Targeting Florida's Cancer Epidemic

lthough significant progress has been made since then-President Richard Nixon declared the war on cancer in 1971, Florida retains the dubious distinction of having one of the highest rates of cancer in the nation. Thousands of aging baby boomers and droves of retirees add up to a disproportionate number of older people in Florida--residents whose risk of developing cancer grows with age. As we approach the new millennium, the University of Miami's cancer-focused researchers and physicians are bracing themselves for a virtual epidemic of cancer in the state.

How will the School of Medicine address this challenge? And with huge sums flowing into state coffers as a result of the settlement with tobacco companies, is the state doing enough to support this effort?

W. Jarrard Goodwin, M.D., director of the University of Miami/Sylvester Comprehensive Cancer Center, discussed this challenge with Karen Clarke, UM/Sylvester's director of marketing and communications. Dr. Goodwin oversees the University's cancer-related services at UM/Sylvester, the University of Miami Hospital and Clinics, and Jackson Memorial Hospital, and is a professor in the department of otolaryngology.

KC How will UM/Sylvester address the state's cancer epidemic?

JG Complex diseases that strike epic numbers of people have to be attacked on multiple fronts. UM/Sylvester is the only research-based comprehensive cancer center serving South Florida, and a growing population of about five million people. We offer innovative clinical cancer programs, multidisciplinary basic science and clinical research, as well as education that targets cancer patients, the community, and medical students.

Let me be frank: I believe that research cures cancer. According to the National Cancer Institute, seven million people are alive today because of cancer research, and it has improved the quality of life for countless others. So as a university-based comprehensive cancer center, our focus on research--on bringing new treatments and innovations directly to patients--is one of the most important things we can do. It is our best hope.

KC We live in a large, urban area where the quality of cancer care in community hospitals is quite good. Why is a university-based cancer center so important?

JG First, let me say that the quality of care here is very good. But a comprehensive cancer center--one that combines excellent research in addition to outstanding patient care--is an incredible asset for any community. The presence of such a center truly raises the bar and reduces the human burden from cancer across that entire region. It elevates the level of care in terms of new treatments, more aggressive therapies, and top-quality education and community outreach. This has a tremendous influence on the entire community of caregivers.

A stellar university-based program assures that patients have access to state-of-the-art clinical care. Our multidisciplinary focus means that all the pertinent members of the patient's caregiving team are located in the same spot. They come to one center for their diagnostic services, surgical care, chemotherapy, radiation oncology, psychosocial support. We have 23 different multidisciplinary groups that get together regularly for conferences, educational programs and other sessions to discuss the best ways to care for our patients. Because of this level of expertise, there is a declining need for people in South Florida to go outside our region for truly world-class cancer care. That is a tremendous advantage for our patients.

KC You were appointed by the governor to chair the state's Cancer Control and Research Advisory Council (C-CRAB). What is the purpose of this council?

JG C-CRAB was created by state legislators to review the special cancer problems in Florida and make recommendations that would help reduce the cancer burden in this state. Our membership is diverse and includes physicians, cancer prevention specialists, representatives from hospitals, nursing associations, the Department of Health, the American Cancer Society, and members of the general public. Our job is to develop the "Florida Cancer Plan," set priorities, and make recommendations to assure the coordination of cancer control and research in the state. A significant part of what we do is review pending legislation and offer comments to legislators who will review and debate its merits.

KC Do you think the Legislature places a priority on the issue of cancer in Florida?

JG Yes, but we need to do more. In the past two years, at least a dozen pieces of legislation have passed that have made important strides for us. This year, the Legislature awarded $1.5 million to the University of Miami to help support cancer research. The Florida Tobacco Pilot program was established to encourage healthy lifestyles and disease-prevention behaviors. Dr. Ed Trapido at UM/Sylvester is the principal investigator within the program's research and evaluation center. Dr. Trapido also heads the Florida Cancer Data System based here at UM, which serves as the state's cancer registry. This system was established by the legislature and allows us to identify cancer trends and problems so we can address them more readily. These are just a few examples that directly involve the University, and there are many others.

KC What issues will you stress in the legislative session this spring?

JG We are fortunate to have Senator Jim Sebesta serving on C-CRAB, and he and his staff have been actively involved in our discussions and plans. With his leadership and advice, we hope to address a number of important issues in the upcoming session. The newly-created Prostate Cancer Task Force, which is chaired by UM's Dr. Mark Soloway, submits its report to the Governor and Legislature in January, outlining several important recommendations regarding prostate cancer. A somewhat controversial issue that we support is legislation that would offer financial incentives to employers whose employees participate in cancer prevention and screening activities. We also want managed care plans to assure that their members have access to state-of-the-art cancer care, including clinical trials. There is much to be done.

KC It appears that through C-CRAB, there is some degree of coordination among the key parties in tackling this issue. How does UM/Sylvester's partnership with Jackson Memorial Hospital strengthen the University's cancer program?

JG Our partnership with Jackson has many benefits, but one of the most significant is that it makes our cancer center very diverse. We treat people of all ages and ethnic backgrounds, and everyone has access to clinical trials and research innovations regardless of their socioeconomic situation. Our faculty takes great pride in this. For example, I recently visited one of our outpatient clinics at Jackson, and the physician there was clearly proud that patients in her care had access to new drugs like Taxol and other developing therapies even before they were available to affluent members of our community through their community hospitals. That's one example of how the greater Sylvester makes a real difference in the lives of people in this region.

But it has long-term benefits for us as well. Because we see such a diverse patient base, we have access to a diverse array of tissues to study in our research labs. This is a tremendous advantage that this University has over other medical schools. Some excellent medical schools have strong educational programs but suffer from a lack of access to a diverse patient population to support a growing research enterprise. We are fortunate to have the best of both worlds, and it allows us to have a stronger research program and more depth in our clinical expertise. For that reason, we are fortunate to be located in this community, and in turn, this community is fortunate to have a world-class cancer center right in their own backyard.