Ambitions Stalled

It's hard to think of a bigger challenge than trying to cure cancer, but Michael Seiden, president and chief executive officer of Fox Chase Cancer Center, has that, and much more, to worry about.

Like politics, money, competition, fund-raising, retirements and defections, and the learning curve of a guy who got a big promotion last year.

Demand for care at the venerable Northeast Philadelphia institution is up, Seiden says, and landlocked Fox Chase must grow soon - and a lot. Its plans, estimated to cost $2 billion over 25 years, are mired in a years-long tussle with neighbors over the Burholme Park land it covets. So, Fox Chase recently announced Plan B: building a second campus in Delaware. Opposition is already surfacing there as a Delaware hospital with a big cancer program questions the use of state money to lure an outsider into its territory.

While Fox Chase's ambitions stall, other hospitals - big research centers and smaller community hospitals alike - are scrambling to attract the growing numbers of cancer patients in Philadelphia's highly competitive market. Hospital of the University of Pennsylvania (HUP), Fox Chase's biggest rival, has opened part of its new $300 million Perelman Center for Advanced Medicine, which will house outpatient cancer care. Its $145 million Roberts Proton Therapy Center is slated to open next year.

Abington Memorial Hospital, an easy drive from Fox Chase, has mounted an advertising campaign that focuses on its cancer expertise. "What if," one ad asks, "I have an emergency while I'm being treated for cancer?" Fox Chase does not have an emergency room. Across the river, Cooper University Hospital is touting its new CyberKnife, a radiation treatment that can be an alternative to surgery.

Plus, it's a new job for Seiden, 49, and a big step up from his previous position. Last at Massachusetts General Hospital, where he was chief of the clinical research unit in the cancer science division, he's been at Fox Chase for about a year. He went from managing 75 to 100 people and a $7 million budget to 2,100 people and $300 million. And he replaced the well-liked Robert Young, who led the hospital for 18 years before stepping aside to become chancellor. Since Seiden's arrival, several senior leaders have announced their retirements, and some well-known doctors have jumped ship. Seiden says the expansion insecurity has made recruiting tough.

Then there's funding. Government money for research has been flat the last few years, a trend that's squeezing budgets at top cancer hospitals across the country. Given all the issues, Seiden said, Fox Chase is breaking even, but the bottom line is suffering.

He concedes it's been a "challenging" year, but adds, "I didn't come here thinking it would be easy."

He's thrown himself into the new job, he said, with the goal of doing what's best for the institution, not necessarily his own career.

His personal experiences as an ovarian cancer specialist, who watched hundreds of his patients die, and now as a cancer widower, help him put the job stresses in their proper place. His wife died in 2006 of breast cancer. "It generates a healthy perspective to everything else going on in life," he said.

There are rumblings of morale problems. Carlo Croce, former director of Thomas Jefferson University's Kimmel Cancer Center and now chair of the department of molecular virology, immunology and medical genetics at Ohio State University, thinks Seiden lacks the research stature to lead Fox Chase. The board, he said, "found a guy I never heard of, and I know everybody in the cancer field." He said he knew of many Fox Chase staffers who were looking to leave.

Seiden's curriculum vitae, the academic equivalent of a resume, lists 96 scientific publications.

Board member Thomas Tritton said the center's board was satisfied with Seiden so far. "I think he's doing an absolutely fantastic job," he said.

Tritton has been impressed with Seiden's ability to analyze information and consider other people's ideas. What the board saw in Seiden, he said, was "someone who was extremely talented and who was going to develop a vision we'd all get behind, and that's what he's doing."

Seiden took on this job at a time of growing need for cancer care as baby boomers age. If current trends continue, the American Cancer Society estimates there will be 1.9 million new cancer cases by 2020, up from 1.4 million in 2007.

The region has several high-end cancer centers. Fox Chase is a National Cancer Institute comprehensive cancer center, the government's recognition for the broadest scope of research combined with patient care. HUP's Abramson Cancer Center also has that designation, and Thomas Jefferson University Hospital, which is currently a step below, hopes to be a comprehensive center by 2013.

Independence Blue Cross recently named those three hospitals and Abington as Blue Distinction Centers for Complex and Rare Cancers. In Delaware, Christiana Hospital's Helen F. Graham Cancer Center is an NCI community cancer center, a program meant to bring the latest research to community hospitals.

As advances in cancer care trickle down to community hospitals, places like Fox Chase must constantly reinvent themselves, finding new niches near an ever-changing cutting edge, cancer center, leaders said.

"Like all other academic entities, we train our own competition," said Louis Weiner, who chaired the department of medical oncology at Fox Chase and was a candidate for the top job there. He now directs Georgetown University's cancer center.

The main draw of research cancer centers is access to treatments not yet available elsewhere, he said. "It's the difference," he said, "between having the doctor who read the articles and having the doctor who wrote them."

Fox Chase is one of a few top research and patient-care centers that focus only on cancer. The good thing about that, Seiden said, is that cancer is everyone's top priority.

But cancer center directors at Penn and Abington said that was not ideal, because people with cancer often have other medical problems, too.

Craig Thompson, director of the Abramson Cancer Center, said freestanding cancer centers made more sense when doctors expected most cancer patients to die. Now, they're more likely to need long-term care for their whole bodies. "We expect two-thirds of patients we see here will be alive and doing well in five years," he said.

Seiden said his hospital was working to beef up its staff of noncancer specialists.

He foresees a future when people will be tested for genetic risk for cancer, leading to more interest in cancer prevention and detection. Fox Chase needs to invest in prevention, risk-assessment, molecular-imaging and minimally invasive technology, he said. Technology available today, like robotic surgery, requires major renovations to Fox Chase's aging buildings. Hence, the need for land.

City officials support the hospital's Burholme Park expansion plan, but it is tied up in court, where neighbors argue it violates the will that bestowed the park land on Philadelphia.

Samuel Stretton, the lawyer who represents the opposition, says Burholme is the area's only major park, a place where the neighborhood goes to play. "You lose the heart of the community," he said. And, he added, "15 years from now, they're going to come back and want the rest."

An hour's drive south, the Delaware Economic Development Office is pitching three sites in New Castle County. Its director, Judy McKinney-Cherry, wouldn't say how much money the state was offering as an incentive, but she said the figure would eventually be made public.

Fox Chase board chairman William Avery said only that Delaware has offered a "substantial amount."

At Christiana, the state's largest private employer, Nicholas Petrelli, medical director of the Graham cancer center, can think of better ways to spend state money.

"Economic development begins at home," he said. "We have cancer centers in Delaware that certainly could benefit from whatever funds are being utilized."

His center, which has more than 100 clinical trials and saw 3,000 new cancer patients last year, is building a $45 million addition to its cancer center.

Petrelli said he has seen no reason to refer his center's patients to the comprehensive cancer centers: "There's no need, with the programs we have here . . . for patients to leave the state of Delaware for cancer care."

But McKinney-Cherry said Christiana didn't do basic research like Fox Chase. She estimates that Fox Chase could add $500 million a year to Delaware's economy and help the state become a research mecca.

"All the ships will rise," she said.

Seiden, whose center saw 8,000 new patients last year, said he'd be interested in working with Christiana. "We have absolutely no desire or intention," he said, "of being a bad neighbor to anyone wherever we move."