Jonathan Friedberg tells us how he built a cancer center in an underserved area of New York State

The University of Rochester Wilmot Cancer Institute last week was named the 73rd NCI-designated cancer center. Now, New York State has eight NCI-designated cancer centers. Only California has more—ten.

Wilmot is the only cancer center serving a unique and diverse part of New York.

“Our catchment area is 27 counties in Central and Western New York. All but three of them are not served by any existing cancer center. We’re a white spot on that map,” Jonathan Friedberg, director of the Wilmot Cancer Institute, said to The Cancer Letter.

“This catchment area has over three million people and is very rural. In fact, over a third of patients live in rural RUCA codes, with a lot of access challenges.

“If that catchment area were a state, and it’s certainly big enough geographically and population-wise to be a state, it would have the second highest incidence of cancer in the country behind only the state of Kentucky.”

The University of Rochester and the Wilmot Cancer Institute began their years-long effort to gain NCI-Designation when Friedberg became director in 2013. During that time, Wilmot enhanced its entire clinical research infrastructure and expanded its footprint in the region to include 13 care locations, including its main campus, located at Strong Memorial Hospital in Rochester.

The Community Outreach and Engagement component of the CCSG application was especially useful in preparing the application and figuring out how Wilmot can serve its catchment area.

Said Friedberg:

Ten years ago, we didn’t even know what we didn’t know about our catchment area, and it was really the CCSG that pushed us to invest in building the understanding as to what our catchment area needs are.

Those statistics that I quoted to you earlier, I couldn’t have told you that 10 years ago, because we didn’t really know. And that in and of itself has been incredibly motivating, interestingly, not only to the physicians here, but also our scientists who are so interested in the burden of cancer in our catchment area and how they may be able to contribute.

And it’s become routine now for our scientists to go to our COE office for data and reports, and they even use that for their grants, to speak to why this is an important place to study specific cancers.

So, that part of COE is absolutely critical.

For Wilmot, the designation comes with $10 million in Cancer Center Support Grant funding over five years. 

What are some of the threats Friedberg sees on the horizon?

Certainly, the administration’s efforts to cap indirect costs is among them.

“Fortunately, with the current pause, we haven’t seen a change yet at our institution, but, clearly, our institution is under threat. Our current indirect cost rate is 51%,” Friedberg said.

As a component of Strong Memorial Hospital, Wilmot provides specialty cancer care services at the University of Rochester Medical Center and a network of 13 locations throughout the region, including an 88-bed hospital on the campus of the university’s Medical Center. Wilmot includes a team of more than 190 oncology physicians, 500-plus oncology nurses, and approximately 115 scientists who investigate many aspects of cancer.  

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

This conversation is also available as a video.

Paul Goldberg: Well, Jonathan, it’s wonderful to hear good news about cancer centers now, in March 2025. So, you’ve got good news!

Jonathan Friedberg: Outstanding news. We learned just earlier in the week that we’re the 73rd NCI-designated cancer center.

This has been in the works for quite a few years. How many years?

JF: We had a long haul. I think that’s pretty typical.

Yes.

JF: I started as director about 10 years ago. This was clearly in mind, but we really were working in earnest since 2016 when we had a retreat that resulted in the plan to get NCI designation. We applied in 2021 and received an excellent score at that time.

But the NCI made a decision that we should come back in with an A-1 application. So, in 2024, we put in the A-1 application and we learned that we were funded.

Fantastic. But just to be sure I understand this, this begins with you, or does it begin with Dr. [Richard] Fisher—that quest?

JF: Well, I think Dr. Fisher, when he was hired in 2001, had spoken about getting NCI designation.

He spent much of his initial efforts here, raising funds for a new building that I’m sitting in right now, that was clearly an impactful part of this. I will say, though, that it was really in 2016 that we had some of the magic around alignment of leadership, both at my level as well as the senior leadership of the institution, that led to the necessary investments to make this happen.

What did it take?

JF: So, we are a matrix cancer center, and it’s always a little bit challenging to come up with a final number. But if you look at capital investments as well as personnel investments, easily more than $100 million was invested in this project.

That’s actually kind of modest.

JF: And I think, Paul, part of that is because we were a little bit different from many of the other new cancer centers that have come online in that we had a lot of historic strength in basic science.

We had funding that was at a reasonable level for a long time. What was missing for us was a lot of the organization and a culture around a Cancer Center Support Grant.

And, honestly, I spent more time building culture than anything else—obviously very important in this entity. And then, as we matured, we started investing in Community Outreach and Engagement and some of those other pieces.

But in the end, we ended up recruiting about 30 funded investigators. So, that was still a significant endeavor, but it’s not as if we had to buy entire research programs, like some of the other new cancer centers had to do.

So, what finally got this to really happen? What got you over the threshold?

JF: I would say there were a few critical pieces, and as you say, when you see one cancer center, you see one cancer center. So, I don’t know if these are really lessons for others, but the first two years of my tenure as cancer center director, we built a regional network.

We moved from two locations to 13 locations, installing linear accelerators and chemotherapy infusion throughout our broad region, which is a very large rural region.

And that was important, because part of that generated the patients that we needed to conduct clinical trials in rare and complex cancers. That was also important, because it helped us raise resources that the institution could invest specifically in cancer.

And I think that got the attention of senior leadership that led to much more openness around the necessary investment to get to the CCSG.

The other pivotal part was the first meeting of our External Advisory Board, which was in 2018. Mark Evers chairs that group, and we have several cancer center directors on that group, including Candace Johnson, who’s down the road 70 miles in Buffalo, who is very much in support of this.

Interesting. So, you have the next closest competitor… on your EAB? Wow!

JF: Right. Yes, we’ll come to that in a minute, because I think it’s clear that we’re not really competitors.

Right.

JF: But that board meeting was essential in multiple ways.

First, it humbled me as a leader and our team, because they pointed out that we still had a lot of work to do.

But importantly, they also said with clarity that they could see a path and that we really should do the work, because we could get there. And our senior leadership, our CEO and dean at that time heard that message, and that’s when we could do what we needed to do.

And, in fact, even through COVID with financial pressures, this investment didn’t slow down at all, all the way through to us getting the grant just this week.

JF: So, we have to start by describing our catchment area, which is unique. There are only three counties that overlap between our catchment area and Roswell Park’s.

Our catchment area is 27 counties in Central and Western New York. All but three of them are not served by any existing cancer center. We’re a white spot on that map.

Our institution is under threat. Our current indirect cost rate is 51%, [which is] lower than some institutions, but clearly substantially higher than 15%. And that delta would be potentially paralyzing to broad research programs in our institution that even go beyond cancer.

This catchment area has over three million people and is very rural. In fact, over a third of patients live in rural RUCA codes, with a lot of access challenges.

If that catchment area were a state, and it’s certainly big enough geographically and population-wise to be a state, it would have the second highest incidence of cancer in the country behind only the state of Kentucky.

Why is that?

A lot of it is that the demographics of our catchment area are much more aligned with Kentucky than they are with New York City.

And, in fact, 14 of the counties that are in our catchment area are officially part of Appalachia. And a lot of the rural poverty, sedentary lifestyle, high tobacco use, challenges with education, and lack of access to healthcare are drivers of cancer incidence in our catchment area as they are in other parts of Appalachia.

So, that’s the beginning as to what we’re about. We’re the only academic cancer center that is capable of helping to bend that regional disparity.

And I think that really resonated with NCI, despite the fact we’re from a state that has a number of cancer centers, the majority of the state land area was not being served by any of those other cancer centers.

Now, the other things that we bring that I think are somewhat unique, we have broad and well-recognized expertise in cancer and aging, and this goes from fundamental biology of aging, looking at long-lived rodents and mammals and understanding why they don’t get cancer, all the way through to one of the largest geriatric oncology clinical programs in the country that is recognized for contributions around geriatric assessments to predict outcome in older patients and to help decide treatment plans.

And I’d say a third unique part of Wilmot is that we’re one of only two academic centers with an NCORP research base.

The NCORP program conducts symptom management research funded by NCI in parallel with the cooperative groups. The other such cancer center is Wake Forest, and the University of Rochester has been long recognized as leaders in that symptom management field.

And, in fact, our cancer prevention and control program is our best funded program and scored very, very well in the review. I think that’s another area that I did not have to build as much as some of the other new cancer centers, because we had that historical strength.

Plus before that, you had a CCOP.

JF: Yes, exactly. This is the legacy of the CCOP. You’re exactly right. It’s Gary Morrow who ran the CCOP, transitioned it to this NCORP research base, and he’s still around as a senior advisor, but his legacy is really that NCORP research base.

Yes, Gary is a giant in the field.

JF: Yes.

I used to talk to him all the time.

JF: He’s always a character to speak to, Gary. He’s quite entertaining, and he says what’s on his mind, so it’s been great having him around.

Always a pleasure. I’m just wondering about those 13 outposts, if that’s the right word, that you created. Did you buy practices, or did you start your own? How did you do it?

JF: It was a combination of a few different things.

We leveraged the medical center, basically purchased a few hospitals in the region and in those hospitals we created cancer programs. In two locations, we acquired practices that were there and took over those programs. And in others we created new bona fide cancer programs from scratch, essentially.

So, it was a combination of purchasing and opening facilities in strategic areas of strength where we had primary care base and where we recognized there was an unmet need for cancer services.

That must’ve been quite an undertaking.

JF: It was… I joined as director here, I was an interim director after Dr. Fisher left, and he left rather abruptly [to become director of Fox Chase Cancer Center] (The Cancer Letter, Aug 2, 2013). 

So, it took a little bit of time for things to settle out. And then my first step, which was a bit of a comfort zone to me, was to build this clinical program.

And I have to say it turned out to be incredibly informative as I was cancer center director because I really understood our region well, because it took a lot of trips back and forth to all of these places.

I know the people there, and we had to deal with their town boards and counties to sign off on this.

New York State is a Certificate of Need state. So, as we were building new infusion rooms, we had to deal with state officials as well, and that was a crash course in some of those activities of being cancer center director.

I now am privileged to have a medical director who helps oversee that component. But having built that, it really, I think, directly informed to me the need for us to have a CCSG.

And it really created, to some degree, as I said, the resources and the energy at the institution behind cancer. And I think when our CEO saw the success of those regional programs, he realized that a CCSG was the logical next step.

So, it took several years, but doesn’t sound like it took forever.

JF: When our first EAB met in 2018, I said that our plan was to submit in 2021, and they thought that was a very bold timeline. That said, I think that we had some pivotal recruitments that came through that really helped us.

People like Paula Vertino who was on Subcommittee A and came on as our associate director for basic research. David Linehan, who is our current CEO, but he came on as chair of surgery and our associate director for clinical research, and Ruth O’Reagan, who is our chair of medicine, who oversees our CRTEC program.

And having that level of strength in our leadership group really helped, I think, to catapult us and move forward very quickly. And the other thing I’ll say, Paul, is that COVID, if anything, helped us a little bit, because people weren’t traveling and we were all in on this and we really didn’t miss a beat.

I think that having everybody around really helped us writing things up. Instead of slowing us, COVID took away many of the distractions that otherwise could have been there.

Sorry to be so non-linear, I’ve been accused of that frequently, but how long have you been in Rochester and what is your area of expertise?

JF: I’m a lymphoma clinical investigator. I trained at Dana-Farber and then I worked at Dana-Farber as faculty for a couple of years before moving here to join Richard Fisher and build the lymphoma program.

I moved here in 2002. And Richard was also a lymphoma investigator, so he was a mentor to me when I moved here. And I kind of rose through the ranks here. I became the chief of the Hematology Oncology Division in 2009, and then the cancer center director in 2013.

Academically, I’m still the chair of the SWOG Lymphoma Committee, and I sit on the Lymphoma Steering Committee. So, I help run the national clinical Trial portfolio in lymphoma.

And I’m also the editor-in-chief of the Journal of Clinical Oncology, which I’ve served in that role for about three years, and that’s obviously an incredible privilege to be in that seat.

JF: Yes. 

So, COE has really been critical for us, as I said.

And to be honest, the CCSG really pushed us in this direction. Ten years ago, we didn’t even know what we didn’t know about our catchment area, and it was really the CCSG that pushed us to really invest in building the understanding as to what our catchment area needs are.

Ten years ago, we didn’t even know what we didn’t know about our catchment area, and it was really the CCSG that pushed us to invest in building the understanding as to what our catchment area needs are.

Those statistics that I quoted to you earlier, I couldn’t have told you that 10 years ago, because we didn’t really know. And that in and of itself has been incredibly motivating, interestingly, not only to the physicians here, but also our scientists who are so interested in the burden of cancer in our catchment area and how they may be able to contribute.

And it’s become routine now for our scientists to go to our COE office for data and reports, and they even use that for their grants, to speak to why this is an important place to study specific cancers.

So, that part of COE is absolutely critical.

And I think that the whole CCSG enterprise, and I guess it was Henry’s vision, but to think that we have these unique cancer needs in this catchment area, that even though we have amazing cancer centers in the state like Memorial Sloan Kettering and NYU and all the rest, they’re not going to pay attention to those needs. We need to do that.

The second part of COE that took longer was the creation of the community advisory boards and trying to get bi-directional engagement over our research programs. And Erin Kobetz from Miami is a member of our External Advisory Board, and she really pushed us hard in this direction.

And if you know Erin, that wouldn’t surprise you.

But the result was really some great examples as to how our research was improved through input by the community. And we now have a very vigorous community advisory board. We’re making our public announcement tomorrow.

They can’t wait to be there. They’ve been part of this for the last five or six years in earnest.

And this community advisory board is an incredibly diverse group of people. We have a lot of rural members.

Rochester has the largest per capita deaf community in the country based on schools for the deaf that are here and long-standing relationships. So, we have deaf members of that community advisory board. So, that’s an example of how we’ve learned strategies to help engage that important patient population and understand what their needs are.

I remain optimistic about COE, whatever it’s called moving forward. I would hope, that all cancer center directors recognize the importance of serving their community. That’s why we’re here. That’s the mission of academic medical centers, and even though we didn’t have a CCSG until earlier this week, we made the decision to invest, and our budget for COE is over $1 million a year.

We’re investing in COE activities, including a large office with numerous people, and including staff that sit in some of the rural counties to make sure that we’re educating and engaging those individuals. I do not see that stopping, and I think that investment has really only helped us.

Otis Brawley is always quoting from one of his papers, one of the ACS papers, that the largest underserved population in the United States is white.

JF: Numerically, right. And I think we also have clear challenges in our urban centers with very diverse populations, racially and ethnically.

But clearly, across our catchment area, all but one of those counties has disproportionate amounts of poverty, and a lot of that is rural poverty and an aging population. In demographics, as I said, that are similar to Ohio and Kentucky.

But that would be largely white.

JF: Yes.

Predominantly white.

JF: Right.

Interesting. Can you imagine if… Can you even have disparities research if COE is not there? Would become kind of undoable?

JF: I think COE has been helpful at helping us understand what disparities exist, and at some level, that information base is critical to proposing any research, at least what I’ve been hearing is that disparities research as a scientific subject matter remains okay.

You’re correct in saying that I think some individuals are challenged by differentiating that from the diversity, equity and inclusion initiatives. But we remain optimistic that disparities research is going to go on and it’s an important component of our cancer center.

What about CRTEC?

JF: We did very well on CRTEC. I don’t like to talk about scores, but for a new cancer center, we got outstanding to exceptional on CRTEC.

I think that we’ve been recognized nationally for a very long time around quality of education here. Many luminaries in cancer have come through the halls here, particularly in hematologic malignancies, and I think we’ve leveraged that.

One of Gary Morrow’s contributions, we were talking about him earlier, is he has a T32 in cancer control research that really focuses on symptom management.

And in their most recent renewal of that T32, he got a 10, a perfect score. And I think that speaks to some of the strengths we have in CRTEC, that we have some of these very well recognized education programs.

What about indirect costs? That’s something that everybody’s talking about. How is that affecting you?

JF: Fortunately, with the current pause, we haven’t seen a change yet at our institution, but, clearly, our institution is under threat. Our current indirect cost rate is 51%.

It’s lower than some institutions, but clearly substantially higher than 15%. And that delta would be potentially paralyzing to broad research programs in our institution that even go beyond cancer.

And I think it’s been quite revealing how we’ve stumbled into this indirect way of funding essential research elements and the challenge to translate that explanation to lay people who don’t understand how this research is funded and what this is really paying for.

And I’ve seen certain things written about it with some good analogies about how essential infrastructure is around research, and particularly research that requires high technology, shared resources, investments and expensive laboratories, all of which are funded through the indirect cost mechanism.

What about data science? Can you do data science without indirect costs?

JF: I think it’s mandatory for all research, at least in the current funding model. And if the vision is to move some of the indirect costs to direct costs, I mean ultimately that might be a reasonable goal.

That can’t be done in 12 hours or 12 days or 12 months. That’s going to take time in order to understand how the budgeting is, and what goes in, and what goes out. And I think that the abruptness of the decision-making was very challenging for medical centers.

And it appears that we may have a reprieve for a few months, but I think in the big picture, all of us as cancer centers need to understand what the models are going to look like moving forward.

And in parallel with all the challenges to some of the other sources of revenue like 340B and site neutrality, I think it could be a perfect storm where research funding is really under threat.

And I have to say that the cancer centers group has been having meetings about this that I find very productive because I think shared wisdom from all of the cancer center directors is going to be critical moving forward.

Maybe we should just go some more on the indirect. I have a question about CAR T-cell therapy. For example, how much of your CAR T is being done through facilities that are funded through indirects?

JF: Most of the CAR T studies that we’ve done have been in collaboration with industry. We don’t have a GMP facility making our own CAR Ts right now. So, that’s not as much under threat as some of the other clinical research that we’re doing. And certainly, I think from a laboratory standpoint, that’s an area that’s only growing.

We have a scientist who’s been very focused on some new solid tumor-targeted CAR T cells and ways of directing CAR T cells using light to pull CAR T cells into cancers.

And all of that expensive work, including radiation shared resources would be very challenged without the indirect costs, without question.

Well, I think that the 15 is not the number that’s probably going to stick.

JF: Right.

I’m hearing in Washington, I don’t know if you’re hearing something else, is that it’s more likely that there’s time to negotiate this thing. Time has been bought. So, it’s not going to be 15% or not 15%. So, the litigation continues, that’s fine. But some negotiating will have to be done.

JF: I’ve heard similar rumors, I guess, that at least right now the federal stance is that they’re looking to have a fixed rate and not a variable rate based on institution, and that number is probably not going to be 15, but it’s not going to be 50 either.

And it depends on where it lands. I mean, if it landed at 40 or 45, we could probably absorb that a lot easier than if it landed at 25.

Those are the numbers I’m kind of hearing as a goal.

JF: Right.

They can also put some things in direct costs that are now in indirect costs.

JF: And I think that’s the important detail that we have to understand. I mean, at some level, if the budget for NIH stays fixed and they’re going to shift dollars into more research-oriented investment and allow for some of the current indirects to be counted as directs, that may be in the long run more sustainable and better for certain investigators.

It’s just that seeing that path is not quite apparent yet I think to many of us.

This will be a very interesting set of negotiations. But I think it’s also really, to some extent, reasonable to be expecting something more transparent than the current system.

JF: I agree. I think that the reason why we’re in this situation now is that the current model of the direct costs are only partially funding research, and every institution, even with the indirect costs, is making an investment up to 50 cents on the dollar for research, because there’s such limited budgets for NIH-funded grants.

So, if part of this fixes that piece, that would be a good result. NIH modular grants haven’t changed in my whole career as far as how much they fund. And we know the level of inflation in science is higher than inflation nationally.

If all of that can be fixed as part of that, with greater transparency, I think that is better for the American public and for the scientists.

But all of that has to be part of this decision. You can’t just look at one line item and cut it and not fix those other pieces.

When this began, in my spare time, I looked at the old stories we’ve done about indirect costs and they go back to the ‘70s in The Cancer Letter. I have this one particularly fun story where Vince DeVita is raging that the NCI got a certain thing, $11 million, some crazy number like that, and he has to waste all of this on SBIR and the indirects, which he doesn’t want to pay (The Cancer Letter, Dec. 2, 1983). 

JF: I mean, the other part that indirects really help pay for are the buildings where scientists work.

I think that’s an important level of investment that goes beyond the scientists working in those buildings. That helps communities, there’s construction and all of that expense, and there really aren’t straightforward ways to put up those buildings without some investment by indirect costs.

In the past, there was talk about having specific grants from the government for buildings like this. And instead, the indirect cost evolved as a partial mechanism to pay for some construction.

So, I think that’s the other piece that would need to be part of any negotiation is to understand these buildings all need to house very high technology, fancy microscopes, radiation facilities, ventilation, all the like, that needs to be in place for laboratories, and you need a way to pay for that.

Does your congressional delegation understand this? Have you explained it?

JF: We’re fortunate, our representative from Rochester is extremely supportive. He’s been public about this, but he lost his daughter to cancer, she was cared for at our institution. And he’s been a tireless advocate for cancer and NIH research. And obviously our senators from New York have historically been very supportive.

Who’s your House member?

JF: Joe Morelle.

That would be very interesting, to see what happens with this now. I guess we’ve covered a lot of ground. But I’m sure we’ve missed something.

JF: Let me add a comment about Roswell Park because I briefly went through that, and you mentioned the word competition.

Roswell Park is 70 miles west, in Buffalo. They’ve been a longstanding NCI-designated cancer center. And for many years, our scientists have often enjoyed collaborations with Roswell.

And I’ve seen certain things written about it with some good analogies about how essential infrastructure is around research, and particularly research that requires high technology, shared resources, investments and expensive laboratories, all of which are funded through the indirect cost mechanism.

It’s drivable, particularly in the summer. In the winter, it’s a snow belt, so depends on the day. But they have a lot of complementary strengths. There was some brief period where Dr. Fisher and Dr. Trump at that time who was leading Roswell, were speaking about a consortium cancer center between the two institutions.

And as part of that effort, they asked the question, “Are they competing for patients?”

And it was very clear from data that patients in Rochester were not driving to Buffalo for care and vice versa, that they really were two very different areas. And the cities are somewhat different historically as well, just because they’re both in upstate New York, they have a very different feel to them.

Buffalo is a blue-collar, industrial city.

Rochester’s industries historically were Kodak, Bausch & Lomb, and Xerox. So I would say that they were culturally somewhat different, and some of that has remained.

So, it was clear that there wasn’t competition for patients, but the decision was made at that time that it was going to be hard to build a consortium center. And candidly, we weren’t ready for that. We weren’t organized well enough.

We decided we were going to go for the designation ourselves.

But all along, Candace has been incredibly supportive. And I think she really sees the advantage of having two designated centers in this part of the country, that there are a lot of things like COE that we can collaborate on.

And as I said, she was a member of our External Advisory Board. And I’ll say that when we were practicing for our site visit, the most helpful practice that we had was a team from Roswell who came and put us through our paces in a very friendly, but supportive and rigorous way.

And that was much better practice than even our external advisory board, because they took a real fresh look at us, and I really thank them for that.

When was your site visit?

JF: About a year ago. It was in May of 2024.

And then you would have been approved in December maybe?

JF: Right. We heard initially in December that this was coming, and then the NIH was sort of in lockdown, as you’re aware, since the inauguration. It took a long time for us to hear anything. And then it was only very recently that we had to make a couple of adjustments and they funded us.

But NCAB would have approved it in December?

JF: That’s correct.

Okay. Has the money come through?

JF: Yes, we got the NOA just last week.

So, it was just a little bit slower than you would have expected.

JF: Right.

Not too bad. Can you imagine the world without the NCI cancer centers, or the world without NCI?

JF: I have to say, Paul, that this CCSG process has made our cancer center so much better. We’re a real case study because 10 years ago when I was recruited for this position, I spoke to potentially doing this, but this was not necessarily 100% expectation.

It wasn’t like, “You don’t get a CCSG, you’re fired,” kind of thing.

And what I can tell you is the following: The CCSG template, building the research programs, the infrastructure, the CRTEC office, our COE office, all of those pieces in the way that the CCSG grant dictates has made us so much better. And we have doubled our clinical trial accrual.

We deeply understand our catchment area. We nearly doubled our NCI funding. We were able to recruit specialists, and we’re just a much better place.

So, I have to say that although there are parts of this that can get a little crazy: The site visits and the whole choreography and all of that, we’ve probably gone maybe a little too far, the process of pulling all of us together and making us all work on this over years has made us so much better. And I have to say that it would be such a shame for us to lose that.

I think cancer is the envy of all parts of the medical centers, because we have the CCSG.

And all medical centers are really forced to disproportionately invest in cancer, because it’s an expectation of the CCSG.

Without having that CCSG-required infrastructure, I fear that the contributions that we’ve made in cancer and the leadership positions we have globally would disappear.

So, you’re right, it’s a hard day to picture.

Is there anything else we’ve missed? There’s a lot to cover.

JF: No, I guess the one final point I’d make is one of the happy surprises is how supportive other cancer centers have been around this.

You’d kind of think that at some level, this is a competition, a grant, but it really feels like everybody is in it to help the patients. And we’ve had literally dozens of people from other cancer centers help us with various pieces of this, from informal consultations to being members of our External Advisory Board, to practice site visits, and all of those pieces.

I feel fortunate to be working in a field where people are so collaborative and collegial. It’s really inspiring at some level, and I hope to be able to give that back now that we’re officially part of the club.

Well, congratulations again. This is a happy day.