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Welcome to the Becker's Healthcare podcast.
I'm Elizabeth Gregersen, a reporter here at Becker's,
and I'm thrilled today to interview doctor Robert
Figlin,
interim director of Cedars Sinai
Cancer and interim director of the Samuel Ocean
Comprehensive Cancer Institute on the podcast today. Doctor
Figlin, thank you so much for joining me.
I'm so grateful to share your insights with
our audience.
Thanks so much for the invitation. Happy to
be here.
Great. And before we dive in, could you
introduce yourself and maybe just give a little
bit about your background and your organization?
Certainly. So I'm the Steven Spielberg family chair
in hematology oncology.
I'm a professor of medicine and biomedical sciences
at the Cedars Sinai Health Sciences University.
And I lead the service line and the
cancer efforts across our health system,
which include multiple hospitals,
many practices,
as well as our flagship center in, in
West Hollywood and Beverly Hills, our which is
our academic medical center.
Perfect. Thank you. And I'm grateful to talk
to you. You know, it's not January 1,
but it's still the beginning of the year.
So I'm grateful to kind of get your
insights on,
the landscape of cancer care today and maybe
what we can look forward to in the
future.
But before we get too far ahead of
ourselves, I'd love to know from your vantage
point.
Our audience, you know, they're made up of
health system leaders that maybe aren't completely in
the cancer space,
other specialties, other priorities.
I'd love to know in your experience where
you've seen maybe
misalignment
between a cancer program's growth ambition
and those broader system priorities.
And how can our audience as health care
executives
strategically decide how to balance,
you know, those priorities,
maybe deciding where to invest
or not to invest,
in cancer care over the next three to
five years?
Yeah. That that's a great question. And I
think a question that we all struggle with,
not just today, but we struggle with over
the last decade.
And I think that,
what Cedars Sinai is a horizontally integrated health
system.
And what I mean by that is that
there are always going to be competing priorities
for assets,
whether it's, brick and mortar assets or research
assets or,
or personnel.
And I think that what's clear is that,
we as a service line,
constantly
try to make the case to leadership
that,
the changes that will occur in care for
cancer patients
over the next decade
will dictate the priorities of what we do
today. What do I mean by that?
You just heard from the American Cancer Society
that more than seventy percent of patients survive
more than five years with cancer.
Now what that means is that more and
more cancer patients are going to become part
of our health system
whether it's patients with active cancer,
patients who are in remission,
or patients who are survivors,
or for a place like like Cedars,
people who are at risk
and need, aggressive screening.
So I think it's important for us to
continue to make the case
recognizing
that those competing interests
are also aligned with a horizontally integrated system,
meaning that more cancer patients are developing cardiovascular
disease.
More cancer patients are developing diseases associated with
chronic toxicity
and survivorship,
and these are all gonna be required.
But for the active cancer patient,
the patient with newly diagnosed cancer,
the key for the patient and the key
for the system is access.
Access, access, access. If you're a cancer patient
and you want access to our health system
or any health system across the country,
you wanna know that when you are at
risk for that diagnosis,
that you're going to be able to access
experts,
people people capable of delivering care in an
expedited fashion.
So one of the ways that we've dealt
with that in the Cedars Sinai health system
is in what I would otherwise call a
distributed model. What do I mean by that?
We have other hospitals.
We have other practices that are all under
our domain.
They use our infrastructure,
our,
EHR,
our organizational,
supply lines.
But it's critical because I think one thing
that's also changed about cancer care in 2026
and going forward
is patients would like to receive their care
close to home if at all possible.
And I always like to to give this
anecdote.
Cedars Sinai Health System serves a population of,
approximately
11 plus million people in our catchment area.
We are larger
than some states.
And that's important for those of you that
visited Los Angeles, unlike Manhattan as an example,
as we are a very horizontal,
community.
And sometimes it can take an extended period
of time to travel short distances.
That's why we believe that what people should
be considering
in the health system
is bringing their expertise
to their communities
so that they can have town and gown
delivered
and reserve the,
expertise of the center for those things that
are necessary that can't be delivered in the
community.
Absolutely.
Thank you for laying that all out and
kind of giving, you know, that geographic visual,
but I think it just ties back perfectly
to what you said about access. You know,
when there are all those, you know, survivorship,
considerations
and
this chronic now condition that people are are
saying cancer may be,
none of that care can happen, right, without
access. So, you know,
we need that access first in order for
patients to to receive
all that innovation. And and I I think
that's absolutely true, but it but it can't
has to be more than access only
because it has to be access with deliverables,
in my view. And what I mean by
that is we need we have what I
I think most places would consider a team
approach,
whether it's our multi d clinics,
in pancreas cancer, colorectal cancer, lung cancer, and
breast cancer.
But it's also, as we'll talk about in
a bit, the appropriate use of mid level
providers
to make sure that we are delivering care
in a comprehensive way where everyone is practicing
at the top of their license
and making sure that we bring patients through
the system in a way that's compatible with
what they need for their care.
Perfect.
I'd love to
talk about another operational bridge,
discovery and clinical care. Right? So that's that's
a big one I always hear is the
bench to the bedside.
How at Cedars Sinai and Samuel Ocean have
you approached kind of building that bridge between
discovery and clinical care? And what lessons might
be relevant for other health systems?
I've covered a lot recently that are trying
to kind of scale innovation and research
responsibly?
Yeah. So that's that's a great question, Elizabeth.
And I think,
first, let me say,
in my multiple decades as a cancer investigator
Mhmm. I would just regret
I would I would not I would regret
not being able to say to people
that the care that we deliver today
is on the backs of patients that had
participated in clinical research previously.
Mhmm. So there is no line in my
view between clinical care and research.
Why?
Because I believe when cancer patients want to
receive their care, they wanna know not only
what is best available for them today,
but what might be available to them for
a possible treatment that might be in the
future.
So I think at Cedars Sinai, we fully
embed
our clinical research efforts in our EHR.
We deliver our clinical research across our health
system.
We drive our clinical research and our basic
research through the paradigm of translation.
We expect our cancer programs of cancer biology,
cancer therapeutics,
and and population science to ask and answer
questions that are critical to our catchment area.
And I wanna remind people, Los Angeles is
a unique city,
probably not unlike New York City, but very
different than other populations in the country.
We have a large Latino population, African American,
Asian, especially Korean, LGBTQ,
large,
BRCA population.
So the key for us is to align
our priority cancers
with the people that are seeking our care.
And to do that through a collaborative effort
from the lab to the clinic,
never forgetting that even the laboratory
questions being asked
must in the future have translational applications
and recognizing that the patients that we serve
are critical. One of the ways that we've
done that, and I would encourage many people
to do that, is we have what's called
an active community advisory board.
Our community advisory board is diverse.
It is established through our community outreach and
engagement program.
And what that does is it informs the
science of what's important in the community.
Sometimes as investigators, we might not completely align
with what does the community want. And our
community advisory board has been a strong advocate
for asking the right questions for what's important
for the people that we serve.
Perfect. Yeah. And I feel like, you know,
having that community center too can just inform,
like you said, that connection between discovery and
and the clinical care. It it all matches
up completely together.
On a similar note, we can't really talk
about clinical care without talking about the workforce.
And even, you know, research, we can't talk
about without talking about the workforce.
You know, for our listeners who may be,
you know, leading health systems, not leading just
cancer service lines, but leading, you know, entire
systems that are balancing workforce issues,
what are the oncology
specific
considerations do you feel that they should be
watching more most closely when it comes to
the cancer work workforce?
And maybe how does Cedars Sinai think about
recruitment and retaining talent
in in the environment today?
So I think I think I think it's
a a pertinent question to 2026
and going forward.
The workforce
is,
is a challenge in large part
because we're not training enough cancer experts.
So part of the challenge is the pipeline
for,
physicians is challenged within the oncology workforce. Having
said that,
the way we manage that is through the
lens of we have
experts in diseases in our 13 disease research
groups at the main,
academic medical center, Cedars Sinai Cancer Center.
But we have other types of of physicians
in the cancer workforce that are in our
community practices
where physicians coming out of training programs are
looking more toward a community type practice as
opposed to an academic practice. And then what
we try and do is we are trying
to align incentives
so that they're aligned with where they practice.
So not one size fits all. We don't
expect our community physicians
to, compete for peer reviewed research in high
impact journal publications, but we do expect that
from our from our our faculty.
Having said that, I think the other big
piece that we're thinking about extensively
as we talked about previously is the use
of the,
advanced practice people, whether it's a PA or
an NP. Why?
I I think it's because,
with as our population ages,
unfortunately, there will be more new cancer cases.
And we need to make sure that our
cancer physicians
have the capacity
to take up the new cancer cases
and are not burdened by the more chronic
cases
where they don't allow for the new cases
to enter. And that's where APP is practicing
at the top of their license
can support the care of the patient, the
care of the journey, and the care of
the outcome. And I just for those of
you that might be interested, I did a
podcast with Oncology News Central just a little
bit ago with Sunita Puri from, Irvine.
And it was the title of it was
new reality for terminal cancer.
And what that talked about and much different
than when I started my training
is the number of patients that we have
in our clinics
that have had extended lives
as a result of the treatments that we
can offer.
Those lives are likely not cured
as in some patients, but they can live
for years. And those patients now need to
be managed through a cohort of groups of
pay of of of of caregivers,
including advanced practice to make sure that not
only do they deliver the care they're seeing
and seeing the right person at the right
time, have access to the expert,
but allows the expert to actually access the
new patients that need to see us in
the system.
Thank you for for sharing that. Yeah. And,
if
I'm
taking it incorrectly, it's kind of
the advanced practice providers. They have the space,
and if they're practicing at the top of
their license, they can care for those
patients and then allowing for the new diagnosis
to fuel through to the physician, you know,
no matter the care setting, to kind of
maybe support that survivorship balance that we were
talking about, right at the beginning.
And I think and I think further, Elizabeth,
I think
one of the things that we have not
done a good job in nationally
is allowing our patients and our future patients
to understand
that the team approach to cancer care is
still going to be,
best of class.
And then and then I you know, patients
often become very attached to their physicians.
That's understandable.
But it's best that they we start to
educate them about being attached to their physician
teams
as opposed to just the physician themselves.
Yeah. I love that. I love that mindset.
I guess, speaking of building a team, kind
of looking ahead,
maybe this that team mentality is is one
strategy. But what other kind of strategies have
you seen
succeed or stall cancer care within health systems?
Maybe that's organizational capabilities, you know, government,
position alignment, all sorts of different things. You
could take it at any direction. But
what, you know, two or three have you
seen that really determine whether a health system
cancer strategy succeeds?
So I I think that it is absolutely
critical that we be creative.
Mhmm. And and and we think about
cancer care through the lens
of other technology advances that are taking place
in our in our country and in the
world, whether that's the use of artificial intelligence,
whether that's the use of relationships with commercial
vendors.
And and I think that that,
you know, service lines in my view, especially
cancer care service lines
need to be looked through the lens of,
a bit of a corporate structure. What I
mean by that is
how does one align,
grow,
and deliver care across the cancer continuum?
So I'll give you a good example of
where I think we are succeeding
in an out of the box way.
As you know,
while taking care of cancer patients is is
at the cornerstone of our care,
there are many more million people at risk.
People at risk,
whether they're receiving screening for breast cancer, lung
cancer, prostate cancer, or other cancers in the
future,
wanna receive that, at risk screening at what
we'd otherwise call point of care. They don't
wanna travel to the the main medical center
for their screening. They want something that's convenient.
They don't wanna have to leave their children
and leave their work and leave their jobs
in a way that is gonna make it
in in in insufficient. So one of the
things that we are doing
is we are
a a a joint venturing with a imaging
company,
and we'll just leave the names out of
it for the moment. But the purpose of
which is there are imaging organizations in our
country which are at the point of care
for patients that wanna receive screening.
And then what we've done is we have
established warm handoffs
between the screening evaluation
and the academic cancer center or their affiliates.
And what we have found in breast cancer
and now expanding that to lung and and
and prostate cancer is what patients want is
they want easy access for screening. They wanna
note if there's an abnormality
that they have a warm handoff to an
expert, and they wanna know that that's gonna
be conducive with respect to their own insurance
or their own payer. So we need to
be thinking about innovative models.
Other things that we're doing is we're obviously
thinking about other vendors that are building our
infrastructure.
That's whether that's the infrastructure for molecular testing
and precision medicine,
the infrastructure for clinical trial enrollment.
Those are all things that can be centralized
at the hub and distributed across the system
that I think make the patient and the
system more user friendly.
Right. Yeah. I I love that mindset of
kind of collaboration and care coordination.
It all ties back to access. Right? And
and making those intentional choices
to to help patients receive care.
Yeah. I think I think, you know, as
as we close, Elizabeth, I think that
that, you know, one of the things I
love about Cedars and have for my sixteen
years being here is we are a patient
centric organization.
What what does that mean?
It means that we have to view everything
that we do through the eyes of the
patient, whether that is science,
access,
translation,
discovery.
It has to be viewed through the lens
of the of the patient. And as long
as we keep our so called eye on
the ball, I think that we we will
succeed because the patients,
want to see that they're part of a
larger organizational
structure so that if and when they need
us, we will be there for them.
Amazing. Well, I think that's the perfect spot
to leave it for today. Thank you so
much for joining me, for taking the time
to share your insights. I know that they'll
be so valuable and informative to our listeners.
So thank you for joining me. Thanks for
inviting me, Elizabeth. Have a great day. Thanks.
And I invite our listeners to tune in
to more podcasts from Becker's Healthcare by visiting
our podcast page
at beckershospitalreview.com.
Hope you have a wonderful rest of your
day.