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Becker’s Healthcare Podcast
Expanding Access, Translational Research, and the Future of Cancer Care with Dr. Robert A. Figlin
00:19:43
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:32]
B
Welcome to the Beckers Healthcare Podcast. I'm Elizabeth Gregerson, a reporter here at Beckers, and I'm thrilled Today to interview Dr. Robert Figlin, interim director of Cedar Sinai Cancer and interim director of the Samuel Ocean Comprehensive Cancer Institute, on the podcast today. Dr. Figlin, thank you so much for joining me. I'm so grateful to share your insights with our audience.
- [00:57]
C
Thanks so much for the invitation. Happy to be here.
- [00:59]
B
Great. And before we dive in, could you introduce yourself and maybe just give a little bit about your background and your organization?
- [01:06]
C
Certainly. So I'm the Steven Spielberg Family Chair in Hematology Oncology. I'm a professor of medicine and biomedical sciences at the Cedars Sinai Health Sciences University, and I lead the service line and the cancer efforts across our health system, which include multiple hospitals, many practices, as well as our flagship center in West Hollywood and Beverly Hills, which is our academic medical center.
- [01:35]
B
Perfect. Thank you. And I'm grateful to talk to you. It's not January 1st, but it's still the beginning of the year. I'm grateful to get your insights on the landscape of cancer care today and maybe what we can look forward to in the future. But before we get too far ahead of ourselves, I'd love to know from your vantage point, our audience, they're made up of health system leaders that maybe aren't completely in the cancer space. Other specialties, other priorities. I'd love to know in your experience where you've seen maybe misalignment between a cancer program's growth ambitions and those broader system priorities. And how can our audience as healthcare executives strategically decide how to balance those priorities, maybe deciding where to invest or not to invest in cancer care over the next three to five years?
- [02:32]
C
Yeah, that's a great question, and I think a question that we all struggle with, not just today, but we've struggled with over the last decade. And I think that what Cedars Sinai is a horizontally integrated health system, and what I mean by that is that there are always going to be competing priorities for assets, whether it's brick and mortar assets or research assets. Or personnel. I think that what's clear is that we, as a service line, constantly try to make the case to leadership that the changes that will occur in care for cancer patients over the next decade will dictate the priorities of what we do today. What do I mean by that? You just heard from the American cancer society that more than 70% of patients survive more than five years with cancer. What that means is that more and more cancer patients are going to become part of our health system. Whether it's patients with active cancer patients who are in remission, or patients who are survivors, or for a place like cedars, people who are at risk and need aggressive screening. I think it's important for us to continue to make the case, recognizing that those competing interests are also aligned with a horizontally integrated system, Meaning that more cancer patients are developing cardiovascular disease, more cancer patients are developing diseases associated with chronic toxicity and survivorship. And these are all going to be required. But for the active cancer patient, the patient with newly diagnosed cancer, the key for the patient and the key for the system is access, access, access, access. If you're a cancer patient and you want access to our health system or any health system across the country, you, want to know that when you are at risk for that diagnosis, that you're going to be able to access experts, people capable of delivering care in an expedited fashion. One of the ways that we've dealt with that in the Cedars Sinai health system Is in what I would otherwise call a distributive model. What do I mean by that? We have other hospitals, we have other practices that are all under our domain. They use our infrastructure, our ehr, our organizational supply lines. But it's critical because I think one thing that's also changed about cancer care in 2026 and going forward is patients would like to receive their care close to home if at all possible. And I always like to give this anecdote. Cedars Sinai health system serves a population of approximately 11/4 million people in our catchment area. We are larger than some states. That's important for those of you that visited Los Angeles, Unlike Manhattan as an example, as we are a very horizontal community, sometimes it can take an extended period of time to travel short distances. That's why we believe that what people should be considering in the health system is bringing their expertise to their communities so that they can have tanning gown delivered and reserve the expertise of the center for those things that are necessary that can't be delivered in the community.
- [06:07]
B
Absolutely. Thank you for laying that all out. And kind of giving that geographic visual. But I think it just ties back perfectly to what you said about access. When there are all those survivorship considerations and this chronic now condition that people are saying cancer may be. None of that care can happen without access. So we need that access first in order for patients to receive all that innovation.
- [06:37]
C
And I think that's absolutely true. But it has to be more than access only because it has to be access with deliverables in my view. What I mean by that is we have what I think most places would consider a team approach, whether it's our multi d clinics in pancreas cancer, colorectal cancer, lung cancer and breast cancer. But it's also, as we'll talk about in a bit, the appropriate use of mid level providers to make sure that we are delivering care in a comprehensive way where everyone is practicing at the top of their license and making sure that we bring patients through the system in a way that's compatible with what they need for their care.
- [07:19]
B
Perfect. I'd love to talk about another operational bridge, discovery and clinical care. Right. So that's a big one. I always hear is the bench to the bedside. How at Cedars Sinai and Samuel Ocean have you approached kind of building that bridge between discovery and clinical care and, and what lessons might be relevant for other health systems? I've covered a lot recently that are trying to kind of scale innovation and research responsibly.
- [07:48]
C
Yeah, so that's a great question, Elizabeth. And I think first let me say in my multiple decades as a cancer investigator, I would regret not being able to say to people that, that the care that we deliver today is on the backs of patients that had participated in clinical research previously. So there is no line in my view, between clinical care and research. Why? Because I believe when cancer patients want to receive their care, they want to know not only what is best available for them today, but what might be available to them for a possible treatment that might be in the future. I think at Cedars Sinai we fully embed our clinical research efforts in our ehr. We deliver our clinical research across our health system. We drive our clinical research and our basic research through the paradigm of translation. We expect our cancer programs of cancer biology, cancer therapeutics and population science to ask and answer questions that are critical to our catchment area. I want to remind people Los Angeles is a unique city, probably not unlike New York City, but very different than other populations in the country. We have a large Latino population, African American, Asian, especially Korean lgbtq, large BRCA population. The key for us Is to align our priority cancers with the people that are seeking our career and to do that through a collaborative effort from the lab to the clinic, Never forgetting that even the laboratory questions being asked must in the future have translational applications and recognizing that the patients that we serve are critical. One of the ways that we've done that, and I would encourage many people to do that, is we have what's called an active community advisory board. Our community advisory board is diverse. It is established through our community outreach and engagement program. What that does is it informs the science of what's important in the community. Sometimes as investigators, we might not completely align with what does the community want. Our community advisory board has been a strong advocate for asking the right questions for what's important for the people that we serve.
- [10:18]
B
Perfect. Yeah. And I feel like having that community center too can just inform, like you said, that connection between discovery and the clinical care, it all matches up completely together. On a similar note, we can't really talk about clinical care without talking about the workforce. And even research we can't talk about without talking about the workforce. For our listeners who may be leading health systems, not leading just cancer service lines, but leading entire systems that are balancing workforce issues, what are the oncology specific considerations you feel that they should be watching most closely when it comes to the cancer workforce? And maybe how does Cedars Sinai think about recruitment and retaining talent in the environment today?
- [11:09]
C
I think it's a pertinent question to 2026 and going forward, the workforce is a challenge in large part because we're not training enough cancer experts. Part of the challenge is the pipeline for physicians is challenged within the oncology workforce. Having said that, the way we manage that is through the lens of we have experts in diseases in our 13 disease research groups at the main academic medical center, Cedars Sinai Cancer center. But we have other types of physicians and in the cancer workforce that are in our community practices where physicians coming out of training programs are looking more toward a community type practice as opposed to an academic practice. And then what we try and do is we try and align incentives so that they're aligned with where they practice. So not one size fits all. We don't expect our community physicians to compete for peer reviewed research and high impact journal publications, but we do expect that from our, from our faculty. Having said that, I think the other big piece that we're thinking about extensively, as we talked about previously, is the use of the advanced practice people, whether it's a PA or an np. Why I think it's because as our population ages, unfortunately, there will be more new cancer cases. And we need to make sure that our cancer physicians have the capacity to take up the new cancer cases and are not burdened by the more chronic cases where they don't allow for the new cases to enter. That's where apps practicing at the top of their license can support the care of the patient, the care of the journey, and the care of the outcome. For those of you that might be interested in, I did a podcast with Oncology New Central just a little bit ago with Sunita Puri from Irvine. The title of it was New reality for Terminal Cancer. What that talked about, and much different than when I started my training, is the number of patients that we have in our clinics that have had extended lives as a result of the treatments that we can offer. Those lives are likely not cured, as in some patients, but they can live for years. Those patients now need to be managed through a cohort of groups of caregivers, including advanced practice, to make sure that not only do they deliver the care they're seeing, and seeing the right person at the right time, have access to the expert, but allows the expert to actually access the new patients that need to see us in the system.
- [13:59]
B
Thank you for sharing that. Yeah. And if I'm taking it incorrectly, it's kind of the advanced practice providers, they have this space, and if they're practicing at the top of their license, they can care for those patients. And then allowing for the new diagnosis to fuel through to the physicians, you know, no matter the care setting, to kind of maybe support that survivorship balance that we were talking about right at the beginning.
- [14:29]
C
And I think further, Elizabeth, I think one of the things that we have not done a good job in nationally is allowing our patients and our future patients to understand that the team approach to cancer care is still going to be best of class. And patients often become very attached to their physicians. That's understandable, but it's best that they we start to educate them about being attached to their physician teams as opposed to just the physician themselves.
- [15:02]
B
Yeah, I love that. I love that mindset. I guess speaking of building a team, kind of looking ahead, maybe that team mentality is one strategy, but what other kinds of strategies have you seen succeed or stall cancer care within health systems? Maybe that's organizational capabilities, governance, physician alignment, all sorts of different things. You could take it in any direction. But what two or three have you seen that really determine whether a health system cancer strategy succeeds?
- [15:36]
C
I think that it is absolutely critical that we be Creative. And we think about cancer care through the lens of other technology advances that are taking place in our country and in the world. Whether that's the use of artificial intelligence, whether that's the use of relationships with commercial vendors. I think that service lines, in my view, especially cancer care service lines, need to be looked through the lens of a bit of a corporate structure. What I mean by that is how does one align, grow and deliver care across the cancer continuum? I'll give you a good example of where I think we are succeeding in an out of the box way. As you know, while taking care of cancer patients is at the cornerstone of our care, there are many more million people at risk. People at risk, whether they're receiving screening for breast cancer, lung cancer, prostate cancer, or other cancers in the future, want to receive that at risk screening at what we'd otherwise call point of care. They don't want to travel to the main medical center for their screening. They want something that's convenient. They don't want to have to leave their children and leave their work and leave their jobs in a way that is going to make it insufficient. So the things that we are doing is we are joint venturing with a imaging company and we'll just leave the names out of it for the moment. But the purpose of which is there are imaging organizations in our country which are at the point of care for patients that want to receive screening. Then what we've done is we have established warm handoffs between the screening evaluation and the academic cancer center or their affiliate. And what we have found in breast cancer and now expanding that to lung and prostate cancer is what patients want, is they want easy access for screening. They want to note if there's an abnormality, that they have a warm handoff to an expert. And they want to know that that's going to be conducive with respect to their own insurance or their own payer. So we need to be thinking about innovative models. Other things that we're doing is we're obviously thinking about other vendors that are building our infrastructure, whether that's the infrastructure for molecular testing and precision medicine, the infrastructure for clinical trial enrollment. Those are all things that can be centralized at the hub and distributed across the system that I think make the patient and the system more user friendly.
- [18:17]
B
Great. Yeah. I love that mindset of kind of collaboration and care coordination. It all ties back to access. Right. And making those intentional choices to help patients receive care.
- [18:29]
C
Yeah. I think, you know, as we close, Elizabeth, I think that, you know, one of the things I love about cders and have for my 16 years being here is we are a patient centric organization. What does that mean? It means that we have to view everything that we do through the the eyes of the patient. Whether that is science, access, translation, discovery, it has to be viewed through the lens of the patient. As long as we keep our so called eye on the ball, I think that we will succeed because the patients want to see that they're part of a larger organizational structure so that if and when they need us, we will be there for them.
- [19:14]
B
Amazing. Well, I think that's the perfect spot to leave it for today. Thank you so much for joining me for taking the time to share your insights. I know that they'll be so valuable and informative to our listeners. So thank you for joining me.
- [19:27]
C
Thanks for inviting me, Elizabeth. Have a great day.
- [19:29]
B
Thanks. And I invite our listeners to tune into more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com Hope you have a wonderful rest of your day.