Grey image of Helford Hospital

The road to comprehensive cancer care

“People thought City of Hope was a ship!”
It’s hard to believe, but there was a time when the sprawling, globally recognized City of Hope we all recognize today was a smallish institution that barely registered a blip in the cancer community.
“People had never heard of City of Hope,” recalled John Zaia, M.D., Aaron D. Miller and Edith Miller Chair in Gene Therapy, director of the Center for Gene Therapy and a fixture at City of Hope for 40 years. Did people really think it was a ship? “It was a pretty small place,” he smiled.
In fact, for the first 30-plus years of its existence, City of Hope’s focus had nothing to do with cancer. It was established in 1913 as a tuberculosis sanatorium, a purpose that all but disappeared after 1945, when newly discovered antibiotics pushed TB into decline.
With its original mission no longer a priority, leadership pivoted. Executive Director Samuel L. Golter drew up a plan to transform City of Hope into a national institution dedicated to the research and treatment of cancer and other diseases. His vision continued under Ben Horowitz, who took over in 1953 (and remained until 1985) with the goal of creating, in his words, “a pilot medical center that handled people with diseases that were not well understood or where treatment was not easy to come by.”
Breakthroughs and innovations — a radiation therapy machine, bone marrow transplants, recombinant DNA techniques — came rapidly. Would national recognition follow?
Then in 1971, as part of President Richard Nixon’s “War on Cancer,” the National Cancer Act established standards and guidelines for cancer institutions and designated three official levels of such facilities: basic laboratory cancer centers, clinical cancer centers and comprehensive cancer centers.
With this new, centralized infrastructure in place, it became clear that National Cancer Institute designation would bring many benefits to centers that received it: national attention, increased funding and a powerful tool for recruiting top clinicians and researchers.
“The designation is very meaningful,” said NCI Director Norman E. Sharpless, M.D. “It signifies high quality and commitment, and it’s highly sought after.”
“It’s a mark of distinction,” agreed Michael Friedman, M.D., emeritus chief executive officer at City of Hope and its leader for a decade (2003 to 2013). Surprisingly, not every eligible medical center sought that “distinction” at first. “In 1971, there was still great naivete about the biology and treatment of cancer,” he continued. “It’s possible some institutions didn’t want to be known as cancer centers. One actually turned down the designation!”
Not City of Hope. Almost immediately, work began toward achieving NCI designation, and it paid off, first in 1981 with official cancer center status under the direction of Charles Todd, Ph.D., followed by the comprehensive cancer center title in 1998.

Reaching for the Top

Getting there wasn’t easy or quick or inexpensive, especially when it was decided to reach for the “comprehensive” level, demonstrating excellence in a broad array of disciplines, from research to clinical care to community work and population studies.
“Our components were not yet fully developed,” recalled John Kovach, M.D. He came aboard in 1994 with the “main charge” of reaching that “comprehensive” status, familiar turf for him, having presided for 18 years at the Mayo Clinic, one of the first NCI-designated centers.
Some of those missing pieces required extensive recruitment. Others, like population studies, called for some “formalization.” Kovach went about the task one component at a time, from a better-staffed pediatrics department to building up the genetics studies area to developing a manufacturing capability. He downplays his own efforts, but praises the board of directors for their open minds — and wallets.
“Everyone pulled together — they all shared the same vision,” he said. “I was just the ‘admiral’ brought in to hire a few new crewmen. The talent was already there. The board was remarkable. Every time I brought a new program suggestion to them — and each one came with a cost — they said, ‘Go ahead!’”
Getting the designation is one thing. Keeping it is quite another.
“It can take up to a year and a half just to prepare the application, and it must be renewed every five years,” explained Deputy NCI Director James H. Doroshow, M.D. He’s done it more than once. From 1983 to 2004, Doroshow chaired City of Hope’s Department of Medical Oncology & Therapeutics Research.
To maintain the coveted designation, City of Hope typically brings in dozens of outside experts to assess the center’s fitness. It’s a rigorous process that kept some administrators up at night.
“I worried about it all the time,” admitted Friedman. “I didn’t want to be the one who lost it!”
Today, City of Hope benefits from the veteran, highly experienced leaders who know what it takes to maintain NCI’s standards of excellence. Director Steven T. Rosen, M.D. is the longest-tenured comprehensive cancer center leader in the U.S. Before City of Hope, where’s he’s been since 2014, Rosen helmed the comprehensive cancer center at Chicago’s Northwestern University for 25 years. At City of Hope since 2017, President Michael Caligiuri, M.D., is also running his second comprehensive cancer center; he spent 14 years in charge of The Ohio State University’s facility in Columbus, Ohio.
For patients, seeing that NCI “mark of distinction” can be reassuring. Doroshow calls it a “stamp of approval” not easily earned. “It means the institution has assembled a faculty of excellence. Very few institutions wouldn’t want that.” It also points to, in Kovach’s words, a critically important “diversity of talent and broad base of expertise” conducive to collaboration, innovation and new ideas.
As for the staff itself, already renowned worldwide for compassionate care, maintaining NCI’s highest standards provides important direction.
“Meeting those requirements affects our daily decisions,” stressed Zaia.
“It charts the seas upon which we sail.”