OHSU Knight Cancer Institute will get a $2 billion donation. What will that mean for cancer care in Oregon?

Phil and Penny Knight have pledged $2 billion to Oregon Health & Science University for cancer research. The Knight Cancer Institute will become self-governed within OHSU and will have its own board of directors. In December, renowned cancer researcher Brian Druker announced his resignation as the institute’s CEO, but will return as the inaugural president of the Knight Cancer Group, which will be created to lead that institute.

He joins us with details about what this means for cancer care in Oregon.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Back in December, the renowned cancer researcher Brian Druker stepped down from his position as the leader of the Knight Cancer Institute at OHSU. He said the hospital had lost sight of what is crucial and forgotten its mission.

What a difference eight months make. Last week, Phil and Penny Knight announced that they are nearly quadrupling down on their earlier gifts to the hospital system. They are contributing $2 billion over the next 10 years. That money will go towards cancer research and clinical care. It will enable the Knight Cancer Institute to become a self-governed entity at OHSU.

What’s more, they’re bringing Brian Druker back. He’s going to be the inaugural president of the new Knight Cancer Group, and he joins us now. It’s good to have you back on the show.

Brian Druker: Thank you, Dave. It’s a pleasure to be with you. We’ve got a lot to cover, but I’m so glad to be here in the Gert Boyle Studio – my dear, dear friend – and it brings back such wonderful memories of her. Thank you.

Miller: I want to start with what this is going to mean for patients. What have you heard from your patients or the patients of colleagues over the years about the challenges that they face not from cancer specifically, but from the health systems that they’re navigating to try to get well?

Druker: That’s exactly one of the things we need to fix, Dave. When somebody gets a diagnosis and hears the words, “you have cancer,” their mind goes numb. Then all of a sudden we tell them you’ve got to make 10 different appointments. You’ve got to get all these things lined up. You’ve got to think about getting leave from work. You’ve got to fight with your insurance company about coverage. All these things entering … Why don’t we make it easy for patients to navigate?

I can tell you dozens and dozens of stories, and I bet most of your listeners have a story of how difficult our health care system can be to navigate. What if you made one phone call, everything was taken care of and we actually made it easy to access care, speed up the diagnosis, get you onto treatment and provide you with all the support you need through that journey?

Miller: OK, so that’s the goal here. You make that one phone call. Does that mean that there’s a kind of concierge or somebody who is globally focused on your care and they’re the one – and they work for the Knight Cancer Institute – making all the other calls?

Druker: That’s exactly right. We make it easy by having a navigator who can make sure that everything’s well coordinated. All the services you need. If that’s nutrition, if that’s exercise, if that’s financial counseling, mental health counseling. All the things get coordinated and you get to focus on getting well.

Miller: Do these positions exist right now?

Druker: They exist in some form or another, but they aren’t widely accessible. Again, I can tell you lots of stories where we fall down some on the coordination of care. We’ve got to do better and we will.

Miller: Five years ago there was a study in the journal JAMA Oncology about the cost of parking. It found that parking at National Cancer Institute designated cancer treatment centers can reach $40 a day. In some ways, it’s small, it’s just about parking. But it seems like an example of the things that patients and families have to deal with in addition to grief, fear and fatigue from treatment or the disease itself.

I’m curious how you think about the totality of all these things … How you actually accomplish that goal? Because it’s one thing to say, “wouldn’t it be great if we could have these people you call them to take care of everything.” But organizationally, it seems like a daunting challenge.

Druker: It is absolutely a daunting challenge and I don’t for a minute suggest that this is going to be simple or quick. But what I can promise you is that we’ll get a team of people together to work on the problems and to commit to continuous improvement. So if something comes up, if parking’s a bottleneck, we’ll fix it. If something else is a bottleneck, we’ll fix it. We’re gonna listen, we’re gonna react and we’re gonna commit to doing better.

Miller: What’s it going to mean in practice that the Knight Cancer Institute will now be run independently from the rest of OHSU?

Druker: One of the things that this gives us with a gift of this magnitude is [it] allows us to get things done efficiently and effectively. So if we need to fix something, we can actually get that done. If there’s a problem, we can manage it. It’s up to us and it’s on us, and if we don’t, that’s our problem. But again, we’re going to commit to continuous improvement and make sure that we can get things done to achieve the goal.

Miller: Let’s say that I go to OHSU because I break a bone, I see an orthopedic surgeon, I get fixed up. Two years go by and I’m diagnosed with cancer. I go back and I get treated for that. At the highest level, my care would actually be managed in these two different scenarios by separate entities?

Druker: OHSU and the Knight Cancer Institute will be one entity. All the cancer services will be managed by the Knight Cancer Group. So for you, it’ll be a seamless integration of services.

Miller: But behind the scenes there are different people who are in charge, who are making important decisions.

Druker: Oh, absolutely we’ll have our own leadership team, we’ll be making our own decisions. It might be that there’ll be some differences, but we’re gonna make sure that we’re seamlessly integrated across the institution and we’re already working incredibly collaboratively to make this happen.

Miller: What does it say about your take on OHSU as a whole that you think this is important for patient care, that it’ll be better if you remove control from the rest of the institution? I mean, there are people up the hill right now, or down the hill a mile north of us, who are getting care for all kinds of things that are not cancer. Should they be worried that you think care would be better if you were in charge of it?

Druker: My hope is that we set an example for how care is administered throughout the entire institution. Again, that’s the goal. The goal is to start somewhere, make an improvement and then let it spread. I’m hopeful that this just sets an example for what can be done if you have the right backing with the generosity of the Knight family, the right leadership, and then we can actually move this forward.

I’m also hopeful that this isn’t just an example for OHSU in Oregon. What if this example spreads around the country? Isn’t that gonna be good for patients everywhere, and Oregon sets that example and sets the bar higher for everybody?

Miller: I imagine that might happen if you can show not just increased patient satisfaction and increased patient outcomes, but also that it’s not a gigantic cost increase. How are you thinking about costs here, especially for places who can’t count on the largess of sneaker money?

Druker: My view, as we’ve always done with Knight investments in [the] Knight Cancer Institute, has been to look at the sustainability of this – and we’re already looking at that. Of course, some of the funds are going to go into endowment that will be helpful that some institutions may not have access to. But we’re already looking to, “How do we ensure the financial stability?” And it actually all pencils out. The reality is that even Phil Knight once said, “If you do things right, you’ll be fine financially.” I’m confident we can do that.

Miller: That it’s not going to be a lot more expensive to have patient coordinators.

Druker: Exactly. No, it won’t.

Miller: What’s this gonna mean for research?

Druker: For research this is gonna be … it comes at an incredible time. As I’m sure you’re all aware, there are threats of cutbacks in funding from the federal government for research. This is an incredible time for research. The technology we have to bring to bear on cancer, neurodegenerative diseases like Alzheimer’s, Parkinson’s and many, many others is unprecedented.

Miller: What’s also unprecedented though, and you were hinting at this, is the level of federal disinvestment in all kinds of science in all kinds of places.

Druker: Yes, and my hope is that this will allow us at least a bit of a buffer in continuing to enhance and expand our research efforts to accelerate new treatments for patients and to combine the best treatments with the best care so patients have the best outcome.

Miller: Two billion dollars over 10 years is an enormous sum of money, but it can’t create the kind of biotech and academic infrastructure that exists right now in a couple specific hubs in this country: In the Boston area and in the Bay Area. How do you compete against those, given the enormity of the academic and the corporate structures that have sort of bubbled up around there?

Druker: I guess I don’t view it as a competition, Dave. I view it as collaboration.

Miller: Is it not a competition though in some cases if you … Don’t you want some of that talent to come to OHSU?

Druker: We absolutely want to have talent that comes here, but that talent then starts to form companies. That talent brings venture capital, but it also brings revenue or resources from collaborations from pharmaceutical companies and other companies starting up in AI or other things that we’re going to uniquely do here that is gonna attract that attention nationally.

So once the spotlight gets focused on, “hey, this is a place where great things are happening,” wouldn’t you want to work with the investigators at the OHSU Knight Cancer Institute? We’ve already seen that with the initial investments of the Knights over the past decade and I’m confident we’re going to continue to see that.

Miller: Do you have a number in your head for how much bigger you’d like the research footprint to be in terms of researchers alone?

Druker: I haven’t come up with an actual number, but I’m not sure that bigger is the right way to think about it. I’m thinking about better. I want national, international talent stars that are gonna do amazing work. Let them get their work done and train the next generation. The size isn’t as important to me as the quality.

Miller: What about patient care? I can imagine you saying the same thing. It’s not that we need 75 more interventional radiologists or whatever, but we want the best. How are you gonna recruit?

Druker: Well, first of all, we are gonna need more interventional radiologists and pathologists in every discipline that touches cancer. We have to ensure that we’re expanding to meet the capacity needs of the patients that we serve so that if somebody is diagnosed with cancer, they can get in quickly, diagnosed quickly and treated quickly. We owe that to our patients. But clearly, having this kind of a buffer and this infusion … I think this is going to attract talent and if this doesn’t help our recruitment efforts, I can’t imagine what will.

Miller: When did the Knights first contact you or first start talking to you about what this gift could be and what it could lead to?

Druker: I’ve spoken with the Knight family quite often over the past few years and one of the things that’s unique about Phil and Penny Knight is they have continually asked the question, “what are you doing that nobody else can do?” And really what they’re saying is dream big. If you read an Oregonian article, the words they used were “aspire and achieve,” and they were continuously challenging me to think what could we do that would be inspiring? As part of that, I came up with a vision for continuing to enhance our research efforts [and] to use those efforts to enhance the outcomes for patients, but also to think about the patient care experience. They have clearly doubled down on that vision.

Miller: Did you bring that vision to OHSU leadership a year ago?

Druker: Yes, it’s been a little bit over a year.

Miller: OK, but as I mentioned in my intro, you stepped down from the leadership of the Knight Cancer Institute in December in a very public way. Was that partly because the old leadership of the hospital was not interested in what you were bringing forward?

Druker: I guess I’d look at this a little bit differently, Dave. When I first came here almost 30 odd years ago, I was recruited by the founding director of the Oregon Cancer Center, a guy by the name of Grover Bagby, who was an incredible mentor. What he taught me was hire great people, get out of their way and let them do great things. Over the past decade, like most academic medical centers, OHSU’s gotten kind of incredibly bureaucratic. And even though I have goals and ambitions, it’s gotten increasingly difficult for me to get those things done.

As I stepped away, the message was, “We really want to get things done. We aspire to do great things, but we need the ability to get those things done.” Now, we have all those things in place and with the backing of the Knight[s] with this new structure … I think we can aspire to do great things and will do great things.

Miller: Do you think that this could have happened if you hadn’t stepped down or was that a kind of catalyst for the gift and coming back?

Druker: It’s hard to know how much of a catalyst this was, but what I’ve recognized, and I think OHSU now recognize[s], is that we shouldn’t be afraid of being outrageously ambitious and doing something great in Oregon. I think as our interim president Steve Stadum came in and was incredibly helpful in making this happen, there was just a commitment to, yes, let’s do something big and bold, and make Oregon the place that people want to live and work.

Miller: It’s hard to imagine any institution, especially one that currently … a hospital now, which all hospitals are struggling with a lot of gigantic financial questions with Medicaid and a lot of other things. It’s hard to imagine anyone saying without a lot of misgivings, “no, we, we won’t take your $2 billion.” If that had been on the table in the past, or some gigantic gift was floated, was the hesitancy on the part of leadership in the past that this would be an independent organization or independent arm within the university? Was that the stumbling block in the past?

Druker: It’s hard for me to speak for how decisions were made. All I can say is that we are now looking to the future and we’re gonna do something amazing.

Miller: OK, fair enough. If the goal of the Knights is to improve health population-wide and to do something big, can you make the argument that this is the best use of $2 billion?

Druker: What I care passionately about is ensuring the best care for my patients with cancer. And the best care requires the best outcome based on the leading edge science. Let’s face it, cancer in Oregon is the number one leading cause of death in this state and in much of the country that’s also true. If we can make things better – better outcomes, better treatments, easier navigation – that’s a win for every single cancer patient. I do think this is a great investment and a great gift that the Knights are giving to humanity.

Miller: I ask it because the CDC says that the leading cause of death nationally, it’s not cancer. Cancer is close, but heart disease is above it and then there are plenty of other killers, obviously: stroke, chronic lower respiratory disease, Alzheimer’s, diabetes … You’re a doctor, not me, so you know much more on that list.

Without taking anything away from the horrors of cancer, I’m still curious how you think about putting this much money towards one killer, as opposed to an organizational change that would more directly touch on a lot of other diseases as well.

Druker: It’s interesting. I haven’t really thought about it quite in those terms, Dave, and I guess the way I think about it … I won’t dispute the CDC, but in Oregon actually cancer is number one and in other states it is. Nationally, yes, heart disease is. But cancer is the most feared diagnosis that I can ever imagine giving somebody. And again, I’ll go back to what I said earlier. If you hear the words, “you have cancer,” that is a frightening, life changing experience. We can and have to do better, and if we show the way in cancer, how that experience can be better, it will trickle over to every patient in every entity. We have to start somewhere and we’re going to start here.

Miller: Brian Druker, thanks very much.

Druker: My pleasure.

Miller: Brian Druker is going to be the president of the new Knight Cancer Group.

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