The Baylor Scott And White Dallas Foundation’s first quarterly meeting of 2022 was a virtual triple header on Tuesday, February 8. In addition to a get-to-know-you chat with former Baylor Scott And White Health CEO Jim Hinton’s successor Peter “Pete” McCanna, there was also a discussion about “Immunology and the Future of Cancer Detection” with Baylor Scott and White Chief of Oncology Dr. Ronan Kelly and Foundation Advisory Board Member/cancer patient Jeff York.
For the first part, Foundation Board Chair Norman Bagwell had a question-and-answer talk with Pete, who is originally from Wisconsin, met his wife at the University of Texas and has three daughters, the youngest enrolled at SMU as a junior.
What got him into healthcare? In addition to his mother being a nurse, Pete studied under Wilbur Cohen, who was Lyndon Johnson’s first Secretary of Health Education and Welfare. “He really encouraged me to get into healthcare and as he put it, ‘Healthcare is all messed up, so you’re not going to be lacking things to do. It’s really the place to be.’”
What has he taken away from the past two years? “The near-term issues are our nurses, healthcare providers and staff are very fatigued. And as a result, we are facing a severe labor shortage.” As for the future, Pete said he sees it as a twofold situation: #1 – to add to the workforce and adjust the way that healthcare is delivered. #2 – Over recent years, services have been designed around the customer, or in the case of healthcare, the patient—while for the past 100 years they were designed around hospitals and physicians. “Particularly the younger generation, but all generations, are going to be expecting us to provide accessible, seamless, well-navigated services with the highest quality possible.”
How does he see Baylor Scott and White positioned in the future? It’s in a very good position because “we have a highly diverse health system both in terms of its patient base so we can do clinical trials with a large diverse patient base. We’re diversified in the place of the settings of care. A lot of care is moving out of the hospital. We have many other businesses at different aspects of care outside the hospital that are delivering care. It makes us a breeding ground for innovation and we are fortunate to be in Texas. (For) every new disruptive healthcare innovative company, Texas is one of their geographies because the population is growing and there are fewer barriers to starting a new business.”
What role does philanthropy play? He feels that philanthropy is a key element for excellence in a healthcare organization. First, it is a way to connect with the community and influencers; second, the “resources generated from philanthropy are that extra element that take us from very good to excellent; and finally, active donors want to give money to organizations that are going to make good use of it.”
What is his vision for the Foundation Board? Pete feels that the 100+ board members are out in the community and provide both him and the Foundation staff with what they’re hearing from friends and others as patients and customers on what’s working and what isn’t working.
The second part of the program was a discussion with Ronan and Jeff moderated by Foundation President Ben Renberg about the work being done at the Charles A. Sammons Cancer Center.
Ben set the discussion by reporting that Baylor Scott and White Health has “the largest network of cancer-based hospitals in Texas, with 13 dedicated cancer centers. It is the third largest network of cancer centers accredited by the Commission on Cancer in the United States. And with its presence on this campus, between Sammons Cancer Center and Pickens Hospital, it is one of the largest providers in the state as well.”
Ronan said that he came to Baylor in 2019 from John Hopkins because he saw the ability to “connect the dots across our cancer service line,” thanks to the 13 cancer centers across the state that provide multiple diverse backgrounds.
He described today’s oncology as “population medicine” with two central themes — 1) the power of the human immune system in the fight against the disease and 2) how to detect cancer earlier.
There is a third part — the future for cancer care is to take it away from the hospital and into the community. The idea is to be able to detect cancer by testing a blood or perhaps urine sample taken at home and then being able to connect with patients via their smartphones.
Just months after Ronan’s arrival the pandemic began, resulting in a reduction in cancer screenings, with 9M screenings being missed in the past two years. As a result, Ronan said, “We’re expecting a tsunami of cancer cases in the next two years.”
On the other hand, Ronan pointed out that as a result of the pandemic, people are more aware of the power of the human immune system, and he expects tremendous advances to reduce cancer mortality in the years to come.
Ben then directed the conversation to Jeff, who was diagnosed with stage 4 cancer of the stomach and esophagus in August 2015. In starting off, Jeff stressed the importance of relationships. In his battle against cancer it was his relationship with Ronan that had been vital to his journey.
Ironically, it was on the day that he met Ronan that he received a report that his cancer had recurred. “We finished lunch and he said ‘Do you have an hour?’ He took me through the litany of data and research and things that were happening in immunotherapy. And what he did that day was give me a tremendous amount of hope. I call him our Chief Hope Carrier, which is what people really need in these situations.”
Jeff recalled how he didn’t have symptoms until the cancer had already developed to a very late stage. He ended up in the “largest cancer center in Houston” and went through 14 weeks of radiation and chemotherapy. He dropped to 125 lbs. and then went through surgery.
When the cancer reappeared, he was told that he had to come back for 12 more rounds of treatments. Additional tests showed 24 more tumors in his stomach. When he asked his oncologist what he should do, the response was “statistics that I didn’t appreciate.” He asked his general practitioner for the best person in the world to treat a recurrence of this cancer: “I don’t care where I have to go. I wasn’t scared to die. I just don’t want to go now because I had a lot of things to do.”
The answer came back in 24 hours — Dr. David McCollum at Baylor’s Sammons Center in Dallas.
“I met him and on the subject of relationships, he spent more time with me on that Friday late in the afternoon than I had collectively with all of my doctors in Houston.”
Within eight months, Jeff had a clean PET scan. He admitted that he’s had “a couple of small recurrences since, but nothing to speak of.” He does have preventative therapy via the infusion center “pretty much for the rest of my life. It was daunting to hear, but then I realized there must be a great purpose. I get a tremendous overwhelming joy when I go down there because I get the opportunity to meet new people and hopefully help them to get inspired and realize that not everybody is a winner but most are and you’ll probably be okay.”
Regarding Ronan, Jeff described him as a very competitive person who wants to beat cancer and is “building a remarkable juggernaut” based on two pillars to defeat cancer: early diagnosis by blood testing before anything is present and immunotherapy.
According to Ronan, screening is done in the U.S. for only breast cancer, cervical cancer, colon cancer and lung cancer. “That makes up for about 30% of the cancers we see. There is no screening for the other 70%. You just either pick it up on a random scan or you present with a symptom.”
He explained that within a one centimeter scan there are a billion cells all in one place. “But we have the technology now based on little fragments of a tumor that break up and circulate around your blood to diagnose them well before any scan would.”
Ronan compared the situation to a strand of hair coming out when one brushes their hair. “It doesn’t mean our hair is falling out. Or, we get a bad sunburn and our skin sloughs off. Doesn’t mean all of our skin is falling off. Think of the same thing with cancer, but at a microscopic level. Tiny little fragments are breaking off and we call that circulating tumor DNA. And its little fragments of the tumor floating around … tiny, but would never be picked up on any scan. We now have the ability to detect that on a blood test.”
Because Baylor has hundreds of thousands of patients in its primary care network, an integrated system with electronic medical records and the My Baylor Scott and White Health app [MyBSWHealth], Ronan had all the elements for a potential study. The hope is to screen 100,000 Texans who go to their general practitioner and ask if they would like to be part of the study. “If they say ‘yes,’ we’ll take a sample of blood and the results will take about two weeks. It will tell one of two things — cancer signal detected or cancer signal not detected. 98% of people will get nothing detected. 1% will have a true positive. 1% will have a false positive.”
The 2% will then get PET scanned to see if something is found. If so, then they will be connected to the right surgeon.
“We want to go a step further that no one else has by creating a digital cancer experience on the app.” Through the app the patient will be hand-held through the process of the PET scan, the results and the next steps. Patients will also be able to deal with the stress and concerns by zooming with their team.
If cancer can be detected early, Ronan’s expectation is a 35% drop in mortality as well as the cost of care. But he admits, “It’s not prime time yet. People may get their blood test and not bother to have their colonoscopy when there’s no data for that. The blood test is going to be a supplementary addition to our armamentarium.”
Regarding the second pillar of immunotherapy, it started about 10 years ago when they started seeing remarkable results from PD-1 inhibitors that “we hadn’t seen before.”
Today when almost anyone with metastatic disease gets cancer, they are probably going to get one of these “immune checkpoint inhibitors, which turns on your immune system to wage a microscopic war between your good cells and bad cells,” Ronan said.
Now the program has moved to the early stages of cancer. In the past the routine was chemo, radiation, surgery and then to watch the situation. “But in some cancers, watching it isn’t always good enough. Immunotherapy is the fourth pillar. What we’ve done is move those drugs into an early stage. While the patient is waiting, we can give them a year of immunotherapy to really give them a much better chance for the cancer to never come back.”
Before last year, the only cancer that you could use those drugs on was melanoma, and then “quickly came esophageal cancer and triple negative breast cancer, both led by colleagues of mine at the Charles H. Sammons Center. At one point we were the only cancer center in the world to say that we were responsible for two out of three FDA approvals for the use of these immunotherapy drugs in early stage malignancies.”
In late 2021, the FDA also approved this strategy for kidney, bladder or lung cancers.
The developments of immunotherapy made by Baylor’s oncology team at Sammons have been noted by the New England Journal, with studies published by Ronan on esophageal cancer and Dr. Joyce O’Shaughnessy on triple-negative breast cancer.
The best known example of the immunotherapy was former President Jimmy Carter’s recovery from his diagnosis of terminal cancer. The question that Ronan is dealing with is, “Why do some people have such remarkable results and others not so?”
To find out, Baylor Scott And White created the Texas Immuno-Oncology Biorepository (TIOB) to collect, catalog and stores samples of biological materials (i.e. urine, blood, stool, tissue, cells, DNA, RNA and protein) in an effort to better understand cancer.
Ronan is “passionate” about TIOB because less than 5% of Americans are usually involved in trial studies. They are “mostly Caucasian and in the affluent criteria where they can travel to the academic center. We’re not learning about real-world people.”
The “vision for the TIOB is to not just treat every patient but to learn from every patient across multiple diverse backgrounds, multiple racial backgrounds, and multiple social backgrounds. Together we can start learning how the immune system evolves and adapts over time in real Texans.”
In addition to Baylor Scott and White’s network across Texas, “when people come to us, they stay with us, providing us with a chance to monitor over the years.”
Ronan is creating a triangle with “Baylor Scott And White at the top with its hundreds of thousands of patients partnering with academia and industry together in a private-public partnership, and we are positioning ourselves to become a really important cancer service.”
In closing, Ben asked Jeff about his approach to philanthropy. Jeff directs his financial support “toward things that actually help relationships and the mental state that people go through while they’re having cancer… Looking forward, I would like to see ways that we can advance the mental coaching and the psychotherapy that needs to happen to help patients be in the best possible mental condition to fight this disease.”
From firsthand experiences, Jeff said, “Every person that goes through the cancer center that’s a survivor wants to join the army of volunteers, they just don’t know how. They want to know how they can pitch in and be an inspiration to others going through the same journey that I was going through last year or 20 years ago.”