One month ago, Dr. William Henrich, president of the UT-Health Sciences Center in San Antonio (UTHSCSA), appeared before the City Council’s Economic and Human Development Committee to promote a pending partnership between the Cancer Therapy and Research Center (CTRC) and the MD Anderson Cancer Center in Houston.
The partnership, Henrich said, would end the necessity of San Antonio cancer patients moving to Houston for treatment, a prospect that animated all those attending the meeting. Such treatment is expensive and beyond the reach of many working class families who cannot afford to leave home and lease apartments near the Houston treatment centers.
Henrich asked Committee Chair Joe Krier (D9) and his City Council colleagues to earmark $5 million in the 2017 bond to help UTHSCSA reach its fundraising goal of $52 million that will be spent in two phases to revitalize the CTRC campus, replace aging equipment, and recruit new faculty.
What wasn’t disclosed at the June 8 meeting is the plan to conduct a national search for a new CTRC director, the post held since 2008 by Dr. Ian Thompson, one of the most respected physician leaders in San Antonio.
Word of that planned search has now spread through the community of medical professionals and donors, upsetting many who oppose removing Dr. Thompson from his leadership position. The news of the search for new leadership has triggered growing concern among some donors that MD Anderson will have an outsized say in the selection of a new director and will gain administrative control of the CTRC.
“One myth in the ether going around is that the CTRC is about to be taken over by MD Anderson, which is completely untrue,” Dr. Henrich said in a lengthy interview on Friday. “We are entering this partnership to advance the array of clinical services we can deliver to the people of San Antonio. The CTRC is not going to become a satellite of MD Anderson.”
Dr. Thompson, meanwhile, has been invited to apply for his own job, an invitation that his supporters say belittles his significant contributions to cancer therapy and research in San Antonio, and has left him distraught over his standing in the medical community and his future role at CTRC. He declined to be interviewed for this article, but did confirm he has been invited to apply for the job.
Asked if he would do so, Dr. Thompson said, “I am seeking counsel with family, friends and my minister.”
The negotiating details and term sheets being traded between the San Antonio and Houston partners have not been released. City Council members reacted enthusiastically to the picture of robust economic growth in the Medical Center presented by Dr. Henrich, and in particular, the prospect that San Antonio families with a cancer patient would no longer have to go to Houston for world-class inpatient care. Terms of the deal likely will be sought by Mayor Ivy Taylor and City Council before any bond funds millions are committed.
Dr. Henrich said there is no firm timeline for concluding the negotiations with MD Anderson or carrying out the $52 million in capital improvements to the CTRC. Critics of the process say the proposed partnership will not end the flow of patients to Houston for inpatient treatments unavailable in San Antonio.
”We were led to believe that the deal would enable San Antonio to offer in-patient cancer treatment, which is more lucrative for hospital systems, attracts more talent and research dollars, and allows patients to be near home and family,” said one CTRC donor. “Now we think that’s not going to happen the way it was described.”
One physician previously associated with UTHSCSA said it costs $1-1.5 million per bed to build an in-patient cancer treatment center, so the $52 million campaign, he said, would not be adequate to offer such services here. Dr. Thompson and others have long advocated for a cancer treatment hospital in San Antonio, which along with children’s hospital, has been seen by many as important missing pieces of the puzzle in the city’s fast-growing health care and medical service economy which now accounts for one in six jobs here and a $30 billion annual impact.
Dr. Henrich takes issue with that view.
“About 95% of all cancer patients are receiving outpatient treatment,” he said. “We don’t need to build a hospital for the community at this time because there isn’t demand for it at this time. As better therapies come online the usual approach is to manage cancers on an outpatient basis.”
The debate over the continuing outflow of cancer patients to Houston isn’t the only issue dividing the traditionally low profile medical leadership at the South Texas Medical Center, where public controversy is assiduously avoided and most conflicts play out behind closed doors.
The CTRC, which became part of the UTHSCSA system in 2007, is one of only four cancer treatment centers in Texas with the coveted rank as a National Cancer Institute designated cancer center. That designation is worth as much as $5 million in research dollars in some years.
The CTRC’s expertise is in outpatient treatments for cancer patients. Aside from the excellent medical outcomes the center achieves, it is known for delivering high levels of care and support services to its patients and their loved ones during and after treatment.
“There are many cities in the U.S that spend hundreds of millions of dollars to become an NCI designated cancer center, which we have been since 1991,” said one person close to the CTRC. “There are 69 nationwide, but only four in Texas.: Two in Houston, one at MD Anderson and one at Baylor College of Medicine, and one at UT-Southwestern in Dallas. There are many cities far larger than San Antonio that do not have one. On a per capita basis, Texas having only four puts us way behind New York and California. Having one in South Texas to focus on our population is critically important.”
Dr. Thompson, say those close to him, has cautioned Dr. Henrich and Dr. Francisco González-Scarano, Dean of UTHSCSA’s School of Medicine here and vice president for medical affairs under Dr. Henrich, that the partnership must be constructed in a way that does not cause professional staff turnover and put at-risk the NCI designation. That caution, his supporters say, appears to have hurt Dr. Thompson’s chances of keeping his job.
Dr. Henrich said such reports are not based in fact.
“We are going to do everything we need to do to keep the NCI designation and grant,” Dr. Henrich said. “MD Anderson wants us to continue the NCI grant and compete for its renewal in a few years. We want the community to know that.”
Dr. Thompson’s many supporters, including some donors, oppose him being assigned to a lesser role. The CTRC is known for unusually strong support from its donors, many of whom have personally experienced a loved one being treated at CTRC.
In January, at the CTRC’s 40th Anniversary Reunion Dinner, the Mays Family Foundation announced a gift of $5 million to endow the Mays Family Foundation Distinguished University Presidential Chair for the director of the CTRC.
Some are especially bothered that Dr. Thompson would have to step down less than one year after being awarded the endowed chair. If the UTHSCSA and MD Anderson partners want a leader with impressive credentials, it will be hard to beat Dr. Thompson. He is a West Point graduate (Class of ’76) and a retired U.S. Army physician who served his residency in San Antonio here and went on to serve in Operation Desert Storm in 1991 when U.S. military forces invaded Iraq from neighboring Saudi Arabia and liberated Kuwait.
Thompson is a urologic oncologist whose speciality is prevention and early detection of prostate and other urology cancers, including cancers of the kidney, bladder and testis. He is as deeply respected outside the San Antonio medical community as he is here. Thompson serves as a trustee of the American Board of Urology, and as chairman of the Early Detection Research Network of the National Cancer Institute. He also is chairman of the Genitourinary Cancer Committee of the Southwest Oncology Group, one of the largest cancer treatment trials organizations in the world.
I’ve known Dr. Thompson for more than a decade, before he ascended to the position of CTRC director. He was the principal investigator of the Prostate Cancer Prevention Trial, an 18,882-subject study published in 2003 that demonstrated that the drug finasteride can reduce the risk of prostate cancer.
In 2004, he and his colleagues published news of a significant discovery, finding that cancers, including aggressive prostate cancers, can be present at lower levels of prostate-specific antigen. Dr. Thompson might not remember, but I consulted him years ago at the recommendation of then-UTHSCSA President Dr. Francisco Cigarroa, and today am one of the many the beneficiaries of finasteride.
“I hate the idea that the CTRC might become, in effect, a part of MD Anderson,’ said one significant donor. “I hate the idea of a change in leadership and I hate for San Antonio to lose the CTRC and its San Antonio identity. I would not have contributed to the endowment if I knew this was coming. Nothing against MD Anderson, but I want my money to go to San Antonio.”
Again, Dr. Henrich said such sentiments are misguided.
“I appointed Ian to his current role and I have supported him and the CTRC. I respect him enormously and we will work diligently together on this project,” Dr. Henrich said. “When two organizations come together it’s common practice to undertake a search for the director of the enterprise. It has nothing to do with any element of dissatisfaction with Dr. Thompson. His track record of achievement makes him an ideal candidate. He’s given seven years, a minimum of 60 hours of work, to the CTRC.
“I’m leaving it completely up to Ian to decide what to do, and I hope everyone gives him room to make his decision,” Dr. Henrich said. “He’s not being fired, he’s not being pushed aside. We celebrate what he has accomplished. I am his colleague and his friend and I am devoted to his continued professional success, and he is devoted to the CTRC. It’s up to him how he wants to contribute in future.”
Change, Dr. Henrich said, is always hard, and some people in San Antonio are reacting to the coming changes at CTRC with unwarranted fears of losing what already has been accomplished in cancer care treatment and research.
Early History
The CTRC opened its doors as a nonprofit outpatient radiation therapy in 1974. It became the CTRC in 1976 and since has evolved into one of only four academic cancer centers in the state to be named a National Cancer Institute designated cancer center.
Its Institute for Drug Development conducts one of the largest oncology Phase I clinical drug programs in the world, and participates in the development of cancer drugs approved by the Food and Drug Administration. In 2007, the CTRC Foundation transferred ownership of the assets to the UTHSCSA to better integrate the city’s oncology treatment facilities and administration of those services.
Top image: The Cancer Therapy and Research Center. Courtesy of The UT Health Science Center.
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I have a strong opinion of support for MD Anderson + UTHSC based on my personal experience. I was one of many faced with making that difficult decision to move to Houston and incur the added costs associated with maintaining (2) homes. An apartment for my family to stay in while in Houston so that I would not be alone, and my house in SA, while I was an inpatient at MDA for 6 months receiving treatment for leukemia. I was advised by my oncologist in SA to go to MD Anderson. The rent and associated costs were $4,000/month. More than my home here. That’s not an option for some patients. I still go 3 times a year for followup visits requiring an overnight stay. I am one of many who live in SA that do this. The article mentions that 95% of cancer treatment is outpatient care. With those treatments nearly wiping out the patient’s immune system, it’s an incredible risk to the patient. Is that 95% due to the lack of available focused cancer care care hospitals? A general care hospital puts a cancer patient at risk of contracting infection(s).
I am not alone in saying that there is more benefit to having the best cancer hospital in the country, and considered one of the best in the world, here in SA.
There is so much to gain in so many ways. Perhaps the real story is one focused on the great potential for positive outcomes for the patient, caregiver, and elevating the level of care and research, and collaboration. The impact this would have as further advancement is made to bring an end to cancer by providing unmatched education, research and training is also important to stress.
Ruffled feathers and pride, are of least importance and should not overshadow the real story that needs telling.
As a practicing CTRC member and Orthopedic Oncologist affiliated with UTHSCSA, I found this article to be thought provoking on many levels. As a physician that trained outside of San Antonio, I have always found that general San Antonian opinions on CTRC and UTHSCSA contrarian to the views that other city populations have on their primary academic facilities and cancer center. My training took me through the University of Michigan, Emory University, and the University of Florida: all highly-respected academic institutions. The general ‘feel’ was that those were the places individuals went to obtain the highest level of evidenced based and ethical practices. Here in San Antonio, in many circles, the perception is otherwise. Although there are innumerable clinicians in private practice that are exceptional at what they do and follow the same evidence and ethical practices, the academic institutions are perceived to be the site for unfunded or poorly funded only. They are not seen as the centers of excellence. To me, it makes little to no sense. As someone who has only lived in San Antonio for 5 years, I don’t know the genesis of the community feelings nor why they have persisted as long as they have. It baffles me.
The oncologists at CTRC are exceptional. I trust my colleagues implicitly if it were my own health or that of a loved one. This excellence is often forgotten because we are in service to the public, by law, we are required to serve all, and we do, with pride.
I personally know that many physicians specifically chose to practice in San Antonio over being at MD Anderson Houston simply because they prefer SA as a city. Additionally, I have many patients that have asked if they should go to MD Anderson for their sarcoma while we are capable of providing the same services here in San Antonio without the challenges associated with receiving care in Houston. That is all the while under the NCI designation and a multi-disciplinary team trained to treat sarcomas.
As Dr. Heinrich has pointed out in this article, truths are largely in the eye of the beholder. Dr. Thompson is a poignant leader that has been put in a difficult position. However, for the sake of San Antonio and CTRC, we must put our best foot forward. I personally hope that he will consider leading this new endeavor as his contributions should not go unnoticed. As an institution, our common goal should be to combine what MD Anderson has to offer with our cancer center in order to create a world-class facility for loved ones here in South Texas.
It was my go-to choice back in the old days — 2002. My only quibble was that the patient load is high and wait times for appointments was long. I never had the resources to go to Houston.
There is an unmet need here. Whatever helps reduce that, I’m all in.