The UF Health Cancer Center at Orlando Health

First, I hope you had a joyous holiday season and New Year celebration! 2013 was an extraordinary year for UF Health. The next two editions of OTSP will summarize our progress, but first I’d like to address a major development that occurred at the end of 2013.

On Dec. 16, we announced the creation of the UF Health Cancer Center at Orlando Health.

Why are UF Health and Orlando Health joining forces in the fight against cancer? Essentially, it gets back to our core commitment to serve patients with the highest quality of care, and an opportunity to do so in collaboration with a health care system that is culturally aligned and has complementary strengths.

Our 2010 Strategic Plan (“Forward Together”) puts quality patient care at the heart of everything we do, and expresses a commitment to our local community, our region and the state of Florida. Indeed, as stated in Forward Together, “our goal is to develop a regional approach to the provision of health care that presents an effective model for the state and the nation.”

As systems of health care delivery evolve, academic health centers like ours are increasingly taking responsibility for the health needs of an overall population. The goal is to create a system that improves health through prevention, through early diagnosis and treatment of acute illness, and through optimal management of chronic illness — focusing on the home and on outpatient services that maintain the highest quality of life possible.

When someone is diagnosed with a serious illness like cancer, our goal is to bring the best minds together, from all pertinent disciplines, to understand the medical history of that particular patient and all the findings related to his or her specific cancer, and determine the best treatment based on accumulated medical evidence.

The immediate population we serve is, of course, Gainesville and the surrounding region. Indeed, in the course of implementing our strategic plan, we have invigorated our commitment to serving our community as the first choice for any health care need, from primary care through the most highly specialized service. In view of our statewide mission as Florida’s premier integrated academic health center, however, along with the goals of population health care, it has become increasingly apparent that patients in both the Gainesville and Orlando regions would benefit from coordination of the services of health systems in their respective communities. As applied to the new UF Health Cancer Center at Orlando Health, this means that a patient with newly diagnosed cancer now will benefit from a larger number of experts giving thought to his or her particular situation, exchanging relevant scientific and clinical data, and making treatment decisions on that basis.

In view of these considerations, and in recognition that we have common goals and a shared commitment to quality as Job 1, on Oct. 14, 2010 Orlando Health and UF Health (i.e., the University of Florida and Shands HealthCare) announced a memorandum of understanding “to form joint clinical programs in the areas of pediatrics, neuroscience, oncology, women’s health, and transplantation and cardiovascular medicine.” It was also stated that UF Health and Orlando Health would “look to increase undergraduate and graduate medical residency and fellowship training opportunities at Orlando Health, and open opportunities for conducting clinical trials through UF’s robust clinical research program, while also launching common approaches to quality care and safety initiatives.”

Since then, there has been progress on a number of fronts:

• Neurosurgery: UF neurosurgeons, led by department chair William Friedman, M.D., began helping with call coverage on April 1, 2013. Four neurosurgeons and one stroke/endovascular surgeon are now employed in the joint UF Health – Orlando Health program, and UF faculty are now doing the vast majority of neurosurgical cases at Orlando Health. Since Comprehensive Stroke Center status was achieved in November, the stroke alert volume has increased from five/week to 30/week.
• Urology: The UF Department of Urology has been working collaboratively with Orlando Health since July 2012 to create a urologic services program led by department chair Johannes Vieweg, M.D. This is evolving as a comprehensive service staffed by UF faculty, Orlando Health urologists and private practitioners under a single governance umbrella that promotes common clinical pathways, joint educational conferences and joint quality programs.
• Pediatrics: Under the leadership of Scott Rivkees, M.D., chair of the UF Department of Pediatrics, the pediatrics residency at Orlando Health’s Arnold Palmer Children’s Hospital is now under the auspices of the UF College of Medicine. Effective Jan. 1, UF now staffs and oversees the medical education and general pediatrics division (about eight faculty members) of Arnold Palmer Children’s Hospital. In addition, pediatric patients with serious conditions requiring highly specialized services, such as kidney transplants and liver transplants, are now coming to UF Health.
• Recovery Center: An agreement is in place for the UF Health Florida Recovery Center to manage a substance abuse intensive outpatient program at Orlando Health’s South Seminole Hospital. This program is led by UF addiction medicine physician Timothy Huckaby, M.D.
• Cardiovascular Program: In support and enhancement of the clinical, educational and research programs in cardiology, interventional and general cardiology fellows from UF rotate through Orlando Health’s Orlando Regional Medical Center. These fellows benefit from exposure to community practice patterns, to higher volumes of patients with acute myocardial infarction and peripheral vascular disease, and to a large volume of imaging studies.

These UF Health – Orlando Health programs are continuing to develop and have set the stage for the UF Health Cancer Center at Orlando Health, which will officially begin on Jan. 31, when Orlando Health’s contract with MD Anderson Cancer Center in Houston expires.

According to recent studies by the National Cancer Institute, Florida now has the second-largest cancer burden in America, and cancer has surpassed heart disease as the leading cause of death in the Sunshine State. As stated by the chair of the Orlando Health Board, Dianna Morgan, “A need of this magnitude requires an innovative strategy for meeting this growing demand for cancer treatment and care. By connecting some of the nation’s most experienced cancer doctors and leading cancer researchers, we can collaborate to provide the best possible care and the most favorable treatment outcomes for cancer patients.”

The process by which this joint oncology program was created is summarized by Paul Okunieff, M.D., a professor and chair of the UF Department of Radiation Oncology and director of the UF Health Cancer Center: “Although announced formally last month, this has been a two-year process of warm and enthusiastic bilateral collaborations. We have created a relationship that is unique and special. Specifically, the administration, physicians, and clinical and basic researchers at Orlando Health and the UF Health Cancer Center are now a true joint entity. The relationship includes key components of the finances, clinical programs and research. The center will be led by a superb surgical oncologist from Orlando Health, Mark Roh, M.D., and is driven at both institutions by physicians with a mutual desire to advance care for individual patients and become a national leader in precision medicine. The common and warm synergy of cultures of our institutions and our dedication to the patients have been the keys to forging the UF Health Cancer Center at Orlando Health, and will continue to be the keys to our success in the future.”

Thus, the fundamental rationale for the UF Health Cancer Center at Orlando Health reflects our tri-fold mission: to create a virtually integrated environment in which synergies between patient care, research and education improve the care of patients with cancer in central and North Central Florida and beyond, create new knowledge that will improve the outcome of cancer patients in the future, and provide best-in-class training for the next generation of cancer specialists.

Working Groups on Quality, Clinical Care, and Clinical Research have already been collaborating for months to get things right before the UF Health Cancer Center at Orlando Health opens Jan. 31. They have had several retreats and have developed exciting and significant collaborative strategies that will improve and strengthen our clinical, research and educational programs. Joint clinical protocols have been established, as have joint tumor boards, and an approach to the treatment of patients for special services that are available only at one or the other site. For example, 140 people in the Orlando area require bone marrow transplant each year, a service not available at Orlando Health. Through collaboration between hematologic oncologists at UF Health and Orlando Health, most treatment prior to a transplant can be rendered in Orlando. This collaboration will involve a single, common, multidisciplinary treatment plan that moves with the patient whether in Orlando or Gainesville. From the patient’s perspective, their caregivers are one, unified team. When a transplant is required, and the patient must come to Gainesville for the extended hospitalization period of the transplant, the patient’s Orlando physicians participate in the treatment via access to Epic MyLink and joint multidisciplinary Tumor Board videoconferences. With completion of inpatient BMT the patient’s care continues uninterrupted back in Orlando.

In addition to the Hematologic Malignancies Joint Tumor Board, which will assist patients requiring bone marrow transplantation, joint multidisciplinary Tumor Boards focused on gastrointestinal cancers, head and neck and lung cancers, and breast cancer also have been set up. These joint tumor boards bring together UF and OH experts in medical oncology, surgical oncology, radiation oncology, pathology and radiology to individually assess each patient’s case, to define the best possible treatment course. Thus, any given patient’s case will be reviewed by many expert oncologists who specialize in that individual’s type of malignancy, instead of a single cancer physician who sees all types of cancers.

The individualized treatment plans generated by these joint Tumor Boards will be able to access treatment resources available that were not possible with each program separately. For example, while bone marrow transplantation is available for Orlando Health patients in Gainesville, intraperitoneal chemotherapy is available for Gainesville patients in Orlando. In addition, Gainesville offers several programs for side effects of cancer, such as the cancer cardiomyopathy clinic, and advanced endoscopy and bronchoscopy procedures to open up cancer-obstructed bowel or bronchi. Orlando offers a unique cancer survivors clinic, complete with psychological counseling to help patients overcome the often devastating emotional toll of their illness.

One of the first new initiatives to launch at the UF Health Cancer Center at Orlando Health will be personalized or “precision” cancer care, which takes into account the abnormal genes and gene products of a patient’s tumor in designing optimal chemotherapy. Genomic analysis will be performed in UF Health’s pathology laboratories. Dr. Phillips Charities has committed $1.5 million to the program. As Dr. Roh pointed out at the ribbon-cutting ceremony, this gift continues the strong and generous support of Dr. Phillips Charities over many years in helping Orlando Health fulfill its mission to the Orlando community.

Another important initiative is the joint integrated data base that we are developing under the direction of Gigi Lipori, senior director for operational planning and analysis. This database currently includes information on inpatient, observation and ER patients, and ultimately will include information on outpatients, all of which will allow us to compare results, look for improvements in therapy and identify patient populations for clinical trials.

The UF Health Cancer Center will be among the top 5 largest academic cancer centers nationally, and the largest in Florida, with more than 10,000 new patients treated annually. Many of these patients will have tremendous new opportunities to participate in clinical trials. The joint oncology program with Orlando Health will have a single, common system for these trials. For example, an Orlando bone marrow transplant patient may be eligible to participate in a UF trial to prevent recurrence of hematologic cancer in patients after bone marrow transplant. The greater clinical volume will also facilitate phase 1 and 2 clinical trials, where new cancer drugs will be made available to Floridians that would not have been possible with a smaller cancer center. This will in turn lead to easier access to investment in translational research and the discovery of new treatments from our cancer center researchers. The UF Health Cancer Center in Gainesville has several clinical trials of new drugs not available in Orlando, and Orlando has clinical trials of new drugs not available in Gainesville. With the collaboration of our cancer centers, these trials will be opened at both locations. We expect to develop a stream of new medicines in collaboration with the pharmaceutical industry, which will provide a pipeline of new and effective treatments for cancer patients in Florida and beyond.

In summary, as President Machen stated succinctly during his speech at the ribbon-cutting ceremony: “This is an important new step for cancer treatment in Florida. By connecting our university’s research and treatment expertise with the exceptional health care organization that is Orlando Health, we bolster our capacity to improve patient care and outcomes. We can’t expect a magic bullet here. But we can create a dream team.”

Forward Together,

David S. Guzick, M.D., Ph.D. Senior Vice President, Health Affairs President, UF Health