John Yarbro’s “memos for the record” provide a detailed overview of the NCI Cancer Centers Program in 1975

Major topics covered:

• Institutions that are performing well are MD Anderson, Roswell Park, Sloan Kettering Institute, Sidney Farber Cancer Center, University of Miami Cancer Center, University of Wisconsin Cancer Center;
• The administrations of two institutions—Duke University Cancer Center and Yale Comprehensive Cancer Center—have been “refractory to all attempts to improve the structure of the cancer center.”
• Institutions that have “problems of one degree or another in which the influence of the [NCI] cancer centers staff can be useful” are described in detail.

Major topics covered:

• Yarbro recommends that “a number of developing programs should be considered hopeless and written off.”
• Conclusion: the centers described here and in other Yarbro memoranda “if developed successfully will lead to an appropriate geographic balance of comprehensive cancer centers. However, centers would need to be developed in San Francisco, New Orleans, Atlanta, Hawaii and Puerto Rico. Yarbro describes logistical and political problems in these areas.

Major topics covered:

• The memo provides Yarbro’s perspective on the long-range goal of establishing geographically balanced comprehensive cancer centers that will eventually become self-supporting;
• Yarbro emphasizes the need for “academic stability” of cancer centers “to ensure that they are organized and established in such a fashion as to be long lasting.”
• Yarbro proposes “third party payments and competition for grants and contracts in the ordinary peer review system so that the centers will tend to become self supporting in the long run in the same way that a department of medicine or a department of surgery is self supporting.”

Major topics covered:

• Yarbro provides a historical perspective on cancer centers to expand on the concepts described in the memo in the “Comprehensive Cancer Center evolution.”
• Yarbro distinguishes centers developed on the basis of departmental structures from those developed as institutes affiliated with medical schools.

Major topics covered:

• Using examples of cancer centers, Yarbro describes two approaches to developing cancer centers which offer the potential for stability. The two models are: (1.) A free-standing institute which has independent sources of support but is affiliated with a medical school, and (2.) A multidisciplinary department established within a medical school which is able to have tenured faculty and other departmental prerogatives.
• Yarbro develops this point further in a paper: “Cancer Centers: Their Relationship to the Academic Community.”
• Yarbro proposes creation of a program that would provide short-term support contingent upon an institution providing hard money budgets for the development of departments of oncology.