Latest / Becker’s Healthcare - Clinical Leadership Podcast / Expanding Access, Translational Research, and the Future of Cancer Care with Dr. Robert A. Figlin

Transcript

Expanding Access, Translational Research, and the Future of Cancer Care with Dr. Robert A. Figlin · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
  This is where health care leadership comes together.
• 0:04
  Becker's sixteenth annual meeting brings more than 3,500
• 0:07
  hospital and health system executives and nearly 800
• 0:10
  speakers to Chicago April.
• 0:14
  This year's event includes keynote conversations with Dallas
• 0:17
  Cowboys legend Troy Aikman and former president George
• 0:20
  w Bush. For the agenda and event details,
• 0:22
  visit beckershospitalreview.com
• 0:25
  and click on the events tab in the
• 0:26
  upper right. We're looking forward to hosting you
• 0:29
  in Chicago.
• 0:31
  Welcome to the Becker's Healthcare podcast.
• 0:34
  I'm Elizabeth Gregersen, a reporter here at Becker's,
• 0:37
  and I'm thrilled today to interview doctor Robert
• 0:40
  Figlin,
• 0:41
  interim director of Cedars Sinai
• 0:43
  Cancer and interim director of the Samuel Ocean
• 0:47
  Comprehensive Cancer Institute on the podcast today. Doctor
• 0:50
  Figlin, thank you so much for joining me.
• 0:52
  I'm so grateful to share your insights with
• 0:54
  our audience.
• 0:56
  Thanks so much for the invitation. Happy to
• 0:58
  be here.
• 0:59
  Great. And before we dive in, could you
• 1:01
  introduce yourself and maybe just give a little
• 1:03
  bit about your background and your organization?
• 1:06
  Certainly. So I'm the Steven Spielberg family chair
• 1:09
  in hematology oncology.
• 1:11
  I'm a professor of medicine and biomedical sciences
• 1:14
  at the Cedars Sinai Health Sciences University.
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  And I lead the service line and the
• 1:20
  cancer efforts across our health system,
• 1:23
  which include multiple hospitals,
• 1:26
  many practices,
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  as well as our flagship center in, in
• 1:30
  West Hollywood and Beverly Hills, our which is
• 1:32
  our academic medical center.
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  Perfect. Thank you. And I'm grateful to talk
• 1:37
  to you. You know, it's not January 1,
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  but it's still the beginning of the year.
• 1:41
  So I'm grateful to kind of get your
• 1:43
  insights on,
• 1:44
  the landscape of cancer care today and maybe
• 1:47
  what we can look forward to in the
• 1:48
  future.
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  But before we get too far ahead of
• 1:52
  ourselves, I'd love to know from your vantage
• 1:54
  point.
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  Our audience, you know, they're made up of
• 1:58
  health system leaders that maybe aren't completely in
• 2:01
  the cancer space,
• 2:03
  other specialties, other priorities.
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  I'd love to know in your experience where
• 2:08
  you've seen maybe
• 2:10
  misalignment
• 2:11
  between a cancer program's growth ambition
• 2:14
  and those broader system priorities.
• 2:17
  And how can our audience as health care
• 2:19
  executives
• 2:20
  strategically decide how to balance,
• 2:23
  you know, those priorities,
• 2:25
  maybe deciding where to invest
• 2:27
  or not to invest,
• 2:28
  in cancer care over the next three to
• 2:31
  five years?
• 2:32
  Yeah. That that's a great question. And I
• 2:34
  think a question that we all struggle with,
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  not just today, but we struggle with over
• 2:39
  the last decade.
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  And I think that,
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  what Cedars Sinai is a horizontally integrated health
• 2:46
  system.
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  And what I mean by that is that
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  there are always going to be competing priorities
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  for assets,
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  whether it's, brick and mortar assets or research
• 2:56
  assets or,
• 2:58
  or personnel.
• 2:59
  And I think that what's clear is that,
• 3:03
  we as a service line,
• 3:06
  constantly
• 3:07
  try to make the case to leadership
• 3:09
  that,
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  the changes that will occur in care for
• 3:13
  cancer patients
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  over the next decade
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  will dictate the priorities of what we do
• 3:19
  today. What do I mean by that?
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  You just heard from the American Cancer Society
• 3:24
  that more than seventy percent of patients survive
• 3:26
  more than five years with cancer.
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  Now what that means is that more and
• 3:31
  more cancer patients are going to become part
• 3:33
  of our health system
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  whether it's patients with active cancer,
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  patients who are in remission,
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  or patients who are survivors,
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  or for a place like like Cedars,
• 3:45
  people who are at risk
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  and need, aggressive screening.
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  So I think it's important for us to
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  continue to make the case
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  recognizing
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  that those competing interests
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  are also aligned with a horizontally integrated system,
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  meaning that more cancer patients are developing cardiovascular
• 4:03
  disease.
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  More cancer patients are developing diseases associated with
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  chronic toxicity
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  and survivorship,
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  and these are all gonna be required.
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  But for the active cancer patient,
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  the patient with newly diagnosed cancer,
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  the key for the patient and the key
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  for the system is access.
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  Access, access, access. If you're a cancer patient
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  and you want access to our health system
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  or any health system across the country,
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  you wanna know that when you are at
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  risk for that diagnosis,
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  that you're going to be able to access
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  experts,
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  people people capable of delivering care in an
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  expedited fashion.
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  So one of the ways that we've dealt
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  with that in the Cedars Sinai health system
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  is in what I would otherwise call a
• 4:48
  distributed model. What do I mean by that?
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  We have other hospitals.
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  We have other practices that are all under
• 4:56
  our domain.
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  They use our infrastructure,
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  our,
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  EHR,
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  our organizational,
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  supply lines.
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  But it's critical because I think one thing
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  that's also changed about cancer care in 2026
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  and going forward
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  is patients would like to receive their care
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  close to home if at all possible.
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  And I always like to to give this
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  anecdote.
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  Cedars Sinai Health System serves a population of,
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  approximately
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  11 plus million people in our catchment area.
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  We are larger
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  than some states.
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  And that's important for those of you that
• 5:34
  visited Los Angeles, unlike Manhattan as an example,
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  as we are a very horizontal,
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  community.
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  And sometimes it can take an extended period
• 5:44
  of time to travel short distances.
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  That's why we believe that what people should
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  be considering
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  in the health system
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  is bringing their expertise
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  to their communities
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  so that they can have town and gown
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  delivered
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  and reserve the,
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  expertise of the center for those things that
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  are necessary that can't be delivered in the
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  community.
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  Absolutely.
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  Thank you for laying that all out and
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  kind of giving, you know, that geographic visual,
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  but I think it just ties back perfectly
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  to what you said about access. You know,
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  when there are all those, you know, survivorship,
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  considerations
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  and
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  this chronic now condition that people are are
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  saying cancer may be,
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  none of that care can happen, right, without
• 6:28
  access. So, you know,
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  we need that access first in order for
• 6:33
  patients to to receive
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  all that innovation. And and I I think
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  that's absolutely true, but it but it can't
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  has to be more than access only
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  because it has to be access with deliverables,
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  in my view. And what I mean by
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  that is we need we have what I
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  I think most places would consider a team
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  approach,
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  whether it's our multi d clinics,
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  in pancreas cancer, colorectal cancer, lung cancer, and
• 6:58
  breast cancer.
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  But it's also, as we'll talk about in
• 7:01
  a bit, the appropriate use of mid level
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  providers
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  to make sure that we are delivering care
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  in a comprehensive way where everyone is practicing
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  at the top of their license
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  and making sure that we bring patients through
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  the system in a way that's compatible with
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  what they need for their care.
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  Perfect.
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  I'd love to
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  talk about another operational bridge,
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  discovery and clinical care. Right? So that's that's
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  a big one I always hear is the
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  bench to the bedside.
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  How at Cedars Sinai and Samuel Ocean have
• 7:34
  you approached kind of building that bridge between
• 7:36
  discovery and clinical care? And what lessons might
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  be relevant for other health systems?
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  I've covered a lot recently that are trying
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  to kind of scale innovation and research
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  responsibly?
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  Yeah. So that's that's a great question, Elizabeth.
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  And I think,
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  first, let me say,
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  in my multiple decades as a cancer investigator
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  Mhmm. I would just regret
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  I would I would not I would regret
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  not being able to say to people
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  that the care that we deliver today
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  is on the backs of patients that had
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  participated in clinical research previously.
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  Mhmm. So there is no line in my
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  view between clinical care and research.
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  Why?
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  Because I believe when cancer patients want to
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  receive their care, they wanna know not only
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  what is best available for them today,
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  but what might be available to them for
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  a possible treatment that might be in the
• 8:32
  future.
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  So I think at Cedars Sinai, we fully
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  embed
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  our clinical research efforts in our EHR.
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  We deliver our clinical research across our health
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  system.
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  We drive our clinical research and our basic
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  research through the paradigm of translation.
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  We expect our cancer programs of cancer biology,
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  cancer therapeutics,
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  and and population science to ask and answer
• 8:58
  questions that are critical to our catchment area.
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  And I wanna remind people, Los Angeles is
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  a unique city,
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  probably not unlike New York City, but very
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  different than other populations in the country.
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  We have a large Latino population, African American,
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  Asian, especially Korean, LGBTQ,
• 9:18
  large,
• 9:18
  BRCA population.
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  So the key for us is to align
• 9:23
  our priority cancers
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  with the people that are seeking our care.
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  And to do that through a collaborative effort
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  from the lab to the clinic,
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  never forgetting that even the laboratory
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  questions being asked
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  must in the future have translational applications
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  and recognizing that the patients that we serve
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  are critical. One of the ways that we've
• 9:44
  done that, and I would encourage many people
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  to do that, is we have what's called
• 9:48
  an active community advisory board.
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  Our community advisory board is diverse.
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  It is established through our community outreach and
• 9:56
  engagement program.
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  And what that does is it informs the
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  science of what's important in the community.
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  Sometimes as investigators, we might not completely align
• 10:07
  with what does the community want. And our
• 10:09
  community advisory board has been a strong advocate
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  for asking the right questions for what's important
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  for the people that we serve.
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  Perfect. Yeah. And I feel like, you know,
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  having that community center too can just inform,
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  like you said, that connection between discovery and
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  and the clinical care. It it all matches
• 10:28
  up completely together.
• 10:30
  On a similar note, we can't really talk
• 10:32
  about clinical care without talking about the workforce.
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  And even, you know, research, we can't talk
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  about without talking about the workforce.
• 10:41
  You know, for our listeners who may be,
• 10:42
  you know, leading health systems, not leading just
• 10:46
  cancer service lines, but leading, you know, entire
• 10:48
  systems that are balancing workforce issues,
• 10:51
  what are the oncology
• 10:52
  specific
• 10:54
  considerations do you feel that they should be
• 10:56
  watching more most closely when it comes to
• 10:58
  the cancer work workforce?
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  And maybe how does Cedars Sinai think about
• 11:03
  recruitment and retaining talent
• 11:05
  in in the environment today?
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  So I think I think I think it's
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  a a pertinent question to 2026
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  and going forward.
• 11:14
  The workforce
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  is,
• 11:16
  is a challenge in large part
• 11:19
  because we're not training enough cancer experts.
• 11:22
  So part of the challenge is the pipeline
• 11:25
  for,
• 11:26
  physicians is challenged within the oncology workforce. Having
• 11:31
  said that,
• 11:32
  the way we manage that is through the
• 11:34
  lens of we have
• 11:36
  experts in diseases in our 13 disease research
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  groups at the main,
• 11:41
  academic medical center, Cedars Sinai Cancer Center.
• 11:44
  But we have other types of of physicians
• 11:47
  in the cancer workforce that are in our
• 11:49
  community practices
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  where physicians coming out of training programs are
• 11:53
  looking more toward a community type practice as
• 11:56
  opposed to an academic practice. And then what
• 11:59
  we try and do is we are trying
• 12:00
  to align incentives
• 12:02
  so that they're aligned with where they practice.
• 12:05
  So not one size fits all. We don't
• 12:07
  expect our community physicians
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  to, compete for peer reviewed research in high
• 12:11
  impact journal publications, but we do expect that
• 12:15
  from our from our our faculty.
• 12:17
  Having said that, I think the other big
• 12:19
  piece that we're thinking about extensively
• 12:22
  as we talked about previously is the use
• 12:24
  of the,
• 12:26
  advanced practice people, whether it's a PA or
• 12:28
  an NP. Why?
• 12:31
  I I think it's because,
• 12:33
  with as our population ages,
• 12:37
  unfortunately, there will be more new cancer cases.
• 12:40
  And we need to make sure that our
• 12:42
  cancer physicians
• 12:44
  have the capacity
• 12:45
  to take up the new cancer cases
• 12:48
  and are not burdened by the more chronic
• 12:50
  cases
• 12:51
  where they don't allow for the new cases
• 12:53
  to enter. And that's where APP is practicing
• 12:57
  at the top of their license
• 12:59
  can support the care of the patient, the
• 13:01
  care of the journey, and the care of
• 13:04
  the outcome. And I just for those of
• 13:06
  you that might be interested, I did a
• 13:07
  podcast with Oncology News Central just a little
• 13:10
  bit ago with Sunita Puri from, Irvine.
• 13:13
  And it was the title of it was
• 13:15
  new reality for terminal cancer.
• 13:18
  And what that talked about and much different
• 13:20
  than when I started my training
• 13:22
  is the number of patients that we have
• 13:25
  in our clinics
• 13:26
  that have had extended lives
• 13:29
  as a result of the treatments that we
• 13:31
  can offer.
• 13:32
  Those lives are likely not cured
• 13:35
  as in some patients, but they can live
• 13:37
  for years. And those patients now need to
• 13:40
  be managed through a cohort of groups of
• 13:43
  pay of of of of caregivers,
• 13:45
  including advanced practice to make sure that not
• 13:48
  only do they deliver the care they're seeing
• 13:50
  and seeing the right person at the right
• 13:51
  time, have access to the expert,
• 13:53
  but allows the expert to actually access the
• 13:56
  new patients that need to see us in
• 13:57
  the system.
• 13:59
  Thank you for for sharing that. Yeah. And,
• 14:01
  if
• 14:02
  I'm
• 14:03
  taking it incorrectly, it's kind of
• 14:06
  the advanced practice providers. They have the space,
• 14:09
  and if they're practicing at the top of
• 14:11
  their license, they can care for those
• 14:13
  patients and then allowing for the new diagnosis
• 14:18
  to fuel through to the physician, you know,
• 14:21
  no matter the care setting, to kind of
• 14:23
  maybe support that survivorship balance that we were
• 14:25
  talking about, right at the beginning.
• 14:27
  And I think and I think further, Elizabeth,
• 14:29
  I think
• 14:30
  one of the things that we have not
• 14:32
  done a good job in nationally
• 14:35
  is allowing our patients and our future patients
• 14:39
  to understand
• 14:40
  that the team approach to cancer care is
• 14:43
  still going to be,
• 14:44
  best of class.
• 14:46
  And then and then I you know, patients
• 14:48
  often become very attached to their physicians.
• 14:51
  That's understandable.
• 14:52
  But it's best that they we start to
• 14:54
  educate them about being attached to their physician
• 14:57
  teams
• 14:58
  as opposed to just the physician themselves.
• 15:01
  Yeah. I love that. I love that mindset.
• 15:04
  I guess, speaking of building a team, kind
• 15:07
  of looking ahead,
• 15:09
  maybe this that team mentality is is one
• 15:11
  strategy. But what other kind of strategies have
• 15:14
  you seen
• 15:15
  succeed or stall cancer care within health systems?
• 15:20
  Maybe that's organizational capabilities, you know, government,
• 15:23
  position alignment, all sorts of different things. You
• 15:25
  could take it at any direction. But
• 15:28
  what, you know, two or three have you
• 15:30
  seen that really determine whether a health system
• 15:32
  cancer strategy succeeds?
• 15:35
  So I I think that it is absolutely
• 15:37
  critical that we be creative.
• 15:39
  Mhmm. And and and we think about
• 15:42
  cancer care through the lens
• 15:45
  of other technology advances that are taking place
• 15:48
  in our in our country and in the
• 15:50
  world, whether that's the use of artificial intelligence,
• 15:53
  whether that's the use of relationships with commercial
• 15:56
  vendors.
• 15:58
  And and I think that that,
• 16:00
  you know, service lines in my view, especially
• 16:04
  cancer care service lines
• 16:06
  need to be looked through the lens of,
• 16:09
  a bit of a corporate structure. What I
• 16:12
  mean by that is
• 16:13
  how does one align,
• 16:16
  grow,
• 16:16
  and deliver care across the cancer continuum?
• 16:20
  So I'll give you a good example of
• 16:21
  where I think we are succeeding
• 16:23
  in an out of the box way.
• 16:26
  As you know,
• 16:28
  while taking care of cancer patients is is
• 16:30
  at the cornerstone of our care,
• 16:33
  there are many more million people at risk.
• 16:36
  People at risk,
• 16:38
  whether they're receiving screening for breast cancer, lung
• 16:41
  cancer, prostate cancer, or other cancers in the
• 16:43
  future,
• 16:44
  wanna receive that, at risk screening at what
• 16:47
  we'd otherwise call point of care. They don't
• 16:50
  wanna travel to the the main medical center
• 16:52
  for their screening. They want something that's convenient.
• 16:54
  They don't wanna have to leave their children
• 16:57
  and leave their work and leave their jobs
• 16:59
  in a way that is gonna make it
• 17:01
  in in in insufficient. So one of the
• 17:03
  things that we are doing
• 17:05
  is we are
• 17:06
  a a a joint venturing with a imaging
• 17:09
  company,
• 17:09
  and we'll just leave the names out of
• 17:11
  it for the moment. But the purpose of
• 17:13
  which is there are imaging organizations in our
• 17:16
  country which are at the point of care
• 17:18
  for patients that wanna receive screening.
• 17:21
  And then what we've done is we have
• 17:22
  established warm handoffs
• 17:24
  between the screening evaluation
• 17:26
  and the academic cancer center or their affiliates.
• 17:30
  And what we have found in breast cancer
• 17:32
  and now expanding that to lung and and
• 17:34
  and prostate cancer is what patients want is
• 17:37
  they want easy access for screening. They wanna
• 17:40
  note if there's an abnormality
• 17:42
  that they have a warm handoff to an
• 17:44
  expert, and they wanna know that that's gonna
• 17:46
  be conducive with respect to their own insurance
• 17:48
  or their own payer. So we need to
• 17:51
  be thinking about innovative models.
• 17:53
  Other things that we're doing is we're obviously
• 17:56
  thinking about other vendors that are building our
• 17:58
  infrastructure.
• 17:59
  That's whether that's the infrastructure for molecular testing
• 18:02
  and precision medicine,
• 18:04
  the infrastructure for clinical trial enrollment.
• 18:07
  Those are all things that can be centralized
• 18:09
  at the hub and distributed across the system
• 18:12
  that I think make the patient and the
• 18:14
  system more user friendly.
• 18:17
  Right. Yeah. I I love that mindset of
• 18:19
  kind of collaboration and care coordination.
• 18:22
  It all ties back to access. Right? And
• 18:24
  and making those intentional choices
• 18:26
  to to help patients receive care.
• 18:29
  Yeah. I think I think, you know, as
• 18:30
  as we close, Elizabeth, I think that
• 18:33
  that, you know, one of the things I
• 18:35
  love about Cedars and have for my sixteen
• 18:38
  years being here is we are a patient
• 18:40
  centric organization.
• 18:42
  What what does that mean?
• 18:44
  It means that we have to view everything
• 18:46
  that we do through the eyes of the
• 18:48
  patient, whether that is science,
• 18:51
  access,
• 18:52
  translation,
• 18:53
  discovery.
• 18:54
  It has to be viewed through the lens
• 18:56
  of the of the patient. And as long
• 18:58
  as we keep our so called eye on
• 19:00
  the ball, I think that we we will
• 19:02
  succeed because the patients,
• 19:05
  want to see that they're part of a
• 19:07
  larger organizational
• 19:08
  structure so that if and when they need
• 19:10
  us, we will be there for them.
• 19:13
  Amazing. Well, I think that's the perfect spot
• 19:15
  to leave it for today. Thank you so
• 19:18
  much for joining me, for taking the time
• 19:20
  to share your insights. I know that they'll
• 19:22
  be so valuable and informative to our listeners.
• 19:25
  So thank you for joining me. Thanks for
• 19:27
  inviting me, Elizabeth. Have a great day. Thanks.
• 19:29
  And I invite our listeners to tune in
• 19:31
  to more podcasts from Becker's Healthcare by visiting
• 19:33
  our podcast page
• 19:35
  at beckershospitalreview.com.
• 19:37
  Hope you have a wonderful rest of your
• 19:39
  day.