In 1993, when William Hait came to New Jersey to start work toward the NCI designation for Rutgers, the place had one office and three cubicles.
Four years later, in 1997, the Cancer Institute of New Jersey received the NCI Cancer Center designation, and on the next review cycle, in 2002, it received the Comprehensive Cancer Center designation.
The Cancer History Project invited Hait, the first director of Rutgers Cancer Institute of New Jersey to sit down for a conversation with Steven K. Libutti, the institution’s current director.
“That’s almost unprecedented today, to be able to achieve that, and so, that’s an amazing accomplishment,” Libutti said to Hait.
How did Hait get it done?
“I was given some very sound advice from my colleagues at Yale. They said, ‘Your instinct will be to build the basic science programs first.’ They said, ‘Build the clinical programs first, because that’s what the center at first will be known for.’
“So, I tried my best to recruit outstanding clinical people, clinical researchers, master clinicians, people who could really be dedicated to giving incredibly high-level care to the people in New Jersey.”
Rutgers, now a part of a health system and a scientific consortium with Princeton University, recently started construction of a $750 million cancer hospital in collaboration with RWJBarnabas Health.
The text of the conversation follows.
Steven K. Libutti: Well, Bill, first, I want to start by thanking you for taking the time out of what I know is a very busy schedule to join me today to talk a bit about the Rutgers Cancer Institute in New Jersey, both the history of the cancer institute, and where we’re going as we move towards the future.
William N. Hait: Thank you, Steve. It’s great to be here. Absolutely great.
Libutti: So, can you tell me a little bit about how your vision formed for the Cancer Institute of New Jersey? When you joined in 1993, coming from Yale, the cancer institute was really in its infancy.
Hait: The actual cancer center was physically in its infancy. We had one office and three cubicles, but the planning had gone on for several years, by the dean and by the associate dean for research, and Mike Gallo respectively, who had put together a planning grant, with faculty across the medical school and Rutgers, to plan for an NCI-designated cancer center, at least one that could be capable to even compete.
Because back then, there was no place in New Jersey that could even compete for NCI designation, because none would have the eligibility criteria.
Libutti: And so, when you arrived, after that initial planning had taken place, what was your vision, and what were your first steps in terms of trying to operationalize that vision?
Hait: I was given some very sound advice from my colleagues at Yale. They said, “Your instinct will be to build the basic science programs first.” They said, “Build the clinical programs first, because that’s what the center at first will be known for.”
So, I tried my best to recruit outstanding clinical people, clinical researchers, master clinicians, people who could really be dedicated to giving incredibly high-level care to the people in New Jersey.
Libutti: And how long would you say it took for you to kind of get that center of gravity in place as you were doing those recruitments?
Hait: It’s a very good question. In retrospect, it seemed overnight, but it was a lot of hard work to convince people of a vision.
We didn’t have a building, we had some cubicles, we had some lab space over across the river, but I was very fortunate to have been involved with training many outstanding fellows at Yale, who went on to join faculty at other places, who I sort of pulled in the chit, and I said, “Come on, we’re going to start a cancer center in New Jersey. Let’s give it a try.”
And a few fantastic people joined, and they recruited their friends, and before you knew it, we had some people who were actually very good at seeing patients, and then we built the relationships on the basic science campus to start building out the basic science programs.
Libutti: When I think about it, you joined in 1993 and you successfully obtained NCI designation in 1997, then moving on in the next cycle in 2002 to get comprehensive designation, which is truly remarkable.
I mean, that’s almost unprecedented today, to be able to achieve that, and so, that’s an amazing accomplishment. Why did you think at that time it was so important to achieve an NCI designation for the cancer institute?
Hait: I really felt that the designation by the NCI was the highest standard you could reach, and it was clear to me, for a variety of reasons, that New Jersey needed at least one cancer center, maybe more, that could compete at that level in terms of patient care, clinical research, basic research, population research, and then not just say ourselves that we’ve done it, but have the highest authority, like the NCI and their peer review say, “You guys make the grade, and now you have the designation.”
And I think that has been, as you know, Steve, the key differentiating factor for the Rutgers Cancer Institute of New Jersey.
Hait: So, as we celebrate the 50th anniversary of the National Cancer Act, how important, Steve, do you think the Cancer Centers Program is in the fight to ultimately someday eliminate cancer?
Libutti: So, that’s a great question, and I truly believe that the Cancer Centers Program is critical to continued progress in our fight against cancer.
I think when you look back at the progress we’ve made over the last 20 years, many of those seminal discoveries, discoveries leading to checkpoint inhibitor therapy, or discoveries leading to CAR T-cell therapy, or discoveries leading to sort of molecularly targeted therapies or precision medicine, really had their birth in cancer centers across the United States.
Libutti: And it was the National Cancer Act, back in 1971, when that was signed, that gave birth to the Cancer Centers Program, and I think that that program continues to evolve and adapt to changing landscapes.
It has, particularly, over the last five to 10 years, taken a new focus on the community, on the importance of cancer centers reaching out into their communities, in their catchment area.
The Cancer Centers Program has put a premium now on diversity and inclusion, which I think is of incredible importance as we better understand unique aspects of the cancer burden in different communities.
So, I think the Cancer Centers Program continues to play a critical role, and will continue to do so as we implement many of the findings over the next 20 to 50 years.
Hait: Well, I do think the new approach to the community and to the broad aspects of preventing, intercepting, and curing cancer is so critical. I know that, having taken care of patients for so many years, you and I never saw someone come in and say, “I’m so happy I’ve been diagnosed with cancer, so you can treat me.”
It’s always, “What could I have done differently, so I wouldn’t have to wind up with this very difficult disease?” And I think your focus and the focus of the Cancer Centers Branch, to really look at prevention, and screening, and intercepting the disease, and maintaining health is absolutely essential.
Hait: Steve, you were recruited to become the director of the Rutgers Cancer Institute and senior vice-president of oncology services for RWJBarnabas Health in 2017. That dual appointment was really a first, and showed the commitment and partnership of the health system.
Can you talk a little bit about that partnership and what it means for cancer patients in New Jersey?
Libutti: So, yes, stepping into that role in 2017 was an interesting experience, and I often, when I talk about this, you like to look back and think that all of these entities were well-established, etc., at that time, but the RWJBarnabas Health system had really only become a health system a year before in 2016, and Rutgers Cancer Institute had existed as a Rutgers entity for only four years at that point.
And so, coming into that role, it was interesting in that it was bringing together two newly formed cultures to create a new culture around cancer care and cancer services, but it’s been a tremendous opportunity, and very exciting.
The health system is the largest in the State of New Jersey, and cares for over half of the New Jersey population, approximately five million people, and sees about 11,000 new cancer cases a year, analytic cancer cases. And so, there’s a tremendous amount of opportunity for an NCI-designated cancer center to partner with a health system of that size.
It was also incredibly important to me that the health system is very focused on patient health, not just patient healthcare, and I think that’s of critical import for cancer care as well, cancer prevention.
Cancer screening is a critical aspect of what we do as NCI-designated centers, and we serve a very diverse community, and New Jersey is the fourth most ethnically diverse state in the United States.
And so, being partnered with a health system that takes that diversity as a real important focus and enables us to impact so many patients, was really key. And the integration into Rutgers has been truly enabling as well.
There are so many outstanding schools and investigators at Rutgers that provide this very ripe and fruitful environment for the cancer institute to do its work in terms of studying the biology of cancer, and then trying to translate those findings.
So, while it was challenging, wearing those two hats, I think the position allows a much greater ability to deliver the outcome of those research efforts to the largest population we can possibly touch.
Hait: What were some of those challenges? I mean, the opportunity sounds fantastic, but integrating into two new systems, both large, must’ve been an experience. What were some of the challenges that you had to overcome, and how did you do it?
Libutti: Well, any time you’re coming into a new environment, you have to be careful to try to listen and appreciate what the cultures are, and as I had said already, these were forming cultures between the two, with an underpinning of legacy culture from the prior UMDNJ, where CINJ had been based, and the two health systems that ended up forming RWJBarnabas.
And so, there were differences of scale of vision and focus at the individual hospital sites, but I think in fairly short order, it became very clear to me that the leadership, both at the system level and the level of the hospitals, were really passionate about leveraging the strength of this system to care for as many folks as we could.
And so, what originally seemed daunting, quickly became a very supportive environment, and I came in the middle of these conversations between Rutgers and RWJBarnabas Health about executing this new MAA, or master affiliation agreement, between the two entities, and I sort of look at us at the cancer institute as sort of being at the tip of the spear for that relationship. And we’d learn things a bit by trial and error.
There’s a certain amount of freedom in not having to follow a script, but you also do a little bit of recon by fire.
You go in one direction, you hit a speed bump, or you fall in a pothole, and you have to readjust a bit, but because both institutions really wanted the cancer program to succeed, even when there were some of those missteps early on, the support was there that we could continue to carry on.
Hait: As you know, Steve, one of the great aspects of a cancer center and what makes the cancer center so successful was the ability to create collaborations with the medical school, with the entirety of Rutgers, and now with the health system, and most recently, the consortium partnership with Princeton University. Can you tell us a little bit about that?
Libutti: We’re especially proud of the fact that we are an NCI-designated consortium cancer center, and that partnership is with Princeton University.
It brings together the largest private research university in Princeton, and the largest public research university at Rutgers, together with one cancer center program. And it really drives tremendous, both basic and translational research, some examples of which are around our studies of cancer metabolism.
Eileen White at Rutgers and her collaborator, Josh Rabinowitz at Princeton, have made some seminal discoveries in understanding the metabolic processes in cancer cells, and within the tumor microenvironment, that can be leveraged as potential targets for cancer therapeutics.
Recently, the Ludwig Cancer Research Institute, has established a new branch at Princeton University, the Ludwig Princeton branch, which has focused on cancer metabolism, and is directed by Josh Rabinowitz and co-directed or associate directed by Eileen White, and it’s another example of the power of this collaboration that manifests itself through the Rutgers Cancer Institute of New Jersey.
Libutti: I think being at Rutgers gives us the opportunity to collaborate with many of the other schools and institutes. We have robust collaborations with the School of Pharmacy, with the School of Nursing, with the School of Public Health, with both medical schools, and with the School of Arts and Sciences.
And so, there’s a tremendous opportunity for investigators in different disciplines to combine their intellect and their knowledge around the cancer problem. And so, those collaborations, I think, are key to our success, and what one would hope would happen with an NCI-designated cancer center.
Hait: One of the really important aspects of this cancer center has been the unwavering support of the state of New Jersey. Going back to the original announcement that there would be an effort to build an NCI-designated center, back to Governor Florio, and then the governors thereafter all were very supportive. Can you talk a little bit about that support, including the State Cancer Registry that brought forth Screen New Jersey?
Libutti: Absolutely. So, we, as you’ve mentioned, have incredible support both from the executive branch, from the governor’s office, as well as from both houses of the legislature, the Assembly and the Senate have been incredible supporters of the Cancer Institute throughout those years.
And this manifests in a variety of ways, it manifests in real dollars in terms of their commitment to the Cancer Institute of New Jersey each year in the governor’s budget, but also to particular programs, as you mentioned.
And our New Jersey State Cancer Registry, which is actually the home of a national SEER database, is co-managed between the New Jersey Department of Health and the Cancer Institute in New Jersey, and that gets competed competitively every five years for the SEER grant, and we’ve been very successful in maintaining that.
And then our ScreenNJ program, which is a program that focuses on screening for colon and lung cancer, and we’re hoping to expand to other tumor types, was launched in fiscal year 2018 through the support of the state of New Jersey, and continues to be supported by the state moving forward.
So, without the state support, we would not be successful.
Hait: Steve, we started the cancer Institute with one office and three cubicles, and you have just a broken ground for New Jersey’s first freestanding cancer hospital. Can you tell us a little bit about this incredible facility?
Libutti: So, I’m very excited about this project that also is a joint effort between the health system, RWJBarnabas Health, the city of New Brunswick, the county of Middlesex, state of New Jersey, and Rutgers University, all coming together.
The New Brunswick Development Corporation, DEVCO, is instrumental in this activity, as is the New Brunswick School Board. Part of this project, building a 510,000 square foot, 12-story cancer pavilion, complete with inpatient and outpatient activity, advanced imaging capabilities, multidisciplinary clinics, operating rooms, 10 brand new state-of-the-art research laboratories.
In addition to that project, which I think is going to have incredible positive impact, not only on New Brunswick and the surrounding community, but on the entire state, having a destination cancer hospital within New Jersey, as a part of that project, we’re building a brand new school for the City of New Brunswick, a $55 million school, with no taxpayer dollars being expended to build that school.
And we believe that that’s an investment in the future cancer researchers and physicians that may go through that school, and then ultimately decide to pursue a career in cancer research and cancer care, and may wind up practicing or performing research in the new pavilion.
And so, how can you not be excited about being a part of a project that’s covering all the spectrum of activity like that?
Libutti: So, Bill, as we wrap up our discussion, what would you say is the thing you were most proud of accomplishing in your tenure as the director of the Rutgers Cancer Institute of New Jersey?
Hait: It’s a tough question. Certainly, we’re proud of getting the NCI comprehensive designation, that was very important, proud of the faculty and people, the staff we were able to attract to New Jersey, but the most proud I think we would all say, was that we were really able to deliver extraordinary care to people in New Jersey and from beyond New Jersey, but really, fundamentally for the people of New Jersey, who really needed a center of this quality.
And I think to this day, as I look back at the cancer center and I think about the thousands of patients that we cared for, that I think sticks with me as perhaps the greatest accomplishment. There’s no better place in the world to get cancer care today than at the Rutgers Cancer Institute of New Jersey.
From my perspective, Steve, and I know I speak for many of the people who had this idea that we could create a cancer center of extraordinary quality for the people of New Jersey, I think where you’ve taken it was to previously unimagined places, and I know ,on behalf of all of us who were here some years ago, and all the people in New Jersey that this institution has touched, we owe you and your team a tremendous debt of gratitude, so a big thank you.
Libutti: So, Bill, thank you for those kind words, but I owe you, as does the rest of the Cancer Institute, a tremendous thank you, to you and the original team, many of whom are still here at the cancer institute, as a testament to that loyalty to what you built.
Without your vision, without the foundation that you built here, all that we’re trying to accomplish now and what we want to continue to accomplish into the future, would not have been possible.
And I am truly indebted to you for all you did in launching this great center, and I hope to make you proud as the team continues to move forward.
Hait: Well, thank you, Steve, and the feelings are mutual.