History of Cancer Care

Genesis
by George A. Beller, M.D.

Senator Emily Couric was diagnosed with metastatic pancreatic cancer in July 2000. She had just launched her campaign for lieutenant governor of Virginia and was slated to be Mark Warner’s running mate on the Democratic ticket. At the time of her diagnosis, experts stated that her life expectancy was approximately four months. She withdrew from the campaign, but remained in her position as a state senator from the Charlottesville-Albemarle district.

Emily lived for fifteen months before she succumbed to this dreaded disease. All her treatment regimens were either partly or totally experimental. She underwent her initial chemotherapy treatment at the UVa Cancer Center. Her cancer activity was being monitored at the National Cancer Institute with PET imaging which was not yet available at UVa. One observation Emily made during her chemotherapy treatments was the crowded conditions of the Infusion Center where outpatient chemotherapy was administered to patients. There were only a few private rooms for patients to receive the infusion of their intravenous drug therapy. Most of the patients had to sit in reclining chairs in a large room during these infusions, some of which lasted much of the day. Continuing her work as an advocate for others, after a few months of several different experimental courses of chemotherapy, Emily obtained a pledge from Leonard Sandridge, the executive vice-president and chief operating officer of the University, to improve the Infusion Center. More specifically, he promised that the center would be moved into a new facility and enlarged in order to make it more patient friendly. The planning for this expansion was undertaken while Emily was still alive and it was completed after her death.

In September 2001, after a period of stabilization and even regression of some of her liver metastases, Emily relapsed. Her doctors found additional tumor growth in the liver, bone, and peritoneal cavity. At that time, no clinical trials were being conducted at the UVa Cancer Center for advanced pancreatic cancer. As a result, the unfortunate reality was that Emily—although quite ill and experiencing great discomfort—had to leave her home and community to travel with me to San Antonio, Texas, to continue treatment. There she enrolled in a Phase 2 clinical trial of a new biologic agent being tested for its efficacy in metastatic pancreatic cancer.

Emily’s ten-day stay in San Antonio was a nightmare. She experienced serious complications of her treatment which required hospitalization. She endured a fever, ascites (a painful accumulation of fluid in the abdominal cavity), anorexia, nausea, and pain. The day she developed these complications was September 11, 2001, now known simply as 9/11.

After we flew back on a private jet for further care at the University of Virginia Hospital, Emily gradually went downhill and transitioned to palliative hospice care at home. During her hospitalization in San Antonio, I vowed that after Emily died, which was inevitable, I would do all I could to advocate for a new stand-alone state-of-the-art Cancer Center building at UVa. I no longer wanted to see patients like Emily forced to leave Charlottesville for enrollment in clinical trials because we did not have the facilities and personnel to offer experimental care to cancer patients. An expanded cancer center would allow cancer patients to stay with their families and within their community while receiving the most advanced treatments available in the United States.

Emily died on October 18, 2001. Almost immediately, her family, friends, and colleagues asked what could be done to honor her legacy. Even before her own diagnosis, Emily had been a tireless advocate in the legislature and in the community for cancer patients. She authored the first bill in the nation which mandated that insurance companies pay for colonoscopies to screen for cancer. She gave speeches and interviews about the necessity of supporting high-quality cancer care. In partnership with UVa Women’s Basketball Head Coach Debbie Ryan, Emily established a fund for supporting families of cancer patients who had to stay in Charlottesville while their loved ones received treatment. She had already done so much for the cancer community before she was diagnosed. So when I received calls asking what was being planned as a memorial for Emily, it seemed natural to suggest a fundraising effort in her name to build a totally new Cancer Center at UVa.

The first step was a meeting with University of Virginia President John Casteen who gave his blessing to start the planning for such a free-standing Cancer Center building. It would be named after Emily if fifty percent or more of the donations were made in her name. Casteen then hosted a dinner at Carr’s Hill for distinguished community leaders and friends of Emily and me to announce the planning for such an undertaking. We received an initial pledge from Ed Howell, vice president and chief executive officer of the UVa Medical Center, to launch the project. We needed a large contribution, however, in order to solicit additional gifts successfully from multiple sources. To aid in this effort, Emily’s sister, Katie Couric, agreed to serve as the honorary chair of the fundraising effort.

At this point, though, progress in getting the campaign off the ground seemed to stall. Fortuitously, I happened to encounter President Casteen in Nantucket where we both were vacationing. He saw me unloading groceries into my family’s rental house and later came by to talk. During that conversation sitting on the front porch, I believe I convinced him of the great need we had for an expanded Cancer Center. I informed him that the reality was we still lacked a much-needed, NCI-designated comprehensive cancer center in the commonwealth. The proposal for an independent facility would support the center’s current clinical programs and ability to offer Phase 1 and Phase 2 clinical trials. Improving the center’s standing in these two key areas would not only bring greater care for patients, but also, in turn, would permit us to get this “comprehensive cancer center” designation.

To enhance the fundraising effort to reach the goal of $70 million, I received permission to arrange a meeting in Charlottesville between Governor Mark Warner, President Casteen, L.F. Payne (a member of the UVa Board of Visitors and a former congressman from our area), and me. The purpose of the meeting was to formally request the sum of $25 million for the proposed center from Warner’s annual budget. The governor came to the UVa Cancer Center and did meet with the three of us. We convinced him that the Commonwealth of Virginia needed this Cancer Center and that it would serve the citizens of central and southwest Virginia, as well as patients from every part of the state. He said it was too late to add anything in the current budget proposal, but that he would consider including this line item in his last budget in year four of his term.
Governor Warner kept his pledge and the House of Delegates and the State Senate voted to keep this $25 million in the budget for the new Cancer Center building. Once we had this amount from the Virginia legislature, it became easier to raise money from foundations and private donors. Another large donation I personally solicited was $5 million from Sheridan Snyder, a member of the Ivy Foundation. We received this amount from the board of the foundation. From then on, many generous individuals made donations to make the dream of the Emily Couric Clinical Cancer Center a reality.