New deputy CMO brings Texas-sized expertise to Fred Hutch

Fred Hutch Cancer Center’s new deputy chief medical officer, Nicole Fleming, MD, brings expertise as a doctor, surgeon, researcher, administrator, mentor and mother of three school-age children that fits well with the mission of a recently merged organization coping with growing pains.

Fleming is a gynecologic oncologist specializing in the treatment of gynecologic malignancies with both surgical and systemic therapies. She  has spent the last 13 years at The University of Texas MD Anderson Cancer Center, the largest cancer center in the United States.

She played a key role in expanding regional cancer care — which also is a priority for Fred Hutch — as medical director of MD Anderson’s Sugar Land Cancer Center in suburban Houston.

“I have a real passion and love for women’s healthcare in general, but also for surgery, cancer treatment and research,” Fleming said.

At Fred Hutch, she will divide her time evenly between overseeing daily operations of the South Lake Union outpatient clinic and seeing patients.

“When you meet her, you realize that she is a very engaging person who really gets clinical medicine,” said Fred Hutch Chief Medical Officer Tom Purcell, MD, MBA. “I’m very excited about having another surgeon as part of our leadership team.”

Deputy chief medical officer is a new position at Fred Hutch.

In the three years since Purcell became chief medical officer, clinical volume increased by 30%, driven by the 2022 Fred Hutch merger with Seattle Cancer Care Alliance that integrated research and patient care into a single institution that also serves as UW Medicine’s cancer program.

“As we have grown in the size of our organization, involving the integration of University of Washington and all of the cancer care across the enterprise, it is a tremendous amount of work related to care delivery,” Purcell said.

Fleming emerged as the top candidate in a national search because of her administrative experience running the Sugar Land center as well as her expertise as both a medical oncologist and a surgeon.

“She’s worked at a big institution that has been very successful, so she’s going to bring a lot of ideas that we need,” Purcell said.

Minimally invasive surgery now the standard of care

Fleming attended University of Texas Medical School in Houston, where she was drawn to women’s health, oncology, and surgery.

She completed her residency training in obstetrics and gynecology at Duke University Medical Center and a fellowship in gynecologic oncology at UCLA Medical Center before returning to the Houston area to join MD Anderson.

She developed an expertise in minimally invasive surgery, including robotic-assisted laparoscopy.

Instead of opening the patient’s abdomen with one large incision, the surgeon makes a few small incisions and places cannulas through which narrow instruments held by robotic arms are inserted along with a high-definition 3D camera. The surgeon controls the instruments and camera at a console.

Benefits to patients include less risk of infection, reduced blood loss, less pain during recovery and shorter hospital stays. Patients may even be able to go home the same day after some procedures.

The technique is especially appropriate for select patients with early-stage uterine and ovarian cancers. The robotics platform allows surgeons to perform more precise movements in small spaces than they could with their own hands, and the camera gives them a much better picture of the anatomy than they could see with their own eyes.

“The benefits not only to the surgeon but also patients are growing through research,” Fleming said, particularly in using the camera for tumor detection. “We can actually perform smarter oncologic surgery now with the minimally invasive tools.”

She has contributed to that research herself as a collaborator in a study at MD Anderson that tested the efficacy of a specific fluorescent dye to identify the first lymph nodes in which cancer is most likely to spread.

“This type of research is taking oncologic surgery to the next level,” she said.” Can you use a targeted dye to show you where the cancer cells are during surgery and to make that area glow?  It is truly transformational.”

Robotic-assisted laparoscopy is no longer a niche specialty in her field.

“It’s the new standard of care,” Fleming said. “You have to learn this technology to stay current.”

Reaching patients where they live

Cancer centers such as Fred Hutch and MD Anderson treat the most difficult cases, provide the most complex therapies and pioneer new approaches through clinical trials for patients who have exhausted standard treatment options.

While it is a strength that sets them apart, it also creates a perception that they are the places patients go only when all else has failed.

“MD Anderson was always seen as a place to go for a second opinion if you have failed all standard therapies elsewhere and need a clinical trial, which may be similar to certain patient groups at Fred Hutch,” Fleming said.

Traffic and parking difficulties also influenced where people sought care.

“Some patients don’t want to travel to a busy downtown central location,” Fleming said. “That can be overwhelming to many patients. I personally have had patients who say, ‘I would rather not get care at MD Anderson if I have to drive into the central location because that adds to the stress of my cancer diagnosis and makes me more anxious.’  They were willing to accept potentially lower quality care and maybe even worse outcomes to alleviate that stress.”

That’s a familiar story in Seattle, as well. Fred Hutch has five community site clinics in the Puget Sound area with plans for further expansion, Purcell said.

“One year after I started at MD Anderson, we ventured out into smaller, ambulatory outpatient cancer centers that were located anywhere from 25 to 45 miles away from the central campus,” Fleming said.

In her first three years on the job, she was named medical director at one of the MD Anderson ambulatory cancer centers in Sugar Land, a suburb about 20 miles from downtown Houston.

“Not all cancer services can be delivered in a community setting, but a lot can," Fleming said. “We started small with clinical care and standard treatments, but then over time we were able to expand therapeutic clinical trials and radiation trials into community sites, which increased our reach with clinical trial enrollment and the diversity of the patient population we serve.”

Her primary focus will be on improving the efficiency and quality of care delivered at the main South Lake Union clinic, but she is eager to help with Fred Hutch’s expansion efforts.

“That's definitely something I'm very interested in here as well, because I think there's a tremendous opportunity to expand the high-quality Fred Hutch cancer care and research breakthroughs into different geographic regions throughout the state and even geographically in the surrounding states we serve here in the Pacific Northwest,” Fleming said.

Word of mouth was key to MD Anderson’s success in the community, Fleming said.

“Once one patient has a good experience, they talk to their friends and family members and the referring physician who actually sent them,” she said. “Over time, we really built something that was very patient-centered and continues to be successful today.”

A mentor’s advice: “You’ve got to know when to turn it on and turn it off”

Mentors have been important to Fleming throughout her career, and she provides many kinds of mentoring depending on the situation and need.

In 2020 and 2024 she received an Excellence in Teaching award from the Association of Professors of Gynecology and Obstetrics.

But some of the most important mentoring she has given and received involved figuring out how to be a mom and an oncologist at the same time.

Her advice: it’s OK for two working parents to ask for help, which will look different depending on shifting needs as children become more self-sufficient.

“In the early childhood years, getting help from family, utilizing a nanny or daycare service was critical for us, however, as our kids have gotten older, we see that our needs have changed and we no longer require as much assistance at home,” she said.

Fleming, her husband, Matt, and their three children moved to the Seattle area during the first week of August. They enrolled their 6-year-old in elementary school and their older children, ages 11 and 13, into middle school.

Getting them settled into new schools with new peer groups, sports and activities has kept her family busy.

She still remembers the advice she received from a mentor and physician-mom at MD Anderson about how to balance professional and home life.

It’s hard to do both equally well all the time.

Sometimes work will require more focus and energy and sometimes home will, making it less like maintaining a balance and more like flipping a switch.

“Her piece of advice to me always rings true to even today: You’ve got to know when to turn it on and turn it off,” Fleming said.

When things are going smoothly at home, you can turn it on at work and pour all your energy into writing that grant or publishing that paper.

“In academic medicine, everyone wants to get the New England Journal paper, and to be on podiums and to be well known for their work,” Fleming said. “But then a child’s or family need is going to come up and they really need you. You’ve got to know when to turn off the academic focus and turn it back on at home.”

From beginning to end

When it comes to a patient’s needs, Fleming relies on building strong relationships with everyone involved, including family, caregivers and other supporters.

“I’m a gynecologic oncologist,” Fleming said. “It’s a unique specialty because we are both a surgical and a medical oncologist all in one. For patients with gynecologic cancers, we see and treat them from the beginning and throughout the continuum of care.”

She wants patients to feel like she’s heard their concerns, answered their questions and explained clearly what’s happening to their bodies and what will happen next.

“What's very important to me is patients and caregivers need to have a deep understanding of their diagnosis and what the treatment options are,” Fleming said. “I never want a patient to leave my office saying I don't really know what I have and what the next step in the plan is.”

Fred Hutch will take its next steps with Fleming as the first deputy chief medical officer.