In the Season 5 debut of On the Edge of Breakthrough, City of Hope CEO Robert Stone openly shares the experiences that shaped his career and ultimately led him to the organization 30 years ago. He reveals how a visit to the Duarte campus changed his perspective and set him on a career path he never expected to take.
In the Season 5 debut of On the Edge of Breakthrough, City of Hope CEO Robert Stone openly shares the experiences that shaped his career and ultimately led him to the organization 30 years ago. He reveals how a visit to the Duarte campus changed his perspective and set him on a career path he never expected to take.
The conversation offers a personal look at the influences that shaped Stone's leadership, from lessons learned as a college athlete to balancing family and a demanding career. He reflects on what it means to lead a national organization through tremendous growth while staying connected to the mission and people at its core.
Stone also shares his perspective on the future of cancer care, including the growing role of artificial intelligence, expanding access to clinical trials and City of Hope's efforts to reach more patients nationwide. Throughout the conversation, he returns to a belief that has guided his career and the organization: keeping patients at the center of each decision and earning their trust every step of the way.
Robert Stone (00:00:00):
The country is listening to what we collectively have to say, and I think it's because we've put cancer patients first. So in California, we helped lead a coalition to push the passage of a cancer center bill of rights, something called the Cancer Care Equity Act, which guarantees patients on Medi-Cal from some of the, um, most underserved communities would have access for complex cancers to the opinions that we have. We've done the same thing with the Bill of Rights in Illinois. We had the Microbiome Summit here on campus that we co-hosted with, uh, Dr. Badacharya in the, uh, director of NIH. And there is a, an obligation on City of Hope that I believe, which is to put the patient in the center and advocate for what policy decisions are being made, how they impact cancer patients.
Dr. Monty Pal (00:00:54):
I'm Dr. Monty Pal from City of Hope, and this is On the Edge of Breakthrough: Voices of Cancer Research. Each episode, we bring you the minds behind the science, the stories behind the data, and the breakthroughs that could change everything. Let's dive in. Welcome, everyone. It's my distinct pleasure today to have the Helen & Morgan Chu distinguished chair and the chief executive officer of City of Hope, Mr. Robert Stone here with us today. Robert, welcome.
Robert Stone (00:01:26):
Dr. Pal, it's a pleasure to be here.
Dr. Monty Pal (00:01:28):
Oh, gosh. We're gonna go by first names today. Robert, so nice to see you. And I have to say that in preparing for this episode, I learned so much about you. I had no idea that you were a collegiate athlete. Your collegiate career was, you know, centered to some extent around basketball. Tell us about this.
Robert Stone (00:01:43):
Well, so I was a division three athlete, and back in the day, I'm not sure that that would qualify as an athlete. But yeah, athletics has always been an important part of growing up. Uh, I think it provided a foundation for things that as I became, uh, went into the working world and became ultimately a leader, you can reach back and take things you've learned. And so yeah, I played basketball in college for four years and I played baseball in college, if you can believe it.
Dr. Monty Pal (00:02:12):
Amazing. And do you have time for any of that nowadays?
Robert Stone (00:02:15):
Well, so your question is, do I have time? I'm sure I could make time.
Dr. Monty Pal (00:02:19):
Okay.
Robert Stone (00:02:20):
Do I play? No. No. I, I, I gave up playing basketball. Basketball is a contact sport, Monty, even though people don't realize that, at least the way I played it with two left feet. And I played pretty late here in, in City of Hope. We're on our, our campus. And we used to have a basketball league here. And I played with scientists, mostly scientists, a few physicians.
Dr. Monty Pal (00:02:44):
Okay.
Robert Stone (00:02:45):
And it took me a while to realize they play for keeps. And I wanted to say during the up and down, I, I'm not deciding budgets today. You can take it easy. And I tore a ligament in my, uh, ankle and that kind of ended my career.
Dr. Monty Pal (00:03:02):
So I, I remember this game on the south end of campus.
Robert Stone (00:03:04):
It was.
Dr. Monty Pal (00:03:05):
And it was pretty vigorous. I, I do remember that. I tried playing once, uh, and once and only. That was it for me.
Robert Stone (00:03:10):
So I was told stories and, and part of the beauty of City of Hope, and, and I really mean this, are the stories. I mean, when, when people talk about what's special here, the culture inevitably shows up somewhere in the description. And the culture lives through stories. And the story I got from multiple people on multiple occasions about that basketball game on the South Side, on Blacktop, remember it's outside - I do. On Blacktop was that I should just be thankful that by the time I joined and started playing, Art Riggs had stopped playing. Because Art, who is, is, I believe, City of Hope's most renowned scientist - Indeed. In 110 years was an aggressive basketball player.
Dr. Monty Pal (00:04:01):
Well, well, you know, Robert, let me just ask you, you know, one thing that you have always made time for in the years that I've known you is family. You, you've got a wonderful family. Tell us a little bit about that. Your daughter's in medical school now at UCLA, which is my alma mater, which is super exciting.
Robert Stone (00:04:15):
Yeah, it's why she did it. I said, you know, any place that Dr. Pal went is good enough to know. Um, yeah. So I've been married 30 years. Uh, I, I remember that, both that anniversary and my service anniversary at City of Hope because they happened in the same month.That's right. It's 30 years at City of Hope, right? September of 1996. I, I got married to a wonderful woman, Charlotte, who is, uh, as the years go by, I c - 30 years ago, I've told you we can't be closer. And as each year goes by, I have the pleasure of, of getting closer and closer. And I married up, which is just a wonderful. I know you did the same. So we share that. Indeed. Yeah. Um, and we have two kids. Our eldest, Ellie, is, uh, finishing her first year of medical school at UCLA, which we love because she went to undergrad at Emory in Atlanta.
(00:05:04):
So she was gone for four, for five years because she took a gap year. And our son, Thomas, uh, is a junior at Chapman University here in Orange.
Dr. Monty Pal (00:05:14):
Oh, phenomenal. So both close by, I imagine you get to stay in close touch over that time.
Robert Stone (00:05:19):
Yeah. For, for reasons you'd appreciate more than I perhaps would, Monty. Apparently, first year of medical school doesn't leave a ton of time - Fair enough. To get together with your parents, but we do get to see her quite often, much more than when she was in Atlanta. And, um, so yeah, it's great.
Dr. Monty Pal (00:05:35):
Phenomenal. Phenomenal. Uh, you know, we are gonna talk about City of Hope now, and I wanna start with what initially brought you to the campus. You know, it's been 20 years here for me, 30 years for you. Um, I could talk for hours about, you know, how I was sort of linked originally to the campus. I wanna hear how you originally brought to our, our illustrious institution.
Robert Stone (00:05:54):
For me, with the benefit of 30 years of hindsight, that, that story leads me to conclude luck plays a lot into history for, for people. I, um, I lucked into coming to City of Hope. Uh, I turned down the offer to interview twice. Really? Yeah. Yeah. So I, I'm a lawyer by training. And, um, I went to work in a firm downtown Los Angeles right out of law school. And a partner that I had worked with there, uh, went out and started his own firm and asked me to join him. A couple years later, a part - another partner at the same firm had become City of Hope's first general counsel in its 86, then 86 year history. And he asked me to come and be the second full-time lawyer in the office. And I grew up in Whittier, which is just, you know, a few miles away, 20 minutes away from the campus here.
(00:06:54):
Um, so I knew of City of Hope, but I didn't know anybody that had, had benefited from our services. And I thought I was happy doing what I was doing. I had a lot of responsibility. I was, um, learning every day. I was intellectually curious. And so I said no. And then he said, "I'll buy you lunch in the cafeteria if you'll come and interview." Lucky piece number one is I'm here because of hospital food. So that, that's a, that's a true story. Luck number two is I came and I met wonderful people. I mean, I, I still can remember who I met with, but I still wasn't sold on coming. And I took a tour of the campus and it looked very different 30 years ago than it looks today. And the building on my right now is the Briskin, uh, Clinical Research Center, was then the pediatric bone marrow transplant unit.
(00:07:48):
And out in front of me was, uh, a nurse pulling, literally pulling a red wagon. And in the red wagon was a kid who had no hair. I, I, to this day, 30 years later, can't tell you if the child, uh, was a boy or a girl, probably four or five years old, beautiful blue skies, uh, sunny day. And the kid's just smiling. Uh, he's having a great day. And you can tell that was evidence of what City of Hope can do for people. I still wasn't sold. It wasn't until I looked to the right of, of that young pediatric patient and a step behind pushing an IV pole was clearly his or her mother, and she's silently sobbing. And to this day, Monty, I don't know if she was crying because, um, her child clearly was go - undergoing transplant or if she was crying because her child had been undergoing transplant and now was outside and starting to enjoy the day like a, a, a, every kid should.
(00:09:00):
But it was that mom that sold me on City of Hope. Never spoke to her, never said anything, wish I had. Um, but that's how I ended up coming here.
Dr. Monty Pal (00:09:10):
What, what a beautiful story. And, and, and certainly, you know, I think that I understand that transition towards a role here that carries so much, so much meaning. Uh, you know, your role at City of Hope has evolved so much, you know, initially, as you'd mentioned, in the office of general counsel, um, then towards strategy and now of course to, you know, president and CEO of the hospital. Tell me a little bit more about, you know, that, that transition for you. How, how did you migrate through these positions, um, and take on this role that's, you know, so sort of, uh, I would say grand within the hospital and, and command so much direction?
Robert Stone (00:09:42):
I went to the University of Chicago for law school, and I went to law school because I had been a political science major as a, an undergrad. And at that time, you either taught, and I didn't really wanna teach, or you went to law school. And it wasn't that I had a passion for the law, but the law taught me how to structure thinking, how to put pieces together, um, to figure out, well, if, in, in our case now, if something's happening in the clinical care arena over here and something else is happening in research over here, how do they impact each other and how do we put them together? And what I found when I came was a. I, I wouldn't have told you I had a natural curiosity at the time because I didn't even think that way. But I clearly, looking back, had a natural curiosity.
(00:10:38):
This was a place that was caring. It was much smaller. We had about 2,500 employees just here on the Duarte campus, not what we've become. And I got to get involved in all kinds of things. And ultimately, that led to the next job, to the next job, to the next job. And the, the two places that had the biggest shifts for me were one, uh, in 2009, if you can think back that far. Yeah. President Obama had just been elected. Okay. So we knew healthcare reform was coming, but we didn't know what it was gonna look like. And I went to the then CEO, Mike Friedman, who I'd worked for, for, uh, quite a while at that point, about five years, and said, you know, Mike,
(00:11:28):
I think I wanna do something else and, and expand. And I went into strategy and Mike was, uh, gracious enough to give me that opportunity. So that was the big move. I, I moved out of the law. I haven't practiced law since our, our general counsel, Kristen O'Callaghan will tell you at the few times now when I opine on legal issues, she'll say, "Okay, leave it to the expert." I love Kristen. Yeah. Um, uh, we don't. And then when I became CEO, uh, I was announced in 2013. Mm-hmm. We had a board meeting in the room next door to where we're, we're talking right now. And at the time, my belief was that the organization would put, would hire, would go out and hire a physician, probably a physician scientist for the role of CEO. Mike, uh, Friedman, who I'm very close to to this day, was a physician scientist.
(00:12:24):
Sure. And he, uh, he believed strongly, as close as we were, that it should be a physician. There were 54 comprehensive cancer centers at the time. Everyone was led by a physician or a scientist. Okay. And I had set up meetings with faculty members and others for our board the following week to, um, interview and start the process for choosing the next CEO. Board had their quarterly meeting, took two to three hours in executive session, came out, then board chair and, and immediate past chair asked me to come over. We sat down and they said, "We're gonna make you CEO." And, um, that was the other big change.
Dr. Monty Pal (00:13:06):
Well, I, I think it's a brilliant decision. You've done amazing things for the campus and we've had periods of explosive, explosive growth since then, which I wanna highlight in just a moment. But, but tell me a little bit first about leadership, leadership style. You know, everybody comes to the position, um, at the helm of a cancer center or business or any institution with a certain philosophy. Tell us about yours.
Robert Stone (00:13:29):
Well, so you started the conversation, uh, early about basketball and about athletics. And, and for good teams, you play a role. I mean, that, that, that goal in, in athletics was winning. Our goal here is how do we help patients win? The competition is cancer. And so my, I started my leadership style and it stayed true as a true, um, north for me is it's not about one person. I, I had the benefits, the same benefit you've had in your time here. Um, we were, we, as I said, we were smaller and we had one campus. I got to watch Art Riggs. I got to watch Steve Foreman. Um, part of the story I left out, uh, uh, when I arrived is that one of the guys who had been CEO for 30 something years before me, a guy by the name of Ben Horowitz and a couple of other, uh, long time employees, Manny Feinman, Isadore Familian, they were still around.
(00:14:34):
They were in their 80s. But that group, from Art to Steve, to Ben, to Man - in their own ways, they taught me what it meant in this context to be humble, to demand excellence, and to put something bigger than yourself in the middle. And as we've grown, I've tried to live with those, by those principles throughout. I, I was taught a lesson very early on, uh, Monty. Um, I was new. It had to be in my first year or two. Uh, I was still in my 20s when I came. And I sat down f- first time, so probably the first year with Steve Foreman. And Steve Foreman, as I'm sure everybody knows, is the most incredible physician. If I have a family member who not just has cancer, has any disease, I'm asking Steve to.That's how, how fabulous he is. And I, but I did know him then.
(00:15:35):
And we sat down, so humble. He's undoubtedly, he's wearing a sweater then. I think it's probably the same sweater he's wearing now. Sure. And he said, "So I was here when we built the transplant program and here's what my research interests are and here's where the program stands.
(00:15:54):
What are you an expert in?" And, and I swallowed hard and it, and it really did was an early teaching of you need to have the right attitude to be a leader. You also have to demand excellence of yourself and of those around you, because if you're gonna get excellent people, they're gonna motivate themselves to do that.
Dr. Monty Pal (00:16:16):
Yeah, that makes perfect sense. And I've gotta ask you, and this builds on your experience with Steve. Y- you know, you've presided over this, uh, array of department chairs, all of whom are luminaries. Uh, what does it take to really sort of corral a bunch of these brilliant minds oftentimes with, you know, differing thoughts on, you know, what direction to take departments in or the institution in?
Robert Stone (00:16:36):
So a couple of things it takes. One, I actually believe now more firmly than I did 13, 14 years ago that not being a physician or a scientist is a real advantage because I walk in with a deep, deep appreciation for what, not just our chairs, our chiefs, our faculty, what they bring that I could never bring and that most can't. What you, what you do, Monty, you, you're an inspiration for me. What you do, um, I couldn't replicate, but what I can do is create an environment that allows you to even be more successful. You'd be successful no matter what you did. I can help create an organizational infrastructure that allows that talent to, to come out. So that's one, is a deep appreciation. Two, I learned a lesson, a leadership lesson very early. I don't think I was CEO. Yeah. In fact, I know I wasn't.
(00:17:41):
Uh, maybe I'd just been named. And we had a chair of the medical staff, um, a surgeon name of Fred Granis.
Dr. Monty Pal (00:17:51):
Oh, I remember Fred.
Robert Stone (00:17:52):
We, we've become actually pretty close, but at the time, Fred thought I had done some things wrong and Fred was not shy at telling people that I had not, I'd done some things wrong. And we sat down to talk and he paid me ultimately years later and I got it secondhand. He told a group that there were things he agreed that I did, there were things he disagreed, but that he always knew where I stood and that I was always honest with him. And I think that part of faculty members are brilliant. There's a challenge sometimes faculty members have, which is when you become so specialized in your work, you can become narrow and not see the whole, the whole field. Um, my job is to help you see the whole field as a leader and part of that is delivering messages that help. And part of that is delivering messages that you don't necessarily like, but having that dialogue around it.
Dr. Monty Pal (00:18:55):
Brilliant. And, and you know, I, I wanna assure our audience, this is not hyperbole. Every time, Robert, that I've ever passed you in the hallway, two questions come to mind, right? Ev- every time I've passed you, you've asked me, "Monty, are you happy?" And Monty, what can I do for you? And that means the world to me. I brag about this all the time as I go to visit colleagues at other cancer centers, many of them, you know, have never met their CEO. Uh, it, it's just wonderful to have this rapport and relationship that, that we do. And it seems to pervade much of our faculty. So thank you for that.
Robert Stone (00:19:25):
Thank, thank you, Monty. I think of it this way. Um, I had a nurse who was leading the joint commission survey some years ago when I was sitting down with and getting the, the, the results, which were very positive. And she said, "Just remember, oncology is a tough business and it's tough emotion. It's very rewarding, but it's tough." And I tell people, I've told you, I think this, um, you have to find what gives you energy, what up - not every day is gonna be smooth sailing. And in fact, character is formed on those days that aren't, and part of our sacred mission is actually for those, for those, um, days that aren't good and that people lose their battle. What, one of the things that gives me energy is knowing and helping our faculty. So if I was listing the, the handful of things that really, when I'm having a day that, you know, you wanna pull your hair out, things aren't going right, I get uplifted by coming and talking to you.
(00:20:30):
And, and the only thing you could have said that was more flattering, and so I'll give you the, the advice for next time - Sure.
(00:20:37):
Is how are you, are you happy? Um, what can I do for you? And how's Rena doing?
Dr. Monty Pal (00:20:45):
Oh, there you go.
Robert Stone (00:20:46):
Because there's an aspect of the fact that if your wife walked into the studio right now, I would know her and give her a hug. And if my wife walked into the studio right now, you would know her and give her a hug. It, it's not a job, it's a calling and it's about family. So that's very uplifting for me. Oh,
Dr. Monty Pal (00:21:07):
Indeed. Indeed. Y- you know, Robert, I wanna shift gears and talk a little bit about what's changed at City of M - I just don't even know where to start. You know, you've been here for 30 years, a decade and a half at the helm of the institution, um, and you've overseen so many changes. I think the perhaps most prominent change in many folks' minds is this massive expansion that we've had. Uh, and we can talk about this in the context of this new beautiful center we have in Irvine. I've had the good fortune of actually practicing there and I just absolutely love it. Uh, we have new sites in Chicago, Atlanta, and Phoenix, which I, I think are really led by some of the, the best experts in oncology in the country. Um, tell us about, you know, what sort of took us from, uh, the singular entity focused here in Duarte, California to this really sort of nationwide enterprise.
(00:21:54):
What was the philosophy and driving force behind that?
Robert Stone (00:21:57):
So I don't think I've told part of this story publicly. So you're, you're gonna get the first. Okay. All right. You've worn me down, Monty. Um, the context is I see right now in other health organizations' reaction to, um, the health environment, to consolidation, to all of the changes, almost with a strategy that, well, size is gonna overcome all, and there's growth for growth's sake. I fundamentally disagree with that. I think that if you're not well run and you don't have a mission purpose, getting bigger just exacerbates your problems, not makes it easier. So it wasn't the idea that we woke up one day and said, "Let's just grow and we'll have more voice if we're bigger." It's true. We have more voice, uh, when we go to advocate, uh, nationally than we did because we. But that wasn't the goal. Back, I, I said that in 2009 after President Obama had been inaugurated and I changed jobs, there were conversations in the quiet hall, some in this building, um, but in the boardroom, in senior leadership room that said, "Okay, we're seeing consolidation." It ca- came right around the time we had.
(00:23:18):
There's a large, well-respected medical group in Los Angeles that was sending us, number I remember was like 40 transplant patients a year, okay? Not insubstantial. And they went, one year they gave, sent 40, the next year they sent one. Hmm. And the only thing that changed is they were bought by another health system and all of their transplants went to the other health system, except the one was the spouse of the managing partner who made sure that his wife got the care that she needed. Interesting. And so we were having the dialogue of can a then niche player, just cancer, survive going forward in an environment where you're seeing consolidation and the payer landscape is changing? And we, we ultimately decided yes, um, we would, and that we would lean into that, um, cancer only focus because while I'm very proud of our diabetes work, it's really diabetes research.
(00:24:27):
We're not a primary care place for diabetes patients. Sure. Um, it really was about the cancer at the time. And if you fast forward from 09 to, you know, 2016, 2017, when the growth really started happening, by that time it became clear, because people were talking about access and access in, in the environment meant you have insurance. It didn't mean you have access to great care. Right. And we started with a model. We formed our medical foundation, which was our partnership with our physicians back in 2011, 2010, 2011. And we started growing in Southern California. And we did that for two reasons. We grew so that we believed if patients didn't have to travel to Duarte, um, they, they shouldn't have to, then get great care to home. And that we could create an infrastructure where care could be delivered in the community and still have the access to the experts and the subspecialists in what at the time was just Duarte.
(00:25:38):
And that led us to grow Southern California, which is now 31 sites. Um, it led us to go into Orange County, uh, and make a bet in Orange County, which was seen as risky at the time because there are a lot of institutions providing cancer in Orange County, but we though that focus could make us do, have an advantage in focusing and helping cancer patients. And then that led to the CTCA acquisition to, uh, forming a company called Access Hope, which was designed not for us to provide the care, but make sure our experts did. And, and it, it ultimately, you know this as well as I do, four out of every five cancer patients in this country don't have access to a comprehensive cancer center. Yep. They get their care elsewhere. And if all of the comprehensive cancer centers were, had the ability to remove all barriers to access, we couldn't collectively make a dent in that 80% statistic.
(00:26:40):
So we're gonna forget about those people. And as you see so much innovation happening in science, um, that gap gets wider because the care is more exciting. The care, the possibilities are more exciting. Um, you just have to figure out a way to make access available.
Dr. Monty Pal (00:27:00):
Indeed. Indeed. You know, I'll go back to a time when I was the only geomedical oncologist on our campus, but I never felt alone. This was more than a decade ago and our, our group has grown immensely since then. Never felt alone because I always had those partnerships with colleagues in Pasadena or colleagues in our upland site or colleagues out in Corona. And it meant so much to be able to, you know, really sort of have that, uh, a group related force associated with my program just by having all these wonderful colleagues spread out through Southern California. And, you know, it's great to have those guys out in Chicago and Atlanta and Phoenix to partner with as well.
Robert Stone (00:27:33):
Yeah. Well, think of it this way, M- Monty, and, and I wish I, I was quick enough to come up with an example other than you, because people are gonna think that I'm only agreed to come on or you had me on so that I could compliment you. I appreciate that. But it's, yeah, it's, it's really true. I, I was speaking recently on a, on a panel and I said something that I kinda wish I didn't say, and I'm gonna exacerbate it because I'm gonna say it again here. Let's hear it. Which is, I, I told a patient, I said, "If you have to choose, cancer patient has to choose between somebody who is excellent, expertise in your cancer, and somebody who's nice to you. If you had to choose, choose the expert." Okay? Yeah. Most patients understand and choose the nice person. Mm. And I absolutely believe what, what is.
(00:28:30):
Our model can be replicated pieces of it by others. We're actually pushing to have it replicated by others. But the piece that's hardest to replicate is at City of Hope, you don't have to choose between an expert in your cancer and somebody who's gonna treat you with respect and see you as a person and not see you as just a number. And you do that better than anybody.
Dr. Monty Pal (00:28:57):
So, so let's talk about the secret sauce, right? This, this unique mix that we have, because I fully agree with you. We've got, in my mind, you know, some of the top physicians in oncology by their CV, but also folks that you would just, you know, love to grab dinner with, you know, people that are just at their core, fundamentally nice people. And it is really the best mix, in my opinion, for our patients. You know, City of Hope grows and grows. I think we've been able to do it so far, but you tell me, what's been our, um, formula for this? How do we keep that secret sauce alive as we expand?
Robert Stone (00:29:28):
So there are a number of answers to that. Let me, let me take it a couple of paths. One, um, all of us who are working here today are incredibly fortunate to have come in and stand on the shoulders of giants. And I know that that's a saying that many places, but that history is true here and you live it every day. I, I go back, we have something that was put together right after World War II from one of our leaders, and it was called the, uh, it was a philosophy, right? The articles of, of faith, of what do we stand for? And it talks about each individual who comes into our care is an individual and deserves to be treated with kindness, love, and compassion. Think about how few organizations have codified that, much less can go back, you know, a hundred years for that.
(00:30:32):
And, and when you have the Art Riggs and the Steve Foremans and the others, they attract people who have those ethos. And so part of the secret sauce starts with what are the ethos of the people that come here? And, and it's almost like your, your, um, sports questions earlier. If you wanna have a championship sports team, look to how your star players operate. And if your star players operate like they're entitled, you're never gonna win. If they operate as if they are one of a broader team, you have a chance. That's, that's where it starts for me for City of Hope. Two, the fact that we're able to focus on cancer means we can approach a world renowned expert, Dr. Monty Pal, as an example, and say, "Monty, you don't have to worry about how our football team is doing this year or how much money we're gonna put into undergraduate education.
(00:31:37):
Um, you don't have to worry actually that as you're trying to provide great care and create the breakthroughs in the next generation of therapies that those happen siloed or separately. Too many cancer centers, the health system is separated from the, the medical school and separated from the research. Our secret sauce is to bring that together and to keep pushing. And there is a, there's a humility of people that work here. There is a hunger of people that work here. Um, they want to help people. I'll tell you a quick story. Um, a couple years ago, I think, I've never asked you this, um, and we can talk offline. I think the patient that I'm about to refer to was a patient of yours. Okay? And we, we, I know many of your patients and they love you. But, but somebody stopped me. I was going into my office.
(00:32:35):
It was relatively late. I was coming from a meeting at 7:00, 8:00 at night. And the woman stopped me and she asked me if I worked here. And I said," Yeah, I do. "And she said, uh," Do you, do you, are you in charge? "I said," Well, when I ask people to do things, sometimes it happens. "And she said," Well, a year ago, I came to City of Hope because I have pancreatic cancer. And I am here today. Two things have changed my life. One, you all came up with a cocktail that, um, I'm an N of one and it was innovative. It wasn't. The FDA approved it for compassion. And I'm here because you had that expertise. And second, my first moment here, I didn't know where to go. And a woman who had to be in her 20s walked me to where I needed to go.
(00:33:33):
And not only walked me, she gave me flowers. She happened to have flowers with her. She gave me flowers. And on the way home that night, I started crying because not only had I found a place that could give me hope for my cancer, I found a place that I wasn't gonna be alone. And h- hearing you have cancer, no matter how many people you're surrounded by often can l- lead you feeling alone. That ethos and the combination of it all being together, I think is our secret sauce at the end of the day.
Dr. Monty Pal (00:34:10):
Indeed. Indeed. And, and, and I've heard anecdotes like this for, you know, decades now at this point, and it's just so touching. And, you know, I, I really know that that's something that we're gonna retain through this expansion. But as long as we're divulging details of our secret sauce - Yeah. Uh, I wonder if you can give our audience some insight on something that I think really does sort of guide the, the path of our institution, and that's our strategic plan. Do you mind sharing some sort of top line elements of that?
Robert Stone (00:34:36):
Yeah. So I, I had reason to count it the other day and we're about to roll out what is the fifth multi-year strategic plan I've been involved with in my time here. And there are a couple of elements that, that you'll see, Monty. Um, one, you know how many organizations, much less cancer centers, but I'll, I'll talk about cancer centers, talk about our aspiration is to be the best. Our inspiration is to be number one. I mean, whatever it is, to me, the, the air of that, and it's not a lack of confidence on our part, but the air of that is it makes it about us, not about our patients. So the top line aspiration you will find in, in our strategic plan is we want to be the most trusted cancer center in the country. We wanna be trusted by our patients to provide the right care, to take care of them, to as, as Steve Foreman says, hold their hand and never let it go.
(00:35:43):
We wanna be trusted by families of patients who are, are entrusting us to care for the patient. We wanna be trusted, uh, partners in research. We wanna be those that are though of as moving the field forward. Our donors who are in this environment, in particular, research funding environment in particular, our donors are gonna make a huge difference pushing the field forward and allowing us to do things. So point number one is we wanna be the most trusted cancer center out there. We wanna make four or are making four commitments in, in so doing. Um, one, we will tackle the access problem that we've talked about. We've been on this journey for more than a decade. That journey will continue. And it's both creating a model that is even more seamless so that patients, you know, we, we're close to 200,000 patients a year, cancer patients in our system.
(00:36:42):
They should have access to the expertise that they deserve no matter where they fall in the system. I've, I've said many times, cancer patients I talk to, they want an expert in their cancer. They want access to a clinical trial that's relevant for them, and they wanna be treated with dignity. So that access both in our system, and then how do we take that expertise and continue to export it to other areas, to other cancer centers? How do we support others in remembering cancer's the competition, not each other? So that's a, a commitment that we make. Two, um, this commitment to how we actually treat the patient beyond the expertise, what's the experience that they're gonna have? Um, what's the supportive care element around them? How do we s - meet their psychosocial needs? How do we take care of them after they stop being a patient and go into survivorship and, and carry that?
(00:37:43):
There was a int - there was an interesting article last year in The Lancet. Now, this didn't frame my thinking, but it really, um, put a fine tooth comb on it that talked about we're in this age of wondrous innovation. We risk, especially with AI, we risk losing the human element. City of Hope is uniquely positioned to, to define cancer care, optimal cancer care as having that human element. Third, research is, has been and will be a bedrock for the organization. We're gonna lean in, and we've started this years ago, we're gonna lean in even further to translational research that at the end of the day, we have to have urgency and speed to, uh, to turn our research into something that benefits patients. And fourth, and this has surprised me a little bit, if I'm being honest, um, the country is listening to what we collectively have to say.
(00:38:48):
And I think it's because we've put cancer patients first. So in, in California, we, we helped, um, uh, lead to the passage of, lead a coalition to push the passage of a cancer center bill of rights, something called the Cancer Care Equity Act, which guarantees patients on Medi-Cal from some of the, um, most underserved communities would have access for complex cancers to the opinions that we have. We've done the same thing with the Bill of Rights in Illinois. We had the Microbiome Summit here on campus that we co-hosted with, uh, Dr. Batacharia in the, uh, director of NIH and HHS Secretary Kennedy came. There is a, an obligation on City of Hope that I believe, which is to put the patient in the, in the center and advocate for what policy decisions are being made, how they impact cancer patients. So all of those, uh, there's a lot more, it'll be supported by some of the f- fueled by some of the things that you won't be surprised at.
(00:39:55):
Technology, AI is gonna change all that we do. Indeed. Philanthropy is a huge advantage, and we're gonna lean in even further to our people and our culture and use that as, as an advantage for helping patients.
Dr. Monty Pal (00:40:08):
Well, I, I wonder if we can talk a little bit about AI and philanthropy, you know, those two elements that you just brought up. Maybe we begin with philanthropy. Kristen Patel runs a, a brilliant department there and, you know, I've had so many meaningful relationships with patients, as have so many of my colleagues who just really wanna find a way to give back for the exceptional care they've received. Tell us about philanthropy and its, its role in City of Hope.
Robert Stone (00:40:31):
We were founded in 1913 by philanthropists. Um, so philanthropy has been with us all along, 110 years. It's changed in recent years. And it's both grateful patients, um, and people who have not been patients, but who wanna make a difference. Ca- cancer in a country that is polarized right now in many things. Cancer is a unifier, Monty. Y- you speak all the time at, at events and at philanthropy events, I do as well. And occasionally I'll ask people, you know, sitting there with a thousand of your closest friends, you know, you'll ask them, raise your hand. Who here has either had cancer, had a loved one had cancer, a family member, a friend, a whole room, the hands go up. So people want to make a difference. So Bernie and Judy Briskin, over whom our clinical research center is named, the first gift that they gave us of multiple gifts was to set up a center for multiple myeloma.
(00:41:36):
And Bernie was a multiple myeloma patient. And I got to be very close to both of them. Bernie has, has passed, uh, recently. Judy is, is still going strong. And, and what Bernie said to me, we celebrated their gift and he pulled me aside and he said, look, we're giving you the gift for two reasons. One is in multiple myeloma, we, we've searched the country. There's nobody better. So he wasn't a patient of ours. Right. But he wanted the best. And he said too, my biggest worry as somebody who, who makes donations, who's been blessed with accumulating, um, funds that I now wanna use for the greater good is not that. I don't worry that things won't all work. I worry they'll be wasted and that time will be wasted. And at too many places, the infrastructure is set up because it's siloed, it's incremental, it's not set up for speed.
(00:42:43):
City of Hope is. And he said, you all, you're not, you don't run a business in the sense of you don't have shareholders. The mission is still central to what you do. It's, it's your true north, but you can apply, you do apply a discipline and business-like principles that say, how can we help this patient fastest? That's where I think philanthropy, you know, I think there's, there are a lot of people, a lot of wealthy people in this country who feel blessed and have raised dollars by their own two hands. They may get recognition to put their name up on a building, but we have to talk them into that. What most of them want is, are you going to make a difference and how are you going to? And so that's how philanthropy fits.
Dr. Monty Pal (00:43:36):
That's so true. And I have to tell you that the blessing of philanthropy, you know, in my own personal practice has been that whenever I have an idea that I wanna apply to kidney cancer, you know, I, I have that, that pool of funds to just make it happen right away. You know, no waiting years for that grant or perhaps the time for that idea to pass it. It just happens immediately. You know, and, and, you know, onto something else that really sort of increases that efficiency. And I mentioned I was gonna bring this up, AI. And, you know, it's impossible to have a conversation like this in the future of any institution without thinking about how AI might sort of pervade into our model or help our model. Um, tell us a little bit about your perspectives on AI and, and the future of AI with City of Hope.
Robert Stone (00:44:18):
So I believe AI is gonna change everything that we do. The question is simply how fast and what does that really mean? My intuition is it's moving pretty fast and I would've undersold how fast it's actually moving a, a, a year, a year ago. First and foremost, I think it will disrupt research more than anything else. It will disrupt how operations will, are run and how efficiently and quickly we can move through. It'll disrupt patient care and, um, uh, it'll disrupt the patient experience. And I think it's all positive. We've gotta act responsibly with it. And there, there's a tension, Monty. We're an organization that discovers things. We're innovative. How much are we going to discover ourselves? How many, uh, models are we gonna train? How is our data gonna be used to fuel our research and our insights? Versus how much are we gonna partner with others because together we can move faster?
(00:45:26):
And I think if you keep that two things in, in front and center, that true north of how do we benefit patients the best, number one. And number two, how do we train our people and get them comfortable with using AI in appropriate and safe ways? I, I've become convinced that AI will not replace doctors, will not. Doctors who use AI will replace doctors who don't.
Dr. Monty Pal (00:45:54):
I, I have to agree with you 110%. You know, I've, I've seen it pervade our practice in a number of ways. The, our AI department's already doing these amazing synthesis. It used to take me hours to pour through documents, uh, uh, CT scan reports, MRI scans from patients who are coming to see us for second, third opinions. Um, and now AI has enabled me to sort of get a very succinct summary in two minutes or less. I mean, it's just remarkable. And, and I can only imagine where that's gonna take us in the future in terms of improving efficiency, right?
Robert Stone (00:46:24):
I have to imagine if I was in your shoes, patient comes in, exam room closes, door closes, and they say, "Dr. Pal, I've been Googling my disease and here's what it says." Just walking them back from the misinformation and the errors that they're making has to be a, uh, uh, something that is front of mind for you. In the future, patients are gonna be better informed and they're gonna be more right. I, I had this conversation with a physician the other day, uh, not at City of Hope who said, "Ugh, yeah, but they're gonna be wrong in all the stuff they bring in." I think increasingly with the AI models, they're gonna be right more than wrong. They just won't know how that applies to them, how the information they're having fits into what's best for them. And you're gonna have the challenge of both, uh, deciding what's best for them, what best to advise them, and you're gonna need people skills to interact with patients who are gonna be better informed than ever.
(00:47:36):
And that's gonna be right in your sweet spot because patients that I know who, who, for whom you're their doctor, they love the interaction. They love the fact that they can talk to you and that you're not, you know, up on high telling them this is what you need to do. They're living that life and you're there to help them live it to its fullest. You're gonna succeed at places where doctors are just used to go do this and there's no empathy, there's, there's very little compassion patient, they're gonna really struggle.
Dr. Monty Pal (00:48:10):
Indeed. Indeed. I kinda agree with you there. O- one of the great treasures of my career has been the opportunity to really sort of shepherd a lot of our younger faculty, uh, develop their careers as scientists, as clinicians. Um, it's a challenging environment right now. You think about, you know, for instance, the, the, the element of grants and the level of competitiveness out there right now. I do feel like we offer a good breeding ground, however, for folks that are entering into the field of oncology. Tell us about your perspective on early career scientists and, and what we can do for them at City of Hope.
Robert Stone (00:48:42):
So Monty, I, um, I think early career scientists are a crucial part of our future. If, if you look back, I was having this conversation. You, you know, I'm sure, uh, Dan Vonhoff at each legend in, in the field. And we had a dinner and we were talking about this issue with about 10 people on it, uh, around the table. And Dan said to the group, he said, look, if you went back and in medicine, looked at the Nobel Prizes that have been awarded and looked at the age of when, of the scientists when the work was done, you would find it disproportionately leaning to the late 20s and early 30s that there's, there's a, when you wanna be disruptive, actually being creative and being willing to try new things is important. And so early, uh, career scientists are a focal point of our strategic plan and of our, uh, where we're gonna put some money to support, because it is a tough funding environment.
(00:49:49):
I get asked the question, what advice would you give them? Mm-hmm. A lot. And, and I, I give them several. One, it's gonna sound, um, trite, but find your passion. Don't. Uh, this, this is true whether you're an early career scientist, uh, an administrator, um, find your passion because that will get you through a lot of the hard times, one. Two, I'd urge them continually lean towards translation. I, I, I think AI, in many ways, I said earlier that it's going to disrupt research more than anything else. You're gonna be able to write grants, you're gonna be able to identify targets in hours and days in what used to take you weeks, months, and years. So the, the big change is, that's gonna change. The big advantage for early career people is figure out how that translates into really patient benefit, because what places like City of Hope are always gonna have is this is the place that that great science, that technology, and that care come together for, for, for patients.
(00:51:00):
So translation is one. And third, my, my, I mentioned earlier, my daughter is in medical school and, uh, she did come home, um, for breakfast, uh, between studies, I think to get her laundry done. And, um, we were talking about medical school education, and I gave her a piece of advice that I would give early career scientists that I don't think is, is as focused in the, um, medical curriculum, uh, as it could be. Don't follow the dollars, but understand how the dollars flow. Hmm. So, so, uh, think about. I'll give you a, a non-scientific, uh, uh, scientist example. A physician. I can't tell you the number of times I've heard from physicians over the years, if we could just get this managed care contract, boy, somebody could get in. Have an understand. You don't have to be an expert in that, but have an understanding of how do, how does insurance work?
(00:52:11):
How do patients actually have the ability to access you? What are the policy decisions that have to be made? How is research actually gonna be funded? How much. What do philanthropists want? Because one of the things I often hear from early stage scientists is, "If I could just get philanthropy, it would help smooth out the ups and downs on grant." Absolutely true. And we have the benefit of a wonderful scientific community. My, my, um, comment to them, "Do you understand what philanthropists want? Not just that your idea is very interesting. Does it meet what the needs are? How will the dollars actually flow?" And again, you don't chase the dollars. We have a, a pure mission than that, but you have to understand those principles or you're gonna be left not understanding why you're not getting, uh, donations, why your research isn't funded and, and why your lab is struggling.
Dr. Monty Pal (00:53:13):
Brilliant. Uh, you know, Robert, you've shared so much with me on this podcast. I'll share something with you. Uh, I grew up in Covino, which is about 15 minutes east of City of Hope. You grew up in Whittier, 15 minutes south, right? Um, and, you know, a- as a kid, I used to drive right past City of Hope to our favorite family restaurant in Arcadia, not far away. Never knew what City of Hope was until I hit my college years and started really getting interested in oncology. Um, so back then, you know, we always used to say City of Hope itself was just a well-kept secret, right? Uh, you know, since that time, we've had this massive expansion. I think we're out there. I think we're quite well known. How do we get word out there about this exciting work that we're doing? What's your perspective on how to broadcast what we're doing so that, so that more patients are, are getting that message and, and trying to access the care that we provide here?
Robert Stone (00:54:01):
So a couple of, couple of things. If you, um, put the cancer patient in the center again, it means two things. One, we need to continually increase awareness of City of Hope. So not somebody who has cancer, but people know about it. The example, great example is in, in Irvine. So Irvine, as the crow flies, our campus in Irvine is just under 35 miles away. When we, we agreed to go down there, you know, many patients, we were averaging like three, 4,000 patients a year from Orange County who would drive up to Duarte. And we did a marketing survey of how well is City of Hope's name known in the community, and would City of Hope be your first choice if you. And we were something like sixth, sixth or seventh on the list. I was shocked as it was. So in addition to growing the expertise and growing the, the infrastructure, we spent time getting the, the word out there.
(00:55:07):
It's being in the community. It's talking to people. It's talking to leaders, to patient advocacy groups. It's sharing what they can get here. Clinical trials. Everybody says they have a clinical trial and you open up the hood, they have one. We have, you know, 800. Um, it's getting that word out. And today, in Orange County, so five years later, not only are we number one, number two is half our score in Orange County. And it's part of not just thinking one path is gonna do it. It starts with the expertise of you and your colleagues. It starts with the compassionate care, but it's being in the community and figuring out what does that community need. That, that's how you start raising the awareness.
Dr. Monty Pal (00:55:49):
You know, you mentioned clinical trials, and I wanted to sort of round things out on that note because clinical trials are just. I mean, they're such a big part of my practice and a big part of, if I may say, my philosophy, right, around oncology care. Um, tell me your vision for clinical trials at City of Hope. Uh, what really makes us different in that regard?
Robert Stone (00:56:08):
Yeah. So, um, clinical trials have always been important. I think it's even more important now because innovation's coming so fast. The standard of care lags so long that in many respects, the best care is not the standard of care. It can be delivered through a clinical trial, and increasingly, clinical trials are, um, having smaller and smaller populations they apply to. They're more and more targeted. And it's funny when I, um, suggested to our board of directors at the penultimate meeting that we agree to buy Cancer Treatment Centers of America, which has led to hospitals in Phoenix, Chicago, and Atlanta, the number one reason for doing it that I gave was to create a clinical trial network that allowed trials to be available in those very distinct and spread out populations. I mean, if you think of those three populations for CTCA, Los Angeles, and Irvine, 86 million people in the country live within driving distance of those.
(00:57:16):
They should have access to a centralized, coordinated clinical trial network, and that's what we've spent our time building, and it's very unusual. And it's both partners, you know, so industry sponsored trials and investigator initiated trials that are unique to us. And we talked a few minutes ago about AI. Think about trial matching and the, the challenge that you've had over time of figuring out what trials are there and what trials are available for your patient with your patient's conditions, spec- speci- specific conditions. Um, that's where AI can help us do it. And if you couple on top of that, a belief that our job is to get a patient the best, when appropriate, the best clinical trial, whether it's our clinical trial or somebody else's, we can impact lives at, at an even greater, uh, amount.
Dr. Monty Pal (00:58:11):
Well said. I mean, it's, it's such a simple formula, but such an important one in the sense that, you know, when I think about what I can do as an investigator now, say I plan a trial to evaluate new drug X with 100 patients, it might have taken me three to four years to do that here at City of Hope Duarte. Now with my colleagues, Alan Bryce and Phoenix, you know, Walt Stadler in Chicago, Kristen Higgins in Atlanta, I can do the study in half the time, you know, a third of the time. I mean, it's just incredible power, I would say.
Robert Stone (00:58:39):
Yeah. Well, think about it, Monty. You, um. It ha. It, it's an example of what I think is research as a whole at City of Hope. You shouldn't be doing research just for the sake of doing research. Mm-hmm. What's the impact? Whether that impact is new knowledge, whether it's getting the new knowledge out or, or a product that's gonna help people. And for clinical trials, it's hard enough to come up with what's the right clinical trial, put all the regulatory safeguards around it. But you then wanna accrue as quickly as you reasonably can and safely can so that you get the learnings from it as quickly as you can. And that network of now 200,000 people almost gives us a better chance of accelerating the learning that we have.
Dr. Monty Pal (00:59:26):
Absolutely. Absolutely. Robert, this has just been a brilliant conversation. We always round out the podcast with one question, and it lends itself to our title, On the Edge of Breakthrough. We've asked every single guest this and we get brilliant different answers each time. What does On the Edge of Breakthrough mean to you?
Robert Stone (00:59:43):
Uh, so I, I, I guess the, the, um, question was coming because I'd seen your other podcasts. Okay. Okay. Fair enough. Lord knows I'm way down on the list of people you wanted to talk to, so I've had a lot - Absolutely. I've had a huge library to, to work through. Um, I'd answer it two ways, Monty, because three ways. One way is just think back of everything we've been talking about for the last hour, because it goes to being on the edge of breakthrough, one. Two, it's a moment in time. I mean, I, I find I, I, um, was asked very early in my career of what legacy do you wanna leave? Legacy, I'm, I'm, I'm A, young, and two, um, and it isn't about me, it's about the people we can help. I'm, I'm now, it's still about the people we can help. I'm not as young as I once, as I once was, but I'm more appreciative of the moments in time.
(01:00:38):
And if you think about the convergence of what City of Hope can offer with the talent that we have, bringing the science together with the patient care at a scale in which we're no longer the best kept secret in the San Gabriel Valley, we are nationally known. Um, and I don't mean we've, we've been nationally known for decades in the oncology space. I'm talking about everybody. People know City of Hope. So there's a specialness of that edge of breakthrough being at a moment in time. And the third thing is I think of it, I think of it as a wave of catching the top of the wave and, and, you know, as a surfer on the top of a wave, the wave's curling and about to slam down and then ride out. We're not getting crushed by the wave. Cancer is getting crushed by the wave.
(01:01:33):
We're at that precipice of it's about to break and we're about to be able to take our innovative discoveries, apply them to more people, be able to predict where people are most at risk, be able to find screening early, develop new therapies that are tailor-made and follow more and more people to, through survival. That's what being on the edge of breakthrough means to me.
Dr. Monty Pal (01:01:59):
Brilliant. Brilliant. Robert, I, I have to say thank you and congratulations for just leading us through this massive, massive growth over the past several decades. I mean, it, it's really been a pleasure to work with you, to work for you. And, and I have to tell you, I hope I get to work with you at City of Hope for decades to come.
Robert Stone (01:02:16):
For decades, Mazi. It's a deal. Thank you for having me. Appreciate it.
Dr. Monty Pal (01:02:21):
Thanks for tuning in to On the Edge of Breakthrough. See you next time for more insights from the front lines of cancer research and care.