The following reflections on the Association of American Cancer Institutes from AACI are excerpted from “The History of the Association of American Cancer Institutes ” by Donald L. Trump, MD, and Eric T. Rosenthal. A PDF version of the book is available here.
Reflections on AACI by Past Presidents
In the spring of 2021, Donald L. “Skip” Trump, MD, and Eric T. Rosenthal—co-authors of Centers of the Cancer Universe: A Half-Century of Progress Against Cancer— reached out to AACI’s past presidents about their respective experiences with AACI and thoughts about the association’s value and accomplishments. These are the past presidents, in chronological order, who were interviewed. (See Appendix 5 for a list of AACI Presidential Initiatives).
Jerome W. Yates, MD, MPH
Dr. Jerome “Jerry” Yates was president of AACI from 1991 to 1992 when he was senior vice president for clinical affairs at Roswell Park Cancer Institute. He may be the only AACI president to hold office without serving as the director or CEO of a cancer center; however, he noted that Roswell Park’s president at the time, Tom Tomasi, PhD, was a basic scientist and not directly involved in many of the clinical issues that faced AACI members. Yates had also formerly overseen NCI’s cancer centers program during the 1980s and had participated in AACI meetings in an ex officio capacity.
Yates said that Memorial Sloan Kettering Cancer Center, Fox Chase Cancer Center, and Roswell Park Cancer Institute were the most active centers in the early 1960s, and AACI meetings provided opportunities to:
• share ideas and stories, involving administration issues, fund-raising, and getting money from the NIH through lobbying
• influence the implementation of guidelines for NCI-Designated Cancer Center grants
• protect reimbursement
He recalled that meetings would often rotate among the various member institutions, but that they would occasionally be held in Washington, DC, which would include time for lobbying members of the House and Senate and were part of the effort to double the NIH budget in the 1990s.
Quoting former Speaker of the House of Representatives Tip O’Neill’s “all politics is local,” Yates said AACI members had the ability to lobby members of Congress from districts and states across the nation. He implied that some of the issues championed by AACI might have also been of interest to the National Comprehensive Cancer Network, established in the early 1990s, since it also represented cancer centers, although its membership was much more limited and highly (geographically) selective.
Paul A. Bunn, Jr., MD
Dr. Paul A. Bunn, Jr. was founding director of the University of Colorado Cancer Center from 1986 to 2008 and served as president of AACI from 1995 to 1996. His early recollection of AACI history was that it was the organization that could help the NCI with its plans to create a national cancer center program, and “served as a not-for-profit advice-giving organization.”
He recalled that during his presidency AACI had a parallel mission and agenda as that stated in the National Cancer Act of 1971, including having comprehensive cancer centers in every region of the United States; overcoming disparities in clinical trials; providing care to the underserved; and institutional commitment to outreach, education, and diversity.
He said that there were very few NCI-Designated Cancer Centers in the Southwest at the time that the University of Colorado received its initial designation in 1989, and that the state of Colorado was a big proponent of gaining NCI-designation for his center.
Bunn noted at one time there had been some discussion about AACI getting involved in developing NCI designation guidelines, but it was decided that it should not be an organizational goal. During his tenure as president, he said that about 80 percent of members were NCI-designated and the other 20 percent wanted to become designated centers.
Bunn also commented on the great value of having camaraderie among its members and how helpful it was to interact with colleagues facing similar issues and challenges.
Max S. Wicha, MD
Dr. Max Wicha served as director of the University of Michigan Rogel Cancer Center for 29 years, stepping down in 2015, and as AACI president from 1997-1999.
His presidency spanned a critical transitional time for AACI since it was when the decision was made to create a permanent headquarters with a full-time professional staff. He said that he was not really aware of AACI’s history prior to his own involvement with the association.
Wicha said that it was the custom of AACI presidents to name their administrators as AACI executive director and that position was held by Suzanne Mahler. He noted that she still served half-time as his administrator and that the job required more time than she had. It was agreed by the AACI board to seek bids for a permanent headquarters and executive director and that incoming AACI President Ronald Herberman’s lobbying efforts prevailed and the contract went to the University of Pittsburgh Cancer Institute, with Herberman’s administrator Barbara Duffy Stewart assuming the role of executive director. Wicha said that the organization was then able to transition from a “mom and pop” operation to a more effective professional one. His presidential initiative was communicating the message of the importance of cancer research to Congress, and he felt that involving patient advocates in lobbying efforts was always more effective. He thought that more could have been done during his presidency to champion clinical research but that seemed to happen about a decade following his term. He mentioned the challenges faced today by academic cancer center directors reporting to more business-oriented hospital system CEOs and said that he would like to see AACI “get really good data that indicates how much clinical research benefits an institution.”
John E. Niederhuber, MD
Dr. John Niederhuber, who served as AACI president from 2001 to 2003, has a unique perspective on AACI, having served as a member when he was director of the University of Wisconsin Comprehensive Cancer Center (where he consolidated two NCI-Designated Cancer Centers), and then later as director of the NCI from 2006-2010.
Niederhuber said that he was unaware of AACI when he had served in (nondirector) leadership positions at other institutions, such as Stanford and Michigan, but remembered Dr. Ronald Herberman contacting him about becoming active when Niederhuber was named Wisconsin cancer center director in 1997.
He considered AACI a “club for directors,” noting there was no other real forum for cancer center directors to meet. Interestingly, as NCI director he met annually with many of the directors at the NCI-Designated Cancer Centers directors’ retreat but recalled that not all NCI directors shared the same interest in issues related to cancer centers. He said that he believed “the more communication the better,” and that listening to the directors was important to better understand what the problems were.
Niederhuber said that AACI provided an opportunity for cancer center directors to discuss how they would present their issues with the NCI, and that interacting with the administrative officers of each center’s grants was an important part of AACI as well. He found the presentations by NCI program office staff to be very helpful, and he said that he appreciated having a forum to share experiences about “hostile academic environments” at certain university-based cancer centers.
Harold L. Moses, MD
Dr. Harold “Hal” Moses served as AACI president from 2003-2005. He was founding director of the Vanderbilt-Ingram Cancer Center from 1993 to 2004. Moses said that he was unaware of AACI until he became director of Vanderbilt’s cancer center and was asked to join the organization. However, at the time, the fledgling center did not have enough money to pay the annual membership dues of several thousand dollars.
In 2001 he was encouraged to put in his bid for the AACI presidency (beginning with president-elect) by Dr. Ronald Herberman because it was thought that his standing in the cancer community and past service as AACR president from 1991-1992 could help elevate AACI’s status among professional oncology organizations. Moses said that a major interest at AACI was to place the organization on a more level footing with ASCO and AACR.
Moses’s AACI presidency overlapped with the presidencies of Lynn Matrisian, PhD, at AACR, and David Johnson, MD, at ASCO, who were both also colleagues from Vanderbilt. This provided an opportunity for the three organizations to work more cooperatively, and they all agreed a topic of mutual interest would be cancer clinical trials.
A subsequent joint conference on the issue was held in northern Virginia, and Moses was disappointed that the moderator did not follow up with a written report that could be published.
He said that there was interest at the conference on pushing for a greater focus on data intensive cancer clinical trials with lots of laboratory correlates, which would make the trials more expensive, and that the industry representatives at the conference said they were willing to pay a lot more to get trials done with a lot of correlative data, provided they would have access to that data. However, he said he did not know if there was any follow-up at the time.
Although AACI presidents at his time were not expected to have a theme or initiative during their tenures, he would have chosen clinical trials.
Moses said that then-NCI Director Richard Klausner, MD, was very supportive of AACI, and would attend meetings, and that one of the great benefits of membership was this interaction with the NCI director.
H. Shelton Earp, III, MD
Dr. H. Shelton “Shelley” Earp, III, served as AACI president from 2005 to 2007. He was director of the University of UNC Lineberger Comprehensive Cancer Center from 1997 to 2015, when he was succeeded by Norman E. “Ned” Sharpless, MD. Sharpless left UNC to become NCI director in 2017, at which time Earp was reappointed Lineberger director.
Earp said he was first involved with AACI in the 1980s when he was an associate director at Lineberger under then-director Joe Pagano, who served as AACI president from 1996 to 1997. He attended an AACI meeting with Pagano held at Fox Chase in the 1980s where he remembered that most cancer center directors were “kvetching about not having enough money,” causing him to vow at the time, “never to go back” to another meeting.
Earp recalled that during its early days, AACI was pretty much in the “suitcase” of Roswell Park’s Ed Mirand, who served as secretary-treasurer and was the association’s “constant,” as annual meetings rotated among AACI members’ institutions.
The association’s turning point came when AACI decided to establish a permanent office with a paid staff. Earp saw most of AACI’s growth following this event and said that for several years AACI’s focus was on increasing the size of NCI core grants, but that it became more involved in clinical trials toward the end of his presidency and began its clinical research initiative.
He said that as cancer centers became more profitable for their medical centers, they gained more local, regional, and national prestige, which ultimately was beneficial to AACI. The association became more robust over the years and has been helpful to aspiring centers interested in receiving NCI designation.
Edward J. Benz, Jr., MD
Dr. Edward Benz, Jr. served as AACI president from 2007 to 2009. He was president and CEO of Dana-Farber Cancer Institute (DFCI) from 2000 to 2016.
Benz said he had never heard of AACI until he became president of DFCI and was contacted by Pitt’s Ron Herberman about joining. He noted that it took him a while to figure out what AACI was and that he had thought it was founded by Herberman in the late 1990s. He was surprised to learn that AACI had a 50-year history prior to its formal establishment in Pittsburgh.
Benz’s presidential initiative was related to the oncology workforce. AACI’s interest in the initiative ended with Benz’s presidency, but he said that it was picked up by C-Change and later by ASCO and AACR; so AACI did play a catalytic role on some issues that were continued by other groups. He said that AACI could have done a better job of continuity between presidents by integrating its strategic plans with those presidential initiatives that were worth pursuing beyond the two-year terms of each president.
He thought that AACI was a unique and important forum for cancer center directors to meet informally and served as a good training ground for future directors and administrators. He said that some of the larger centers, for example, Memorial Sloan Kettering, seemed to be less interested and active, but that also largely was dependent on who was the cancer center director at the time. He added that there was sometimes tension between the truly academic cancer centers and some of the smaller quasi-academic centers that may not have had a meaningful relationship with an academic center.
Benz said that AACI meetings provided an opportunity to pick up a lot of information relevant to running a cancer center, which would not be available in the same concise package elsewhere.
He praised such efforts as Mike Caligiuri’s initiative to lobby elected officials locally and said it was very instructive for other centers. He thought it much more effective when he lobbied on behalf of AACI than just Dana-Farber. Meeting with other center directors allowed for comparisons, not just of programs, but of discrepancies between the states for such policies as clinical trial coverage. AACI membership also allowed centers to share best practices, as well as strategies of dealing with NIH, and in some cases, learning how to disobey NIH
William S. “Bill” Dalton, MD, PhD
Dr. Bill Dalton was the president and CEO of the H. Lee Moffitt Cancer Center and Research Institute from 2002 until 2012, when he stepped down to become CEO of M2Gen, a Moffitt Cancer Center biotechnology company. His term as AACI president began in 2011 but ended a year later when he resigned as Moffitt’s center director.
Dalton said that he began attending AACI meetings when he was associate director at Moffitt and had been encouraged by his then-director Jack C. Ruckdeschel, MD. He was aware that the association was first started in 1959 and credited the association’s subsequent growth and success to its first executive director, Barbara Duffy Stewart.
“To me, the AACI equals Barbara Duffy Stewart, she was executive director for 20 years and was a tour de force,” he said, noting her organizational skills and ability to achieve goals and create priorities.
Dalton’s presidential initiative was to build an AACI website or portal “in-house,” which lived on for eight years until the association decided to hire a contractor to run it. This was noteworthy because many other former AACI presidents said that their initiatives ended after their two-year term. Dalton said that the initial idea for the portal was to provide a forum for interaction among the centers to share best practices and discuss other issues.
He said that AACI was responsible for building camaraderie and created a collective learning experience and thought that it was very helpful concerning clinical trials, core grants, and lobbying efforts.
Michelle M. Le Beau, PhD
Dr. Michelle Le Beau served as AACI president from 2012 to 2014, and as director of the University of Chicago Cancer Center from 2004 to 2021.
She said that she knew nothing about AACI before her appointment as cancer center director and was told by an administrator that she “had to go” to AACI’s annual meeting.
She admitted that it took her a few years to understand AACI’s role, and that she later appreciated its value as the only forum for cancer center directors to meet and discuss problems, issues, and initiatives. Le Beau added that meeting with other directors helped members share best practices and learn how to deal with such issues as unfunded mandates.
As with a number of other former AACI presidents we spoke with, she noted that the annual NCI cancer center directors’ retreat was not as interactive as AACI meetings; NCI directors’ retreats were rather a one-sided event with NCI staff talking to the AACI members and often not responding directly to questions. NCI’s interest in those retreats was also dependent upon who was NCI director at the time.
Le Beau’s presidential initiative was molecular diagnostics and how cancer centers could integrate NCI’s CaBIG initiative. However, she felt that the initiative was not successful and was not continued by AACI when the next president’s initiative began.
She said that AACI has been involved in several impactful initiatives that led to some white papers and noted that both Ed Benz’s report on the oncology workforce and Mike Caligiuri sharing how to talk with legislators were especially useful. Through networking, concepts such as the Big 10 Clinical Trials Consortium came into being, she said.
Le Beau commented that she thought AACI could have had a bigger voice and more visibility and may have benefited from more joint initiatives or projects with NCI and other cancer organizations. She also would have liked to have seen some presidential initiatives sustained beyond two years but realized that the organization had limited resources.
George J. Weiner, MD
Dr. George Weiner served as president of AACI from 2014 to 2016. He has the distinction of having served the longest consecutive tenure as director of the same NCI-Designated Cancer Center, becoming head of the University of Iowa’s Holden Comprehensive Cancer Center in 2000.
Weiner said that when he took office, he knew little about AACI other than what then-executive director Barbara Duffy Stewart had told him, and that its governance had rotated among its respective presidents for years before Pittsburgh’s Ron Herberman decided it should be permanently housed at the University of Pittsburgh with a professional staff in the late 1990s.
Weiner said that he felt that the most important part of AACI was the opportunity for networking among peers. This was followed by the ability of AACI to act as a voice for academic cancer centers in advocacy efforts as well as providing access to the director of the National Cancer Institute, which, he noted, depended largely on who was director at the time.
He said that the organization’s relatively small size—about 100 members—was an advantage.
He observed that the organization’s importance seemed to increase in the mid2010s, as it provided an institutional voice, distinct from that of ASCO or AACR, and that the collective impact of cancer center directors seemed an advantage when working with legislators.
Weiner’s presidential initiative was called Academic Difference, and although he and his colleagues had written a paper on the subject, they could never decide whether it was a commentary or manuscript, and it was never published. He said that the group tried to collect objective data showing that academic cancer centers had improved outcomes, but “the effort didn’t quite materialize the way we had hoped that it would.”
Weiner added that the “academic difference” has become an issue with the rise of community and hybrid academic-community cancer centers seeking AACI membership, since these centers are not fully cancer research institutions.
Stanton L. “Stan” Gerson, MD
Dr. Stan Gerson is director of Case Comprehensive Cancer Center, and interim dean of Case Western Reserve University’s School of Medicine. He has served as head of the cancer center since 2003 and was AACI president from 2016-2018.
Gerson said he knew little about the organization when he first became a member, but witnessed its value increase over the years, primarily for networking purposes among his peer cancer center directors.
When he originally joined, Gerson said he viewed AACI as an advocacy organization that could benefit academic cancer centers through navigating clinical trials with “big pharma,” but it has since evolved as a voice of academic cancer center directors when dealing with legislators.
AACI institutions also represent members of both ASCO and AACR, but in a more manageable size (about 100 institutional members) that deals directly with the issues of running cancer centers and is the only organization that “has the pulse of what’s going on and provides the structure to coordinate interaction.”
He noted that AACI matured from a less formal organization to one that sponsors annual Hill Days on Capitol Hill, roundtables for commercial strategies with pharmaceutical companies, and opportunities for the NCI director and cancer centers’ branch director to address and meet its cancer center director members, adding “Where else would you be able to get 100 cancer directors together in one place?”
Gerson’s AACI tenure began shortly after then-President Obama and Vice President Biden announced their “Cancer Moonshot,” making the timing propitious for cancer research initiatives.
Gerson said that when he served as AACI president, he would send a note to new cancer center director members “welcoming them to the club and urging them to be active.”
The theme for his presidency was the Network Care Initiative, which involved increasing access to clinical trials through academic cancer center affiliations, but he added the difficulties inherent in different types of employment models. Gerson also opined that AACI might benefit if it took on more aspirational, “big ideas.”
Gerson asserted that he found the camaraderie among cancer center directors linked through AACI “astonishing and unequaled” and said that the organization was invaluable when it came to providing cancer center directors links to, and a forum for, colleagues to discuss common issues and problems and learn better ways to operate their centers.
Roy A. Jensen, MD
Dr. Roy Jensen has served as director of The University of Kansas Cancer Center since 2004 and was AACI president from 2018-2020. He was at Vanderbilt-Ingram Cancer Center before coming to Kansas and said that Hal Moses was his mentor and helped prepare him for his future as a cancer center director.
“When I started at Kansas, Hal encouraged me to join AACI, saying it would be very beneficial for an emerging cancer center, and it turned out to be true,” he said. Jensen said that he was surprised at how open other center directors were in providing “nitty gritty details” about their institutions, noting that David M. Livingston, MD (Charles A. Dana Chair in Human Cancer Genetics at DanaFarber Cancer Institute and Emil Frei III Distinguished Professor of Medicine, Harvard Medical School), and Ed Benz had invited him and his staff to visit Dana-Farber, where about a dozen senior staff members devoted an entire day to presentations about how things were done at Dana-Farber.
He called AACI’s CRI meeting the “world’s largest group therapy session” for clinical trials offices, where people can share problems and resource information.
His presidential initiative addressed moving AACI, and particularly NCIDesignated Cancer Centers, toward being more active in public policy by creating a web-based library of cancer-specific public policy initiatives that had been developed at the state level by AACI member institutions. Jensen said that developing a repository of specific actions and initiatives taken by centers related to their respective state legislatures was helpful in providing models to be adapted by others centers and cited that emulating what was done in Florida (through collaborations among Florida’s three state-supported cancer centers) had led to his center receiving an additional $5 million from the state of Kansas.
He said that AACI “increasing its footprint” in the public policy arena would be very beneficial to issues related to cancer, and that many cancer center directors may be underestimating their influence with state legislators.
Karen E. Knudsen, PhD
Dr. Karen Knudsen had been head of Sidney Kimmel Cancer Center at Jefferson Health for seven years and stepped down as president of AACI in June when she left Jefferson to become CEO of the American Cancer Society. She was succeeded by Caryn Lerman, PhD, director of USC Norris Comprehensive Cancer Center.
When she announced her plans at the 2020 AACI/CCAF Annual Meeting, she said that AACI “will address cancer health disparities by leveraging the expertise of North America’s 102 leading cancer institutes. Using a two-staged approach, the initiative will convert understanding of cancer disparities across AACI centers into meaningful, measurable actions to improve the lives of patients with cancer.”
“Now more than ever, it is essential for the major cancer centers to join forces toward accelerating progress against cancer,” said Knudsen. “The presidential initiative to reduce cancer disparities is just one arm of AACI strategies to increase the pace of positive change. I am honored to serve and counting on the partnership of all AACI centers toward common goals.”
Knudsen said she was especially excited to be elected AACI president because of the incredible value of the organization using the information generated through its cancer center members “to go home and effect change.”
She cited AACI’s uniqueness as the only organization that has cancer centers— not individuals—as members, and said it was of the few places where center directors could come together in a safe environment and work collegially rather than competitively. She noted that having other center directors to discuss issues with has been especially helpful during the COVID-19 pandemic since it allowed for “rapid real-time communication.”
Knudsen gave high marks to AACI’s Physician Clinical Leadership Initiative and the organization’s leadership in supporting clinical trials. She said that AACI can serve as an excellent training ground for those who will be stepping into a cancer center directorship, and that there are opportunities for AACI to have a greater voice in research.
She stressed the importance of understanding a cancer center’s catchment area to deal with its specific problems and make an impact and said that AACI provided a powerful voice for cancer centers collectively.
Caryn Lerman, PhD
Dr. Caryn Lerman began her term as AACI president on June 1, 2021, succeeding Karen Knudsen who left the position early to become CEO of the American Cancer Society.
Although Lerman has only been director of the USC Norris Comprehensive Cancer Center since 2019, she had been attending AACI meetings since 2006 as deputy director of the University of Pennsylvania Abramson Cancer Center. She said that she had never heard of the organization before then.
Lerman said that she was very excited to be given the opportunity to be part of AACI for so many years and viewed it from the perspective of “a kid in a candy shop,” since it allowed her to be part of a conference centered around cancer 38 centers that went beyond just science to focus on every element that is critical to having a successful organization. She added that AACI meetings helped her to learn about the politics—including the national scene and advocacy involved in running a center—and that it was a great networking opportunity.
She found the experience to be extremely beneficial and believes it helped groom her for her future role as a cancer center director, as did appointments to external advisory boards.
Lerman said at the time of the interview that she had not yet officially unveiled her presidential initiative to AACI but that it would deal with leadership development in cancer centers, and that she also intended to continue Knudsen’s diversity-related initiatives.