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In New Jersey, Focus in Fight Against Cancer Changes, and Care Comes Closer to Home

Mary K. Caffrey
A spokesman for the NJ Department of Treasury, Christopher Santarelli, said in an e-mail that $391.5 million in cigarette tax revenues are deposited “for general state use.” Currently, 76% of the MSA funds are used to pay bondholders and the rest goes to the Treasury; Santarelli said that this use is consistent with the purpose of the MSA, which is to repay states for the cost of  tobacco-related illnesses.

“Would it be ideal to have more money?” Grana asked rhetorically. It would always be better to have more, but she and Robles-Rodriguez sounded hopeful about how far they have come, using funds from multiple public and private sources. Said Grana, “The governor’s Office on Cancer Prevention and Control has done a great job of building the infrastructure we have.”

At CINJ, Getting the Right Therapies to Patients

The annual retreat on cancer research, co-sponsored by CINJ and the Commission on Cancer Research (CCR), came on May 21, 2014, at the height of the effort to restore millions in research dollars to the state budget. It was a display of contrasts, which at the time were quite serious. At the check-in table, a CCR commissioner hawked the familiar “Conquer Cancer” license plates while grumbling about Christie’s proposed cuts to research. Meanwhile, keynote speaker Arnold J. Levine, PhD, formerly of Princeton and Rockefeller Universities and today a professor at Rutgers Robert Wood Johnson Medical School, treated medical students to a high-level talk on his decades of work with p53-knockout mice, which has revolutionized the study of how cancer develops.

The breadth of studies at New Jersey’s research retreat was impressive: posters featured everything from preclinical studies on agents to treat pancreatic cancer, to studies of breast cancer among women veterans at the East Orange Veterans’ Administration hospital. With 134 clinical trials in various phases, the East Orange VA is yet another important source of cancer research.

At a session designed for the public, medical oncologist Janice Mehnert, MD, a Rutgers graduate, covered the rising incidence of melanoma along with CINJ’s ability to deliver newer immunotherapies to treat it through clinical trials. Mehnert was among those sounding the alarm about the dangers of too much sun. “Many of my patients come from Monmouth and Ocean counties,” she said.

In a later interview, CINJ’s Kaufman said getting the best, new therapies to cancer patients is among the institute’s main goals. “The division of clinical science is dedicated to identifying the most promising new drugs in development, to looking at new technology, in terms of diagnosis as well as treatment, and to fostering that translation into getting these things to the patient,”

Kaufman said.

Bringing CINJ into Rutgers, he said, has allowed better integration with the research units that do basic science; for example, the chemistry department has faculty that work on drug  development, but in the past lacked the connections to get their work into clinical trials. “We’re also trying to develop much stronger relationships with Newark, which has a different population of patients and different types of cancer,” Kaufman said. Both Rutgers and the state medical school have long had a presence in Newark, and the integration will open doors for more clinical trials at multiple sites that attract both larger numbers and a more diverse patient population.

Already, Kaufman said, CINJ is expanding its precision medicine program; the program has treated an initial 100 patients and is in the process of treating 500 patients. Of the first 100, Kaufman said, “40% had a change in clinical management based on information identified in genomic analysis.”

For South Jersey, a School of Its Own

Arguments for giving South Jersey its own medical school and cancer center have been around for years. The population is growing. The demographics tilt toward seniors, who don’t want to travel far for care. Putting new medical facilities in Camden would provide jobs and economic development the city desperately needs. But most of all, the case makes sense medically. All one has to do is look at a map.

The southernmost counties that make up the area MD Anderson at Cooper serves have higher rates of cancer incidence and mortality than the rest of the state, according to CDC data. Higher smoking rates and demographics account for most of this, Grana said.

A visit to MD Anderson at Cooper reveals a hospital built from scratch with customers in mind. A wide driveway designed for easy pickups and drop-offs gives way to an airy entrance, and the facility features ample room for families and a healing garden. Patients receiving infusions can do so together or in private rooms. There’s no more hurrying to multiple appointments on different floors; instead, the doctors take turns visiting the patient in a state-of-the-art “pod.”

The relationship between MD Anderson and the medical school is close, with the cancer center’s physicians serving on the Cooper Medical School faculty, according to Grana. She said members of the incoming class were admitted based on both academics and their embrace of Cooper’s service ethic, for the purpose of “populating South Jersey with physicians who are well-trained and committed to the mission of the school.”

Cooper’s third class is highly competitive, according to data supplied by John McGeehan, MD, associate dean for student affairs and admissions. Some 5200 applicants vied for 72 spots in the class of 2018, and 53 members of the incoming class are from New Jersey.

Bringing the MD Anderson name and relationship to Cooper was no small feat, Grana said. Three factors that made MD Anderson interested were Cooper’s “completely employed physician model,” an existing infrastructure that supported clinical research and strong community outreach for cancer prevention and control, Grana said. After initial meetings took place, a 6-month due diligence period followed during which MD Anderson reviewed “every aspect” of Cooper’s program, she said. The agreement was signed in September 2013, and the new facility opened a month later.

There’s plenty of back-and-forth travel between Houston and Camden; faculty from the 2 sites sit on each other’s tumor boards and take part in numerous committees that cover everything from health information technology to patience experiences. Outreach is expanding, too. Robles-Rodriguez is seeing her role grow into new prevention and survivorship programs, which will be measured more than ever under the ACA. Cooper’s historic role as the provider for those without insurance is allowing the hospital to take the cancer screening data on patients who now have coverage, and deliver it to new patient-centered medical homes.

For those who have survived cancer, group sessions are allowing those who have had similar diseases to support one another as they work with Cooper to get nutrition information and develop a treatment plan, a new ACA mandate.

During 17 years at Cooper, Robles-Rodriguez has seen plenty of change, and she sounds optimistic. Years ago, patients fighting breast cancer “only had a handful of medications,” she said. “Now we have an arsenal of weapons. That has made a big difference, especially for those with more aggressive disease.”

More and more people are hearing the message, she said, “The earlier you detect the cancer, the higher your chances of surviving the disease.”

References

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6. Skin cancer: a call to action. Cancer Institute of New Jersey website. http://cinj.org/patientcare/skin-cancer-prevention-call-action. Accessed August 10, 2014.

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8. New medical school building opens in Camden [press release]. Camden, NJ: Rowan University; July 24, 2012. http://today.rowan.edu/home/news/2012/07/24/new-medical-schoolbuilding-
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9. George J. Get a look at the MD Anderson Cancer Center at Cooper. Philadelphia Business Journal. http://www.bizjournals.com/philadelphia/blog/health-care/2013/10/get-a-look-atthe-md-anderson-cancer.html. Published October 7, 2013. Accessed August 4, 2013.

10. Heyboer K, DeMarco M. Gov. Christie signs higher education merger bill. The Star-Ledger. http://www.nj.com/politics/index.ssf/2012/08/gov_christie_signs_nj_higher_e.html. Published August 22, 2012. Accessed July 25, 2014.

11. Livio SK. Chris Christie’s budget proposal slashes funding for cancer research. The Star-Ledger. http://www.nj.com/politics/index.ssf/2014/04/nj_lawmakers_physicians_questions_state_budget_cuts_to_cancer_research.html. Published April 19, 2014. Accessed May 11, 2014.

12. Johnson B. Christie partially blames cancer research cuts on public worker pension costs. The Star-Ledger. http://www.nj.com/politics/index.ssf/2014/04/christie_blames_cancer_research_cuts_on_public_worker_pension_costs. html. Published April 29, 2014. Accessed July 25, 2014.

13. Johnson B. NJ Senate passes state budget that makes pension payment, hikes taxes. The Star-Ledger. http://www.nj.com/politics/index.ssf/2014/06/nj_senate_passes_state_budget_that_makes_pension_payments_hikes_taxes.html. Published June 26, 2014. Accessed August 4, 2014. Confirmed final outcome of NJ budget via e-mail with District office of state Sen. Loretta Weinberg August 5, 2014.

14. Spending on tobacco prevention: New Jersey. Campaign for Tobacco-Free Kids website. http://www.tobaccofreekids.org/what_we_do/state_local/tobacco_settlement/new_jersey. Updated February 27, 2014. Accessed July 25, 2014.

15. State legislated actions on tobacco issues 2010. American Lung Association website.http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB8QFjAA&url=http%3A%2F%2Fwww.lungusa2.org%2Fslati%2Freports%2FSLATI_2010_Final_Web.pdf&ei=SvLnU4vzL9P7yATtk4H4CQ&usg=AFQjCNGdL2JVKUsO9zGD0J7xoLAgPqoDNg&sig2=qrphIP3fcOyLWEYSjJmf2Q&bvm=bv.72676100,d.aWw. Published 2010. Accessed August 9, 2010.

16. Kitcheman A. Linking industrial pollution to cancer in Toms River. NJ Spotlight. http://www.njspotlight.com/stories/13/06/02/linkingindustrial-pollution-to-cancer-in-toms-river/. Published June 3, 2013. Accessed August 7, 2014.

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18. Hayes A. N.J. bans minors from tanning beds. CNN.com. http://www.cnn.com/2013/04/02/health/new-jersey-tanningminors/.Published April 2, 2013. Accessed August 9, 2014.
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