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From OncoLog, June 2011, Vol. 56, No. 6

MD Anderson Celebrates 70th Anniversary

By John McCool

Photo: Surplus barracks
From the late 1940s to 1954, patients at MD Anderson were treated and housed in 12 surplus army barracks.

Its first clinical facility was a converted Army barracks, its first headquarters was a renovated residential estate near downtown Houston, and its first cancer research was conducted by four scientists in a former horse stable.

It was a rather inauspicious beginning, to be sure, especially for an institution that now, 70 years later, anchors the vast Texas Medical Center with its main campus; has two additional research campuses and seven regional care centers, as well as numerous national and even international affiliations; and for the past 4 years has been ranked by U.S. News & World Report as the best hospital in the United States for cancer care.

The story of how The University of Texas MD Anderson Cancer Center rose from its state legislative creation in 1941 to its current status among the world’s leading cancer centers cannot be told merely in terms of new building construction and expanding square footage. Neither was it a foregone conclusion that the name of its original benefactor, Monroe Dunaway Anderson—a successful cotton merchant and philanthropist—would become synonymous with lifesaving cancer treatments and research aimed at transforming cancer, as historian James S. Olson put it, “from an acute to a chronic disease.”

One way to explain MD Anderson’s evolution is to focus on three pillars that have long defined, supported, and animated the institution, namely translational research, multi-disciplinary patient care, and education.

Translational research

John Mendelsohn, M.D., the institution’s president from 1996 to 2011, once said, “What is most unusual about MD Anderson, what we are acknowledged to lead the world in, is translating scientific discoveries into the clinic for the benefit of patients.” Indeed, within a decade of the institution’s founding, two MD Anderson faculty members—physician Gilbert H. Fletcher, M.D., and physicist Leonard G. Grimmett, Ph.D.—designed and tested the world’s first cobalt-60 radiation therapy unit. Later perfected by Dr. Fletcher himself, the revolutionary cobalt-60 unit provided a more effective and far less expensive means of delivering radiation therapy to cancer patients.

Examples abound of other translational research advances by MD Anderson faculty over the past 7 decades. Some of these include:

  • introducing limb-sparing surgery using donor bones (and later metal prostheses) to save the arms and legs of patients with bone tumors and soft tissue sarcomas;
  • documenting that combination chemotherapy was effective for children with rhabdomyosarcoma and osteosarcoma;
  • determining appropriate techniques for mammograms and showing that such radiographic studies could detect minimal, highly curable breast tumors;
  • developing the C-banding technique to precisely locate genes on various chromosomes;
  • conducting countless clinical trials to investigate novel anticancer treatments, including early clinical trials of paclitaxel and the three-drug combination of 5-fluorouracil, doxorubicin, and cyclophosphamide—both of which proved highly effective against breast cancer;
  • pioneering the fields of chemoprevention and genetic therapy;
  • advancing the use of microvascular tissue transfer to repair defects caused by the removal of cancers and introducing immediate reconstructive surgery following tumor excision;
  • documenting a direct molecular link between cigarette smoking and lung cancer;
  • revealing a possible hereditary component to nicotine addiction;
  • and advancing radiation therapy once again by developing pencil-beam proton therapy, which enables a greater radiation dose to be delivered directly to the tumor and is particularly effective in treating tumors in children and complex tumors—like those in the prostate, brain, skull base, and eye—while leaving healthy tissue and critical structures unharmed.

The past, it is often said, is prologue, and this is certainly true for translational research at MD Anderson. The institution is currently the single largest recipient of both research grants and grant dollars from the National Cancer Institute, and MD Anderson researchers are involved in a wide range of studies, including the growing field of epigenetics, the testing of targeted therapies, the development of new anticancer drugs, and the increased understanding of metastasis and angiogenesis.

Multidisciplinary care

Photo: First research laboratory
In 1942, MD Anderson opened its first research laboratory in a building that had once been a horse stable.

When MD Anderson opened its doors to its first patient on March 1, 1944, surgery—in many cases radical surgery—was the most common, and often the only, cancer treatment. However, guided by people such as R. Lee Clark, M.D., the institution’s president from 1946 to 1978, MD Anderson established the multidisciplinary patient care model as one of its key distinguishing features. Under Dr. Clark’s leadership, patients benefited from having close access not only to surgical oncologists, but to radiation oncologists, medical oncologists, and pathologists. This model evolved into today’s team approach that includes oncological nurses, social workers, nutritionists, genetic counselors, and many other specialists.

Moreover, Dr. Clark’s formation of the Physicians Referral Service in 1957, which pooled all physician income into a central fund and paid MD Anderson physicians fixed salaries, eliminated competition for patients among the various disciplines and helped ensure that the only professional motivation was providing high-quality patient care. This system, Dr. Olson wrote, “became the economic foundation for multidisciplinary care.”

Two prominent early practitioners of multidisciplinary patient care were the aforementioned radiation oncologist, Dr. Fletcher, and surgical oncologist William S. MacComb, M.D., who in 1959 came to MD Anderson to direct the Head and Neck Surgery Section. Cross-trained in radiation therapy, Dr. MacComb closely collaborated with Dr. Fletcher in treating head and neck malignancies. They later coauthored a seminal book titled Cancer of the Head and Neck, published in 1967, that became the standard text for decades to come.

Three years later, in 1970, MD Anderson had its “coming of age” moment when it hosted the 10th International Cancer Congress and some 6,000 visiting physicians and scientists. By then there had been a definite sea change in cancer treatment. Radical surgery, of the kind once associated with Dr. William Stewart Halstead, had gradually but steadily been giving way to an understanding that many cancers required systemic treatment, such as combination chemotherapy, or even a combination of surgery, radiation therapy, and chemotherapy.

At the forefront of this trend toward a multidisciplinary approach to cancer care and a treat-to-cure culture, MD Anderson was named one of the first three comprehensive cancer centers upon passage of the 1971 National Cancer Act, of which Dr. Clark himself was an architect. This act infused hundreds of millions of federal dollars into the nation’s declared “war on cancer” through the National Cancer Institute.

Education

Photo: Intraoperative MRI suite
In 2006, MD Anderson installed the world’s first fully integrated intraoperative magnetic resonance imaging suite.

The criteria for earning the comprehensive cancer center designation were having fully developed programs in research, patient care, and education. Although affiliated with and under the jurisdiction of The University of Texas System, MD Anderson did not originally have an educational infrastructure. This “lack of an academic venue,” Dr. Clark believed, “would hamper recruitment of top-quality scientists and clinicians.” Thus, in 1948, The University of Texas Postgraduate School of Medicine was formed as part of MD Anderson. But even though the institution could now offer residencies and fellowships, it could not yet offer academic degrees. That changed in 1963 with the establishment of The University of Texas Graduate School of Biomedical Sciences (GSBS), which was staffed by faculty from MD Anderson and offered graduate degrees in physics, biochemistry, and biology. Faculty from the newly created The University of Texas Health Science Center at Houston joined in the early 1970s. Not until the turn of the 21st century, however, did GSBS master’s and doctoral degrees officially bear the MD Anderson name. And in 2006, the new MD Anderson School of Health Professions began offering bachelor’s degrees in eight allied health disciplines, replacing the certificate programs the institution previously offered.

Throughout the institution’s 70-year history, continuing medical education has been an important part of MD Anderson’s educational mission, from the offering of short courses and in-service training for physicians to the presentation of seminars, grand rounds, conferences, lectures, and workshops. In the past year alone, nearly 7,000 physicians, scientists, nurses, and other health professionals have taken part in educational programs at MD Anderson, and thousands more participate annually in continuing education and distance-learning opportunities.

In addition to providing educational opportunities for the medical community, MD Anderson has produced educational programs and materials for the general public—particularly in the area of cancer prevention. Cancer prevention has long been an important adjunct to MD Anderson’s educational programs, and in many ways it is supported by the other two institutional pillars, translational research and multidisciplinary care. A charge originally taken up by Charles A. LeMaistre, M.D., MD Anderson’s president from 1978 to 1996, cancer prevention is a clinical and research initiative with an educational component, and this initiative directly benefits not only patients but also healthy individuals, those at risk of developing cancer, survivors, and caregivers.

Dr. LeMaistre once said, “Most cancers are avoidable and most cancers are preventable … but curative medicine, despite its remarkable achievements, will not single-handedly lead us to significant control of cancer.” By successfully integrating translational research, multidisciplinary patient care, education, and cancer prevention efforts, MD Anderson continues its stated mission “to eliminate cancer in Texas, the nation, and the world.”

Reference
Olson JS. Making Cancer History: Disease and Discovery at the University of Texas M.D. Anderson Cancer Center. Baltimore, MD: The Johns Hopkins University Press; 2009.

For more information, talk to your physician, visit http://www.mdanderson.org, or call askMDAnderson at 877-632-6789.

Other articles in OncoLog, June 2011 issue:

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