A DOCTOR AND
A LEADER
Karen Fields brings her Expertise to the
Cancer
Therapy & Research Center
By JASMINA WELLINGHOFF
Photography LIZ GARZA-WILLIAMS
Dr. Karen Fields’ right arm is in
a cast, so she offers her left
one in greeting. She is a bit
embarrassed to explain how
the arm got broken but eventually confesses
that she was trying to ride a trikke,
the new three-wheel contraption with
no pedals that can be, well, tricky to
maneuver. This small setback, however,
is by no means slowing down the enthusiastic
president and CEO of the Cancer
Therapy & Research Center (CTRC). She
just has too much on her plate.
For one thing, there is good news from
Austin regarding the seemingly endless
battle against cancer. In an unprecedented
move last May, the Texas legislature voted
to create a $3 billion fund that would be
dedicated to cancer research, prevention
and treatment over a period of 10 years. If
voters approve the general obligations
bonds to pay for it, $300 million a year will
eventually become available to Texas
research facilities, substantially boosting
their efforts to find a cure for the disease
that affects 85,000 Texans each year.
Naturally, Fields is excited about the initiative.
Like many cancer specialists, she feels
we are on the cusp of a true breakthrough
in treatment.
“It’s an exciting time now. In the last
couple of years, cancer statistics are
finally showing a decrease in mortality
from the disease,” says the physician
who took the helm at CTRC in January
2005. “There are many reasons for that,
including better screening, earlier diagnosis
and better therapies to improve
patients’ quality of life and survival.
“But so far, we have been using the
nuclear bomb approach to treatment. We
kill both cancer cells and regular cells, but
since cancer cells proliferate faster, they
are more susceptible to chemotherapy.
The main reason for excitement is that we
are now gaining the tools to look at the
disease at the cell level and develop targeted
therapies to turn off the specific
genes’ functions that cause your cancer.
We’ll be able to develop drugs to block the
expressions of these genes.”
It’s not science fiction, she adds, it’s
real stuff. In fact, there are already a few
cancers, such as chronic myelogenous
leukemia, where this therapy can be
applied. A lot of that new knowledge
came out of the massive work on the
human genome project, a basic research
undertaking that is paying off in very
practical terms for all of us. “That’s why
we need to invest in basic research,” says
Fields. And that’s why the recent legislation
is so welcome.
Fields was one of the advocates lobbying
for the bill, together with Lance
Armstrong and representatives of the
American Cancer Society and other concerned
nonprofits. And she was present
when Gov. Perry signed it into law last
June. However, she sees more work
ahead for San Antonio.
“We have some special challenges
here,” she points out. “We need to stay
involved in how the distribution of funds
gets structured. We need to make sure
that we get our representatives on the
committees that will be making the
funding decisions. There is one provision
that they added between the House and
the Senate that is especially challenging
for San Antonio, namely that each institution
that receives funding has to raise
matching funds as well. Big cancer centers
such as M. D. Anderson and Baylor
have bigger communities to draw from.
We have to see how we’ll come up with
the matching dollars. As a community,
we also have to work hard to coordinate
our efforts and submit the best scientific
proposals so that they will get funded.”
Though the first grants won’t be given
out until 2010, Fields already knows what
she has to do: hire more of the best scientists
she can get and form high-caliber
research teams. The process is already
under way, she says, at CTRC — and its
main research arm, the Institute for Drug
Development (IDD) — and through the
San Antonio Cancer Institute (SACI), an
organizational partnership created by
CTRC and the Health Science Center to
combine the two institutions’ efforts. The
joining of forces allows SACI to fulfill the
requirements of the National Cancer
Institute (NCI) in Bethseda, Md., which
funds cancer research throughout the
United States. The idea is to foster the
speedy incorporation of promising lab
results into patient care.
When Fields, 51, took the job here,
however, both SACI and CTRC had lost
some momentum. A number of key scientists
had left, affecting both funding and
operation. What’s more, SACI was stripped
of its prestigious “comprehensive cancer
center” designation from NCI, though it
retained a lesser recognition as a “designated
cancer center.” Yet Fields left her longtime
position at the H. Lee Moffitt Cancer
Center in Tampa, Fla., to come here. Why?
“I took the job because I could see that
this place had an incredible potential, a
great history and some really fine scientists,”
says the physician. “You know, I
watched Moffitt grow in 16 years from a
small place whose name no one could
spell to one of the three largest centers in
the United States. It was incredibly fun to
be in a place like that, to be one of the
architects of its growth. When I saw this
place, I thought I was going to have that
kind of experience again.”
A NEW START FOR CTRC
Since her arrival, Fields has been busy
rebuilding both her own house and SACI.
To that end, one of her first goals was to“reaffirm” the partnership with the Health
Science Center. Together, the partners have
hired some 60 new scientists and physicians,
including Dr. Tyler Curiel to head
SACI and Dr. Francis Giles, the new ID
director. These moves are reinvigorating
the development of new anti-cancer drugs
at IDD — something it had become
famous for — as well as the Phase I clinical
trials of these and other drugs, also something
CTRC had been known for. In fact,
for quite some time, this was the only place
in the country to conduct Phase I trials,
attracting patients from across the United
States. Fields proudly points out that 15 of
the most important anti-cancer drugs have
been developed here, including Taxol,
Iressa, Novantrone and Vectibix, used for a
range of cancers, from breast to colon.
When we meet the second time, she
takes us on a tour of the main CTRC
campus on Wurzbach Road, an outpatient
treatment facility that cares for
120,000 people a year. It is the only
place in town where children can receive
radiation therapy, she points out, and it
is also among the first cancer centers in
the country to acquire the $3.5 million
Tomotherapy machine, which can irradiate
a tumor without affecting surrounding
tissue. It also allows clinicians to see
the tumor before each treatment and
adjust dosage and other parameters
accordingly. In fact, innovative radiation
therapies have been part of the center
since its beginning in 1974.
We also visit the handsomely appointed
prostate and breast cancer clinics on
the fifth and sixth floors, designed with
patients’ comfort and privacy in mind; the
chemotherapy rooms, the diagnostic
imaging unit and the clinical trials wing.
There’s even a kitchen where dietitians
teach patients healthy cooking. Employees
don’t seem surprised to see the boss in
their midst. Friendly greetings are
exchanged, and then everyone goes back
to work. A few times, as we encounter
certain individuals, Fields appreciatively
explains the importance and the complexity
of their jobs. Everywhere, names of
donors whose contributions made certain
facilities possible are prominently displayed.
CTRC is an independent nonprofit,
and such generosity is very valuable.
A major change that Fields has introduced
has resulted in the restructuring of
patient care by creating multidisciplinary,
disease-specific clinics. The idea is to bring
together all the specialists a patient has to
see in one place. “There are two advantages
to our approach — first, they all will
be physically in one area, and they will
function as a scientific team in charge of a
patient’s care,” explains Fields. A team
may include a surgeon, a gynecological
oncologist, a radiologist, a dietitian, a
physical therapist, lab scientists, a mental
health counselor, etc. “We need to offer
the range of services that patients need
under one roof,” she says.
FROM FARM GIRL TO LEADER
When you walk into Dr. Fields’ spacious
office at CTRC, you may or may not notice
the soft music playing in the background.
But you’ll be aware of pleasant, uncluttered
surroundings. And unlike many executives,
she won’t sit behind the desk while
talking to you. Instead, there is a round
conference table in the room to facilitate a
sense of comfort during meetings. That’s
all by design, she explains, to foster a calming
atmosphere “so that no one will yell at me.” Though we doubt that people ever
yell at her, it reflects her desire to create “a
good, nurturing environment” throughout
the center. That’s one of the hallmarks of a
good leader. Another one is humility. “Good leaders know they are in charge,
but they also know how to appreciate their
team and how to thank them for their contributions,” she says.
Oddly, though there are many women
doctors today, few achieve top leadership
positions. Fields is one of only three in the
nation to head a cancer center. Raised on
a farm in a small Ohio town, Karen Keyse
entered medical school in the late 1970s
hoping to become a family practitioner.
At the time, cancer was still a death sentence
in most cases. But a lecture by Dr.
Larry Einhorn, who later treated Lance
Armstrong, made her look at oncology
with new eyes. “He spoke about a drug
that cured 90 percent of testicular cancer
sufferers. That was exciting, to have a
drug that could actually cure,” she
recalls. “The other thing about oncology
is that it was a way to combine science
with taking care of patients.”
After completing two fellowships in
oncology/hematology, she pursued an
academic, research-oriented career at
the University of South Florida and at the
affiliated Moffitt Center, increasingly taking
administrative positions of greater
and greater responsibility. Through it all,
she acquired a wealth of experience in
clinical trials as a principal investigator
for studies of breast cancer, lymphoma,
leukemia and other cancers. To this day,
she keeps letters from desperately ill
patients and their families who wrote to
thank her for the care they received.
Though she misses the daily contact
with patients, she is aware that her current
position can do even more good. “As an
administrator, you are able to work on a
broader scale. A lot of doctors don’t like
administrative duties — lots of meetings,
fund raising, policies and procedures —
but I think it’s rewarding because more
patients will see improvement in their care,
and more doctors will have access to more
knowledge,” she explains.
When she moved to San Antonio,
Fields was surprised to discover that many
San Antonians knew little about such a
valuable resource as CTRC, let alone SACI.
With her husband, Paul Fields, and son,
Michael, still in Florida, she spent the first
six months showing up at as many places
as she could to speak about the center’s
mission. Though her days are long and
full, she sits on a number of community
boards, including Girls, Inc., Bexar County
United Way and the Research and
Technology Foundation.
Now that her family has joined her here— including her 98-year-old grandmother
and her 80-year-old mother-in-law — the
busy doctor/executive tries to maintain a
balance between her many duties and
family life. She loves to attend Michael’s
soccer games and ride a bicycle with him
(though the trikke is probably history). But
her chess-master husband and her son are
used to accommodating her often unpredictable
schedule. When he was younger,
Michael used to say, “We are all a doctor.”
Someday, Fields would like to add an
in-patient hospital to CTRC, but between
now and November, raising public awareness
about the bond issue will be a priority.
Once again, she will reach out to the
community to become an ambassador for
cancer care. “Hopefully, voters will recognize
that to decrease mortality from cancer
is a good thing for all Texans,” she says.
Of course, regaining that coveted “comprehensive” status from NCI is also
on her mind. To that end, she feels that
SACI must strengthen its “cancer control
research,” which studies prevention, outreach
and differences between various
populations, as well as set up the stage for
more Phase II and III clinical trials.
And speaking of prevention, what
steps does Dr. Fields take personally to
ward off cancer? “I just had my mammogram last
week, and I generally have all the screenings
we recommend,” she says. “I never
smoked, and I try to eat a healthy diet
and to exercise. I also take calcium and
use sunscreen, though it may be too late
(to protect her skin). As a kid, I worked a
lot on the farm without sunscreen.”
As one who has seen so much suffering
and death, she is philosophical about
the future: “What I learned from my
patients is that you can’t take a single
day for granted. I’ve seen so many people
lose their loved ones, I’ve learned
that life is precious, and you must take
each day and live it the best you can.”
