 Okay, it looks like we are back live. This is a joint meeting with Senate Health and Welfare and House Health Care. And before we introduce our guest, I'm going to have my Senate committee introduce themselves and then I'm going to turn it over to Representative Howell in the House. So good morning everybody. This is Martine Larocke-Ulich. I live in Burlington and I represent Chittenden Central. Good morning, this is Dave Weigts, representing Rotlin County. I live in Proctor. Ginny Lyons, Chair of the Senate Health and Welfare Committee from Chittenden South East and I live in Willisburg. Terry Williams, representing Rotlin County, from Portland. And joining us in just a bit will be Senator Hardy from Addison County. So Representative Howell, I'm turning it over to you and your committee. Great, thank you. So we'll do introductions as well. I'm going to start with Alan. Alan DeMar, representing Innesburg and Montgomery. Alyssa Black, representing Essex. Lori Houghton, City of Essex Junction. Toppy McFawn, representing Barri Town of the Pot of Williamstown. Marie Cordes, Lincoln, Moncton, Starksboro and Bristol. Leslie Goldman, Window 3, Rockingham, Westminster and Brookline, which is the Bellas Falls area. Our Peterson, representing Rotlin District 2, which is Clarendon, Wellington, West Rotlin and a piece of Rotlin Town. Great, and we'll be having a couple others join us in a couple minutes. So welcome, Dr. Holcomb. I had the pleasure of meeting with Dr. Holcomb earlier this year. And for anyone who's had experience in the University of Vermont Cancer Center, like my family has, they really do amazing work. And I'm going to turn it over to you, Dr. Holcomb, to introduce yourself and tell us about the cancer center. Great, thank you very much. Well, my name is Randy Holcomb, and I've been here for about a year and a half as director of the University of Vermont Cancer Center. I'd like to thank the chairs and members of the committees for the opportunity to speak with you today and tell you a little bit about the exciting things that are going on here at the cancer center. I do have someone here with me off camera, so to stage right is Kate Stropmeyer, who is our director of communications and community outreach. Really, I just hope that this is informational for you to tell you a little bit about the cancer center that you may or may not know about. And then to leave plenty of time for Dr. Holcomb as well. I want to start as I usually do with our mission, and our mission is really to reduce the burden of cancer through research, clinical care, community outreach, and education. We actually serve the entire state of Vermont and Northern New York. So that's about 18,000 square miles that we have, that we feel is the area where we really need to make an impact. And most of that impact has to do with cancer prevention, cancer screening, but also cancer treatment as we do that here at the cancer center. We have four pillars to the cancer center. Each of them is really equally important. The first is clinical care, and that's to provide the best clinical care possible for people that are affected by cancer and to bring new and novel treatments to bear so that patients can benefit from. Just as an example of that, we'll be launching our program with cellular therapy and CAR T-cells sometime later this year, probably in a few months. This is a new therapy that hasn't been available to Vermonters in the past unless they went out of state. And it has the potential to provide long-term permissions and perhaps cures for patients with refractory leukemia and lymphoma. Our second pillar is education. We're part of the university here. And our mission is to provide cancer-related educational opportunities really from high school all the way up to junior faculty and junior professionals. Just as an example, we have a summer research program which is available for undergraduates, graduate students and medical students to spend some time in our cancer center laboratories and learn about cancer research. We also this year had our first career days in cancer where we invited over 100 local high school students to come and learn about different career opportunities related to cancer care and cancer research. Our third pillar is community outreach and engagement. This is especially important to all of us here and especially for me because my feeling is that there's no reason to have a cancer center if we don't serve the community where we're located. And so reaching out to the community and providing to their needs is of utmost importance. As an example of that, we partnered with Dartmouth to do a statewide lung cancer screening program over this past year. That was also a partnership with the Department of Health and the organization for Monsters Taking Action Against Cancer to encourage people to get lung cancer screening if appropriate and also to provide education about lung cancer screening. We've also formed a community advisory board here at the cancer center with representatives from across the state and also some of the representatives in the Vermont legislature to provide input to us about what the needs of the community are so that we can address those. And as an example of their utility, we recently presented options for a research program providing nutritional support for cancer patients which would be statewide. And the community advisory board has endorsed that proposal and we'll be submitting that for funding to the National Cancer Institute. Our research spans from fundamental laboratory research to population-based research focused on cancer screening and cancer prevention to clinical trials, which takes us back into the clinical arena. Clinical trials really represent the opportunity for patients here in Vermont to get tomorrow's therapy today. And so we know that this is an essential component of cancer care and the way that we make progress in developing new cures and new clinical trials. Treatments for people with cancer. The cancer center has all of these things going on at the same time. It has a significant impact across the state and economic impact. We recently had an economic benefit analysis performed by a national organization which showed that the cancer center activities generate about $65 million of economic activity from its clinical component. I think what's even more interesting is that our research component generates an additional $20 million of economic activity for the state of Vermont. And this research component is really funded by dollars that come from the federal government. So these are really a tremendous benefit to Vermont because it's generating a lot of economic activity here without having to put the resources in locally, bringing the resources from Washington to DC. You may have heard that the University of Vermont Cancer Center used to have NCI designation. They lost that designation in 2012. And I have been asked by President Gueramella and the Dean Page to reclaim that designation for the cancer center here and for the people of Vermont. We are working to improve the quality of the patient care that we deliver, including clinical trials and offering tomorrow's therapies today. We're building our research base and targeting problems related to cancer that are specifically a concern of our population. But looking at breast cancer and lung cancer and melanoma, these are very significant problems here in the state of Vermont. We wanna make sure that our research focuses on those along with other aspects of cancer development. We're expanding our education for students and junior professionals. And as I mentioned, enhancing our community outreach and engagement so that we can respond to the needs of the community. So the cancer center, most people think of the cancer center as a clinical entity. Some place where people come to get care and we definitely are that. But I think we're much more than that. We're also an educational entity. We are a research entity and here an entity that strives to serve the community where we are located. And so that's a little summary of the cancer center. And I didn't wanna take too much time so I could leave lots of time for questions and I would be more than happy to answer any questions that you may have. Great, thank you, Dr. Holcomb. That was a great overview. I have a couple of questions I'll start with. They'll let our committee ask some questions and then we'll turn it back over to Senator Lyons. So I do just wanna say, when I met with Dr. Holcomb, we spent a lot of time talking about nutrition and cancer. And so I am thrilled to hear that the advisory committee is endorsing that and hopefully it will move forward. You had talked a little bit about it and I don't know if you wanna share a little bit your history, the fact that there's no research like this happening, am I correct? With nutrition and cancer? This is an area related to cancer care and cancer research that really has major deficiencies and people have not been doing a sufficient amount of research to understand the benefits of nutrition for cancer patients. The trial that we're proposing to the National Cancer Institute which is actually a $4 million grant that I'll be submitting next month is to provide nutritional counseling for all newly diagnosed cancer patients. We have only 2.4 registered dieticians who are serving 2,500 new cancer cases across the state that are receiving ambulatory or outpatient cancer care. It's definitely not sufficient and it's impossible for them to provide the nutritional counseling to all cancer patients and only those who are having specific difficulties with swallowing and digestion really get those consultations at the moment because of the shortage in the workforce. What we wanna do is create an infrastructure so that we can provide that counseling for all newly diagnosed patients. And we're also going to partner with the economics department here at the University of Vermont so that we can do a cost effectiveness analysis of this program and hopefully show that it will actually be cost effective provide this nutritional intervention upfront. And with that kind of information we may be able to impact cancer policy and also insurance reimbursement for registered dieticians. So that's our goal, that's our hope and we'll keep our fingers crossed that the National Cancer Institute is interested in supporting this program here that will be proposed. Great, thank you for that. Any questions, Joe? Yeah, Joe Andreano from Orwell. I'm curious about, you'd mentioned this five year plan to achieve National Cancer Institute designation just in sort of a broad overview what sort of steps should be taken on that and is there any support you would need for that? So I wanna be in full disclosure I'm not asking for any support here today so I'll just start with that. It will definitely take resources and I've been working with both President Caramella and Dean H to make sure we have the resources to do this. We have a few things that we need to do we need to build our research base and expand the activities in basic laboratory research as well as population-based research to qualify for NCI designation. We need to expand our clinical trials activities and enroll more patients onto clinical trials. Part of how we're doing that is working to expand our clinical trials network to other sites across the state so that people can get care locally and have access to some of these clinical trials close to home rather than having to travel to Burlington to the cancer center here. This does, when you get NCI designation it affirms that you're in the top 4% of cancer centers in the country. It allows you access to an additional approximately $5 million a year of NIH funding that otherwise would not be coming into the state of Vermont. It helps us attract talented clinicians, researchers, and educators. So it is a very big step and I think it will be extremely beneficial if we can reclaim that designation. I think I've been through this process a few times when I was deputy director of the Cancer Center at Mount Sinai and director of the clinical cancer program there. We got our first NCI designation. Mount Sinai invested $100 million to get that NCI designation. I was also at the University of Hawaii where we renewed a designation that was very much in jeopardy when I was director there. There was a lot of investment that went into that as well and supported there by the university as well as the legislature. So it does take resources. I think that we're on a path where we've identified the resources that we need and we can get there. I think it will take about another three to four years before we're ready to apply for that NCI designation because it does take some time to build those programs, recruit some new faculty. Thank you. Any other questions in this room, Leslie? Thank you and thank you for this work. It's important, I'm interested in what you're thinking about prevention. And we know that prevention, that would be ideal, right? So no one got cancer at all. There's been a ton of work on cigarettes and smoking and I know that lung cancer is the number one cancer in Vermont, colorectal cancer. So I'm wondering what you're thinking about, what does prevention mean to you on the population level? Where do we see that impact? So we see lots of things in that area. And I think prevention and screening which goes hand in hand with prevention in reducing late stage disease by finding a disease early are critically important from a population standpoint. The tobacco researchers here at the University of Vermont are part of the cancer center. We work with them closely. We work with our clinicians that are focused on lung cancer screening. A lot of that involves education and education about risk factors related to the development of lung cancer. We've had some extensive discussions in our community advisory board about that. We have a representative, Chief Stevens, from the Abinaki tribe. And we're discussing whether we can create a program for them, for example, that takes into account their cultural significance of tobacco but also reduces their risk for development of lung cancer. One of the things that we're also trying to do is create what I call an outreach fan where we can go out into the community, into rural areas across the state and provide cancer education. We're already doing that locally here but I think it's more important that we do it across the rural areas of Vermont because in rural Vermont, people who develop cancer have a significantly higher mortality. Than the people who develop cancer in a more urban area. And we need to reduce that disparity so that we can achieve equity in cancer outcomes. And a lot of that has to do with bringing information to the community about risk factors and how to reduce the risk for developing cancer. So I think cancer prevention is critically important. Part of the component of that will be early detection through screening. All of those things can reduce the burden of cancer and really we'd like to put ourselves out of business and get all of this done so that we don't have to worry about difficult treatments that people have to undergo. And we'll be working to try to reduce the disparities, especially for our rural areas in the state. Thank you. Great, Senator Lyons, so we'll turn it over to you. Terrific, thank you Representative Houghton and thank you Dr. Holcomb for being here with us today. This has been terrific, it's good to see you again. And I'll ask a couple of questions. Our committee, just FYI, our committee will need to disappear at 1115 so we'll be able to go until then. But I do have a couple of questions and then ask the rest of the committee if they will also have questions. So I understand the interest in looking at the cancers that predominate in the state, is there anything that is gender specific, for example, prostate cancer or is there anything related to pancreatic cancer? Every time we read obituaries, we see pancreatic cancer or we see prostate cancer. Are those interests of the Cancer Center or how do you deal with maybe an increase in those particular types or others? Yeah, so we have a few cancers that are particular relevance. Obviously lung cancer and breast cancer are the leading causes of cancer in the state where we have some focus there. Pancreatic cancer is less common than those other cancers but it is, we do have a higher rate here in Vermont and incidence rate than most states across the country. So this is something that we are particularly focused on and also trying to understand the genetics of pancreatic cancer because there are some genetic predispositions and we have a robust cancer genetics program here and we would like to really take that out into the community so that we can understand what contributions the genetic factors may have in development of pancreatic cancer. Another cancer that's a very high rate, incidence rate here in Vermont is melanoma. The reasons for that are not completely clear and so we're doing some laboratory research on that as well as some population-based research to try to understand what the etiologies of that are. Prostate cancer is a very common cancer for men. It's not one of the leading causes of death because a lot of men can live with prostate cancer for quite a while but it is a significant problem here and we are working to build our program. I would say that that's one area here in the cancer center that I've identified as one that we need to have more strain and build because we don't have the fundamental or population-based research focused on prostate cancer that I think we will need to have. So that's one area of growth that's been. Thank you. Just one other quick question. It's probably not a quick answer but the question about the cost of chemotherapy, I mean it just seems so unfathomable that someone has to spend 30 or 40,000 or 50,000 or $100,000 a year for a cure. Are you engaged at all in looking at prescription drug costs for chemotherapy and treatment overall? Well, that's a tough problem because the new therapies that come out generally have a cost set and approved by the FDA and we pretty much have to pay that and insurance has to cover that to provide those therapies for patients. One of the things that we've tried to do is to expand our clinical trials portfolio so that we can get some of these medications that are so very expensive, paid for by the pharmaceutical industry as part of a clinical trial and this actually will reduce the cost that has to be paid for care. I think that overall there are a lot of changes that can be made in cancer care delivery. That's an area of my personal research and we are trying to expand our health services research component of the cancer center to try to address some of those issues like cost and health policy and how we can better provide cancer care across a broad geographic area. Thank you. Senator Gullick has a question. Hello, thank you, Dr. Holcomb. As you know, we have many buildings, especially in our cities and towns that were built in the 60s and 70s that are riddled with toxins and poisons ranging from lead to asbestos to PCBs. And I'm wondering if you ever weigh in on ridding those buildings of cancer-causing toxins or if you are at all active in ensuring that new construction is safe. We aren't directly related to construction. I would say that we are doing research on environmental contaminants that may contribute to the development of cancer. We have several researchers who've been looking at polyphenols and PCBs and other compounds that may be present both within Lakewater as well as the soil across the state. We're trying to see how that relates to the development of cancer. And we've actually published some recent articles about the risk of childhood leukemia related to exposure to some of those compounds. I think the more research we do, the greater the base of knowledge we will have so that that can affect policy in construction and hopefully make safer buildings in the future. Questions? Senator Harding. Thank you. And thank you, Dr. Mulcomb. I was struck by the comment you made about the disparity in outcomes for people living in rural areas versus more urban areas. And I was also happy to hear that you're working with Chief Stevens. So I'm wondering how else are you sort of applying an equity lens to the work that you're doing to make sure that we can narrow the gap between those outcomes for people based on where they live and their race or ethnicity, et cetera. I would say that almost all our population-based research which is pretty robust here at the Cancer Center has a disparities and equity focus. We understand that we have a large rural population here that we serve and that the mortality rates are just far too high in those areas. Some of that has to do with late diagnosis but a lot of it has to do with other factors and may have to do with some environmental exposures as well as they relate to agriculture. So we're partnering with the College of Agriculture and Life Sciences on some projects as well to look at some of those issues about soil contaminants. We know that the rural population is something that we can particularly address here that other cancer centers in the NCI portfolio cannot address because many of them do not have such a large rural population. And so it's a major focus of almost all the research that we do. That's great. And if you have any policy recommendations along those lines, whether they're related to toxins or healthcare access, et cetera, that would be helpful because as someone who represents a rural district, it is really discouraging to hear that there's that disparity. I will bring forward the policy recommendations as we get them. I'm happy to do that and very much welcome that request. Great, thank you. Terrific, that's terrific. Any other questions? Okay, unfortunately, Senate Health and Welfare is going to have to sign off. We have another talk. We do as well. Okay, so we are finished. Go ahead, Representative Halton, finish us off. Great, thank you Dr. Holk over your time. On behalf of both of our committees, thank you for the work you're doing and we look forward to hearing more from you in the near future, I'm sure. Thank you very much. I appreciate the opportunity to talk to you today. Thanks, have a great day everyone. We can go off air, Claire and Alex.