We choose to go to the moon: MD Anderson's aggressive, organized plan to stop cancer

Everything's bigger in Texas, including MD Anderson's goals to prevent cancer.

As part of the 6th Annual Becker's Hospital Review Meeting in Chicago, Ronald DePinho, MD, president of University of Texas MD Anderson Cancer Center in Houston, recapped some of the wins and changes resulting from his system's Moon Shots Program.  

Launched in 2012, the Moon Shots Program challenges physicians and scientists to target seven types of cancer and dramatically reduce mortality for the diseases. The multidisciplinary push was inspired by the all-out team effort it took to meet President John F. Kennedy's promise to send an American to the moon only seven years after he made the pledge to do so in Houston in 1961. The program is meant to accelerate clinical research into cancer treatments for patients that extend or save lives. It is highly organized and orchestrated, with MD Anderson leaders and researchers articulating specific milestones and developing operating and business plans for each moon shot.

"It's a major lens through which we select and guide projects," said Dr. DePinho. MD Anderson decided to first target a select group of cancers that collectively contribute to half of all cancer deaths: triple-negative breast cancer, high-grade serous ovarian cancer, Leukemia (MDS-AML and CLL), lung cancer, melanoma and prostate cancer.

Despite the sophisticated and groundbreaking cancer research occurring at MD Anderson, Dr. DePinho spotted a challenge: What is discovered in a lab does not necessarily translate to public policy or the broader population. Given Dr. DePinho's experience in leadership and faculty positions with Boston's Dana-Farber Cancer Institute, Harvard Medical School and Albert Einstein College of Medicine in New York City, he was familiar with the slow pace of discovery as it moves from the bench to a bill.

"We do a lot, but converting that knowledge into policy, education or services requires a different kind of experience, and that's where cancer control comes in," said Dr. DePinho.

The Moon Shot program has several platforms, one being Cancer Prevention and Control, which is what Dr. DePinho referred to. This is a completely new arm for MD Anderson, one that bridges the gap between prevention and control research and prevention and control activities. The platform includes the expertise of policy analysts, curriculum developers, nurse scientists, community-based navigators, mHealth professionals and others who intervene in public policy, education and community services.

MD Anderson builds its strategy on the idea that prevention is the highest expression of its mission to eliminate cancer. More than half of cancer cases are preventable by applying knowledge we already possess. So what could MD Anderson do — at the policy, education and community level — to prevent cancer cases with what is already known?

It looked to tanning beds.

"We've known for over a decade that excessive UV exposure during childhood drives a significant increase in melanoma," said Dr. DePinho. "We know tanning beds are a very, very powerful carcinogen. But that hasn't been converted to action."

MD Anderson's Governmental Relations Department collaborated with the Melanoma Moon Shot team for legislative activities and education for Texas policymakers, informing them of the link between UV exposure and melanoma. (MD Anderson researchers found tanning bed use before the age of 18 increases a person's risk of melanoma by 85 percent.) On Sept. 1, 2013, Texas enacted a law that bans kids under age 18 from accessing tanning beds. It was one of only a handful of states to enact a full-on ban for minors. Eleven states have followed with similar legislation since.

"We have the expertise to go in and educate legislatures to do the right things for our kids," said Dr. DePinho. "You can educate legislative bodies and they will do the right thing."

MD Anderson is now working on legislative activities for HPV vaccination, as well. This involves reframing the conversation around the vaccine from one about sex to one about cancer prevention. Last winter, Dr. DePinho applauded the FDA for greenlighting use of Gardasil 9, which can prevent certain cancers caused by nine HPV strains. "Up to 80 percent of the world will be infected with HPV at some point, according to estimates," Dr. DePinho said in a statement. The center also developed a national partnership with peer institutions in 18 states to increase HPV vaccination rates.

As part of its End Tobacco Program, MD Anderson recommends more than 100 actions in the areas of policy, education and community-based services to end tobacco at the institutional, local, regional, state, national and international levels. One action is a statewide smoke-free legislation, which would ban smoking in indoor workplaces, including bars and restaurants. This has yet to be achieved, although MD Anderson did enact its own tobacco-free hiring policy in January 2015.

Other platforms with the Moon Shots program include Big Data Analytics, which houses a longitudinal patient disease registry and a suite of analytics that interrogate and break down data to provide actionable answers to clinical and research programs. APOLLO is another platform — it stands for Adaptive Patient-Oriented Longitudinal Learning and Optimization — and it promotes collaboration between MD Anderson's labs, information systems, clinical care and research. Moon Shots also has immunotherapy and proteomics platforms, along with the Institute for Applied Cancer Science and Center for Co-Clinical Trials.  

Since it was launched in 2012, the center's Moon Shots program has received approximately $213 million in private philanthropic commitments. MD Anderson's total revenue in fiscal year 2014 was more than $4.4 billion, 75 percent of which was derived from net patient revenue and about 10 percent form philanthropy and restricted grants. It received nearly $31 million in prevention research funding that year, with about $13 million coming from donors and $18 million from federal grants and contracts.

Dr. DePinho said he is leading the organization at a time of unprecedented opportunity for cancer medicine. There is now a "deep understanding" of what causes and maintains cancer, an advancement largely due to genomic mapping. Moon Shots is how the center organized its efforts "in a way that actually transforms patient care to affect mortality," said Dr. DePinho.

"We have a mission to maintain, because we are a solution-generating institution."

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