Cheryl Willman was named executive director of Mayo Clinic Cancer Programs and director of Mayo Clinic Comprehensive Cancer Center. Her transition to Mayo will occur sometime in August, officials said.
Willman has served as director and CEO of the University of New Mexico Comprehensive Cancer Center for 20 years, the longest uninterrupted stint for any NCI cancer center director in the U.S. today.
Willman, a pathologist, and cancer genome scientist with a particular interest in cancer health disparities, comes to Mayo Clinic Comprehensive Cancer Center at a time when the institution is planning an aggressive expansion, development and recruitment of cancer physicians and scientists in Mayo Clinic sites in Arizona, Florida, and Minnesota, as well as newly developing Mayo Clinic global cancer programs in London and Abu Dhabi.
“In addition to the wonderful opportunity to significantly expand and integrate Mayo Clinic’s exceptional cancer research and cancer care delivery missions, one of the key considerations for me in accepting this exciting new role was Mayo Clinic’s commitment to diversity and health equity. Particularly in these times, when our nation’s long history of social injustice and institutionalized racism has been laid bare, and when the COVID-19 pandemic has had such a disproportionate and devastating impact on racial and ethnic minorities and vulnerable populations, such as Tribal Nations in the American Southwest, every NCI Cancer Center must be committed to deeply engaging the communities it serves to overcome disparities and assure health equity,” Willman said to The Cancer Letter. “To me, this is an ethical imperative.”
“When I had the opportunity to serve on the Scientific Advisory Committee of the Biden Cancer Initiative, President Biden continually stressed that elite cancer centers simply had to disseminate their high-quality cancer care to all and seek innovative ways to do so,” said Willman. “I could not serve as the director of an elite cancer center where the access bar is so high that comprehensive cancer care is not made available to vulnerable, underserved, and diverse racial and ethnic minorities. So, it was a watershed moment for me when the Chair of the Search Committee, Dr. Amy Williams (Mayo Clinic Executive Dean of Practice), and subsequently Dr. Gianrico Farrugia, (Mayo Clinic President and CEO), said, “Why do you think we want to hire you, Cheryl?”
“To my delight, my letter of offer makes a very clear statement and commitment to that intent.
“I am greatly looking forward to working directly with Dr. Farrugia and the Mayo Clinic leadership team, who are leading a visionary transformation to assure that Mayo Clinic continues to have a tremendous national and global impact and is accessible to all through partnerships and highly innovative means of direct and virtual patient care.” Willman said.
Willman serves on the NCI Board of Scientific Advisors, the Scientific Advisory Board of the NCI-Frederick National Laboratory for Cancer Research, the NCI-Department of Energy Collaborative Working Group, and the scientific advisory boards of 10 NCI-designated cancer centers. She has been continuously funded by NIH, NCI and the Leukemia & Lymphoma Society for more than 30 years.
As she takes over at Mayo, Willman will continue to study the genomic, environmental, and behavioral mechanisms underlying cancers that disproportionately affect American Indians and Hispanics, leading to tremendous disparities in incidence and outcomes.
Willman (MPI) and colleagues at The University of New Mexico and collaborators from The Translational Genomics Research Institute (TGen, Phoenix, AZ, led by MPI Jeffrey Trent) and The Black Hills Center for American Indian Health (Rapid City, SD and Window Rock, AZ, led by Jeffrey Henderson and Patricia Nez Henderson), are now leading one of the NCI Participant Engagement-Cancer Genome Sequencing Research Centers: Engagement of American Indians of Southwestern Tribal Nations in Cancer Genome Sequencing. Willman said that with support of the Mayo Clinic, she will seek to expand this collaborative project to other indigenous Tribal Nations across the United States.
Willman received her medical degree in 1981 from Mayo Clinic Alix School of Medicine in Rochester and completed her residency and postdoctoral training in pathology and cancer research at Mayo Clinic, The University of New Mexico, and University of Washington.
Willman spoke with Paul Goldberg, editor, and publisher of The Cancer Letter.
Paul Goldberg: First of all, congratulations.
Cheryl Willman: Thank you so much, Paul. I’m really excited.
Sounds like quite a decision. You’ve been at New Mexico for how many years?
CW: I have been in New Mexico and at the University of New Mexico for 40 years, and I’ve been the cancer center director here for over 20 years. Dr. [Henry] Ciolino recently reminded me that I am currently the longest serving NCI cancer center director in the United States.
That role was previously held by Max Wicha, director of the University of Michigan Comprehensive Cancer Center, but I’ve apparently outlasted him! [The Cancer Letter, Dec. 3, 2013)]
When Max stepped down from the center director role and continued his cancer stem cell research, I remember him teasing me, Paul, about how many competing renewals have you been through?
So, I just finished my fourth, and I can’t believe I signed up to do another one, but I did! I would not have predicted that.
I guess we should probably talk about Mayo first and then return to New Mexico. To quote Joe Simone, as one always should (The Cancer Letter, Jan 29, 2021).
CW: Paul, I have thought so much about Joe Simone during this search process, trust me; he was such a wonderful mentor to me during my career. I told Dr. Farrugia and his key leadership team whom I’ll be working closely with, that I thought of Joe many, many times during the search process, and really wished I could have sat down to talk to him. But I felt he was talking to me anyway, in my own head with his profundities: In these roles, what’s important is how you feel about it, and what your purpose and path is at this point of your life.
In the end, after agonizing consideration, as I never thought I would leave New Mexico, the opportunity and purpose were just too great to refuse and my decision was an intuitive one, after a lot of analytic thinking and discussions that went into great detail, as you might imagine.
What would Joe have said?
CW: I believe at the end, as I became confident in Mayo’s true desire for radical transformation and so excited about their innovative vision of the future, I think he would have said, “Take the leap.”
“Take the leap of faith.” Because at the end of it, Paul, these decisions are leaps of faith. You know, Joe always said that you can get a 20-page single-spaced, written letter of offer with all kinds of guarantees. But in the end, those can be worth less than the paper they are written on.
In the end, do you trust that the institution is who they say they are and that they share your vision and have the resources to achieve it? Because at the end of the day, we are going to have to renegotiate all that in the reality of the job anyway. So, do you have that belief and faith in them?
And I do. That process was very critical for me.
In my final acceptance note to Dr. Farrugia, I shared the indigenous American Indian creation story of “Skywoman Falling.” She is the creator of our world who enters this world from the ancient ones, bringing seeds from the Tree of Life (for all humans, animals, and plants). In some versions she “slips” from the edge of the sky to the earth, in some she is “pushed,” in another she is “thrown”—not from malice, but because she was needed for this sacred task.
But like most women today, I prefer to think she “jumped,” because, “guided by a shaft of dazzling light,” she sees what promise awaits.
I jumped! And Dr. Farrugia, in response, assured me I would have a “soft and safe landing.”
At that moment, I knew for certain I had made the right choice.
It’s a big leap for them, because the culture is very male at Mayo, has always been…
CW: Actually, in the Mayo 2030 “Bold. Forward” plan, there is a strong DE&I initiative. Mayo has hired many women in senior leadership roles, and is committed to both developing and hiring a large cadre of racial/ethnic and diverse scholars to lead the institution forward.
When I look at the institutional leaders whom I will be working with, there is significant diversity. As the cancer center has recently been elevated to the highest levels of the institution, I will report directly to the president and CEO, Dr. Farrugia, originally from Malta—a true innovator, a physician, and a scientist, whom I really have grown to like and respect.
The rest of the leadership team includes Dr. Amy Williams, who I have mentioned is the Executive Dean of Practice. She is just fantastic, and I have come to know her very well as she chaired the search committee. Another key partner is Dr. Gregory Gores, Executive Dean of Research, who is a superb scientist and leader, who will also be a crucial partner.
Other team members I will be working with, all of whom are women, include the Chair of Practice Administration Roshanak Didehban, [MS], the Chair of Research Administration Heidi Dieter [MBA], and my administrative partner for the cancer center Jolene Summer Bolster, [MA].
The opportunity to join this elite leadership team will be quite an adventure for me, partly because, sitting there, I will learn a lot, and also be able to contribute to and impact decisions from a cancer perspective.
You’ve broken a lot of glass ceilings and this is probably the most rigid of those glass ceilings one might think; right?
CW: Yes and no. I went to medical school at Mayo. I did part of my pathology residency there. I grew up in that part of the country as a child, went to high school and college. The upper Midwest is an area I’m very comfortable in, but it’s not particularly diverse, at least not as diverse as New Mexico.
Mayo is rooted in that culture and place. And yet, they have programs in Arizona, with the opportunity to more deeply engage Hispanics and Indigenous Tribal Nations, and Jacksonville, FL, with the opportunity to deeply engage Hispanics of a different genetic ancestry, and the African American community.
During the search process, I was not able to visit in person, because of COVID-19, until late February. We had to wait until everyone was vaccinated and it was safe to travel. And both Mayo and our institution had very strict rules prohibiting business travel.
So, most of my interviews, Paul, during October and November, and my subsequent meetings, have been virtual. Even then, I had a strong sense of their desire for change. But on visiting there in February, thanks to Dr. Gores, I became much more aware of the programs that Mayo has developed, particularly in their NIH-funded Clinical and Translational Science Center, that are deeply engaging minority, diverse, and rural communities in the upper Midwest.
The Mayo Health System has a primary care/community-based practice led by Dr. Mark Wieland that has more than a million covered lives in the upper Midwest, spanning from Rochester through southern Minnesota, Wisconsin, and Northern Iowa.
This network, which serves a large rural population, is ripe for cancer screening trials, cancer prevention trials, navigation trials, and dissemination trials. So, the vision of developing similar intensive, deep community-engaged networks in Arizona and Florida will be something that I will really be driving. I’m very excited about that.
One of the key considerations for me in accepting this exciting new role was Mayo Clinic’s commitment to diversity and health equity. Particularly in these times, when our nation’s long history of social injustice and institutionalized racism has been laid bare, and when the COVID-19 pandemic has had such a disproportionate and devastating impact on racial and ethnic minorities and vulnerable populations, such as Tribal Nations in the American Southwest, every NCI cancer center must be committed to deeply engaging the communities it serves to overcome disparities and assure health equity. To me, this is an ethical imperative.”
When I had the opportunity to serve on the Scientific Advisory Committee of the Biden Cancer Initiative, President Biden continually stressed that elite Cancer Center’s simply had to disseminate their high-quality cancer care to all and seek innovative ways to do so. I could not serve as the director of an elite cancer center where the access bar is so high that comprehensive cancer care is not made available to vulnerable, underserved, and diverse racial and ethnic minorities.
So, it was a watershed moment for me when the Chair of the Search Committee, Dr. Amy Williams (Mayo Clinic Executive Dean of Practice), and subsequently Dr. Gianrico Farrugia, (Mayo Clinic President and CEO), said “why do you think we want to hire you, Cheryl?” To my delight, my letter of offer makes a very clear statement and commitment to that intent.
Mayo has three campuses located far apart. I guess the technology–thanks to COVID–has changed.
CW: Totally. Yes, yes, yes.
How does the three-campus model work?
CW: The Mayo Clinic Comprehensive Cancer Center is an integration of the three campuses of Mayo Rochester, Phoenix-Scottsdale, Arizona, and Jacksonville, Florida.
I see those as hubs for opportunities for much deeper community engagement and collaboration than I think they’ve experienced. That’s very much in line with Mayo’s vision as well. So, I see a huge opportunity to build networks and partnerships with other NCI cancer centers in these regions and community health systems to create a platform for community engagement from all these three sites.
That is clearly an intent of mine and the institution’s, which I am very excited about. I’m am traveling to Mayo next week to hear the presentations of their accomplishments to date in their strategic planning efforts.
They’ve had several work streams and strategy groups working over the last two years to really transform and restructure the cancer center. So, being able to weigh in on those right now is very important.
I’ve reviewed earlier stages of the work last fall. There’s some pretty radical transformation and thinking going on. There’ll be a lot of hiring and a lot of opportunity to change, which excites me.
I really want Mayo in Florida and Arizona to be reflective of the people that they should be serving in those communities.
The intent to partner with other NCI cancer centers in these regions is one of the most exciting and important opportunities for me to purse. It is interesting; there has been a real change in the NCI centers programs. If you asked me 10 or 12 years ago what things looked like, NCI centers were very siloed and often intensively competed with each other.
Today, we’re forming networks and alliances in ways we never did before. No one center can do everything, and we have complementary strengths.
It’s time for centers to collaborate to take our high-quality science and clinical care and truly figure out how to disseminate that to the communities we serve. So that every person in the United States has access to incredible cancer care and can participate in cancer research and clinical trials. There are all kinds of models to do that; right?
It can also be through partnerships with health systems and community-based hospitals. Like other NCI Centers, Mayo has a huge nationwide collaborative network of community-based health systems, The Mayo Clinical Care Network. It can be through development of innovative virtual care delivery platforms that go far beyond the “ZOOM visit” of today. Mayo has hugely committed to innovation in virtual platform delivery medicine with a new initiative called Care@Home that involves providing direct care to patients in their home virtually and partnering with community providers and healthcare providers.
I’m very excited about these new dissemination opportunities. How do deliver care across large rural swaths of the United States? How do you get out on the Navajo Nation that’s as big as most U.S. states, where there aren’t even good roads? And critically, what is your platform and approach where there’s limited broadband access? Until broadband access is addressed, that will remain a root cause of health disparities in my opinion. In my new role, I will continue to be here in the Southwest a lot, in my native area, not just in Mayo Rochester, building on the networks and connections I have here in the Southwest, to use Phoenix and Albuquerque as hubs to build these kinds of interesting, innovative research and care delivery networks.
So, we’ll be seeing the Mayo name in places where it’s never been…
CW: I believe so. I believe through the new Care@Home models and virtual platforms we can do so much more. There’s a new NCI RFA out that just was released that we structured in the BSA for centers to take leading initiatives in developing virtual care. Highly innovative—and not just simple videoconference patient visits.
How can you accrue patients for clinical trials? How can you drive trials through direct delivery of drugs to patients at home or to their community-based healthcare provider? How do you engage patients in care? What’s the blend, Paul, of having to bring a patient to a big center where certain surgical or radiation techniques are available?
How much can we begin to let other providers deliver chemotherapy? I think our own field has limited that to a degree. Perhaps that should change. The reimbursement models preclude us sometimes from doing that. Those who deliver the high-end care make the money. Those reimbursement models, I think, need to change for our country, for health equity. Not just in cancer, but in all types of clinical care delivery. There is, unfortunately, a financial disincentive to innovate in this way under current payment models and systems, but this is going to have to change if we truly want to achieve health equity.
So, what does that future look like?
Mayo is certainly applying for one of those innovation center grants for virtual platforms. And I think several other NCI centers will apply. But I see that as the future.
I live in a land of horrendous healthcare disparities. So, it’s got to be innovative ideas that incorporate many models, like we talked about: partnership with health systems, tele-education like UNM’s Project ECHO that creates a forum for experts at academic medical centers to support community-based health care providers to deliver care, and direct patient engagement through virtual meets.
I’m excited about exploring how that works.
In the Biden Cancer Initiative, dissemination was one of President Biden’s biggest thrusts: How are you going to disseminate quality care from your NCI centers? He would berate us, “You guys don’t even work well together. You don’t play nice together.”
In relating the cancer journey of his son Beau, he would talk about how difficult it is for a cancer patient and family to move from one cancer center to another and have to redo all the tests that the other center had already performed.
All patients find it incredibly frustrating that they cannot control and we do not easily share patient data. So, how can we make it easier for the human being, the cancer patient, at the frontline? Mayo is thinking deeply about that. I’m really excited to participate in that thinking and that design.
You have to think deeply, or it’s over.
CW: I agree.
What about New Mexico? What happens there?
CW: Well, the nice thing is, I’ve been here a long time. My family is here, my close friends are here. I love the culture here. My spiritual heart is in New Mexico. We’re maintaining our home in New Mexico, because I will be in Rochester a lot, but I’ll be also be traveling to Florida and to Phoenix, particularly with the planned expansions at Phoenix and Florida in cancer. And I will be traveling to London and Abu Dhabi where Mayo Clinic is developing new cancer programs and collaborations.
I am pleased that I will still have a piece of me in the Southwest. And Mayo and UNM are working on the structure for me to retain a faculty position at UNM. One of the reasons that’s very important for me is I have developed deep and trusted relationships with Governors and Presidents of indigenous Tribal Nations in the Southwest. I want to be present to continue to engage and collaborate with these communities.
Our NCI Participant Engagement-Cancer Genome Sequencing Center is focused on clinical grade, comprehensive whole-genome, whole-exome, transcriptome, and microbiome sequencing in American Indian and Hispanic cancer patients in our region. That grant must continue to be based in the Southwest to deeply engage those communities that I have gained the trust of and built collaborations with. That will be really interesting for me, too.
I’m assuring that our Genomics Research Center succeeds. But I am also so honored that Mayo, through a personal endowment to me, has provided me the resources to work with TGen and the Black Hills Center for American Indian Health, and the NCI to expand this initiative to other indigenous communities, not just in the Southwest, but in the upper Midwest, and in other states.
We are very interested in working as well with the team at the Stephenson Cancer Center at the University of Oklahoma, with whom we have many collaborative projects in cancer screening and cancer genomics engaging tribal nations as well as other NCI centers and tribal-serving organizations.
We’re particularly interested in creating and expanding an American Indian Cancer Genome Project. That’s part of the reason I want to remain closely linked here. I also think the expansions in the Southwest for Mayo can touch many states and many other NCI cancer centers, leading to new collaborations and initiatives.
We can learn from each other. We can partner, we can share data. Hispanics here have a very different genetic ancestry than San Antonio or LA.
I believe the data we will derive from our comprehensive genome sequencing studies will show that cancer-promoting mutations and mutational signatures of exposure, as well as cancer causation, will differ based on genetic ancestry, where one lives, and how one lives.
I think mutation profiles will be very different in different populations. In many ways, the cancer genome project is in its infancy as so many diverse communities have simply not been studied and have thus not yet benefitted as I believe they will in the future. This is really the overall goal of the NCI Participant Engagement-Cancer Genome Sequencing program, and we are very pleased to be part of it. So, with being able to share that data, collaborate, compare, contrast is going to be an exciting time.
You will continue to do that, obviously.
What about re-designation for New Mexico? I think you just had that completed.
CW: We are in the final phases of evaluation of the competing renewal of our NCI P30 Cancer Center Support Grant for the UNM Comprehensive Cancer Center. We have received our score, which is in the outstanding range, and based on the report of the Study Section and NCI Reviewers, I believe we have retained our NCI Comprehensive Status.
We are awaiting the results of the June NCI council meeting. Given the tremendous difficulty of having to go through a virtual site visit—both for the NCI Centers and the reviewers—I am pleased overall. These are tough and I, and most NCI center directors that have had to go through these virtual site visits during the COVID-19 pandemic hope we never have to do this type of virtual review again.
Part of what led to the long incubation period for my acceptance of the Mayo offer, Paul, was to assure that the center we have built here—which plays such a critical role in our state—was sustained and stable.
We are also very pleased that our New Mexico Governor Michelle Lujan Grisham just signed a bill that significantly increases the state support for the UNM cancer center, as well as provides funding for a very large expansion of our clinical facility. Those were two projects that were very important to me to finish before I left. I feel that things are quite stable now.
But there’s no reason to worry about the fact that you’re leaving? What would NCI do?
CW: I had the opportunity to speak to our program officer [Dr. KrzysztofPtak] and Dr. [Ned] Sharpless this morning to inform them of my transition. We have put an interim leadership group in place that I’ll be working with over the summer. I think we have very excellent transition plans. We have an excellent interim director (Alan Tomkinson, PhD) and two deputy directors (Dr. Zoneddy Dayao and Dr. Carolyn Muller), all of whom are deeply experienced and outstanding, so the center will continue to go forward. I have every confidence in them.
The UNM Comprehensive Cancer Center is such an interesting center in a beautiful place to live with wonderful arts and culture and wonderful multi-ethnic populations and communities, with an interesting research focus in overcoming cancer health disparities.
We also have full control of our clinical operations; most matrix centers don’t have that. We’ve have had physician led hospital-based ambulatory cancer clinics under the control of the center director ever since I started and the center has control and financially benefits from the net ambulatory chemotherapy, radiation oncology, and procedural technical and professional revenues.
When I started as director, I successfully negotiated that control and revenue stream, as well as access to the State Legislature for program and facility funding. These authorities are what allowed us to build a comprehensive cancer center in a state with less resources and grow so quickly. It’s a very attractive job, I believe. I think we’ll have a number of really phenomenal applicants as the institution begins a national search for my replacement this fall.
Plus, of course, at Mayo you’ll be running, as you said, the huge hiring…
CW: Yes, we are developing strategic plans for a large number of hires, and again, we will focus on hiring diverse, highly qualified scientists, physicians, and population health/engagement specialists.
We’d love to know more about that. This is a trivia question, and I probably have it wrong. There are two pathologist cancer center directors, you and Roy Jensen? Is there anybody else?
CW: I don’t think so!
What is the future of NCI designation now. A lot of cancer centers are having financial problems. Big ones.
CW: I think those centers, Paul, that have had problems had a huge referral practice; right? Where most of their patients or a large fraction of their patients were referred from either outside of the primary city or even outside of the state. It is my understanding that many institutions and cancer centers lost revenues during COVID because of the limitations on travel and because people chose to not seek care as they did not feel save.
Here for us, it has been different and very concerning.
Dr. Chuck Wiggins, who runs our New Mexico Tumor Registry, one of the NCI-funded National SEER Registries, tracks all cancer cases in New Mexico, but also within the indigenous communities and Tribal Nations in Arizona. This is rich data source on cancer incidence, mortality, and disparity has driven our hypothesis-driven science. I look forward to continuing to work with Chuck as I transition to my new role.
But the impact of COVID-19 is really greatly concerning to us. In 2020, there were 50 percent fewer cancer cases reported in our two states! You know that there can’t be 50 percent fewer cancer patients.
But that’s the problem: people were not presenting for screening or not accessing care.
Right now, we are just flooded with patients who are coming in with more advanced stages of disease. I understand from speaking with Dr. Lynn Penberthy of NCI that the NCI SEER registries are collaborating to measure the impact of COVID-19 on cancer screening, cancer case reporting, stage of disease presentation, and outcomes. These will be critically important studies.
Our UNM University Hospital normally has 463 beds. But during COVID19, we had to open and manage nearly 600 beds. I remember that one morning, we had 187 patients in our ICU (over 200% of our capacity) of whom 90 were on ventilators with COVID-19.
Our hospital’s just is as full now, Paul, and it’s all the catch-up post COVID. So, my sense is there’s a re-stabilization of health systems financially. Our system, because we don’t have a lot of external, non-New Mexico referrals, we just stayed so incredibly busy and that allowed us to come financially through the COVID epidemic fine.
Emotionally and workforce-wise, however, it has been devastating and tiring and exhausting for our health care providers as we have limited hospital and ICU resources across our State. We became the primary referral site for indigenous patients. In the first wave of COVID-19, 70% of our cases and 50% of the COVID-19 deaths in New Mexico were members of indigenous Tribal Nations.
I believe Mayo has also rebounded from their losses. Again, post-COVID, their patient volumes have returned to very, very high levels, as the pandemic and new case rates have slowed a little bit.
Nonetheless, maintaining and growing a NCI Cancer Center is challenging in these times.
You have to have a diverse portfolio of resources, including state and institutional support, philanthropic support, and clinical revenue support. As you know, during the Trump Administration through an Executive Order, The Centers for Medicare & Medicaid Services enacted a 30% reduction in reimbursement for life-saving cancer drugs enacted to safety net hospitals and cancer centers like our own.
These cuts were just completely devastating. I had to manage an annual $12 million reimbursement cut in 3 months. These cuts disproportionately impacted matrix NCI cancer centers embedded within academic institutions, in contrast to the free-standing cancer centers, which were held harmless. This just wasn’t fair or right. Certainly, one of the major concerns I had, had President Biden not won the election, was that CMS had slated those reimbursement cuts to go even deeper.
This CMS action seems to be suspended under the Biden administration and we are all grateful for that. There’s no question that maintaining NCI status and continuing to grow your center as expected takes really creative financial management. In the last two year, here in New Mexico, we have doubled our state’s support of our center. That’s terrific. Our philanthropy is good, and our clinical revenues have sustained. We’re all right.
This is shifting gears pretty radically. ARPA-H is on everybody’s mind. Since we’re talking…
CW: Yes, very interesting.
What are your thoughts about that? Maybe a little bit more about the Moonshot. What is it? What can it be?
CW: I think the ARPA-H proposal is actually exciting, and I understand why President Biden wanted to do it. I’m actually pleased he put ARPA-H within NIH. I think there was an option to have it be freestanding. I would have been uncomfortable with that.
At Harold Varmus’s and Ned Sharpless’s request, I have sat on the NCI-Frederick National Center for Cancer Research Advisory Board for some time.
That’s a national laboratory-like model, which has much more freedom for partnership with industry and more creative ways to use funds than perhaps the requirements of NIH and other federal funding mechanisms.
It’s my sense, though, and I have engaged in the discussions only peripherally, because of other boards and cancer organizations I participate in, the ARPA-like agency will have more freedom in terms of academic-pharma collaboration, academic-philanthropy collaboration, to really push innovation. For that reason, I think it’s an exciting model.
Yet, we all have concerns. Exactly how will the peer review be done? How does the money get dispersed? What are their research priorities going to be? That’s where the questions get very interesting. All of us want to have input into that; right?.
Yeah. The fact that it’s an engineering issue and it’s going to be more contracts, does it mean that like DARPA, it’s going to be Beltway bandits who are going to be playing rather than cancer centers?
CW: It’s going to be really interesting. Mayo has very big partnerships on their virtual platform transformation with several prominent industries in the United States. Could projects like that be funded through this initiative? I would hope so.
I think it’s innovative and exciting. So, I see it as a positive thing. I know there are a million questions about what is the research focus and the research priority? What will that cluster be? What defines innovative research? Is that just laboratory drug development, or is it going to be in dissemination and access in health care delivery models as well? I would argue that the spectrum of research there needs to be maybe broader than we traditionally think of.
That would be fascinating. Is there anything we’ve missed? Anything I forgot to ask?
CW: No. I think it’s important to me that I am excited about this opportunity. I think the most common phrase I have overused in this interview is that “I am excited.” I like to think of myself as a transformative leader. I was a surprised by the Mayo offer and their willingness to allow me to work through the decision-making process for such a long time.
But I believe they respected me and had a clear understanding that it was essential for me to complete the competing renewal and gain the increased state funding and facility expansion for the UNM Center before I could transition to a new role. I respected that they respected me and felt I had integrity in doing that.
The opportunity to take an incredible health delivery system and to be able to grow and deepen the commitment to discovery science as well as enhance community engagement and dissemination is an exciting opportunity for me.
And Mayo resources are incredible, Paul. Frankly, I’m not used to working in a resource-rich environment. I’m used to working in a resource-constrained environment. The ability to use those resources to do good is really exciting to me. I’m also really pleased at Mayo’s thoughtfulness in honoring the need to keep one of my feet in the Southwest.
That’s part of their initiative in terms of the Arizona transformation. The ability to still run this genomic sequencing center and do that here in the land embedded with the indigenous people we serve and maintain those relationships really pleases me. That’s a piece of my heart that I’m not willing to let go of. The fact that Mayo Clinic has honored this through this process and have provided me the resources to even expand that is tremendously exciting.
This was an issue we need to get back to and really focus on in terms of our coverage, because that’s a fascinating story.
CW: Yes. We spent a great deal of time, really 30 years, engaging with Tribal Nations to lay the collaborative foundation and partnerships that were essential for our NCI Participant Engagement and Cancer Genome Sequencing Center. Key for us was how to work within the NCI data sharing policies and requirements to still honor the sovereignty of Tribal nations. We had to have deep discussion about how to work within the NCI data sharing framework and those discussions are still ongoing.
Tribal communities lack trust and so many non-tribal investigators don’t understand that a Tribal community must define “beneficence” from their perspectives and beliefs. Sending samples to NCI and letting the NCI do the sequencing and then hold those samples for future use was a complete non-starter. No Tribal Council’s is going to approve that or frankly should approve that.
Being able to develop a framework for data sharing that was acceptable to tribes was a four-year endeavor for me. The fact that we had been working on that for four years, when the NCI PE-CSG initiative came up was critical. Had we not already been deeply engaged, I would not have had the letters of support we needed from the tribal communities and the tribal resolutions to make everyone believe we could do it, but also just the interaction with the NCI over the last couple of years has really been fun.
Data generated by our center will be loaded into the NCI Genome Data Commons, but it will not be released until the tribal councils have had that data presented to them and understand it and participate in what we call the “data narrative” and finally agree to its release.
How do you write up your discoveries and data in a way is devoid of unconscious bias? In a way that isn’t harmful to the group on whom you are reporting?
Our colleague, Jeff Trent, President of TGen, has discovered a novel spectrum of kidney cancer mutations in tribal communities that are linked to specific environmental exposures.
That is sensitive to write about. So how do you engage a community to collaborate on this endeavor together with scientists and do that in a mutually respectful way? Jeff and his team have done this beautifully with the Salt River Pima-Maricopa Indian Community in Phoenix and I think this is a model for all of us.
We are thrilled to collaborate with them on an expansion cohort of kidney cancer cases from New Mexico Tribal Communities, and we have formal MOUs in place to do so. We all must engage our communities in the research from the formulation of a project at the very beginning all the way through the end—a novel concept.
And as we presented our approach at NCI meetings and in the NCI Moonshot seminars, we’ve had a lot of other racial and ethnic groups say, “Why should that be true just for American Indians? Why shouldn’t that be true for a Black community or a Hispanic community?”
That’s has led to lots of interesting discussions, but I’m convinced that we’ll have many more discoveries of novel mutations in special populations that are related to both their genetic ancestry and their unique environmental exposures and ways of living.
So, to me, the Genome Project has only just begun. I’m excited that the NCI PE-CGS initiative is performing clinical grade comprehensive genomic sequencing that can be returned to the patients we serve and their treatment physicians for clinical use.
All of the sequencing we are doing is under CAP CLIA regulations. It’s going back to the patient chart and the treating physician. So, it’s truly beneficent to the research subject. This is the first genome initiative at NCI that requires direct patient engagement and return of results in real time for the benefit of the patient. Taking that more broadly into these communities is exciting for me.
This is engineering and science working together in a way which is a fascinating ARPA-H issue.
This is a great time to be a cancer center director.
CW: I think so, Paul, the science is phenomenal. I love being a Cancer Center Director. What I love about it, coming from where I live in the Southwest, is that in this challenging time of COVID—where cancer health disparities and our inadequate public health delivery systems and the structure of our national healthcare systems and how they do not serve vulnerable populations—we are actually engaged in intensive conversations about the roles of NCI Centers in assuring health equity.
When 30 percent of tribal communities don’t have drinking water or electricity and they live in multi-generational housing with inadequate healthcare, how is that ethical or how can that even still be?
Sometimes I laugh at NCI meetings and say, “I know you want us to do global research.” But I can do that research in my own backyard. There are so many “left behind” communities within the United States that have completely unacceptable means or no access to quality healthcare.
Returning to our earlier discussion, with all the beautiful stories you’ve done on race and racial inequities and social justice in The Cancer Letter, this is a time where a NCI cancer center director must think deeply about whether it is ethical just to deliver care in my four walls to whoever happens to walk in the door, or not!
No, that’s not our mission anymore. That’s why I’m willing to still be an NCI cancer center director. This is not a time to walk away. This is a time to grab it and take the big leap and think big about the hard things. I’m just really enjoying so many of my NCI director colleagues, because we’re having those deep discussions.
It’s a change, Paul… I just feel the NCI centers program has evolved to be something different than it was 10 years ago.
Much more collaboration. Much more deep thought about equity in terms of care delivery and participation in research. I had thought that maybe at this point in my life, I was ready to be done, but I’m not. I’m just ready to do it more, perhaps on a bigger stage.
That’s so fantastic. Thank you very much for talking with me.
CW: You are welcome. Whatever we can do to help.