Portal de Periódicos da CAPES

First person: Derek Raghavan, MD, PhD

2018; Wiley; Volume: 124; Issue: 14 Linguagem: Inglês

10.1002/cncr.31631

1097-0142

Carrie Printz,

Global Cancer Incidence and Screening

Derek Raghavan, MD, PhD, credits his mentors, including John Sands, MD, and Munro Neville, MD, PhD, for much of his career success. The former was a major influence during his residency at the University of Sydney, whereas the latter was his PhD supervisor at the University of London. A physician as well as a businessman who led his family's successful game and computer hardware distribution company for many years, Dr. Sands “had a very high standard of clinical medicine, but also taught me how to be a Renaissance man,” says Dr. Raghavan, adding, “Dr. Neville is another Renaissance man of great scientific talent and diverse interests and remains my mentor to this day.” Taking those Renaissance influences to heart, Dr. Raghavan has capped a long and successful career as a cancer researcher, medical oncologist, and administrator by leading the development of a new cancer center for the Carolinas region as president of the Levine Cancer Institute in Charlotte, North Carolina. Established in 2011, the Levine Cancer Institute is part of Atrium Health (formerly the Carolinas HealthCare System), a nonprofit health system that comprises 40 affiliated hospitals and more than 500 care locations in North and South Carolina. Dr. Raghavan came on board to help create an innovative model of decentralized cancer care delivery that expands its reach to patients across the region. “We call it an academic hybrid cancer center,” Dr. Raghavan says, noting that the goal is to bring cancer care to small and midsized communities throughout the region rather than requiring patients to come to the bigger cities. “We have outpatient units at county hospitals and about 12 freestanding clinics.” The approach was highlighted in 2017 by NEJM Catalyst, which summarized the ongoing challenges of providing high-quality cancer care, including wide variations in care, the hardship of traveling long distances to appointments, and inconsistent or duplicated care resulting from a lack of coordination among providers.1 When the center first launched, the system's cancer care consisted of approximately 5 urban branches and a staff of 85 individuals. Since that time, it has grown to 25 locations, a staff of 1500 individuals, and more than 100 oncologists throughout North and South Carolina, according to Dr. Raghavan. Although unique specialties such as the bone marrow transplantation program still are centered in Charlotte, practice groups of medical and radiation oncologists now are located in smaller towns as well. These clinics also offer early-phase clinical trials, genetic counseling, and molecular diagnostics while their physicians have electronic access to the center's tumor boards, grand rounds, and conferences. “We're doing identical studies all the time,” Dr. Raghavan says. “Everything is set up via pathways that can be downloaded on iPads, recommending how to treat every problem and listing which trials are available.” The main Levine Cancer Center in Charlotte opened a new 175,000-square foot building 3 years ago, and is about to open a second, 185,000-square foot building. The number of patients treated has increased from approximately 8000 in 2011 to 16,500 last year, Dr. Raghavan adds. At the same time, many more national clinical trials and locally launched studies now are offered to patients. For example, of the first 200 patients enrolled in the American Society of Clinical Oncology's Targeted Agent and Profiling Utilization Registry Study, 100 were from the Levine Cancer Institute, including 50 patients from the smaller community centers, he says. Colleagues are quick to credit Dr. Raghavan for much of the cancer center's success. “I spent 12 years at MD Anderson and had a lot of exposure to some big thought leaders at the clinical and administrative level, and as I reflect on my experience with people I've worked with, Derek Raghavan is one of the most impressive leaders I've worked for,” says Edward Kim, MD, chair of solid tumor oncology and investigational therapeutics at the Levine Cancer Institute. “Not only is he a good system leader, but he also has been a very strong advocate for rare cancer and disparities research.” Nor is this effort the first time Dr. Raghavan has led a cancer center. Prior to his arrival at the Levine Cancer Institute, he was director of the Cleveland Clinic's Taussig Cancer Center for 6 years, during which time he helped to significantly improve its national rankings and lead it to National Cancer Institute designation. That term followed positions as chair of the division of oncology at the University of Southern California (USC) in Los Angeles and associate director for clinical research at the USC Norris Comprehensive Cancer Center. “At USC, I worked with Don Skinner, one of the best urologic surgeons in the world, and we did a lot of nice work together as part of the Southwest Oncology Group at the time,” he says. A “diplomatic brat” who was born in Buenos Aires, Argentina, but grew up all over the world, Dr. Raghavan cites his grandfather, who started medical school in 1912 but had to change his career plans after enlisting during World War I (and always regretted leaving medicine), and his mother, a diagnostic radiographer, as his early influences. After earning his medical degree from the University of Sydney in Australia in 1974 and his PhD from the University of London's Institute of Cancer Research in 1984, he spent 10 years in Sydney honing his skills in genitourinary oncology and then moved to the United States to eventually become chief of the department of solid tumor oncology at Roswell Park Cancer Institute in Buffalo, New York. Along the way, he led studies on the neoadjuvant treatment of patients with nonmetastatic bladder cancer using cisplatin, which was paradigm shifting; cooperative group studies of gemcitabine for metastatic bladder cancer; and active surveillance for patients with stage I testicular cancer. The latter eventually led to a new standard of care that “saved men a lot of side effects,” Dr. Raghavan says. In his newest post, he has championed efforts to reach underserved populations and to work with Planetree Inc, which partners with providers to encourage patient-centered care. Previously, Planetree only had certified inpatient programs, but the Levine Cancer Institute became the first institution to be certified by Planetree for its outpatient care, which constitutes approximately 85% of the center's work, he notes. Ultimately, Dr. Raghavan hopes to increase the number of clinical trials offered to patients and gain increased national recognition for the center, including National Cancer Institute designation. Last year, more than 500 patients at Levine Cancer Institute were enrolled in therapeutic clinical trials, but he wants to see that number grow to above 1000. He credits the many leading physician researchers he has recruited from across the country for the center's success to date. “The vision I've developed with my team is a pretty exciting one,” he says. “I'm a big believer in letting leaders lead and not looking over their shoulder. When we bring recruits here, they say it seems like a very happy place. That suggests we've got good consensus and an integrated leadership team.” An adviser to cancer centers, organizations, and professional societies around the world, Dr. Raghavan also manages to find time to be the medical oncology editor and write a regular column for HemOnc Today. His wide-ranging topics include cautioning investigators against being too willing to accept the results of mediocre clinical trials and urging clinicians to take a stand on sociopolitical issues that impact health care. In his spare time, Dr. Raghavan keeps busy with his wife, 2 daughters, a step-daughter, and a step-grandchild, as well as “playing a horrible game of golf” and chairing the symphony board. “I admire his dedication to civic duty, including dancing on stage with a ballerina in front of 1100 people to raise money for the Levine disparities program and the Charlotte Ballet at their 2016 Dancing with the Stars competition and gala,” Dr. Kim says, adding with a chuckle, “You know how competitive these high-level type As are.”