Cancer Care Close to Home
In this episode:
- How the Sarah Cannon Cancer Institute’s integrated care model allows for high quality patient care close to home.
- The research being done at Sarah Cannon, including finding the potential cure for sickle cell disease.
- Hospitals are safe and patients should not put off cancer screenings – they save lives.
Guest: Dr. Dax Kurbegov, Vice President and Physician-in-Chief of Clinical Programs of Sarah Cannon
Sarah Cannon offers patients the unique opportunity to receive world class cancer care without traveling far from home. Dr. Dax Kurbegov joined Chip to discuss the benefits of the center’s integrated structure for patients, the research they are working on, and the importance of patients being regularly screened for cancer from their providers.
Speaker 1 (00:05):
Welcome to Hospitals In Focus, from the Federation of American Hospitals. Here’s your host, Chip Kahn.
Chip Kahn (00:14):
Cancer, just saying the word conjures up all sorts of feelings and emotions, sadness that it’s happened, surprised that it came out of nowhere, fear of what it means for an individual in their loved ones, and perhaps hope that a miracle treatment close to home will give a new lease on life. Here with me today is Dr. Dax Kurbegov. Dax is the vice president and physician and chief of clinical programs for Sarah Cannon, the cancer institute of HCA healthcare headquartered in Nashville, Tennessee, but with facilities in many parts of the country. Frankly, Sarah Cannon is the most influential cancer treatment center that you’ve probably never heard of, so I’m delighted to bring your attention to it today. Thanks so much for being with us, Dax.
Dr. Dax Kurbegov (01:01):
Glad to be here, Chip.
Chip Kahn (01:03):
Dax, as I mentioned, Sarah Cannon is an incredibly influential research and treatment center, even though you don’t have the name recognition of a Sloan Kettering or MD Anderson. Would you tell us a bit about its history and maybe explain its name also?
Dr. Dax Kurbegov (01:18):
Yeah, I’d love to, Chip, and thank you for the invitation. Sarah Cannon’s history really dates back to 1993 and there’s some novelty to the establishment of Sarah Cannon. And our founders really established what arguably was the first community based research program for cancer patients. And that history is really important to our identity and who we are as an organization, because it establishes really from the outset that for us delivery of great cancer care is intimately paired with delivery of great research opportunities. So we are always looking to bring those opportunities to patients in the communities in which they live.
And as the organization grew and evolved, we moved beyond simply being a research entity, but really evolved as a care delivery group as well. And in 2010, HCA formalized Sarah Cannon as its global cancer institute, really with a commitment to the idea that excellence in cancer care and research needed to be brought to the patient, rather than asking patients who get these terrifying diagnoses to transport themselves or bring themselves to where care lives. And I think we’ve always taken that to heart.
There are moments when I like to think that we share a little bit of history with Tesla. When Tesla disrupted the auto industry, it didn’t do so by starting with basic base model car. They really started with a bang, and the demonstration that sophisticated high complexity products could be brought forward. Sarah Cannon did a little bit of the same. When Sarah Cannon entered that clinical space, some of our initial effort was centered around transplant and cellular therapy, arguably amongst the most complex care that’s delivered around cancer patients. And it started with a group of both employed and affiliated providers.
That wasn’t important to us. We understood that employment wasn’t always the best marker of alignment, but how do we bring people together to share best practices? And how do we do that across geographies and scale? And within the context of that cellular therapy and transplant network, we’ve evolved to a point where despite their disparate origins, all of those physicians, all of those entities share standardized standard operating procedures. They have a single quality plan. They’re aligned on clinical pathways and criteria. And the success in that effort really led us to believe, or reinforced our belief, that we could have an impact, that we could be successful at bringing together providers across specialties, across geographies to help shape cancer care in a really positive way.
And if I fast forward a little bit, now we span the entirety of the HCA footprint across 19 states and internationally in the UK. And we’re grounded in the idea that great cancer care starts with multidisciplinary planning, that nurse navigation is integral to that patient experience and overcoming barriers that are inherent to cancer care and sometimes unique to patients. And that we drive quality by establishing physician-led benchmarks and pathways that we adhere to. And that footprint now encompasses more than a hundred commission on cancer accredited programs, and has the opportunity to care for more than 120,000 new cancer patients a year. So it’s really been an extraordinary journey.
And with regard to the name, always a great question and a sweet story here too. Sarah Cannon was a TV and radio personality, probably best known for her Grand Ole Opry character of Minnie Pearl, beloved to many. Sarah Cannon had cancer, Minnie Pearl never did. And when Sarah Cannon had breast cancer, she was treated in our founding facility here in Nashville. And so struck by the care and the teamwork around her case, that she shared her name in support of a vision that was really focused on early detection, clinical trials, and that team based approach. And we’ve carried that name since 2004.
Chip Kahn (06:09):
Wow. That’s quite a story. And I can see how that, as well as the way you are organized, really sets you apart from the other cancer centers as you’ve described. But you’re also part of a large system across the country, HCA healthcare, that has acute care hospitals, really almost throughout the nation. How does integration into a healthcare system help you in terms of meeting the needs of the patients and disseminating both the learning and the improvement in patient care?
Dr. Dax Kurbegov (06:48):
Yeah, it’s a wonderful question and something I like to think of as a strength for the organization. So one, I think at heart we are a physician-led organization, and not just a physician-led inform that is a couple of physicians up top, but what we have done and what HCA has facilitated for us is really an effort to bring together the best and brightest providers from across this expansive network of 177 hospitals, and to allow us to work with physicians upstream of the cancer diagnosis, downstream of the cancer diagnosis and everywhere in between to define what good really needs to look like.
It’s really been a game changer, I think, for our physician partners. And again, this is irrespective of employment status because our conversations with them are non transactional, right? They’re really about building sustainable, high quality programs. And we can really only do that in settings where we are effectively connected to other service lines, pulmonary, GI, women’s and children’s, our imaging partners, so that we can configure and continue to iterate around program improvement in a way that has meaningful impact. And I think at the end of the day, what does that do? One, I think it establishes an ecosystem that really bright, talented physicians want to be a part of. And two, it allows us to disseminate new evidence, new standards of care in a really effective and relatively rapid way.
Chip Kahn (08:33):
As you pointed out that Sarah Cannon isn’t just a treatment center, it’s also a research center, can you give us some idea what the research agenda is of the Sarah Cannon Research Institute?
Dr. Dax Kurbegov (08:45):
I’d love to, and if you’ll recall when Sarah Cannon was first established, it was established as a research center for oncology back in 1993. In 1997, Sarah Cannon really innovated and took what was already unusual and made it really unusual by bringing forward this idea that we could do drug development work, early phase, first in human clinical trials, in a community setting, and that really still represents our sweet spot.
We’re both a site for clinical trials, but we’re also a full service CRO. So we work very closely with industry partners, thinking about new molecules, new opportunities to target cancers, and provide the full range of services to those organizations, to develop these new strategies, to bring them forward, develop the evidence. And ultimately then, we leverage that clinical organization we just spoke about to speed adoption. And at this point, we have nine drug development units across the nation, and we put more than 1200 patients on phase one clinical trials and have completed more than 601 first in human trials. So we span all phases of clinical trials, late phase and early phase, but there is a particular expertise in those first in human opportunities that are so critical to advancing these new types of treatment.
Chip Kahn (10:23):
As an example of your research, I just read an incredible article in the New Yorker about the potential cure for sickle cell disease discovered by a researcher at Sarah Cannon. Can you talk about that a bit and about this sort of developing achievement?
Dr. Dax Kurbegov (10:38):
Yes. You’re referring to Dr. Haydar Frangoul, our medical director of pediatric hematology and oncology here in Nashville, and what a story this is, right? Sickle cell disease is a debilitating disease that affects more than a hundred thousand individuals in this country every year. It’s characterized by hemoglobin that is rigid or leads to rigidity of red blood cells. They then occlude small blood vessels, and this leads to all sorts of sequelae, including frequent and debilitating pain crises. So what a challenge to take that on.
And we’ve known for a while that patients, when they’re born, don’t suffer those types of crises, and that’s because fetal hemoglobin is resistant to that sickling process. And so the idea behind this research was if there was a way that we could in older individuals, in older patients, not infants anymore, convert them back to fetal hemoglobin, that their red blood cells wouldn’t sickle anymore and we might have a positive impact. And so that’s really what was done.
Dr. Frangoul lead the team in 2019 that treated the very first patient in the world with this gene-editing strategy, using a technology called CRISPR, used the patient’s own bone marrow cells, gene edited them so that they would start producing or encourage them to produce that fetal hemoglobin, and then reinfuse them in the patients. And Victoria Gray was really the first individual that was treated. And up until that time, her life had been characterized by dependence on pain medicine and frequent hospitalization. And I’m thrilled to report, as per that article, that she continues to do well. Did well almost instantly after the treatment, has not been on pain medicine, and hasn’t been in a hospital, at least hospitalized for a pain crisis, since her original treatment. Really remarkable.
Chip Kahn (12:44):
That is really wonderful. Additionally, I understand you shared something significant in terms of findings recently at the American Society of Clinical Oncology conference. Can you talk a bit about these results?
Dr. Dax Kurbegov (12:58):
I’d love to, and thank you. First, it was great to be back in person at the American Society of Clinical Oncology, the nation’s largest cancer, and really the world’s largest cancer focused meeting. And we’re really privileged. We had more than 140 abstracts or presentations made at that meeting. 75 of those involved phase one studies and posters and oral presentations. And some of those were really important game changers, right? Dr. Hamilton, who’s a breast medical oncology, leads our breast research program, presented important data from the DESTINY 3 trial, which has helped to establish the safety and efficacy of new antibody drug conjugates for advanced breast cancer patients. And that study showed more than 70% reduction in the risk of progression or for death for patients with an advanced breast cancers that expressed the HER2 new proteins, so really impactful.
And sometimes it’s not just about the nuts and bolts of research, but I think the other place where I’m thrilled we can have an impact is by sharing our stories of how we’ve operationalized change that positively impacts the landscape. Right? How do we tell the stories of success? One of those was around our personalized medicine program. Dr. Andrew McKenzie leads that group and was able to share some of our insights on how molecular profiling, coupled with technology and support from the right infrastructure, really enhances physicians’ abilities to offer patients the right treatment or to identify clinical trials that might be game changers for those patients. So all of that was in scope for ASCO this year and great fun to commune and share those with our colleagues.
Chip Kahn (14:55):
That’s great. Though, I don’t think we can have a conversation today without talking about COVID. During the COVID shutdowns and surges, both prevention and treatment for cancer was considered elective treatment. It doesn’t sound elective to me at all, but COVID precautions meant many people couldn’t get screened and frankly couldn’t get treated, so many patients were diagnosed in later stages of the disease. What effect has that had on care? And what should patients know about receiving screenings and treatments today?
Dr. Dax Kurbegov (15:34):
Yeah, wonderful question, and sobering as well. I want to make one point out of the gate here and that is that none of us consider cancer care to be elective in any way, shape or form. And we’ve really stayed true to that philosophy from the early days of the pandemic. So Chip, it’s true that there were moments, particularly in those first few months, where the threat of overwhelming available resources translated into shutdowns or limitations of services, but really days and weeks into the pandemic, we were convening this broad community of physicians and operators across the nation to say, “How do we ensure that patients who need a diagnostic workup get the workup that they need so that they’re not delayed in diagnosis? And how do we make sure that the patients who need treatment, which isn’t optional by any stretch of the imagination, get the right treatments?”
So we mobilized, we adjusted, we prioritized, we communicated and educated both providers and patients around the importance of cancer care. And it’s interesting because there was so much fear in those early days, and yet in some ways, the hospitals, which for many years really been pioneers in how to protect people from infectious disease, hospitals were some of the safest places for patients to be.
So in answer to your question, one, I think we moved very quickly and with great purpose to ensure that patients got the treatments that they needed. I think the second was, as we came out of those first few months and things started to reopen, we really accelerated our outreach to patients and to the primary care community to articulate and rebuild confidence coming into the health system. So I think that is an advantage of the network that we invested in. I don’t think any of us ever wanted to have to leverage the network in that way, but I sure am thankful that our community rallied in the way that it did.
Chip Kahn (17:52):
Cancer has deeply scarred President Biden’s family. The president lost his son Beau to the disease. In his budget, he has ignited a Cancer Moonshot. His ambitious program is to accelerate the rate of progress against cancer. How will this program impact Sarah Cannon, and how will it affect not just research but treating patients as well?
Dr. Dax Kurbegov (18:19):
Yes, the Moonshot program is an aggressive endeavor, right? With a target of reducing the death rate of cancer by 50% over the next 25 years, as well as improving the lives of the increasing number of patients who are cancer survivors in this country. We’ve had the privilege to be a part of the Moonshot effort since its original IPS inception when President Biden was vice president for President Obama, really focused on cancer navigation, and we’re gratified to be a part of that community and at the table with the Biden administration again.
I think what’s encouraging to me is that we share a lot of the same priorities here. One is how do we accelerate the personalization of cancer care? That is how do we find the right treatment for the right patient at the right time? And we’ve made substantial investments in our research program and our personalized medicine program. We actually leverage a technology called Genospace that can process those complex molecular profiles that we now routinely get on advanced cancer patients and translate that into actionable insights for providers so that they’re directing the patients to the right treatment.
We are, as an organization, at the forefront of something called multi-cancer early detection. So those same technologies that we use to identify mutations that make cancers cancer, we can now detect those fingerprints or clues in the peripheral blood of healthy patients as a potential strategy for earlier detection. And as you know, Chip, if we can detect cancer earlier, we have a much better chance of curing it. That’s a priority for the Biden administration.
I want to be truthful here. There are probably more questions than there are answers today, but we are pioneering those efforts in alignment with the Cancer Moonshot program. And as we’ve articulated, we’ve always been about bringing research to patients, not asking patients to go and find the research. So these are all dimensions in which our partnership with our public sector, our private industry peers and the federal government are synergistic in terms of how we work together.
Chip Kahn (20:40):
You’re giving us here sort of a glance into the future. How do you see cancer treatment developing? And is there hope, I guess cancer really is many different diseases, but is there hope that we will someday have a broad based approach to curing cancers?
Dr. Dax Kurbegov (20:59):
Yeah, it’s a complicated question, but I’ll try and give a simple answer, and you’ll have to forgive me. You can’t be in this business without being an optimist, and I certainly am. As you alluded to, I don’t think it’s going to be a one size fits all, but I think now more than ever, we’ve defined multiple different paths that we can take that are likely to dramatically improve outcomes and increase cures for patients. And I like to think that the progress and the momentum across all of these paths will meaningfully translate into more cures, and that ranges from we got to get better. We’ve got to get better at identifying people who are at risk and supporting them in making thoughtful and wise decisions. We just spoke a second ago about the promise of early detection, and that’s critical to improving outcomes because right now we screen for four cancers. That leaves a lot of cancers that unfortunately tend to be lethal without any strategy for early identification. So lots of promise there.
We’re committed to, and I think access to innovative therapy is increasing across the country, and particularly some of these really exciting strategies: immunotherapy, harnessing the power of our immune systems; targeted therapy that can be specifically administered to subsets of patients that will benefit from those therapies and who will be then able to avoid the toxicity of treatments that don’t work; and this whole field of cellular therapies, where, again, it’s another variant of harnessing R innate immune systems, allowing that immune system to do what it does in tracking down and eradicating those cancers. So lots of opportunity, lots of momentum, and we are thrilled to be a part of that field.
Chip Kahn (22:58):
Dax, thank you so much for this very informative conversation that gives us a sense for the role in our healthcare system, of HCA Healthcare’s Sarah Cannon. Any other final thoughts as we close out?
Dr. Dax Kurbegov (23:12):
Maybe just one, and we’ve talked a fair bit about personalizing therapy. I think more than an ever that ability in our cancer space, in our cancer realm, to identify treatments that are specifically going to work for the individuals that are across the table from us is tremendously exciting. I think we all recognize that journey to ever more personalized treatment is really a critical path to achieving the best possible outcomes and that we all have to be in it together, right? Academic centers, community health systems, patient advocates, federal government, industry providers, and that’s the model that we embrace here. So thrilled to join you today, thrilled to share with you some of the work that we do and reflect on some of the opportunities in front of us.
Chip Kahn (24:03):
Dax, so appreciate your service.
Speaker 1 (24:09):
Thanks for listening to Hospitals In Focus, from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media at FAH Hospitals and follow Chip @ChipKahn. Please rate, review and subscribe to Hospitals in Focus. Join us next time for more in-depth conversations with healthcare leaders.
Dax Kurbegov, MD
Vice President & Physician-in-Chief of Clinical Programs
Dr. Kurbegov is the vice president and physician-in-chief of clinical programs at Sarah Cannon. Dr. Kurbegov oversees Sarah Cannon’s clinical program development, ensuring consistency and quality and fostering collaboration across our global network of cancer programs. He works with clinical operations teams and tumor specific workgroups across the network for strategic development, implementation and evaluation of clinical programs and services for patients facing cancer in Sarah Cannon communities.
Dr. Kurbegov has led the development of both clinical and research programs across tumor sites for national oncology programs, focusing on strategic initiatives to improve patient outcomes. He joined Sarah Cannon from Catholic Health Initiatives in Colorado where he served as physician vice president of the national oncology service line for 50 cancer centers across the U.S.
Dr. Kurbegov received his bachelor of science from Stanford University and his medical degree from Baylor College of Medicine. He completed his internship and residency in internal medicine at University of Colorado Health Sciences Center and his medical oncology fellowship from The University of Texas MD Anderson Cancer Center. He has served as a physician advisor for the American Society of Clinical Oncology (ASCO®) and chair of the ASCO Research Community Forum Steering Group for the 2017-2018 term. He has been recognized as a “Top Doc” by U.S. News & World Report, amongst many other recognitions.