Dr. Fred Divers is a master of the long game. An oncologist with Genesis Cancer and Blood Institute in Hot Springs, he has spent more than two decades of a distinguished medical career in the trenches against cancer.
During that time, he has watched the pharmaceutical and medical industries develop far more effective medications delivered with a high degree of precision. More people than ever can claim cancer survivorship today, being given more quality years over mere consolation and being made comfortable while awaiting the end.
Divers’ voice rings like a bell as he shares the progress that hundreds of years of medical evolution and billions of dollars in research and development have brought humanity — but he stops short of claiming at-long-last victory over one of mankind’s most sinister and enduring plagues.
Dr. Fred Divers
Improved outcomes is one thing, but eradicating cancer is quite another, and Divers has been in this business too long to blind himself to medical realities.
“It drives me nuts when the American Cancer Society or any other group says, ‘Donate! We’re going to cure cancer.’ I just, like, throw up in my mouth,” he said. “I mean, these are your own cells, right, and normally they’re restrained, but if a mutation occurs in certain areas, it creates a competitive advantage for themselves. They’re just doing what they do, kind of like natural selection in fast-forward. It’s not a curable entity.
“This is not a virus that you can eradicate like we thought we did with measles or smallpox or whatever. We all have inheritable DNA with junk viral DNA, and we’re getting hit by cosmic neutrinos that pass through the earth into your DNA and cause damage. We smoke, we do things that are not healthy for our immune systems, and all that leads to cancer development, so there’s not a singular cure — but we can be better at diagnosing and detecting [cancer] earlier.”
For whatever is out of humanity’s control in its existential battle with cancer — one that dates back to ancient Chinese and Egyptian civilizations — the steps that the species can control appear to be working better today than at any time in history. In June, Cancer Today published an article entitled simply “Survivorship Soars,” in which the magazine gave a glowing assessment of the state of the industry.
The outlet cited results of a Journal of the National Cancer Institute study that found there were 18.1 million cancer survivors in the U.S, about four times as many as 30 years ago or, as The American Journal of Managed Care put it, 5.5 percent of the total U.S. population. About 7 out of 10 cancer survivors today had lived five or more years since being diagnosed, half had crossed the 10-year mark, and more than 1 in 10 had lived a quarter-century or more postdiagnosis.
Divers credits those strides to a better understanding of various cancer species and their individual characteristics. That, in turn, has enabled the medical community to attack strategically, using the medical equivalent of laser-guided missiles instead of lobbing hand grenades in the dark.
“Look at lung cancer. It used to be you got lung cancer, and we said, ‘Man, that’s tough. Sorry,’” he said. “You gave them four cycles or whatever, even if there was no benefit after that. We just treated them all the same.
“Now the lung cancer bucket is divided into literally 15 to 18 different slices based on genetic biomarker testing and mutations within the tumor. If you speak to me as an oncologist and say, ‘Hey, I’ve got lung cancer,’ I’m like, ‘OK, well, we need to know a lot more than that before I can even begin.’ As a result, we look at patients with Stage 4 lung cancer today, and 25 percent of them are still alive at five years.”
While all of that is undeniably positive, there still remain some very thorny issues when it comes to improving outcomes for cancer patients. The best and most cutting-edge drug or therapy in the world is of little use if it is out of the reach of the people who need it, for instance, which puts the onus on hospitals and cancer centers to improve access.
Some, like Rogers-based treatment center Highlands Oncology, have put considerable time and resources into physical expansion. Highlands operates six locations in northwest and north-central Arkansas, the most recent opening in Mountain Home in 2023. Jeff Hunnicutt, CEO, said bringing next-level cancer treatment to both urban and rural areas are goals of equal importance.
Jeff Hunnicutt
“As this area grows, we find having our cancer centers close to the [Interstate 49] corridor works really well,” he said. “It’s very easy to get to and from those locations, and as this region continues to grow, accessible points of care are going to become more important.
“Now for rural points of care, and I would say Mountain Home counts as more of a rural point of care, we continue to look at these hotspots of growth that are outside of northwest Arkansas. As people continue to migrate to more remote areas of our state, it’s going to be important to evaluate those on a case-by-case basis and absolutely look at the possibility of bringing high-level care to people in those more remote areas.”
Hunnicutt chalked up the company’s expansion strategy as part and parcel of delivering the best quality care available, as important as employing the latest medical robot or delivering quality face-to-face interaction at the bedside. He said facilities and practitioners that ignore that immutable fact of life in today’s health care arena do so at their own peril.
“One constant factor in caring for patients over the last 20 years in oncology has absolutely been the imperative of keeping the patient at the center of the journey,” he said. “It’s no secret we’re running businesses here, and you have to be able to keep the lights on and generate revenue, but what I’ve seen over the years is that when practices lose sight of that core tenant, it opens up a door toward declining reputation and poor patient experience. That’s a very quick and, unfortunately, perilous path.”
Hunnicutt said patient experience is a great equalizer in the marketplace and may, in fact, favor smaller treatment organizations that can often more easily pivot than larger health systems can.
“I think one major factor that sets Highlands Oncology apart from some of the other providers in the state is the truly independent nature of the practice as far as the patient experience and the possibility of reducing financial toxicity,” he said. “When you combine that lower cost of care with the ability to move quickly when it comes to business decisions, there’s an advantage in an independent setting’s ability to deliver a low-cost, high-quality patient experience.”
Little Rock-based CARTI has also aggressively expanded in the state, offering hematology/oncology services, radiation therapy and diagnostic radiology in various combinations at more than a dozen locations in Arkansas. They include small, rural communities from Clarksville to Crossett and Clinton to Stuttgart.
Jeremy Land, CARTI’s senior vice president of regional operations, said the organization’s impact on cancer care in the state extends well past the doors of its clinics.
Jeremy Land
“CARTI takes a holistic approach to patient care,” he said. “Even in communities without a CARTI Cancer Center, we partner with primary care providers and organizations to ensure patients’ needs are met. This may entail our physicians serving as sounding boards and second opinions or inviting local providers to join us for weekly tumor board meetings.
“We’re steadfast in our focus of offering early detection screenings and complementary services such as cancer genetics and risk management to help improve patients’ outcomes while also reducing health care costs. Increasing the utilization of proven screenings — such as mammograms, low-dose CT scans for lung cancer and prostate-specific antigen tests — is one of the most effective ways to enhance patients’ outcomes.”
Maintaining a physical and consultative presence on that scale takes resources, and given the state’s notoriously low reimbursement rates, CARTI, like most medical facilities in Arkansas, faces a daily challenge of generating the dollars it needs to operate.
“With greater access to [diagnostic and treatment] tools in rural areas of our state, we can reach patients sooner, ideally before the disease can advance, increasing the likelihood of successful treatment and better quality of life,” Land said. “While reimbursement rates have been a persistent challenge in oncology care, particularly for nonhospital systems, we’ve been fortunate to find generous individuals and organizations that connect with our mission of making trusted cancer care accessible.
“As a not-for-profit cancer care provider, CARTI is dedicated to maximizing our resources to deliver the best possible care. Our decisions have always been — and will continue to be — patient focused.”
Expansion by Highlands Oncology, CARTI and others continues to pay dividends from an economic development perspective. In 2024, the total annual economic impact of hospitals in Arkansas was more than $18 billion, up from $15.2 billion in 2022, a report released recently by the Arkansas Hospital Association states. Overall, the health care industry also provided jobs for more than 48,000 individuals last year, roughly 1,000 more than three years ago.
The curious reality of an industry that generates billions of dollars being made up of health care institutions facing an uphill battle to fund operations is not lost on administrators.
“Health care accounts for a significant portion of our GDP,” Land said. “The American Cancer Society estimates 19,700 Arkansans will receive a cancer diagnosis in 2025, While this statistic is sobering, survival rates for many types of cancer continue to improve.
“With increased accessibility, particularly to early-detection screenings, we can reduce the need for more expensive and invasive treatments, decrease cancer care costs, and improve patient outcomes. I believe there is a reason for hope in the fight against cancer.”
The University of Arkansas for Medical Sciences in Little Rock’s top cancer executive administrator, Dr. Michael Birrer, shares that optimism. He said the potential for increasing the economic impact of quality cancer treatment, as well as the benefits to society at large, is poised for a significant boost in the coming years as UAMS seeks to take the crucial element one step further in its ongoing quest to achieve National Cancer Institute Designation, a kind of Good Housekeeping Seal for cancer centers.
Dr. Michael Birrer
Awarded by the National Cancer Institute, NCI Designation alone is expected to generate $72 million in additional economic impact for Arkansas and create about 1,500 new jobs over five years, to say nothing of the impact it would have on the state as a destination of choice for patients coast to coast.
“The practicality is NCI Designation is a title, but it’s title with a certain amount of power,” said Birrer, vice chancellor and director of the UAMS Winthrop P. Rockefeller Cancer Institute and spearhead of the designation efforts. “First of all, you’re not going to get [designation] unless the cancer care is outstanding. That itself will benefit patients in Arkansas who are suffering from cancer. The general health of the state, I think, will get better as [cancer] competes with cardiac disease as either the state’s No. 1 killer or No. 2 killer, depending upon the week.
“I also think that [designation] will grow the product in at least two ways: First of all, cancer treatment is not just a UAMS experience. If we were designated, it will affect, in very positive ways, the entire state, which includes practices like Highlands Oncology, which we collaborate with, which will grow their business. We already have a joint venture with Baptist [Health] that will grow their product, bringing in Medicaid and Medicare dollars in addition to, of course, private insurers.”
Birrer said NCI designation could also benefit cancer treatment in Arkansas through major infusions of cash and medical weaponry. Designated institutions have access to grant funding that other health care entities do not and also carry clout with the world pharmaceutical manufacturers.
“We would have enough business to attract the Pfizers, the AstraZenecas, the Eli Lillys in some format, at least in Little Rock, if not elsewhere,” he said. “This is because we’ve got the use of their medications both commercially approved but also in clinical trials.
“There’s been this massive increase in clinical trials, which really serves the cancer patients of Arkansas because these are trials that go through all of the big four — lung, breast, [gastrointestinal], [genitourinary] tumors — and even includes rare tumors like multiple myeloma. That creates a portfolio [of drugs] that, no matter what your cancer is, it’s highly likely we’ve got something to offer you.”
UAMS is already working closely with drug companies to conduct testing of cancer medications, giving patients with few options left a ray of hope.
“We established the first academic Phase 1 unit in the state, trials where the companies have spent billions of dollars developing drugs, and they’re coming off the shelf for the first time in humans,” he said. “There’s a certain amount of risk involved, but these are patients who usually are at the end of their rope. They’re at the end of the natural history of their disease.
“We’ve got these Phase 1 trials where they’re new agents, new targets, and it’s been remarkable. We’ve had over a 30 percent response rate in our Phase 1 unit, including two notable patients who had refractory tumors, really had no other choices, and ended up in a complete response. The state needs more of this, and it doesn’t have to all be UAMS, but those kinds of really novel therapies are what cancer patients in Arkansas need right now.”
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