Many discovery-orientated types of research across the country make the headlines. However, most of these were breakthroughs from a scientific perspective and not from a clinical perspective. This means that the patients don’t benefit from it, and sometimes the discovery doesn’t get translated for quite a long time. This is what the Terry Fox Research Institute or TFRI is trying to solve with their translational cancer research. Dr. Victor Ling takes a deep dive into translational research and how TFRI is figuring out how to translate discoveries so people and patients may benefit from these.
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Building and Leading a National Research Organization with Dr. Victor Ling
We have a very special guest, Dr. Victor Ling. He’s an Officer of the Order of Canada. He’s one of Canada’s leading cancer researchers known around the world, especially for his work and understanding drug resistance to anticancer drugs. Since 2007, he’s been the President and Scientific Director of the Terry Fox Research Institute. Thank you for coming, Dr. Ling.
I’m very pleased to be on your show. I’m very happy to say a few words about how we started Terry Fox Research Institute or we call it TFRI for short to make it easier. Shortly after 2005 was when the Terry Fox Foundation that most of us know organized the annual Terry Fox Run. They raised money to support cancer research in memory of Terry Fox. 2005 was anniversary year for Terry Fox Foundation and they raised extra money and they asked a number of scientists including myself what should they do with the extra money, which is quite a bit more than what they normally raise on the Annual Terry Fox Run.
We’ve come to the conclusion that many of the research across the country, if they are discovery orientated, that a lot of these do make headlines but they were breakthrough from a scientific perspective. They were not breakthrough from a clinical perspective, which means that the patients don’t benefit from it and sometimes the discovery don’t get translated for quite a long time. We felt it necessary to start a new initiative to try and fund and stimulate what we call translational cancer research, especially trying to figure out how to get the discovery that may have been made at a molecular level or maybe an animal. How can we translate it so people and patients may benefit from this? This is how TFRI was first started.
You have those initial conversations about having this national organization that’s going to take what’s happening in the lab and help translate that or accelerate that to actual therapies that are available for patients across the country. Everyone said, “Yes, that’s a great idea.” People have had that idea before. What was different about the TFRI that made it happen? If you remember back to those early days, what caused it to go from that idea to the institute as it is now?
What stimulated was some dedicated money to do translational research because most of the research at that time was focusing on discovery research to cure cancer, the mechanism of cancer, so on and so forth. Very few organizations were funding research that could be translated. We dedicated some money at that time. It was significant. We dedicated up to $50 million over five years to focus on translational cancer research. That brought a focus to this initiative.
I know you’ve encountered this. Having spent nearly a decade in the cancer fundraising space myself, I certainly encountered this. When you say we’re going to start a new cancer organization, you can almost hear donors rolling their eyes because there are many different organizations that donors perceive, it’s often not true, are competing and aren’t working together. How did you approach that issue from the perspective of the new institute when you were starting it?
At that time, I had a day job as Vice President of Research at the BC Cancer Agency. Darrell Fox, the head of the Terry Fox Foundation, at that time asked me if I would leave that job to head up the Terry Fox Research Institute. I did that and the first thing I did was to start meeting people across the country, just meeting them one-on-one. I already knew these people but to share the story with them of what we’re trying to do and say that if we were to work together across the country, there has to be money under the table. That’s number one.
Number two, what we said to everybody involved is that the Terry Fox Research Institute are not to have any share in potential intellectual property on any other discovery that may come out of that research. That means that we are enabler and we’re not a competitor or we’re going to profit from any of the additional work that other people might do. What we require is that people have to have a plan that they will be willing to work together. I think that makes a big difference. In a nutshell, meeting people one-on-one, hearing what their thoughts are at how to do translation research, and they’re putting money on the table so people will see that this is not just talking. We’re serious about funding this area of research.
It has been successful. Since 2007, you have brought some of the best minds in cancer research and translational science to the table. Looking back since 2007, you have been very successful at bringing some of the brightest minds in cancer research and translational science to the table. What has been the hallmark of the projects that have been successful since the institute got started?
We wanted to not necessarily do the thing that everybody thought was popular at that time. We want to do the thing that would have the most impact. We invited scientists and clinicians from across the country to give us their best idea. We created a workshop which will bring people together and ask people to tell us about what’s their best idea. One of the good ideas that came out was the question of how we deal with lung cancer. Lung cancer by the time it’s detected, normally it’s very late stage and the survival after detecting lung cancer is probably around 15% or 10%. That’s not very good news. If we’re able to detect it earlier, there’s an opportunity to have survival rates of anywhere between 50% to 80%. That potentially has a huge gain upside.
We decided to support across the country a project on detection of lung cancer early, especially among the heavy smokers who are at the highest risk. That was our very first project that was launched. That project was saving many lives within the five years that we had launched the project. We were able to detect lung cancer early which is stage one, curable, rather than the normal stage four or three. Out of the 2,000 people that we undertake the early detection study, over 150 people to over 20 people were identified that were stage one that normally would have been probably three or four. That study alone saved many lives.
One of the things I’m interested in understanding and asking you about is your progression as the leader of a lab, a world-renowned oncology researcher where you’re the one making the decisions for the lab. You’re getting the grants, building the teams, writing the papers, making the breakthroughs. You’re the vice president of research where you’re coordinating others to do that work, then you move into this role as the Founding President of the Terry Fox Research Institute where you’re not the one necessarily setting the direction. You’re the one building the space for people to have a conversation about what might work or what’s the best path forward. From a personal perspective, what was that transition like?
It was a difficult transition in some ways, but I realized early on after I took on the role of the Scientific Director of TFRI, my role is to be an enabler to make other people more effective or help them to become more effective rather than being the one that is doing all the work. There’s no way that a single person can do the work that a team can do. That was a difficult transition. I made transitions a number of times in my life. Initially as a research scientist then later on the head of a lab and then finally as VP of Research of the BC Cancer Agency and each step was hard. Moving to TFRI was very interesting because it was a little bit easier getting people to come together because all the scientists and clinicians were looking for resources to do the research they thought were important. With somebody like myself who is a researcher and was interested in the science behind that, they felt that they were able to talk to somebody who understood where they were coming from. It’s a combination of having the knowledge as well as having the resources and then having the perspective of wanting to be an enabler rather than a doer.
How important do you think that credibility that you had as a scientist contributed to people’s willingness to have those initial one-on-one conversations with you?
It was important from two perspectives. One is that they knew that I understood what they were talking about. Number two, they also knew that they could not put a wall on my eyes. I thought that was very important because it’s not that people try to mislead other people, but sometimes they try to simplify things and say, “We can make progress in five years,” but we know that often it takes much longer than that. When we talk one-on-one, we come down to the reality of what’s possible to do and what resources we needed.
As you started out and were putting these teams together and you’re having these conversations, were there particular traits that you are looking for in these research projects that weren’t happening before the TFRI started?
We were looking for projects that others weren’t doing. There were many proposals at that time that had to do with breast cancer. At that time, those were quite well-funded compared to other cancer types. Almost nobody was funding lung cancer. We said, “With the amount of resources that we have, where can we make the biggest impact in terms of the saving lives or the amount of time to get a readout?” Very few people were funding lung cancer at that time. People who had lung cancer didn’t live very long. If we were to make an impact which showed up quite soon and that’s the way it turned out. As we became more established, we also wanted to do more things that are impactful. We have more patience to wait longer than we do with the lung cancer project.
Our conversation has been focused on the investing and research side and the partnerships that you’ve built across the country. I want to shift a little bit and talk about the partnerships you’ve created with the fundraising organizations across the country. In your role as Vice President of Research at BC Cancer, you were quite involved in fundraising for the new research center that was built during your time there and the establishment and the creation of the Michael Smith Genome Center. What was it like to be trying to pull multiple fundraising organizations together around the same table? How did you approach that?
Early detection study alone saves many lives. Click To TweetI try to work with another fundraiser to ask a question of whether or not what we were doing aligned with what they were interested in or what they would like to do as well. To try to show them that we’re working together. They would have more impact on the dollar that they were spending than if they will do it alone. That fills in the work on our part. The most important thing was when we first started TFRI, we decided we had to build on it, making sure we have the right culture and the right value for our organization. When we look across the country and see how much cancer research dollars are being spent, how much we are putting into the cancer research environment. We realized that TFRI only represents somewhere around 2% or maybe at most 5% of the total funding of this country for cancer research.
We said, “Our impact was relatively small if we did what everybody else did.” We decided that we were only going to focus on team science research, bringing people together. We do not fund individual research, but we fund team science. We wanted to make sure that the team were truly excellent. We invested a fair amount of money to make sure that the application submitted by the team are internationally peer-reviewed by top scientists around the world. These top scientists around the world would have a chance to meet our team to get feedback. This is what we call a face-to-face site visit. This costs us more money but at the end of the day, everybody realized that two things happened. One is our scientists learn from the review committee even if they didn’t get the grant.
The second thing that happened was that the international reviewers get to realize that these scientists in Canada were truly outstanding. They go back and say, “Do you realize that some of these teams in Canada are among the very best in the world, the top one or two in the world?” Our reputation then began to build. The reason I’m doing all this is that by adopting this value proposition that we want to be the best in what we do, even though what we can do is relatively small in the great scheme of things. If what we’re doing is truly outstanding, then other people will come and join us. When we say that we’re funding the best cancer research in Canada, as shown by the international peer-review, that these are truly world-class research than the BC Cancer Foundation, Michael Smith and others across the country say, “We don’t have to do our due diligence. We can say to our donors we’re going to partner with TFRI to fund research. We can say that we’re doing some of the best research in the world.” I think everyone wins from that.
That opportunity to partner with TFRI, what we’ve seen across the country has been very compelling for other cancer research fundraising organizations as well as donors themselves. How often do you get asked the question about the difference between the Terry Fox Foundation and the Terry Fox Research Institute?
They’re very insightful. Most people say they’re the same organization. The simple way I put it is the foundation raises the money and the institute spend the money. That’s a tongue in cheek way. What we try to say is that the institute invests the money on behalf of the foundation for the best cancer research that we can do.
Is there an overlap between the two boards?
There are separate boards. Although there’s a representative from the Terry Fox Foundation that sits on our board. That’s so that the foundation knows at the board level what’s going on. We have at least one or often two or more board meetings between the foundation and the institute.
Say more about what happens at those joint board meetings.
It’s very interesting. The foundation board would like to know how we’re spending money. They want to make sure that their dollars are being spent carefully. The TFRI board would ask the foundation board how is the fundraising going. At the end of the day, it turns out well, just having an understanding because there are a lot of things that the foundation and the institute could do to support each other more. Building that understanding of why the money is needed to do the kind of research that the institute is doing. The institute needs to understand the challenges that the foundation had for raising money.
How do you think about or understand the importance of being part of the Terry Fox legacy? Even more than Wayne Gretzky, Terry Fox is the Canadian known on the international stage and revered as a hero to children in Canada. How do you think about being a steward of that legacy?
I take it very seriously. That’s why I’ve spent a lot of time when we first started the institute to talk about our values. We say excellence is key, but what excellence means is integrity. It means that we follow the guidelines and the principles of what the Terry Fox Foundation follows in terms of what Terry’s vision and values are. The foundation world and the research world are different. We have to make sure that we don’t cross the line and we’ll put it that way of doing things that might not adhere to attaining value. One of the things that we do is we have Darrell Fox, who is Terry’s younger brother, being on our board to provide that guidance and also as a special advisor to me to make sure that I’m aware of what some of the values and situations are. I hear Darrell a lot. Sometimes we get into areas I’m not sure whether we should be doing or not. We always get good advice from people like Darrell and family members.
It’s satisfying to be able to see that connection to Terry the person and to what he represents. He’s still an active part of the work of the institute. You’re doing a lot to build on that legacy. Maybe you could tell us a little bit more about the Marathon of Hope Cancer Center project.
Excellence means a willingness to take the risk, the willingness to fail, and the willingness to learn from your failure. Click To TweetWe are in existence for many years now, but a few years ago we come to realize that all the great research we’re funding, the teams across Canada and the projects we’re doing are great but in a long run, we want to make sure that all these findings continue to be translated. We put it into a benefit patient. We also realize that we need to bring the institution together, the cancer centers together. We spend a lot of time studying other countries. For example, the United States have comprehensive cancer centers. The reason for that is sometimes the information or data from cancer patients, the outcome may need to be followed for many years and probably longer than some careers of some scientists.
What we were worried about is that the data will be lost in the computer of these scientists. We want to make sure that the data that’s important for long-term outcomes for cancer are in the institution and available for future scientists and clinicians to do research and to benefit from. The whole idea was that team science is great. Would it be great if we could get the cancer centers across the country becoming a team together and working together? That sounds easy to do but it turned out to be extremely challenging for a number of different reasons.
To anyone who’s been involved in the cancer world, that does not sound easy to do.
A couple of situations arrive almost immediately, that is because even though we’re a publicly funded healthcare system, every province has their particular way of undertaking healthcare. Even in cancer, the BC Cancer Agency, they look after the province of British Columbia is very different from Quebec or even from Ontario. They manage it in a somewhat different way. We came to the conclusion that if the major cancer centers across Canada work together, there are some obvious benefits. Number one, data could be shared across the country. Number two, because we’re moving in the era of what we call digital health, the information of patients and the research done and the immediate outcome can be interrogated. It can be studied so that personalized and precision medicine, as we call it, can make better decisions for individuals across the country. We came to this idea that we need to try to get the cancer centers together. That’s where we decided to approach the federal government for support along those lines.
You’ve had some exciting announcements to tell our audience what the federal government’s response to that was.
They announced that they would support the Marathon of Hope Cancer Center Network for five years for $150 million. As we had suggested to them that this $150 million will be matched by the cancer centers and by the Terry Fox Foundation, match one-to-one. What we’re essentially doing is that we are putting $300 billion into the system to try and detect precision medicine. We will link up the major cancer centers across the country into a network where research data, outcome data will be shared. Those patients, whether they’re in the major centers like Vancouver throughout Montreal, they would know to benefit because they’re major cancer centers. The patients in the smaller community would also benefit because their centers would also be part of the network.
One of the exciting things for me is that the Atlantic provinces have agreed to come together at the consortium to form Atlantic Consortium. Montreal and a low of four hospitals and three research institutes come together to form the Montreal Consortium. That has never been done before, just to become part of the network. The prairie provinces, Alberta, which I know is a province that’s dear to your heart, Doug, and Manitoba, it’s to form a consortium to become part of the network. We undertake a pilot project to make sure that they’re working together first as a consortium before having them join the network.
One of the themes that come through in your discussion is it’s a great pathway for organizations and for leaders and aspiring leaders to follow. You told us starting with the values, upholding the legacy and the values of Terry Fox and the Terry Fox family, the values of excellence when it comes to science, putting that focus on the team. I love your line that cancer is a difficult problem to solve and no one can do the work that a team can, bringing people together, sharing the resources, sharing the credit has brought the Terry Fox Research Institute and cancer research in general in Canada to a place that was unimaginable not that long ago.
I would like to add a couple of lines that resonated with us with the federal government. It’s the idea that as an academic, we try to compete with each other and see who’s the better person, the better lab will get the grant. In this case, we’re trying to build teams and we’re trying to build a network of cancer centers. We’re saying that we’re not competing against each other. We’re competing against cancer together. That resonates with a lot of people. At the same time, we try to use a hockey analogy to say that when team Canada comes together, we truly have an outstanding team that is often in the gold medal competition.
We would like to think that by working together, having Canadian talent, Canadian institution working together, we’re building the team Canada Cancer Research. That had been part of our branding and we’ll put it that way, to what the Marathon of Hope Cancer Centers is about. Another point I would like to make, which may be obvious to your audience is that excellence means a willingness to take the risk, willingness to fail and willingness to learn from your failure. That’s what’s needed in cancer research because we need to try not to do safe things but to do things that we don’t know how to deal with, but we have to learn from our failures.
That is great advice in cancer research and across the entire social profit sector. I appreciate you sharing your journey as moving from researcher to national leader at the Terry Fox Research Institute and the journey of the organization that you have been with since the very beginning in 2007. This is a blueprint in a lot of ways for how social profit organizations, regardless of their area of focus, can build a team, legacy and credibility to accomplish great things against their mission. Thank you so much for being a part of the Discovery Pod and sharing the journey with us.
It’s a real pleasure to be on your Discovery Pod and I enjoy chatting with you.
Thank you, Dr. Ling.
Important Links:
- Terry Fox Research Institute
- BC Cancer Agency
- Michael Smith Genome Center
- Darrell Fox
- Marathon of Hope Cancer Center
- http://TFRI.ca/
About Victor Ling
Victor Ling OC, OBC, Ph.D. President and Scientific Director Terry Fox Research Institute Distinguished Scientist and Professor BC Cancer Agency and the University of British Columbia.
