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Effort to fund endowed chair for Dr Paul Lange, prostate-cancer research pioneer

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Passing the leadership baton is usually accompanied by fanfare and fond farewells, but for Dr. Paul Lange, who co-founded the Institute for Prostate Cancer Research (IPCR) and built it over nearly three decades into one of the most prestigious research institutions of its kind in the world, it was a low-key transition befitting his style.

       Dr. Paul Lange
But once word of his retirement at the beginning of 2017 spread among his friends and admirers in the medical community and well beyond, there was a growing agreement that one of the true pioneers in prostate cancer research and treatment would not be permitted to quietly step aside.

Thus commenced an initiative by those friends to raise the $2.25 million to create an endowed chair in his name, designated to the development of future leaders in prostate-cancer research. Those friends include a cadre of men in the region whose prostate treatments or surgeries were performed by Lange, as well as many, like me, who came to know Lange and learn of his impact on prostate cancer after their surgeries.

In fact, because Lange learned a few years ago that he had prostate cancer and decided to have a prostatectomy, a bond of sorts developed between him and many others of us who, like him, turned to Dr. William Ellis, the UWMC prostate surgeon who is frequently referred to his patients as The Top Prostate Doc.

An example of the reaction to the endowment effort came at a recent breakfast meeting where I advised a prominent Eastside businessman (who will remain nameless) about the endowed-chair campaign and he said "Great idea! I'm in for 100(assuming I understood the three zeroes following)."

It was Lange who, among other leadership roles with prostate cancer innovations, was instrumental in bringing to prominence the blood test with the now universally known initials PSA to assess the presence of prostate cancer. In addition to working closely with the firm that developed the test, he was said to have been present the day the FDA approved it.

When Lange first learned of the endowed-chair effort, he was described as "especially excited." Those who know Lange know it wasn't because of any ego gratification about having the development of a chair in his memory but because of the role the funds would play in retaining the talent to create the research in the battle against the disease.

As Lange has told me on numerous occasions, the IPCR, despite its world-class prominence, is urgently in need of further private support to keep it in the forefront as one of the leading research entities."

IPCR ranks in the top 10 in the country for federal funding and is in the top five in prostate-cancer funding, with Lange estimating that over the years at least $60 million, mostly from NIH, has come to IPCR.
 
But ironically, IPCR has dramatically lagged in raising the private funds that the NIH views as a key to its own funding decisions.
"We are significantly behind the eight to 10 of the top prostate-cancer research institutions in the country in keeping up with private fund raising, which is essential if we are to retain a world-class team and explore new ideas that need to be developed because they are not yet advanced far enough for the NIH to fund," says Lange.
Dr. Daniel Lin 
Dr. Daniel W. Lin, who has been Chief of Urologic Oncology in the Department of Urology at the University of Washington and recipient of numerous awards from his scientific peers, was tapped early this year to succeed Lange as director of IPCR. Lange has not yet actually retired from his work at the institute, only from the top roles.

"One of Paul's greatest attributes has been his ability to motivate young scientists in their early research careers, inspire them to pursue novel investigations, and encourage them during the inevitable ups and downs of all scientific endeavors," Lin told me.

"Paul had the insight and energy to bring together researchers and clinicians from across the Pacific Northwest to apply for federal grants as a collaborative research enterprise and to form  the IPCR that continues to push the boundaries of prostate cancer discovery and progress," Lin added.

Lange, MD, and Robert Vessella, PhD, had already been a team at the University of Minnesota for a dozen years when they decided in 1989 to accept an offer to come to the University of Washington to launch the collaborative effort that a few years later would officially become the IPCR. By then he had helped it become an unusual collaboration between the University of Washington School of Medicine and the Fred Hutchinson Cancer Research Center.
The unusual team of Vessella, an academic prof, and Lange, a medical doctor, went on to build a world-class team and guide leading-edge research that have made Seattle a nexus for prostate-cancer research.

As I wrote in a Harp I did on the 25th anniversary of the IPCR in 2004, "In a sense, Lange and Vessella were medical opportunists in deciding to focus on a cancer for which they thought there might be a light at the end of the tunnel."
At the time there was basically no funding available for prostate-cancer research and, as Lange recalled for that column: "No one really cared at the time about an old man's disease."
But far from being "an old man's disease," the number of younger men diagnosed with prostate cancer has increased nearly six fold with more than 10 percent of new prostate cancer diagnoses in the U.S. being in men younger than 55.
And significantly, the disease is often much more aggressive in younger men, compared with a usually slower progression in older men.
It's routinely said of accomplished leaders that their contributions are too many to list, but in Lange's case several are too important not to list because they frame essential chapters in the role IPCR has come to play on the global prostate-cancer research stage.

One was a partnership that emerged in 1992 with Leroy Hood, who had recently arrived at the University of Washington, with funding from Bill Gates Jr, to found and chair the Molecular Biotechnology Department.
The other was the relationship that Lange helped bring about between The Hutch and the University of Washington Medical School, viewed as so noteworthy as to be almost unique.
Hood, already internationally prominent as developer of the automated DNA sequencer that was a key to the human genome project, recalled in an interview for the 2004 column how he and Lange, both then heading departments at UW, got together at a retreat in 1992 to discuss how genomics could be applied to prostate-cancer research.
"We decided to work together and I outlined on a napkin at dinner a genomic approach to prostate-cancer research," Hood recalled for me. "Then Paul and I agreed to help Michael Milkin, as he created a series of seminal meetings on the genomic approach to prostate cancer."
"Lee was hugely instrumental in putting us in the national spotlight," Lange said. "Thanks to a variety of influences, Lee decided to devote a large part of his translational research efforts to prostate cancer. The support of the Michael Milkin organization to the tune of about $12 million over the years was largely due to the participation of Lee and his group in our research efforts."
Dr. Pete Nelson     
And one of the important developments from the relationship was the recruitment of Dr. Pete Nelson to prostate cancer research from Hood's lab where Nelson was working on another cancer. He has since then been Lange's key research leader at IPCR, where his work has garnered international honors and recognition.
As Nelson, who has assumed the role of IPCR Research Leader, noted to me: "Paul created IPCR at a time when there were few bridges between The Hutch and UW and certainly to engage the two in community philanthropy was the kind of bond that just isn't seen."

"I'd be hard pressed to name two medical research institutions in the world that raise funds together," added Nelson, whose IPCR role is noteworthy because he has continually turned down opportunities at the top research institutions in the nation to remain here.

"Paul masterfully engaged scientists, administration, and community leaders to come together in establishing research priorities and allocating resources into the science that would most rapidly impact patients," Nelson said. "Through this effort, he was even able to obtain funding from the State of Washington that supported prostate cancer research."
A third initiative by Lange and Vessally that was disease altering was the creation early on of what they called a "rapid autopsy program" in which metastatic cancer cells that are still living are removed from more than 20 bone sites of patients within a couple of hours after death.

This Rapid Autopsy Program, the first of its kind in the world and still one of only a few in operation, has now been ongoing for over 20 years. More than 150 such autopsies have been done, resulting in one of the largest tumor banks on metastatic prostate cancer in the world.
"It is quite safe to say that several of the major treatment advances in the field that have extended the survival of men with advanced prostate cancer were fueled by the UW-IPCR Rapid Autopsy Program," Nelson said. "Biospecimens have been shared with numerous investigators throughout the world--at academic centers as well as pharma and biotech companies, usually with the none-to-minimal cost to them."
Of the initiative to gather the funds to create the endowed chair in Lange's name, Nelson told me it "will serve as a lasting and living legacy that will be used to support young scientists who embody Paul's curiosity, tenacity, creativity, and drive to eliminate prostate cancer."

Lange has repeatedly predicted that prostate cancer "will be controlled if not mostly cured" in his lifetime, reducing the disease from the second leading cause of cancer death among men to a minor cause. And he believes the IPCR will figure prominently in this achievement.
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City of Hope's Biller Center underpins grants to bring 'humanistic side' to healthcare

In a healthcare world where breaking down traditional silos will be a key part of addressing the challenge of change that lies ahead, the hands-on philanthropy of a Seattle couple in their involvement with City of Hope has been the underpinning of two grants to provide training on the humanistic side of medicine.

 

The grants, both $1.5 million for five years, are from the National Cancer Institute to City of Hope, a nationally regarded cancer research and treatment facility in Duarte, east of Los Angeles, and are designed to train representatives from cancer centers around the country. By seeking involvement in the programs, the institutions have indicated they wish to change, and want to understand how to go about it.

 

Matt Loscalzo, executive director of the department of supportive care medicine at City of Hope, helped create the models for both the breaking-down-silos grant and one for a tablet-based program to train health professionals in how to screen cancer patients for issues that might affect their care.

 

He credits City of Hope's Sheri & Les Biller Patient and Family Resource Center, supported with both dollars and direct involvement by the couple who transplanted from Los Angeles to Seattle several years ago, with attracting the attention of NCI to the grant applications.

 

"We would not have gotten these grants, at a time when very few grants are being funded, without the philanthropic and institutional partnership that exists between CoH and the Billers, who are veryactively involved in the operations of the Center," Loscalzo said. "Most institutions say to philanthropists, 'we're pleased to get your money, now please leave us alone.' It doesn't happen that way with CoH and the Billers."

 

City of Hope bills the center, which in October is celebrating the fifth anniversary of its opening, as "the international model for compassionate care" and touts CoH itself as "one of the only institutions in the United States to offer this level of comprehensive support."

 

The grant that is likely most exciting to Loscalzo, whom I met at City of Hope two years ago in an introduction by Sheri Biller, is the one to train representative teams from other cancer-care institutions in the use of the tablet, a device named theSupportScreen. He pioneered the device that has become a vital part of the compassionate care that is the key to the Biller Center's success.

 

Loscalzo says the SupportScreen, a "primitive prototype" of which he brought to City of Hope when he came there from UC-San Diego in 2007, is used to identify physical symptoms, psychosocial problems, family concerns and triages the patient's concerns to the designated professionals or resources."

 

The SupportScreen prompts patients to answer various questions regarding their care and concerns and researchers have found that patients are frequently more likely to share fears and concernswhen prompted by a computer application rather than by face-to-face personal questions.

 

Although the Billers have moved to Seattle, where Les has become chairman of Sterling Bank, they remain closely involved with City of Hope, where Sheri is chair of the board.

 

The purpose of both grants is to, as Loscalzo puts it, "transform the humanistic side of medicine, a recognition that innovative approaches that are patient and family centered represent an idea whose time is coming, real soon. And the rest will come later."

 

While both grants are focused on cancer care, Loscalzo suggests "they are models for dealing with other chronic diseases."

 

Evidence of the interest the silos-breakdown concept is having with healthcare facilities around the country is that the next session, to be held in October at Mt Sinai Hospital in New York, which is City of Hope's partner in the grants, attracted more than 200 applicants for the 50 spots. City of Hope and Mt. Sinai will rotate in conducting the semi-annual programs.

 

The grants will entail training teams of health care professionals: physicians, nurses, social workers, psychologists, business administrators and chaplains who, when they return to their respective institutions, will be expected to begin a process of changing the cultures there.

 

The institutions that have sent representatives to the sessions have agreed in advance that they want agents of change trained in how to do that, and the programs involve regular followups with the attendees to track their progress and assist with challenges in leading the change process.

 

And the breadth and extent of interest by cancer centers around the country should be taken as a positive sign that they understand the need to change.

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Patient advocates represent a growing trend in healthcare system evolution

As dramatic changes in the healthcare system unfold, an emerging piece of those changes is the growing role being played by advocates who become in-person navigators of the system for patients and their families.

 

It's a healthcare innovation that won't mean the eventual end of one-on-one doctor-patient interactions, but proponents of the advocate role suggest it will lead to far larger percentage of physician visits in which a patient is accompanied by his or her "team."

 

Scott Forslund, director of strategic communications for Premera Blue Cross of Washington, suggests that "One benefit of a patient advocate model is that it may provide a fiduciary responsibility by allowing for focus on only the one patient that the advocate is serving."

 

Forslund adds that "The escalating cost of care and the complexity and fragmentation of the healthcare delivery system are hugely driving the need for better coordination of care and greater economic engagement by consumers and advocacy on their behalf."

 

It's that "advocacy on their behalf" that is driving the new trend on behalf of patients. And it is attracting a growing number of entrepreneurs who are parlaying their years of experience in the healthcare industry into new companies that they hope will grow as the field becomes more broadly known.

 

Three of those businesses, created by entrepreneurs who have picked different pieces of the advocacy picture, are in the Seattle area. One is a health advocacy company, another is focused on home healthcare and the third is seeking to create a personal heathcare guide for patients and their advocates.

 

Robin Shapiro
Robin Shapiro,
Allied Health Advocates 

Allied Health Advocates (AHA) is a health advocacy company focused on providing in-person assistance to patients and their families who are navigating the health care system, "whether facing a new diagnosis, an immediate health care issue or managing a chronic and complicated medical condition."

 

Robin Shapiro, president and COO of AHA, which she co-founded in 2008 with partner Beth Droppert, says the advocate industry is forming around the idea that patients want to get more engaged in the healthcare experience, but lack the background to be really involved.

 

"Patients don't understand the pressures on doctors, so we act as navigators and as a sounding board, bringing good communications to the process so doctors can be more efficient with patients," Shapiro says.

 

She admits it's a field too new for a lot of doctors "to even know about the role we play." But she adds that "the doctors we have worked with have been very supportive, cooperative and at times grateful that we work with the patient and the health care team."

 

Virginia Kenyon
Virginia Kenyon
Kenyon HomeCare 

Virginia Kenyon, whose Seattle-based Kenyon HomeCare Consulting provides consulting services for a variety of home health hospice and home care agencies, views the advocate role as "critical in this day and age of complex medications and procedures and the options now available to all of us."

 

At this point the advocate role is not covered by insurance or Medicare.   

  

But Kenyon, who started her business in 1999, suggests that if insurance companies could see that the advocate role would reduce costs and improve health and care, they might be willing to pay for it.

 

"Right now they probably would view it as costing them more because the advocates would push for coverage that companies currently will deny," Kenyon added.

 

Kenyon recalls that early in her career as a nurse, in the 1970s, "nurses used to be required to advocate for their patients, which sometimes was very difficult because it could out you at odds with the physician."

  

She notes that a settlement in a recent federal suit against Medicare for its requirement that home healthcare agencies had to close cases of patients who weren't showing progress will also serve to reduce healthcare costs.


 "Keeping people at home and keeping them stable, even if they are no longer making progress or improvement, will keep people at home and stable rather than being in the hospital," she said. 

 

Trini Evans
Trini Evans
StrataLife Solutions 

StrataLife Solutions LLC was founded two years ago by Trini Evans, who brings a 25- year healthcare background in nursing and home healthcare roles to her effort to launch her publication-focused business.

 

The Health Advocate Guide, the launch product for her business, is designed to be a personal medical communication system that is taken by the patient or a "team" member to each physician visit. The three-ring binder (which also has a patient's information on line), contains forms and legal documents, such as healthcare directive and durable power of attorney for healthcare, as well as pages to guide the collection and retention of doctor-visit records.

 

One of the pages in the guide advises patients on "gathering your team," suggesting that one team member would accompany the patient to doctor visits, thus serving as advocate to take notes, ask questions and ensure accuracy in dealings between patient and medical professional.

 

"It's designed to give a patient the ability to be a participant in their care, rather than an observer of it," she says.

 

Some involved in the healthcare industry suggest there is a latent pressure building for advocates who will help patients navigate the array of procedures for various diseases and conditions, balancing benefits with costs, and actually slowing, or bringing down, healthcare cost

 

Thus part of the effort to get control of the escalating costs of healthcare might find advocates, for example, helping a patient with a particular cancer weigh the relative benefits of an array of similar procedures to address the cancer that, in Seattle, can range in cost from $800 to $57,000, depending on where the procedure is done.

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