In the year and a half of its existence, the Cancer Treatment Panel saw approximately 250 patients. A great deal of knowledge was gained. Among other things, the doctors felt that they should have an opportunity to examine the patient's records prior to the panel. They possibly should have a chance to research the particular type of cancer in advance. They wanted an opportunity to discuss the case amongst themselves prior to discussing the case openly in front of the patient and their family and friends. They conscientiously felt that they were depriving the patients of the best possible solutions.

Annette and I have a goal of giving the next person who gets cancer the best possible chance of beating it. We do not want to be associated with anything that is second-best. If the doctors had this many objections to what was agreed to be the best thing available, then we had to find a way to improve it.

In keeping with the thought that people who have cancer and do not have the time or money to go out of town should still have the opportunity to receive proper treatment, we decided to try to open a treatment center to serve them. We would incorporate the best aspects of all the centers around the country. We could probably get the primary structure built for around $100 million. That, however, was not a realistic approach.

Furthermore, all the resources were currently available in Kansas City, but they were fragmented. We had radiation-therapy equipment sufficient for any need scattered throughout the various hospitals. As a matter of fact, a survey showed that we had a surplus of radiation equipment. We had a sufficient quantity of oncologists, pathologists, radiation therapists, radiologists, surgeons, hematologists and other specialists who, we believe, were as qualified as any in the country. We certainly had enough hospital beds and related facilities. The problem was, as in most cities, that all of this was fragmented. We spent many hours discussing the problem and trying to figure out a practical solution. How could we as laymen organize the available resources and do this so it could be copied in other cities?

The critical element in successfully treating cancer is in promptly receiving the proper treatment. In other words, it is doctors and knowledge that successfully treat cancer, not bricks and mortar. We know that cancer is more than a hundred different diseases. There is no relationship between breast cancer and brain cancer other than the name and the fact that they are both rapidly dividing cells. It is impossible for one general doctor to be informed on the latest and best treatment for every type of cancer. Furthermore, it is impossible for one specialist, such as a surgeon, radiotherapist or oncologist, to know the very latest and best treatment in his own specialty for every one of the more than one hundred different types of cancer.

Our initial thoughts were subsequently substantiated in the draft of the May, 1985 publication of the National Institutes of Health entitled Cancer Control Objectives for the Nation 1985-2000. It stated, "The application of the state-of-the-art treatment is complex. At all levels of the health service delivery system-from the primary care physician who has initial contact with the patient to specialists directing the cancer treatment- physician knowledge is not yet optimal. That knowledge should include an appreciation for state-of-the-art treatment information and an interest in ensuring early multidisciplinary decision making. ....For about 70 percent of cancers, optimal therapy derives from multidisciplinary discussions. The relative rarity of some of the most responsive tumors means that proficient treatment can be maintained only at some major cancer centers. ...Malpractice considerations may result in physicians selecting "safe" therapy, which neither offers significant risk nor the chance of cure ....A major determinant of outcome for most newly diagnosed cancer patients with curable disease hinges on early multidisciplinary treatment planning and the availability of expertise and resources to carry out such a treatment plan."

On this premise, we came to the conclusion that our goal was the establishment of panels similar to the Cancer Treatment Panel. Furthermore, this series of panels should have a home in an absolutely neutral site. We determined that the ideal site would be on an academic campus with no medical facilities at hand. In our case, this was the University of Missouri at Kansas City.

Now, how do we go about getting all the doctors and hospitals to cooperate and make it a joint effort? We would make it a not-for-profit organization to be governed by a board of directors composed of one representative from each major hospital in the metropolitan area. To our knowledge, this is the only time all the hospitals in the area have cooperated on any project.

Four outstanding physicians representing different specialties met at our home from November 1981 through April 1982 to plan the details. All the planning was based on a set of fundamental principles that were derived from one primary statement, "Everything will be done that is for the best interest of the patient, and nothing will be done that is not for the best interest of the patient."

Because there is a great deal of psychology involved in the recovery from cancer, it was felt that the Center needed to be in a prestigious appearing facility. While the University of Missouri at Kansas City (UMKC) was an ideal setting for our needs, we would prove to be a tremendous asset to the University, which is involved in research and dissemination of knowledge. Our Center would be a focal point for cancer activities in the area and eventually be part of a network comprising several universities, which would share knowledge and progress made in cancer care.

It was agreed that our goal was to help cancer patients, not build a mammoth institution. Our hopes were for this Center to be a prototype to be copied by other institutions of learning around the country. The Center was designed with three examining rooms and one conference room.

The University provided a ground-floor area of a very imposing stone building on the campus with a private entrance and handsome exterior sign. Our decorator, James Gohl, donated his services in designing and decorating the Center, and he did an outstanding job.

The discussion as to the name of the Center was interesting, and it indicates the uniqueness of this disease called cancer. This was not a diagnostic center. Patients who went there had already been diagnosed as having cancer. This was not a treatment center. We did not have an IV bottle, an X ray machine, or anything else to give any kind of treatment. A physician could send his patient here with no fear that he would lose the patient to the Center. What we were was strictly a management center to recommend the proper treatment for cancer. Think about this! Have you ever heard of any other disease that requires management?

To assure our continuous personal support of this unique concept, we lent our personal names, Richard and Annette Bloch, and called it the R. A. Bloch Cancer Management Center.

On May 1, 1982, the R. A. Bloch Cancer Management Center became a reality. The date chosen was most significant and meaningful to us; it marked the second anniversary of the day I was told I was cured. It also was another step in fulfilling my promise to devote my life to helping people with cancer. Here is a project accomplished not only without any government money, but also with relatively little private money.

There was no charge to anyone to attend the panel. There was no bank account. No donations were accepted. The doctors generally would not even treat a patient they had seen on the panel. They wanted this to be truly an independent second opinion. They were donating their time to see that the patient had the best chance of beating cancer as easily as possible.

Volunteers organized a program to assist patients coming from outside the city. These volunteers 116 Cancer… there's hope were available to discuss and help with housing, transportation, restaurants, and so forth. We knew what a traumatic experience it is to go away from home for medical treatment. We wanted to make this as simple and pleasant as possible.

A great deal of discussion was held as to which geographic areas we should accept patients from. The initial purpose of the Center was to help people in Kansas City. However, if a person could not get proper service wherever they were, we would be available.

Initially, we received a tremendous amount of publicity from the Associated Press, United Press International, and various radio and TV networks. On the morning the Center opened, I was there with the Acting Director and the Director of Admissions. The three of us handled over two hundred calls from people all over the country wanting to come to the Center. The response was extremely gratifying, but, at the same time, it presented three major problems. People who were already receiving qualified care in their community wanted to come; people thought we had magic solutions, and there was no way we could handle this volume. Cancer cases must be treated promptly, and there was no way we could see so many people right away.

Our board of directors promptly made two restrictions: first, no more publicity on such a grand scale for the time being, and second, admissions were restricted to Missouri and Kansas. Why have someone travel hundreds of miles when a major cancer center is nearby? For individuals residing outside of Missouri or Kansas, institutions that have stated they will, if specifically requested, make available a multidisciplinary second opinion with the patient and friends or family present are listed on our web site at www.blochcancer.org. If you do not have access to a computer you may call the Cancer Hot Line (800-433-0464) and request a list be sent to you.

Much discussion was also held about the concept of physician referral-that is, whether to require a patient's physician to call before the patient could be admitted. Most physicians would prefer doctor referrals, so we started off requiring it.

An individual called me and said that his doctor refused to refer his father. The doctor's refusal was based on the fact that he knew the patient would be dead in two years, so there was no point in wasting the patient's time or the Center's time. When our doctors heard this, they promptly took in the patient. I understand the patient left with a more optimistic outlook. After that time, the Center's position was that it would like a doctor's referral or the opportunity to talk with the doctor as to the reason for his refusal to refer.

The Center did not want a patient who was running from doctor to doctor for no good reason. For the patient who is not satisfied with his doctor's prognosis or has any doubt in his mind about his doctor and cannot find qualified help locally, this Center or any more convenient Center should be available. Remember, you have to be selfish with your disease!

Of the first group of patients, all but one had to request their respective doctors to refer them. One patient whose doctor opposed his coming was found not to have cancer at all, even though this doctor was treating him for it.

The last few paragraphs may give the impression that many doctors were not in favor of the Cancer Management Center. The good doctors, the quality doctors, the qualified doctors were solidly in favor of the Cancer Management Center. These were the doctors who would normally insist that their patients get an independent second opinion prior to treatment. We had over one hundred physicians, from all specialties and representing all institutions in the area; they not only were in favor of the concept, but had volunteered to serve on the panels and were approved by a rigorous screening committee.

The panel made a point to never shake the patient's faith in their physician. These wonderful doctors on the panel generally concurred with the patient's prescribed or recommended treatments. This reinforced their confidence and enabled them to partake of their treatments with more certainty. Occasionally the doctors would recommend investigating additional methods of therapy or different treatments. This could only increase the patient's chance for success. The patient always left knowing they were better off for having come to the panel.

At the front entrance of the R. A. Bloch Cancer Management Center was a slogan for all physicians and patients to read and practice: