It started as a small cancer hospital back in 1904—the nation's first—and now Philadelphia's Fox Chase Cancer Center has embarked on a sweeping 25-year expansion plan, the most ambitious in its history.
At the same time, Fox Chase President and CEO Robert C. Young, MD, Chair of OT's Editorial Board, has announced that he will step down when a successor is found to lead Fox Chase forward into this new growth phase, which will more than double its size and its capacity to serve cancer patients and support cancer research.
The new master plan has been completed by EwingCole, an architectural and engineering firm, and Fox Chase is in the process of obtaining city approvals.
“This decision was mine, and it was based on timing,” Dr. Young said of his decision to step down once a suitable successor is found. In an interview, he said, “Our next core grant [from the National Cancer Institute] will be reviewed in 2010 and I will be 70 years old…the expansion is perfect for a new director coming in. I'm very excited about the search for a new person.”
He added, “The beauty of this job is that the president and CEO basically control everything; one of the most attractive things about the position that we're now seeking to fill is this flexibility.”
Dr. Young, a past president of the American Cancer Society and the American Society of Clinical Oncology, said, “I don't want this to be a retirement article; first of all, I'm not going to retire. I have too much energy. I'm not going to have any difficulty occupying my time.”
He added that he would not rule out serving at Fox Chase in another capacity, should the new president and CEO present him with that opportunity. However, he plans to take a sabbatical when the new leader comes to Fox Chase.
Dr. Young, who served on the Institute of Medicine's National Cancer Policy Board and chairs the Board of Scientific Advisors of the National Cancer Institute, also said he would stay as long as necessary, until Fox Chase's board finds a suitable replacement.
“Now we have a search committee,” he said. “We hope to identify a new leader in mid to late 2007, so I'll stay as long as necessary.”
During a lengthy internal planning process beginning in 2003, key staffers and board members at Fox Chase—which in 1974 became one of the first NCI-designated Comprehensive Cancer Centers—explored what the center might look like as an institution in 2015.
Dr. Young said he and others were mindful of US demographics: the aging of the 76 million baby boomers will require greatly expanded cancer care, research, and resources. “By 2015 we expect to see 10,000 to 12,000 new patients each year,” said Dr. Young. “This is the reality of an aging society.”
From One Million Square Feet to Two and a Half Million Square Feet
Currently Fox Chase has one million square feet; the planned expansion will add an additional 2.5 million square feet.
Fox Chase has already experienced major growth before the wave of aging baby boomers, now referred to as “the silver tsunami,” starts flooding through its doors.
442% Increase in New Patients between 1988 and 2006
From 1988 to 2006 Fox Chase saw a 442% increase in new patients, a 366% increase in patient visits, and a 77% increase in staff. In 1988, Fox Chase saw 1,200 new patients; in 2006 it has seen 6,500 new patients. Its annual total revenue and support has increased by 300%—from $75 million in fiscal year (FY) 1988 to $300 million in FY 2006.
Research support increased by 235% from 1989 to 2004—from $17 million to $57 million. And grants to individuals are also strong, at a time when money for cancer research has eroded. Fox Chase's V. Craig Jordan, OBE, PhD, DSc, recently received a $10.7 million Center of Excellence grant from the US Department of Defense (DoD) for research on new breast cancer therapy.
Dr. Jordan, Vice President and Scientific Director of Medical Science at Fox Chase, pioneered research on tamoxifen, leading to its approval as the first drug to prevent breast cancer. Dr. Jordan will use the DoD grant to study anti-hormonal drug resistance in breast cancer.
Fox Chase's 25-year expansion plan, which involves an agreement with the Fairmount Park Commission to lease 19.4 acres on the adjacent Burholme Park, will be done in phases, Dr. Young said.
The first phase—which has received all necessary city approvals—is the 125,000 square-foot, five-floor Cancer Research Pavilion, slated for ground-breaking in the spring of 2007. “It will have a substantial outpatient capacity, classical wet bench labs, and a novel women's center,” Dr. Young said of this new center.
He said the women's center will link women's clinical cancer care with researchers whose science labs will be on a floor right above the patients. Fox Chase is especially strong in the area of women's cancers. In addition to Dr. Jordan's research, Fox Chase maintains an ovarian SPORE grant under Robert F. Ozols, MD, PhD. Fox Chase houses the Margaret Dyson Family Risk Assessment Program, which serves women with a family history of breast and/or ovarian cancer, and offers surgical removal of the ovaries for prevention of ovarian cancer for women who elect such risk-reducing surgery after extensive counseling and thought.
The new Cancer Research Pavilion will have a substantial radiation therapy unit, and Dr. Young said its top floor will provide expanded space for researchers working on population science: epidemiologists, genetic epidemiologists, and specialists in behavioral modification among high-risk patients.
$100 Million Fundraising Campaign
Fox Chase has launched a $100 million fundraising campaign, which has raised $52 million. The long-range expansion of Fox Chase includes a $1 billion phased development plan on a portion of Burholme Park, which will create about 4,000 new jobs and add an estimated $40 million in local tax revenues to the city of Philadelphia over 20 years.
“We've always valued the park-like setting of our campus and we intend to preserve that as our expansion progresses,” Dr. Young said. “The patient's spirit seeks green and restfulness.”
He noted that the glassed windows overlooking plantings and the eclectic artwork on the walls of the current facility—landscapes and water views, abstract and impressionist paintings, happy primitive scenes—are designed to provide an attractive environment for patients under stress.
This theme of a pleasing physical environment will be continued in the planned expansion. Dr. Young, whose wife Barbara is an art conservationist, said the walls were bare at Fox Chase before a conscious effort was made to turn them into pleasing passages.
“People don't elect to walk down your halls,” he said. “We started with posters and expanded from there; now we have an annual art show at Fox Chase.”
Result of Long-Term Planning
In a separate interview, Thomas K. Garvey, Fox Chase's Vice President for Facilities Planning and Design and Vice President for External Affairs, said the extensive, planned Fox Chase expansion was not undertaken lightly.
“We engaged in a long-term planning exercise through a series of retreats,” he said, “It was the right way to do it.” Mr. Garvey added that looking down the road 20 to 25 years from now was not easy. ''The farther out on the horizon you look, the more difficult it is to see, but you have to try. We spent the better part of a year not talking about buildings or square footage, but rather what should a nationally known Comprehensive Cancer Center look like?
“Early in the process it was difficult to engage people in conversations without talking about space or resources, but we started with program goals.”
Mr. Garvey noted that every five to seven years since the early 1980s Fox Chase has undertaken some kind of expansion, due not only to patient demand but also to the fact that more scientists wanted to come to Fox Chase to work.
“This plan allows us to embrace and expand what we do and do it in a cogent way,” he said. Asked if relocation was considered, he said yes. “Our first choice was to stay here and not relocate,” he said, citing “an excellent workforce, a stable and vibrant community, and good transportation,” including access to the Pennsylvania Turnpike, good bus and train service, and a regional rail system.
“We've had a good relationship with the Fairmount Park system over the years; we felt it was logical to approach the park with a partnership proposal,” he noted.
In Line with Trend
While Fox Chase's planned expansion may be particularly large and ambitious, US cancer center expansions are not unusual today at this time of increasing need. “Every cancer center I know is in some phase of expansion,” Mr. Garvey said.
Suggestions & Lessons Learned
For cancer center administrators thinking about a major expansion, Mr. Garvey shared the following suggestions and lessons learned:
- Before even contemplating breaking ground, engage in a serious, thoughtful, and long-range participatory planning initiative which involves the right mix of faculty, board members, and staff. “Don't cut it short,” he advised. There will always be competing faculty interests, but “when people have been involved in the planning process they can accept no as an answer.”
- Identify program goals for achieving continued excellence in areas where the center is especially strong, or, after much thought and deliberation, decide to add a new area of science. “I think many institutions would benefit from spending more time in that process,” Mr. Garvey advised.
- Assess the necessary monetary resources and decide when to launch a targeted fund-raising campaign.
- Physically design the new space so that research and patient care are linked, not segregated into separate silos. “The buildings should foster interaction” between research and patient care, he said. “That interaction is weakened in vertical structures,” he added, noting that carefully designed horizontal structures can help to foster contact between basic scientists and clinicians in such spaces as shared auditoriums, shared cafeterias, and shared interactive lounges.
- Make sure the design of interior spaces engages the occupants and helps to encourage the activities that will take place within them. “The place needs to be human and to address the emotional needs that people have,” Mr. Garvey said. “In waiting rooms patients are anxious, and often not at ease. So the selection of art is very important.” For nervous patients, he pointed out, the artwork needs to be quieting and restful, not frenetic and overly stimulating. In laboratories, in contrast, scientists might prefer provocative abstract works that actively excite the viewer.