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When a moving van pulls up to the curb of a new home, it often marks the beginning of a family's next stage of growth.
For the Dana-Farber family, that moving van arrives this winter, when many clinical operations move to the new Yawkey Center for Cancer Care, signaling the next phase in the Institute's 63-year battle against cancer.
The Yawkey Center, opening in February 2011, will create stronger links between patient care and research, with treatment areas organized by disease type and focused on the individual needs of adult patients. It will introduce improvements such as concierges and laboratory services to make the patient experience smoother.
"Planning the Yawkey Center gives us more opportunities to rethink and refine how we are doing things," says Ellen Frank, PhD, a leukemia survivor and co-chair of the Adult Patient and Family Advisory Council at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC). "The essence of Yawkey will be a whole team, including the researchers across the way, focused on each patient's particular type of cancer."
The majority of patient-care floors in the new center, where most DF/BWCC patients will receive their treatment, will connect by bridges to the Richard A. and Susan Smith Research Laboratories, where much of Dana-Farber's laboratory science is done. For the most part, each bridge will link a particular clinic to research labs focused on the same type of cancer.
"The Yawkey planners listened to what researchers and clinicians asked for," says Barrett Rollins, MD, PhD, chief scientific officer.
"Today in our cafeteria, hard-core scientists have lunch with leaders in clinical care. Scientists concerned with molecular mechanisms can ask questions about clinical disease, and vice-versa."
The design of the Yawkey Center will further facilitate such collaboration. Intended to be far more than passages from one building to another, the light-filled bridges will overlook the new center's rooftop gardens and serve as a staff lounge, offering wireless Internet access and space for conversation.
"The bridges will create a place where scientists and clinicians can meet to compare notes on research and care," says Wendy Gettleman, senior director of planning, design, and construction for the Yawkey Center project.
This type of collaboration has long been a hallmark of Dana-Farber's care. For example, Thomas Roberts, PhD, co-chair of Cancer Biology, who is studying a family of enzymes called kinases that prevent abnormal cells from dying naturally, will be only a short walk away from Eric Winer, MD, who, with other investigators, is leading clinical trials based on Roberts' findings.
"It should be very motivating for lab scientists to know that patients in a connected building may be benefiting from their research, and for patients to know that research related to their disease is taking place so close by," says Winer, director of DF/BWCC's Breast Oncology Center.
The two men work together in one of Dana Farber's National Cancer Institute-funded Specialized Programs of Research Excellence, which bring together basic and clinical researchers.
Winer had been observing that, although the drug trastuzumab (brand name Herceptin) was very effective (when combined with chemotherapy) in most women with HER2 positive breast cancer, in some cases the cancer became resistant or relapsed.
Roberts and his colleague Jean Zhao, PhD, meanwhile, had learned that when HER2 cancer is shut down by trastuzumab, abnormal kinases are sometimes activated in the tumor cells.
"It turned out that the enzymes we'd been studying are also of interest to Eric, since they are a primary way tumors can avoid Herceptin," recalls Roberts.
The discovery suggests that some patients might benefit from drugs that block these kinases, and a clinical trial is underway to test the theory. (The Yawkey Center will include a significantly expanded Clinical Research Center for patients who need close monitoring in complicated clinical trials.)
"While these types of collaborations between scientists and clinicians are certainly going on now, they will only grow stronger after the Yawkey Center opens," Roberts points out.
In addition to providing a literal connection between research and patient care, the new bridges are also powerful symbols of the synergy between the two.
Dana-Farber devotes equal parts of its staff and resources to each endeavor. It offers a robust translational research program that brings laboratory findings to patients quickly and creates numerous opportunities for scientists and clinicians to work together.
"Our balanced portfolio of research and care sets us apart," says Rollins. "If you're a clinician you're always hearing about research, and if you're a scientist you're always hearing about patient care. Both sides talk to each other to a greater extent than I've ever seen elsewhere."
Knowing that Dana-Farber is a place where basic and clinical research gets done is often meaningful for patients, as well, who believe the Yawkey Center's design will reinforce that message.
Although Dana-Farber has many clinic-based MDs and lab-based PhDs, most of its medical staff fit somewhere on the physician-scientist continuum.
"When it comes to involvement with lab work, our clinicians in the Women's Cancer Program are a broad mix," says Winer.
"I am fundamentally a clinician who used to have little interest in basic research, but over time I have become much more involved in how lab-based science can help my patients."
The Yawkey Center gave Dana-Farber an opportunity to design a clinical building from the ground up. This was a dream come true, say project leaders, because it allowed them to more closely focus on the facility's key constituents.
Patients with certain illnesses will be concentrated on the same floor, their caregivers will be experts in this type of cancer, and, in general, scientists working on treatments for it will be nearby.
"Each floor will have fewer disease groups and will be more focused on both the exam and infusion care for patients with those diseases," explains Anne Gross, RN, PhD, vice president of Adult Nursing and Clinical Services.
She and other leaders believe this model will help improve communication between providers by eliminating barriers and facilitating flow and flexibility.
"One of the things we always liked about the first floor of the Dana building is that patients can see their provider and receive chemotherapy all on one level," says Gross.
"The infusion nurse and care team in the exam practice have easy access to one another. We wanted to base the Yawkey Center clinics on this concept of co-location and the experience of patients not having to travel from floor to floor, checking in and out each time."
Patients and families worked closely with Gross and other leaders in bringing about these changes, offering their perspectives on the value of centralized care and other improvements. The end result, says Frank and other patient advocates, is a building equally committed to comfort and the search for cures.
Paths of Progress Fall/Winter 2010 Table of Contents