Dr. Karen Fields’ right arm is in a cast, so she offers her left one in greeting. She is a bit embarrassed to explain how the arm got broken but eventually confesses that she was trying to ride a trikke, the new three-wheel contraption with no pedals that can be, well, tricky to maneuver. This small setback, however, is by no means slowing down the enthusiastic president and CEO of the Cancer Therapy & Research Center (CTRC). She just has too much on her plate.
For one thing, there is good news from Austin regarding the seemingly endless battle against cancer. In an unprecedented move last May, the Texas legislature voted to create a $3 billion fund that would be dedicated to cancer research, prevention and treatment over a period of 10 years. If voters approve the general obligations bonds to pay for it, $300 million a year will eventually become available to Texas research facilities, substantially boosting their efforts to find a cure for the disease that affects 85,000 Texans each year. Naturally, Fields is excited about the initiative. Like many cancer specialists, she feels we are on the cusp of a true breakthrough in treatment.
“It’s an exciting time now. In the last couple of years, cancer statistics are finally showing a decrease in mortality from the disease,” says the physician who took the helm at CTRC in January 2005. “There are many reasons for that, including better screening, earlier diagnosis and better therapies to improve patients’ quality of life and survival.
“But so far, we have been using the nuclear bomb approach to treatment. We kill both cancer cells and regular cells, but since cancer cells proliferate faster, they are more susceptible to chemotherapy. The main reason for excitement is that we are now gaining the tools to look at the disease at the cell level and develop targeted therapies to turn off the specific genes’ functions that cause your cancer. We’ll be able to develop drugs to block the expressions of these genes.”
It’s not science fiction, she adds, it’s real stuff. In fact, there are already a few cancers, such as chronic myelogenous leukemia, where this therapy can be applied. A lot of that new knowledge came out of the massive work on the human genome project, a basic research undertaking that is paying off in very practical terms for all of us. “That’s why we need to invest in basic research,” says Fields. And that’s why the recent legislation is so welcome.
Fields was one of the advocates lobbying for the bill, together with Lance Armstrong and representatives of the American Cancer Society and other concerned nonprofits. And she was present when Gov. Perry signed it into law last June. However, she sees more work ahead for San Antonio.
“We have some special challenges here,” she points out. “We need to stay involved in how the distribution of funds gets structured. We need to make sure that we get our representatives on the committees that will be making the funding decisions. There is one provision that they added between the House and the Senate that is especially challenging for San Antonio, namely that each institution that receives funding has to raise matching funds as well. Big cancer centers such as M. D. Anderson and Baylor have bigger communities to draw from.
We have to see how we’ll come up with the matching dollars. As a community, we also have to work hard to coordinate our efforts and submit the best scientific proposals so that they will get funded.”
Though the first grants won’t be given out until 2010, Fields already knows what she has to do: hire more of the best scientists she can get and form high-caliber research teams. The process is already under way, she says, at CTRC — and its main research arm, the Institute for Drug Development (IDD) — and through the San Antonio Cancer Institute (SACI), an organizational partnership created by CTRC and the Health Science Center to combine the two institutions’ efforts. The joining of forces allows SACI to fulfill the requirements of the National Cancer Institute (NCI) in Bethseda, Md., which funds cancer research throughout the United States. The idea is to foster the speedy incorporation of promising lab results into patient care.
When Fields, 51, took the job here, however, both SACI and CTRC had lost some momentum. A number of key scientists had left, affecting both funding and operation. What’s more, SACI was stripped of its prestigious “comprehensive cancer center” designation from NCI, though it retained a lesser recognition as a “designated cancer center.” Yet Fields left her longtime position at the H. Lee Moffitt Cancer Center in Tampa, Fla., to come here. Why?
“I took the job because I could see that this place had an incredible potential, a great history and some really fine scientists,” says the physician. “You know, I watched Moffitt grow in 16 years from a small place whose name no one could spell to one of the three largest centers in the United States. It was incredibly fun to be in a place like that, to be one of the architects of its growth. When I saw this place, I thought I was going to have that kind of experience again.”
A NEW START FOR CTRC
Since her arrival, Fields has been busy rebuilding both her own house and SACI. To that end, one of her first goals was to”reaffirm” the partnership with the Health Science Center. Together, the partners have hired some 60 new scientists and physicians, including Dr. Tyler Curiel to head SACI and Dr. Francis Giles, the new ID director. These moves are reinvigorating the development of new anti-cancer drugs at IDD — something it had become famous for — as well as the Phase I clinical trials of these and other drugs, also something CTRC had been known for. In fact, for quite some time, this was the only place in the country to conduct Phase I trials, attracting patients from across the United States. Fields proudly points out that 15 of the most important anti-cancer drugs have been developed here, including Taxol, Iressa, Novantrone and Vectibix, used for a range of cancers, from breast to colon.
When we meet the second time, she takes us on a tour of the main CTRC campus on Wurzbach Road, an outpatient treatment facility that cares for 120,000 people a year. It is the only place in town where children can receive radiation therapy, she points out, and it is also among the first cancer centers in the country to acquire the $3.5 million Tomotherapy machine, which can irradiate a tumor without affecting surrounding tissue. It also allows clinicians to see the tumor before each treatment and adjust dosage and other parameters accordingly. In fact, innovative radiation therapies have been part of the center since its beginning in 1974.
We also visit the handsomely appointed prostate and breast cancer clinics on the fifth and sixth floors, designed with patients’ comfort and privacy in mind; the chemotherapy rooms, the diagnostic imaging unit and the clinical trials wing. There’s even a kitchen where dietitians teach patients healthy cooking. Employees don’t seem surprised to see the boss in their midst. Friendly greetings are exchanged, and then everyone goes back to work. A few times, as we encounter certain individuals, Fields appreciatively explains the importance and the complexity of their jobs. Everywhere, names of donors whose contributions made certain facilities possible are prominently displayed. CTRC is an independent nonprofit, and such generosity is very valuable.
A major change that Fields has introduced has resulted in the restructuring of patient care by creating multidisciplinary, disease-specific clinics. The idea is to bring together all the specialists a patient has to see in one place. “There are two advantages to our approach — first, they all will be physically in one area, and they will function as a scientific team in charge of a patient’s care,” explains Fields. A team may include a surgeon, a gynecological oncologist, a radiologist, a dietitian, a physical therapist, lab scientists, a mental health counselor, etc. “We need to offer the range of services that patients need under one roof,” she says.
FROM FARM GIRL TO LEADER
When you walk into Dr. Fields’ spacious office at CTRC, you may or may not notice the soft music playing in the background. But you’ll be aware of pleasant, uncluttered surroundings. And unlike many executives, she won’t sit behind the desk while talking to you. Instead, there is a round conference table in the room to facilitate a sense of comfort during meetings. That’s all by design, she explains, to foster a calming atmosphere “so that no one will yell at me.” Though we doubt that people ever yell at her, it reflects her desire to create “a good, nurturing environment” throughout the center. That’s one of the hallmarks of a good leader. Another one is humility. “Good leaders know they are in charge, but they also know how to appreciate their team and how to thank them for their contributions,” she says.
Oddly, though there are many women doctors today, few achieve top leadership positions. Fields is one of only three in the nation to head a cancer center. Raised on a farm in a small Ohio town, Karen Keyse entered medical school in the late 1970s hoping to become a family practitioner. At the time, cancer was still a death sentence in most cases. But a lecture by Dr. Larry Einhorn, who later treated Lance Armstrong, made her look at oncology with new eyes. “He spoke about a drug that cured 90 percent of testicular cancer sufferers. That was exciting, to have a drug that could actually cure,” she recalls. “The other thing about oncology is that it was a way to combine science with taking care of patients.”
After completing two fellowships in oncology/hematology, she pursued an academic, research-oriented career at the University of South Florida and at the affiliated Moffitt Center, increasingly taking administrative positions of greater and greater responsibility. Through it all, she acquired a wealth of experience in clinical trials as a principal investigator for studies of breast cancer, lymphoma, leukemia and other cancers. To this day, she keeps letters from desperately ill patients and their families who wrote to thank her for the care they received.
Though she misses the daily contact with patients, she is aware that her current position can do even more good. “As an administrator, you are able to work on a broader scale. A lot of doctors don’t like administrative duties — lots of meetings, fund raising, policies and procedures — but I think it’s rewarding because more patients will see improvement in their care, and more doctors will have access to more knowledge,” she explains.
When she moved to San Antonio, Fields was surprised to discover that many San Antonians knew little about such a valuable resource as CTRC, let alone SACI. With her husband, Paul Fields, and son, Michael, still in Florida, she spent the first six months showing up at as many places as she could to speak about the center’s mission. Though her days are long and full, she sits on a number of community boards, including Girls, Inc., Bexar County United Way and the Research and Technology Foundation.
Now that her family has joined her here— including her 98-year-old grandmother and her 80-year-old mother-in-law — the busy doctor/executive tries to maintain a balance between her many duties and family life. She loves to attend Michael’s soccer games and ride a bicycle with him (though the trikke is probably history). But her chess-master husband and her son are used to accommodating her often unpredictable schedule. When he was younger, Michael used to say, “We are all a doctor.”
Someday, Fields would like to add an in-patient hospital to CTRC, but between now and November, raising public awareness about the bond issue will be a priority. Once again, she will reach out to the community to become an ambassador for cancer care. “Hopefully, voters will recognize that to decrease mortality from cancer is a good thing for all Texans,” she says.
Of course, regaining that coveted “comprehensive” status from NCI is also on her mind. To that end, she feels that SACI must strengthen its “cancer control research,” which studies prevention, outreach and differences between various populations, as well as set up the stage for more Phase II and III clinical trials.
And speaking of prevention, what steps does Dr. Fields take personally to ward off cancer? “I just had my mammogram last week, and I generally have all the screenings we recommend,” she says. “I never smoked, and I try to eat a healthy diet and to exercise. I also take calcium and use sunscreen, though it may be too late (to protect her skin). As a kid, I worked a lot on the farm without sunscreen.”
As one who has seen so much suffering and death, she is philosophical about the future: “What I learned from my patients is that you can’t take a single day for granted. I’ve seen so many people lose their loved ones, I’ve learned that life is precious, and you must take each day and live it the best you can.”
Author: Jasmina Wellinghoff
Photographer: Liz Garza Williams