The Cancer Research at UCSF in 2030 Strategic Planning process began in late 2018, following the CCSG Site Visit (January 2018). Senior leadership defined three broad groups from which it would be important to coalesce and gather information from: (1) the ten extant CCSG programs; (2) other research initiatives, not funded by the CCSG, some of which were defined during this planning process, but also including important aggregations of researchers such as (a) site committees and (b) developing initiatives; and (3) thematic task forces, which we convened in brainstorming sessions as a new way of aggregating people into task forces that covered the cancer continuum from basic research to prevention to diagnosing to treating to delivering health care.
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(1) CCSG Programs |
(2a) Site Committees |
(2b) Other Initiatives |
(3) Thematic Task Forces |
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Breast Oncology Cancer Control Cancer Genetics Cancer Immunology Experimental Therapeutics Hematopoietic Malignancies Neurologic Oncology Pediatric Malignancies Prostate Cancer Tobacco Control |
Breast Cutaneous/Melanoma Cancer Control Cancer Immunotherapy Experimental Therapeutics GI GU Gynecology Hematopoietic Metabolic Imaging and Radioisotope Therapy Neurologic Oral, Head, and Neck Pediatric Radiation Oncology Symptom Management Thoracic |
Geriatric Oncology Global Cancer Integrative Oncology Survivorship and Symptom Science Theranostics |
Understanding the Mechanisms of Cancer (etiology) Preventing Cancer Detecting and Diagnosing Cancer Developing Cancer Cures Delivering Heath Care to All Developing Tools to Study Cancer |
From August 2018 to September 2019, HDFCCC administration supported membership-wide surveys and brainstorming and information-gathering meetings of the groups described above. Each group produced a brief White Paper report that outlined (1) predictions for 2030, (2) scientific gap analysis (current state of research at UCSF and what is still needed to reach 2030 goals), and (3) summary of themes[BE1] .
HDFCCC Scientific Leadership identified the common themes and priorities across all White Papers, which are reflected in the overall framework document[BE2] . The intent was to ensure all current and anticipated research at UCSF would be represented in the strategic planning process. Importantly, throughout the process, additional inputs included UCSF leadership, department chairs, HDFCCC leadership, the HDFCCC external advisory board, and program advisory boards.
Figure: Schematic of Strategic Plan process leading to the overall roadmap: an iterative process with the framework document, provocative questions, and tactics.[BE3]
In order to define Center-wide mission, goals, research priorities, and provocative questions around which to provide institutional support, we developed the (1) Transdisciplinary Framework and (2) Patient Experience Perspective Continuum around which to organize the common themes and priorities. Combined into our overall Strategic Plan Framework, it will be used to drive the development of Provocative Questions, around which RFAs and other galvanizing support can be organized to provide tactics (resources, financial support) to drive research forward.
This framework, by definition, promotes research questions, teams, and methodology that are cross-disciplinary, based on team science, and translational aligning with a “cells to society” model. Importantly, this merging also defines a “society to cells” pathway, by which the etiology of broader societal and demographic factors may be uncovered.
- Individual[BE1] and Population Health: An individual is living their life, with a certain genetic background, certain biology, in a certain place, and following certain behaviors. Some may be individual risk factors for cancer, some risks are a function of the environment and not the individual, but all are factors that inform a person’s eventual risk. In this “pre-tumor” phase, interventions focus on prevention, behaviors, early detection, and improving the environment at a social level in order to allow individuals to live in an equitable and healthy environment and to make it easier to implement preventive measures and stay healthy. There is a loop here: health –> preventative measures –> change in health (etc.).
Early Detection and Diagnosis
- Disease Characterization: An individual may develop symptoms and be diagnosed with a tumor. Now, as a patient, their tumor biology becomes the focus including both the characteristics of the tumor and the microenvironment, and the interacting effects of the tumor and the broader characteristics of a patient (e.g., immune function, microbiome, environmental exposures).
Intervention (Therapeutic and Non-therapeutic)
- Clinical Response: Intervention(s) are implemented, targeting the tumor and the microenvironment, or patient biology. Layered on targeted therapies are non-therapeutic interventions (e.g., lifestyle, integrative medicine, diet). Here, data on clinical response, resistance, side-effects, etc. are important to drive clinical decisions. Also a factor here is the environmental framework that allows patient compliance, access to clinical trials, and support during care. There is a loop here: intervention –> response –> recurrence/side effects –> alter intervention –> response (etc.).
Quality of Life
- Survivorship and End-of-life: The patient is on a quest to live a healthy life after cancer treatment, which may include symptom management, palliative care, monitoring/screening, changes in environment and behavior, integrative medicine, etc. These factors alter the individual biology as the patient re-enters the continuum cycle. This stage also includes accommodations for end-of-life care and wellness measures to provide comfort and dignity to individuals at the end of their life. Inherent in these discussions is an understanding of the patient’s environmental framework that may affect decision-making and adherence to interventions.
New Biology back to (1)