PROVIDENCE — Ward Thrasher didn’t think he would still be alive now.
Diagnosed with Stage 4 colon cancer in July 2018, he was told there was an 88 percent chance he would die within five years.
The 58-year-old had tumors in his colon, lungs, and liver and, due to a genetic mutation, he could not be treated with chemotherapy. The only reason he is alive, he said, is because of the clinical trials that have been made available to him at a hospital just minutes away from his home.
“I’m now into my fifth clinical trial,” he told the Globe. “My faith in my care team has gotten me through all of this.”
For decades, most cancer patients in Rhode Island were sent out of state for care, to hospitals in Boston, New Haven, and New York that have cutting-edge treatments and host clinical trials. But thanks to new investments in cancer care in Rhode Island, patients like Thrasher have been able to stick close to home without sacrificing their quality of life or adversely impacting their outcomes.
Now, Rhode Island’s top cancer centers are getting ready to seek a National Cancer Institute designation, the highest federal rating a cancer center can achieve. It would change the landscape of cancer care in the Ocean State, elevating Lifespan’s and Brown’s cancer centers to the same level as Dana-Farber in Boston or the Yale Cancer Center in New Haven, both of which have already received the NCI designation.
In December 2022, Thrasher was the first person in the world to be given TriNKET, a new immunotherapy by clinical stage biotechnology company Dragonfly Therapeutics. The drug, according to his oncologist Dr. Howard Safran at The Miriam Hospital in Providence, was designed specifically to help patients who have few other therapeutic options — like Thrasher.
This experimental drug is being tested exclusively at The Miriam. Thrasher said it’s what has allowed him to keep his quality of life and maintain his full-time job.
“I’m approaching my five-year anniversary. Hey, I beat the odds,” said Thrasher. “It’s been a journey I wouldn’t wish on anyone. There have been bumps along the way and really hard days.”
“But you can see it. I don’t look sick,” he added. “My quality of life is good. That’s really all I can hope for.”
Thrasher is one of a handful of patients at The Miriam’s new Stephen and Diana Lewinstein Center for Innovative Cancer Research, named for the center’s biggest donors (who are also minority owners of the Boston Celtics).
What patients find at large cancer centers elsewhere “is being offered right here at The Miriam,” said Dr. Benedito A. Carneiro, the director of clinical research and cancer drug development.
Hospital president Maria Ducharme, a nurse who has spent her entire career at The Miriam, told the Globe that the Lewinstein Center “has had a tremendous impact on our patients, those who once had to leave the state and their care teams at home to seek clinical trials elsewhere, no longer must do that,” she said. “Some of our most vulnerable patients are now able to continue with leading edge care.”
The Miriam is owned by Lifespan Corp., Rhode Island’s largest health care system, and Lifespan’s leaders’ ambitions have been clear: “[We] want patients to be able to receive all of their care here in Rhode Island, at Lifespan” said Julie Abilheira, the vice president of the Lifespan Cancer Institute.
Better access to in-state cancer care has been a welcome change for local patients. But it’s part of a bigger plan: The Lifespan Cancer Institute and their academic research partner, the Legorreta Cancer Center at Brown University, are working to apply for a National Cancer Institute designation within the next few years.
“This work of getting NCI designation actually, I think, pushes our cancer care delivery towards demonstrating with evidence and data that we are becoming a place where people get top notch cancer care,” Dr. Ashish Jha, dean of the School of Public Health at Brown University, told the Globe in an interview.
Only 72 cancer centers in the country have the NCI designation, including Dana-Farber in Boston, the David H. Koch Institute for Integrative Cancer Research at the Massachusetts Institute of Technology in Cambridge, Mass.; the Yale Cancer Center in New Haven, Conn.; Dartmouth Cancer Center in Lebanon, N.H.; and The Jackson Laboratory Cancer Center in Bar Harbor, Maine. The designation represents the top 2 percent of cancer centers in the country.
The Roger Williams Medical Center was the only facility to hold this recognition in Rhode Island for 20 years, until 1994, when it lost its NCI status after federal reviewers ruled the center no longer met NCI standards due to administrative problems.
Having a center with a NCI designation offers “tremendous marketing cachet,” Dr. Joseph Espat, the director of the cancer center at Roger Williams, told the Globe in late 2022.
But the designation is more than a marketing tactic. It comes with millions in federal research dollars, advances collaborative research, increases the portfolio of clinical trials, and attracts talent to the local health care workforce.
Cities that have NCI-designated cancer centers have also experienced positive economic impacts.
For example, the University of Kansas Cancer Center started working toward its NCI designation in 2007. By the time it was granted in 2022, the cancer center had contributed an estimated $2.5 billion in economic impact, a number which executives say is only expected to increase.
The Stephenson Cancer Center in Oklahoma, which was awarded NCI designation in 2018, was immediately given a five-year, $10.1 million grant to support programs that included community outreach efforts. In 2016, the University of Alabama at Birmingham’s cancer center received a $29 million NCI grant.
Lifespan has been preparing to apply for NCI designation for nearly a decade. The initial application is nearly 2,000 pages long, and centers have to reapply every five years, proving to the NCI that they offer their local communities services and programs that are attuned to their unique needs and populations.
Lifespan Cancer Institute Director Dr. David Wazer told the Globe that an application will be submitted by July 1, 2025, which will kickstart the rigorous evaluation process. In the meantime, he has been focused on improving access to care in underserved pockets of Rhode Island and establishing satellite cancer care centers in Lincoln and East Greenwich.
”Without question, this is a huge opportunity for the local economy,” said Wazer. “Look at the broad scope of activity in cancer research. That’s not just wet laboratory space. It’s in care, development in medical devices, academic partnerships, and the spinoffs that could come out of this and be developed in Rhode Island are just beyond count, quite honestly.”
For oncologists like Dr. Hina Khan, making a patient drive to Boston or wait until a doctor can see them in Providence “isn’t going to cut it.”
“One aspect to better overall care is better access to that care,” she said.
Khan specializes in thoracic cancers, like lung cancer, which is one of the most prevalent cancers in Rhode Island. About 13 percent of adults in Rhode Island are being screened for it, which is higher than the nation’s 6 percent average, according to a recent report from the American Lung Association. But it’s not enough.
Currently, the screening process relies “too heavily” on primary care services, Khan said, and there’s a shortage of those services in Rhode Island. Screening often and early can mean the difference between a Stage 1 diagnosis where the survivor rate is much higher and treatment is more manageable, and a more advanced stage, where treatment can become complicated and expensive for patients.
In April, Khan helped open a new lung screening and nodule program at The Miriam that focuses on helping high-risk patients who are over 50 years old and have a history of smoking. She’s working on opening another new program south of Warwick.
Improving access to care has a measurable effect, she notes.
The Blackstone Valley Community Health Center serves approximately 25,000 patients in Pawtucket, Central Falls, Cumberland, and the surrounding communities. The center hired a patient navigator in 2021 specifically for cancer screenings and prevention work. Just a year later, the number of patients being screened jumped from 3 percent or 4 percent to 24 percent, Khan said.
Lifespan is looking to close the gap between patients seeking cancer screenings and the providers that care for them in historically underserved populations. Dr. Sheldon Holder is forming a new outreach and participatory engagement board, which will launch a public event series called “Cancer Talk Cafe” this summer. Oncologist Dr. Emily Hsu is launching a new program to increase breast and cervical cancer screenings in the AAPI community, in which the percentage of breast and cervical cancer screenings is less than 2 percent. And Safran, the Lifespan Cancer Institute’s chief of hematology and oncology, in 2022 announced the creation of Future Gen Cancer Scholars program to to help train high school students of color for careers in cancer medicine.
“There’s a general mistrust of the medical system that we need to address,” said Safran. “One way is drawing in local residents, inspiring them as young as possible.”
Lifespan is also working on bringing new treatments to Rhode Islanders, instead of referring patients to out-of-state hospitals and clinics.
In June 2022, Lifespan was approved by the state to operate an autologous stem-cell therapy program, which was “absolutely necessary” before the health care system submitted an application to the NCI, says hematologist-oncologist Dr. John Reagan. Previously, the institute had to refer at 60 to 100 patients elsewhere annually for stem-cell transplants and other cell-based therapies.
“That’s a pretty sizable number of people that have to go elsewhere for something that’s a pretty standard treatment, and has been since the 1990s,” said Reagan.
“No one will solve Rhode Island’s problems with cancer other than a home-grown cancer center at NCI standards,” Dr. Wafik El-Diery, the director of Brown’s cancer research center, said. This year, he requested that the state set aside $374 million of its $1.13 billion in American Rescue Plan Act dollars as an investment in the fight to cure cancer in Rhode Island. The funding, he said, would be spread out over 10 years and matches the level of support other states have earmarked for cancer care infrastructure.
“We have a window to do this here in Rhode Island,” he said. “And state support is a critically important part of getting there.”
The Miriam’s Carneiro, who works to bring investigational drugs to cancer patients in Rhode Island, said applying for NCI designation is “a precious opportunity” for local patients.
“Cancer has touched every person in this state one way or another,” he said. “I go to work everyday and think that what we’re doing could offer someone a second chance, to do it here, and to give them some hope.”