Fall 2014 
 

Robert S. DiPaola, MD, is director of the Rutgers Cancer Institute of New Jersey and program committee chair for the 2014 AACI/CCAF Annual Meeting.


Commentary Overview

* A matrix cancer center's ability to fully leverage funding opportunities may be limited by insufficient authority and control over its organizational structure, the appointment and promotions process, and available resources.

* When provided with enough authority and autonomy, cancer centers can manage a clinical service line with hospital partners, providing greater quality of care for the patient and more financial benefit to the university and medical school as well as the cancer center.

* Cancer centers are uniquely suited to discussing state investment in a cancer plan that stems from cancer center activities and that brings economic value to a state's citizens.
About AACI Commentary

As part of AACI's efforts to feature the work and views of its member centers, AACI has launched AACI Commentary, a quarterly editorial series. Written by cancer center leaders, each edition will focus on a major issue of common interest to the nation's cancer centers.



Rutgers Cancer Institute of New Jersey: Reorganizing Within an Evolving Matrix Structure

BY ROBERT S. DIPAOLA, MD

With more than 1.6 million cancer diagnoses expected in 2014 and 585,000 patients projected to die from the disease, effectively uniting teams of researchers with synergistic expertise is critical. For example, advances in technology, including genomic applications and more molecularly targeted therapies, can be leveraged for greater impact by multidisciplinary teams of researchers.

To improve cancer research and take advantage of multidisciplinary opportunities, the National Cancer Institute's (NCI) Cancer Center Support Grant (CCSG) underwrites research infrastructure and activities to enhance scientific depth through collaborative, transdisciplinary, and translational efforts. Now numbering 68, NCI-designated cancer centers, funded in part by the CCSG, embody a diversity of organizational structures, scientific niches, and activities beyond the CCSG domain. Many centers provide services to their communities and foster financial stability for further cross-subsidization of their research mission. The evolution of cancer centers has led to a diversification of funding sources including: enhanced clinical operations, often with networks and satellites; philanthropy; state support; business opportunities; and other services. A center's organizational structure—freestanding, matrixed within an academic institution, or research based consortia—can determine to large degree the success of many of these revenue opportunities.

A matrix center's ability to fully leverage such opportunities may be limited by insufficient authority and control over the organizational structure, the appointment and promotions process, and available resources. For example, the inability to organize and optimize a clinical service line with surgical, radiation, and medical oncology disciplines can constrain negotiating clout with hospitals and commercial payors. Direct contact with state and other institutional entities may be limited, along with direct authority over philanthropic efforts due to competing priorities. In addition, overall responsibility for faculty and staff recruitment and retention, as well as administrative processes, may be suboptimal.

A New Jersey Consortium
One example of an evolving matrix structure within a university is the Cancer Institute of New Jersey (CINJ), the only NCI-designated center in the state, which recently integrated within Rutgers University. CINJ started as an institute within the Robert Wood Johnson Medical School and the cancer research epicenter of the eight schools of the University of Medicine and Dentistry of New Jersey (UMDNJ). Designation occurred in 1997, comprehensive status in 2002, and formal recognition as a consortium center with Rutgers University in 2004 and both Rutgers and Princeton University in 2010. CINJ received state support--with a statewide responsibility--and University support, with some autonomy to grow statewide research, clinical and philanthropic activities. The consortium with Princeton enhanced scientific depth in key areas such as cancer metabolism. Collaborations with the Institute for Advanced Study (located in the town of Princeton, but not affiliated with the university) boosted CINJ's strength in systems biology. Collaborations across a matrix center within a single medical school in UMDNJ expanded CINJ activity and membership, although with some organizational limitations. Signed into law in 2012, the historic New Jersey Medical and Health Sciences Education Restructuring Act integrated most of UMDNJ into Rutgers effective July 1, 2013, with CINJ reorganized as an autonomous institute and "responsibility center" and renamed Rutgers Cancer Institute of New Jersey. This reorganization gave the Rutgers Cancer Institute essentially free-standing center authority, with direct reporting to the university's President under a Chancellor of Biomedical and Health Sciences and responsibility for its own financial stability as a business operation.

Being part of a large university matrix also provides a number of benefits including:

• Faculty recruitment with appointments optimized in appropriate departments across many of Rutgers' 32 schools and colleges, including two medical schools in diverse campuses, a school of pharmacy, school of public health, and school of engineering;

• Direct discussions with the state to provide services such as incorporating NCI's Surveillance, Epidemiology, and End Results (SEER) Program and tumor registry and additional state support;

• Development of multiple hospital co-managed partnerships with authority over all oncology disciplines for comprehensive clinical service lines, which have increased revenue;

• Partnerships with other schools and institutes across the Rutgers campus, leading to new programmatic initiatives (one of which attracted a $10 million dollar donation to enhance the application of next generation sequencing, within a Genetics Institute, in clinical trials for patients at the cancer center, as part of a precision medicine initiative);

• Development activities in direct support of the cancer center conducted within the university foundation by a distinct unit under the authority of the cancer center director;

• Opportunities to expand population science research in diverse communities including the Rutgers Newark campus; and,

• Access to outstanding students and trainees.

Matrix Commonalities and Considerations
Although one size does not fit all, some common themes emerge related to stability and growth of a cancer center's mission. Operational considerations of a matrix, as well as a free-standing cancer center may be more important than ever before, given current financial constraints and programmatic pressures. When provided with enough authority and autonomy, cancer centers are in a position to manage a clinical service line with hospital partners, with greater quality of care for the patient and more financial benefit to the university and medical school, as well as the cancer center. They can more successfully attract cancer-related philanthropy and better leverage financial opportunities to cross subsidize the critical cancer research missions, and they are also uniquely suited to discuss state investment in a cancer plan that stems from cancer center activities and that brings economic value to the state's citizens.

As opportunities emerge with such new structures, and since these opportunities can add value to the larger institution, attention must be paid to both financial stability and collaborative, cross-campus decisions that mutually benefit the cancer center as well as the various schools and other entities of the university.

Representing 93 of the nation's premier academic and free-standing cancer centers, the Association of American Cancer Institutes is dedicated to reducing the burden of cancer by enhancing the impact of the nation's leading cancer centers.