At first Candace S. Johnson took herself out of the running for the top job at Roswell Park Cancer Institute. But once she accepted it, she started with a bang.
Within a few months, Johnson put her stamp on a new leadership team, a move that shook up the resistance to change that exists in many big institutions like Roswell Park.
She made an impression in her first major presentations at the cancer center by stressing accountability in scientific research and medical care, and the need to recruit new people to bolster the institute’s profile.
And, she came away from a state foreign trade mission to Havana with Gov. Andrew M. Cuomo and others with an arrangement to study a lung cancer vaccine developed in Cuba and, it’s hoped, a closer relationship with the governor.
“I am a very high-energy person,” Johnson said. “I really am trying to get people jazzed again about Roswell Park; not that we weren’t. It’s just anytime there is change, there is time for a new beginning,” she said during a recent interview in her office.
Johnson, 66, became the first woman and first non-physician to serve as chief executive officer at the institute in its 117-year history. A change in the by-laws five years ago allows a non-physician with a doctorate in health sciences to head Roswell Park.
Her to-do list is daunting:
• Operate a $663 million organization;
• Interact with a staff of more than 3,200;
• Serve as chief lobbyist in Albany and ambassador to the community;
• Attract top scientists and physicians;
• Train new oncologists;
• Compete for research money in an era of stagnant government support;
• Contend with intense competition for patients.
There’s also this item on her to-do list: try to marshal the talent at the institute to hit a medical home run to prevent or treat cancer.
Johnson was named chief in February but had been in the job on an interim basis since October 2014, when Dr. Donald L. “Skip” Trump stepped down after seven years as CEO. Trump took over as head of the Inova Comprehensive Cancer and Research Institute in northern Virginia.
Johnson came to Roswell Park with Trump more than 13 years ago from the University of Pittsburgh, where she was deputy director of basic research at its cancer institute and professor of pharmacology and medicine at its medical school.
Moving up the ladder
Initially at Roswell Park, she headed the pharmacology and therapeutics department. She also held the positions of Wallace Family chair for translational research and professor of oncology. She received additional duties in 2014, when the institute named her deputy director, a role that gave her oversight of scientific research, including the institute’s $19 million support grant from the National Cancer Institute.
The plan was that once a new chief executive arrived, there would be a new management arrangement, with Johnson taking the title of cancer center director and reporting directly to the institute’s board of directors. Instead, after a national search, the board, impressed with her performance as interim CEO, decided the Snyder resident was the best candidate and persuaded her to accept the position.
“Candace was so close to Skip that she said she didn’t want the job,” said Hugh Russ, a board member. “But after we developed a short list of candidates and interviewed them, we realized we had the better candidate in house. The others were strong, but she is exceptional.”
Aside from her scientific credentials, Johnson brings to the $775,000-a-year job a reputation for determination and people skills.
“She will make tough decisions, and I believe she has the support of the faculty,” said Donna Gioia, another board member.
Michael Joseph, chairman of the board, said that if the cancer center is to succeed in obtaining research grants, increasing patient revenue and reducing its dependence on state support, the organization must make good on its plans for greater self-sufficiency. He expressed confidence that Johnson can accomplish this.
“Candace is changing the environment internally,” he said.
Paul Goldberg, editor of the Cancer Letter, an independent newsletter in Washington, D.C., that follows the nation’s 41 comprehensive cancer centers, offers a view from outside Buffalo.
“She’s nice,” he said.
Goldberg described Johnson as very qualified but noted that the job of directing a major cancer center poses a monumental challenge to even the most talented individuals.
“It has never been easy. But it has become so much more complex in all respects,” he said.
“Everything in cancer has become so specialized. You have to delegate, and you have to make sure the people you delegate to can handle it. You don’t want to be overwhelmed by a bureaucracy,” he said. “Some people can do this extraordinarily well. But it’s kind of like practicing psychiatry without a license.”
A passion for science
Growing up in Columbus, Ohio, Johnson dreamed of being a ballet dancer, a reflection of her lifelong interest in the arts. Her father would hear nothing of it.
“He was a very practical man,” she said. “‘He said to me, ‘What are you going to do? How are you going to make money?’ So I geared myself toward the things that I was good at, and the things I was good at were math and science. And the more I got into math and science, the more it became a passion for me.”
She earned a master’s in microbiology/pathology and a doctorate in immunology from Ohio State University, eventually pursuing research in the interactions of the immune system and cancer. Later, in collaboration with Trump and others, she carved out a research niche on the role of vitamin D in preventing cancer.
Johnson, in her new executive team, has given most of the roles she held to three people. Among other changes, she created a new position, chief information medical officer, a sign of the increasing importance of electronic medical records in medicine.
She talks about leading by example.
“It’s not that anybody who was here was bad,” she said. “It’s just sort of me putting my team in place. I have high standards, and accountability is going to be an issue. I’m not saying we weren’t accountable in the past. I am saying that I want to make myself accountable and the people around me in leadership positions.”
During her tenure with Trump, the institute developed OmniSeq Target, which analyzes the DNA of a patient’s cancer cells to search for genetic abnormalities. The test marks a move away in cancer care from the use of one-size-fits-all chemotherapy. Instead, the thinking goes that it will let doctors customize treatment to a patient’s tumor, increasing the likelihood that a drug will be more effective and result in milder side effects. The institute invested more than $25 million to develop OmniSeq, making it the largest commercial venture ever for Roswell Park, and raising hopes for national recognition and a financial success story.
Johnson remains careful not to overstate its potential. But there is no question OmniSeq is considered a breakthrough at Roswell Park.
“It could be really extremely important in royalties if it works even conservatively,” she said. “But it all depends on the timing. There are many people getting into this space while we’re trying to get into it and get enough customers so that this can succeed.”
No easy answers
National Institutes of Health funding, a measure of success, has increased at Roswell Park from $43.1 million for 170 projects in 2009 to $49.7 million for 250 projects in 2015. Revenue from patients during the same period rose from nearly $294 million to $486 million.
Still, the institute faces familiar questions about its future.
Can it maintain government research funding and respond to the pressure to reduce its reliance on state support, currently more than $102 million a year? As a more expensive facility, can it remain competitive? Can it expand into new markets, focusing on complex treatments while, perhaps, working with others to care for the more common cancers? Can it recruit top-notch scientists who bring with them well-funded research projects that translate into new treatments? Can it navigate a changing health care landscape that demands greater collaboration with other hospitals and large medical groups?
There are no easy answers.
If a cancer center is able to attract more funding for particular research, for instance, it comes with an added cost to fully fund the project. It’s not clear who to partner with or in what way, especially when potential collaborators are also competitors. Roswell Park already accounts for about one-third of the cancer care in Western New York, making it difficult to increase its market share here without taking business away from someone else.
The annual state support constitutes a lot of money. But it is the state that rebuilt Roswell Park in the 1990s before turning it into a public-benefit corporation that continued to carry the construction debt and higher labor costs of the former state-owned facility.
“I want to put us on better grounds financially,” Johnson said. “Every year we have issues with and we worry about our budgets. We want to be more efficient. We really need to think more outside the box about how we can do that.”
Every cancer center director must pay attention to a larger picture, as well, especially the constraints on federal cancer center funding.
The Association of American Cancer Institutes last year started a national initiative to define and defend the value of academic cancer centers like Roswell Park that do research, provide care, and train cancer physicians and scientists. Among other things, advocates say, the leading cancer centers give birth to the state-of-the art tests and treatments that filter out to community oncologists, and they play a key role in the development of local biotech industries.
Johnson also is running the institute at a time of frustration over the incremental progress in the field.
Strides have been made in the fight against individual cancers. Overall death rates, however, have decreased only modestly since President Richard Nixon declared war on cancer in 1971. The decline in cigarette smoking accounts for much of that improvement.
Meanwhile, perspectives on cancer have changed. It doesn’t appear as though its cause can be reduced to some basic underlying processes, as previously believed. Instead, scientists now see cancer as a highly complicated collection of hundreds of different diseases.
“It’s something that, when you are in this business, gives you pause,” Johnson said. “Cancer is such a complex disease and, sometimes, we make great strides in a little area that we can celebrate. But you also can wonder, ‘How many people does it really help?’ I guess if it helps one, it is important.”
Regardless, she remains optimistic, noting that researchers are gaining new insights into how cancer develops and spreads in the body. The targeted therapy envisioned with OmniSeq illustrates a promising direction, she said.
“If you look at individual diseases, we have made strides,” she said. “We just have to keep going. We are at a time in science where we know so much more. But it’s going to take more time. We still have a lot of work to do.”