National Center for Tumor Diseases Heidelberg

National Center for Tumor Diseases Heidelberg

National Center for Tumor Diseases Heidelberg

Contents 4 An Ideal Environment for Clinical Medicine and Research A home for the NCT NCT Board of Directors 6 Words of Welcome Dr. Philipp Rösler Federal Minister of Health Prof. Annette Schavan Federal Minister of Education and Research Stefan Mappus Premier of Baden-Württemberg Hans-Peter Krämer Chairman of German Cancer Aid Prof. Otmar D. Wiestler Chairman of the DKFZ Prof. J. Rüdiger Siewert Chief Medical Director of Heidelberg University Hospital Prof. Hendrik Dienemann, Prof. Michael Thomas Thoraxklinik at Heidelberg University Hospital 14 18 22 26 30 36 42 44 54 56 The Centers of Excellence Concept Optimal treatment for every cancer patient Optimal Structures Focus on the patient Joining Forces How Heidelberg University Hospital and the NCT collaborate From Bench to Bedside Translational research at the NCT The Six Program Areas Clinical research Shared Resources/Core Facilities Where research and clinical practice overlap The New Building Visions and history On the Architecture A vision takes shape Art at the NCT Sculpture of Mildred Scheel The Partners Introduce Themselves German Cancer Research Center, Heidelberg University Hospital, Thoraxklinik, German Cancer Aid 3

An Ideal Environment for Clinical Medicine and Research A HOME FOR THE NCT Christof von Kalle Drilling, hammering, the pervasive smell of glue, and dust everywhere that was the NCT in the days when it was still a construction site and the flights of stairs ascending diagonally across the triangular atrium were still without railings. Yet the vision, the excitement, and the aspirations embodied in the building were slowly but surely becoming visible. Science has drastically altered the world we live in over the past few centuries. Not just chemistry, biology, and mathematics, but philosophy and the other humanities have changed almost beyond recognition. Their findings are applied in the real world we now inhabit. The introduction of scientific methods to medicine, in particular, has brought breathtaking progress of existential significance to each and every one of us. Soon we will be able to say the same about cancer, too or so we hope. The work which began in the experimental research laboratories of the surgeon Vincenz Czerny in the early days of the last century, and which more than forty years ago entered a new phase with the opening of the German Cancer Research Center (DKFZ), is now being continued at the National Center for Tumor Diseases (NCT), as always with a firm focus on the patient. Cancer research is thus advancing from bench to bedside. Here at the NCT, physicians, biologists, and other scientists work together both with and for patients in the here and now, tending to their daily needs, while at the same time pursuing projects for the future. Their shared objective is to enable patients to benefit from the extraordinary advances now being made in our understanding of the genetic and cellular causes of cancer and to translate these into clinical applications as rapidly as possible. Their overriding mission is to treat cancer more effectively. That goal often lies far in the future. But the people who work here are both optimists and realists at the same time. Some have already achieved great things, while others have exciting discoveries still ahead of them. The new building will inspire us all to forge ahead by working together even more effectively. The roof of the atrium of the new NCT points skyward like a precious stone. Seeing the light radiating from it, visitors become aware of all the many different people whose paths intersect as they pass each other on the stairs. It is here that the underlying concept of the NCT the idea that the best way to combat cancer is to join forces and work together for the good of the patient becomes a visible, almost palpable reality. 4

THE BOARD OF DIRECTORS OF THE NCT HEIDELBERG PROF. DR. CHRISTOF VON KALLE (CHAIR) PROF. DR. DIRK JÄGER PROF. DR. CORNELIA ULRICH PROF. DR. DR. JÜRGEN DEBUS PROF. DR. PETER KRAMMER PROF. DR. WOLFGANG WICK 5

Words of Welcome DR. PHILIPP RÖSLER Federal Minister of Health People who are diagnosed with cancer often report feelings of great anxiety coupled with a sense of helplessness. Comprehensive cancer care therefore has a positive impact not only on their life expectancy, but also on their quality of life. As one of eleven oncological centers of excellence in Germany, the National Center for Tumor Diseases (NCT) Heidelberg helps to ensure a consistently high level of care for cancer patients in the region. Close cooperation between researchers and specialist clinicians under one roof allows the findings of cancer research to inform the treatment of cancer sufferers as quickly as possible. This prompt implementation of new standards in the diagnosis and treatment of cancer thus takes us a good deal closer to our goal of continuing to provide tumor patients with topquality care. German healthcare policy is committed to people s wellbeing and has long attached great importance to the ongoing fight against cancer. In 2008, the Federal Ministry of Health, German Cancer Aid, the German Cancer Society, and the Working Group of German Tumor Centers (ADT) teamed up to draft a National Cancer Plan. The aim was to ensure that what the NCT exemplifies at the level of clinical care in other words close collaboration between all the individuals and institutions responsible for delivering cancer care is practiced throughout the system. I am therefore delighted to have this opportunity to inaugurate the new premises of this modern cancer center and wish all NCT staff every success in their important work, as well as the satisfaction of a job well done. I personally am convinced that here in this new building, they will continue to make an indispensable contribution to cancer care that is focused firmly on the patient s wellbeing. 6

PROF. DR. ANNETTE SCHAVAN Member of the German Parliament Federal Minister of Education and Research Man s best medicine is man, says an old Nigerian proverb. And how true that is! For in many cases, a few kind words are all that is needed to make us feel better. Yet if we are to stay healthy, or to have our health restored, we still need a thriving and intact healthcare infrastructure, which is why I am so pleased that the National Center for Tumor Diseases (NCT) Heidelberg is moving into such attractive new premises. Our life expectancy has risen significantly over the past few decades: in the space of just a century, we have gained almost thirty years of life on average. This is thanks not least to medical research. Research finds out where the main health risks are. Research develops new prophylactic methods to prevent us becoming sick in the first place. Research enhances our quality of life by constantly finding new ways of combating disease. Common diseases in particular, of which cancer is but one, are becoming a major social and economic challenge that must be addressed in our research policy as well. This means that in future years, greater emphasis will have to be placed on translational research. As scientists find out more, so their responsibility to translate their findings into effective new therapies grows. The NCT is a wonderful example of how translational research does best when researchers and clinicians work together under one roof. Here, patients can take part in clinical trials and can benefit from innovative therapies informed by the latest research findings. This is the only Comprehensive Cancer Center of its kind in Germany. Heidelberg is thus a shining example for our other hospitals and a beacon for us all! The experience of recent years has taught us that research teams both inside and outside universities are especially instrumental in driving medical research forward. Here in Heidelberg, we have two outstanding institutions, the German Cancer Research Center and Heidelberg University Hospital, working hand in hand to combine clinical care and research. And now they have pooled their resources in the National Center for Tumor Diseases Heidelberg joining forces for the benefit of the patient. 7

Words of Welcome STEFAN MAPPUS Premier of Baden-Württemberg Cancer is the second most common cause of death after cardiovascular disease. Over 24,000 people in Baden-Württemberg died of cancer in 2009. Demographic change and the aging of the population mean that we are going to see an increase in the incidence of cancer in the coming years. Thanks to the great progress made in the early detection, diagnosis, and treatment of cancer, however, both survival rates and the quality of life for people with cancer have improved enormously over the past decades. Combating cancer will nevertheless remain a key health policy objective in the future. With a total of five tumor centers and twelve oncology units, Baden-Württemberg has an effective and readily accessible cancer care system in place. The tumor centers, one of which is the National Center for Tumor Diseases (NCT) Heidelberg, provide an important link between science and research on the one hand and clinical practice on the other. They are the cornerstones of the structures our state has built up to diagnose and treat people with cancer. They ensure that everyone affected by cancer is offered integrative and interdisciplinary treatment and care of the very highest standard. The NCT Heidelberg is a leading competence center for all of Germany. Thanks to close cooperation between all the fields of specialization involved in cancer care and between inpatient and outpatient care, the NCT can provide cancer sufferers with tailor-made treatment plans in accordance with the most recent research findings. The aim of the translational cancer research done at the NCT is to get the latest advances from bench to bedside as fast as possible so that cancer patients can have a share in the progress that is being made all the time. Leading cancer research institutes and cancer care facilities of international standing work together at the NCT, among them the German Cancer Research Center (DKFZ), Heidelberg University Hospital, the Medical Faculty of the University of Heidelberg, and German Cancer Aid. I would like to thank German Cancer Aid in particular for having so generously supported the realization of the NCT and for its upfront financing of the new premises. In closing, it remains for me to wish the NCT s directors and staff all the very best for the future as well as the strength they need to continue doing their important and valuable work with patients and their families. 8

HANS-PETER KRÄMER Chairman of Deutsche Krebshilfe e.v. (German Cancer Aid) Every year 450,000 people in Germany are diagnosed with cancer, and the number is rising steadily. This is because people are getting older and the incidence of cancer increases with age. It follows that cancer is one of the great challenges of our time. To win the battle against cancer, we have to find new ways of improving the chances of a cure for those who already have the disease. This means making it standard practice for cancer patients to be referred to primary care oncologists and cancer centers, improving interdisciplinary cooperation, aligning clinical practice with best practice guidelines, investing in cancer research, and focusing much more heavily on prevention. These are all core objectives of German Cancer Aid. Collaborating closely with the German Cancer Society, German Cancer Aid has initiated a shift in focus in cancer medicine in Germany and has introduced a three-stage concept for the formation of cancer centers. This will be described in greater detail elsewhere in this brochure. Yet it is not just the care of cancer patients that has to be improved; more must be done to advance cancer research in Germany as well. This is vital if the steady improvements in patient care are to be maintained. German Cancer Aid is especially anxious to see those doing basic research collaborating more intensively with clinical researchers and physicians. Only in this way can cancer patients benefit right away from the latest scientific findings. Under the auspices of the National Center for Tumor Diseases, whose new premises were built with funding from German Cancer Aid, Heidelberg is a model for both cancer centers elsewhere and for close cooperation between researchers and clinicians. I would like to wish all those who work here at the NCT every success in their work, and to wish the cancer patients in their care a speedy recovery and all the very best. 9

Words of Welcome PROF. DR. OTMAR D. WIESTLER Chairman and Scientific Director of the DKFZ Cancer research has now entered an exceptionally exciting phase. Thanks to the findings of basic research, we now understand exactly how a healthy cell becomes cancerous and which risk factors have a key role to play in this process. Scientists at the German Cancer Research Center (DKFZ) have made a number of important contributions to the translation of these research findings into cancer medicine. What counts now is to ensure that knowledge is transferred from bench to bedside faster and more efficiently in the interests of better diagnostics, more effective therapies, and not least more efficient cancer prevention. The National Center for Tumor Diseases provides an excellent platform for the DKFZ to do just this. Here, scientists work side by side with patients and physicians so that new therapeutic concepts can be put into practice as rapidly as possible, and so that questions and problems that arise on the clinical side can be put to scientists without delay. We do our best to enable every patient to participate in a clinical trial and so to gain access to the best treatments available. The Comprehensive Cancer Center (CCC) concept, which originated in America and is premised on close collaboration between clinicians and researchers under one roof, is the first of its kind in Germany and was implemented here in Heidelberg as a joint project by the DKFZ together with Heidelberg University Hospital, Heidelberg Medical Faculty, and the Thoraxklinik at Heidelberg University Hospital. The possibility of such intense interaction between a major research center and a renowned university hospital is what made Heidelberg such an ideal location for the NCT. Thanks to the support of German Cancer Aid, moreover, the NCT has been able to build fantastic new premises. We are therefore sincerely grateful to German Cancer Aid for its ongoing support and partnership. The NCT has set an example for others to follow. The founding of the German Consortium for Translational Cancer Research marks a further intensification of our collaboration with partners at Germany s university hospitals. What this means in practice is that the NCT concept is to be adopted at six different locations across Germany so that there, too, bench and bedside can be brought together under one roof for the benefit of the patient! I wish the NCT every success for the future. 10

PROF. DR. J. RÜDIGER SIEWERT Chief Medical Director of Heidelberg University Hospital The opening of the National Center for Tumor Diseases in Heidelberg in November 2010 marked another milestone in the more than 600-year history of Heidelberg s Medical Faculty. With the support of German Cancer Aid, Heidelberg University Hospital and the German Cancer Research Center have created an internationally competitive Comprehensive Cancer Center. The aim is to offer patients interdisciplinary cancer care at the very highest level and by providing a new home for translational cancer research to create the necessary conditions for the introduction of innovative cancer therapies. The treatment of cancer patients and research into their disease have always been a core concern in Heidelberg. The surgeon Vincenz Czerny saw the sense in having doctors in all fields of oncology work side by side with researchers under one roof 100 years ago. Czerny therefore founded the first interdisciplinary cancer center in the House of the Samaritans, and in doing so created a facility which began practicing NCT philosophy more than a century before the fact. Czerny s center can therefore be regarded as a legitimate precursor of the NCT. But what makes the National Center for Tumor Diseases so special? Why is it quite rightly regarded as the mother of all Germany s oncological centers of excellence? The foundation on which the NCT rests is the top-flight research done at the DKFZ, which is the basis both for the development of new therapies and for Heidelberg University Hospital s international reputation for excellence in all areas of oncology from surgery to radiotherapy. Effective collaboration is hard work for everyone involved. It means departing from the familiar approach of organ-specific, monodisciplinary cancer care and adopting a genuinely interdisciplinary approach. This in turn requires the physical existence of one roof, meaning premises in which this kind of collaboration can take place in other words the NCT. One manifestation of how such collaboration works in practice is the existence of numerous tumor boards which discuss each case individually and draw up treatment plans tailored to the needs of each individual patient. The outpatient clinics of the new NCT building, moreover, bring together all the hospital s chemotherapy programs under the supervision of experienced oncologists. German Cancer Aid deserves both thanks and praise for having erected a building which is architecturally appealing to patients and NCT staff alike, and which, while underscoring the innovative character of the NCT, also takes account of the anxieties and need for reassurance on the part of those who come here in search of help and treatment. 11

Words of Welcome PROF. DR. MICHAEL THOMAS Thoraxklinik at Heidelberg University Hospital PROF. DR. HENDRIK DIENEMANN The opening of the new NCT building marks the dawn of a new era. Six years after it was first founded, the NCT Heidelberg at last has premises that are fit for purpose, the purpose being its combination of basic and translational cancer research with patient care. The Thoraxklinik at Heidelberg University Hospital is a partner of the NCT specializing in tumor diseases of the thoracic cavity. Besides providing interdisciplinary expertise, the Thoraxklinik also holds consulting hours for tumor diseases of the thoracic organs inside the new NCT building. Here, patients can seek advice or a second opinion on their condition. As an NCT clinic, the Thoraxklinik also holds daily interdisciplinary tumor boards for tumor diseases of the thorax and discusses some 1,500 2,000 treatment plans every year. Close cooperation between all partners at the NCT makes for rapid decision-making and prompt action, which is a gain for everyone of course, but most of all for the patients. Thanks to its size and the expertise concentrated there, the NCT enjoys widespread recognition and is able to offer a broad range of therapy options including participation in clinical trials all of which finds expression in the architecture of the new NCT building. 12

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The Centers of Excellence Concept OPTIMAL TREATMENT FOR EVERY CANCER PATIENT GERMAN CANCER AID ESTABLISHES ONCOLOGICAL CENTERS OF EXCELLENCE Progress in the prevention, early detection, diagnosis, and treatment of cancer has vastly improved the survival chances and quality of life of cancer patients in Germany in recent years. Yet treatment quality still varies greatly from place to place. When German Cancer Aid launched its Oncological Centers of Excellence program as a funding priority in 2006, its aim was therefore to improve the quality of medical care for all cancer patients and to ensure that all patients had access to state-of-the-art diagnostics and therapy. Adopting the American model of the Comprehensive Cancer Center (CCC), German Cancer Aid now provides funding for eleven centers of excellence at university hospitals in Berlin, Dresden, Erlangen, Essen, Frankfurt, Freiburg, Hamburg, Cologne/Bonn, Tübingen, and Ulm, and for the National Center for Tumor Diseases (NCT) in Heidelberg. The centers were each allocated three million euros for an initial three-year period to enable them to develop and optimize their structures. German Cancer Aid clearly defines what an oncological center of excellence should offer: it must be a first port of call for cancer patients and it must also provide tumor board conferences, consulting hours for cancer patients, interdisciplinary therapy at the highest level in accordance with the principles of evidence-based medicine, and a modern quality assurance system. Centers are also expected to constantly upgrade the therapy they provide, to bring treatment plans into line with current standards, and to draft trial concepts. Networking is a similarly crucial component, as is close cooperation with local hospitals and physicians in private practice. The availability of palliative care and care structures, psychological support for cancer patients, collaboration with patient self-help organizations, and cooperation with clinical cancer registries are also key criteria that must be fulfilled to qualify for funding. Researchers and physicians at the centers are expected to work in tandem to intensify translational research. The aim, after all, is not just to improve patient care, but also to advance cancer research in Germany. As significant as the breakthroughs of recent years have been, there is still a lot to be learned about how cancer can be combated. Researchers have yet to form a complete picture of what causes tumors and how they develop, and only by keeping the path from bench to bedside as short as possible can cancer patients benefit right away from what they discover. Translational research is thus an important part of the work of all oncological centers of excellence. 14

German Cancer Aid plays an active role in the work of the centers it funds. Its Network of Oncological Centers of Excellence Funded by German Cancer Aid facilitates the sharing of ideas and close collaboration between the ten centers of excellence and the NCT. The centers are evaluated regularly by international experts, and they are required to demonstrate why they should qualify for further funding. German Cancer Aid also plans to give centers that are not yet part of the program regular opportunities to apply for funding. The aim is to ensure that the centers of excellence do not flag in their efforts and that the care processes and structures already initiated are constantly upgraded. German Cancer Aid plans to support up to thirteen oncological centers of excellence in the mediumterm future. German Cancer Aid s Oncological Centers of Excellence program is part of a larger, three-stage program launched together with the German Cancer Society with the aim of resetting the compass of Germany s oncological care processes and structures. This was rendered necessary after experts in the year 2000 complained that very few of Germany s tumor centers met current oncological standards. Responding to this, German Cancer Aid teamed up with the German Cancer Society and the Working Group of German Tumor Centers (ADT) to carry out a joint evaluation of the work being done at the centers. Their findings revealed major discrepancies, for although all the centers espoused similar goals, how these goals were realized in practice varied enormously from one center to another. Uneven care standards and lack of interdisciplinary cooperation between the various parties involved in cancer patient care were among the points criticized. German Cancer Aid therefore set itself the task of remedying these shortcomings as quickly as possible by changing the way the centers worked. It was this that led to the launch of the Oncological Centers of Excellence program in Germany. The project to establish a National Center for Tumor Diseases, motivated by much the same philosophy, got off the ground in Heidelberg at around the same time. The funding applications submitted by the various cancer institutions were assessed by a committee of international experts. German Cancer Aid hopes that these oncological centers of excellence will bring about a steady improvement in both the content and structure of cancer patient care in Germany. The improvements made by the oncological centers of excellence are expected to have a knock-on effect and to contribute to the provision of comprehensive, quality-assured care for cancer patients throughout Germany. To achieve this, all the advances made, and all the standards agreed for the various aspects of cancer care, research, early detection, and prevention are to be made available to all Germany s oncological centers. Steps will be taken to ensure that when cancer patients leave hospital, they continue to have unrestricted access to information and support, and to enjoy the same high standard of care as an outpatient that they enjoyed while in hospital. The new standards are to be implemented for the benefit of patients in the second tier as well, meaning for patients in clinical oncology centers. One of the main differences between these centers and the centers of excellence attached to teaching hospitals is that here, research is not a primary focus. The third tier in the three-stage concept is that of the organ cancer centers. The ultimate aim of these structures is to provide cancer patients in Germany with a comprehensive cancer care system of a uniformly high standard. Thanks to the National Cancer Plan launched jointly by the Federal Ministry of Health (BMG), the German Cancer Society, German Cancer Aid, and the Working Group of German Tumor Centers (ADT), the outlook for translating this three-stage concept into health policy is good, as the plan provides both a basis and a platform for consolidating all activities in the field of cancer medicine for the benefit of patients. 15

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Optimal Structures FOCUS ON THE PATIENT CASE STUDY: THE PATH OF A CANCER PATIENT AT THE NCT Frau Berger (not her real name) has been diagnosed with breast cancer and therefore contacts the outpatient department of the National Center for Tumor Diseases (NCT) Heidelberg. With a referral from her own physician, she is immediately given an appointment for one of the next interdisciplinary consulting hours. There is a breast cancer consulting hour every day. Interdisciplinary outpatient clinic Consulting hours for all kinds of cancer are held on a daily basis at the interdisciplinary outpatient clinic. Either the referring physician or the patient him- or herself makes an appointment via NCT Patient Reception. Patients are asked to bring all important test results and treatment records with them to this appointment. Once the patient has been thoroughly examined and the test results evaluated, a treatment plan is drawn up on the basis of input from all the relevant specialists. The NCT s own diagnosis and therapy guidelines ensure that the decisions taken are the best decisions possible for every patient according to the latest research. Frau Berger has heard about a new drug whose efficacy is currently being tested at the NCT. Her physician has already been in touch with the NCT to inquire whether this innovative new treatment might be suitable for Frau Berger. She has also sent in all the relevant records, lab reports, and test results, which the NCT has entered in an electronic patient record that can be called up on the computer in every consulting room. Today, Frau Berger will meet her doctor, who will welcome her at Patient Reception and escort her to the consulting room. The doctor is a breast cancer specialist, and since he has already looked at her record, he can begin by asking specific questions. All the oncologists at the NCT have attended the NCT s communication training program KoMPASS; they are therefore well equipped to address the questions, needs, and fears of cancer patients. Frau Berger s doctor takes account of these while talking to her and takes the time to answer her questions properly. The KoMPASS communication training program KoMPASS is a communication training program for doctors which is offered in Heidelberg and at six other oncological centers in Germany. The aim of the program is to sensitize doctors to the special psychological and social needs of cancer patients. By providing funding for this program, German Cancer Aid hopes to find out how communications between patients and doctors and hence doctor-patient relationships might be improved. Frau Berger describes the history of her disease as well as her current complaints and fears, and asks questions about the course that both the disease and its treatment are likely to take. She inquires specifically about a new drug which her physician at home has told her about. Frau Berger learns that all fundamental medical decisions at the NCT are taken only after consultation with the specialists responsible for each case. 18

A tumor board conferring An interdisciplinary board of experts drawing up a treatment plan Like Frau Berger, many patients who come to the NCT already have an exact diagnosis and are looking either for specific help, or at least for confirmation that the treatment they are receiving is the best treatment for them. Treatment recommendations are based on the NCT s own guidelines, which comply with international standards. These Standard Operating Procedures (SOPs) for every kind of cancer are developed by a committee of experts made up of specialist physicians in various disciplines. The SOPs are continuously upgraded in line with the latest research to ensure that patients get to benefit from the latest advances in oncology as soon as possible. If a particular case of cancer cannot be treated according to these standards, the treatment plan is discussed by a tumor board. Frau Berger s doctor also plans to discuss her treatment with a multidisciplinary board of experts. Tumor board A tumor board is an interdisciplinary board of experts. What it entails in practice is experienced physicians from all the fields of relevance to the treatment of a particular case getting together to evaluate the test results and images. After discussing these in depth, the board makes a treatment recommendation unless of course further diagnostic measures are required. The recommendation is then discussed with the patient. 19

Optimal Structures Frau Berger s treatment plan, for example, is worked out by a breast cancer tumor board made up of gynecologists, internal oncologists, radiation therapists, radiologists, and pathologists. To facilitate information-sharing, the physician who originally referred Frau Berger to the NCT is also invited to attend. The doctor who examined Frau Berger at the initial consultation presents her case history to the board. The test results, X-rays, and results of other examinations prepared by the case manager prior to the meeting are projected onto the wall using the latest presentation techniques. The doctors then discuss whether Frau Berger, who has a pre-existing condition, is a suitable subject for the clinical trial that her referring physician told her about. After discussing the case thoroughly, they recommend that Frau Berger undergo treatment as part of the trial. While the tumor board is conferring, Frau Berger goes to the NCT cafeteria to have a coffee with her husband. Patient Reception has given her a pager to notify her when it is time to return to the consulting room. While his wife was being examined that morning, Herr Berger attended a consulting hour of the Cancer Information Service (KID) to ask about the contradictory information on breast cancer that he had found on the internet, which had made him feel insecure. The KID adviser he spoke to was able to reassure him with reliable facts and information confirmed by studies. Cancer Information Service (KID) The Cancer Information Service (KID) provided by the German Cancer Research Center offers free information and advice about cancer for anyone who requires it. Highly competent staff answer all kinds of questions about cancer asked mainly by patients and their families. The KID can be contacted by telephone (0800-420 3040, lines are open daily between 8 am and 8 pm), e- mail, or internet (www.krebsinformationsdienst.de). The KID has its own consulting hour at the NCT. Frau Berger filled out an electronic questionnaire that morning. This questionnaire, which includes questions about the patient s emotional state, allows psycho-oncologists to help patients come to terms with their disease. If requested, the NCT also offers short-term psychotherapy to help patients cope with acute crises. NCT staff can also tell patients about the therapy options on offer near to where they live. The questionnaire that Frau Berger answered also includes questions about pain, exercise, her social environment, and diet. Experience has shown that these are particularly important issues for cancer patients, and the NCT therefore has support services for all three. The completed questionnaire enables the staff of the various advisory centers to ascertain immediately how they can best help Frau Berger in each area. Advisory services Alongside the KID, advice and support from the psychooncology service, from the social support service, and from dieticians are all part of the extensive support services provided by the NCT for patients and their families. There is also an NCT sports program and a genetic advisory service. The social support service advises patients and their families on all social issues, including the benefits to which they are entitled, and so helps patients to come to terms with their sickness and avoid social hardship. The service could help Frau Berger to apply for a severely disabled person s pass, to organize medical rehabilitation, or to deal with the authorities, sick funds, and pension funds, for example. As an NCT patient, Frau Berger would also be able to participate in the Sports and Cancer program provided in tandem with cancer treatment. Becoming physically fitter helps patients to counteract the effects of the wasting process known as tumor cachexia, and to cope better with the danger of anemia and fatigue. Supervised by qualified physiotherapists and sports teachers, Frau Berger will be able to retain her agility and improve her overall emotional stability and wellbeing. 20

Following the tumor board meeting, Frau Berger receives a message from Patient Reception. This time she takes her husband along with her to the meeting, at which her doctor and the senior physician responsible for her case tell her that she may participate in the trial to test the efficacy of the new drug. The two physicians then explain her treatment plan to her. Patients participating in the trial must follow a precisely defined procedure. During her time at the NCT, Frau Berger s health will be closely monitored. Her general state of health, weight, nutritional status, and her blood counts will all be checked regularly. Frau Berger discusses the situation with the physicians and her husband, and after receiving satisfactory answers to all her questions agrees to participate in the trial. As stipulated by the trial protocol she is informed in detail about how the trial will be conducted, her rights as a patient, the chances and the possible risks. Clinical trials Before a trial can be conducted at the NCT, it first has to be approved by the relevant authorities and an ethics commission. All the trials conducted at the NCT follow the rigorous international standards of Good Clinical Practice (GCP). These standards ensure that all the details of the treatment of any patient participating in the trial are meticulously monitored. Patients who participate in clinical trials have many advantages: not only can they benefit from new treatments that have yet to be approved, but they are also closely monitored. Part of the NCT s future concept is therefore to offer as many patients as possible the opportunity to participate in a trial. Frau Berger will receive the drug that is being studied as an outpatient twice a week at one of the NCT s two day clinics, each of which has light, spacious therapy areas for up to thirty patients, partitioned into smaller, more intimate spaces. If Frau Berger is to be given intravenously administered chemotherapy, she can decide whether she would like to have a port implanted. Port A port is a small point of access to the vein which is implanted beneath the skin under local anesthetic. This enables patients receiving frequent infusions and intravenous medication to avoid having a needle inserted into the veins of their lower arm each time. A port protects the veins and makes it easier to administer chemotherapy. It can also be used for administering parenteral nutrition. The competent team of clinicians and nursing staff has a lot of experience and takes care of each individual patient throughout the course of treatment. To make the patient as comfortable as possible during treatment, a special recliner was designed for the NCT s new building specifically to meet the needs of cancer patients. Frau Berger can talk to other patients while receiving her medication. Sharing with other patients makes its easier for many cancer patients to endure the difficult treatment period. After four months, Frau Berger has completed her treatment at the NCT. She will now be looked after by her physician at home, who will continue to collaborate closely with the NCT. Frau Berger will also attend regular aftercare check-ups at the NCT so that physicians there can gather additional clinical information about the long-term effects and possible sideeffects of the drug tested in the trial. The data collected will be evaluated in the clinical cancer registry and at the NCT s own trial center so that they can inform the treatment of other patients. Clinical cancer registry Data about the progression of a cancer and its treatment are gathered in clinical cancer registries to provide physicians and researchers with reliable information on the long-term consequences of cancer treatment in Germany. Each patient s data are treated with the utmost confidentiality. 21

Joining Forces WORKING TOGETHER FOR THE BENEFIT OF THE PATIENT HOW HEIDELBERG UNIVERSITY HOSPITAL AND THE NCT COLLABORATE Heidelberg s unique combination of top-flight research institutes and the University Hospital make it an ideal location for a Comprehensive Cancer Center in Germany. The establishment of nine clinical cooperation units by the German Cancer Research Center (DKFZ) and Heidelberg University Hospital paved the way for this some time ago. These formed a natural bridge between research and clinical practice, not least because the head of each clinical cooperation unit is both a physician and a research scientist. The real breakthrough, however, came in 2004 when an alliance between the German Cancer Research Center (DKFZ) and Heidelberg University Hospital, including the Thoraxklinik in Heidelberg-Rohrbach, led to the creation of the National Center for Tumor Diseases (NCT Heidelberg) with funding from German Cancer Aid. After moving into the new building in the fall of 2010 after years of intensive preparation, the NCT is now in a position to meet both the high standard of interdisciplinarity in patient care and the excellence in translational cancer research demanded of it. Cooperation with Heidelberg University Hospital s oncology units and with the Thoraxklinik plays a key role here. Their physicians work in the NCT s specialist outpatient clinics and sit on the interdisciplinary tumor boards. The new NCT building now houses the outpatient clinics of the Medical Oncology, Gynecological Oncology, Dermatological Oncology, Neuro- Oncology, Radio-Oncology, and Radiation Therapy departments as well as a range of treatment and advisory services for patients, including pain therapy, dietary advice, exercise therapy, and psycho-oncology. Centralized chemotherapy The new building is designed to take account of the special requirements of an interdisciplinary cancer center. For the first time, all the outpatient chemotherapy until now provided by the Otto-Meyerhof Center at the University Hospital and in the specialist units has been centralized under one roof headed by the Medical Oncology department. This centralization principle is a model for Germany, explains Professor J. Rüdiger Siewert, Chief Medical Director of Heidelberg University Hospital. The Medical Oncology department, headed by Professor Dirk Jäger, coordinates the care of outpatients at the NCT. It is also responsible for the centralized provision of chemotherapy and for conducting clinical trials in its own department. Inpatient care also headed by Professor Jäger is provided in three different units. 22

Radiation treatment at the Heidelberg Ion-Beam Therapy Center (HIT), an important cooperation partner of the NCT Integration of the organ centers The integration of certified organ centers is part of the concept behind the Comprehensive Cancer Center and Germany s oncological centers of excellence, which must fulfill certain requirements in terms of both staffing and their technical facilities, and must also have a proven track record in the treatment of the relevant type of tumor. The certified Breast Center of Heidelberg University Women s Hospital, the Prostrate Cancer Center, the Lung Cancer Center, and the Skin Cancer Center have all been integrated into the NCT. Their interdisciplinary tumor boards are coordinated by the Medical Oncology department. Treatment guidelines The interdisciplinary treatment of patients at the NCT follows certain binding guidelines. For every type of tumor there is a Cooperative Oncology Group comprised of doctors and researchers from different fields. They are responsible for drawing up and monitoring a set of binding guidelines for diagnosis, therapy, and aftercare, known collectively as the Standard Operating Procedures or SOPs. They also maintain contact with patient self-help organizations, with physicians in private practice in their field of specialization, and referring hospitals. The guidelines are informed by the latest evidence-based medical findings and are binding for all participating units. The aim is also to have as many patients as possible participating in clinical trials in order to improve diagnostics and/or the treatment provided and hence the patients prognosis. 23

Joining Forces Cooperation with oncologists in private practice One important quality feature of the NCT is its close collaboration with oncologists in private practice throughout the region and further afield. The NCT and the North Baden branch of the Berufsverband der niedergelassenen Hämatologen und Onkologen in Deutschland e.v. (Professional Association of Hematologists and Oncologists in Private Practice in Germany) formalized their collaboration in an agreement signed in 2007. Cancer patients are the chief beneficiaries of this close cooperation. Not only does it greatly improve the flow of information between hospital and practice, but patients with complicated case histories can be referred to the NCT and there participate in clinical trials. At the same time, patients who have undergone surgery or radiation treatment at Heidelberg University Hospital can be entrusted back to the care of the oncologist who referred them with a minimum of bureaucracy. This cooperation agreement has brought us one step closer to our goal of a truly comprehensive cancer center, says Jäger. Oncologists in private practice can participate directly in the NCT s clinical trials and share its infrastructure with the result that the NCT can rely on competent primary care providers to give our patients first-class therapy. Surgery, drug treatment, and radiation are the three pillars of cancer treatment 24

Pain therapy and palliative medicine One important cooperation partner of the NCT is the Pain Center which is part of Heidelberg University Hospital s Anesthesiology Department. The center organizes conferences, symposia, and further training programs on the subject of pain therapy and advises both primary care providers and patients on how to deal with chronic pain. It also runs the palliative unit at Heidelberg s St. Vincentius Hospital. This is a cooperative project between Heidelberg University Hospital and the Diakonisches Werk Heidelberg in which internists and specialists in palliative medicine treat patients in the advanced stages of cancer who are seriously ill and whose prognosis is limited with the aim of minimizing their pain and improving their quality of life. The patients in this unit are cared for by an interdisciplinary team made up of specially trained nursing staff, physiotherapists, social workers, and music therapists from the German Center for Music Therapy Research, whose services complement the medical care provided. Oncological nursing The high standard of oncological nursing at Heidelberg University Hospital is a key factor in the quality of the cancer care provided at the NCT. Proper training plays an especially important role in the professional care of cancer patients. The two-year oncological training program Nursing Chronically Sick Cancer Patients was introduced by Heidelberg University Hospital in 1992 and was the first of its kind to receive state accreditation. The Oncological Nursing Symposium has also become an established tradition; as one of the largest nursing congresses in Germany, it was held for the sixteenth time in 2010. The hospital s bridging care first introduced twenty years ago is also an important part of its oncological care concept. Bridging care forges a link between the hospital and the carers who will look after the patient after he or she has returned home. It prepares for the patient s discharge from hospital, organizes and coordinates home care, and ensures that the patient receives the best possible care at home. The aim is always to provide the patient with home care of a standard comparable to that received in the hospital. Returning home usually gives the patient a psychological and emotional boost, leading to an improvement in his or her quality and enjoyment of life. As well as providing inpatient nursing care, the NCT s nursing staff are also involved in outpatient care and patient management. Good organization is especially crucial to the NCT s interdisciplinary outpatient clinics. With its multiple alliances both inside and outside Heidelberg University Hospital and the DKFZ, the NCT Heidelberg is indeed a model project for translational research and interdisciplinary cancer care in Germany and the ones to benefit most from this are the patients. 25

From Bench to Bedside TRANSLATIONAL RESEARCH AT THE NCT SOME FIFTY GROUPS WORKING IN SIX PROGRAM AREAS Thirty years ago, only about one in every three cancer patients survived the diagnosis longer than five years. Today, it is one in every two! This significant success is due partly to better treatment and partly to improvements in early diagnosis. A tumor diagnosed at an early stage can be removed, unlike a tumor that has already metastasized. Nevertheless, one in every two patients succumbs to the disease. The aim of everyone working at the National Center for Tumor Diseases is therefore to improve the cure rate for all cancer patients. In recent years, basic research has broadened our understanding of how cancer develops, in other words the mechanisms that are involved when a healthy cell degenerates into a cancer cell. At the National Center for Tumor Diseases, physicians and scientists work together to translate the findings of basic research into clinical applications as rapidly as possible. Conversely, the data obtained in clinical medicine are analyzed in the laboratory to permit the near real-time monitoring of the response to therapy and its correction where necessary. About fifty research groups of varying sizes are involved in the pursuit of this goal at the NCT. They work in the following program areas: Clinical Research Molecular Diagnostics and Therapy Immunotherapy Novel Therapeutics Integrative Radiation Oncology Cancer Prevention, Control and Outcomes On the following pages we will present examples of the research projects being done in all six areas. 26

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The Six Program Areas CLINICAL RESEARCH Clinical trials are the best way we have of assessing and improving our treatment options in oncology. As a rule, it takes several years for a drug to pass through all clinical trials until it is approved, says Professor Dirk Jäger, head of the NCT Clinical Research area. Clinical trials go through various phases, each building on the findings of the last. Only when one phase has been completed with a positive outcome is the next phase initiated. The individual phases may last weeks, months, or even years. That s why we need structures to help us streamline the process and so speed it up, Jäger explains. Hurdles in trial planning The majority of projects are phase I or phase II trials, in which the aim is to ascertain the optimum dosage or to define the adverse reaction profile of a substance or therapeutic method. Phase II trials, moreover, deliver the first indications of the therapies efficacy. Implementing trial projects has become an elaborate and expensive process subject to a host of regulations. Professional support is the key to meeting the objectives within the allotted timeframes, says Jäger, explaining the specific challenges of his program area. When planning a trial, we have to focus on the following issues: How do I finance the project and who will manufacture the substance? How do I settle on a trial design? How do I get the relevant authorities and ethics commissions to approve my project? How fast can I find patients who will want to be treated as part of the study? Every trial has its own trial protocol in which the objective, the procedure, and the analytical methods are clearly defined. The protocol also has to define the criteria for including or excluding patients. And it has to be approved by the authorities and by an ethics commission. Only then can the trial get off the ground. Ultimately, of course, the decision is still the patient s. Before patients participate in a trial, they have to be fully informed of its objectives, the procedure, and the risks, and they must give their informed consent. The future belongs to intelligent, individual therapies The trials conducted at the NCT vary considerably. We have some substances in very early phases of their development and others close to approval. We are also involved in largescale studies that are being conducted at a number of different centers concurrently, says Jäger, describing the situation at the NCT. I see the future in personalized medicine. The trend in oncology will be to identify the right medicine for the right patient. Investigating the molecular features of the patient s tumor and how his or her immune system interacts with it will eventually enable us to predict more accurately whether or not a patient is likely to benefit from a particular treatment. It follows that the analysis of these individual molecular features will have to become an integral part of innovative trial concepts. MOLECULAR DIAGNOSTICS AND THERAPY Molecular diagnostics is of crucial importance to oncology because every tumor is unique. While certain genetic materials are altered in all tumor cells compared with healthy cells, exactly which genes and how many of them are involved in such mutations differ from one type of cancer to another. According to present-day knowledge, there are often substantial differences even between patients with the same type of cancer. In the International Cancer Genome project, cancer researchers from around the world are studying a total of fifty common types of cancer to identify the genes most often affected by mutations. Physicians at the NCT also want to use this knowledge: Our goal is to offer patients at first only some of them, but within about five years all of them the option of having the complete genome of their cancer cells analyzed. Using this DNA sequence and other molecular information to design a personalized oncology, we will then develop individual treatment plans tailor-made for each patient, says Professor Christof von Kalle, Chair of the NCT Board of Directors. The architecture of the new NCT building provides us with ideal conditions for this. We can examine tumor material for particularities in our own labs and with researchers and clinicians working so closely together can make swift use of the results to arrive at a decision about therapy. 30

Research for patients Discoveries in the lab may become the medicines of tomorrow Professor Peter Lichter, who heads the Molecular Genetics division at the German Cancer Research Center, also coordinates one of Germany s three contributions to the International Cancer Genome project. He and his colleagues in Heidelberg are sequencing genetic mutations in children s brain tumors and early-onset prostate cancer. He, too, is very optimistic: With the findings from this mega-project, we ll probably soon be able to combine existing drugs in such a way that we can help individual patients to combat their particular tumor disease. Over and above this, the project is bound to uncover many hitherto unknown mutations for which new, targeted therapies can be developed. Whatever happens, the situation is sure to improve! No two brain tumors are alike Brain tumors are just like other forms of cancer inasmuch as they, too, exhibit significant genetic differences. The Neuropathology Clinical Cooperation Unit headed by Professor Andreas von Deimling is investigating just such differences. The distinctions are of tremendous importance to research projects and the development of therapies in clinical trials, as researchers selecting investigational material or study subjects have to know exactly which tumor causes can be treated. Von Deimling s team, for instance, has developed an antibody with which to identify brain tumors with a particular mutation that makes the tumor grow less aggressively. Using this antibody, the team can pick out suitable patients who may even be given a more tissue-conserving treatment. That s a major step forward, says a justifiably proud von Deimling, especially as the antibody is so sensitive that it reliably stains even individual tumor cells located in healthy brain tissue, which we would not have been able to discover using the methods previously available. 31

The Six Program Areas Defective gene sequences as targets of gene therapy Christof von Kalle s Department of Translational Oncology is also involved in high-tech genome decoding for the benefit of patients. His group has succeeded in developing highly sensitive methods of identifying defective gene sequences. A reliable method of finding genetic needles in the immense haystack of the genome would significantly speed up the development of techniques for gene repair and gene therapy. One of the first applications will likewise target malignant brain tumors, and for a very good reason: The cancer cells are often resistant, meaning that only half of these patients respond to chemotherapy, says von Kalle regretfully. While chemotherapy does indeed kill off the tumor cells, the hematopoietic stem cells in the bone marrow are also destroyed in the process, with the result that the patient suffers life-threatening anemia and immunodeficiency. Gene therapy enables us to introduce a gene into the blood stem cells of the bone marrow. This gene makes the hematopoietic cells more resistant to chemotherapy so that when we treat that patient with chemotherapy, only the brain tumor cells and the unmodified blood stem cells die. The blood stem cells that have been modified by gene therapy, on the other hand, survive and supply new blood stem cells. That, at any rate, is the theory, which has so far been confirmed only in animal testing. Von Kalle therefore hopes to be able to test this approach in an international trial for glioblastoma patients in the near future. IMMUNOTHERAPY The immune system plays a critical role in the battle against cancer because the weapons of the immune system have a major advantage over conventional therapies: they can distinguish between tumor cells and healthy cells. The immune system identifies tumor cells by means of tiny features on the cell surface, meaning that in theory it could home in on them to destroy them. Unfortunately, this does not succeed in all cases. Why this is so, and how the immune system could be groomed to target the tumor, is what the scientists and physicians in the Immunotherapy area are trying to find out. We ve got some powerful attack dogs here, says Professor Peter Krammer, the program area s spokesperson, describing the objective of immunotherapy research. But we have to learn how to train them properly so that they attack in exactly the right place. The scientists are therefore looking for special telltale structures on the tumor cells tumor antigens against which the body can trigger an immune response. Professor Dirk Jäger has discovered just such an antigen: called NY-BR-1, it is present almost exclusively in breast cancer cells, which makes it an excellent candidate for a vaccine. The physicians are therefore planning a trial in which patients will be vaccinated with fragments, or peptides, of the NY-BR-1 protein in order to stimulate their immune system to reject the tumor. Receptor blockade Another team is working on developing antibodies, the immune system s precision weapons. Antibodies attach to certain structures called receptors on tumor cells and in this way mark them as targets. Among the antibodies that are already being used to treat cancer is trastuzumab, an antibody which blocks a receptor for a growth factor on cancer cells in breast cancer. Once the factor can no longer bind to the cells, the cells no longer divide. Other antibodies are mixed with toxic substances and then used to transport the toxin straight to the tumor. The immunologist Dr. Gerhard Moldenhauer is cooking up so-called bi-specific antibodies: These are antibodies with two different arms, explains Moldenhauer. We combine tumor cells with killer cells of the immune system, for instance, and in this way can trigger an effective immune response to the tumor. T-regs guard the immune system It is precisely because the immune system s weaponry is so effective that it is vital that it does not shoot blindly. Autoimmune diseases such as multiple sclerosis and rheumatism are salutary reminders of what happens when the body s own defenses turn against it. A healthy immune system therefore has defensive mechanisms to ward off such an attack. Many tumor cells take advantage of this mechanism, explains Dr. Philipp Beckhove. He and his Translational Immunology research group are studying T-regs, which are regulatory T cells or defense cells that stand guard over the immune system. Tumors often contain a surprisingly large number of these T-regs, which by suppressing killer cells prevent them from putting up an effective defense. It seems that tumor antigens activate the regulatory cells, too. The structures on tumor cells 32

that the T-regs recognize was largely a mystery until recently, says Beckhove. The scientists in his group have since discovered that the regulatory T cells only recognize some tumor antigens, whereas the T killer cells are activated by all tested tumor antigens. So we re planning a clinical trial in which we take killer cells from patients with colon cancer and activate these cells with tumor antigens to which the killer cells, but not the regulatory cells, respond, explains Beckhove. If the method proves effective, it could be tested for other types of cancer as well. The immune system plays a role in all tumor diseases, says Peter Krammer. We want to exploit its potential to help tumor patients with therapies that are both more effective and less aggressive. NOVEL THERAPEUTICS What makes a healthy cell turn into a cancer cell? After many years of basic research, cancer researchers are gaining an ever better understanding of which molecular changes in a cell result in its dividing uncontrollably, leaving its environment, spreading in the organ affected or elsewhere in the body, and finally forming metastases elsewhere in the body. And the more exactly we understand the causes of tumor growth, the sooner we will be able to develop new medicines to target the disease. This is the objective of the Novel Therapeutics program area headed by Professor Wolfgang Wick, Germany s first full professor of the innovative but highly complex field of neurooncology. Tumors of the brain are particularly difficult to treat, says Wick. Glioblastomas, in particular, invade nearby healthy tissue at an early stage, which is why they cannot be completely excised by surgery. Molecular investigations have demonstrated that glioblastoma cells do not respond to the signal of the death receptor CD95. As soon as the ligand CD95L binds to the death receptor, the tumor cells begin to invade adjacent tissue instead of dying as healthy cells would. We know that occasionally, radiotherapy can cause just such an invasion. We re therefore conducting a study on glioblastoma patients in which we target the capture of CD95L parallel to radiation therapy. We hope that this will enable us to prevent the tumor from spreading further, says Wick, explaining the objective of the trial being conducted under his leadership at sixteen European centers. What is the connection between stem cells and tumor cells? The biologist Professor Andreas Trumpp heads the Stem Cells and Cancer division at the German Cancer Research Center. Stem cells and cancer cells are very similar. Both have the capacity to proliferate to produce millions of descendants; they can change their form; and they can wander around the body. We believe that many tumors develop from stem cells. As a result of genetic mutations, they turn into tumor stem cells which produce huge numbers of tumor cells and at the same time have mechanisms that make them impervious to chemotherapy, says Trumpp, adding, these tumor stem cells are presumably also responsible for recurrences of the tumor or the formation of metastases after what had seemed to be a successful course of therapy. At the NCT, Trumpp works together with Professor Andreas Schneeweiss of Heidelberg University Gynecology Clinic. We re looking for tumor stem cells in the blood and bone marrow of patients with breast cancer, says Schneeweiss, because these cells will give us a clue as to whether the therapy being used is effective and what course the disease will take. Viruses to fight cancer Dr. Dirk Nettelbeck is working on completely novel therapeutic agents as befits the name of the program area. His special field is oncolytic viruses. These are viruses that dissolve, or lyse, cancer cells, explains Nettelbeck, who heads a junior research group at the German Cancer Research Center and is a researcher at Heidelberg University Dermatology Clinic. Our goal is to engineer adenoviruses which are actually harmless viruses that normally cause nothing more serious than a cold so that they attack and destroy cancer cells. Nettelbeck and his colleagues have begun by modifying the viral coat, or capsid, so that the virus fits particular structures on the surface of cancer cells, like a key in a lock. The next step will be to introduce foreign genes into the viruses to make them even more effective at killing tumor cells. Lastly, virotherapy opens up the prospect of integrating the patient s own immune system in the treatment: The cancer cells destroyed by the viruses offer numerous points of attack for the cells of the immune system, explains Nettelbeck. Therapy using viruses could therefore produce immunity to the tumor; it would target only tumor cells and so destroy the tumor, we hope, or at least keep it in check for a long time. 33

The Six Program Areas INTEGRATIVE RADIATION ONCOLOGY If radiotherapy is to be successful, it must reach as much of the tumor as possible and spare healthy tissue. This is how Professor Jürgen Debus sums up the approach of his program area. As spokesperson for the Integrative Radiation Oncology program area, his mission is to integrate cutting-edge imaging techniques into oncological radiotherapy. The ultimate aim is to be able to find and then strike specific tumor areas in the body by means of real-time or near real-time imaging techniques. That s the best way for us radiotherapists to treat each patient in a way that is tailored to his or her needs and is as tissue-conserving as possible, explains Debus. MRI or CT or PET/CT? Another important avenue of research is to improve positron emission tomography (PET) and computer tomography (CT). Nuclear medicine specialists at the NCT perform whole-body scans using tracers, which show up as hot-spots at the site of the tumor. Besides working constantly on improving the significance of the findings produced by this method, which is still very expensive, they are also evaluating it in relation to other methods. Working together with radiologists and radiotherapists, they compare the various radiodiagnostic techniques available and try to ascertain whether magnetic resonance imaging (MRI) or CT, or combined PET plus CT is more successful in tracking down tumors and metastases. They also address the question of whether these methods could produce different results performed at different intervals for different diseases. Research is teamwork Personalized cancer treatment can only work if the individual features of each patient can be identified 34

Radionuclides in diagnostics and therapy Nuclear medicine works with radioactively labeled substances known as tracers. The tracers accumulate in tumor tissue and render it visible on a PET/CT scan, for example. At the NCT, Professor Uwe Haberkorn is working to develop substances that can be administered to patients both for diagnosis and for therapy. Right now, it is only in rare cancers such as neuroendocrine tumors that we can use a protein first for diagnosis and then, if there has been sufficient accumulation in the tumor, for therapy by conjugating it with a radionuclide capable of delivering treatment, says Haberkorn. It would be great if in the future we could treat patients with common tumors such as colon, breast, or prostate cancer using similar substances, he adds in a rather more speculative vein. Radiotherapy Radiotherapy is one of the three supporting pillars of cancer therapy. Since some 50 percent of all patients receive radiotherapy, the number of patients who stand to gain from whatever improvements and advances are made to existing techniques is very large indeed. Much of the research being done at the NCT is therefore aimed at optimizing radiotherapy, for example by distributing the radiation in the tissue so that it matches the exact shape of the tumor. One special challenge in radiotherapy is the fact that the radiation target in the body is constantly moving because of the patient s breathing, for example. Researchers are therefore grappling with techniques to overcome this problem too. Heavy-ion therapy Heavy-ion therapy is a completely new field of radiotherapy which is being studied in cooperation with the Heidelberg Ion-Beam Therapy Center (HIT). Ion-beam therapy holds out the promise of maximum precision and is more effective at destroying tumors than is conventional photon radiation. What is more, heavy ions can destroy tumors that grow very slowly or that have a poor blood supply. Photons are not as therapeutically effective in such cases, explains Jürgen Debus, Medical Director of the HIT and a member of the NCT Board of Directors. We re planning several clinical trials for the coming years in which we intend to investigate whether protons or heavy ions are more effective in treating, and perhaps even curing, other tumors in which radiotherapy has had little success to date. Precise diagnosis, intelligent combinations Modern molecular biology has led to a deeper understanding of tumor pathophysiology. Applying this knowledge to radiotherapy is the declared aim of Dr. Amir Abdollahi, who heads a German Cancer Aid Max Eder junior research group at the NCT. We re employing new molecular methods to identify so-called biomarkers that will enable us to predict tumor response to radiotherapy more accurately, explains Abdollahi. Our knowledge of tumor-specific resistance mechanisms can also be used to develop more effective and tailor-made combination therapies. 35

The Six Program Areas CANCER PREVENTION, CONTROL AND OUTCOMES The most effective method of fighting cancer is to prevent it from occurring in the first place, says Professor Cornelia Ulrich, summing up what her program area is all about. The simplest approach would be to give up smoking. It s the number one avoidable cause. In research parlance, preventing cancer is called primary prevention. Secondary prevention refers to screening programs and early detection strategies, because if cancer is detected early enough, it can usually be treated or even cured. Tertiary prevention means the measures taken to prevent a recurrence of cancer once it has been successfully treated. What can patients do for themselves? One of Professor Ulrich s tasks is to head the ColoCare trial, which is a long-term study to investigate the impact of various lifestyle factors on colon cancer patients being conducted together with colleagues in both Germany and the USA. Our aim is to find out to what extent diet, physical activity and obesity, genetic factors, intestinal bacteria, and medications impact on the prognosis of the patients we re studying. We ask questions such as: Is physical activity enough, or do the patients also have to lose weight? Are patients better off staying outdoors in order to raise vitamin D levels? explains Ulrich. We re basically looking for answers to the question that cancer patients ask us every day: What can I do to beat the cancer? The purpose of this and the other studies in this program area is to develop better therapies and scientifically based recommendations for healthy living during and after treatment for cancer. Patients at the NCT are already benefiting from this approach: the NCT s Sports and Cancer program combines the promotion of physical activity with research. Cancer prevention is it possible? There s always an element of chance in any case of cancer. But there are several ways in which we can all improve our chances of a long, cancer-free life! says Ulrich. New techniques can accurately track multidimensional movements, for instance, or detect biomarkers in the blood that reflect diet and metabolism. Taking a multipronged approach, scientists use these findings to develop new ideas on how to prevent cancer from occurring. They have found, for example, that the provitamin folic acid is important for embryonic development, but may well be harmful to the metabolism of cancer patients. Scientists in the Oncological Prevention department, moreover, are studying how non-steroidal anti-inflammatory drugs aspirin is one such NSAID interact with the genome. Aspirin (acetylsalicylic acid) might serve some patients not just as a painkiller or anti-inflammatory, but as a means of guarding against cancer, too. Studies have already provided some evidence of this prophylactic effect. Personalized prevention may thus soon be much more than wishful thinking. Early cancer detection helps save lives Professor Herman Brenner is an expert in the early detection of colon cancer. He reckons that some 15,000 cases of colon cancer have been prevented in the eight years that have passed since Germany s sick funds and health insurers started bearing the costs of colonoscopy. His main interest, however, is in less elaborate preventive measures. Tests for blood in the stool are still important because people are far more willing to have a simple laboratory test done than to undergo colonoscopy. We nevertheless need tests that detect the precursor stages of colon cancer more effectively, says Brenner. The past few years have seen the development of new immunological techniques which according to a study by Brenner are far superior to conventional tests, especially in detecting the precursor stages of colon cancer. The tests are still too sensitive, however, and Brenner and his team are still working on lowering their sensitivity threshold to make them suitable for routine use. 36

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Shared Resources/Core Facilities WHERE RESEARCH AND CLINICAL PRACTICE OVERLAP Oncological research and patient care are closely intertwined at the NCT Heidelberg. Both areas share a common infrastructure and it is this which allows them to interact so intensively and which then supports this interaction. The infrastructure includes the NCT Cancer Registry, the NCT Tissue Bank, and the NCT Trial Center. The Heidelberg School of Oncology offers training for physicians wishing to specialize in oncology as well as a wide range of courses for professionals in clinical oncology and other scientific fields. The NCT Tissue Bank The NCT Tissue Bank is a key component in the study of disease-specific or disease-relevant changes in patients tumor tissue. Tissue samples obtained during surgery or by biopsy are collected, analyzed, characterized, and stored at the Tissue Bank. Staff at the Tissue Bank can then prepare multitissue arrays, for example, which by displaying up to a hundred different tissue samples on a slide provide a basis for comparative tumor analyses. The Tissue Bank also provides scientists from the NCT and its supporting institutions with paraffin-embedded sections of these arrays for research purposes. The NCT Registry The NCT Registry is a clinical cancer registry covering all patients who have been examined or treated at the NCT. Registry staff record each patient s precise diagnosis including the disease stage, the therapies received, and their outcome. One of the NCT Registry s aims is to ensure and improve the quality of oncological care. The NCT Registry is also responsible for mandatory cancer incidence reporting to the Baden-Württemberg State Cancer Registry, as required of it by law. In addition, numerous research projects at the NCT use data provided by the NCT Registry. To facilitate such research, registry staff create scientific dossiers from which NCT physicians and scientists can retrieve data from the cancer registry in pseudonymized form, either for scientific analysis or for preparing clinical trials. How often has a particular therapy had to be interrupted because of poor tolerability? How has the survival rate after diagnosis developed for a particular type of tumor? For how long does a new therapy delay cancer growth? With its scientific dossiers, the NCT Registry bridges the gap between oncological research in clinical trials and day-to-day clinical care. Physicians can therefore determine how methods tested in the favorable situation of a clinical trial actually perform in routine clinical practice. 38

NCT Patient and Trial Center The NCT Patient and Trial Center provides quality-assured services for both the NCT s own trials and international, multicentric oncological trials. The aim is to increase the range of scientifically based clinical trials for cancer patients, to improve patient care, and to establish scientific treatment standards in oncology and hematology. Most of these studies are investigator-initiated trials whose aim, generally speaking, is to improve or to develop existing therapies and treatment concepts. With its more then 7,000 or so patients every year, moreover, the NCT is an increasingly interesting partner for large-scale drug registration studies by the pharmaceutical industry. Working together, biometricians and physicians plan and analyze clinical trials and interpret the data. They also support research projects within the NCT by helping to analyze the results. The Trial Center s own project management unit takes care of scheduling and budgeting, ensures that all the legal requirements are met, provides feasibility and risk assessments, and maintains contact with the relevant authorities and ethics commissions. Data management specialists see to the validity of the data obtained and ensure compliance with quality standards as well as with national and international guidelines. Trial investigators medical doctors with extensive experience in clinical trials provide support at all stages of the project, while patient care is entrusted to specially trained study nurses for all clinical trials. The Patient and Trial Center ensures that all trials conducted at the NCT are implemented in accordance with the internationally recognized principles of Good Clinical Practice (GCP). The Heidelberg School of Oncology One of the main tasks of a Comprehensive Cancer Center is to ensure that research findings are shared with outside specialists as well. The NCT offers outstanding training and educational opportunities for medical students and doctors, nursing staff and paramedics in the field of oncology. Scientists in other fields working in translational cancer research can also receive training here. While the NCT Updates, the NCT s advanced training events for oncologists, have become a regular fixture, the purpose of the Heidelberg Grand Rounds, which are aimed at both physicians and scientists, is to examine one specific oncological topic from both the clinical and the scientific point of view. Regular seminars are also part of the offering. Heidelberg School of Oncology has an extensive professional development program for physicians. It provides a three-year, full-time training course for recognition as a specialist in hematology/oncology. Physicians who wish to pursue a career in science can embark on a four-year curriculum consisting of two years in clinical oncology followed by two years in translational research. Specialist physicians in training can thus devote 50 percent of their time to translational research projects in NCT, DKFZ, or Heidelberg University Hospital research teams and so receive the best possible foundation for an academic career. In addition, Heidelberg School of Oncology offers a one-year program for licensed oncologists who wish to broaden their knowledge and for specialists in oncological surgery who wish to gain further training in specific aspects of their field and to obtain an additional qualification. On the scientific side, there are special training groups in translational research for both physicians and fellow professionals with a background in the life sciences. 39

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The New Building VISIONS AND HISTORY Gottfried Schaaf German Cancer Aid first held discussions aimed at establishing a Comprehensive Cancer Center (CCC) in Germany in Heidelberg in 2004. CCCs, which have existed in the United States for many years, are dedicated to combining optimal patient care with innovative oncological research. A strong link between care and research was the main specification for the new building that was to house the National Center for Tumor Diseases. Another essential objective was to create a center that would serve as a communication hub and meeting place for doctors, researchers, and patients. The search for a suitable site on the campus was soon narrowed down to the plot of land between the Children s Hospital, the Heidelberg Ion-Beam Therapy Center (HIT), and the Head Clinic. The main criteria behind the choice of site were its good transport connections, its internal links to the automatic goods transport system, and the possibility of moving patients between clinics underground. Access to the building for patients was to be as easy and convenient as possible, enabling them to use the other medical facilities if necessary. Over and above all the functional prerequisites, Dr. Hans-Joachim Möhle, the former chairman of German Cancer Aid who was tasked with implementing the project on behalf of the organization s executive board, stressed what his organization considered an essential criterion: We want a very special building in which the cancer patient can feel at ease despite his or her difficult situation. This was the yardstick that German Cancer Aid had applied to earlier projects elsewhere in Germany. The NCT in Heidelberg was to be a model project for the public, and it was to set an example for similar facilities throughout Germany. After space requirements had been calculated and the financial situation clarified, German Cancer Aid, together with Heidelberg University Buildings Department and the Baden- Württemberg Chamber of Architects, held a competition by invitation for the best design, in which ten firms of architects from all over Germany participated. All the projects submitted were of the highest architectural quality, each of them expressing a language of forms which set out to match the client s objectives. 42

The jury headed by Professor Carlo Weber (center) with Dr. Hans-Joachim Möhle (left) on behalf of German Cancer Aid and Gottfried Schaaf (right) of B. I. S. GmbH on behalf of the client in Heidelberg on February 24, 2005 The model submitted for the competition by Behnisch Architekten In the end, four prizes were awarded: 1st prize Behnisch Architekten, Stuttgart 2nd prize Heinle, Wischer und Partner Freie Architekten, Stuttgart 3rd prize Nickl & Partner Architekten AG, München 3rd prize TMK Architekten Ingenieure GbR, Düsseldorf The jury explained its decision in favor of the plan submitted by Behnisch Architekten in March 2005 as follows: A special language of forms gives rise to exciting architecture. The building is both distinctive and self-contained. The open-plan interior makes for a welcoming atmosphere. A sense of security and generosity prevails. As the client s representative speaking at the awards ceremony, Dr. Möhle added: The NCT will lead the way for modern, patient-friendly cancer medicine. An agreement between the Dr. Mildred Scheel Foundation for Cancer Research, the German Cancer Research Center Heidelberg, Heidelberg University Hospital, and the University of Heidelberg based on the criteria defined for the building and the competition was signed on March 8, 2007. This henceforth served as the legal basis for the realization of the project. After Behnisch Architekten and the other specialist planners had been commissioned, a steering committee was established to monitor both German Cancer Aid s quality requirements and costs during the entire planning and construction process. The committee was chaired by Dr. Möhle, who was supported by B. I. S. GmbH of Munich, a firm commissioned to represent the client by the Dr. Mildred Scheel Foundation for Cancer Research. In addition to the planners, various user groups also contributed valuable input from the point of view of clinical medicine and research. Of paramount importance during the construction phase was the guidance implicit in the vision of German Cancer Aid / Dr. Mildred Scheel Foundation for Cancer Research and in the outstanding quality of the design submitted by Behnisch Architekten, and the fact that the project was widely perceived as a team effort. The benchmark for all discussions was the vision of German Cancer Aid and it was this that made it possible to find compromises where necessary. Living this vision and keeping it alive is now the task of the users. 43

On the Architecture A VISION TAKES SHAPE Behnisch Architekten The idea More than anything else, the new premises of the National Center for Tumor Diseases were to be open, friendly, and welcoming for patients, their families, visitors, and staff. The new building was to be free of that typical hospital atmosphere, but at the same time an optimum care facility for patients and an ideal workplace for staff at all levels. From the layout of the rooms down to the tiniest details, everything at the new NCT was designed to generate confidence and trust. Lageplan The NCT is a first port of call for cancer patients, each of whom receives an individual treatment plan based on the latest scientific findings and drawn up by an interdisciplinary team of experts. Thanks to close cooperation between clinicians and researchers, the NCT is able to translate promising research findings into clinical practice without delay. The architecture of the NCT s new premises in Heidelberg is intended to highlight both the interdisciplinary concept behind the facility and its model character. Its central, light-flooded atrium extending over four floors was designed as a focal point that would encourage encounters and communication between doctors and scientists, patients and visitors. The eastern part of the building, whose three stacked floors accommodate the laboratories, responds to the orthogonal structure and closed order of Heidelberg University Hospital s adjacent Head Clinic. By contrast, the western part of the building develops more freely and in a friendly gesture seems to reach out toward the Children s Hospital. The first two floors of this wing house classical clinical functions and thanks to a façade of green tinted glass blend in well with their surroundings. Site plan Perched above them is a two-story, freely shaped volume which cantilevers over both the main entrance to the north and the west-facing façade and so lends the building coherence. This element accommodates the consulting rooms and tumor board conference rooms as well as offices for research and medical staff. The white rendered façade of this upper volume features beveled window frames making for an interesting play of light and shade depending on the time of day. The monolithic corpus looks almost as if it were floating on the lower stories. The sculpted shape of the new building underscores the NCT s importance as well as endowing it with an identity of its own on the campus. 44

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On the Architecture Clinical areas Patients enter a spacious and friendly reception area from which they are guided to the four outpatient modules on levels 00 and 01. These feature screened-off waiting areas which look out into the countryside. The examination and treatment rooms are arranged along the façade. Clerestory glazing along the walls flanking the corridors allows daylight into the access areas. The corridors have polished screed floors, while the therapy and waiting areas have oak parquet flooring. The inside façades are also oak-clad so as to generate a warm and homely atmosphere. The outpatient modules on levels 00 and 01 each have a day clinic for chemotherapy with a separate waiting area and reception area. Treatment is administered in open, lounge-like areas in which half-height shelf units and partitions are used to separate off groups of three, four, or five recliners. The areas are both friendly and personal and the façades liberally glazed so that patients enjoy unrestricted views of the garden in front of them. The terrace on level 00 can also be used during chemotherapy, while the day clinic on level 01 has a balcony where patients are likewise free to stroll. Floor plan level 00 The nurses station is situated behind a large counter unit which is of a piece with the open furnishings used throughout the therapy areas. From here, nurses have a clear view of the therapy area in their purview. The day clinics have oak parquet flooring throughout. They are furnished with special recliners that were developed by Behnisch Architekten and a manufacturer of medical recliners in close consultation with users and therefore have little in common with the furniture commonly used in such therapy centers. In addition to the lounge-like therapy areas, two closed rooms for individual treatment are provided on each floor of the day clinics. The patient area with its consulting rooms, multipurpose hall, and gym is located centrally next to the atrium on level 02. E00 47

On the Architecture Laboratories The cancer research labs occupy three floors of the east wing of the building and are clearly separated according to function. The visible ceiling installations underscore this functionality. Situated parallel to the eastern façade is a documentation zone with six workstations per module. Thanks to the glazed partitions fitted with sliding doors, people working at these desks can still see what is going on in the labs. Proceeding inward are the dry workspaces followed by the wet workspaces and dark zone with refrigeration space and storage rooms. Situated along the northern façade is a wash-up room on level 01 and S2 labs on the other levels. Along the southern façade are the rooms for cell cultures as well as consulting rooms, offices, and recreational areas, which thanks to their glazed doors retain visual contact with the atrium and hence remain an integral part of it. Administration The tumor conference facilities are positioned centrally next to the multipurpose hall and gym. The two rooms one smaller, one larger can be connected by sliding away the movable partition to create one large room, which can be blacked-out completely. The gold-trimmed lampshades lend these rooms a touch of elegance, which in turn underscores the value of expert consultation. The offices for medical and scientific staff are located on levels 02 and 03 of the west wing. The director s offices are situated next to them on level 03. The movable partitions are made of satinized glass alternating with wooden panels. The side rooms are located in the core zone and thanks to their carpeting and color scheme form a single unit. The windows of the volume with the sculpted rendered façade feature oak window reveals with built-in shelves on the inside. The window reveals at the end of each corridor, however, contain benches to sit on, making them a place of interaction and communication. Next to the atrium is a spacious central conference room with large windows. E02 Floor plan level 02 48

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On the Architecture Atrium Patients, visitors, and staff enter the building from the northern forecourt. The central, light-flooded atrium which extends over four floors is the nerve center of the NCT, a communication hub, and meeting place for visitors and users. It is also the place where newcomers obtain their first overview of the NCT s facilities. Free-standing single flights of stairs lead visitors up from floor to floor. The parapets flanking the atrium and flights of stairs alternate between glass paneling and rows of oak laths allowing for many visual connections. There are flower beds with seats at various levels inviting people to linger. Several special places adjoin the atrium: situated in a central position on the ground floor is Patient Reception from which visitors are escorted to various parts of the building. The cafeteria in the style of a coffee bar which serves beverages and snacks is located on level 01 right next to the atrium, ensuring that it is clearly visible from the entrance area. The cafeteria has an extension in the form of a south-facing terrace with views of the patients garden and the Heidelberg Ion- Beam Therapy Center (HIT). The Raum der Stille is a quiet room for rest and relaxation that is clearly visible and accessible from level 02. To set this haven of peace and quiet apart, it is screened off on the outside by a web of stainless-steel strips, while the inside takes the form of a freely sculpted shell with a skylight that allows occupants to gaze up into the sky. Longitudinal section / Atrium 51

On the Architecture The grounds The new building is reached via a driveway at the northeastern end of the Neuenheimer Feld campus. The grounds are divided into three areas, each of which has its own distinctive character: an open, spacious entrance area; a spatially contained, almost intimate garden in front of the day clinics; and an area set aside for parking. Criss-crossing the grounds are trimmed hedges of varying height, which make for both a nuanced sense of space and a peaceful atmosphere. The language of forms used for the grounds supports that of the architecture and makes this a very special and distinctive part of the campus. The attractively designed entrance area comprises the driveway, the forecourt, and the foyer. The paving on the outside continues on the inside, extending all the way from the parking lot and forecourt into the entrance area without so much as a single step. Context Level 99 next to the sunken courtyard provides an underground connection between the Head Clinic / Heidelberg Ion- Beam Therapy Center, and the Children s Hospital / Gynecology Clinic / Dermatology Clinic. Shallow ramps are provided to level out the differences in height between the various areas. Large, oak-framed windows make for a well-lit corridor as well as affording patients framed views of the garden in front. The graphic designs on the wall of the corridor passing through the campus of Heidelberg University Hospital provide a constant reminder of the NCT. The technical systems are housed underneath the laboratory wing. All the rainwater that falls on the building is collected in a trough and fed into the groundwater. A combination of activated slabs and air-conditioning used only where necessary helps minimize the installation and running costs of the ventilation system. The building thus complies fully with the requirements of an energetically optimized functional building. The NCT s supply and disposal systems are extensions of those already in place in the hospital. The gardens belonging to the day clinic on level 00 allow patients to stroll round the garden while receiving treatment or waiting their turn. The trimmed hedges shield them from view, while the gardens themselves are divided up into paved terraces and modeled flower beds. Exotic maples are planted at irregular intervals throughout the gardens. 52

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Art at the NCT SCULPTURE OF MILDRED SCHEEL Sabina Grzimek Fulfillment for a sculptor means imagining yourself as another, capturing the essence of that other in a sculpture, and then seeing that fleshed-out manifestation positioned in an architectural context in which it can unfold its full potency. This is also the story of my sculpture of Mildred Scheel. For what formed my work was not just the importance of Dr. Mildred Scheel as a public figure, but above all her warm and empathic nature. The sculpture in her honor is to stand here in Heidelberg, in the National Center for Tumor Diseases, a building designed and built by Behnisch Architekten whose central atrium is a high rhomboid space with refracting light flooding in from above. I modeled the 2.40 m figure in clay and then had it cast in bronze. Preceding that large figure were two much smaller studies (one 23 cm and the other 54 cm high), a 92 cm movement study done from a model, a larger-than-life head executed in plaster, and various drawings and paintings. While working on the sculpture, I kept a log containing drawings, photos, and texts. German Cancer Aid supplied me with photographs and video footage of Mildred Scheel, but it was the videos that made this tall, slim, elegant woman come alive for me. My sculpture had to embody all the many different facets of her character, yet at the same time find an abstract idea to convey the essence of her person. The sculpture of Mildred Scheel gives the new cancer center a face. Works by Sabina Grzimek (selected) Weinheimer Reiterin (Horsewoman of Weinheim), Weinheim, pedestrian passage; Grabstein für Dr. Renate Lepsius (Grave Monument for Dr. Renate Lepsius), Weinheim; Trümmerfrauendenkmal (Monument to the Rubble Women), Heilbronn, Hafenmarktturm; Mutter und Kind (Mother and Child), Heilbronn, Frauenklinik; Junges Paar (Young Couple) Mannheim Cemetery; Sich Umwendender (Turning Figure), Kamp Lindfurth Park; Sinnende (Pondering Figure), Chemnitz, Theaterplatz; Gerhart Hauptmann-Denkmal (Monument to Gerhart Hauptmann), Erkner, Gerhart Hauptmann Museum; Liegende und stehende Gruppe (Lying and Standing Group) and Mutter und Kind, Magdeburg, Museumspark; Mutter und Kind, Berlin-Lichtenberg, Freyaplatz; Brunnenplastik (Fountain), Berlin, Pratergarten; Sinnende, Berlin, Humboldt University; Pferd (Sandstein) (Horse [Sandstone]), Koserow (Usedom), Otto Niemeyer-Holstein Gedächtnisstätte; Klöppel Relief, Darmstadt Biography of Sabina Grzimek 1942 born in Rome, raised in West and East Berlin 1961 62 work experience at the Meissen porcelain manufactory 1962 67 studied sculpture in Berlin-Weissensee 1967 69 freelance sculptor, painter, and graphic designer in Berlin-Prenzlauer Berg 1969 72 masterclass student at the Academy of the Arts, Berlin 1975 birth of son, Anton Schwarzbach from 1972 freelance artist in Berlin and Erkner 1979 birth of daughter, Anna Maria Grzimek 1997 02 guest lecturer at the School of Graphic Design in Anklam with extended visits to Hungary, Siberia, Uzbekistan, Italy Left: first study, 23 cm high, bronze, 2009 Right: second study, 54 cm high, bronze, 2009 sabina.grzimek@web.de / www.sabinagrzimek.de 54

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The Partners Introduce Themselves The German Cancer Research Center (DKFZ) is the largest biomedical research institute in Germany. It was set up as a foundation under public law in Heidelberg in 1964 on the initiative of the surgeon and cancer researcher Karl Heinrich Bauer. GERMAN CANCER RESEARCH CENTER, HEIDELBERG The center s 2,500 staff, including more than 1,000 scientists from forty-five different countries, engage in research to investigate the mechanisms of cancer and to identify cancer risk factors. The DKFZ s more than sixty research divisions, junior research groups, and clinical cooperation units address issues such as signal transmission within and between cells, genomic research, epidemiology, and the role played by the immune system in cancer. New imaging and radiotherapy techniques are also investigated, as is the question of how cancer can be triggered by infections. DKFZ scientists use their research findings to develop new approaches to the prevention, diagnosis, and treatment of cancer. The DKFZ has made significant advances both in basic research and in the development of new clinical methods in recent years. The best example of this was the awarding of the Nobel Prize for Medicine to Professor Harald zur Hausen in 2008. Zur Hausen, for many years the DKFZ s Scientific Director, was the first to identify the causal role played by human papillomaviruses (HPV) in cervical cancer. Over and above research, the DKFZ also provides a National Reference Center for Cancer Information (the Krebsinformationsdienst or KID) so that cancer patients, their families and friends, and anyone else interested can obtain free, scientifically founded, and neutral information on all aspects of cancer by telephone, e-mail, or via the internet. The DKFZ, a member of the Helmholtz Association of German Research Centers, receives 90 percent of its funding from the Federal Ministry of Education and Research and the remaining 10 percent from the State of Baden-Württemberg. 56

Heidelberg University Hospital is one of the largest and most highly regarded medical centers in Germany, while Heidelberg University Medical Faculty is one of Europe s leading centers of biomedical research with a tradition dating back over 600 years. HEIDELBERG UNIVERSITY HOSPITAL AND MEDICAL FACULTY Their shared objective is to develop new therapies and get them from bench to bedside as rapidly as possible, often by working hand in hand with partners on the same campus, such as the German Cancer Research Center, or elsewhere in Germany and abroad. The treatment of cancer patients and development of new methods of diagnosing and treating cancer are an especially important focus. Of the more than 550,000 patients per year who receive inpatient or outpatient treatment at Heidelberg University Hospital with its forty different clinics and some 2,000 beds, some 40 percent are tumor patients. The hospital has won special acclaim for the treatment of pancreatic cancer and multiple myeloma, for stem-cell transplants, and for multimodal radiation therapy, which in 2009 was further upgraded by the opening of the Heidelberg Ion- Beam Therapy Center (HIT) to date the only facility of its kind in the world. The Hospital and Medical Faculty employ some 10,000 people and are actively involved in training medical students, physicians, and consultants. Training for nursing staff is also provided by the hospital s own Academy of Healthcare Professions. The Medical Faculty pursues a broad spectrum of internationally competitive research, ranging from basic research in molecular biology to applied clinical research and clinical studies. As part of the German government s Excellence Initiative, it is a key player in a Cluster of Excellence, a graduate school, and Heidelberg University s interdisciplinary Marsilius Kolleg. 57

The Partners Introduce Themselves THORAXKLINIK AT HEIDELBERG UNIVERSITY HOSPITAL The Thoraxklinik at Heidelberg University Hospital is a 100-year-old maximum care hospital which in 2009 became an accredited lung cancer center. It specializes in the treatment of patients with diseases of the lungs, central respiratory passages, mediastinum, pleura, and chest wall. The clinical focus is on the surgical treatment of lung cancer, minimally invasive procedures on the thorax, interventional bronchoscopy, and the application of antineoplastic systemic therapy. In addition to direct patient care, the clinic has also taken up the challenge of developing new, standard-setting diagnostic and therapeutic methods. It collaborates closely with Heidelberg University Hospital and the German Cancer Research Center. Thoracic Surgery and Internal Medicine-Oncology are the only such departments to have a full professor on the University of Heidelberg Medical Faculty. The Thoraxklinik has three large inpatient departments for Thoracic Surgery, Internal Medicine-Oncology, and Internal Medicine-Pneumology/Respiratory Medicine, as well as an Anesthesia department that includes an interdisciplinary intensive care unit. Daily interdisciplinary conferences (tumor boards) ensure that all the patients entrusted to it are diagnosed and treated in keeping with recognized guidelines. 58

DEUTSCHE KREBSHILFE E.V. (GERMAN CANCER AID) For people, against cancer German Cancer Aid actively fighting cancer for thirty-six years Dr. Mildred Scheel founded German Cancer Aid as a citizens action group against cancer on September 25, 1974. Since then, the nonprofit organization has become a force to be reckoned with in German healthcare. Numerous developments of recent decades in both cancer medicine and cancer research can be traced back to the work and initiatives of German Cancer Aid. Every year, some 450,000 people in Germany are diagnosed with cancer, among them some 1,800 children and young people aged under fifteen. Helping these people and their families and friends is German Cancer Aid s most important mission. The organization, whose motto is Helping. Researching. Informing. supports projects aimed at improving the prevention, early detection, diagnosis, treatment, and aftercare of cancer; it also promotes the psychological and social care of patients and patient self-help groups. German Cancer Aid publishes and disseminates information on cancer and ways of preventing cancer or of detecting it early on. It regards itself as an advocate of all cancer patients and by becoming actively involved in medicine and research at all levels and lobbying the government on healthcare and research policy ensures that cancer patients in Germany receive the best care available. German Cancer Aid does not receive any public funding but finances all its activities exclusively from donations and voluntary contributions from the general public. German Cancer Aid has four subsidiary organizations: the German Children s Cancer Aid Foundation, the Dr. Mildred Scheel Foundation for Cancer Research, the Mildred Scheel Association, and the Dr. Mildred Scheel Academy for Research and Education. German Cancer Aid, like its subsidiary organizations, operates from its headquarters in Bonn and since 2007 has had an office in Berlin to coordinate its lobbying activities. Further information on German Cancer Aid is available at www.krebshilfe.de. 59

Project Data & Impressum PROJECT DATA NATIONAL CENTER FOR TUMOR DISEASES, HEIDELBERG Property owned by Property and Building Works Baden-Württemberg Heidelberg University Buildings Department www.uba-heidelberg.de Client Deutsche Krebshilfe e.v. (German Cancer Aid) / Dr. Mildred Scheel Foundation for Cancer Research www.krebshilfe.de Users NCT Heidelberg Supporting organizations: German Cancer Research Center (DKFZ) Heidelberg University Hospital Thoraxklinik at Heidelberg University Hospital Deutsche Krebshilfe e.v. (German Cancer Aid) www.nct-heidelberg.de Client s representative, project coordinator, health and safety coordinator B.I.S. GmbH Beratende Ingenieure Schaaf, Munich www.bis-network.de Architecture, landscape Behnisch Architekten, Stuttgart Stefan Behnisch, David Cook, Martin Haas www.behnisch.com Engineering Pfefferkorn Ingenieure, Stuttgart www.pfefferkorn-ingenieure.de Technical systems ZWP Ingenieur-AG, Dresden www.zwp.de Laboratory planning, medical equipment woernerundpartner planungsgesellschaftmbh, Frankfurt/Dresden www.woernerundpartner.de Building physics ITA INGENIEURGESELLSCHAFT FÜR TECHNISCHE AKUSTIK WEIMAR MBH, Weimar www.ita.de Project supervision, tendering bauleitende ingenieure porstein gmbh, Dresden www.pro-leitung.de Furnishings, labs German Cancer Research Center (DKFZ), Heidelberg www.dkfz.de Furnishings, medical Heidelberg University Hospital Office of Medical Equipment Planning / Center for IT and Medical Engineering www.klinikum.uni-heidelberg.de Legal advice Rechtsanwälte Christoph Schmidt, Dresden www.vanrecum.de Fire safety Heidelberg Fire Service Fire Prevention Division, Heidelberg www.feuerwehr.heidelberg.de Smoke simulation I.S.T. Integrierte Sicherheits-Technik GmbH, Frankfurt www.ist-net.de Lighting consultant Belzner Holmes LDE, Stuttgart www.lde-net.com Signage Ockert und Partner, Stuttgart www.ockert-partner.com 60

IMPRESSUM Footprint 5,565 m² Gross floor area 13,120 m² Gross built-up volume 55,875 m³ Total costs 29,000,000 (gross) Competition February 2005 Planning commenced February 2007 Construction commenced May 2008 Topping-out March 13, 2009 Completion / Keys handed over August 2010 Completion ceremony November 2, 2010 Published by National Center for Tumor Diseases Heidelberg Im Neuenheimer Feld 460, 69120 Heidelberg www.nct-heidelberg.de Account for donations 7421500429, code (please always quote): D 100 70680, LBBW Stuttgart, BLZ 600 501 01 German Cancer Research Center Im Neuenheimer Feld 280, 69120 Heidelberg www.dkfz.de Account for donations 0157008, Deutsche Bank Heidelberg, BLZ 67270003 Heidelberg University Hospital Im Neuenheimer Feld 672, 69120 Heidelberg www.klinikum.uni-heidelberg.de Thoraxklinik-Heidelberg ggmbh Amalienstr. 5, 69126 Heidelberg www.thoraxklinik-heidelberg.de Deutsche Krebshilfe e.v. (German Cancer Aid) Buschstr. 32, 53113 Bonn www.krebshilfe.de Account for donations 82 82 82, Kreissparkasse Köln, BLZ 370 502 99 Graphic design OCKERTUNDPARTNER, Stuttgart Printed by Dr. Cantz sche Druckerei, Ostfildern Photo credits Philip Benjamin (5, 13, 16, 17, 19, 27, 28, 29, 31, 34) Sabina Grzimek (54) Adam Mørk (Cover, 55) Frank Ockert (40 41, 45, 46, 49, 50, 53) Medienzentrum Universitätsklinikum Heidelberg (23, 24, 37) Neither this publication nor any part thereof may be reproduced unless all sources are cited and prior permission obtained. NCT-Hotline for patients: +49 (0)6221 56 48 01