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86 THOUGHT LEADERSHIP 7 Questions with Memorial Sloan Kettering Cancer Center's Dr. Craig Thompson By Tamara Rosin I t's an exciting time to lead a cancer center. e rapid pace of scientific medical discover- ies, the development of new diagnostic sys- tems and therapies and the promise of hundreds of clinical trials lends clinicians and leaders of cancer specialty hospitals optimism that the patients they treat on a daily basis will soon no longer face the disease at all. e Obama admin- istration's precision medicine and cancer moon- shot initiatives only add to this momentum. Craig B. ompson, MD, is one of those leaders. Dr. ompson has served as president and CEO of Memorial Sloan Kettering Cancer Cen- ter since 2010. For 11 years prior to joining MSK, Dr. ompson was affiliated with Philadelphia-based University of Pennsylvania, first as a professor and scientific director, then as director of the university's Abramson Cancer Center and associate vice president for cancer ser- vices of the University of Pennsylvania Health System. He received his medical degree in 1977 from the University of Penn- sylvania Medical School and received clinical training in internal med- icine at Harvard Medical School in Boston and in medical oncology at the Fred Hutchinson Cancer Research Institute at the University of Washington in Seattle. Dr. ompson has published more than 350 peer-reviewed manuscripts and more than 85 reviews in the fields of cancer biology and immunology. Here, Dr. ompson took the time to answer our seven questions. Note: Responses have been lightly edited for length and clarity. 1. What is the No. 1 issue facing your patient population today? Patients come to MSK because they are told they have cancer. is is of- ten the most serious illness they've experienced in their lives. ey come to us to confirm their diagnosis and to explore and discuss treatment. Many patients enroll in clinical trials because they are state-of-the-art or because we can offer them hope with the development of new therapies and modalities, especially in the new field of immuno-oncology. Cancer is a disease many of our patients are unlikely to have already faced in their lives. ey come to us with all of their concerns and fears. 2. What is the biggest issue facing your organization? e biggest problem for our organization is the fact that we — and many of the other hospitals involved in cancer care — are becoming increasingly successful. Today's cancer patient wants therapies to be more accessible. Once the initial scare of the diagnosis is over and they begin their treatment plan, patients don't want to be in a complicated hospital setting. ey want a treatment setting that is more conducive to their lives, that will enable them to continue their jobs and take care of their families. However, cancer can affect every organ of the body; hospital resources are difficult to replicate in the outpatient setting. e question is, how can we increasingly deliver effective cancer care on the outpatient side? Today, 90 percent of cancer patients receive care in an outpatient set- ting. It used to be 10 percent. We expect that by 2025, 85 percent of the patients we treat will never spend a day in the hospital unless they have surgery or a complication from treatment. 3. What is your biggest goal for MSK in 2016? Right now, so much has been learned in cancer diagnostics, particularly the ability to go beyond organ-site specific diagnosis. It is no longer enough to say "breast cancer," "lung cancer" or "colon cancer." Our No. 1 goal is the effective implementation of molecular diagnosis to per- sonalize therapy. We are incorporating precision medicine and immu- no-oncology, and combining them with traditional forms of cancer therapy, including radiation and chemotherapy. 4. What is your reaction to the Obama administration's na- tional cancer moonshot initiative? How do you see this ini- tiative affecting cancer care? e cancer moonshot initiative is, in its broadest sense, a unique op- portunity for leaders of the medical, science and political communi- ties to advance an ambitious and important goal. Better understand- ing the genome will help us make strides in bringing new scientific results into new therapies. One thing we've learned is cancer is not just one disease. It's really as many as 400 diseases — each person and tumor is different. Despite the announcement of the cancer initiative, there is not just one goal. ere won't be one treatment for all cancer patients. e initiative is exciting, but will it really accelerate the rate of break- throughs for treatments for cancer patients? Scientific research that underpins our understanding of cancer can produce treatments and ul- timately help us lower the risk for cancer. e moonshot's goal of accel- erating the pace of transition from research to treatment is something everyone can embrace. No one would argue that we couldn't use more funds. But the important issue isn't the amount of money the adminis- tration has assigned for the initiative. e more important issue is rec- ognizing the significance of molecular diagnosis to pair patients and their tumors with the most effective treatment options and creating the regulatory changes necessary to enable it. 5. How do you think the NIH's goal to get 1 million people to volunteer their medical and genomic data will impact research and development for precision medicine? I don't believe that with our state of knowledge on aggregating data the approach will be technically feasible in this decade. To bring together medical and genomic data is cost-prohibitive in the current healthcare climate and not scaled sufficiently to recognize the genetic diversity of the American population. It will be a big struggle to aggregate all of the healthcare data — Amer- icans oen change jobs, insurers and providers. eir medical data is not all in one system. ere are also challenges around the willingness to share all of that information from health records and DNA. It would be more practical to start with a specific disease population for whom we need to understand the underpinnings of why the disease arises. e Cancer Genome Atlas program was program like this from the NIH that was more limited in scale but very successful. 6. What do you think are the main differences between leading a cancer hospital and a non-specialty hospital? We are unique in that we only take care of one major disease. MSK is the oldest and largest private hospital serving cancer patients. We've existed