centers care deeply about achieving equity in cancer care. This is a passion of mine as well. ACS also holds this value. So, finding ways to work together with cancer centers, pharma, and other partners, I think has to be part of the strategy moving forward for ACS.

Our catchment area for Jefferson is a seven-county catchment area. Seven counties doesn’t sound like a lot, but that population, when you add it up, if it was a state, would be the 25th largest state in the United States. We serve this dense, heterogeneous population with a high degree of cancer incidence and cancer mortality that outstrips the nation, that outstrips either the State of Pennsylvania or the State of New Jersey.

So, we’ve got a lot of challenges. Understanding what those are and working with ACS is one of our partners to mitigate those issues, has given me good insight into what the challenges are nationally.

Philadelphia really, I think, is a microcosm of the world. I’m a known Philadelphia lover, so there’s some bias in there, but I actually believe that to be true. I brought this forward with all the other cancer centers as part of my presidential initiative at AACI to turn the attention toward what are all of us doing to mitigate cancer disparities, and what can the cancer centers do? What do they need to do in partnership with organizations like ACS? And how much success have we had? What works, what doesn’t?

Although I will have to step down as president of the AACI, I still hope to complete that first aspect of the cancer disparities project. But certainly, I hope that these competencies will be an asset to ACS as we go through and sharpen the priorities toward near-term patient impact.

What happens to BSA? You’re still there; right?

KK: I will still be on the Board of Scientific Advisors. I have spoken briefly to Dr. Sharpless about this. I believe that to be true. It’s just that AACI’s bylaws require you to run a cancer center in order to stay on. So, I’m very sorry to leave my cancer disparities project behind.

But I have had a chance to speak briefly to Dr. [Caryn] Lerman, who is the president elect, who will be coming after me. And she and I are talking about unique ways to combine my presidential initiative on understanding and mitigating cancer disparities with her proposed presidential initiative, which I won’t unveil, I’ll let her do that. But, there’s some synergy there. So we’ll continue to work together in different ways.

So she will end up serving two terms, essentially?

KK: There will likely be an election more quickly than normal. So, she won’t serve two terms as a president, it’s more that she’ll need to ascend to the presidency more quickly than she had anticipated. Poor thing, and she’s going through a site visit right now. So, I feel that I have piled on to Dr. Lerman, my sister, Caryn, as we call each other. It’s not a good year to be a Karen. 

But, you’re both cool. No problem.

KK: Yes. We both just are out to buck the trend and eradicate that stigma. But, she’s ready for it. She’s wonderful. She’s going to be a terrific president of the AACI.

KK: My answer to that question might have been different six years ago, seven years ago. But, after having gone through almost seven years of consistent merger and acquisition, where each time there’s a new acquisition you are going from a federated model to an organizational model– it’s not simple. It is a journey that evolves over time, and that cements itself with trust. The trust comes from achievement, and aligning strategies so that the individual sites are thinking globally, but acting locally.

There is a way to thread that needle, so that everyone is functioning toward a single mission: let’s improve the lives of cancer patients and their families, and we’re going to do it through advocacy, patient support, and discovery.

That’s okay. But then, fine-tailoring what that means for Philadelphia versus Los Angeles, or Iowa is very achievable. That I feel probably the most comfortable about of anything. I understand how that process goes. ACS, I feel just has to just complete that journey.  There’s a path forward.

They’re correct in that ACS started out with this very grassroots mission; right? The Women’s Field Army that were knocking on doors. Well, knocking on doors in 2021 is probably not a solid plan, but thinking locally is.

So, what does “local” mean now? It doesn’t mean neighborhoods. People’s communities mean very different things. It can mean their online community, how patients connect to each other, because they have a common disease, or a common interest, or a common concern.

ACS’s new strategy or refined strategy has to go to where the patients and their families live, work, and play. So, it’s a different kind, I’d say, of grassroots that needs to happen. But again, as we talked about before, my leadership style is such that good ideas and shaping a vision have to include both bottom-up and top-down strategies. Not just in the listening tour, but, one of the goals for me personally, as the CEO of the American Cancer Society, is to stay connected to those local needs.

I’ve come to realize the value of that as well at Jefferson.

If I sat in my office in Center City, Philadelphia, 365 days a year, I would become pretty disconnected with these outlying advanced care hubs that we have stood up that are hours away from my office. That would be a problem.

I anticipate having that same kind of philosophy at ACS, which is to be not just in touch with the local groups, but also to be one of them, and to experience firsthand what it is that they’re trying to accomplish in their different geographies.

KK: This has been an important core of ACS. It’s the case that I need to learn more about why decisions were made and what the current plan is moving forward in post June 1. There’s new leadership that oversees that research pillar.

Understanding what the vision is of that senior leadership team, I think is going to be really important. What I do think is that if ACS in its simplest form stands on these three pillars of research, discovery, advocacy and patient support, finding ways for these to optimally synergize with each other has to be a way. But I will say, without question, I’m a scientist. 

I have benefited from ACS funding– not personallym but as a cancer center director.  Having those pilot funds to let bold new research directions take flight, especially from early-career investigators has been mission-critical. We can point to those and say “that went right to clinical trial, and it’s been impactful”.

I think telling the story about the impact of ACS-funded research has to be part of what it is moving forward, so that we’re more effectively communicating to stakeholder groups what the value is of the research mission and how that relates to things that the advocacy group is really focused on, like cancer equity, or access to care. All of these things need to tie together, so that ACS is making strategic choices for the highest and best use of the valuable funds, time, and resources that go into the organization.

So, do you think you’re going to give more money to research, or can you? I mean, I’m sure it takes the board as well, but do you see yourself upping that investment, or not?

KK: Yes. Well, this is what we’ll decide in the next strategic plan, after the listening and learning tour. Research is a core tenet of ACS, and it has to be. And so, again –I don’t want to speak for the relatively new leader in the research team–but I’d like to understand what that strategic goal has looked like, how it intersects with the overall goals of the ACS and the mission of the ACS.

Research has to continue to be one of the core mission and values of ACS if they truly believe, as I know that they do, that they can improve lives. Research is a key component of that.

Yeah. I have full confidence in the fact that you get that. So, where do you see ACS a year from now, three years from now, five years? Ten is probably too much to ask for, but three…

KK: I don’t know. Let’s go! Let’s be aspirational. I like this. This is good. . In one year we will certainly have a new strategic plan and begin to pivot into that next phase.

Hopefully, as a nation, we will have emerged from COVID. And as we talked about before, ACS has to play a central role in reengaging the population in screening. But by the time a year has gone, I hope we’re already making progress in improving lives through the tripartite mission, and have things to stand up to discuss with the nation, as ACS already does, about the positive impact of what they do.

So, I think the in next phase of ACS, we’’ll start to be more visible.

By five years, I’m hoping that we have refined our strategy so that we’re meeting the specialized needs of patients in different geographies. Again, the rural versus urban type of tailoring that ACS should be part of, leading for the understanding and leading to mitigate.

As part of that, I know ACS, under my leadership and in the previous leadership, has a real interest in reducing cancer disparities. That has to be a component of what it is that we do. And I’d like to have a measurable impact. Again, as a scientist and as a business person, I do believe in metrics of success planned out, a priori at the time that the planning is completed.

I’d like to increase our impact in cancer prevention. Obviously, that’s where we want to go, and again, tailor resources toward near-term patient benefit. I think that’s the role of ACS. 

By 10 years, let’s be very aspirational. A big win in 10 years is that declines in cancer mortality allow us to start to shift resources increasingly toward quality of life, and cancer survivorship.

If that’s where we are 10 years from now, (and you and I are going to sit down and have this conversation), that will be a win for the cancer community as a whole.

What about money? How is that going to work?

KK: Well, obviously resources have to come in.

In order for us to achieve, resources have to come in. But again, I think that’s where sharpening our focus and making strategic choices of what can ACS do that’s unique to this organization, and what differentiates us? And then, what are the things that we partner for, for example, with other organizations who are interested in research, but also, pharma, and cancer centers.

How we optimize that partnership I think has to be part of it as well. There are resources that fund the things that are truly ACS-driven. But then, we need partnerships that can be utilized as a way to achieve, and that has to be part of the plan too.

Yeah. Well, I mean, just looking at this as a natural competitor, St. Jude, because they were at the same spot in 2007. And at ACS, as ACS went down, St. Jude went way up. So, something went right there that went wrong with ACS. And that may very well be vision or some connection to the world.

KK: Well, it may be. I have a great love for both organizations, deep love for both organizations. And they have a slightly different place in the universe. St Jude’s actually does cancer care delivery for a specialized population. ACS has an impact on a much larger group of individuals and communities in the US, but they both have their place in the place in the universe. Finding ways for those two organizations to work more optimally together, I think can be a goal moving forward.

St Jude’s has made very clear their impact on the pediatric cancer population, and we are better off for it as a nation, and as a world.

I believe the same for ACS. I believe that we are better off for the funding that ACS has given to transformative research, to the funding that has gone toward passing new legislation, or impacting local, state, and national policies that increase access to cancer care and improve equity, and reduce financial toxicity. The advocacy arm has been incredibly effective.

But again, the patient support component of providing navigation, providing transportation, providing lodging to families who are undergoing a cancer experience — I can tell you from my experience in Philadelphia, that’s impact. And it is impact that is felt deeply by the families and the providers alike. It’s irreplaceable. That aspect of ACS is something that truly differentiates the organization.

And so, what I hope at the end of the day is that my microcosm experience in Philadelphia is what the world begins to know about ACS, because what I see is an incredibly positive, irreplaceable organization.

And it’s all about vision; isn’t it? Is there anything we forgot? Anything you would like to mention?

KK: Well, maybe we end how we began, which is the ACS: why do they exist? They exist because the burden of cancer is unacceptably high. One in two men, one in three women over their lifetime with a cancer diagnosis is just too much. 

The ACS tripartite strategy is to improve lives, and I think that they have a great start on that. They have a terrific history. And now, we tailor for the future.

But, not to be forgotten, they’ve given out $5 billion in research funding since 1946. This is a really significant investment in time and resources, with more than three million patients and lives touched by directed ACS programs. So, tailoring that for 2021 and beyond is what I’m looking forward to. I’d love to continue this dialogue with you, too. 

I always find it useful to talk to you, Paul. It gives me new ideas about how it is that the organizations I’m working with (now Jefferson, soon to be ACS), can better work together toward a common goal. I really believe that that’s the answer.

Well, this is fascinating. Well, thank you so much for talking with me.

KK: My pleasure. My pleasure. Thank you, Paul.