Over the past three years, the American Cancer Society has recovered from the fundraising decline brought on by COVID-19 and has reversed the years-long fundraising slump in public support.
This three-year financial performance has led the charity’s board to extend the employment contract for its CEO, Karen E. Knudsen.
Public support for the charity has increased by nearly 25%, from a $559.8 million in 2020 to $738.2 in 2023.
Granted, 2020 was a COVID year, which means that the metrics of Knudsen’s stewardship of the charity are in part the metrics of the nation’s—and the healthcare system’s—recovery from the pandemic.
This acknowledged, the charity’s public support in 2023 exceeds the pre-COVID 2019 level of $709.9 million by $28.3 million.
“We’ve had three really great years of increasing impact, which is the most important thing, but then also increasing revenue in order to be able to fund that impact,” Knudsen said to The Cancer Letter.
Here are a few other metrics of Knudsen’s leadership at ACS:
- Late last year, Charity Navigator gave ACS the highest—four-star—rating and a score of 99%.
- The number of new research grants has recovered from 129 in 2020 to 257 in 2023. The annual amount of new grant funding grants has climbed from $54.6 million in 2020 to $124.7 three years later. At this time, ACS has over $445 million in currently committed grant funding.
- The number of nights spent in the ACS Hope Lodges, where patients and their caregivers can stay at no cost, has gone up from 26,703 in 2020 to 507,408 in 2023.
- The number of car rides provided to patients through the Road to Recovery program has gone up from 855 in 2020 to 47,197 in 2023.
By hiring Knudsen, the first translational bench scientist, the first cancer center director, and the first woman to lead ACS, the board demonstrated resolve to break with the past (The Cancer Letter, Sept. 3, 2021). Knudsen is the former director of the Sidney Kimmel Cancer Center, EVP of Oncology Services—Jefferson Health, and past president of the Association of American Cancer Institutes.
FIGURE 1: Public support and new grant funding
FIGURE 2: Patient support
ACS watched gross receipts erode from the financial crisis of 2007, with the charity’s purse in 2020 at about half of its size before the downward slide set in—and that’s without adjusting for inflation.
Under Knudsen, not only has the financial position of the charity grown, but overall expenses are down.
In 2020, in the midst of the pandemic and before Knudsen’s hiring, ACS staff members were instructed to urgently vacate the charity’s gleaming headquarters at 250 Williams Street at Centennial Olympic Park in Atlanta (The Cancer Letter, July 24, 2020).
After she stepped in, Knudsen decided that the society didn’t need to spend money on leasing new headquarters, with clear priorities toward supporting the mission.
Said Knudsen:
My commitment to cancer patients and families—as well as all our volunteers and donors—is that if we have extra dollars that come in, they go directly out into mission.
We are very proud of the fact that we are now at 81% functional allocation. What that means is 81 cents on the dollar goes right back out into mission for cancer patients and families, which I think there is no, to my knowledge, other charitable organization this size that does that.
We are not simply a granting organization. We work in over 5,000 communities to provide direct patient support, so to have that size operation and 81% functional allocation is profound.
The ACS “National Home Office,” the society’s Atlanta headquarters that epitomized the earlier era cost the charity an estimated $5 million a year. And if anything, the expenditure would distract from the society’s national mission.
Said Knudsen:
As I think I made a promise to you three years ago, everyone on my team, even my chief financial officer, owns the metrics of lives touched.
How many lives are we touching through practice-changing, paradigm-shifting cancer research that we fund or conduct? How many lives are we touching through advocacy, through our ability at the federal and state level to pass legislation?
Not just do an activity, but pass legislation that improves lives.
And then, third, on our patient support side, how many lives are we able to touch and improve through the transportation, lodging, education, navigation?
Everyone on my team is centered on that. That’s our goal. That’s the north star.
Knudsen lives in Philadelphia, and members of the ACS executive team live around the country. They work on Slack, meet on Zoom, and once a month they meet in person for three days, sometimes holding meetings at ACS Hope Lodges.
Said Knudsen:
Bricks and mortar cost dollars; right?
But it’s more than just that which made the decision for me. I fully believed, if we were going to transform the American Cancer Society and sharpen the focus on our stakeholders, I wanted to bring in diversity of thought across the whole of the organization.
When I looked at my executive team, and the people who sit at the chief table, I wanted to get the best and brightest.
To get the best and brightest in 2021 and beyond, I would opine, you have to be agnostic to thinking about geography. I think we’re kind of blazing a new trail for what it really looks like to have a largely remote workforce.
I think it’s really important for us as an executive team to see where we are doing well, and where is it, from hearing from the community directly, that we need to do better
But the other part of it is that we truly get a chance to have people able to function at the top of their license, be the best that they can possibly be, while still having the quality of life as an executive that they want. It’s hard work at ACS, and so, the flexibility of allowing people to stay where they want to live, I think has given us great benefit.
Knudsen spoke with Paul Goldberg, editor and publisher of The Cancer Letter. The conversation is also available as a video.
Paul Goldberg: Well, Karen, thank you very much for finding the time to talk with me, and I understand congratulations are in order, because your contract has been extended by three more years.
Karen Knudsen: Yes. I feel really terrific about it. I’m excited about what it is that we did in the last three years, and even more excited about what it is that we can do now, in this more formidable phase of ACS really truly functioning as one ACS against cancer.
Well, extrapolating from the fact that your contract has been extended by three years, the financials have improved, the curve has changed.
KK: It has, actually.
If we harken back to three years ago, when we were having this first conversation, ACS was 110 years old.
True and false; right?
It had come together as one organization. We’ve had three really great years of increasing impact, which is the most important thing, but then also increasing revenue in order to be able to fund that impact.
But at the same time, the cost of what it takes to do this as one organization is significantly lower than it was when ACS was a federated model with truly 12 separate organizations around the country.
We’re leaner, we’re meaner, and I would say even more effective. We’ve really hit our stride in functioning as what is truly a new organization, as one ACS against cancer.
Can you share some numbers on all of this?
KK: It depends on how you want to look at it, but whether it’s gross operating or cash modified, there’s a lot of ways that we report our numbers, which I’ll get to you. I’ll get it to you in a graph form, but we’ve had three years of increased growth in revenue generation.
How we get to that revenue is very different than it was three years ago, which I think is a really great thing about the new ACS and incorporating mission-aligned businesses.
But most importantly, it’s how we set our revenue goal.
Our revenue goal is not set by, let’s see how much money we can raise and decide what to do with it. It’s completely the opposite.
The way that we run the current era is by asking what are the things that we need to do to achieve our mission to improve the lives of cancer patients and their families? What’s the programming that we want to run? What does that cost?
We’re leaner, we’re meaner, and I would say even more effective. We’ve really hit our stride in functioning as what is truly a new organization, as one ACS against cancer.
And then we fundraise against that. Luckily we’ve been able to not just meet our fundraising goal, but in some years even extend beyond even what we thought was possible, such that at the end of the year, including last year and the year before, that we were giving out additional dollars at the end of the year for research, and also for direct patient support, because we knew what fell just below the line.
My commitment to cancer patients and families—as well as all our volunteers and donors—is that if we have extra dollars that come in, they go directly out into mission.
We are very proud of the fact that we are now at 81% functional allocation. What that means is 81 cents on the dollar goes right back out into mission for cancer patients and families, which I think there is no, to my knowledge, other charitable organization this size that does that.
Because, remember, we’re not check-writers. We don’t just raise funds for cancer research and write checks. Yes, we fund cancer research, but I also have my own scientists.
Our advocacy arm has a presence in all 50 states and Puerto Rico to affect change at the policy level, but my biggest team is that patient support team doing prevention and screening, patient education, transportation, lodging, patient navigation programs.
We are present in 5,000 communities across the country.
To have that size workforce, a little more than 3,300 people, and have a functional allocation of 81% is incredible. There’s no way we could go to 82; it’s not possible. Otherwise, we’d have to stop some of the patient support activities that we do.
But this is also why this year for the first time, first time I think current era, we got the highest possible rating from Charity Navigator.
They recognize what we’re doing—putting dollars right back out to people. That’s my commitment, and under my watch at ACS, that will remain the highest possible priority.
Yeah, because I remember when you stepped in, the baseline was pretty bad. It was in the $500 million range or maybe $400 million. How much was that?
KK: In 2019, I think it was pretty low because of COVID, but we’re well over the $700 million mark.
But for me, the more important number is the number of people that we impact every year. And so we look at that.
As I think I made a promise to you three years ago, everyone on my team, even my chief financial officer, owns the metrics of lives touched.
How many lives are we touching through practice-changing, paradigm-shifting cancer research that we fund or conduct? How many lives are we touching through advocacy, through our ability at the federal and state level to pass legislation?
Not just do an activity, but pass legislation that improves lives.
And then, third, on our patient support side, how many lives are we able to touch and improve through the transportation, lodging, education, navigation?
Everyone on my team is centered on that. That’s our goal. That’s the north star.
For us, that’s the most important part. The revenue generation, of course, has to happen in order for us to do those things but the primary goal, new era ACS, the primary goal of how it is that I judge my own success, my team judges their success, is by organizational goals that we’ve committed to with our board that is all around lives touched through programming.
Well, Joe Simone said years ago that leadership does matter—that’s one of his maxims to live by. But I’m trying to figure out how to allocate credit here because when you step in, you are in the low 500s, I think…
KK: I think maybe we were closer to six, but we’ve grown.
And then grown in impact. The research budget alone, we’ve increased by more than 10% in the last few years, which I think, given what’s happened at the level of the federal government, is actually pretty impressive.
And I have to credit Bill Dahut, my chief science officer, for really taking the helm in what it is that is just a formidable thinking about what is the science that we need to fund right now.
There’s our own science that we do, obviously, that’s so critically important, including guidelines, cohorts, and the cancer trends that everybody uses in the United States, but it’s the case that he’s thought very differently about the kind of things that we fund in the extramural space.
Every year, we poll the NCI-designated cancer center directors and ask them, “What are your top priorities with regard to funding mechanisms? Is it early career, is it full professor? What is it?”
And then the topics. This year, we actually had them force rank what are the things that are highest priority for you?
I was actually really surprised this year when I saw the NCI-designated cancer center directors force rank implementation science as their number one.
And I think the feeling is—and they’re not wrong—that there are these incredible innovations that have happened. And by our own best estimate, if we could get people to the innovations that exist right now, the cancer science, everything from prevention through management that we know about right now, all innovation stopped, the estimate is that we could reduce mortality by up to 20%.
The center directors are not wrong.
We’ve done a lot of great things. We’ve got to get people to it.
Bill Dahut, our chief science officer, has thought deeply about “What should we be funding, then?”
He’s lifted up incredible new grant mechanisms. Example: AHEAD Grants.
They’re called AHEAD—it stands for Advancing Health Equity and Addressing Disparities.
There are implementation science grants intended to get cancer screening and management strategies closer to home, in fact, in the home, if possible. That’s a whole new area of funding that we’ve undertaken in response to what we heard from the community and what we think patient needs are.
He’s also lifted up something to help diversify the workforce in very new and different ways than I think others are really thinking about it.
We have centers of excellence for health health equity cancer research centers CHERC that are more center-wide grants.
We have DICR, which is Diversity in Cancer Research, specific to getting more engagement from individuals who are being trained at the HBCUs to get into cancer research.
Those he enriched. But a new one that he lifted up, which we are very excited about is with post-baccs. So, there’s that sweet space…
We all know that there’s not enough diversity going into PhD and MD programs. We all know that to be true. You’ve got to work at the undergraduate level, that’s in part what the DICR grants are helping to do, but what about that in-between, someone who’s gotten their bachelor’s degree? Maybe they want to go into science or medicine, cancer science or medicine, but they’re not sure.
The post-bacc program gives them an opportunity to experience what that’s like.
That post-bacc program is really, I think, pretty unique to ACS and allowing us to capture a whole new diverse set of individuals, geography and demographic.
We’ve just gotten in our first sets of, that first cohort, and we’re very excited about what this means for the future. Also, just diversifying the kind of person who’s in a laboratory or a clinic getting a cancer research experience.
It’s not just that we’ve raised up the cancer research budget and are giving out many more grants than we were in the past, but it’s the case that we’ve thought deeply about what that portfolio should look like, informed by the community.
Just to put a number behind this, 2021, we gave out 176 new grants. 2023, we gave out 257.
Well, plus you have more money to play with, because you’re not wasting money on the fancy headquarters that John Seffrin was told by McKinsey he needed. How much money have you saved through that, by not having a headquarters in that flashy place?
KK: Yeah. Well, bricks and mortar cost dollars; right?
But it’s more than just that made the decision for me. I fully believed, if we’re going to transform the American Cancer Society to really sharpen the focus on our stakeholders, which are cancer patients and their families.
We love scientists, we fund scientists, but they’re not our stakeholder. We’re not a member organization. We are science-based, but we are not for scientists. We are for cancer patients and families.
We were going to really sharpen our focus on that, and I wanted to bring in diversity of thought across the whole of the organization.
When I looked at my executive team, everybody who sits at the chief table, everything from the chief patient officer, which was a new invention with the new ACS, to the chief marketing officer, I wanted to get the best and brightest. To get the best and brightest in 2021 and beyond, I would opine, you have to be agnostic to thinking about geography.
Truly, my chiefs are all over the country. We make a commitment to get together once a month, and that’s proven to be just wonderful for us. We’re not building brick-and-mortar, but I think it’s got now three years in, Paul, it’s got so much -benefit. One, when we get together once a month in person, we get to see where we are doing work.
If we are in Salt Lake City for our executive team meeting once a month, we will go to the Hope Lodge, have our meeting at the Hope Lodge, where we house cancer patients and families free of charge.
We get a chance to see how things are going. We meet with the patients, we’ll meet with the caregivers, we see where we do work. We meet with volunteers who make rides, for example, back and forth to the Hope Lodge possible. So, we get a chance to see where we work. We get a chance to meet with partners and donors who live in that area.
I think it’s really important for us as an executive team to see where are we doing well and where is it, from hearing from the community directly, we need to do better.
But the other part of it is that we truly get a chance to have people able to function at the top of their license, be the best that they can possibly be, while still having the quality of life as an executive that they want. It’s hard work at ACS, and so, the flexibility of allowing people to stay where they want to live, I think has given us great benefit.
How many days do you usually meet as the executive team?
KK: It’s a great question. We meet every week at least by Zoom in a two-and-a-half-hour executive team meeting, and it’s where we get a lot of our work done.
But once a month, we meet in person for three days. To me, that has to be the commitment of if we are not all going to report to the same city and create some building to ACS, which I don’t think would be a good idea. We have to be committed to getting together in person.
We save a lot of the really hard decisions for then. We, like I said, go out into the community that we are in and have a look and we change that every single month.
There’s very little repeat that happens. We get a chance to see everything. And people have to be committed to being fully engaged in that meeting, and they are. It really helps.
I think we’re kind of just, irrespective of what our industry is, I think we’re kind of blazing a new trail for what it really looks like to have a largely remote workforce.
The exception to that, and I’m so thankful for this group within ACS, are those who work at the Hope Lodge; right? We have 32 Hope Lodges around the country.
They are 24/7/365, so that group is reporting in every single day into arguably one of the most important things that we do of giving patients a place to stay near care.
I recognize that that’s a part of ACS that’s not able to take advantage of the flexibility that we have, is a great place to work, but at the same time, they’re mission-critical, and they know it.
I think that’s why they love their jobs.
Our first conversation was at the Hope Lodge, after you took this job, but how many Hope Lodges have you added since then?
KK: We opened Houston after I started. Houston is our largest Hope Lodge—67 rooms; remembering each room is for a patient and a caregiver.
And that lodge has really been just so impactful already. The Hope Lodge program overall at present last year was more than 500,000 nights for cancer patients and families. If you totaled all that up, that’s about $50 million we saved for cancer patients and families.
When you’re CEO, you’re up at night a lot, whether you want to be or not. I’m so proud of what it is that we’ve done. We have really picked up the pace, and I am constantly trying to balance the sense of urgency to do more and not burning out my team.
And my commitment to the Hope Lodge is high. Every Hope Lodge requires me to get about $1 million of operating cost every year, so it’s about $32 million I need to raise every year just for the Hope Lodges, but I am deeply committed to them.
The next one will be in San Antonio.
We’ve already committed to that.
Of course, we start with need. Where is a very high need where patients are traveling from far and wide to get care for complex cancer cases, and what does that demographic look like?
So, San Antonio fit the criteria.
The second criterion is can we support it? Can we find a spot, a physical location for the Hope Lodge? How much will it cost to build, how much will it cost to operate, and are we satisfied that we can continue it?
So, San Antonio is next.
There are three other cities that we are in deep conversation with, where we’ve been reached out to by the community to say, “We really feel like we need a Hope Lodge.”
And so, I’m in the process. One has already checked the need box, maybe times 10, it’s a really high-need area, but I’ve got to go through and do the rest of those gates. I’ll be hopefully able to announce those later in this year. But I would like to understand where the next 10 will be, so we’re really planning into the future.
I don’t know if I shared this with you in the past, Paul, but part of the legacy of the federated nature of ACS when it was these 12 separate organizations is that they all valued the Hope Lodge differently.
West of the Rockies, there’s only one Hope Lodge, and it’s in Honolulu.
All of California—none.
Nevada, Washington, Oregon—none.
And these are states where people travel long distances to go to get high-quality cancer care if they have a complex case.
Now, the Hope Lodge in Honolulu absolutely exemplifies why it’s so important to have a Hope Lodge. One, it’s very expensive to stay in Honolulu, but two, for someone with a complex cancer case, even if you live on Maui or the Big Island, you really need to come to Oahu for care.
And if you’re thinking about someone needing to stay five weeks in Oahu for radiation therapy, five weeks in Oahu for chemotherapy, it’s a lot. It’s a lot of cost, it’s a lot of concern about safety.
And also then you don’t have that network of meeting with other patients and caregivers to support each other through the journey, which is part of, as I know you know, the magic of the Hope Lodge. That Honolulu Hope Lodge is truly mission-critical.
People have to fly to it, and we help offset that, as well.
We want to take that example of Honolulu and how that has been so important for cancer patients and families, and then replicate that in other areas.
I guess it’s probably difficult to answer this question, but let’s try. What’s the balance between research and services, and how has that changed over the past three years, if it’s even possible to do it? Because without the headquarters, with better fundraising, it’s probably not a meaningful statistic, but let’s try.
KK: Well, the balance…
For research, our commitment is, unless something really fundamentally changes, we don’t want the research budget to go down. We always want it to be going up.
And it’s the same for patient support services. The way that we do it is not that I decide top-down, but rather we decide based on the environment around us. We look really carefully every year, who else is funding research and what’s our unique, what are we uniquely positioned to fund versus another organization?
We ask the same question on patient support, we ask the same question on advocacy.
We have an integrated strategic and financial planning lifecycle, not to be too business-y, but it is something that there’s something for us to do every month.
And so every year we go through a stop/start/continue.
Bill, my chief science officer, will say, “Here’s something that I think is less meaningful. I don’t think we should do that anymore, and we should shift priorities to this.”
It’s up to him. He can oversee the whole budget for science.
Dr. Arif Kamal, will do the same thing for patient support and [ACS CAN] President Lisa Lacasse will do the same thing for advocacy.
They ask themselves, “Stop/start/continue?”
They can always find within their own budget different things to prioritize—that’s up to them as leaders. But if they want some incremental dollars, “I would like to add this thing and here’s why,” we do it very much like grant review.
There’s an intake that they would fill out and basically say, “Hey, I’ve got a proposal for a new program. This is something I’d really like to do. I would like to increase the research budget to fund AHEAD grants,” for example.
Those then at the specific time of the year these ideas compete. Each of the executive team members who want to sponsor a thing say, “Look, I would really like to get incremental new dollars for this.”
We talk it through. Does it align to our strategic plan? How will it help a cancer patient or family? Is it aligned to our commitment to eradicate cancer disparities? Can it be scaled? Are we uniquely positioned to do this versus someone else?
There’s a score sheet. And they present it.
We have a lot of dialogue back and forth, question-and-answer, and people individually, just like in peer review, score it. And so that night, myself and my chief financial officer, we look over all of the scoring and what the cost would be to ACS in terms of what it is that we think we can probably fundraise for the next year, because it has to be realistic, and then we draw a line, and here are all the things that, “Yep, okay, Bill, you’ve got your new program,” or “Arif, it’s your year. You got a new patient navigation program.”
But that’s the way it works.
It’s not me or any single person.
Ultimately, I have to make the hard decision and be responsible for it, I’m the CEO, but I really like the inclusive nature of how it is that we’re devising the programming, and that’s everybody from our chief diversity officer Tawana Thomas Johnson, to our chief marketing officer can put in a new program that’s important for ACS.
Does that make sense?
Yes. Well, I guess maybe another way of getting at this is three years ago you were telling me about the pillars. You’re clearly still thinking about the pillars. Have you modified that kind of philosophical approach in any way—or no?
KK: The pillars are our secret sauce. It’s how we function.
The way I see it, the simplest form of ACS is we have to be for cancer patients and families. Since we last talked, I codified this, I formalized this in a complete refresh of our mission statement and our vision statement, the mission being what we do every day: improve the lives of cancer patients and their families through discovery, advocacy, and patient support. So that’s what we should be doing every day.
When we start to question should we do a thing or not do a thing, we ask is it aligned to our mission, and so the pillars are aligned to that. The “what does success look like” is something that we’re constantly striving for, and that’s something we believe is very critical to our DNA and our success vision statement is, “Ending cancer as we know it for everyone.”
I call those the eight words that define us, where notall words are created equal. It’s those last two, “for everyone” that is key to us at ACS.
It means that we might not like what you did, we might disagree with something that you do—it’s everyone. It doesn’t matter who it is. If this person has cancer, is burdened by cancer, we are going to help them. That has to be the ethos of what it is that we do.
So what do we stand for?
Cancer patients and families.
And we have to have this foundation of a commitment to cancer care equity. We don’t lift up a program that’s not intended to solve for cancer care equity.
And then those programs then get overseen by one of the three pillar leaders: Bill Dahut for science, Lisa Lacasse for advocacy, Arif Kamal for patient support, and then Tawana Thomas Johnson holds us all accountable for those health equity programs that span multiple pillars.
For example, she lifted up this incredible program last year called Health Equity Ambassadors. This is an idea where we work with communities, not in, but with communities to train people called health equity ambassadors who are key stakeholders already in the community, but give them critical information.
Like, “Hey, you live in Washington, DC! Here is the current state of cancer in Washington. Here’s where it disproportionately is burdening people in your city. Here’s what we can do about it, especially if there’s a prevention or screening link, but certainly on a cancer education link, and here are materials and things like a 24/7 call line that you can use and we can help you get to the right thing when you need it.”
The goal was to train in the last year and a half 1,500 health equity ambassadors, she’s over 4,000. If you want to talk about a force of nature, our chief diversity officer is incredible.
That’s just one of the things that she’s lifted up that truly flanks all of the pillars. She’s the glue between the pillars. But she’s also recognized that there’s a lot to learn, to partner with the major cancer centers.
She recognized that the chief diversity officers and the ADs for health equity, depending on how they’re structured at the different cancer centers, don’t have a place to meet and share experiences, best practices, what works, what doesn’t work, to develop partnerships.
She’s now gotten them all together twice in a meeting that will continue to have that cadence so that there is a concerted place for those within the centers as well as ACS that are devoted to eradicating health disparities in cancer and so that they can get a chance to meet.
Clearly, the board understands what you’re doing. Because I’ve always thought of ACS until you came in as a kind of political structure unto itself, and some folks that I knew and liked within the ACS have been kind of experts in ACS, as opposed to cancer.
And some came up through that system. You didn’t. You’re from the outside completely. How is that playing out?
Because that kind of classic political science would suggest that there is a bit of a tension.
KK: Well, I think it’s important for every CEO to have the backing of the board.
We have a large board of 20 people, and so very diverse in thought, very diverse in background.
But every CEO needs to feel that the board is with them and view the board as, of course they have a responsibility to make sure that we’re doing the right thing by our mission, but a really good sense of partnership.
What I’ve just described with regard to the organization is, yes, growth, but very significant transformation. We are not the organization that we were four years ago by any stretch of the imagination, and I think that with transformation and evolution of the organization comes transformation and evolution of the board.
I think they knew who they were hiring, I hope. They got it. I felt that there was a sense of urgency to really take this organization and get it to meet its very strong potential.
I can’t say enough good things about the 3,300 people that I work with. It’s a special kind of incredible when you know you lead a team that wakes up every single day to do good in the world and they do it. And that’s measurable, it’s not a subjective idea. So I love that.
The board, especially I think those that have been with ACS for a while, they’ve had to adjust. As the organization evolves, the board evolves. But I will say that everybody there is very well intended and comes with a different perspective.
And I do look forward to working with them in the future. And, obviously, they are giving me backing since they asked me to sign another three-year contract, which I was really glad about.
What I would say is it’s so exciting now, the conversations that we have, in part because of some of the people who joined the board.A sad thing about the board was that Monica Bertagnolli was on our board and needed to step off the day she became the NCI director, but we’ve had just truly incredible people come in in these last couple of years.
For example, Ned Sharpless, a former NCI director and acting FDA commissioner and my peer as a former NCI designated cancer center director, he’s been absolutely fantastic and really giving good insight into the kinds of things that not only can be achieved through thinking differently about our grant funding, but also insight into how it is that we might shape our advocacy strategy.
And I’m just picking on Ned as a truly excellent board member, but we have a lot of people who are even outside science who’ve joined in the last few years who’ve just been absolutely incredible.
We have our first board member from Puerto Rico, who is just really fantastic ,and we’re thinking very differently as a result. His name is José Buenaga, we are thinking very differently based on his ability to input.
We’ve put together new structures on the board, so we now have an official committee of the board that’s on science and technology. That’s new to ACS. It’s led by our board science officer, Mark Goldberg, who has been in the biopharma space, but is a medical oncologist by training out of Boston. He’s really allowing us to think differently about the future through that science and technology community.
We have our first ever chief information officer on the board, Karen Etzkorn. She’s a CIO for Qurate [Retail Group], so she is from the for-profit world, but obviously new technologies—even outside the science—new technologies are going to shape the ability that we connect with patients and caregivers.
These are just a great examples of very different kind of thinking now that’s coming into that board, which is making it a really exciting place to be.
They had enough of a sense to bring in somebody who understands how cancer centers work. And I guess right now, you’re working closely with ACS, you’re working very closely with Cancer Research UK, and of course NCI. Is that something that is, I don’t even know how to turn that into a question, but maybe we could talk about that…
KK: To me the question is “what are partnerships that you’ve really gotten?”.
That’s a good question, yes.
KK: I have to say, we can’t do it alone. Again, when I talked about our strategic priorities process, one of those gates that we talked about is what is it that we are uniquely positioned to do versus something that would be better through a partnership versus something that’s honestly better for a different organization to do?
We think through that all the time, especially if someone’s pitching a new program. Partnerships have to be key and in the science community, those are essential.
I’m very grateful for the leaders of the other science organizations or cancer organizations that we’ve been able to partner with. We have our first ever research grant award with ASTRO.
One of the things we recognized is that radiation oncology is underfunded, so super excited that we lifted that up.
With AACI, we partner very deeply with the other cancer centers, and of course, Rob Winn.
Dr. Winn is also on my board, so he’s one of my bosses, and also president of AACI. It’s a great place for us to partner, we’ve got a few other ideas percolating of things that we’re doing. That’s the place, actually, where we get together the chief diversity officers from the other organizations is actually through AACI, which we’re very grateful for.
I have to say, a huge standout for partnership for us is ASCO. I cannot say enough good things about Cliff Hudis. He was one of the first CEOs to reach out to me from any industry the day that my leadership of ACS was announced to say, “Let’s think about how we accelerate progress against cancer together.”
We had a partnership in cross-referencing our websites so that patients and providers can seamlessly flow from one to another. We have another very exciting announcement that we’re going to give that’s embargoed right now at ASCO about that next phase of our partnership.
We also partnered in Ukraine to get information to individuals who were displaced by the violence in Ukraine through connecting our ability to connect and put it together, hotlines and chat lines in multiple languages with a complete bullpen of people who spoke Polish, Ukrainian, and Russian from ASCO.
That just was a really great, great partnership and way for us to work together. I just can’t say enough good things about ASCO. But there have been partnerships across the board, those are just some that come to mind.
Culturally, what did change is that in the past, and by “in the past” I mean 50 years or so, the question was, “Oh god, do we have to call the ACS?”
Now, it’s just, “Oh, yeah, let’s just text Karen.” Or Bill…
It has changed.
It’s easy to deal with the ACS, which was not the case in the past.
KK: I think, honestly, Paul, I think this just comes back to again, mission, vision. I don’t care where you work, it is not something that’s just on a page and if it is, you got the wrong mission and vision statement.
My expectation as CEO is that all 3,300 people who work for ACS know how it is that what they do every day improves the life of a cancer patient, of a family.
I don’t care what their function is. There’s the obvious, if you work at a Hope Lodge, you see it and you feel it, right? Work on the IT team, and your job is to make sure that the infrastructure is correct for everybody’s email.
I want that person to be able to understand how that action every day improves the life of a cancer patient or family. And if they don’t know that, then I’m not doing my job.
And so that then turns itself into a situation where someone calls and says, “Hey, ACS, let’s partner.” Then I expect people to take the call and consider is this something ACS should do, better through partnership, better for somebody else to do, but to at least explore and understand because we owe it to cancer patients and families to have that discussion.
For me, when I came on three years ago, there was a lot made about being the first woman to lead ACS in any of its iterations as CEO. And I think that that’s interesting and it’s important, and I’ve probably shoved that aside too much in the past; I’ve heard from fellow female CEOs, quite rightly, that we’re still too few in number. I mean, across the U.S.
I think it’s somewhere less than 10%. I don’t want to negate the importance of that, and I feel really honored to lead this organization.
But to me, the most important thing from my perch is that I’m sitting here as somebody who came from the front line in oncology running clinics across two states, including the safety net hospital of Philadelphia.
Really understanding what ACS can be and then trying to develop our priorities and strategies, so we can’t do everything, but the things that we’re uniquely positioned to do. And I hope if I’m doing my job right, and we’ve got a lot of work still to do, not everything’s perfect, right?
Getting that to permeate throughout the whole of the organization is something that I’m really committed to.
I want to get back to the women CEOs, but can we do that in the question-after-next?
The next one is, you mentioned you have 3,300 people working. I think at the height, the Cancer Society had about 7,500 people. Has the number gone up since you came in? Because there were major layoffs. What are the numbers of employment?
KK: I can definitely get the numbers to you as well.
We were, if I remember correctly, around 2,800, maybe 2,900 when I first came in. But remember, the cost of running ACS has gone down significantly when it came together as one organization.
Because when you’re 12 separate organizations, you have a ridiculous amount of redundancy and things like, things as important, but as basic blocking and tackling is like benefits and HR.
You don’t need 12 HR departments when you’re one organization. So…the percentage of people who are focused on mission is higher, I think than ever, because we don’t have the redundancy in infrastructure. One of the things that every organization has to attend to, and this is my MBA I guess coming out, is employee engagement.
Because it’s so true, culture trumps strategy every time. You can have the best strategic plan you want, but if your people aren’t behind you and don’t feel a passion for what you’re trying to achieve, I don’t care what you’re trying to do, you won’t succeed.
Behind the curtain, a really important thing that we’ve done is to listen to the 3,300 people who work at ACS and say, “How are things going? What can we do better? What do you need to learn more about? What do you need to know more about?”
And there’s a whole science behind that. And one of my most important hires was a guy named Andre, he’s my chief people officer. Having a people strategy is as important to succeeding in our mission as it is to have an actual mission development strategy.
The data are kind of unequivocal about this. Also, as a leader, when you have a greater insight into the things that your people are thinking about as they’re trying to improve the lives of cancer patients and their families every day, you’re going to be better off.
Investing in our people has been really good.
Example, under Andre [Bokhoor’s] leadership, we take our VPs and above, so a little more than 100 people, and we go to a retreat every year in Atlanta, where we talk about how are we doing, leadership strategy, organizational mindset, leadership courage, how it is that what you do connects to mission, and that type of investment in our people is essential for us to succeed. That’s part of our strategic plan.
We’ve had this conversation many times, but with a drink in hand, but maybe we should just do this on record. Should there be a distinct voice for women executives of cancer centers, of the cancer programs?
Look at the number of women now in power: NCI, NIH, ACS, NCCN, I mean, the list goes on. But women are still a minority among cancer center directors.
Should there be more of a distinct political voice right now for women?
KK: I think that’s a great question. The data tell us that women are the majority going into MD and PhD programs, yet have stubbornly stayed as a minority when it comes to full professor, department chair, dean, cancer center director. So that we find very challenging.
Actually, at ACS, we have two different programs that are dedicated toward women in science. One’s called SHE in Oncology, which is a summer program to give women an experience, especially from diverse backgrounds, an experience in cancer science.
But the other is called ResearcHERS, and ResearcHERS is intended to not only give funding to female researchers, but also to help them over the time when they’re most likely to drop out of the pipeline for leadership.
We are trying to be part of the solution, I think, is one of the things that I’m saying.
But I think honestly, Paul, it goes beyond just women in science. I actually think that there’s room for women who, for whatever reason, have gone on to leadership, the ones that you just named, is there a place for us to get together with female CEOs from other industries, from the for-profit world, to talk about what really can we do to have more women see a path toward leadership? I think from the cancer center director point of view, too.
I was just really happy to be part of this really interesting group that’s starting to meet for the first time that’s from CNBC, of all places, called Changemakers.
And they picked 50 women that they thought were doing really unique, innovative things in the world, most of them for-profit, to get us together with the idea of helping to share experiences.
I don’t think any of us individually understand truly how we got to where we are. We know our personal path, but I don’t think we knew specifically what were the right choices to make. I think, deeply suspect, this is certainly in my case, never expected to sit in the chair that I’m sitting in. I never sat down and said, “Yeah, I want to be a CEO.”
That’s not ever what happened. But when the opportunity came, I felt prepared for it because I wanted to solve the cancer problem, and that’s where my passion lives.
But I don’t know that enough of us as women get together to try to figure out what worked, what didn’t, and how we support the next generation of women.
When it comes to cancer center directors—come on.
You and I talked about this a long time ago, we can formalize it with the survey that we did when I was the president of AACI.
You’ve got to look at the pipeline. And I think cancer centers more than ever are looking at their pipeline to ask do you have a woman who could potentially be a successor at your center or at a different center?
And I don’t know that that question is being asked everywhere yet.
Well, do you think the answer is setting up a distinct political group? It could be a group that kind of exists on occasional Zoom call. Really, it’s not that complicated an issue in a way. You don’t need to do studies. You probably need to have a 15-minute phone call once every few months and take positions on things, and be political, maybe.
That’s my suggestion, but I have no standing to make that suggestion.
KK: I’d love to figure out how to make it work.
I do get concerned about the fact that that number of women who are leading cancer centers is relatively stubborn and has not appreciably changed since even before the time I was a cancer center director. But I think that’s a parable just for business overall.
And what does that mean and why, and what can we do about it? I think it’s also the case, and I very much learned this from Rob Winn, right? Unless you set a goal and put a number around something, it’s not likely to happen. But the goal is hard to get to
Here’s what I would hope. If I were the head of a health system or the president of a university and I had an opening for my cancer center director position or the head of the service line, hopefully that’s the same person but if it’s not, I would want to have a very firm grasp of the fact that there was a highly diverse pool of candidates that was considered.
It’s looking at that top of the funnel and making sure that the top of the funnel is filled with your preformed expectation of what sdiversity look like for an appropriate search.
And I think Rob Winn speaks so eloquently on this, and I’ve really learned so much from him about it and taken that on into my own thinking at ACS, that I think that could help the center is almost more than anything.
Yeah, Rob is a terrific guy to have on your board.
KK: No question. No question.
I guess there’s just one leftover question. I know we’ve covered a bunch of stuff. What about MCDs? What’s your thinking about them? You have the model legislation, you’re going after that?
KK: In terms of multi-cancer detection tests, here’s where we are officially at ACS. I really believe this to be true—the data tell us this is coming, right? Cancer risk screening or cancer detection is going to become less invasive and closer to home. All that technology is happening.
What we are looking for at ACS is for there to be two gates that will get us fully behind MCEDs. One is FDA approval, but that’s the relatively easy gate. The second is evidence of clinical benefit. That’s what we’re really looking for, because we don’t want to go into an area where there’s overtreatment or harm, so we really want to make sure that we know how and when to apply which test and when is going to give clinical benefit without any kind of overtreatment that we could avoid.
Although we’ve not hit those two gates yet, we feel very anxious to ensure that when it happens (because we believe that it will), that there’s a pathway for reimbursement. If there’s not, we will create inequities. We stand on a platform of health equity. We have to learn from CAR T-cell, for which we still don’t have a reimbursement code, that’s a problem; right?
It’s difficult to cobble together a very expensive treatment for someone whose life could be saved from it because there was no thought ahead of time about how to lay the framework for reimbursement.
So the MCED Act is one of our major federal priorities. The goal there is not to say yes, it should be reimbursed, but to lay the framework. Without getting too much into the intricacies of advocacy, that’s the first step, but it’s a very bold and important one, and so we will continue to do that.
On the other hand, we also fund in this area and are very active in research in this area because remember, we run cohort studies. We are doing some research testing to determine with current MCED-type technology, could we have detected the unscreenable—things like pancreatic cancer.
From what I understand, you’re actually spending money on this, you’re not getting money from the industry on this?
KK: That’s right.
We are not going to basically take in dollars to promote MCEDs, that’s not at all what we’re doing. We want to understand them and be part of that research solution, but we also want to ensure that we are using advocacy to do some preventative medicine against what could be inequity. Related to this, can I slip in one thing?
Please, please.
KK: So a teaser, May 6th or 7th, you’re going to hear an announcement from us about lifting up our next cohort to study cancer risks specifically in Black women.
Everyone’s cohort where we’ve been able to identify cancer risk, genetic, exposure-related, all things associated with occupation, all of those cohorts have been entirely biased towards whites of European descent.
And so we are very excited about lifting up our new cohort, which you’ll learn much more about in the beginning of May. It’s called Voices. And we hope that this is a game-changer. So this is a plea to the cancer centers who have a catchment area with black women that are disproportionately burdened by cancer to help us enroll as quickly as possible into this 100,000 women cohort.
We should write about it more as it goes on, and thank you for letting us know. Now you’re three years in, what keeps you up at night? What do you worry about?
KK: When you’re CEO, you’re up at night a lot, whether you want to be or not. I’m so proud of what it is that we’ve done.
We have really picked up the pace, and I am constantly trying to balance the sense of urgency to do more and not burning out my team. Because we are working at such a quick clip, and my expectations are high, and the people who are on my executive team, their expectations are high, so we’ve got to make sure that we are taking care of us, making sure that these people who, again, wake up every day to do good in the world can do that and be their best selves and bring their best selves to work.
It’s something I’ve got to really make sure I’m watching across the organization.
And part of that then means priorities. It’s very hard to take something that an organization has done for a really long time and say, “t was great, but this might not, on a list of 20 things rise to the top five anymore because there’s this other big priority that we have to address.”
It’s what my CFO, Kael [Reicin], who is really fantastic, calls the peanut butter effect.
You can’t just slap peanut butter on top: layer, layer, layer, layer, layer.
Making strategic choices is the hardest thing for any organization, but we have to do it so that we can be highly effective in the things that we know we need to do and that are going to be critical for cancer patients five years from now, seven years from now, 10 years from now.
That’s where our priorities have to live.
Well, is there anything I forgot to ask?
KK: I don’t think so. This is a lot of fun, Paul. In even just having this conversation, it gives me ideas as we’re sitting here about things that I need to think about in this next three years.
And I hope that when we’re sitting here three years from now, that I’ve got an even greater story to tell about improving lives and really look forward to, again, that next era.
This is an incredible organization. I’m so proud of my team and what we do every single day. Couldn’t do it without partnerships, and I really am excited about the future.
Well, wonderful. Thank you.
