The air was full of promise and excitement when hundreds of people, including some of Indiana’s top power players, gathered on Aug, 21, 2008, to dedicate the $150 million Simon Cancer Center, a sparkling addition to the IUPUI campus.
A jazz ensemble played in the lobby as people milled around the modern, five story-building, inspecting the outpatient infusion stations decked out with fireplaces, the surgical suites with the latest equipment, and a 45-foot mobile suspended from the ceiling in the heart of the building.
“Today as we dedicate this building, we celebrate the patients and families whose hope rests on the shoulders of our remarkable physicians,” Indiana University President Michael McRobbie told the crowd.
Under one roof, more than 200 physicians and researchers would offer the latest in cancer care, research and education, bringing together experts that had been scattered throughout various buildings, into a handsome home connected to University Hospital, one of the leading teaching hospitals in the state.
But today, just 12 years later, the future of the Simon Cancer Center, a partnership between the Indiana University School of Medicine and Indiana University Health, is full of questions.
Over the next six years, the building will be emptied, and clinics and labs moved two miles north, near Methodist Hospital, as part of a massive transformation and expansion of IU Health’s downtown medical campus. IU Health officials confirmed to IBJ last month that the Simon Cancer Center would not remain as a stand-alone unit at its current site after the transformation, as some had speculated.
The plan calls for IU Health to expand the Methodist Hospital campus by eight blocks, or 44 acres, anchored by a new, $1.6 billion hospital. The campus also will house much of the IU School of Medicine, which will move from the IUPUI campus.
It’s unclear exactly where the cancer center will be located on the new campus or what it will look like, including whether it will continue to have a stand-alone building or will be tucked inside the new hospital. IU Health said the campus design is still in the works.
The current building was funded in part by a $50 million gift from the late Melvin Simon and his wife, Bren—half to support research and half for the construction. But it’s unclear whether the new cancer center will continue to bear the Simon name. IU Health would only say it would “honor the Simons within the design of the medical center campus.” It did not give details.
Dr. Jay Hess, dean of the Indiana University School of Medicine, told reporters in 2015 when the downtown campus transformation was first announced: “There will always be an IU Simon Cancer Center.”
Quick shift in plans
Even so, the decision to move the Simon Cancer Center’s dozens of labs and clinics raises questions about why such a costly building was erected in the first place, only to be abandoned so soon. By 2026, the center’s services will be moved completely out of its current building.
“That’s pretty quick for the amount of money that was put into it,” said Ed Abel, director of health care practice at Indianapolis-based Blue & Co., an accounting and consulting firm.
Some physicians and health care administrators privately say the cancer center is a casualty of uncoordinated plans a decade or so ago and of business results that might have fallen short of targets.
The Simon Cancer Center was designed with an abundance of inpatient rooms and surgery suites for overnight care, just as the industry shifted to mostly outpatient care. The center was designed for 80 private patient rooms, but today has just 46 staffed beds in its oncology and surgical intensive care unit.
When the cancer center opened, officials said the third and fifth floors would be dedicated to inpatient beds. They didn’t say what they would do with the fourth floor. Five years ago, IBJ reported that the top floor of the 405,000-square-foot facility remained unused by patients, due to a flat number of inpatient visits. Simon Cancer Center officials say they have since added clinical and administrative space on the third and fourth floors.
The use of the lower floors has shifted as well. A press release issued in 2008 said the lower floors would be used for surgery, radiation, hematology and infusion, along with space for a pharmacy and guest services. The center has since moved some of those functions around, and built a dedicated outpatient bone marrow transplant clinic and infusion center on the lower floors.
Today, Simon Cancer Center officials say the building is well-used, with inpatient admissions and outpatient visits trending upward. But they declined to provide any numbers. Unlike hospitals, which are required to provide those figures every year to state and federal health agencies, cancer centers and other specialized operations don’t have to.
“We have a vibrant campus program in the Simon footprint,” said Katie McGill, executive director of the IU Health side of the operations.
By any measure, the Simon Cancer Center is an unusual hybrid. It is a partnership of two separate organizations with similar names and historic connections, making the operation challenging to analyze.
IU Health, the state’s largest hospital system, oversees the center’s patient care, including surgeries, chemotherapy and follow-up treatments, which make up much of the building’s activity, with hundreds or thousands of patients a month driving downtown to get treatment.
Meanwhile, the IU School of Medicine, the largest medical school in the nation by enrollment, oversees the center’s research and education programs, as well as clinical trials, where patients are administered experimental cancer drugs.
It’s not always clear where one organization ends and the other begins. IU Health owns the 405,000-square-foot building, but IU owns the land underneath it, as part of the medical school on the IUPUI campus.
On their websites, each of the two partners brands the cancer center under its own name—as either the IU Simon Cancer Center or the IU Health Simon Cancer Center. They even provide different addresses: IU Health Simon Cancer Center on West Michigan Street, or IU Simon Cancer Center on Barnhill Drive. The building sits at the intersection of the two streets.
“The Simon Cancer Center for me is a little bit of an enigma,” said Abel, who has worked in the health care industry for more than 40 years.
“I’ve seen the name. I can speculate as to what it is. But it’s hard to explain. So I think it’s one of two things: It’s one of those hidden diamonds in the rough that nobody talks about and really does outstanding work, or is just not working.”
He added: “And, as with most things, it’s probably somewhere in between.”
But Simon Cancer Center leaders say the research and patient care inside are some of the best in the nation and the current location is working well. The center is the only one in Indiana to win recognition from the National Cancer Institute as a “comprehensive cancer center,” a federal designation that recognizes centers for their scientific leadership in laboratory and clinical research, in addition to patient care and community service.
And there’s no question the center is in the forefront of cancer research. Researchers have made discoveries in cancers across a range of systems, from bladder and prostate to myeloma and leukemia. The center’s bone marrow and stem cell transplantation programs are internationally recognized. It is one of the few health care systems in the state to offer CAR-T treatments, in which a patient’s immune-system cells are genetically engingeered in the laboratory so they will attack cancer cells.
Indeed, IU officials consider the Simon Cancer Center a home base for researchers and scholars across the university’s multiple schools, departments and campuses.
“In this way, it is a center without walls to serve the state of Indiana,” said Dr. Patrick Loehrer, IU’s director of the Simon Cancer Center and a professor of oncology at the IU School of Medicine.
Together, McGill and Loehrer say they administer the Simon Cancer Center under a so-called “dyad” management model, or an equal partnership of an administrative leader and a physician leader.
Along the way, the Simon Cancer Center has picked up hundreds of millions of dollars in grants and gifts from sources ranging from the National Cancer Institute to the Simon family and the Vera Bradley Foundation for Breast Cancer.
Advocates are watching
In the Indianapolis cancer community, dozens of outside groups are keeping an eye on the center to see whether the move will mean big changes. Some patient advocacy organizations say they hope the new location will have space for them. Five not-for-profits share a collaborative space in the current building, which they call a Cancer Resource Center.
“It’s really a one-stop shop for cancer patients and their family members to access a myriad of services in the central Indiana community,” said Eric Richards, president and CEO of Cancer Support Community of Central Indiana, one of the groups.
“We would be very interested in having another similar Cancer Resource Center in the new space and would definitely like to be a partner in that conversation,” he said.
Fred Duncan, director and CEO of the Indianapolis-based Little Red Door Cancer Agency, which offers screenings, educational materials and other services, also said he hopes IU and IU Health open a shared resource center at the new campus.
“I’m sure that they will create an amazing outpatient center for cancer patients in the new facility,” he said.
Part of the widespread interest is that cancer is one of the most vexing disease areas in medicine. Even though survival rates are improving, cancer is expected to kill more than 600,000 people this year, making it one of the leading causes of death, according to the National Cancer Institute.
But another reason for the spotlight is that cancer care can be lucrative. From a business perspective, hospitals view cancer as a gateway for expensive surgeries, radiation treatments, chemotherapy with high-margin drugs, and follow-up care.
Around central Indiana, hospital systems are scrambling to offer the most convenient cancer care, with all medical and support teams in one place, rather than requiring patients to visit numerous locations for various treatments.
In 2017, Community Heath Network opened a $60 million cancer center connected to its Community Hospital North on North Shadeland Avenue. Six years ago, it opened another cancer center at its Community Hospital South.
Franciscan Health and Ascension St. Vincent have been bulking up their cancer care within hospitals, buying additional linear accelerators, multimillion-dollar pieces of technology that beam high-energy particles to destroy cancer cells.
Even smaller hospitals around central Indiana are pouring millions of dollars into cancer care–from Riverview Health, which spent $4 million for an infusion center in Noblesville that opened last year, to Hancock Regional Hospital’s $10 million cancer center in Greenfield, which opened in 2015.
And IU Health in January opened a $55 million cancer center in Carmel, connected to its North Hospital on North Meridian Street. One of the main selling points for the gleaming, two-story, brick-and-glass Schwarz Cancer Center: IU Health patients on the north side of Indianapolis and in the northern suburbs didn’t want to drive all the way downtown, look for parking and walk several blocks to the Simon Cancer Center.
“I would have to say we didn’t know in 2008 [when the Simon Cancer Center opened] what we know now,” McGill said.
“We certainly have learned a lot about cancer care in general as it has shifted and new treatments have come to market,” she said. “But also just what patients are willing to pay for.”
What they are willing to pay for, she said, are efficiency and the best care possible. And that will be made easier when the Simon Cancer Center is moved closer to many other hospital functions a cancer patient might need.
Still, that was the argument IU and IU Health—then known as Clarian Health—made more than a decade ago when they unveiled the Simon Cancer Center.
The new building, the organizations said, would combine “the latest in cancer therapies in one location” and would make care “less stressful for the patient and their loved ones,” according to a 2008 press release.
But the vision ran into trouble quickly. A strategy presentation given by top officials of IU Health cancer care in 2012, obtained at the time by IBJ, concluded that the inpatient market was flat, so increasing patient volume would need to focus on luring patients from the center’s competition.
That presentation set a two-year goal of raising IU Health’s inpatient market share to more than 45%. But by the end of the year, IU Health suddenly shelved those plans and turned its attention to cost-cutting, including plans to close University Hospital.
In recent years, however, as high-tech treatments such as CAR-T became available, the Simon Cancer Center has been filling up its beds—at least until the COVID-19 pandemic hit, and many hospitals and clinics delayed nonessential treatments.
“We were nearly at full capacity, with demand for cancer beds [and] transfers from other facilities typically exceeding availability on most days,” Loehrer said. “With the expanded role for CAR-T therapy and other immuno-oncology treatments, the demand will be growing further.”•