Dr. Cheryl Willman, UNM Comprehensive Cancer Center director and CEO, explains one of her slides. Photo Courtesy of Jane Janson
By Mary Alice Murphy
Toward the beginning of the Silver City-Grant County Chamber of Commerce monthly luncheon on Nov. 2, 2017, Gila Regional Medical Center Board of Trustees member Tony Trujillo introduced GRMC Chief Executive Officer Taffy Arias.
"This is a time in history for Gila Regional," Arias said. "We are at the beginning of something bigger than any of us." She introduced Shelly Carter, the Cancer Center Clinical Manager. "She symbolizes what the Cancer Center means to everyone." Arias also introduced the GRMC Interim Chief Financial Officer, JoBeth Vance, who has helped her with the transition of the Cancer Center to the University of New Mexico Comprehensive Cancer Center as the provider of cancer care services.
Trujillo introduced Dr. Cheryl Willman, the director and CEO of the UNM Cancer Center. "She has been the CEO and director of the center since November 1999." He said she received her MD at the Mayo Medical School and did her internship and residency at the UNM School of Medicine. A fellowship followed at the UNM School of Medicine at the University of Washington. She is UNM Distinguished Professor of Pathology and Internal Medicine and is The Maurice and Marguerite Liberman Distinguished Endowed Chair in Cancer Research. Her interests include leukemia genetics and genomics, discovery of underlying genetic mutations in leukemia through Next Generation Sequencing methods and development of diagnostics and targeted therapies, as well as hematopathology and nanotechnology and nanotherapeutics.
"I am a scientist and a physician, so I will use slides for my presentation," Willman said. "I will talk about how and why we developed UNM's Cancer Center and about the past four months at Gila Regional."
She noted: "Seventeer years ago, we promised that, with your support, we would build New Mexico's finest and most comprehensive cancer treatment program to assure that all New Mexicans would have access to world class cancer care and benefit from advances in cancer research, right here, in our home state, with patients surrounded by families and friends who love and support them and we delivered."
Willman said when she negotiates, "it's not personal. When I was beginning the Canter Center at UNM, I said: 'If you want me to stay, we have to agree to build one of the best cancer centers in the nation. I met Tony at the Legislature, when we went for funding. I asked the legislators if I could do it without going through the university. The late Senator Benny Altamirano was a proponent of creating it."
"We are one of only 49 NCI (National Cancer Institute) designated comprehensive cancer centers in the country," Willman said. "We received the designation in 2015, and we are the only comprehensive cancer center in New Mexico. To receive the award, we had to go through rigorous accrediting." The accreditation and highest commendations came from The American College of Surgery Commission on Cancer, ASCO Quality Oncology Program Initiative, The Joint Commission and the American College of Radiology.
According to a news release on the UNM Comprehensive Cancer Center website, the center delivers the highest quality diagnosis and treatment, provides access to the newest cancer treatments in clinical trials, conducts world-class research and educates the next generation of cancer physicians, scientists and healthcare professionals.
"We have a phenomenal team," Willman said. "Our patients are generally happy with a 94 percent satisfaction rate. I hear that one of the local complaints was that we are a research hospital and not patient-centered. That's B.S. The most important thing to us is care of our patients."
She said Dr. Rich Lauer, chief medical officer, who trained at the University of Indiana and has been at UNM for about 10 years, treated Lance Armstrong and together with his supervising physician, developed a treatment for testicular cancer. She introduced Rodney Martinez, a seventh-generation New Mexican from Questa as the cancer center's chief financial officer. The chemotherapy bill for the center is about $20 million a year. "Rodney has worked with Dr. Lauer to integrate the clinical and financial operations."
Also present was Rae Ann Paden, chief administrative officer.
"Our goals, required of the center, are to have a state-of-the-art cancer center with an integrated team," Willman said. "We use a scientific approach to developing individualized treatment for each patient. We do research. We have a large number working to lower the incidence of cancer in New Mexico. We use the latest cancer drugs, and we have a huge training program with 150 students. The best cancer care comes from research and we benefit from the questioning of students and their learning. We also enhance economic development with our programs."
She said in 1999, the whole state had only nine oncologists. "We now have 134 physicians and surgeons in every cancer specialty, who provide care to more than 12,000 patients. Sen. Altamirano gave us the seed money to recruit."
Willman presented some of the metrics, with the Cancer Center having 114 cancer scientists, who work with partners at Los Alamos and Sandia National Labs, and Lovelace Respiratory Research Institute. And the center has about 600 staff members. "This year, we are on track to see 14,000 patients. We opened a clinic in Las Cruces and now we are opening this one here. Last year, we had 27 patients from Silver City."
She said UNM treats about 60 percent of adult cancer patients in New Mexico and nearly 70 percent of the kids with cancer in the state, with 52 percent being racial or ethnic minorities.
"We are one of only three of the 49 comprehensive cancer centers that takes everybody," Willman said. "Most of the other ones expect you to be rich to get in and they don't take Medicare.
"It is part of our mission to treat anyone," she continued. "We often have bad debt, at almost $10 million, but we bring in more than $100 million in net clinical revenues. We pay our physicians and staff with $65 million from federal grant funding. We get $2 million from Bernalillo County and almost $6 million in state support."
She said UNM CCC has discovered new drugs for patients in the state and UNM cancer scientists have been awarded 106 new patents, with about 100 pending and have started 14 new biotechnology companies. "The state of New Mexico in the late 1960s began a tumor registry to track every case. It came because of Los Alamos National Lab. New Mexico now has one of the finest tumor registries in the nation. We have the world's largest database on Hispanic and American Indian cancers. Melanoma is more common in non-Hispanic white men, but kidney, pancreatic, liver and stomach cancers are more prevalent in Hispanic men. Our cancer center is focused on researching these cancers. For women, breast cancer and melanoma are more common in whites, but the above cancers are more common in Hispanic and American Indian women. New Mexico has had a dramatic increase in pancreatic and liver and hepatobiliary cancers in Hispanics and American Indians. We are doing phenomenal research around this. Hispanic men have also had a dramatic increase in colorectal cancer. That's why our research is important."
UNM practices precision medicine to determine what "your genetic makeup is and to develop a cancer treatment for you. We do human genomic sequencing. We may find women in Silver City and in Detroit with the same cancer, but they may be totally different. We try to understand the mutations of your cancer. We are doing it by zip codes. We use precision medicine so we can do better drug development. Veterans can go through the gene sequencing and be provided care through Walter Reed. We have new multidisciplinary clinics at UNM where we tend to practice in integrated teams on tumor types. We have a great team at the Women's Cancer Center doing breast and gynecological cancers, such as ovarian cancer."
She said seven of their doctors studied at UNM, trained elsewhere and came back to UNM to practice. "We have radiologic oncologists and surgical experts in cancer. We want to work with your surgeons here to collaborate with our surgical oncologists We have our resident Frenchman, who won the Jacques Chirac Prize in France, where he developed Phase 1 drugs. He has brought them to us in New Mexico. We have physicians that do bone marrow and stem cell transplants. In another area, we do cancer immunotherapy."
T-cells fight infection. "It's your immune system that makes your nose run when you have a cold. Most cancer cells shut off the immune system. Experiments in blocking cancer proteins began in animals. Now we're doing them in humans. We are turning the immune systems back on to make tumors melt away. Two of our physicians have developed an antibody for ovarian cancer and one for melanoma. That's immunotherapy."
The UNMCCC Phase I Clinical Trials Unit is the only Phase I program within 500 miles. It assures New Mexicans access to the newest cancer treatments.
"We want to make sure to serve the whole state," Willman said. "I'm a two-time cancer survivor. One was melanoma.
"What have we done in Silver City?" Willman asked and answered. "UNMCCC was selected in the request for proposal in April. We came down here in May, June, July and August. In May, we began an intensive assessment of the facility, the program infrastructure and business and clinical operations. The three-phase contract was completed on July 18. We've been working on building programs. We've been doing tons of hard work. Our first phase is to set all new systems in place. Marvin White went through intensive training in Albuquerque to serve as your new Physician Assistant for the Cancer Center. On Oct. 20, we opened here in medical oncology.
"Gila Regional needed fully integrated electronic records. We want to make medical records belong to Gila Regional," she continued. "All employees will be employees of Gila Regional, except for the physician assistant, who is a UNM Cancer Center employee. We are restructuring the cancer pharmacy and optimizing finances and billing."
She said prior to the talk, she had met with Hidalgo Medical Services, and that they are very excited about the possibilities of working with the GRMC Cancer Center.
For the electronic records system, Willman recommended Mosaic, which is the same system UNM uses. "We are working on installing it and tracking each patient as soon they come in the door. All medical procedures, chemotherapy, everything we do will be tracked. Mosaic will have all the records of any patient and they will be accessible by their physicians. Dr. Lauer has built the protocols and we are loading them into Mosaic."
She said radiation is taking a bit longer, because it takes a lot of quality control. In the presentation, she noted that the radiation oncology should open in December or January, depending on New Mexico Environment Department inspection.
Perhaps most importantly for the hospital, Mosaic generates the bill with inputs of all the many codes required. "That's so you don't leave any money on the table. We have to be able to monitor the patient and the billing. We are just finishing installing Mosaic." Willman said the system usually costs several million dollars, but "we got a deal on it, because we already have it in other parts of our system, so it was only $1 million."
"Right now, we are staffing one day a week, and when radiology is ready, we will staff one radiological oncologist one day a week," Willman said. "By early next year, we are recruiting and hope to have an oncologist that will live here to integrate patients' primary care and cancer care. We will continue to rotate when doctors need training or vacations.
"Something cool we're working on is that we want to build Project Echo for specialty consultation and referral," she continued. "We want to bring clinical trials here and have virtual oncology in Albuquerque and here."
Project Echo uses multipoint videoconferencing, best practice protocols and co-management of patients, so primary care providers in remote and underserved areas can be trained by tertiary specialists to safely and effectively treat complex diseases in their home communities, according to the presentation slide.
She asked for questions.
Scott Terry, Chamber president and director, commented on how extraordinary it is for a town of 10,000 to have such extensive medical services. "I was in a town more than three times the size of this one and they were amazed at what we have."
An audience member asked about the different cancers in New Mexico.
"It costs $7,000 for genome sequencing," Willman said. "We're super sophisticated in finding mutations and treating them. The air we breathe and the food we eat causes millions of mutations in us every day. The individualized treatment revs up the immune system to treat cancers. Our immune system is working every day. Does psychological or physical stress cause cancer? It can, but we don't know why where you live can cause cancer. In New Mexico, we have a lot of heavy metals. We sequenced kids who died of leukemia and the Hispanics and American Indians had different mutations. This is where precision medicine is amazing."
She said her father had melanoma and a surgeon cut it out. "He's been studied and had his own immune system activated. He's alive and well at 84."
A man at the luncheon asked if Willman had ever seen anyone from Rocky Flats, Colorado. "I grew up there (it was a former nuclear weapons production facility near Denver that has since been removed and is now Superfund site). We have a major family history of cancer."
Willman said yes, the area had a cluster of childhood leukemia. "Some of us are more genetically predisposed to get cancer. Cancer is usually a combination of predisposition and environment."
Jane Janson, from the audience, said one of the concerns once word got out that UNM was taking over the cancer center was that it would be revolving door of doctors, with a patient seeing one doctor one week and a different one the next time she went in.
"That will not be the case. Dr. Amy Tarnower and Dr. Ian Rabinowitz will continue to cover when we get the new physician who will live here," Willman said. "We may have the one who lives here also go to Albuquerque to get to know all our doctors in Albuquerque. We want them to know all your doctors here, too."
She said with the Mosaic system here and in Albuquerque, the referring physicians can access their own records. "The infrastructure will help all physicians and patients access their own records."
Trujillo concluded the meeting: "Go out and spread the word about the great things going on at Gila Regional."