Naoto T. Ueno: New director wants to help empower Hawaii’s patients

What do you see as the role of the UH Cancer Center?

This place is unique in the sense that it’s serving a very underserved area with a very diverse population. …

(One of) the Cancer Center’s roles has been to understand the risk factors related to different demographics. Native Hawaiians or Asian Americans, particularly Filipinos, have both poverty as well as access issues, and genetically there are some differences. It’s all of the above. If you look at cancer mortality, Native Hawaiians have the highest mortality compared to the other ethnic groups. So our opportunity has been to understand the multiethnic cohort. … But I think one of the opportunities … is to try to have a much more aggressive approach in terms of lifestyle modification and getting engagement from the community so we have a better cancer strategy. That’s one opportunity I’d like to see go to the next level.

The second area is really the clinical impact on the patient. We have cancer treatments, but there are a limited number of clinical trials, particularly for something really new and innovative that could potentially impact people with advanced cancer. Any kind of cancer in the advanced stages generally will require some clinical trials because standard treatment could only work to a certain extent. So currently if you really need something beyond the standard care, you have to travel to the mainland. So one of my major goals is to make sure you don’t have to go to the mainland. As the Cancer Center, working with the health care system, we want to make sure that we could offer that opportunity.

What are the challenges in conducting cancer research?

Cancer is one of the fields where things move the fastest — new drugs, new approaches. It’s almost like every three months, every six months, something comes up. It’s not easy being up to date. This is where the Cancer Center can play a role. We’d like to see more academic clinical oncologists. There already are clinicians, community doctors who are working. Our goal is to work on education and to improve the quality of care in the community. At the same time, we need to conduct research, and research is about conducting clinical trials.

What kinds of clinical trials?

There are different types of clinical trials. I’ll start with Phase 1, 2, and 3. Phase 1 is generally to understand toxicity. Phase 2 is to define how well (the treatment) works. Phase 3 is comparing it to standard treatment; you want to show that it’s even better.

(UH’s Early Clinical Research Center, now under construction) focuses mostly on Phase 1, maybe Phase 2. The major issues are 1 and 2. That’s probably the biggest reason patients leave the islands. If you have advanced diseases, (Phase 1) studies meet more of the need.

We want the center, working with the health care system, to have multiple Phase 1 trials. Because you don’t want to do just one trial and then it doesn’t work.

But the ideal health system is not just about doing clinical trials; you need to improve quality of life. It’s about supportive care. It’s really creating this entire patient-centered flow so that everybody will get some kind of support, When you hear about early-phase clinical research, it sounds like you’re just doing experimental studies. That’s just one part of it. But once you have it, it will drive other elements. But to make that successful, you need to have a significant number of academic physicians working with the community doctors. Eventually one of the goals is to have medical oncology fellowships.

How do you bring more doctors here for cancer research?

We have smart people, good people, who go to the medical school for internal medicine training or surgery. But we can’t offer (cancer) training that will give them certification here. They will go to the West Coast or other places, and you know what happens: They stay there. Even if they have a tie to this area, they won’t come back.

Also, cancer treatment is getting so advanced that nobody in the next generation wants to go into just simply community and private practice. They all want to have the Cancer Center or some kind of clinical trial opportunity, even if they don’t run it. So if you come here as a next-generation oncologist and we don’t have trials, your hands are tied. There’s more chance on the mainland and they pay better than here, so we’re at a disadvantage.

How does the Cancer Center work with health care systems?

It was 10 or 12 years ago that we created the Hawaii Cancer Consortium (which includes The Queen’s Health Systems, Hawaii Pacific Health, Kuakini Medical Center and Adventist Health Castle, among others), covering about two-thirds of cancer patients. Because we don’t have a university hospital, for the clinical part we have to work with the health care providers — that goes back to the consortium. So the foundation has been created. But how cohesive are we now and how closely are we working to do a better job? Part of the reason it hasn’t gone to the next level is because it’s a chicken-or-egg situation. It’s easy for a researcher to say, “Hey let’s get together and work together.” But generally it doesn’t work that way. You have to have a mass number of clinical investigators or academic physicians and we need to pull together. …

This is an investment. You have to think, if we don’t have a cancer center, it’s not going to go anywhere because cancer management is not simply about treating cancer. It’s about cancer prevention, it’s about strategy, education and then connecting all the different resources so that we can provide seamless care.

Bonus question

Having been a cancer patient yourself, what’s important for patients and their caregivers to consider?

Even myself, having cancer and having all the information, (it’s still) a chaotic situation. What we’re really talking about is patient empowerment. You don’t want … the only reason you’re living is to tackle cancer. We can do a better job of education in patient empowerment, how patients can engage in health care, or how caregivers should be involved. Everyone would like to say, live to your fullest extent and have control of your destiny. That’s something the Cancer Center has to work on with the community.

THE BIO FILE

>> Current position: Director, University of Hawaii Cancer Center (since December)

>> Previous position: Executive director, inflammatory Breast Cancer Research Program, University of Texas MD Anderson Cancer Center

>> Education: M.D. from Wakayama Medical College, Japan; clinical fellowship, medical oncology and blood and marrow transplantation (MD Anderson)

>> Personal background: Born in Kyoto; married, with one son; lives in Kakaako

>> Hobbies:“I like cars. I have a Corvette. I like to drive fast, which is not possible here.”