Cures and Care

IF A SECURITY MACHINE AT THE AIRPORT can detect a few molecules of an explosive, why can’t we detect molecules of cancer cells in the body?” The question is posed by Dr. Dennis Carson, who, as director of the Rebecca & John Moores UCSD Cancer Center, has a single focus: Find ways to detect cancer early, when the chances of curing the disease are optimal.

Carson believes the answer will come from an interdisciplinary approach to studying cancer. To this end, he’s putting together partnerships between clinicians from his center and researchers from the University of California, San Diego, in such fields as engineering, physics, chemistry, math and computer science. “Let’s get their IQs rolling and see if they can’t come back with some answers,” he says.

The UCSD facility is one of only 39 in the country designated by the National Cancer Institute as a comprehensive center, one that combines advanced research, patient care and education. Since it was established in 1979, the cancer center has been scattered across the university’s La Jolla campus. This month, it moves into one building, a 270,000- square-foot facility off Regents Road near UCSD’s Thornton Hospital.

When the building is dedicated April 8, it will symbolize the opening of a new era in high-tech research, a partnership between industry and academia and an emphasis on a more humanistic way of caring for cancer patients and their families.

With the creative brain trusts of the center’s cancer research and clinical programs under one roof, Carson says his goal to establish UCSD as a world leader in early cancer detection will be expedited. He has the credentials to do it.

Named the center’s director in October 2003, Carson is a world-renowned immunologist and cancer biologist who’s also an accomplished inventor, with more than 60 patents to his credit. One of his bestknown developments is the cancer drug 2-CdA to treat hairy cell leukemia. The drug has resulted in long-term remission in about 75 percent of patients.

Carson is specifically interested in what’s known as translational research, taking laboratory discoveries about the biology of cancer and turning that information into clinical therapies. “Huge advances have been made in understanding the structure of cancer,” he says. “But we haven’t translated this into treatment.”

It’s his aim for the center to develop more noninvasive procedures to test for preliminary signs of cancer.

Some of the greatest achievements in early detection have been made with blood-associated cancers, Carson says, while detection of solid tumors is much more problematic because the growth often doesn’t cause pain initially in the cancer’s development.

When a tumor is detected through x-rays or an MRI, it may be at an advanced stage. Future early-detection tests of blood or other easily accessible body fluids could greatly reduce the need for radical surgeries and intensive chemotherapy and radiation regimes.

A major part of Carson’s assignment at the UCSD center is to establish key relationships with the biotech and pharmaceutical companies—including many in San Diego—to help speed the process of bringing new cancer-treating drugs on line. Carson himself is the founder of four such companies and knows firsthand the daunting challenges of getting a new drug on the market, a process that takes up to 15 years and costs about $800 million.

“Our visions are often greater than our resources,” he says. “It’s my job to work out the right strategy and get the right people working together to speed the process.”

Carson says today’s drug industry is “risk averse,” adding that traditional research-funding sources, such as the National Institutes of Health, tend only to underwrite research that’s likely to produce results in about five years.

“What I need is money for the young geniuses I’ve picked out,” he says. “We have to find alternative methods, ones that are very high-risk but which carry the potential for a very high payoff in terms of early cancer detection.”

WHILE THE DAY-TO-DAY RESEARCH of the cancer center is not seen by the public, patients at the new facility will notice some decided improvements.

We have a brand-new building, and we’re building a new way of taking care of patients,” says Matthew Loscalzo, who, as director of patient and family services, oversees the psychosocial aspects of cancer treatment, ensuring patients’ individual needs and concerns are met.

After visiting or studying cancer centers around the country, Loscalzo says, “I was shocked by the lack of support for the patients and their families.” Managed care at many of the centers has eviscerated programs aimed at dealing with a cancer patient’s mental health and emotional well-being, he says.

“We need to open conversations with patients from day one,” says Loscalzo. “All cancer patients are stressed out. If we intercede early, the anxiety doesn’t get out of control.” He notes that patients who are anxious, depressed or angry are not as apt to follow the care that’s been prescribed for them.

A patient first visiting the Moores UCSD Cancer Center is asked to fill out a survey, rating problem areas that range from transportation and finances to such concerns as dependence upon others, controlling anger, managing everyday life while undergoing treatment, even thoughts of suicide. A full-time staff of counselors is available at the center to respond to concerns that need immediate attention.

The survey has been field tested with 1,000 patients, Loscalzo says, and—as a screening tool—provides a unique dimension to the new center.

“We’ve found that patients are very honest,” he says. “All of them have problems, and we want them to know we’re here to help them in any way we can.”

The psychosocial side of the center also involves teaching doctors and nurses how to use the services of counselors. Doctors, Loscalzo says, will be provided with “scripts” to guide them in dealing with a patient who, for example, becomes upset during a consultation.

To better understand the needs of cancer patients, Loscalzo has set up a 15-member patient advisory council composed of the center’s staff, patients and family members. A responsibility of the council is to set service policy for the cancer center.

“The council is adamant that the patient comes first,” says Chris Keays, a family member of a cancer patient, who cochairs the group with Loscalzo.

Recommendations made by the council include setting up procedures so a patient has easy access to a nurse, ensuring that tests are turned around quickly and providing education for the family caregiver.

“And smile, smile, smile. We can’t overemphasize the importance of having the center’s staff smile and just show they are always willing to lend a hand,” Keays says.

Do you like what you read? Subscribe to San Diego Magazine »