Twenty years ago, when Fred Hutch, the University of Washington and Seattle Children’s created a united cancer program in Seattle, they relied on an entity called Seattle Cancer Care Alliance to deliver the consortium’s clinical services.

Now, twenty years later, the consortium is redesigning this structure by merging SCCA into the Hutch to form Fred Hutchinson Cancer Center and consolidating all pediatric services at Seattle Children’s.

The new, streamlined structure would allow innovations to move faster from the bench to the clinic, the consortium’s leaders say. “With the bringing things under one roof, you are going to accelerate the pace of clinical and translational research,” said Tom Lynch, president and director of Fred Hutch (The Cancer Letter, July 16, 2021).

The Cancer History Project invited Nancy Davidson, executive director and president of Seattle Cancer Care Alliance and an official at both Fred Hutch and University of Washington, and Aaron Crane, SCCA executive vice president, to discuss the history of SCCA and the Seattle consortium.

Davidson and Crane spoke with Paul Goldberg, editor and publisher of The Cancer Letter and co-editor of Cancer History Project.

A video recording is posted above.

Next week: a conversation with Robert C. Young, who has observed consortium cancer centers from multiple vantage points: as associate director of the NCI Centers and Community Oncology Program, as president and CEO of Fox Chase Cancer Center, and as chairman of the external advisory board of Dana Farber/Harvard Cancer Center, and as chairman of the NCI Board of Scientific Advisors.

Paul Goldberg: Thank you very much for meeting with me. Since this is the 20th anniversary of the Seattle Cancer Care Alliance, we should start by looking at what it might look like 20 years from now. What are your plans?

Nancy Davidson: Bigger, better, even more attention to how we are going to be able to provide precision cancer care and prevention across our environment, continuing in our theme, Paul, of translating fantastic science into the clinic, and then learning from the clinic what the problems are that we need to continue to solve.

The SCCA, as you know, is a partnership between the University of Washington, Fred Hutchinson Cancer Research Center and Seattle Children’s.

And so, we always keep in mind the organizations with which we work, and the fact that we’re the organization that allows them to really translate their patient care aspirations.

Just to do a quick overview of this, to paraphrase Joe Simone, “If you’ve seen one consortium, you’ve seen one consortium.” Could we kind of do more of an overview of what Seattle Cancer Care Alliance is? The numbers of patients? All the institutions? The catchment area? How fluid is it? How much room is there to grow out, expand?

ND: Sure, I’ll start. And I suspect Aaron can chime in with some of those metrics.

Seattle Cancer Care Alliance is one of four members of their Fred Hutchinson/ University of Washington Cancer Consortium, the NCI-designated cancer consortium.

I looked up and to remind ourselves, Fred Hutchinson became an NCI Comprehensive Cancer Center in 1973.

And then our consortium was approved by the NCI in 2002.

And at that time, it was University of Washington, it was the Fred Hutch, and it was Seattle Children’s. And then, in 2008, the Seattle Cancer Care Alliance, was added to the cancer consortium.

And, as I mentioned, the SCCA, the Seattle Cancer Care Alliance, came about, because those three organizations decided that they needed to found a fourth organization to serve as their clinical arm.

So, the SCCA was actually, technically, established in 1998, but we celebrate our anniversary this year, because that’s the time, in January, when we opened our doors of our flagship building on the South Lake Union Campus—20 years ago.

And who holds the NCI grant and designation? Is it the Hutch or is it you?

ND: The NCI grant is housed at Fred Hutch. And the leader of our consortium is our Fred Hutch president, Tom Lynch. He took up the leadership of that grant about a year ago.

Aaron, did you want to add anything?

Aaron Crane: Sure. Just in terms of our breadth: We serve about 42,000 or so unique patients each year. Our patients under treatment, we add about 9,000 new patients for treatment each year. And so, we’re also doing surveillance and survivorship and other diagnostics, etc.—around that.

Bone marrow transplants [are] in the neighborhood of 500 transplants a year. And our service area, while certainly the tri-counties around Seattle and the Puget Sound, is certainly a big or the dominant share.

We do take patients from every county in the state of Washington, and we have patients are beyond our borders, internationally, as well. I think that may have been some of your questions, so I wanted to add that color.

Is there room to play with the catchment area, because some of the states are those surrounding do not have a cancer center?

AC: We are the only [cancer center] in the state with the NCI designation, the only dedicated cancer center in the Northwest.

We look at the WWAMI region, which is Washington, Wyoming, Alaska, Montana, Idaho. And then sometimes we throw Oregon in for WWAMIO. They do have a cancer center at OHSU, but we have unique services here that aren’t in that region.

So, we see that as a draw. We do have remote sites [added] over the past several years. We’ve started to build our network. We operate at Northwest Hospital north of here. It’s part of UW Medicine now. We operate at Kirkland, in the Evergreen Hospital, and we also have a medical oncology practice in Bellevue, at the Overlake Medical Center.

And about three years ago, we bought a radiation practice out in the peninsula in Poulsbo, Kitsap County, and we’ve added medical oncology there this year as well. So, we have built this community presence to augment our academic presence here in Seattle.

ND: And, Paul, the catchment area for our NCI Designated Consortium Cancer Center is actually the 13 counties in the State of Washington surrounding the Puget Sound. And that’s because that’s where the big population base is in our state.

Most residents of the State of Washington live in western Washington, with a little sparser population on the eastern part of the state.

I understand you’re planning clinic expansion. Can we talk about that?

AC: It’s about a $260 million expansion, adjacent to the existing clinic. We just broke ground on it this year. We are expecting to have finished construction toward the end of calendar 2022, opening in the spring of 2023.

And so, this really is going to double our clinical space over time.

Our goal, obviously, is to grow from where we are, at 9,000 treated patients, ultimately to more than 20,000 treated patients in a year. And with the quality of care we provide, we certainly want to open the doors to more patients.

But we also know, with the research agenda and the discovery and the advancement of cancer care, we need to have a pretty robust population of patients. Because everything now is getting more specific to the genome. You need a larger pool to be able to do the research that the science is really taking us toward.

When you say treated patients, you mean indexed patients; right?

AC: Diagnosed with cancer and undergoing treatment—medical infusion and radiation, etc.

That’s a hard number. So, maybe we could go over some more of the history. SCCA was formed at the same time as [the] Harvard [consortium], just a little bit later. Can we talk about the rationale for creating it? Maybe we could go over the thinking in Seattle and Bethesda. What was Bob Day thinking? What was Rick Klausner thinking? I remember Bob Day telling me this, but this was 20-some years ago, and I probably couldn’t reconstruct it.

ND: So, Paul, because we are thinking about our anniversary, I was, actually, recently provided with a document from one of the civic leaders who recounted the founding of the SCCA. And it’s a wonderful document, a lot of pretty personal stuff in there.

And this is Brooks Ragen, who was a civic leader, and who served as a member of many of the boards in town, including a member of the SCCA board at one point, when I first arrived.

So, he went back and traced the history, actually, back to 1963, Paul. Because he felt that in some ways, the genesis of the SCCA was the arrival of Dr. E. Donnall Thomas in Seattle in 1963. You remember Dr. Thomas is the individual who was very instrumental in bone marrow transplantation, later the Nobel laureate.

And so, Dr. Thomas was recruited by the University of Washington in 1963 to head the oncology unit. So, that was sort of the first  beachhead, if you will, in town.

A lot of work that went on over the ensuing decades,  involve interactions between the university, between the Fred Hutch, which came on board a little bit later. The Fred Hutch was founded in 1973. And then Seattle Children’s, of course, which is also a well-established institution in town.

And so, lots of interactions between those organizations over time, as well as some of the other hospitals in town, particularly the Swedish Hospital, where some of these things were located at one point.

But basically, my sense is that what coalesced over a period of years was first a pretty clear idea that Fred Hutch, which does not have clinical capabilities—it’s a research center—needed to be very well partnered with a clinical care unit. The University of Washington, of course, wanted to maintain enormous strength in terms of cancer research and care. And so, that ultimately led to this decision to, first of all, partner together, as you and I have talked about, ultimately as a cancer consortium, but also to come together over the Seattle Cancer Care Alliance.

A really wonderful history that reflects, for me at least, the importance of the science, that central theme for all of them, while  making sure that we had the best possible patient care. And then, I think also it encapsulated for me some of the impact of the community in which you live.

It was really fascinating to read about the community leaders and how influential they were in trying to think about this as they thought about their fellow citizens. And it also captured for me, Paul, the importance of our political process. It reminded me that two really powerful senators  in health and healthcare came from the State of Washington back in the day.

Warren Magnuson and Henry “Scoop” Jackson—those two individuals were really important, first for us locally, but you know even better than me, they were also really important for all of us when we think broadly about their contributions to health in the United States.

Bob Day, as you point out, was a really influential person here. Bob was the dean of the School of Public Health, as I understand. And he became the leader of Fred Hutch, taking over from the founding director, Bill Hutchinson. S. And Bob was really one of the big architects here in trying to think about what the Fred Hutchinson Cancer Research Center would look like.

And then he was very important in terms of the interactions with the university, with a number of leaders including our current medical school Dean Paul Ramsey, and also with a number of leaders at the Seattle Children’s Hospital.

Another person we really want to put out here as a critical part of our history for a very long period of time is Fred Appelbaum. Fred, as you know, was my predecessor. He held the positions that I hold at the time that these things all came together.

And I was reminded that Fred joined our faculty here in 1978. And so, I think that he was obviously a pivotal figure in helping to shape all these things over time as well. And, of course, he’s still a very active leader on our campus.

So, we’ve just backed up 20 years. Maybe we should back up another 30 while we’re at this. Consortia were there from the beginning of the cancer program, there was the Northern California cancer program. There’s also the Illinois Cancer Center. And then there was also the consortium of Howard, Meharry and Drew.

And then in the mid-80s, they kind of fell out of favor at NCI. And there’s even sort of something I just found out by looking through all the issues of The Cancer Letter, something called the Massacre of 1985, which was when the NCI changed its consortium—well, its cancer center designation—requirements. And so, something changes when Bob Day starts to look at SCCA, what is it? How did it change? Do you understand this? Because I absolutely do not. What happens in 1999?

ND: First, I appreciated the opportunity that you gave me to read some of those contemporaneous issues of The Cancer Letter, about the consortium process. I had not really thought about that history before myself.

And, Paul, I didn’t realize that some of those consortia existed, that they came, and they went. Which was fascinating. I think that what the consortium has done for us and why Bob was interested in it…  And I’ve never talked about it with Bob. I never had the chance to talk with him about this before he passed.

I’m guessing that the key here was that we had three originally, and then four, very strong organizations. Independent organizations between Fred Hutch, University of Washington, the SCCA and Seattle Children’s, that were all wrapped around the concept of optimizing cancer care and treatment. And also, thinking about population health, which was after all Bob Day’s specific strength. He was a public health practitioner.

So, I think it was that that caused them to think about the mechanism that would bring them together. I think it was also, for us, a mechanism to really think about some of the outreach and the population health issues which are very important for consortia, in a way that we might not have been able to do before.

So, that is my belief about why these things came about in our environment and under Dr. Day’s leadership. Great organizations with a shared goal, where there was really a sense that they would be able to be better together.

And I say that, because that is, actually, the tagline for the Seattle Cancer Care Alliance, which is that we are “Better together. The three key organizations—Children’s, Fred Hutch and UW—we are better together, working through the SCCA. So, I think that’s probably what drove it for Bob.

I suspect another key thing for Bob was that he was a visionary. That one of the great strengths for us is that we do have a really solid physical footprint on South Lake Union in Seattle. So, we have the opportunity to co-locate the Fred Hutchinson Cancer Research Center, and the Seattle Cancer Care Alliance on one campus.

Seamlessly, people can go back and forth, and Bob, he had a huge vision to do that, because I think that that part of Seattle was not in the best part of town at the time.

And now it’s really quite an amazing part of town, because, of course, we are adjacent to the downtown, we are adjacent to the Amazon headquarters.

There’s a lot going on in South Lake Union. So, I think it also probably was a catalytic force for him to think about how we could come together physically. And then how that physical co-location would also help us to really have an amazing footprint clinically, and from an academic and a research point of view.

But what about Boston? Same thing is happening in Boston at that same time. These are two data points. I have no idea how to connect them. Do you know?

ND: I don’t know, Paul. I was a medical student in Boston before that time, and I didn’t really follow it as they were developing.

I suspect it’s part of the same thing that you have a lot of really strong, independent organizations who come together and realize that they can be better together than they are separately. And so, I wonder whether that what allowed the Farber and the Brigham and the General to come together as part of the Dana-Farber/Harvard Cancer Center.

Well, there had to be some pressure from NCI. Also, the other piece of it is that when the consortia where the favor… As they were falling out of favor, the idea was that they’re much better for cancer control than for cancer research.

But that also feeds into of course, what Bob Day would be thinking. Because he was thinking cancer control.

ND: Absolutely. Fred Hutch has an enormous public health division. And that, I think, really is something that is a key feature of our consortium cancer center.

And it’s something that I think that we in oncology need to be increasingly thinking about. The pre-diagnostic sphere, the screening sphere, and then the prevention sphere. And then of course, all the things that come after a cancer diagnosis. The survivorship part of life as well.

How does the future of the consortium model look like to you now? You and I both could rattle off names of institutions that are considering some sort of a form of a consortium. Probably not exactly like yours. Can one put together a collaboration working across state lines, even really why not across the oceans, if you wanted to. Do you have advice to people who might be contemplating such plans?

ND: Paul, I don’t think I’m presumptuous enough to think that I would be able to advise others about how they might do this. I do think that that some degree of co-location being together in a geographical catchment area is an important part of the footprint.

Now, I know my Georgetown colleagues have partnered very effectively with Hackensack and they are obviously not contiguous with each other. But I do think that’s a big strength for many cancer centers, because it allows them to, first of all, have all the opportunities for physical co-location for their research. But also it allows them to provide comprehensive care to a patient population that is in a geographical area.

I think the size could vary, as Aaron mentioned to you, we feel we’re partnered with our colleagues in Alaska. We feel pretty close to the folks who work in Idaho and Montana and Wyoming, as part of the WWAMI region, which is a construct that comes out of our university and out of our medical school.

In the documents that you sent me, I read this interesting discussion about whether or not Oregon should be part of this cancer center. And I think the other thing that happens, of course, as populations grow is that places develop their own cancer centers which speaks to the interests of their particular locale. And, of course, our OHSU colleagues were able to do that very successfully.

These were documents I sent you?

ND: The Cancer Letter.

The ‘80s. Yes. The old Cancer Letters and the discussions going back to the 70s.

ND: Correct. So, I personally think it’s going to be a little bit harder to do with time, mostly because we have a lot of really strong cancer centers that are going to want to be able to work effectively with their populations and their academic centers.

That, I think, is one of the great products of the [NCI] Cancer Centers Program, honestly, is that this country now has dozens of really strong cancer centers, and that they are pretty strategically placed across the country.

I don’t know about the value of saying that you would have two groups that are very, very physically dislocated from each other come together.

I can imagine there might be strategic reasons to want to do it. One would hope though, that the overarching goal, ultimately, would be, because you think that you would be able to do better research and provide better care, because you’re doing this together and that you’re the best possible partners to do that.

I do you think the National Cancer Institute looks at this pretty routinely.

And I wonder if you’ve had a chance to talk with Henry Ciolino in the recent past about what the thinking is going forward about the consortium centers. I think what I can say for our center—and I say this as a relative newcomer who had absolutely no role in any of this, who came in to be kind of the beneficiary and the opportunity to stand on the accomplishments of these giants, and to be able to step into what they’ve been able to build—I think the consortium process was pivotal.

I think it really did allow the opportunity for these originally three, and now four, really strong organizations that are separately constituted, but with a singular focus on cancer or a major focus on cancer—certainly the Children’s Hospital and University of Washington focus on other than cancer as well—but to allow them to really have something that allows us to catalyze our cancer efforts across the board.

I guess, since you’ve mentioned the NCI and Henry, the “five and seven rule” is kind of one of the things that they think about. You have to have five [NIH-funded] investigators, holding seven grants—at least—in order to be a part of a recognized consortium.

So, obviously, your consortium institutions have no problems with fulfilling this requirement, but you’ve been around cancer centers for quite a long time. And do you think this rule makes sense? Why not put together an organization that has no clinical mission, with, say, an organization that has no basic science, but has a massive clinical capacity? And why not call it a consortium? Why not just cobble something together? I’m just asking this without…

Really, I have no opinion on this subject, because I’m not entitled to it, but you are.

ND: Well, obviously, the opinion that matters is that of the National Cancer Institute. I guess my thought would be that one should think very hard about what one wants to accomplish. If there’s going to be a true bridge, a true interchange, maybe it could be considered.

But I think one thing I’m sure that all of us want to avoid is a clinical system, for example, deciding that they’re going to make this alliance as a way of trying to enhance their brand, but without necessarily a major commitment to the mission, to that which is so intrinsic to what we’re all trying to accomplish, thanks to the support of the NCI.

So, that would be my concern, is that you’d really have to have a true collaboration and you’d have to have the sense that this relationship would accomplish what it’s supposed to accomplish. Which is to do phenomenal science that translates into improved wellbeing for individuals who have cancer. And then it translates across the environment that it’s obviously that these benefits are hopefully appreciated by everyone, that we achieve true equity in terms of our cancer outreach and care.

How do you set quality measures across all sites? Do you use pathways? How does it work actually?

AC: So, we have two big sites of practice. We’ve got our community sites that I described earlier, with the community-based faculty and they have quality measures around the work they’re doing. We’re working to align all of that.

And then we have our broader quality metrics around our South Lake Union practice. So, we have an executive quality committee that brings representatives from all these forums together, and they meet monthly and review our progress  and our performance against our metrics. We have a dashboard that goes to our board quality committee with… I couldn’t tell you the count specifically, but 20ish measures, that we set standards for each year and measure our progress against them.

And it’s constant work, when you think about the academic-oriented group at South Lake Union and the community oriented group at the community to bring these two groups together, around a common set of measures. And there’s commonality and there are differences too, that reflect what’s going on in those settings.

So, you use pathways?

AC: We had actually started working on that several years ago, investing money to develop our own pathways.

And at the same time, the NCCN has built guidelines. And so, we did all this work on these things, and I think our IT structures. We got to a place of saying, “Is this something we should be continuing to invest in our own build? Or should we be looking at external;-built pathways?”

And we came to the conclusion that the ones out there already are going to be a lower-cost to utilize going forward.

Now, sprinkle in Epic, we just, as an organization, went live and converted to Epic platform last month; it’s been a two-year adventure to build this with the University of Washington Medical Center and deploy it.

So, we’ve now deployed that. And so, we said, “Let’s hold our pathway decision till we get through Epic. And then we’ll come back to the commercially available products and bring those in.”

We’ve had a lot of discussion with our faculty around the kinds of pathways for their patients, because we were building our own. We’ve kind of set that on a hiatus. We’re going to bring a commercial product in to support that. I’m not sure the exact timeline on it. But now that we’ve gotten past Epic, we’re going to come back to that and then we’ll be able to administer a pathway-based process.[/sbq]

ND: Paul, one thing to remember is that the SCCA is one of those dedicated cancer centers. It’s a PPS-exempt group. So, we have 20 inpatient beds that we own and run at the University of Washington Medical Center. And then we have, of course, our very large outpatient practice, not only in South Lake Union, but at the community sites that Aaron already described for you. So, intrinsic in that for us as an independent organization is an incredible attention to quality, that’s part of what we need to do.

Of course, but how do you make decisions on clinical trials? Which sites would get them? How do you distribute resources? This can’t possibly be an easy thing to do.

ND: The clinical trial resource, of course, a lot of those things are overseen by the consortium cancer center, as part of the cancer center process. So, we have all of the usual mechanisms in place that you would see in an NCI-designated comprehensive cancer center.

I think one of the things that is really wonderful here, though, Paul, is that there are a lot of very, very gifted investigators. And, by and large, they are organized in disease-specific teams.

And so, the teams are self-managed in terms of deciding what they think are the top priorities for their research that they want to take forward. The things that are going to be the most important for the patients in our region, or the patients that we serve, the things are the most important from a scientific point of view, things that come out of our own science.

And so, a lot of that prioritization is done at the group investigators [level]. You’re right that at the overarching level, I think that our cancer center uses the same priorities that most do. Which is that we’re incredibly focused on things that are going to be relevant to our catchment area, relevant to our patients, things that try to develop our own science and things that try to help us really move forward progress in cancer care.

So, I think it’s worked pretty well. It is largely a faculty-driven process, and I think the faculty are pretty good at putting this together.

Is there a strategy for understanding the catchment area needs and aligning clinical research and clinical and outreach priorities to the needs?

ND: Absolutely. One of the newer initiatives in the cancer center world, as you know, is the focus on the offices of catchment, outreach and community engagement. And so, our consortium office has led by Jay Mendoza. Jay is a pediatrician by trade, and he helps us to oversee this.

And so, we have, as many cancer centers have done, taken a really, really deep dive into our catchment area, to understand what’s going on in our catchment area, what the needs are in our community. And having brought that back, we’re busy trying to make sure that our programs really do address the needs in our community.

We are, obviously, a cancer center that has a largely urban population if you look at our Puget Sound counties, but a state that has substantial rural populations as well. We’re an area where the minority populations include our African-American population, Asian Americans, and also Native Americans, indigenous peoples.

And so, we’ve worked pretty hard to try to understand the footprint of cancer across all of our populations, to understand exactly where the gaps are, so that we can make sure that we’re paying attention to those things that are really issues within our catchment area.

Well, is there anything we’ve missed? Anything you’d like to add?

ND: We thank you for the opportunity to celebrate more publicly the accomplishments of the Seattle Cancer Care Alliance at the time of the 20th anniversary of opening its doors.

But more importantly, to celebrate the Fred Hutch/University of Washington Cancer Consortium, and all it’s been able to accomplish over its decades in existence. We’re known a lot for our bone marrow transplant, which is where we started, but we are so much bigger than bone marrow transplant and hematologic malignancies right now.

Obviously, we maintain our strength in those areas, CAR T, immunotherapy. But our population sciences are, I would say unparalleled. And our solid tumor programs are really quite impressive right now. Prostate cancer SPORE, a lung cancer SPORE, previous breast and ovary cancer SPOREs.

I think that the excellence across oncology is really impressive, and it was [founded in] our expertise in bone marrow transplant, and we have learned the lessons that they had to teach us about the value of team science and the importance of linking the laboratory and the clinic.

Well, thank you so much.