On April 17, Louis Weiner found himself wishing he could be in two places at once—dance at two weddings, as it were.
His proverbial two weddings:
- The Ralph Lauren Center for Cancer Prevention, a community navigation facility he had been designing (and dreaming of) for years, was finally opening in Washington, DC.
- On the same morning, his daughter was scheduled to deliver a plenary session talk at the annual meeting of the American Association for Cancer Research in Orlando, FL.
“Talk about some parental agony,” said Weiner, director of Georgetown University’s Lombardi Comprehensive Cancer Center. “Our daughter, Elana Fertig, is the associate director of quantitative sciences at Johns Hopkins and is a very accomplished computational biologist who’s actually an applied mathematician.
“I was so proud of her, and I couldn’t wait to go. And then I said, ‘So, Elana, when is your talk?’ She said, ‘Monday morning.’”
Oy.
Weiner chose to attend the opening ceremony for the Ralph Lauren Center, which was funded in part by a $25 million commitment from Ralph Lauren to create five cancer navigation facilities in the U.S. A story about the Georgetown Lombardi center focused on underserved communities in the nation’s capital appears here.
“I said there will only be one opening of the Ralph Lauren Center, and Elana’s going to give many more plenary talks in her career. I broke the news to her of what I had to do, and I told her how terrible I felt. She assured me it was okay.”
“Glad you showed up, Lou,” said Lucile Adams-Campbell, director of the Ralph Lauren Center for Cancer Prevention.
“Well, I also made note of the fact that it’s going to cost my wife and me a considerable amount of effort in babysitting to make it up to her,” Weiner said.
Weiner and Adams-Campbell spoke with Matthew Ong, associate editor of The Cancer Letter.
Matthew Ong: Dr. Weiner, Dr. Adams-Campbell, thank you so much for joining us today to talk about the new Ralph Lauren Center. To start off, can you tell us about the rationale and the genesis of the cancer center and why Lombardi is expanding its services in Southeast DC?
Louis Weiner: This genesis, for me at least, in my journey, extends to when I first moved here 15 years ago.
My vision was to find a way to address the needs of the medically underserved residents of the District of Columbia by enhancing the capacity to provide strong navigation services and other services, as needed, to assure that every person who is being evaluated for the possibility of cancer through screening or being treated for cancer would have the same opportunity for a good outcome as their more medically well-served neighbors.
That was very important to me.
When I moved to Lombardi, one of the attractions was that we already had an effort occurring in a medically underserved part of the District of Columbia, the Capital Breast Care Center, which at that time was not led by Lucile Adams-Campbell, actually.
My first act upon being recruited to Georgetown to lead the cancer center was to recruit Lucile, who was an acknowledged superstar in the field and somebody whose history of passion and commitment to the cause of the underserved in the District was unparalleled.
When she agreed to come, it was a natural fit for her to take over the leadership of the Capital Breast Care Center. And the rest, as they say, is history.
I’ll let Lucile fill you in a little bit, and then I can come back to talk about the Ralph Lauren engagement.
Lucile Adams-Campbell: Well, I’ll tell you that it’s been a natural progression with Ralph Lauren.
They’ve been involved and engaged with Georgetown for over 30 years starting with the Nina Hyde Center. There’s always been a connection with the breast program under Marc Lippman at that time.
For 30 years, Georgetown has been really collaborating, coordinating, and working together in this partnership with the Ralph Lauren Foundation. I think it’s a natural thing to keep expanding. The idea is to grow bigger than what we were.
We were the Capital Breast Care Center. We were strictly focused on breast cancer.
But now, with the Ralph Lauren Center for Cancer Prevention, we’re able to expand our wings and include other cancers in terms of screening, such as colorectal, lung, and prostate cancer screening, the same things that we’ve done in breast cancers.
I think that’s a wonderful thing to bring to East of the River in Washington, DC, where you have more underserved, uninsured, underinsured, minority populations.
I think it’s evolved over 30-plus years, and I think that it’s just natural for us to be in this position at this time. It’s also very fortuitous for us to be in this position at this time.
This is kind of in my backyard in DC, so I’m excited about this. Could you talk about the structure of the center itself as it relates to Lombardi? You’ve talked about the evolution—was the Capital Breast Care Center an independent partner prior to this development?
LW: In 1983, when Nina Hyde, then the fashion editor for The Washington Post, was diagnosed with breast cancer, her good friend Ralph Lauren was really part of that journey.
And her struggle and, eventually, her passing from breast cancer really is what motivated Mr. Lauren to establish the Nina Hyde Center for Breast Cancer Research at Georgetown.
As Lucile mentioned, we had this strong linkage and we have stayed in contact and connected over that activity for many years.
Fast-forward to the pandemic in 2021, I got a call from Bette-Ann Gwathmey, who is a vice president at the Ralph Lauren Foundation, wanting to know how the foundation could help us deliver care to our patients at the time of the pandemic, where everything was being done remotely and there were all kinds of challenges.
We chatted for a bit about it. What happened is that they provided us with practical protective supplies, which we urgently needed at the time. And even more intriguingly, video cameras that we could attach to our computers—which weren’t equipped with video cameras—so we could do telehealth, which was the way we had to see our patients.
We were the Capital Breast Care Center. We were strictly focused on breast cancer. But now, with the Ralph Lauren Center for Cancer Prevention, we’re able to expand our wings and include other cancers in terms of screening, such as colorectal, lung, and prostate cancer screening.
Lucile Adams-Campbell
In the course of that activity, we began chatting about what might be my vision for a future in a way that might be of interest to the Ralph Lauren Foundation.
I shared with her my commitment to providing enhanced navigation to as many people as possible, to provide the greatest amount of opportunity for a good outcome, whether it be from screening and getting to the right care if you have a problem to management of people who have active cancers.
I also talked about the work we were doing with our Health Justice Alliance with the Georgetown Law Center, where individuals who are poor and have legal challenges that interfere with their cancer therapy are given the opportunity to work with a Georgetown Law Center lawyer to help resolve those issues.
We did that, because we felt that it was a good thing to do for our patients. I shared that with her as well. As I said that to her, she said, “My God, it’s like you’re reading our minds about what we want to do with our foundation.”
We began talking at that time about how we might be able to take that idea and turn it into something more concrete.
We had the Capital Breast Care Center that Lucile had nurtured and it had grown, and it provided an ideal platform for what we wanted to do. Even though it largely focused on breast cancer, we all saw the opportunity to expand it to other diseases.
One thing led to another and it culminated with an agreement for the Ralph Lauren Foundation to provide us with support to significantly expand the scope of services offered by the Capital Breast Care Center. We renamed it, rebranded it, and fixed it up. It looks really beautiful, and it’s now the Ralph Lauren Center for Cancer Prevention.
The building is Georgetown’s. The program is Georgetown’s. The Ralph Lauren Foundation is a funder of that activity. It is part of Lombardi. We are them, they’re us, and we wouldn’t have it any other way.
Now, on top of that, they also are supporting a lawyer who is embedded in the clinics at the MedStar Washington Hospital Center. One of the things we’re so proud of and was so surprising to us was that as we were going through a regular report back from our lawyer colleagues who work in that center, they mentioned to us that they were noting the number of their patients who had successfully received legal services.
These were generally the neediest of the neediest who were getting these services, had enrolled at a surprisingly high rate on cancer clinical trials.
We don’t know what that means yet, but we hope it means that if you treat people like they matter, which they do, they feel that you are on their side, and they trust you and your recommendations.
And they’re more willing to engage in being participants in cancer research, which is a very exciting prospect given the well-known challenges that exist with accrual of patients from underserved minority backgrounds into clinical research studies. We hope to follow up on this..
In summary, the Capital Breast Care Center has morphed into the Ralph Lauren Center for Cancer Prevention with the support of the Ralph Lauren Foundation. It is a part of Georgetown Lombardi Comprehensive Cancer Center, and it is deeply connected to our clinical partner, MedStar Health.
The MedStar Georgetown Cancer Institute is the cancer service line for MedStar Health that I also lead.
We think that we’ve created important new opportunities for the people we serve in the community. I just can’t say enough about this spectacular work done by Lucile, by her colleagues, particularly Chiranjeev Dash, who helps lead the efforts of that center, and Vicki Girard from the Health Justice Program at Georgetown Law, who has pioneered this work in the District.
It’s been just a fabulous experience for me to be able to watch this evolve and to be their biggest cheerleader and supporter—to ensure that we can make the difference that we all want to be able to make.
LAC: I was just going to add one thing. As you know, all comprehensive cancer centers are mandated to have community outreach and engagement.
I serve as the associate director for minority health and health disparities research and oversee the community outreach and engagement aspect.
It’s safe to say and I think it’s accurate to say that the CBCC, now the Ralph Lauren Center for Cancer Prevention, represents that outreach arm. We are the outreach component of the Lombardi Comprehensive Cancer Center.
We have many partnerships, many collaborations with other entities, whether it’s federally qualified health centers, whether it’s churches, whether it’s public housing, you name it. It’s the whole gamut.
But it’s important that we represent the outreach arm of the cancer center, which is necessary, and required. We have to be successful in what we do by facilitating the activities that happen in the clinical world and in the basic science world.
I recently looked at CDC data on the prevalence of common non-communicable diseases, including cancer, in parts of Northeast DC around the H Street Corridor, which is where I live. I found it rather grim to see that the large gaps in health outcomes fall along racial lines, which, in this context, is a proxy for—as well as the result of—the sharp racial socioeconomic divide in our city.
That is to say, unsurprisingly and unfortunately, the consequence is that the more white residents a DC neighborhood has, the lower the prevalence of NCDs, vice versa. What are you seeing in Southeast DC and in the primary catchment area for the new cancer center for prevention?
LAC: The primary area is Ward 6, 7, and 8. Yes, East of the River. And definitely your H Street Corridor, for sure. We do needs assessments all the time, and we do look at the social determinants of health.
As we study the social determinants of health, we know that we make a difference, we make a very positive impact when we can address the barriers. It’s not enough just to say, yes, this is a barrier, transportation, etc.
We’ve overcome that. At one point in time, mammography screening rates were disproportionately lower in Blacks compared to whites. There’s no difference anymore.
If you provide access to care, if you provide the fees needed for people to get a mammogram, you wipe that out. I hear what people say, “It’s all about race, it’s all about race,” but it is a social determinant of health, and race may play a factor.
But I think the economy, if you don’t have insurance, that plays a big role. If you don’t have a job, that plays a big role. If you don’t have any transportation or somebody to help take care of your kids to get the care that you need, those play major roles.
Sometimes I think when we overlay all the social determinants of health over everything, race really drops down.
It’s really about addressing the needs of the community. When you can address the needs of the community, you can make a very, very big positive and favorable change. That’s what we do, and we’ve been doing that successfully for over 15 years.
LW: Now, I just want to add one thing to what Lucile said, and I always agree with Lucile, because she’s always right when it comes to community outreach and engagement.
But I would add that those of us who have the privilege of leading NCI-designated Comprehensive Cancer Centers oversee research engines of quite considerable accomplishment and impact.
I think that if we don’t spend as much time worrying about how we’re going to get the fruits of our labors, the clinical advances, the clinical research advances into the community so that everybody can benefit at the level that they’re entitled to, we’re not doing our jobs.
If a great discovery falls in the forest and nobody’s there to hear it, why does it matter?
I think we have to have a way to have our great discoveries translated into action and not just for the favored few. That’s our powerful commitment. I think that’s why the Ralph Lauren Center and the work we do in community outreach and engagement is so central to our mission.
Programmatically, what sets the Ralph Lauren Center apart from cancer centers or other cancer-related initiatives in DC?
LW: The Ralph Lauren Center is a patient navigation enterprise that is a component of the Georgetown Lombardi Comprehensive Cancer Center that is designed to take the cancer center into the community and serve the community’s needs.
We don’t have physicians doing physical exams there. We don’t have scientists who are running laboratory experiments, although Lucile does in the same space run a world-class exercise physiology research operation that’s community-based.
It’s really about addressing the needs of the community. When you can address the needs of the community, you can make a very, very big positive and favorable change. That’s what we do, and we’ve been doing that successfully for over 15 years.
Lucile Adams-Campbell
Lucile is one of the people who taught the world that community-based participatory research is urgently needed and vital for us to have an effect on the people we serve.
The Ralph Lauren Center is one of, I think, many organizations that aim to serve Southeast DC, that aim to serve the underserved populations.
But what I think separates the Ralph Lauren Center from some of those other enterprises is that it’s connected to the research engine of a Comprehensive Cancer Center.
It gives us a strategy to navigate the patients where they need to go for their care through our cancer center’s connection with MedStar Health, which operates the two largest hospitals in the district, MedStar Georgetown University Hospital and MedStar Washington Hospital Center.
We can identify the people who have needs, we can help them get the care they need, and we can support them in their cancer journey.
What can a DC patient or community member, if they walk through the center’s doors, expect in terms of services?
LW: A really nice, new building.
I saw pictures. It’s gorgeous.
LAC: I think we talk about service a lot, but we have to make certain that people understand that we are not, as Dr. Weiner said, we are not a service center. What happens is we do a lot of community outreach.
We are in the neighborhoods, we’re in the communities all the time, and that’s where we identify the people who are in need to participate in screenings, whether it’s going to be for breast or now expanded to colorectal, prostate, or lung cancer.
We navigate them to our clinical facilities. We are not that clinical entity. We navigate them to our clinical facilities, and we make certain that they are taken care of.
They get to the place they’re supposed to be. If there’s an abnormal finding, they are then scheduled and they receive their biopsy or whatever is needed, so that they’re not left hanging.
Oftentimes, the biggest gray zone in screening programs is, “Oh, you found something abnormal, but you get dropped.”
We don’t do that. We ensure that they go through the entire spectrum. And if they are diagnosed with cancer and they came in through Project WISH or one of the programs that pay for their service, then they are signed up for Medicaid or whatever is needed, or Medicare, so they can get their treatment.
We go the entire continuum, making certain that we don’t lose any of our participants for patients if they become diagnosed with cancer. I think that’s the support that we’ve been able to provide and also to provide the resources that people need.
Sometimes, people just need to know what the resources are and we can provide that to them, but we make certain and we follow up and we ensure that they get what is needed for them. I think that’s the beauty of it, that we’re not just calling you and then dropping you. We want to make certain that you adhere to the guidelines for screening.
If you should come back in one year or two years, we’re going to follow up and make certain that you’re doing that. Because getting screened means nothing if you don’t adhere to guidelines. Just going once is not enough. So, we don’t want to leave anybody behind.
It takes the whole village. It takes our entire center, whether it’s outreach individuals, whether it’s the navigators, recruiters, whoever. We’re out in the community. Nobody really walks through our door unless they’re funneled into one of our research projects. It helps us really recruit for our research projects, because we ensure we get a strong minority contingency participating in our studies.
That’s the beauty of it. And also, we do clinical trials. We are navigating people to national clinical trials at Georgetown because we identify them in the community. And if they fit the eligibility criteria, we can navigate them to clinical trials. It also increases our minority participation in clinical trials rates, which we are very happy about.
LW: I just want to make one point about that. We are thrilled about the ability to provide research-inspired cancer care to everybody, including our underserved neighbors.
We are thrilled to be able to conduct research, which is what cancer centers like to do and need to do.
But the enduring primary motivation of this work is to help our neighbors, to give them the care they need when they need it so they have the best possible chance for a good outcome, and where that involves participation in a clinical trial, great.
But first and foremost, we’re here to help. And that’s really near and dear to my heart.
Lucile and I, we love it when we are able to offer clinical trials to our patients and our community members, because that’s what we do, and it’s what’s very important in research cures cancer, in the service of the health and well-being of our patients.
I get that implementation science and community interventions are not engineering projects where you can say, “Well, by year five we’re going to hit these targets.” But what kinds of metrics are you looking at for developing these programs and measuring the impact of, say, increasing the proportion of eligible patients who need to be screened or who should be adhering to guidelines? What are you looking at?
LAC: We have a lot of metrics with the Ralph Lauren Center.
The fact that we’re expanding beyond breast, we have a great database that we work with that we’ve created from the community side. We know what percentage and the numbers of people that have been screened to date for the different cancers.
We are setting goals, whether it’s 5% or 10%. I don’t have the exact numbers in front of me, but we’re setting goals in terms of the percent that we want to see increase annually.
We also have to set goals in terms of the number of people that we reach.
I think we have to have a way to have our great discoveries translated into action and not just for the favored few. That’s our powerful commitment. I think that’s why the Ralph Lauren Center and the work we do in community outreach and engagement is so central to our mission.
Louis Weiner
We do outreach, but outreach is not enough if you don’t have meaningful contact. We actually have to document the numbers of people we have seen and the different types of venues we are engaged in. I think that’s one aspect.
We also talked about clinical trials in the Ralph Lauren Center proposal. We do track and monitor the enrollment of eligible people into clinical trials. I think it’s safe to say that our metrics will tell us if we’re successful based on the impact we have and the impact will be defined based on the effort, the percent change that we see in our assessments.
I know many people say, “Well, are you going to reduce mortality?”
Let’s just say we’re focused on an area and our goal is to increase screening rates, increase adherence rates, increase people getting the care they need, reduce the social determinants of health barriers that we see.
We can document each and every one of those items, and that’s how we’ll show whether we’ve been impactful.
LW: I will say that there is an elephant in the room, which speaks to the condition of the larger society.
To me, the elephant in the room is that we all know and it’s been documented in studies, that if you do a full court press, as it were, on navigation and support for underserved people with cancer, that their outcomes are better, more people’s lives are saved.
We know this. It’s a fact.
This information has been gleaned by a series of studies with relatively short-term time horizons. And then the funding runs out for the project, because it’s typically supported by time-limited philanthropy or an NIH-funded project, and then everything goes back to ground, because it’s financially unsustainable.
It pains me, because I think society has essentially decided that the short-term investment is too onerous for the long-term benefit, which ultimately would save money, because it’s very expensive to die, and it’s very hard on society and on the loss of life and the loss of family structure that’s associated with those deaths. It’s quite clear that if we were to invest in people’s health upfront, that we would actually save money downstream.
One of the things I’m hoping we’ll be able to do is to collect metrics that will help us to make an argument to local authorities or insurers that this is a good investment.
Let’s as a group, as a society, invest in people who are in need of cancer screening, cancer care, and help them through those journeys, save a bunch of lives, and probably save money in the process.
It’s a hard argument to make in the political and economic climates we live in, but it’s something I think we have to discuss.
LAC: I think the prevention model is the better model than the sick care model, and that’s where we’re going.
But one of the other metrics that I didn’t mention is we are moving the needle to the left, the curve to the left, in terms of when people are diagnosed.
When they’re diagnosed, they’re being diagnosed at an earlier stage. And that to me is a very important metric that we have to meet and we do meet it.
When people are now living with cancer, oh, I’ve had cancer for 10 or 15 years and I’ve been with you all, that’s a very different message than you would’ve heard before. We are making a difference.
Right; what did Mary Lasker say? If you think research or prevention is expensive, try disease? Something like that.
LW: Exactly. She’s still right.
You were talking about longevity of operations based on philanthropic funding. How much did the center receive from the Ralph Lauren Corporate Foundation? What is your budget for the center, and what is the outlook in terms of sustainability?
LAC: We have a diplomatic answer, it’s part of the $25 million. Is that a safe answer?
LW: It’s part of the $25 million that they will invest into five different centers.
We’ve received sufficient funding to support seven people on the site of the old Capital Breast Care Center that is now the Ralph Lauren Center for Cancer Prevention, plus supporting a lawyer.
We look forward to working with the Ralph Lauren Foundation to identify additional partners and additional activities down the road that’ll allow us to expand our work.
I have no illusions, and I know that Lucile has none either, that this is enough. It’s not.
We have to do more. But one of the things that I really liked about the Ralph Lauren Foundation is that when we had to make our proposal, they insisted that we come up with a sustainability section in the proposal so that this doesn’t become one of those fly-by-night, do-gooder things that then just fades into the background after a few years. We’re not going to let that happen.
Did we miss anything?
LAC: Well, I will say just one last thing. People who have money continue to get money, and people who are poor tend to continue to be poor.
Having the Ralph Lauren name behind what we are doing is very impressive. It spreads a very good message across the nation, not just DC, but nationwide.
And that’s one thing that can be very important in helping us garner even more funding to continue this effort. But when you have somebody such as Ralph Lauren supporting this type of activity, I think it really, really is a bonus, a huge win-win for everyone.
Great conversation. Thank you.
