Podcasts about Global Oncology

public health booth health systems global oncology

Play Episode Play 55 sec Highlight Listen Later Jan 26, 2024 20:38

The Oncology Journal Club - Delivering Oncology News DifferentlyThe Oncology Podcast, brought to you by The Oncology Network, is proud to present the return of The OJC Meets, sister series of The Oncology Journal Club podcast.Professor Christopher Jackson meets Professor Chris Booth to discuss the ins and outs of common sense oncology.For papers, bios and other links visit the Show Notes on our website.For the latest oncology news visit www.oncologynews.com.au.We invite healthcare professionals to join The Oncology Network for free - you'll also receive our free weekly publication The Oncology Newsletter.The Oncology Podcast - An Australian Oncology Perspective

Oncology, Etc. – Dr. Patricia Ganz' Evolutionary Treatment Of The Whole Patient

Molecule to Market: Inside the outsourcing space

Play Episode Listen Later Sep 5, 2023 35:39

There was time during the early 70's when the field of oncology began to take hold where the singular focus was to extend the patient's life. In this ASCO Education podcast, our guest was one of the first to challenge that notion and rethink methods that focused the patient's QUALITY of life. Dr. Patricia Ganz joins us to describe her transition from cardiology to oncology (6:00), the moment she went beyond treating the disease and began thinking about treating the WHOLE patient (10:06) and the joy of the increasing numbers of patients who survive cancer (21:47). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Patricia Ganz: Leadership - Intrinsic LifeSciences Stock and Other Ownership Interests - xenon pharma, Intrinsic LifeSciences, Silarus Therapeutics, Disc Medicine, Teva, Novartis, Merck. Johnson & Johnson, Pfizer, GlaxoSmithKline, Abbott Laboratories Consulting or Advisory Role - Global Blood Therapeutics, GSK, Ionis, akebia, Rockwell Medical Technologies, Disc Medicine, InformedDNA, Blue Note Therapeutics, Grail Patents, Royalties, Other Intellectual Property - related to iron metabolism and the anemia of chronic disease, Up-to-Date royalties for section editor on survivorship Resources If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed on the podcast page. Pat Loehrer: Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: And I'm Dave Johnson, a Medical Oncologist at the University of Texas Southwestern in Dallas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of the podcast is to introduce listeners to interesting and inspirational people and topics in and outside the world of oncology. Pat Loehrer: The field of oncology is relatively new. The first person treated with chemotherapy was in the 1940s. Medical oncology was just recognized as a specialty during the 1970s. And while cancer was considered by most people to be a death sentence, a steady growth of researchers sought to find cures. And they did for many cancers. But sometimes these treatments came at a cost. Our next guest challenged the notion that the singular focus of oncology is to extend the patient's duration of life. She asked whether an oncologist should also focus on addressing the patient's quality of life. Dave Johnson: The doctor asking that question went to UCLA Medical School, initially planning to study cardiology. However, a chance encounter with a young, dynamic oncologist who had started a clinical cancer ward sparked her interest in the nascent field of oncology. She witnessed advances in cancer treatment that seemingly took it from that inevitable death sentence to a potentially curable disease. She also recognized early on that when it came to cancer, a doctor must take care of the whole patient and not just the disease. From that point forward, our guest has had a storied career and an incredible impact on the world of cancer care. When initially offered a position at the West LA VA Medical Center, she saw it as an opportunity to advance the field of palliative care for patients with cancer. This proved to be one of her first opportunities to develop a program that incorporated a focus on quality of life into the management of cancer. Her work also focused on mental, dietary, physical, and emotional services to the long-term survivors of cancer. That career path has led to many accomplishments and numerous accolades for our guest. She is a founding member of the National Coalition for Cancer Survivorship, served as the 2004 Co-chair of ASCO's Survivorship Task Force, and currently directs UCLA's Cancer Survivorship Center of Excellence, funded in part from a grant from Livestrong. Our guest is Dr. Patricia Ganz. Dr. Patricia Ganz: It's great to be with both of you today. Dave Johnson: We always like to ask our guests a little about their background, where they grew up, a little about their family. Dr. Patricia Ganz: Yes. I grew up in the city of Beverly Hills where my parents moved when I was about five years old because of the educational system. Unlike parts of the East Coast, we didn't have very many private schools in Los Angeles, and so public education was very good in California at that time. So I had a good launch and had a wonderful opportunity that many people didn't have at that time to grow up in a comfortable setting. Dave Johnson: Tell us about your mom. I understand she was a businesswoman, correct? Dr. Patricia Ganz: Yes, actually, my parents got married when my mom was 19 and my dad was 21. He was in medical school at the University of Michigan. His father and mother weren't too happy with him getting married before he could support a wife. But she worked in a family business in the wholesale produce business in Detroit. One of six children, she was very involved with her family in the business. And they were married, and then World War II started, my father was a physician in the military, so she worked in the family business during the war. After finally having children and growing up and being in Beverly Hills, she sat back and was a homemaker, but she was always a bit restless and was always looking for something to do. So wound up several years later, when I was in my early teens, starting a business with one of my uncles, an automobile parts business. They ultimately sold it out to a big company that bought it out. Pat Loehrer: Where did your father serve in World War II? Dr. Patricia Ganz: He was actually D-Day Plus 21. He was in Wales during the war. They had to be stationed and moved down into the south before he was deployed. I have my parents' correspondence and letters from the war. He liberated some of the camps. Actually, as I have learned about the trauma of cancer and post-traumatic stress that happens in so many people, our military veterans, most recently, I think he had post-traumatic stress. He didn't talk very much about it, but I think liberating the camps, being overseas during that time, as it was for that silent generation, was very profound in terms of their activities. He wound up practicing medicine, and Los Angeles had a practice in industrial medicine, and it was a comfortable life. He would work early in the morning till maybe three or four in the afternoon and then go to the gym, there were moonlighting physicians who worked in the practice. But I kind of saw an easy kind of medicine, and he was always very encouraging and wanted me to go into medicine -- that I could be an ophthalmologist or a radiologist, good job for a woman. But I didn't really see the tough life of some of the internists and other people who were really working more 24/7, taking care of patients in the way medicine used to be practiced. Dave Johnson: Yeah. So you were interested in, early in your career, in cardiology. Could you tell us about that, and then a little bit more about the transition to oncology? Dr. Patricia Ganz: I went away to college, I went to Harvard Radcliffe and I came home during the summers. And was interested in doing something during the summer so I actually in a pediatric cardiology research laboratory as a volunteer at UCLA for a couple of summers between my freshman and sophomore year then my sophomore and junior year. And then I actually got a California Heart Association Fellowship between my junior and senior year in college. And this pediatric cardiology lab was very interesting. They were starting to give ketamine, it had an identification number, it wasn't called ketamine. But they were giving it to children in the cardiac cath lab and then were very worried about whether it would interfere with measuring the pressures in the heart. So we had intact dogs that had catheters implanted in the heart, and the drug would be given to the animals and we would then measure their pressures in the heart. That cardiology experience in 1970, the summer between my first and second year of medical school, the Swan-Ganz catheter was being tested. I worked at Cedars that summer and was watching them do the various studies to show the value of the catheter. And so by the time I was kind of finishing up medical school, I'd already invested all this time as an undergraduate. And then a little bit when I was in medical school and I kind of understood the physiology of the heart, very exciting. So that's kind of where I was headed until we started my internship. And I don't know if any of you remembered Marty Cline, but he was the oncologist who moved from UCSF to Los Angeles to start our hem-onc division. And very exciting, a wonderful bedside teacher. And so all of a sudden, I've never been exposed to oncology and this was very interesting. But at the same time, I was rotating through the CCU, and in came two full-arrest patients, one of whom was a campus cop who was very obese, had arrested at his desk in the police station. And we didn't have emergency vehicles to help people get on campus at that time. This was 1973 or 1974, something like that. And he came in full arrest, vegetable. And then another man had been going out of his apartment to walk his dog and go downstairs, and then all of a sudden his wife saw him out on the street being resuscitated by people. And he came in also in full arrest. So those two experiences, having to deal with those patients, not being able to kind of comfort the families, to do anything about it. As well as taking care of patients in my old clinic who had very bad vascular disease. One man, extremely depressed with claudication and angina, all of a sudden made me feel, “Well, you know what? I'm not sure I really want to be a cardiologist. I'm not sure I like the acute arrest that I had to deal with and the families. And also, the fact that people were depressed and you couldn't really talk to them about how serious their disease was.” Whereas I had patients with advanced cancer who came in, who had equally difficult prognoses, but because of the way people understood cancer, you could really talk about the problems that they would be facing and the end-of-life concerns that they would have. So it was all of those things together that made me say, “Hmm.” And then also, Pat, you'll appreciate this, being from Indiana, we were giving phase II platinum to advanced testicular cancer patients, and it was miraculous. And so I thought, “Oh my gosh, in my lifetime, maybe cancer is going to be cured! Heart disease, well, that's not going to happen.” So that was really the turning point. Pat Loehrer: When many of us started, we were just hoping that we could get patients to live a little bit longer and improve the response rate. But you took a different tack. You really looked at treating the whole patient, not just the disease. That was really a novel approach at the time. What influenced you to take that step forward? Dr. Patricia Ganz: Well, it was actually my starting– it was thought to be in a hospice ward. It would turn out it was a Sepulveda VA, not the West LA VA, but in any case, we have two VAs that are affiliated with UCLA. And it was an intermediate care ward, and there was an idea that we would in fact put our cancer patients there who had to have inpatient chemotherapy so they wouldn't be in the acute setting as well as patients who needed to travel for radiation. Actually, the West LA VA had a hospice demonstration project. This is 1978. It's really the beginning of the hospice movement in England, then in Canada, Balfour Mount at Montreal and McGill was doing this. And so I was very much influenced by, number one, most of our patients didn't live very long. And if you were at a VA Hospital, as I was at that time, you were treating patients with advanced lung cancer, advanced colon cancer, advanced prostate cancer, other GI malignancies, and lung cancer, of course. So it was really the rare patient who you would treat for curative intent. In fact, small cell lung cancer was so exciting to be treating in a particularly limited small cell. Again, I had a lot of people who survived. We gave them chemo, radiation, whole brain radiation, etc. So that was exciting. This was before cisplatin and others were used in the treatment of lung cancer. But really, as I began to develop this ward, which I kind of thought, “Well, why should we wait just to give all the goodies to somebody in the last few weeks of life here? I'm treating some patients for cure, they're getting radiation. Some of them are getting radiation and chemo for palliation.” But it was a mixed cancer ward. And it was wonderful because I had a team that would make rounds with me every week: a pharmacist, a physiatrist, a psychologist, a social worker, a dietitian. This was in 1978 or ‘79, and the nurses were wonderful. They were really available to the patients. It wasn't a busy acute ward. If they were in pain, they would get their medication as soon as possible. I gave methadone. It was before the days of some of the newer medications, but it was long-acting. I learned how to give that. We gave Dilaudid in between if necessary. And then we had Brompton solution, that was before there was really oral morphine. And so the idea was all of these kinds of services should really be available to patients from the time of diagnosis until death. We never knew who was going to be leaving us the next few days or who was going to be living longer and receiving curative intent. We had support groups for the patients and their families. It was a wonderful infrastructure, something that I didn't actually have at UCLA, so it was a real luxury. And if you know the VA system, the rehabilitation services are wonderful. They had dental services for patients. We had mostly World War II veterans, some Korean, and for many of these individuals, they had worked and lived a good life, and then they were going to retire and then they got cancer. So this was kind of the sadness. And it was a suburban VA, so we had a lot of patients who were in the San Fernando Valley, had a lot of family support, and it was a wonderful opportunity for me to learn how to do good quality care for patients along the continuum. Dave Johnson: How did you assemble this team? Or was it in place in part when you arrived, or what? Nobody was thinking about this multidisciplinary approach? Dr. Patricia Ganz: I just designed it because these were kind of the elements that were in a hospice kind of program. And I actually worked with the visiting nurses and I was part of their boards and so forth. And UCLA didn't have any kind of hospice or palliative care program at that time. But because the VA infrastructure had these staff already, I didn't have to hire them, you didn't have to bill for anything. They just became part of the team. Plus there was a psychiatrist who I ultimately began doing research with. He hired a psychologist for the research project. And so there was kind of this infrastructure of interest in providing good supportive care to cancer patients. A wonderful social worker, a wonderful psychologist, and they all saw this patient population as very needy, deserving, and they were glad to be part of a team. We didn't call it a hospice, we called it a palliative care unit. These were just regular staff members who, as part of their job, their mission was to serve that patient population and be available. I had never been exposed to a physiatrist before. I trained at UCLA, trained and did my residency and fellowship. We didn't have physiatry. For whatever reason, our former deans never thought it was an important physical medicine, it wasn't, and still isn't, part of our system. Pat Loehrer: Many decisions we make in terms of our careers are based on singular people. Your dad, maybe, suggesting going into medicine, but was there a patient that clicked with you that said, "Listen, I want to take this different direction?" Or was it just a collection of patients that you were seeing at the VA? Is there one that you can reflect back on? Dr. Patricia Ganz: I don't know if you all remember, but there was something called Consultation Liaison Psychiatry where, in that time, the psychiatrist really felt that they had to see medical patients because there were psychological and sometimes psychiatric problems that occurred on the medical ward, such as delirium. That was very common with patients who were very sick and very toxic, which was again due to the medical condition affecting the brain. And so I was exposed to these psychiatrists who were very behaviorally oriented when I was a resident and a fellow, and they often attended our team meetings in oncology on our service, they were on the transplant service, all those kinds of things. So they were kind of like right by our side. And when I went to the VA, the psychiatry service there also had a couple of really excellent psychiatrists who, again, were more behaviorally focused. Again, you have to really remember, bless her heart, Jimmie Holland was wonderful as a psychiatrist. She and Barrie Cassileth were the kind of early people we would see at our meetings who were kind of on the leading edge of psychosocial oncology, but particularly, Jimmie was more in a psychiatric mode, and there was a lot of focus on coping. But the people that I began to work with were more behaviorally focused, and they were kind of interested in the impact of the disease and the treatment on the patient's life and, backwards, how could managing those kinds of problems affect the well-being of the patient. And this one psychiatrist, Richard Heinrich, had gotten money from the VA, had written a grant to do an intervention study with the oncology patients who I was serving to do a group intervention for the patients and their families. But, in order to even get this grant going, he hired a project manager who was a psychologist, a fresh graduate whose name was Anne Coscarelli, and her name was Cindie Schag at that time. But she said, "I don't know much about cancer. I've got to interview patients. I've got to understand what's going on." And they really, really showed me that, by talking to the patient, by understanding what they were experiencing, they could get a better handle on what they were dealing with and then, potentially, do interventions. So we have a wonderful paper if you want to look it up. It's called the “Karnofsky Performance Status Revisited.” It's in the second issue of JCO, which we published; I think it was 1984. Dave Johnson: In the early 90s, you relocated back to UCLA. Why would you leave what sounds like the perfect situation to go back to a site that didn't have it? Dr. Patricia Ganz: Okay, over that 13 years that I was at the VA, I became Chief of the Division of Hem-Onc. We were actually combined with a county hospital. It was a wonderful training program, it was a wonderful patient population at both places. And we think that there are troubles in financing health care now, well, there were lots of problems then. Medicaid came and went. We had Reagan as our governor, then he became president, and there were a lot of problems with people being cared for. So it was great to be at the VA in the county, and I always felt privileged. I always had a practice at UCLA, which was a half-day practice, so I continued there, and I just felt great that I could practice the same wherever I was, whether it was in a public system, veteran system, or in the private system. But what happened was, I took a sabbatical in Switzerland, '88 to '89. I worked with the Swiss International Breast Cancer Consortium group there, but it was really a time for me to take off and really learn about quality of life assessment, measurement, and so forth. When I came back, I basically said, "I want to make a difference. I want to do something at a bigger arena." If I just continue working where I am, it's kind of a midlife crisis. I was in my early 40s, and my office was in the San Fernando Valley at the VA, but my home was in West Los Angeles. One day I was in UCLA, one day I was at the VA, one day I was at the county, it was like, "Can I practice like this the next 20 years? I don't know that I can do this. And I really want to have some bigger impact.” So I went to Ellen Gritz who was my predecessor in my current position, and I was doing my NCI-funded research at UCLA still, and I said, “Ellen, I really would like to be able to do research full time. I really want to make a difference. Is there anything available? Do you know of anything?" And she said, "Well, you know, we're actually recruiting for a position that's joint between the School of Public Health and the Cancer Center. And oh my goodness, maybe I can compete for that, so that's what I did. And it was in what was then the department called Health Services, it's now called Health Policy and Management. I applied, I was competing against another person who I won't name, but I got the position and made that move. But again, it was quite a transition because I had never done anything in public health, even though UCLA had a school of public health that was right adjacent to the medical school. I had had interactions with the former dean, Lester Breslow, who I actually took an elective with when I was a first-year medical student on Community Medicine. So it kind of had some inklings that, of what I was interested in. I had actually attendings in my medical clinic, Bob Brook, a very famous health policy researcher, Sheldon Greenfield. So I'd been exposed to a lot of these people and I kind of had the instinctive fundamentals, if you will, of that kind of research, but hadn't really been trained in it. And so it was a great opportunity for me to take that job and really learn a lot and teach with that. And then took, part of my time was in the cancer center with funding from the core grant. And then, within a year of my taking this position, Ellen left and went to MD Anderson, so all of a sudden I became director of that whole population science research group. And it was in the early ‘90s, had to scramble to get funding, extramural funding. Everybody said to me, "How could you leave a nearly full-time position at the VA for a soft money position?" But, nevertheless, it worked out. And it was an exciting time to be able to go into a new career and really do things that were not only going to be in front and center beneficial to patients, but to a much larger group of patients and people around the world. Pat Loehrer: Of all the work that you have done, what one or two things are you most proud of in terms of this field? Dr. Patricia Ganz: Recognizing the large number of people who are surviving cancer. And I think today we even have a more exciting part of that. I mean, clearly, many people are living long-term disease-free with and without sequelae of the disease. But we also have this new group of survivors who are living on chronic therapy. And I think the CML patients are kind of the poster children for this, being on imatinib or other newer, targeted agents over time, living with cancer under control, but not necessarily completely gone. And then melanoma with the immunotherapy, lung cancer, all of these diseases now being converted to ones that were really fatal, that are now enjoying long-term treatment. But along with that, we all know, is the financial toxicity, the burdens, and even the ongoing symptoms that patients have. So the fact that we all call people survivors and think about people from the time of diagnosis as potentially being survivors, I think was very important. And I would say that, from the clinical side, that's been very important to me. But all of the work that I was able to do with the Institute of Medicine, now the National Academy of Medicine, the 2013 report that we wrote on was a revisit of Joe Simone's quality of care report, and to me was actually a very pivotal report. Because in 2013, it looked like our health care system was in crisis and the delivery of care. We're now actually doing a National Cancer Policy Forum ten-year follow-up of that report, and many of the things that we recommended, surprisingly, have been implemented and are working on. But the healthcare context now is so much more complicated. Again, with the many diseases now becoming rare diseases, the cost of drugs, the huge disparities, even though we have access through the Affordable Care Act and so forth, there's still huge disparities in who gets care and treatment. And so we have so many challenges. So for me, being able to engage in the policy arena and have some impact, I think has been also very important to me. Dave Johnson: 20 years ago, the topic of survivorship was not that common within ASCO, and you led a 2004 task force to really strengthen that involvement by that organization, and you also were a founding member of the National Coalition for Cancer Survivorship. I wonder if you might reflect on those two activities for us for a moment. Dr. Patricia Ganz: In 1986, Fitzhugh Mullen, who in 1985 had written a really interesting special article for the New England Journal called "Seasons of Survivorship" - he was a young physician when he was found to have a mediastinal germ cell tumor and got very intensive chemotherapy and radiation therapy and survived that, but realized that there was no place in the healthcare system where he could turn to to get his questions answered, nor get the kind of medical care that was needed, and really wrote this very important article. He then, being somebody who was also kind of policy-oriented and wanting to change the world, and I would say this was a group of us who, I think went to college during the Vietnam era - so did Fitz - and we were all kind of restless, trying to see how we could make a difference in the world and where it was going. And so he had this vision that he was going to almost develop an army of survivors around the country who were going to stand up and have their voices heard about what was going on. Of course, most people didn't even know they were a survivor. They had cancer treatment, but they didn't think about themselves as a survivor. And so he decided to get some people together in Albuquerque, New Mexico, through a support group that he had worked with when he was in the Indian Health Service in New Mexico. And there were various people from the American Cancer Society, from other support organizations, social workers, and a couple of us who are physicians who came to this meeting, some Hodgkin survivors who had been treated at Stanford and were now, including a lawyer, who were starting to do long term late effects work. And we gathered together, and it was a day and a half, really, just kind of trying to figure out how could a movement or anything get oriented to try and help patients move forward. So that's how this was founded. And they passed the hat. I put in a check for $100, and that was probably a lot of money at that time, but I thought, well, this is a good investment. I'll help this organization get started. And that was the start. And they kind of ran it out of Living Beyond Cancer in Albuquerque for a few years. But then Fitz, who was in the Washington, DC. area decided they weren't going to be able to get organizations all over the country organized to do this, and they were going to have to do some lobbying. So Ellen Stovall, who was a Hodgkins survivor living in the Washington area, beginning to do policy work in this area, then became the executive director and took the organization forward for many years and championed this, got the Office of Cancer Survivors established at the NCI in the 1990s, and really did a lot of other wonderful work, including a lot of the work at the Institute of Medicine. She was very involved with the first Quality of Care report and then ultimately the survivorship report, the Lost and Transition report in 2005, 2006, I was on that committee. So that was really how things were evolving. And by that time, I was also on the ASCO board, 2003 to 2006. And so all of these things were kind of coming together. We had 10 million survivors. That was kind of an important note and a lot of diseases now - lymphoma, breast cancer, multi-agent therapy had certain benefits, but obviously toxicities. We lived through the horrible time of high-dose chemotherapy and transplant for breast cancer in the ‘90s, which was a problem, but we saw a lot of toxicities after that. And so there were people living after cancer who now had sequelae, and the children obviously had been leading the way in terms of the large number of childhood cancer survivors. So this was this idea that the children were kind of the canary in the coal mine. We saw them living 20, 30 years later after their cancer diagnosis, and we were now beginning to see adults living 10, 15, 20 years later, and we needed to think about these long-term and late effects for them as well. Dave Johnson: I'm glad you mentioned Fitz's article in the New England Journal that still resonates today, and if listeners have not read it, "Seasons of Survivorship" is a worthwhile five-minute read. What do you think the most pressing issues and challenges in cancer survivorship care today? Dr. Patricia Ganz: Many people are cured with very little impact. You can think of somebody with T1 breast cancer maybe needing endocrine therapy for five years, and lumpectomy radiation. That person's probably not going to have a lot that they're going to be worried about. But if they're a young breast cancer patient, say they're 35 or 40, you're going to get five years of ovarian suppression therapy. You're going to be put into acute menopause. You're going to lose bone density. You're going to have cardiac risk acceleration. You may have cognitive changes. You may have also problems with cognitive decline later. I mean, all of these things, the more intense treatments are associated, what we're really thinking about is accelerated aging. And so a lot of what I've been studying the last 20-25 years in terms of fatigue and cognitive difficulties are related to neuroinflammation and what happens when somebody has intensive systemic therapy and that accelerated process that's, again, not everyone, but small numbers of patients, could be 10-15-20%. So I worry a lot about the young patients. So I've been very focused on the young adult population who are treated intensively for lymphoma, leukemia, and breast. And that's, I think, something that we need to be looking out for. The other thing is with the newer therapies, whether it's immunotherapy or some of the targeted therapies, we just don't know what the late effects are going to be. Where we're very schooled now in what the late effects of radiation, chemo, and surgery could be for patients, we just don't know. And another wonderful part of my career has been to be able to do quality-of-life studies within the Clinical Trials Network. I've been affiliated with NSABP, I was SWOG previously, but NSABP is now NRG Oncology doing patient-reported outcomes and looking at long-term outcomes in clinical trials. And I think we're going to need this for all of these new agents because we have no idea what the long-term toxicities are going to be. And even though it's amazing to have people surviving where they wouldn't have been, we don't know what the off-target long-term effects might be. So that's a real challenge right now for survivorship. And the primary care doctors who we would want to really be there to orchestrate the coordinated care for patients to specialists, they are a vanishing breed. You could read the New England Journal that I just read about the challenges of the primary care physician right now and the overfilled inbox and low level of esteem that they're given in health systems. Where are we going to take care of people who really shouldn't be still seeing the oncologist? The oncologist is going to be overburdened with new patients because of the aging of the population and the many new diagnoses. So this is our new crisis, and that's why I'm very interested in what we're going to be looking at in terms of a ten-year follow-up report to the 2013 IOM report. Dave Johnson: The industry-based trials now are actually looking at longer-term treatment. And the trials in which interest is cancer, we cut it down from two years of therapy down to nine weeks of therapy, looking at minimizing therapy. Those are difficult trials to do in this climate today, whereas the industry would just as soon have patients on for three to five years worth of therapy as opposed to three to five months. Talk a little about those pressures and what we should be doing as a society to investigate those kinds of therapies and minimizing treatments. Dr. Patricia Ganz: Minimizing treatments, this is the place where the government has to be, because we will not be able to do these de-escalation studies. Otherwise, there will be countries like the UK, they will be able to do these studies, or other countries that have national health systems where they have a dual purpose, if you will, in terms of both financing health care and also doing good science. But I think, as I've seen it, we have a couple of de-escalation trials for breast cancer now in NRG Oncology, which is, again, I think, the role that the NCTN needs to be playing. But it's difficult for patients. We all know that patients come in several breeds, ones who want everything, even if there's a 1% difference in benefit, and others who, “Gee, only 1 out of 100 are going to benefit? I don't want that.” I think that's also the challenge. And people don't want to be denied things, but it's terrible to watch people go through very prolonged treatments when we don't know that they really need it for so long. Dave Johnson: Pat and I both like to read. I'm wondering if there's something you've read recently that you could recommend to us. Dr. Patricia Ganz: It's called A Gentleman in Moscow by Amor Towles. I do like to read historical fiction. This one is about a count at the time of the Bolshevik Revolution who then gets imprisoned in a hotel in Moscow and how constrained his life becomes, but how enriched it is and follows him over really a 50-year period of time and what was happening in the Soviet Union during that time. And of course, with the war in Ukraine going on, very interesting. Of course, I knew the history, but when you see it through the drama of a personal story, which is fictional, obviously it was so interesting. My husband escaped from Czechoslovakia. He left in '66, so I had exposure to his family and what it was like for them living under communism. So a lot of that was interesting to me as well. Dave Johnson: Thank you for joining us. It's been a wonderful interview and you're to be congratulated on your accomplishments and the influence you've had on the oncology world. We also want to thank our listeners of Oncology, Etc., and ASCO Educational Podcast where we will talk about oncology, medicine and beyond. So if you have an idea for a topic or a guest you'd like us to interview, by all means, email us at education@asco.org. To stay up to date with the latest episodes and explore other ASCO educational content, please visit education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

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One-hour special: The biopharma outsourcer

Play Episode Listen Later Aug 25, 2023 64:09

In this episode of Molecule to Market, you'll go inside the outsourcing space of the global drug development sector with Tushar Misra, Chief Manufacturing Officer at Mersana Therapeutics. Your host, Raman Sehgal, discusses the pharmaceutical and biotechnology supply chain with Tushar covering: How his opportunistic nature led him to several roles, companies and locations across the processing and biopharmaceutical sector Being given the task of building a worldwide manufacturing and supply chain infrastructure for the commercial launch of a biologic oncology product globally for Takeda Key components of a strong CDMO partnership ‘beyond checking boxes' and how the type of product impacts the selection process The harsh realities of a recent clinical failure for a biopharmaceutical company that impacts employees and patients How the explosion of modalities have driven growth across all segments the outsourcing space Tushar Misra is the Chief Manufacturing Officer at Mersana Therapeutics, a biopharmaceutical company specializing in the discovery and development a pipeline of antibody-drug conjugates (ADCs) targeting cancers in areas of high unmet medical need. He has over 30 years of experience in developing drugs that involve small and large molecules and ADCs, as well as the development and management of worldwide commercial supply chains. Prior to Mersana, Tushar was EVP, Head of Technical Development & Manufacturing at Laronde, where he led the process development and manufacturing team for end-to-end manufacturing for RNA products. In addition, Tushar worked at Takeda Pharmaceuticals in several positions of increasing seniority, most recently as VP & Head, Global Oncology and Biologics Operations. Please subscribe, tell your industry colleagues and join us in celebrating and promoting the value and importance of the global life science outsourcing space. We'd also appreciate a positive rating! Molecule to Market is sponsored and funded by ramarketing, an international marketing, design, digital and content agency helping companies differentiate, get noticed and grow in life sciences.

head market manufacturing evp rna molecule hour special biopharma tushar adcs technical development raman sehgal global oncology

Oncology, Etc. – The Diversity Mission with Dr Edith Mitchell

Play Episode Listen Later Aug 8, 2023 25:38

Increasing diversity in the field of oncology is an ongoing task. Our next guest has made it her mission to increase those ranks as well as becoming the first African American woman to be a Brigadier General in the US Air Force. Dr. Edith Mitchell describes her early years growing up in rural Tennessee (2:52), the motivation for joining the Air Force in the 70's (7:33) and strategizing to increase ethnic diversity in medicine and oncology (16:53). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Edith Mitchell: Leadership – Corvus; Honoraria - Sanofi, Exelixis; Consulting or Advisory Role Company - Genentech, Novartis, Merck, Bristol Myers Squib; Speakers' Bureau – Ipsen; Research Funding Company - Genentech, Sanofi Resources (related podcasts, courses or articles) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed on the podcast page. Pat Loehrer: Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: And I'm Dave Johnson, a Medical Oncologist at the University of Texas Southwestern in Dallas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of the podcast is to introduce our listeners to interesting and inspirational people and topics in and outside the world of oncology. Pat Loehrer: Imagine knowing in your heart what you wanted to be in life. It usually takes people decades to figure that out, but our next guest knew at age three that she wanted to be a doctor and, later in high school, to be an oncologist. She's achieved much in her lifetime and has incorporated the "pay it forward" by mentoring many others. Dave Johnson: Our guest today is Dr. Edith Mitchell. I first met Edith over 40 years ago when we were both starting out our careers as junior faculty. She grew up in rural Tennessee, and as Pat mentioned, remarkably, she chose a career in oncology at a very early age in high school, despite the fact that oncology was barely a specialty at that time and the lack of role models, particularly role models of color, and women in particular. She received a Bachelor of Science degree in Biochemistry with distinction from Tennessee State University and a medical degree from the Medical College of Virginia and Richmond. In 1973, while still attending medical school, Edith joined the Air Force, receiving a commission through the Health Profession Scholarship Program, and eventually rose to the rank of Brigadier General. She completed a residency in internal medicine at Meharry Medical College in Nashville and a fellowship at Medical Oncology at Georgetown University. Her research interests are broad and involve new drug evaluation, development of new therapeutic regimens, combined modality therapy strategies, patient selection criteria, and supportive care for patients with gastrointestinal malignancies. She is the leader of the GI oncology program at Jefferson Medical College, Director of the Center to Eliminate Cancer Disparities, and Enterprise Vice President for Cancer Disparities at Jefferson's Sidney Kimmel Cancer Center. She's held a number of leadership positions, including those in ASCO, and she's a former president of the National Medical Association. I could go on forever. So, Edith, welcome, and thanks for joining us on Oncology, Etc. Dr. Edith Mitchell: And thank you so much for the invitation, Dave and Pat, it is a pleasure. Dave Johnson: You grew up on a farm, as I recall, in Tennessee. Perhaps you could tell us a little about your early life. Dr. Edith Mitchell: I grew up on a farm that my great grandfather's mother received about 1863 when the Emancipation Proclamation was made. I was the fifth child in my family. My parents were working, my older siblings were in school, so my great-grandparents were my babysitters, so I spent a lot of time with them. He was 89 at the time, became ill, and I overheard family members and neighbors say that they couldn't take him to the hospital because Blacks were not treated properly in the hospital, so they were going to take care of him at home. A physician made a house call. When he left, I told my great-grandfather, “Pa, when I grow up, I'll be a doctor just like Dr. Logan and I'll make sure you get good health care.” So, at three years, I decided I would become a doctor and I would make sure that Blacks received good health care. My work in disparity started when I was three. So, after my sophomore year in high school, there was a National Science Foundation program in Memphis at LeMoyne-Owen College. So, I applied and was accepted. And part of the time in Memphis that year, we were given opportunities to go to St. Jude. So my time at St. Jude made the decision that I would become an oncologist. I became really fascinated by cancers and in pathology, use of the microscope, and how cancers were all different, how they varied from the normal tissue for areas such as the colon or the stomach or the pancreas. Dave Johnson: It's amazing that that early in your life you made that kind of decision. Can I back up just one moment? I want to ask you briefly about the doctor that visited your great-grandfather, Dr. Logan. Dr. Edith Mitchell: Dr. Logan was a family physician, African American, and he had a great interest in Blacks being healthy. In fact, when the polio vaccine was made public, Blacks could only go one day per week because you couldn't go the times when whites were there. Dr. Logan obtained the vaccine and he would line the children up at his office. He gave me my first polio vaccine. He was a very handsome man. And, you know, Dave, I found out later that the medical school that he attended in Memphis was one of the ones closed as a result of the 1910 Flexner Report. So he had to go to Meharry in Nashville and take other courses to maintain his license to practice medicine. Pat Loehrer: Were you the first one to go into medicine? Tell me about that background and how your family influenced you personally. Dr. Edith Mitchell: Neither of my parents finished 8th grade, but they were very smart. They pushed their seven children to do well. They provided educational materials in our home and encouraged us to work and to take advantage of opportunities. Dave Johnson: Let's move forward a little bit. I thought I knew a lot about you, Edith, but I didn't realize that you were a Brigadier General. What was the motivation for joining the service in the ‘70s when you were at med school? Was it scholarship funding, or was there just patriotic zeal or a little of both? Dr. Edith Mitchell: My main objective was, for financial reasons - a scholarship covering all expenses of medical school, plus a monthly stipend. When I was in medical school, one of my laboratory instructors told me about this new scholarship program, and I said, "Okay, I just want to graduate from medical school." So he says, "Well, I know people in the surgeon general's office. I'll have them send you the information." He did, and I looked at it and didn't remember David, that my husband filled out the application. After my neurosciences final exam, I came home, and he says, "Your commission came in the mail today." So I said, "Okay." He says, "Well, I can swear you in. We can't do it at home because you have to have a witness. You take a nap, and then we're going out to job control, which was where all the aircraft controlled, the control room." We went there. We've got a picture of the swearing-in, and we then went to the officers club. It was Friday, and there were lots of people in his group from the Air Force Academy, from Citadel, Virginia Tech, and others. And they were all talking. "Yeah, Edith got a mail-order commission.” So I owed the Air Force two years, and I practiced at Andrews Air Force Base, which was the presidential squadron. You hear the president always leaving Andrews Air Force Base. So I think I was 29 maybe, but I was young, and here I was taking care of senators and other important people in government, and these are people I'd only seen on TV before. So I had a really good experience. I received many accolades, but also many letters from people for whom I cared for. And I was therefore invited to stay on in the Air Force, either go to Walter Reed or to San Antonio. I said, "No, I'm going to Georgetown." So one of the VIPs, if I mentioned his name, you would know, said and wrote a letter for me that the Air Force should give me whatever I wanted and whatever I needed to continue in the Air Force. So I received my Air Force pay while I was a fellow at Georgetown. So I stayed on. I got promoted early and engaged in Air Force work. I loved it, and I did well in that atmosphere and stayed on. After my second child was born, I decided I could not continue active duty and take care of two kids. So I left the Air Force, went to the University of Missouri, and someone called me one day and said, "You know, I hear you are at the University of Missouri now. Would you consider joining the National Guard?" I went, “ Joining the National Guard? Why would the National Guard want an oncologist?” And the information was, the Air National Guard wants good doctors, and you've got a great record. They invited me to St. Louis to just see the National Guard squadron there. I filled out the application while I was there and in a few days was appointed to the National Guard. So after being there for a few years, I was discussing with one of the higher-ranking people in the National Guard who was in Washington, but visiting St. Louis. He said to me, "You know, you've done great work." He had gone through my record, and he said, "And you know, you're one of the people being considered to be in a group for promotion. Promotion at that time meant that it was a higher rank." So he said, "There's one thing you don't have in your records, however, and other competitors in your group have." I said, "What's that?" “You haven't been to flight school.” I said, "Okay." He said, "And everybody who is going to be competing with you will have gone to flight school, and having a flight record will be an important part." So I was in my 40s. My oldest child was 14. I went to flight school and I got my certification, and obviously, I got promoted. And I am the first woman doctor to become a General in the history of the Air Force. And it was really interesting. I'm a Brigadier General. I'm invited to give a talk someplace, and there were lots of people there. So the person introducing me said, "And she is the first African American woman to become a General in the history of the United States Air Force." So I get up to speak and I thank him for this introduction. And I said, "Yes, I was the first Black woman physician to become a General. I said, but, you know, my ancestry says that I'm 30% something white. So I guess I was the first white woman, too." There was a big roar. But I loved every opportunity, and I worked hard at every opportunity. So when I was in the active duty Air Force, I was chief of the cancer center at Travis Air Force Base. So I made my application for research with the Northern California Oncology group, got, they said, one of the highest ratings of the applicants at that time. And I received a phone call from Air Force administration saying “Congratulations, but the Air Force cannot accept this funding from the National Cancer Institute.” There is a law saying you can't transfer money from one area of the government to the other, as they called it, a "gift," but it was a grant. So I call Phil Schein and I tell him about the situation. And he already knew that I had received a top report, and he knew that I had the grant before I knew. So he says, "Well, let's see what we can do.” Now, remember, Vince DeVita was the NCI Chair at that time and Dr. Rosenberg. At every ASCO meeting Phil, Vince, and Dr. Rosenberg would get together and they would bring their fellows. And Bill said, “Let me see what I can do.'" So somebody at NCI made some things happen. And I got this call from Saul Rosenberg. "Edith, congratulations." So I said, "Well, thank you, but I didn't expect a phone call from you." And he says, "Well, there have been some changes. Your grant, the face sheet has been changed." I said, "Oh.” Pat Loehrer: Your husband again. Dr. Edith Mitchell: I can't say who or what, but it had Stanford on it. So my grant went to Stanford. I'm sure they appreciated the kick you get. But Dr. Rosenberg said, "Your grant is now Stanford. We're setting up an account for you at Stanford, and the funding goes to Stanford.” So I had people working for me at the Air Force Cancer Center who were Stanford employees. Dave Johnson: Edith, there are still too few African American and particularly African American men in medicine. What's your perspective on that? Dr. Edith Mitchell: I think that many people are not given opportunities, and I've been concerned about Blacks and other racial and ethnic minorities not entering medicine, and particularly regarding oncology. So fewer than 5% of all practicing physicians in this country identify as Black. Little more than 5% identify as Hispanic. And I've been trying to do something about that. So ECOG-ACRIN has been very good about allowing me, and I set up with others, but I was the lead, a program for individuals - they could either be medical students, residents, fellows, or early faculty - to attend ECOG-ACRIN. And as a result of that program, we identified 12 individuals for each of the two ECOG-ACRIN annual meetings. We bring people in, and that has been a success. There's one person I introduced when she was a resident, she then did a fellowship in oncology, and it is now in her first year as faculty. And we have students mainly from Tennessee State. I do maintain very close relationships with Tennessee State, and I have the first Tennessee State student who has just been admitted to medical school at Jefferson. So trying to work with them. As a result of my work with the National Medical Association and the International Myeloma Foundation, we have a group of medical students that have been mentored for oncology. Whether they will become oncologists, I don't know, but they all 12 are doing well in medical school, and with some anticipation they might select oncology as their area of specialty. We set them up with an individual mentor, various oncologists around the country, and they have conducted research with their mentor. So I'm doing things that I think will be helpful to individuals. And I think we're not giving Blacks enough opportunities. Even in entering medical school, the number of Blacks entering most majority medical schools is still very low. Somewhere nine or ten students per year, Blacks entering medical schools. And also there has been a study conducted by the ACGME, which is the Accreditation Council for Graduate Medical Education, looking at graduate studies in oncology. Do you know that most of the oncologists have been trained at a few medical schools? And there are, I think it was 109 programs did not have a single minority student in the fellowship program. And that's terrible. I think that all fellowship programs should have some racial or ethnic fellows in their programs. Dave Johnson: Yeah. One of the disturbing statistics that I've read from the AAMC is that the number of African American men applying to medical school in 2023 and 2022 is actually less than the number that applied in the ‘70s. It's puzzling to me why we've not been able to attract young men into the medical profession, and perhaps it's because there's a sense of not being wanted or encouraged into the profession. More African American women are applying, but even that number is small, at least in terms of the increase in what we've seen. Pat Loehrer: Edith. You're also the Associate Director of Diversity Affairs at the Sidney Kimmel Cancer Center. What does the recent Supreme Court decision against Harvard in terms of admissions policy, how are you viewing that now at Jefferson? Dr. Edith Mitchell: So I think that the Supreme Court decision certainly was disappointing, but it is what it is, and we've got to deal with it. That is the Supreme Court. So my suggestion and what I am telling students that they have to do, you do have the essay. So when I applied to medical school, I did not talk about Dr. Logan, my growing up on the farm, or my parents not finishing 8th grade. But if I were applying to medical school now, I would use all of that background to include in my essay. And the Supreme Court didn't say that you couldn't include that information in your essay. It said the schools could not use your racial background as a part of the equation, but your letter is still there, and therefore, I would include all of that in the essay, so that you do have an advantage. We've just got to be able to do what we've got to do, not put the university or the medical school at risk because of the Supreme Court decision. But there's nothing in that decision that says you can't include that information in your letter. Dave Johnson: I have one question. What career advice would you offer your younger self? If you could speak to your 30-year-old self based on your knowledge, experience, what career advice would you give yourself? Dr. Edith Mitchell: So the one thing that I did not do when I was about 30 years old and I'm not sure I even knew about it, I think I could have done more in health policy, and the one thing that I have not done is become a White House fellow. And that's usually early in your career plan. But I think my research would have suffered had I done that. And I still say I don't know that I made bad choices. Dave Johnson: No, you didn't make bad choices. Knowing you, you could have been a White House fellow and done everything else you did. Pat Loehrer: And your husband did not make a bad choice either. Dave Johnson: Evidently not. Pat Loehrer: Edith, thank you so much for joining us. You've had such an incredible life, and it's so rich, and we deeply appreciate your spending time with us. I want to also thank all our listeners of Oncology, Etc, which is an ASCO Education Podcast. This is as you know, where we talk about oncology medicine and everything else. If you have an idea for a topic or guest you'd like to see on the show, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, visit education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

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Oncology, Etc. – Dr. Lori Pierce's Path From Engineering To Oncology

Play Episode Listen Later Jul 11, 2023 40:09

There are many treatments available for cancer but how do you make csre delivery equitable? Given the various types of cancers how can you allocate the right resources to create equal outcomes? Dr. Lori Pierce has made equity a primary focus of her career. She describes how physics and radiology inspired her to be an engineer (6:06), and the moment she decided to transition from engineer to oncologist (12;54) and achieving the position of Vice-provost at the University of Michigan (23:01). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Lori Pierce: Stock and Other Ownership Interests Company - PFS Genomics; Patents, Royalties, Other Intellectual Property Company - UpToDate, PFS Genomics; Uncompensated Relationships - Bristol-Myers Squibb, Exact Sciences Resources If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. Disclosures for this podcast are listed in the podcast page. Pat Loehrer: Welcome to Oncology, Etc. This is an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: Hi, I'm Dave Johnson at UT Southwestern in Dallas, Texas. I'm a Medical Oncologist. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of the program is to introduce listeners to interesting people and topics in and outside the world of oncology; hence the ‘et cetera' in our name. Pat, we've got a great guest today. And we've got a great guest today. Pat Loehrer: Our next guest was able to do this despite living at a time when in the United States, certain groups of people faced tremendous barriers to achieve even the basic hint of equality. Our next guest is Lori Pierce. Dr. Pierce attended Duke University School of Medicine and completed a radiation oncology residency and chief residency at the Hospital of the University of Pennsylvania. She was then appointed as a senior investigator at the National Cancer Institute, the National Institutes of Health in Bethesda, Maryland, from 1990 to 1992. And in 1992, she joined the faculty at the University of Michigan, where she currently is a professor with tenure in Radiation Oncology. Since coming to Michigan, she has served as Residency Director and Clinical Director in the Department of Radiation Oncology. In August of 2005, she was appointed by the University Board of Regents to be the Vice-Provost for Academic and Faculty Affairs, a position she still holds. In 2020, she was ASCO President, and while she ascended to the ASCO Presidency, that year COVID descended upon the Earth, and we may hear some stories about that. She's dedicated her career to the treatment of breast cancer patients. She's published over 200 manuscripts and book chapters and has received numerous teaching awards from the University of Michigan, multiple national organizations, and many national awards. Dr. Pierce, thank you so much for joining us today. Dr. Lori Pierce: I am so happy to join you both today. What an incredibly nice introduction. Thank you so much. Pat Loehrer: You were born and raised in Washington, DC. And the family eventually moved to Philadelphia when I think you were in junior high school. Can you paint a picture of what schooling was like for you growing up? Dr. Lori Pierce: Well, schooling, education was just so important to my family and myself. And so, as you said, I was born and raised in DC. Moved to Philadelphia when I was just entering high school. And my parents, who are just the best people on the planet, didn't have an opportunity to go to college. At that point, a lot of people of color didn't really have that opportunity. So education was so important in my family. So if you think about the important issues in my life, there was our faith, our family, and education. And so my sister, who is four years older, she went to college first. After about two years, I transferred and actually graduated from the University of Pennsylvania, and I did that. It was my idea. My parents at that point were living in Philadelphia. My mother was working at Penn, and so I would have free tuition if I went to Penn. And Penn is a great place as is Brown. My parents didn't ask me to transfer, but I did. And I received, obviously, an excellent education at both institutions. I majored in biomedical engineering and I minored in chemical engineering and was pre-med. I had to be strategic in how I was going to pay for my education because my parents and they took out loans, they covered everything, almost everything. My sister and I had some loans, but they took out most of the loans. But they always had an agreement. And the agreement was that both my sister and I would have our college education covered by them. But anything in the graduate arena, we had to cover. So I had to be kind of strategic about that. So I actually applied to medical school and, as you know, got in, and deferred my admission so I could work and earn some money so I could pay for medical school. And I tell you, I did that specifically for the reason, for financial issues. But now this kind of thing is called a gap year. And in retrospect, it was the smartest thing I could have ever done because I took some time away, and during that time away, it made me even more motivated to apply my full attention to medicine. And so education was very important. But I think sometimes you have to kind of step away to then regain the commitment that you need to move forward. And so by the time I started Duke, I was more than ready to be in medical school. Pat Loehrer: I know we talk about underrepresented minorities. I was a mechanical engineer at Purdue. And I can tell you, I don't think there was a single woman in engineering in most of my classes. There were just a few. So to be a woman in engineering is extraordinarily unique. So tell me a little bit about that decision-making and how you got into that. It may have been different in 10 or 15 years later, but were there a lot of women in engineering? Dr. Lori Pierce: No, not at all. And while there may have been two or three in biomedical engineering, there were hardly any in chemical engineering, and as you said, very few in mechanical engineering. So no. But I always was interested in physics. I liked those kinds of things, and hence I went into radiation oncology. It was a perfect blend of my studies and my interest. But no, I often was the only woman, or maybe one of two or three women in my classes, and I was certainly the only person of color in my classes. It taught you things though. It taught you to be comfortable being in that position and to know that you could do it just like anyone else could, and to know that probably a lot of eyes were on you to succeed. Some of that was self-imposed, but some of that was real. But I think learning those lessons then certainly came in handy when I went into medicine because while there are more women in medicine, especially now, compared to what it was when I came through, still, at that point, we were in the minority. And there were very few people of color in medical school where I went to. I was at Duke, and very few people there. You learned lessons early on, right? Dave Johnson: Where did this interest in engineering originate? Dr. Lori Pierce: So it was really more of physics and radiology. So I, as a kid was a really thin kid, and I broke a couple of bones, and I ended up going to get X-rays. And I was fascinated by the X-rays. I was fascinated by this physics. I was fascinated by how you could push this button and these images would appear and I could see my broken bone. So that was really where it came from. So I was pre-med. I did a lot of my pre-med work at Brown, and during the summers I was working in an industry. I was actually in Scott Paper Products industry outside of Philadelphia. And a couple of the other people there who I worked with closely were engineers. And I was just fascinated by it and seemed to be a good way of moving forward my own interest in the physics and the machinery and how it all worked. So I actually switched into engineering. So I switched from Brown to Penn. And being an engineer, it was a great way to make a good living for a year and a half. And I think as an engineer, and Pat, you can probably attest to this, you think in a certain way; you become very methodical in how you approach things. And while I'm sure there are a lot of other disciplines that will give you a similar type of approach, engineering really does—you're very objective in how you make decisions, and I think that serves well. And then, as I said, going into radiation oncology it was just a match made in heaven, so it all worked out great, I think. Pat Loehrer: I think I read that your sister was also into math, is that right? Dr. Lori Pierce: My sister's a systems engineer with IBM. Incredibly gifted. Pat Loehrer: Yeah. Tell me about your parents. How did they guide you? What were your role models in terms of both you and your sister, in terms of math, physics, engineering? Dr. Lori Pierce: I already said my parents were incredibly hardworking and good people. They both had high school graduation education. My mother went straight through, but my father had to get an equivalency for his high school diploma because he was born and raised in North Carolina, had to work on the farm, and didn't get a chance to stay in school. But he got the equivalency of his high school degree. It was interesting, my dad was just incredibly gifted for math. My father was just amazing in math. And my father and I always hung out. He was like my best friend and so I think my emphasis on math in part came from my dad. And I'll say that both my parents didn't, weren't able to get a college education, but they were two of the smartest people I ever knew. My father and my mother, but I just hang out more with my dad, had amazing common sense and whipsmart math. I'm sure that a lot of where I ended up is because of my dad. Dave Johnson: You mentioned that you had family in North Carolina. I remember reading that you were influenced by some of the people you met in North Carolina with respect to your medical career. Can you tell us a little bit about that? I think a Dr. Weaver, was it? Dr. Lori Pierce: That's right. Doc Weaver. That's right. So I used to spend a lot of my summers in North Carolina with my father's family. And Dr. Weaver was an African American family medicine doctor who took care of the vast majority of people of color in the town of where my father's family is from. Whenever anyone had issues and needed medical care, he came to the house. He was the doctor for people of color. I sat back- and take it in a lot when you're young - people never really know how much you're listening and seeing, but you take in a lot. And you see just how revered he was, and he should have been, because he was largely the face of medicine that a large part of that town saw. And that stuck with me. A couple of times, I went with him when he would see patients. Without a doubt, this factored into my wanting to go into medicine. I think that coupled with my interest in those x-rays and the physics of the x-rays, I think that's how it all came together, but Doc Weaver. Pat Loehrer: So you mentioned you did a gap year, which was somewhat unusual at that point. I did a gap year as well for the exact same reason - I wanted to not incur a lot of debt or at least try to defer the debt as much as possible. What did you do in your gap year, and how did that impact your medical training or did it? Dr. Lori Pierce: It definitely did. My gap year was actually 18 months. I moved to Austin, Texas, and I worked in Round Rock, Texas, that was at a time when Round Rock was just a sleepy little town just north of Austin. I haven't been back since. I know Dell computers is now there and now it's almost you can't see a difference between Austin and ROund rock, but that was not the way it was on those days. And I worked in Round Rock because McNeil Consumer Products was there. I worked at McNeil Consumer Products, they make Tylenol. I was the second-shift Glatt supervisor for Tylenol. So Glatt is the machine that mixes up all of the ingredients for Tylenol and it was something that I knew going in that it was only going to be short-lived so I could probably live almost anywhere. And I thought, okay, I'd been on the east coast all my life, let me see what the rest of, another part of the country is like. It was an amazing experience. To go from Brown to the University of Pennsylvania, DC, and Philadelphia, to Round Rock, Texas. In retrospect, I couldn't have picked a better place. I mean I soaked up a little local color, went to some things that the Texans do, and rodeo, that kind of thing. But more importantly, I met people who I would've never met on the east coast. These were people who largely had not been outside of the Austin area. One person said she'd never seen a black person before. That kind of surprised me. So it was a swath of America that I had not been exposed to. It was not easy. But in the end, it was the best thing, because you realize, people are people. And while you might be put off at first because they're put off with you and you put off with them, at the end of the day, it was a great experience of getting to know people who can further enrich your life. And I think that has helped me in medicine in terms of interacting with patients no matter where they're from, no matter what their background, what their financial situation is, people are people. I was on my own. I was truly on my own. And that gap year was invaluable far more than helping me pay off medical school loans. Pat Loehrer: You've focused into radiology and obviously there's diagnostic radiology and therapeutic radiology. How did you end up choosing the career that you eventually championed so well? Dr. Lori Pierce: At the time I went to medical school at Duke, at Duke, radiation oncology was a division of radiology so they had not separated yet. While I was at Duke, they recruited in their first chair of radiation oncology into separation. So long story short, when you're at Duke in medical school, your third year is all research. You could go into a lab and do research. And so when I met with my radiology advisor and looked at the list of options of projects I could sign on to, the one that happened to be most interesting was being done by a radiation oncology researcher in radiology. And I thought, well, it looks interesting, but I don't want to do that because I want to go in radiology so I need to have a radiology project. And my advisor said, “No, it's okay. Radiology programs, they'll take radiation experiments. You can still use that and apply to radiology.” So I said “Okay, that looks really interesting.” So I opted to go with that choice and it was during that year that radiation oncology separated. A chair came in, Dr. Lenny Prosnitz from Yale, and he said, “Why don't you just come down and see what it is that we do?” So when my experiments were set up, I would run down into the basement because we're always in the basement, and I would follow him around and I just loved it because it gave me the physics that I wanted, I got really interested in cancer biology. And I think with my personality, I work well with patients. I love patients. That patient interaction is when I'm at my best. And I wouldn't have had that in radiology. With all due respect, radiology is so important, but you have to do what you gravitate toward, and those interactions when I was following him around with patients. So I never looked back, I changed at that point and decided to go into radiation technology. So I was at Penn for residency and chief residency. When I was getting ready to leave to go to the NCI, the person, Barbara Fowble, who was a well-known breast radiation oncologist, took a sabbatical and asked if would I stay the year she was taking sabbatical to run the breast service. So I deferred going to the NCI to stay at Penn for an additional year as an attending and then went to the NCI when she came back from her sabbatical. I worked with Eli when I got to the NCI. Pat Loehrer: And Norm Coleman, too? Dr. Lori Pierce: And Norm from a distance. He's great. He came in for comedic relief. It was in a while, but he and Eli and Tom Delaney. It was a great time to be at the NCI. It was shortly after that, about a year or so into that when things started changing, Eli left to go to UT Southwestern. But it was a great time to be at the NCI. Dave Johnson: So you've worked with some of the giants of radiation oncology for sure? Dr. Lori Pierce: I did. And the NCI was known as the places where the giants launched. So the Allen Lichters, the Joel Teppers. I mean, I could go through a list. They all had worked with Eli, and Allen was no longer there. Allen had already gone to the University of Michigan. He subsequently recruited me to Michigan. But the radiation oncology branch, the Marc Lippmans of the world, it was a magic time. Even though some of them weren't there, their footprint, their stamp was on the program, and it was really good. And working with Eli was just great. Dave Johnson: So is that where you're working with Barbara where your interest in breast cancer or was it that you mentioned you had an interest in the biology? Where did that interest in breast cancer originate? Dr. Lori Pierce: It came from working with Barbara. So it was a combination. Barbara, who is one of the most amazing people to this day, that I've ever worked with, her command of the data, her synthesis of the data, her interaction with patients. Most people don't appreciate of just how great a clinician Barbara Fowble was. And so it was admiration for that. So she was a part of it, but John Glick was the other part. So John, of course, who everyone knows, the giant in the field, and I think at the time, not sure if when I was a resident, he was the president of ASCO. Even if he wasn't the president at that point, he was certainly highly integrated with ASCO, and he kind of took me under his wing. I'm not sure why, but I was very interested in breast cancer. So he would like bring me over to the Med On clinic and teach me more about chemotherapy. So I had John and I had Barbara, and then also the mammography group was very supportive of me. I would come in literally on weekends and meet with the head of mammography, who would test me on mammograms, reading mammograms. So it was just a very supportive environment. And certainly, breast cancer was the area that I wanted to focus on. It was a great group to train under. Pat Loehrer: Dave and I had the opportunity a short time ago to interview John Glick. And as you're talking, one of the wonderful things about our field of oncology is how it's a close-knit network and there's so much mentoring. And John took both Dave and I underneath his wings, and he had no really rationale for doing that. But Eli, I mean, there are so many wonderful people that we've had the opportunity of meeting. And you yourself have mentored so many other people in another generation. It's hard to explain to people outside of oncology about how special this field is, I think. Dr. Lori Pierce: It absolutely is. And it's an honor for me to serve as a mentor because once you're a mentor, you always mentor. I mean, John, I'll run things by John to this day. Once you develop that closeness and you know them and they know you, you savor that, it never goes away. Dave Johnson: What would you tell a junior faculty or fellow are the characteristics of a great leader? What do you think makes for great leadership? Dr. Lori Pierce: That's a great question. First and foremost, you listen. You need to listen and understand what your mentee, what it is they're seeking, what it is that they want to study, where they feel they are somewhat inadequate, and they want to improve. What is it that they want to accomplish with that relationship? Because as you and Pat both know, mentors come in all shapes and sizes. Mentors come in all locations. You may have someone who is at your institution where they're coming to you to help to shepherd through your institution and the policies and understand the practice of your institution. You may have those that are mentoring you from afar, or perhaps in addition to content, but also getting a sense of what the outside environment is like. So I think first rule of mentorship is to really understand why that mentee has sought you out and whether you are the right person to fill that void, whatever void that they think that they have. I think another part of mentorship is making the time for that individual. We're all very busy people. Most people aren't looking at you to mentor them two hours a day. They are going to be very judicious in what they ask, and you should make sure that what they need, you can accommodate that, and if you can't, perhaps arrange for someone else who can. But in most cases, there's a lot that we all can do for people who approach us. And then I think really understanding, kind of putting yourself in their position, where are they in their trajectory toward greatness, and how can you work with that. And I think most of us have a lot that we can share, and a lot of times we may be sharing things, we don't even realize that what we're saying is impactful to those individuals. But I really think it's starting out by listening and being honored that you are actually asked to be a mentor. Dave Johnson: You've also received numerous teaching awards. You obviously have a gift for that. Tell us, what's the secret to being a good teacher? What are the characteristics of a really great teacher, different than mentoring? Dr. Lori Pierce: Yeah. You have straightforward conversations with your residents and your fellows. I'll give you an example. We have teaching conferences. And teaching conferences have evolved over the years. I've been at Michigan for a long time, since ‘92. And in the old days, the morning conference, you discussed the literature and you had a discussion, and now it's evolved to slides. The residents give the slides and I'm old school. I like to go back to the old school. Some people call that the Socratic method. I think the Socratic method has gotten a bad rap because you can do the Socratic method in not a threatening way, and you can ask questions to residents and expect for them to give an answer. And it was interesting, long story short, when I few years into becoming Vice-Provost here, I'm not able to come to morning conferences very often. And I got a knock on my door here in the cancer center, and I opened up and it was the three chief residents. And I said, “Okay. Hi. Come in. What can I do for you?” And so all male, and they said, essentially, “We miss you. Our residents, we all prepare more for your conferences than anyone else. And even though you ask us questions, we don't feel threatened by your questions. We want that type of style of learning.” And I was bowled over by that because I'm just a simple person, and I don't beat around the bush. I ask questions because these are the kind of questions that you have to know when you manage patients. These are the kind of questions that you have to know when you're in a tumor board and you interact with medical oncologists and surgical oncologists. You have to know the literature, and you have to be able to state it in a clear way that, obviously, physicians get it, but patients get it, and you have to be aware of your audience. And so that little vignette of when those three knocked at my door told me that, clearly, going back to the basics and just asking questions is well received. Pat Loehrer: I'm thinking about your parents who did not go to college, and here you are now a Vice-Provost at one of the most prestigious universities in the country. It's got to be, if you reflect on that really cool. Tell us a little bit about that journey and what it takes. Or was that accidental journey or was this a purposeful journey of leadership that you wanted to go to? Dr. Lori Pierce: It was absolutely not purposeful, for sure. So I can thank my dear Dr. Lichter for that. So, Allen Lichter, after he was chair of radiation oncology, as you probably know became the dean of the medical school. Well, Allen, who had brought me to Michigan, got to know me pretty well. And so, when he became dean, Allen's so strategic. He realized that it would be important to have someone from the medical school to work in the provost's office because the medical school is the largest school on campus, and we're the different ones. We approach life somewhat differently. And so to have that perspective in the provost's office would be very helpful. So he came to me and said, “Would you be interested in doing it?” I didn't know what a provost was. I'd heard about it when I was at Brown, but I was like, “No, I'm not interested.” And he said, “Well, just go and talk with them. Meet with the provost of Central Campus and just see.” So I went and decided not to do it. But they did ask, would you just be a special counselor to the provost? If we have questions, we can call on you. So I said, sure. So I did that for a year, and then by the end of the year, had a much better awareness, understanding of what they did in that office, and a much better understanding of who they were, and they me. So I said, “Okay, if I decide to do this, I want it so that you can fire me at any time, and I can fire you at any time, but I'm never giving up my day job in terms of seeing patients. This is always my night and weekend job.” And so that's how we did it. And so I've been doing it now for a long time—since 2005, 2006. The reason I've done it so long is we do work with amazing people across campus. We have 19 schools and colleges, and I now am the Vice-Provost for Faculty Affairs for the Health Science Schools. And it allows you to not only look at the university as a whole—we tend to have silos, we tend to live in silos. And when you're the Vice-Provost, you can look beyond those silos and you can bring together people and schools for common threads of work. If I see the nursing school is focusing on certain aspects of cancer treatment XYZ, I can bring together people from the medical school, I can bring together the school of public health and put some funding to it to give them seed funds, to then synthesize something which hopefully will then translate into a larger grant. So it is very rewarding in that regard. You oversee promotions, the hiring, and promotions of the faculty, and it further opens your eyes to what can be. And so much of what we do, obviously, in cancer is multidisciplinary, interdisciplinary. We're not just radiation oncology, medical oncology surgeons. So much of what we do in medicine, we interact with public health, we interact with dentistry, we interact with the other health science schools. It has been a very interesting ride in terms of what can happen when you bring like-minded people from different disciplines and you concentrate on a certain topic. And we've started some seed funding. We've had efforts where it really has grown into very significant NIH funding. Pat Loehrer: What are you most proud of as a Vice-Provost or your leadership at the university that we wouldn't know about necessarily? Dr. Lori Pierce: Two things. One, I was one of the key worker bees in changing our policy for time to tenure. We used to have an eight-year tenure clock. And in medicine, we need longer. It's more difficult to get funding, it's more difficult to manage all of the missions that we do and still end up right where you want to be. And so we now have a tenure clock. And so I helped to make that possible. In more recent years, probably the jewel for my provost time is getting maternity leave and parental leave. Many academic institutions don't have maternity leave. Women have to take sick leave. I'm sorry, being pregnant is not sick. That's not a sickness. If you're a dad, you want to have time for bonding, you want to have time to be there when your child is born or adopted. And so I and two other people established a policy of maternity leave and parental leave that was wildly accepted. The leadership of the university could not agree more readily. And now we have a very robust policy, and this is not just for faculty, it's for staff. And I get people who thank me all the time, whether they're staff or faculty, especially the dads, for giving them the time to be with their child. So that's an easy question to answer. I think that has been a change that has been received positively throughout. And even if it's a case where when a person is gone for their parental leave or maternity leave, other people have to step up to cover for them. But people don't complain because everyone knows that that is the way it should be and that people should be given that time. So it's been one of those win-wins. You don't get win-wins very often, and that's been a win-win. Dave Johnson: Kudos to you and your colleagues for pushing that through and making that happen. That's got to be a huge recruitment advantage for Michigan. Dr. Lori Pierce: It absolutely is. And this is something where industry has done a long time ago. But academia, we have been much slower to adopt those family-friendly policies. And obviously, we are well compensated in our careers. People don't leave usually for the money. It's usually the other pieces. And it's pieces like this where people are recognized and rewarded for being a whole person. And that isn't just bringing in grants, it's also respecting their family lives and their family time. Dave Johnson: For sure. That was certainly my experience serving as chairman of a department. The things that prompted departure, there were some academic issues, of course, but the main ones were personal. And oftentimes it was family-related, particularly amongst our female faculty, but increasingly so amongst the male faculty as well. Dr. Lori Pierce: I agree on both counts. That's exactly right. And it's great to see that men want to be present for their children. Having a woman be able to take maternity leave is great, but having a man to take that parental leave is great as well. Dave Johnson: For sure. So let's pivot over to ASCO. ASCO is a huge professional organization, largely, but certainly not solely comprised of medical oncologists. You're one of the few radiation oncologists to lead that organization. What was that experience like? Dr. Lori Pierce: Being President of ASCO is without a doubt the highest point of my professional career. ASCO has always been a place where I felt at home. I always felt that ASCO wanted everyone under the tent. So yes, I know it's primarily medical oncology, but ASCO brings everyone together because in order to move the needle in cancer, we all contribute to improved outcomes. So then fast forward to becoming president. I never, ever thought I would be president of ASCO. It wasn't like something I was like, “Oh, I have to be President of ASCO.” No, I just wanted to be active in ASCO and do the right thing. And so you hear you've been nominated and you're very honored, but you're never going to be president, and you find out that you've been voted president. And my time was an unusual time because it was right in the midst of COVID. And so 2021 was completely consumed with COVID. So my predecessor, Skip Burris, he had a normal year up until about March of 2020, and that's when the world shut down. So of course, that was the first ASCO meeting that was virtual. Then my year came and from start to finish, I often tell people, I hope I will be the only president in ASCO history to say that they'd never had an in-person meeting for the entire time that they were president. All my meetings, every single meeting, were via Zoom. Yeah, you're a little disappointed by that, but in some ways, it worked to my advantage because, long story short, when I was voted president and you pick a theme, this was long before COVID; long before we knew the world was going to change, and I wanted to have an equity theme, but I worried that it wouldn't resonate with people. So I said, “Okay, I'm going to do this and just hope that it works well with the membership.” Well, then you fast forward, and the world changes. You have COVID and you have all these senseless murders that are on TV every night. And so even those who perhaps had their head in the sand before, they got it during COVID: there are so many inequities, and that ended up being, I think, the right theme for that time. And not being able to meet people because of COVID—yes, I missed it, but it was the reason that we missed it because of COVID and the inequities that were borne out during COVID—that really hit home that equity needs to be first and foremost in everyone's mind. So it's a long answer to your very short question. It was an amazing time. I think the organization has gotten stronger because of it. So much of work with ASCO was in equity before, but ASCO really upped its game, and equity is now one of those topics that is ingrained in every aspect of the organization, and that is what you have to have to truly affect change. I remember when I was president-elect, you go through all these interviews, these people want to interview you, and one question they ask or post is what do you want your legacy to be as president? And I was like, you can't make a legacy in a year with an orientation like ASCO. You make a legacy in a year if you have a lousy organization that you can actually make a huge difference in one year. So what you aspire to do is take a great organization and make it even better during your time as president. I think we did that. The world is inequitable. We get so many issues here and there and it all ends up with delivering inequitable care that those who have, can get the care and those who don't have it, cannot. And so I think the biggest challenge is to be able to bring the people to the table who can really make a difference and act on what needs to be done to improve equity in care. Dave Johnson: Pat has devoted a significant portion of his career to the whole issue of equity and I'm sure would agree with you. Pat Loehrer: I want to close with this thought, if you will. Dave or I usually just talk about our books that we've read. And one of the books that I mentioned that I just got through reading is entitled The Things We Make. It's by a chemical engineer and biomedical engineer from the University of Illinois, Bill Hammack. And the whole purpose of the book is really kind of defining the differences between science and engineering. He defines engineering as solving problems using rules of thumb that can cause the best change in a poorly understood situation using available resources. And he says, in a really tangible way, the scientific method creates knowledge while the engineering method creates solutions. Much of what we do in oncology really is really more engineering than it is science. We're trying to create solutions. He went on to talk about this and it ties into the last comment. He talks about the various technological explosions, eras that have great change occurred when science took a step forward and provided better rules of thumb for the engineers. So there was the Bronze Age and the quantum physics age and even the digital age. I would love for us to come up with the health equity age for which we could work together, taking the advances of science, but using these methods of engineering to make things better with the available resources that we have. And I think if we can do that, I think this would be something that I think we can all be very proud of. Dr. Lori Pierce: What an amazing summary of that book. And first of all, what amazing work that you have done, and I'm not just saying that—you are walking the walk and talking the talk. And to your point, Dave, of what is the biggest challenge for ASCO, I couldn't have answered it better than what Pat just said. That is it. That's it. That's it. ASCO can do it, but we can't do it alone. ASCO can't do it. Health can't do it alone. This is all hands on deck and it's bringing the other parts of society to the table so that we all understand the enormity of the problem and we have an action plan. Pat Loehrer: Is there a book you're reading, Lori, that you want to share? Dr. Lori Pierce: There is. I'm reading a book now called In Shock. It's by Rana Awdish, I don't know if you heard of it. I haven't gotten to the end of it, but just briefly, I met her because she's an ICU Doc at Henry Ford in Detroit and she gave the medical school graduation speech at our graduation a couple of weeks ago. So, in advance of her coming, I wanted to read through her book. It's an autobiography. In a nutshell, she had a just horrendous experience, essentially almost died when she was seven months pregnant as a fellow. And she basically bled out and I think it was related to a benign tumor in her liver, which is probably hormonally affected by her pregnancy. And she had sepsis, DIC, liver failure, adrenal failure. So, it goes through what it's like to be on the other side and to be in her own hospital. She wanted to go to her own hospital. She was in ICU in the place that she wasn't attending. Her experience though, as a book, really ends up talking about the hope of medicine because now she's thriving. She's well, she and her husband, she lost the pregnancy, then she and her husband now have a child. She's back to being an ICU attending, and she gave her medical school graduation speech two weeks ago. But in that book, you are reminded of the pitfalls in medicine. You're reminded that we as providers often forget that the patient is sitting right there, and she talks about situations where when she's on the vent, someone saying she's sitting right there, “She's circling the drain.” “She's trying to die on us.” “Your kidneys aren't cooperating.” And one resident who came in eating food and took out his back pocket said, “Oh, I'm sorry, I just had a really bad night last night.” She's dying. It's just yet another reminder that we are in this honorable profession. We have the honor of taking care of patients, and we always need to make sure that we respect every patient that we interact with. And so, it's a very interesting book. Also, there's another book that I read that's probably been out 15, 20 years, it's called The Art of Racing in the Rain. Do either of you know that? It was a New York bestseller. My husband bought this years ago, it was in our library in the house, and I happened to pull it out. It's about a dog. So, I'm a dog person. I've always had dogs. I love dogs with a passion. And this is a book written in the voice of the dog. It's about this dog named Enzo. And it's humorous, but it's also very emotional in places because it talks about what he does to help his owner, who's a wonderful man, and the wife who ends up dying of a brain tumor. As an oncologist, you could see symptoms, and you knew where that was going, and their daughter, and the things that a dog can do to uplift a human. And even when you're at your lowest point and you're about to give up, and the owner goes through just the most horrible, horrible experiences, and you realize that all of a sudden, something very small can make you then take notice of what is really important to you and can turn the tide. This is a great read. It's a quick read. I highly recommend it. It's called The Art of Racing in the Rain by Garth Stein. It really is an inspiring story about human resilience. It's a great book. Pat Loehrer: Lori, thank you so much for taking time from your incredibly busy schedule to spend a few minutes with Pat and me. We really enjoyed it. And I also want to thank the listeners to Oncology, Etc. an ASCO Educational podcast, where we will talk about oncology medicine and beyond. So, if you have an idea for a topic or a guest you would like for us to interview, by all means, email us at education@asco.org. To stay up to date with the latest episodes and explore other educational ASCO content, visit education.asco.org. Thanks again. And before we go, I have a question for you, Pat. How many ants does it take to fill an apartment? Pat Loehrer: I have to cry uncle on this. Dave Johnson: Ten, tenants. Pat Loehrer: Tenants. I thought crying uncle was a pretty good response. Dave Johnson: All right. Thank you, Lori. That was wonderful. Pat Loehrer: Thanks, Lori. It's terrific. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

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Oncology, Etc. – Pioneering Geriatric Cancer Care with Dr. Hyman Muss

Play Episode Listen Later Jun 13, 2023 31:27

Age is a main factor when determining cancer care. In this ASCO Education podcast we speak to one of the top leaders in treatment for older patients who has also credited mentorship as a foundation for his career. Dr. Hyman Muss describes his childhood in Brooklyn, serving as a general physician for troops in Vietnam (6:18), the doctor who influenced his choice of hematology and oncology (7:48) and creating one of the first geriatric oncology fellowships in in the country (21:58). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Hyman Muss: None More Podcasts with Oncology Leaders Oncology, Etc. – Devising Medical Standards and Training Master Clinicians with Dr. John Glick Oncology, Etc. – Rediscovering the Joy in Medicine with Dr. Deborah Schrag (Part 1) Oncology, Etc. – In Conversation with Dr. Richard Pazdur (Part 1) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Pat Loehrer: Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, director of Global Oncology and Health Equity at Indiana University. Dave Johnson: And I'm Dave Johnson of Medical Oncology at the University of Texas Southwestern in Dallas, Texas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of our podcast is to introduce listeners to interesting and inspirational people and topics in and outside the world of Oncology. We have an inspirational guest today. Pat? Pat Loehrer: If you ask anyone who's achieved any level of success and how they've achieved it, most likely they'll mention a number of people who've influenced them along the way. Quite often, these people reflect on their mentors, and after a certain time of accomplishment and reflection, they begin to mentor others. This is very much what our next guest has done. Dr. Hyman Muss has been a mentor to me and to Dave, and he's one of the most outstanding, wonderful people in the world, and we're so excited to have him today. Dr. Hyman Muss served in the US Army in Vietnam, where he was awarded the Bronze Star Medal. He's an experienced Clinician Scientist, the Mary Jones Hudson Distinguished Professor of Geriatric Oncology at the University of North Carolina School of Medicine, and the Director of Geriatric Oncology Program at the UNC Lineberger Comprehensive Cancer Center Program. His interest in education and research is focused on cancer and older patients, and he is internationally recognized in this area. He's been the co-chair of the Alliance Committee on Cancer and Older Adults and won the BJ Kennedy Award from ASCO in Geriatric Care. His particular interest in research expertise is in the care of breast cancer patients, with a focus on the management of women who are of older ages. He's had a major interest in breast cancer survivorship and long-term toxicity of treatment and also served as the co-chair of the Breast Committee for the Alliance Group. He serves as a mentor for medical students, medical residents, junior faculty, and more recently, his Geriatric Oncology fellows. He served on the Board of Directors of the ASCO Foundation and on the ABIM, the American Board of Internal Medicine, where both Dave and I were privileged to work with him and witness his leadership and his deep breadth of knowledge. Dr. Muss, thanks for joining us today. Dr. Hyman Muss: What a pleasure to be here. Thank you so much for inviting me. My mother would have loved the introduction. Pat Loehrer: Well, speaking of that, tell us a little bit. You grew up in Brooklyn, so tell us a little bit about your parents. Your father was a dentist, I think, and your uncle was a general practitioner. So give us a little bit of the early life of Hy Muss. Dr. Hyman Muss: So I grew up in Brooklyn, New York. I was born and bred there. I went to Brooklyn Technical High School. I almost went to Brooklyn College, but I came back and went to Downstate Medical Center, which was just terrific. My tuition was $600 a year, but that's another story. My parents lived in the same neighborhood. My dad was a dentist, so we knew all the people. My uncle was the GP. You came into their office, sat down, and they saw you anytime, day or night, almost 24/7, something we're probably not going back to, but they had a profound influence on me. My uncle, as a GP, used to take me on house calls in Brooklyn when they were done, and he had an old Buick with MD plates. And I would go into these families, and they loved him, and they would give me ice cream and things. Maybe that's what made me a doctor. But it was a terrific and indelible experience. I had terrific parents. In those days, doctors and medical people usually lived in the same neighborhoods as their patients, so they really knew their people well. It was a terrific upbringing. I got to love medicine and have never had a look back. Dave Johnson: So your inspiration for a career in medicine obviously started at home. Tell us more about your formal education. You mentioned your high school education. What about college? And shortly thereafter? Dr. Hyman Muss: Yeah, well, I went to Lafayette College. I was not the best high school student, but I had good college board scores or whatever they called them then. And I went to Lafayette and I thought I was going to be a chemist, a chemistry major. But I took enough premed courses and I spent a summer in a lab building cyclic ketones. And everybody was outside sitting on the lawn of the campus. And I was in there with all these distillation apparatus, and I said, “I don't think I can do this the rest of my life.” So I applied to medical school, and I got into several medical schools. But my father at that time was dying of metastatic bladder cancer. He had been a heavy smoker, and he was still working as a dentist. He worked until the day he unfortunately died. But I got into Downstate. We lived in Brooklyn, and my uncle, the GP, said, "Hy, you need to come home and help take care of your dad." I'm an only child, so I did. And I had a wonderful experience at Downstate. Several years ago, I was listening to NPR and heard that one of my professors had won the Nobel Prize. Dr. Furchgott in physiology, one would have never thought. And I had a wonderful education and subsequently got into what was then Peter Bent Brigham in Boston, did my internship and residency there, joined the army and medical school, so I wasn't drafted, it was a program then. And then after first year of residency, I went to Vietnam, worked with an artillery battalion, a mystical experience, but no regrets. And then subsequently came back and did hematology and oncology at Brigham and at what was then the Jimmy Fund and Sidney Farber Cancer Center. And Tom Frei had just come. And I did hematology with a guy named Bill Moloney in Boston at Harvard. I'll tell you, a wonderful man. He was like a surrogate father. My dad had died by then, and I just feel I've had every opportunity to have a wonderful education and terrific mentors along the way. Dave Johnson: So we want to ask you about both of those gentlemen, but I would like to just, if I may, drop back to your experience in Vietnam. What was that like? Dr. Hyman Muss: Well, I was 27 years old and I was put as the doctor for 500 men in artillery. My job was to take care of the general health of the troops. Fortunately, we didn't have many casualties. It wasn't a front war like my uncle, who was a GP actually in World War II, landed in Normandy about a week later and went all through World War II as a doctor. But Vietnam was an unusual war, there wasn't really a front. So my experience was I would go out to fire bases, which were units of about 100 men in the jungle, go out three days in a week in a helicopter, do sick call, check people. I dealt with really alcohol problems, unfortunately, a lot of drug problems. You had young people with really not a lot to do during the day, nothing much to do, and no real goal of being there. I did that for a while, and actually, the reason I got the Bronze Star was because I set up– It was nothing like standing in front of a machine gun. I'm not that kind of brave guy, but I set up a drug amnesty program so I got a lot of support from our regular field people to do this, so we didn't have to keep sending kids home with dishonorable discharges. And I learned a lot. I think we were reasonably successful. I learned a lot about artillery. I think overall it was a great experience in my life. Dave Johnson: Tell us how your interest in hematology and oncology originated. Where did that come from? Dr. Hyman Muss: When I was an intern at the Brigham, Dr. Moloney was a very famous Harvard professor. He had studied war casualties after Hiroshima, he was one of the people that found the Philadelphia chromosome in CML. He was a guy that rounded on every single one of his leukemia patients every day. So I was an intern. So in those days I would go and see all the hematology people rounding because all the acute leukemia patients and all the serious cancer patients were right on the floors, right on the wards. We had 17-bed wards, and then we had some private rooms. And he loved what he did. And before I left for Vietnam, we didn't have Ara C and daunomycin. So every leukemia patient I saw died. This is '68 to '70. Yet we tried all these different regimens. Occasionally you got someone who did well for six months, a year. But his bedside manner was absolutely wonderful to me. He knew all the patients. He'd ask them about where they lived in Boston. His humanism was terrific, and yet I loved the diseases he treated. The stakes were high. We didn't have good treatment, and I decided that that's probably what I want to do. So when I was in Vietnam, I applied and got back in the Hematology Fellowship and came back and did that. I saw Ara C and daunomycin. I gave the chemotherapy to them, and he'd say, "Go up and treat Harry Smith with Ara C and daunomycin." I had the syringes in my pocket, guys. Forget about hoods and mixing. And I'd go up and treat them and the marrow would be gone within four or five days. I did a bone marrow. They published their regimen in the New England Journal called COD, C-O-D because they also gave vincristine. So it was cytarabine, vincristine, and daunomycin, the COD regimen. It fit Boston. And I saw it was like the emergence of cisplatin after Larry Einhorn. You saw people that never survived going into remission and I saw some remissions in AML and it cemented it. About my second year of residency, we had a child. I was running out of money. I was being paid $6,000 a year and I had the GI Bill. I went into Dr. Moloney and he talked with Dr. Franny Moore, who was head of surgery at the Brigham, and they made me the Sidney Farber Research Fellow, doubled my salary and I had to go to the Jimmy Fund and see cancer patients. And it so happened that was when Tom Frei came to Dana-Farber. And so I started rounding with Dr. Frei and seeing those patients. And I think the first day I walked in, I knew I wanted to do more than just leukemia because I saw groups of patients with every disease. We treated everybody with CMFEP, it didn't matter what cancer they had. And I just loved it and said, "My God, there's so much we can learn. What a great career." And so that got me into the oncology portion. And then I was offered to stay at Harvard. They were going to make me an assistant professor, but they wanted me to do lab work. And I knew my personality, it just wasn't for me. I worked with a lovely guy named Frank Bunn, one of the world's great hem guys in his lab, and he's still a close friend in his 80s. And he told me one day, he said, "Hy, I don't think the lab is for you." And he actually helped me get my first job at Wake Forest University, which turned out to be wonderful. So that's how I ended up with my circuitous in HemOnc. And it's really from great mentors, it's from Bill Moloney, it's from Tom Frei, Dave Rosenthal, tons of wonderful people along the way that not only taught me a lot, but they seemed to love what they do, which is a gift in life to love what you do and love the people you're doing it with. They instilled that in me. Pat Loehrer: From there you went to Wake Forest and there's a couple of colleagues down there, I believe, that inspired you, Charlie Spurr and Bill Hazzard, who was the founding founder of geriatrics. Tell us about that experience and how'd that shape your life. Dr. Hyman Muss: I was looking for a clinical job and I looked at Rochester, and I got snowed in one night in Wake Forest, and I said, “Where's the contract?” And I signed it. And my mother, who was living in New York City, didn't know where North Carolina was. My mother was from a family, was born over a candy store in Greenwich Village, and said, “Where are you going?” And then I showed her where it was, and she says, “They're going to kill you down there.” And it turned out to be one of the best decisions of my life. My wife Loretta, who both of you know so well, we got out of our VW with our dog and our daughter when we moved here, and VW bug, by the way, not a van, and she cried. It turned out it was one of the best opportunities. Charlie Spurr was an iconic oncology leader. He actually did some of the early work on nitrogen mustard in Chicago during the war, the first chemotherapy drug. He was a terrific leader. He had patients programmed in on those IBM punch cards. He had little cards for the protocols, CMFEP, CMF, AC on little laminated index cards. I learned so much from him, and he was to me, great leaders and great mentors morph from things they do themselves to teaching other people, and whose brains have the ability of having the same dopamine shot when you see one of your fellows or young faculty present a wonderful study as you do. And your brain isn't saying, “I wish I was up there.” It's saying, “Isn't this so cool that this young man or woman or fellow or medical student is doing such a wonderful job?” And I had something to do with providing the soil for this seed to grow. That's the kind of guy he was. And so it was wonderful there. And as I moved on, we got a new Chief of Medicine, Bill Hazzard. And I still hear from Bill on rare occasions, but Bill was one of the first geriatricians in the United States. He wrote the textbook, and his wish was that all the faculty and all the specialties get involved in a geriatric project. And so I had all those little index cards, and I looked and saw how many older people with metastatic breast cancer we'd given chemotherapy to. And these were little protocols, nothing like the protocols today, no 50-page consent forms, 50 pages of where your data is stored. They were like, here's the treatment, here's the dose mods. And I looked at those 70 patients with one of our residents, Kathy Christman, she may be retired now, but in any event, we wrote a paper and showed the old people did as well as the young with breast cancer. And we published it in JAMA. And it's one of the few papers in my career, I got no reviewers. They accepted the paper. I got no reviewers. So because I'm from Brooklyn, and my English is not what it should be, I had my friends read it to just make sure I didn't say anything egregious. But it got published and the next thing I know, my friends in medical oncology in the state were calling me. They said, “I got a 75-year-old woman here.” I'm saying, “Guys, I just wrote this paper. I really don't know anything about older people.” But slowly, with Bill Hazzard and others, I got more and more interested. I started reading about Geriatrics and I ended up making it a focal point of my career. It was kind of happenstance. And Bill was a wonderful mentor. And then as I subsequently moved on, I worked with terrific people like Harvey Cohen, Lodovico Balducci, and Martine Extermann, all of them heavily involved with ASCO over the years as well, and B.J. Kennedy. They were wonderful to work with. And BJ was inspirational because BJ would get up at an ASCO meeting and he'd say when he saw the age cut off, he'd say, “How come you didn't let old people on that study? There'd be 1000 people in the audience.” And so he really was a great mentor. And I had the bittersweet opportunity of writing his obit for JCO years ago and kept up with his family a few years, but he was a wonderful man. Dave Johnson: I'm just reflecting on the fact that today, patient registries are sort of mainstream, but certainly in the ‘70s, ‘80s, even into the ‘90s, having a list of patients with a particular disorder seemed almost novel in many respects. And to have that was a godsend. Dr. Hyman Muss: It was a godsend. I still remember those little file cards. And he called it the Oncology Research Center and it was a godsend. And you've got to remember, this is like ‘74, ‘75, it's a long time ago. Dave Johnson: So many of our listeners may not be as familiar with Wake Forest as they are with Duke and North Carolina, the other medical schools located there. But you were at right at a point where I mean, it was one of the top oncology programs in the country at that time. Still is, I don't mean to diminish it, but there was a who's who of people there at the time. And you were also involved in creating, I think, one of the first cooperative groups of sorts. It was the Piedmont Oncology Group. Tell us about that. Dr. Hyman Muss: Oh, yeah, well, that brings back memories. So the NCI at that time wanted to get more, I think, rural and other smaller places involved in research. And they put out an RFA to form like regional cooperative groups. And we formed the Piedmont Oncology Association, the POA. We actually did well for a few years. We wrote some really good studies. We got one or two New England Journal articles. I worked with all the people, mainly in the community, community docs who would go on, and put people on the protocol. I mean, I looked at all the X-rays and scans in a lot of these patients myself as part of the studies we did. And it turned out to be a wonderful organization and it's still run today by Bayard Powell, who is one of our terrific fellows who's the head of Oncology at Wake Forest. But after a while, we just couldn't compete with CALGB, of which I was a member of also, and ECOG and SWOG, even North Central Group, which was kind of formed in a similar venue, eventually merged. So we did a wonderful job for a while but the truth is we just didn't have the manpower to write studies for every disease site. So eventually we kind of petered out as a clinical trials group. But it's been maintained for educational programs and it's really served as a good resource for a lot of good education for the community oncologists who give most of the care in this country in the state. So it's been good. I think Pat kind of exceeded us with HOG, the Hoosier Oncology Group, which was in a similar vein. But it was a great experience and it was all Dr. Spurr, who thought of doing this and built it. Dave Johnson: Certainly, it was inspirational in many people in and outside of Wake Forest. So with such an idyllic life, what in the world possessed you to move north to Vermont? Dr. Hyman Muss: Well, you get this urgent life. You want to be a leader, you want to be a chief. Now, I tell younger people, if they love what they do, don't do it. So I got a wonderful opportunity at the University of Vermont to go up there and be Head of HemOnc. Chief of Medicine was a terrific guy, Burt Sobel. The university at that time, at one time it had a wonderful Oncology program. It had a federally funded cancer center with Irwin Krakoff and Jerry Yates, two other iconic guys. I don't know what the politics were but it had lost a tremendous amount of faculty, especially its clinical faculty, and they needed to rebuild it. And I went up and I thought, “Well, I'm in my 50s. This is going to be a great opportunity. If I don't do it now, I may never get the chance.” So I went up there and actually, it was a great opportunity. We hired terrific people. We got CALGB and we participated. We had actually a very good accrual for a small place and we had a very small but very effective cancer center. So it turned out to be a really good experience. I worked with wonderful people. I recruited some wonderful people. But over time, the issues of the business of medicine, all the issues that happened, I'm saying I'm kind of losing my focus on clinical care and clinical trials, which I love to do. I don't need to tell either of you. I mean, Dave, you've been chief and department chair and Pat has run cancer centers. After a while, the administrative tasks just were so overwhelming and I didn't enjoy them, that I said, “I've got to get back in some type of more clinical focus.” And that's when I decided to look around and fortunately found what's turned out to be a dream job at UNC. But it was a time of life. Maybe my ego got in the way of my logic. I don't regret it. I met and I think we rebuilt a wonderful clinical program. But you realize some of the resources of big places with- we never had the research infrastructure to hire a lot of people and get big programs going on and great translational programs, just didn't have the funding. But it was great, and I have no regrets. And I learned how to tolerate the cold weather. And I have a lovely daughter, Sarah, who still lives up there. So we get back occasionally. And I've kept up with a lot of the people there. There are some wonderful people at UVM. Pat Loehrer: From there, though, you were pulled down to North Carolina, where you've, again, built an incredible breast program there is outstanding. But you've created a Geriatric Oncology program, one of the first geriatric fellowships in oncology in the country. So tell us a little bit about that and what you feel may be your legacy is there at North Carolina. Dr. Hyman Muss: Well, I had the opportunity over the years when I was at Wake, really, I got to know Shelley Earp, who's our cancer center director. I think maybe you were close to him, Pat. The longest surviving cancer center director on the planet, or among them. And we were good friends. And North Carolina's legislature actually gave the University of North Carolina substantial funding to improve cancer care in North Carolina, not just research. And so I had talked with Shelley about maybe moving, and because of the generosity of the state, really, he was able to really get me going, start a Geriatric Oncology program. And what I wanted to do was develop trials. As Dave says, I built a registry in 2009 here for older cancer patients using geriatric assessment. I have 2000 patients, which has been a resource for all types of faculty and fellows, and students to write papers. But I was able, with the support, to do things like this right from the get-go. And plus, I joined probably one of the best breast groups on the planet with Lisa Carey and Chuck Perou, and Larry, terrific people, Claire Dees. I had great luck in doing this, so I was able to really focus, get great support from my colleagues to build studies focusing on older people. And then I had the great fortune of meeting Ned Sharpless, our prior NCI director. And Ned is one of the world's great aging biologists. And I don't mean aging as an adjective, he's really been a master on why we age, the biology of aging, cell senescence. So Ned taught me all about cell senescence and the mechanisms, especially the gene expression p16, which is like our own CDK inhibitor. And so I was able to start using his lab, collect samples, treat people with chemotherapy, follow them off with geriatric assessment. It was a great opportunity to do that here, and we got a lot of studies going and we showed what the pediatricians have known for years, that chemotherapy dramatically ages people, not just children, but adults. But it also allowed me to work with my colleagues in lymphoma and lung cancer to do little studies along the way. And we eventually then built a T32 program. We got a T32, which we're kind of completing now our first five years to train oncology specialists in geriatrics. So the way we do it is they can be surgical oncologists, GU, we had a GYN oncologist, medical. With their HemOnc training, they do a year where they work with the geriatricians, so they go on geriatric inpatient service for a month and they really learn about older people. And part of it is a project. So we've been able to build that and develop a lot of programs with that. And I should say we've been very successful with mentorship and with ASCO support for things like YIAs, the late and great Arti Hurria, who absolutely an amazing woman. Some of her legacy at ASCO, the YIAs, and things. We've been successful in applying for some. So we've been able to build a whole spectrum of med and hematologists. We have an interest in Myeloma and AML focusing on older people. We've been able to build a whole team approach, including translational projects related to older people. And it's just been a great opportunity, and hopefully, my legacy here will be, too, and I'm working on it. We have a wonderful guy, Bill Wood, who is very effective and has built this incredible coaching program to continue this legacy. Like many of us in this field, we are bothered because we all know the stats, we all know that first slide of the demographics of cancer, and yet it's been very hard in our culture to provide a lot of the services and build the clinical trials we need to best care for older people. It's still a major problem in this country. So as I cut back on my clinical care, I'm going to still advocate to try to improve the care of older people. Do geriatric assessment, build it into your clinical programs, get your hospitals to support you, convince them, build business plans, et cetera. And hopefully, that'll be my ultimate legacy, that we've made greater awareness of the older people, other than the usual stats, and we're really trying to care for them in a much more global sense, in a much more holistic sense than we've done. I hope we'll be successful. It's a slow haul, but we've got lots of great young people coming up through the pipelines, ASCO has been a great player in this. Many of you know people like Supriya Mohile and William Dale, Heidi Klepin, people, the next generation that's going to keep building this. So I hope the legacy will be that we get more buy-in, more interest, more trained people in other oncology-related subspecialties RadOnc, SurgOnc that will really focus on the care of older people. Dave Johnson: I don't think there's any doubt that that will be a part of your legacy Hy, but I think your legacy will be much broader than the world of geriatric oncology. Your mentorship leadership, your clinical skills, your educational capabilities, all of that will certainly last for many, many years in the future. Well, I don't want to bring up a touchy topic, but you yourself are geriatric and we're wondering what your plans are for your semi-retirement. I recognize you're not retiring, but what do you like to do outside of medicine? Dr. Hyman Muss: I'll tell everybody who's interested in hearing this. On Tuesday, I had my 80th birthday. Dave Johnson: Congratulations. Dr. Hyman Muss: And I think I'm one of the most blessed guys. I'm pretty healthy. I married up - my wife Loretta, who both of you, Pat Loehrer and Dave Johnson, know well. Dave Johnson: Yeah, you definitely married up. Dr. Hyman Muss: Yes. It's really carried me most of my life. She's great and so she flew up our three kids and we celebrated and I'm very fortunate. I have the enthusiasm and strength to do more clinical medicine. But I think the time has come for me to cut back my clinical medicine, so I'm going to do that in June. The hardest thing I've done is say goodbye to so many of my patients here. We've been blessed. We have a lovely family. We're pretty close. I'm never bored, probably you two know well, I love to do things like fishing, outdoor stuff. I've really gotten into woodworking, so I'm not going to be bored. But there will be a small piece out of me when I walk out of that clinic in June. I know that and my two close psychiatry friends think it's going to really be a hard fall, but I don't think so. I still have some grants. In fact, I'm working with a fellow in City of Hope, Mina Sedrak, who's been very involved in ASCO, too. We are hoping to get an R01 looking at senolytic drugs that may prevent aging, and exercise in older women with breast cancer to see if we can reverse the trends of chemo. So my brain is still on that stuff, but the clinical care is going to be tough. I had a note and for some reason, we talked about so many things. I wanted to mention that one of my great opportunities was joining the CALGB and then the Alliance and getting the support of Dr. Schilsky, Rich Schilsky, who's been one of the icons of ASCO to build cancer in the elderly working group with Dr. Harvey Cohen at Duke. And Harvey is one of the world's great geriatricians. And using that to get studies done, to incorporate studies with Arti Hurria on geriatric assessment, and really have it as a place where a lot of younger investigators could get started on a career in geriatric oncology. And that was really a great opportunity. It was kept on by Dr. Bertagnolli, who now is our NCI director, and I think was really the first group to really give good support for this. Dave Johnson: So we want to thank you very much for being our guest today. We also want to thank our listeners of Oncology, Etc. This is an ASCO Educational Podcast where we talk about oncology medicine and much more. So if any of our listeners have an idea or a guest they would like for us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, visit ASCO's website at education.asco.org. Thanks again for being our guest, Hy. Dr. Hyman Muss: My pleasure. Thank you so much. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

united states new york director university texas head new york city chicago english philadelphia board north carolina medicine chief cancer harvard world war ii md vietnam wake npr alliance guys ibm vermont bj ac pfizer muss us army rochester gp nobel prize gu unc indiana university rediscovering frei pioneering hiroshima hogs lafayette my god internal medicine vw cod normandy wake forest oncology american board jama brigham geriatrics health equity new england journal older adults greenwich village wake forest university bronze star hyman cancer care hy aml buick asco brooklyn college rfa gyn in conversation gi bill north carolina school poa moloney dave johnson bronze star medal lafayette college medical oncology uvm nci cdk myeloma harry smith cml cmf dana farber downstate abim jco jimmy fund geriatric care clinician scientist texas southwestern alliance group ecog bill wood swog global oncology brooklyn technical high school calgb downstate medical center lilly foundation radonc

Oncology, Etc. – Devising Medical Standards and Training Master Clinicians with Dr. John Glick

Cancer Stories: The Art of Oncology

Play Episode Listen Later May 2, 2023 29:34

The early 1970's saw the start of the medical specialty we now know as oncology. How does one create standards and practices for patient care during that time? Dr. John Glick is a pioneer during the dawn of oncology. He says that early work involved humanity, optimism, and compassion, all of which were the foundation of his career. Dr Glick describes the clinical experiences that drove him to oncology (4:28), his rapport with patients, which was portrayed in Stewart Alsop's book Stay of Execution (9:21), and his groundbreaking work developing the medical oncology program at the University of Pennsylvania (12:22). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. John Glick: None More Podcasts with Oncology Leaders Oncology, Etc. – In Conversation with Dr. Richard Pazdur (Part 1) Oncology, Etc. – HPV Vaccine Pioneer Dr. Douglas Lowy (Part 1) Oncology, Etc. – Rediscovering the Joy in Medicine with Dr. Deborah Schrag (Part 1) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed in the podcast page. Pat Loehrer: Welcome to Oncology, Etc. This is an ASCO education podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: And I'm Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of our podcast is to introduce listeners to interesting people and topics in and outside the world of oncology. Today's guest is someone well-known to the oncology community. Dr. John Glick is undoubtedly one of oncology's most highly respected clinicians, researchers, and mentors. I've always viewed John as the quintessential role model. I will add that for me, he proved to be a role model even before I met him, which hopefully we'll talk about a little bit later. To attempt to summarize John's career in a paragraph or two is really impossible. Suffice it to say, he is to the University of Pennsylvania Cancer Center what water is to Niagara Falls. You can't have one without the other. After completing his fellowship at NCI in Stanford, John joined the Penn faculty in 1974 as the Ann B. Young Assistant Professor. Some five decades later, he retired as the director of one of the most highly respected comprehensive cancer centers in the nation. Among his many notable accomplishments, I will comment on just a few. He established the Medical Oncology program at Penn and subsequently directed the Abramson Cancer Center from 1985 to 2006. Interestingly, he established the Penn Medicine Academy of Master Clinicians to promote clinical excellence in all subspecialties across the health system. He's been a driving force in philanthropy at Penn Medicine, culminating in his role as Vice President Associate Dean for Resource Development. Over the past several decades, he has helped raise over half a billion dollars for Penn Med. We need you on our team, John. As a clinician scholar, John's research has helped shape standards of care for both breast cancer and lymphomas. For example, he pioneered the integration of adjuvant chemotherapy and definitive breast irradiation for early-stage breast cancer. In 1985, he chaired the pivotal NCI Consensus Conference on adjuvant chemotherapy for breast cancer. He also was a driving force in a clinical landmark study published in The New England Journal some 20 or so years ago about the role of bone marrow transplant for advanced breast cancer. Most impressive of all, in my opinion, is John's legacy as a mentor to multiple generations of medical students, residents, and fellows. So, John, we want to thank you for joining us and welcome. Thought we might start by having you tell us a little about your early life, your family, your parents, where you grew up, and how you got into medicine. Dr. John Glick: Well, thank you for having me on the podcast, Pat and David, it's always a pleasure to be with you and with ASCO. I grew up in New York City in Manhattan. My father was a well-known dermatologist. He was my role model. And from the age of eight, I knew I wanted to be a doctor. Nothing else ever crossed my mind. But having seen my father's many interests outside of medicine, I realized from very early that there was much more to medicine than just science. And that really induced me, when I went to college, to major in the humanities, in history, art history, and I actually took the minimum number of science courses to get into medical school. That probably wouldn't work today, but it was the start of my interest in humanism, humanities, and dealing with people outside of the quantitative sciences. Dave Johnson: So that's reflected in how we all view you, John. You're one of the most humanistic physicians that I know personally. I wonder if you could tell us about your interest in medical oncology, and in particular, as one of the pioneers in the field. I mean, there wasn't really even a specialty of medical oncology until the early 1970s. So, how in the world did you get interested in oncology and what drew you to that specialty? Dr. John Glick: Well, I had two clinical experiences that drove me into oncology. The first, when I was a third year medical student at Columbia PNS, my first clinical rotation in internal medicine, I was assigned a 20-year-old who had acute leukemia, except he was not told his diagnosis. He was told he had aplastic anemia, receiving blood and platelets, and some form of chemotherapy. And I spent a lot of time just talking to him as an individual, not just taking care of him. And we became friends. And he was then discharged, only to be readmitted about two weeks later. And in the elevator, the medical assistant had his admission sheet, and unfortunately, it was facing the patient, and it had his diagnosis, acute leukemia. So he came into the ward and he confronted me. "Why didn't you tell me I had acute leukemia?" Well, I couldn't say the attendees forbade me to do that. So I took what today we would call ‘the hit', and apologized. But it stimulated me to reflect that honesty with patients was extremely important, and that oncology was just in its infancy. We knew nothing about it. It was not considered even a specialty. I don't think we used the word "oncology." But that inspired me to take an elective in my fourth year at PNS, at an indigent cancer hospital called the Francis Delafield Hospital. It only took care of indigent cancer patients, and there were wards, twelve patients in a ward, six on each side, and nobody would go see the patients. It was almost as if they were afraid that if they were to touch the patient, they would get cancer. And I started talking to the patients, and they were human beings, but nobody had told them their diagnosis. Nobody had told them if they were terminal. And there were a few patients who were getting a new drug at that time for multiple myeloma called melphalan, and they actually had relief of some of the symptoms, of their bone pain. But I realized that there was a huge void in medicine that I could possibly help to fill. And that was the era of Vietnam, and so I applied to the National Cancer Institute to become a commissioned officer in the Public Health Service to avoid the draft, to be on a service with, at that time, some very notable oncologists Vince DeVita, Ed Henderson, Paul Carbone. I had read some of their papers, and I was lucky to be accepted. And I was a clinical associate at the National Cancer Institute. And that was life-changing because there every patient was considered to be potentially curable. The advances at that time using MOPP for Hodgkin's disease, C-MOPP for lymphoma, some treatments for leukemia. George Canellos pioneered the use of CMF for metastatic breast cancer. It was an amazing, amazing experience. That was in 1971 to ‘73. Oncology did not become a true specialty till ‘73, but my two years at NCI were formative. However, I realized that there was something missing in my training. Everybody was considered curable, but I had never seen a patient with metastatic colon cancer, metastatic lung cancer. The radiotherapists there did not like to teach clinical associates, and I knew that there was a place called Stanford. And Stanford had Saul Rosenberg in medical oncology for lymphomas and Henry Kaplan in radiotherapy. So, everybody was going to California, and my wife and I packed up and went to California and spent a year at Stanford, which, combined with my training at the NCI, led me to the principles that guided my career in oncology; humanity, optimism, reality, compassion, and a love for clinical trials. I was very, very fortunate to be there at the dawn of medical oncology shortly after I decided to go to Penn, which at that time did not have a medical oncologist. In fact, I was the only medical oncologist at Penn for four years and did every consult in the hospital for four years, much to the chagrin of my wife. But I was fortunate to have great mentors in my career: Paul Carbone, Vince DeVita, Saul Rosenberg, Henry Kaplan, among many, many others. And that impressed me about the importance of mentorship because my career would never have been where it was or is without these mentors. Pat Loehrer: John, just to echo what Dave said, you've been such a tremendous mentor for us. Dave and I particularly, you took us under your wings when you didn't know who we were. We were people in the Midwest. We weren't from any place shiny, but we really appreciate that. Dave Johnson: So, John, I mentioned at the very beginning that I met you before I met you, and the way I met you was through Stewart Alsop's book, Stay of Execution. He portrayed you as an extraordinarily caring individual, and it tremendously impacted me. It was one of the reasons why I chose oncology as a specialty. I realize it's been 50 or more years ago and most of our listeners will have no idea who Stewart Alsop was. And I wonder if you might share with us a little bit of that experience interacting with someone who was particularly well-known in that time as a columnist for The New York Times. Dr. John Glick: His brother Joe Alsop and Stu Alsop were two of the most famous columnists at that time. Joe Alsop was a hawk right-winger who lived in the Vietnam War. Stewart was charming, was a centrist Democrat, wrote the back page for Newsweek for years. He and I had very similar educational backgrounds and interests. And we functioned on two different levels—one as a physician-patient, and then we became friends. And he and his wife adopted us into the Georgetown set. And I received a lot of criticism for socializing with a patient. But over the years, I've been able to become friends with many of my patients, and I've been able to compartmentalize their medical care from our friendship. And I use the analogy if I was a doctor in a small town and I was the only doctor, I'd be friends with people in town, with the pastor and likely the mayor. But I have always believed that patients can become your friends if they want it and if they initiated it. Taking care of Stewart Alsop was an amazing, amazing experience. We didn't know what he had. People initially thought he had acute leukemia. In reality, he had myelodysplastic syndrome, but that hadn't been described yet. He had a spontaneous remission, which I rarely see, probably due to interferon released from a febrile episode, all his blasts went away in his marrow. One of my children's middle name is Stewart. But professionally and personally, it was an incredible experience. It taught me the importance of being available to patients. They had my home phone number. We didn't have cell phone numbers in those days. We had beepers, but they didn't work. And from that point on, I gave my home phone number to patients, and I actually trained my children how to answer the phone. “This is Katie Glick. How can I help you? My father's not home. You need my father? Can I have your phone number? I'll find him and he'll call you back.” Patients still remember my children and their way of answering the phone. Pat Loehrer: One of the things you did do is create this medical oncology program at Penn, which has graduated some incredible fellows that have become outstanding leaders in our field. But can you reflect a little bit about the process of creating something that was never created before, like a medical oncology program? Dr. John Glick: Well, I came to Penn, my first day. Person who recruited me was on sabbatical. I asked where my office was and there was no office. There was an exam room. There was a clinic for indigent patients which we scrubbed by hand. There was another office for patients who paid. Within two months, I had abolished that. We had one– I hate to use the word clinic, people still use the word clinic today, but one office that took care of all patients, irregardless of means. I saw every oncology consult in the hospital for four years. But I had a mentor, not only Buz Cooper, but fortunately, Jonathan Rhoads was Chairman of Surgery, and he was also Chairman of the President's Cancer panel. And what he said at Penn in surgery became the law. And then when we introduced lumpectomy for breast cancer and radiotherapy, he endorsed it immediately. All the other surgeons followed suit. I don't think there's any hospital in the country that adopted lumpectomy and radiotherapy for breast cancer as quickly. And the surgeons were instrumental in my career. Now, I was taking care of gliomas, head and neck cancers, and it was difficult. If I had a colorectal patient, I'd call Charles Moertel at Mayo Clinic and say, “What do I do?” I was there when Larry Einhorn in 1975 presented his data on testicular cancer with the platinum. Unbelievably inspiring, transformational. It also showed the importance of single-arm studies. You didn't have to do randomized studies because the results were so outstanding. And so in my career, I did both single-arm studies, proof of principle studies, and then many randomized trials through the cooperative groups. But the first four years were very difficult. I didn't know what the word ‘work-life balance' meant in those days. If somebody was sick, I stayed and saw them. It was difficult introducing new principles. When I first mentioned platinum after Larry's presentation, I was laughed out of the room because this was a heavy metal. When patients were dying, they died in the hospital, and I wanted to hang up morphine to assist them. The nurses reported me to the administration. I had to fight to get the vending machines for cigarettes out of the hospital. So there were a lot of victories along the way and a lot of setbacks. It took me several years to have an oncology unit of six beds, and now I think we have 150 or 160 beds and need more. So it was an interesting and, in retrospective, a wonderful experience, but I didn't know any better. Fortunately, I had a great wife who was working at Penn and then at Medical College of Pennsylvania, and she was incredibly understanding, never complained. And I think my kids knew that on Tuesdays and Thursdays, don't bring up anything difficult with dad because he's had a really tough day in clinic. Dave Johnson: We were not in that era, but we were very close. And many of the struggles that you had were beginning to dissipate by the time we were completing our training. But it was still a challenge. I mean, all those things. I gave my own chemotherapy for the first few years I was in practice. I don't know that our colleagues today who have trained in the last, say, 10 or 15 years, actually realize that that was what we did. Most of the chemo was given in the hospital. It was not uncommon in the early days to have 20, 30, 40 inpatients that you would round on because there just wasn't an outpatient facility. But the corporate mind made a big difference, allowing us to give drugs like platinum in the outpatient arena. You span all of that era, and so you've seen the whole panoply of change that has taken place. John, the other thing you did that has impressed me, in part because of my time as a Chair of Medicine, is you created this Academy of Master Clinicians. Can you tell us a bit about that and what was the motivation behind that? Dr. John Glick: Ben had a strategic plan, and one of the pillars was talking about valuing clinical medicine and clinical excellence. But there was no implementation plan. It was sort of just words and left in the air. And I was no longer director of the cancer center, and I realized we had a lot of awards for research, awards for education, and no awards for clinical excellence. So I created the idea of having an academy and master clinician spend six months talking to all constituencies, chairs of various departments, directors of centers to get a buy-in. Wrote a three-page white paper for the dean, who approved it immediately. And then, as typical at Penn, I raised all the money for it. I went to one of my patients who was an executive at Blue Cross. I said I need $500,000 to start this program. And then subsequently, I raised $4 million to endow it. Today, it is the highest honor that a Penn clinician can receive. You could be on any one of our multiple tracks. You have to see patients at least 60% of the time. You not only have to be a great doctor, you have to be a humanist. So the world's best thoracic surgeon who has a demeanor in the operating room that is not conducive to working with a nurse as a team doesn't get in. We emphasize professionalism, mentorship, citizenship, teaching, national reputation, local reputation, and clinical excellence. And so we've elected over 100 people, maybe 3% of the Penn faculty. We give an honorarium. We have monthly meetings now by Zoom. We have monthly meetings on various topics. We never have a problem getting any dean or CEO to come talk to us. We were the first to do Penn's professionalism statement. The school subsequently adopted, and it's become the highest honor for a Penn clinician. It's very competitive. It's peer-reviewed. The dean has no influence. And we're very proud that 40% of the members of the academy are women. We have a high percentage of diversity compared to the numbers on our faculty, but you really have to be elected on merit, and some people that you might expected to be members of the academy aren't. It's one of the things I'm proudest of. It will go on in perpetuity because of the money we've raised. I think many of my accomplishments as a researcher will fade, as they typically do, but I'm very proud of the Academy, and I'm very proud of the people that I've mentored. Dave Johnson: It speaks to your values, John, and I think it's one of the reasons why you're so widely admired. Thank you for creating that. It proved to be a model for other institutions. I know that for a fact. One would think that valuing clinical care would be preeminent in medical schools, but in fact, it's often ignored. So again, I know that your colleagues at Penn appreciate your efforts in that regard. Tell us a little about your term as ASCO president. What are you most proud about and what were your most difficult challenges? Dr. John Glick: Well, the most difficult challenge was that ASCO was in transition. I had to fire the company that ran the meeting. We had to decide that ASCO was going to hire a CEO. We hired John Durant, made a small headquarters, tiny staff, and did a lot of the work as being chief operating officer myself. It was the year that email was just getting started, and ASCO wasn't using it. So every Saturday from 8:00 to 6:00, I came into the office and my secretary wrote letters inviting people to be on the program committee or various committees. But it was a society in transition. The growth of membership was huge. The meeting sites had to be changed. We emphasized science. Some of the things that we did are still in existence today. We formed the ASCO ACR Clinical Research Methods course. It's still given. That's one of our real highlights. We forged relationships with other societies, the National Coalition for Survivorship. We made the ASCO guidelines much more prominent. And I remember that we were going to publish the first guidelines on genetic testing for breast cancer, and the MCI went up in absolute arms, so I arranged a meeting. I was at the head of the table. On my right were Francis Collins, Richard Klausner, Bob Wittes, and a few other people. Then the ASCO people who wrote the guideline were on the left, and they didn't want us to publish it. They thought it was premature to have a guideline about genetic testing. And what I learned from that meeting is that you can agree to disagree with even the most prominent people in oncology and still maintain those relationships. But we did what's right, and we published a guideline on the JCO. There were so many wonderful things that happened at ASCO that I can hardly restate all that happened I guess 27 years later. It was exciting. ASCO was still young. There was a lot we had to do, and we could do it. You could just go ahead and do it. It was exciting. It was gratifying. It was one of the most fun years of my life. Dave Johnson: I mean, that transition from an outside company in many respects, controlling the premier activity of ASCO, its annual meeting to ASCO, taking that on, that defined ASCO, and that's what I remember most about your time as president. It was a bold move, and the hiring of John Durant was brilliant. I mean, he was such an incredible individual, and it was great that you guys were able to pull that off. Pat Loehrer: Thank you for what you've done. You've had a number of your mentees if you will, and colleagues that have gone on to prominent positions, including, I think, at least three directors of NCI Cancer Centers. Can you just talk briefly how you would describe your mentoring style because you've been so successful? Dr. John Glick: First, there are two aspects. One is when people come to you, and then when you go to people, you sense they're in need. The key aspect of mentoring is listening. Not talking, listening. Looking for the hidden meanings behind what they're saying, not telling them what to do, presenting options, perhaps giving them clues on how to weigh those options in pros and cons, being available for follow-up. Mentoring is never a one-time exercise. Not criticizing their decisions. You may disagree with their decision, but it's their decision, especially if they've considered it. Being proud of the mentee, being proud of their accomplishments, following them over the years. And when they've gotten in trouble or failed to get the job that they wanted, always be there for them, not just in the good times, but in the times that are difficult for them professionally. I think that's one of the most important things. Even today, I mentor three or four clinical department chairmen, and people ranging from full professors to newly appointed assistant professors. Now that I'm retired, mentoring is the one activity that I've really retained. It's extraordinarily satisfying, and I'm proud of the people that I've mentored. But it's their accomplishments, and the key aspect of mentoring is never to take credit. Dave Johnson: I'll give you credit for mentoring me, and I appreciate it. You were very instrumental at a very decisive point in my career when the old Southeast Cancer Group disbanded, and we were looking for a new cooperative group home. And you were instrumental in helping my institution come into the ECOG fold, and not just as a very junior member, but really as a player. And I'll never forget that, and we'll always appreciate that very much. Pat Loehrer: Ditto on my side, too. Dave Johnson: John, you mentioned that you're retired. What do you like to do in your "free time” if you're not mentoring? Dr. John Glick: Life is good. My daughter says I have a disease, O-L-D. My grandson says, “He's not old; he's almost 80. Look how well he's done.” “Here's $20.” I'm having fun. We are fortunate to have homes in different places. We spend the summer up in the Thousand Islands on the St. Lawrence River, spring and fall down in Charleston, then lots of time in Philadelphia. We travel. I play golf poorly. I'm getting a chance to read history again, go back to one of my great loves. I'm with my children and grandchildren more. I lost my first wife. I've been remarried for about twelve years, and I'm enjoying every moment of that. I'm not bored, but I do wake up in the morning with no anxiety, no realization that I have to herd sheep or herd cats. I have no metrics, I have no RVUs, not behind of the EMR. Dave Johnson: You're making it sound too good, John. Dr. John Glick: We're having fun. And I have not been bored. I've not been down in the dumps. Each day brings a different aspect. We see a lot more of our friends. I exercise. I deal with the health problems that people get when they get older, and I have plenty of those. Seeing doctors takes a lot of time, but I'm grateful that I'm having these few years of retirement. I'm one of the people who is most fortunate to have attained everything they wanted to do in their professional life, and now I'm trying to do some of the same in my personal life. Dave Johnson: John, Pat and I both love to read. We love history. You mentioned that you're reading some history. Is there a book that you've read recently that you might recommend to us? Dr. John Glick: “the Last of the Breed” {With the Old Breed} It's about a private in the Pacific campaign who was not a commissioned officer; it's just a grunt on the ground. It brings the horrors of the Pacific island campaigns to life. But there's a huge number of books, some historical fiction. I'm a great fan of Bernard Cornwell, who's written about the Medieval times, Azincourt, 1356. I'll read two or three books a week. I'm devoted to my Kindle. Dave Johnson: If you could go back in time and give your younger self a piece of advice, what would that advice be? Dr. John Glick: Try and achieve more of a work-life balance. I didn't have any choice. If I didn't do the consult, it didn't get done. That's not the situation today. But I have a second piece of advice, don't treat medicine as a 9 to 5 job. If a patient is sick, stay with the patient. Give the patient your home or cell phone number. Remember, medicine is not just a profession, but it can be a calling. Too few of our physicians today regard medicine as a calling. And even if you're employed, as most of us are by an academic or other institution, do what's right for the patient, not just what's right for your timesheet or the EMR. Remember that the patient is at the center of all we do and that medicine is a calling for some people, as it was for me. Dave Johnson: Great advice, John. Great advice. Well, I want to thank Dr. Glick for joining Pat and me. This has been a delight. You're one of our role models and heroes. I want to thank all of our listeners of Oncology, Etc., which is an ASCO educational podcast where we will talk about oncology medicine and other topics. If you have an idea for a topic or a guest you'd like us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content of ASCO, please visit education.asco.org. Thanks again. Pat, before we go, I've got an important question for you. I've been trying to school you recently, and you've failed miserably. So I'm going to ask you, why is it that McDonald's doesn't serve escargot? Pat Loehrer: I can't do it. I don't know. I give up. Dave Johnson: It's not fast food. Pat Loehrer: I like that. It's good. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

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Capturing Memories for Children with Cancer in a Low-Resource Setting

Play Episode Listen Later Apr 11, 2023 22:42

Listen to ASCO's JCO Global Oncology's essay, “Capturing Memories for Children with Cancer in a Low-Resource Setting” by Dr. Allison Silverstein, an Assistant Professor at the University of Colorado School of Medicine. This Art of Global Oncology essay is followed by an interview with Silverstein and host Dr. Lidia Schapira. Silverstein shares her launch of a framed picture legacy project in Malawi for those with childhood cancer in a low-resource setting. TRANSCRIPT Narrator: Capturing Memories for Children With Cancer in a Low-Resource Setting (10.1200/GO.23.00001) I was the paparazza, capturing salient moments from our program's “Palliative Care Day” where children with cancer and their guardians played games, completed artwork, sang and danced, and enjoyed meals together. It was a precious day for these children with life limiting disease to shed the weight of their diagnoses and instead share laughter and joy with one another. As a pediatric resident on a global health year in Malawi, I was invited to document our team's activities with the intent to share with potential donors. However, with a click of the camera's button, I realized the opportunity for an unintended greater impact. I scrolled through the day's pictures and could not help but think the recipients of the pictures should not be strangers, but instead the families or even children themselves. Although families had already provided consent for each picture, they never expected to see them. Pictures capture moments in ways words cannot describe. Coming from a Western society where we celebrate and honor life in pictures, I wondered what happens when you do not have a camera or phone capable of capturing these events. What visual memories do you have when your child dies? Does it feel differently when remembering a lost child without pictures to look at? Do vivid memories fade and, in time, make it difficult to imagine your child's face? As I reflected on this, I acknowledged the overwhelming frequency of childhood cancer death in our setting—in contrast to a .80% survival rate for childhood cancer in the United States,1,2 the childhood cancer mortality rate is estimated to be as high as 90% in sub-Saharan Africa.3 Most of these children present with advanced disease, where disease directed treatment is less likely to be effective,4 and limited availability of medical and supportive care further contribute to poor outcomes. Although progressive medical infrastructure has sprouted across regions of sub-Saharan Africa to help address these disparities, widespread gaps exist in interdisciplinary services. Families of children with cancer face substantial psychosocial, emotional, and spiritual distress. Many families are fortunate to have robust community support, but we must consider how we, as a medical system, can further support families. Our role includes providing comfort to families, especially when curative medical therapy is not an option and a child's final days near. We must integrate humanities and holistic support for our families as we scale up global health programs, just as is already done in high income settings. So, when I set my camera aside, I earnestly turned to my local colleagues for their counsel. They grinned as they confirmed the potential value of my blossoming idea. I went to a nearby store where I printed the pictures and purchased basic supplies—glue, string, tape. We collected old boxes from prior hospital pharmacy deliveries and bought local vibrantly colored fabric—chitenje—from the market. From these materials, our first frame was designed. These local materials were obtained on a minimal budget. I shared the first picture and its frame with our social worker who presented the aunt of P with the picture (Fig 1); P had leukemia and had died recently from complications associated with central nervous system disease. In his picture, there he was, coloring during the event we held a few weeks prior. He wore sunglasses and shared that smirk we had all quickly fallen in love with. As she graciously accepted the frame, the corners of P's aunt's mouth turned upwards into a rarely seen smile; she bowed her head silently as we spent a moment remembering P and sharing in his memory. The next week, I had the privilege of joining our team on a bereavement visit to the home of B's father. B had recently died at home and our team visited to provide grief support and share prayers together. We sat in a circle on well-worn couches and chairs as B's father offered he did not have any physical belongings or keepsakes of his son beyond leftover medical supplies from home wound care management; any clothes or toys were passed along to other children and other families. As he shared with us, he removed a cloth covering their makeshift table to reveal a cardboard box, inside of which he retrieved these remaining medical supplies so they could be given to another family. We pulled out a framed picture of B that was taken before the program had formally started but was printed and framed just as the others. I watched as B's father's eyes welled up with tears in surprise and gratitude; he accepted the gift and stood to shake each of our hands. One by one, we started taking more pictures. My colleagues explained the idea of the project as we obtained consent from each new family. Often we were met with a bit of initial skepticism but also willingness to participate. Pictures were taken away from the crowded medical wards and instead in courtyards with benches, grass, and trees as possible. As we delivered the first batches of framed pictures to families, the skepticism was quickly replaced with enthusiasm, and families embraced the program. We could not seem to print consent forms fast enough, as caregivers changed outfits, brushed their hair, and sought us on the wards to request portraits. They claimed their pictures like prizes. Some of the children lived to see them. Others died. The picture project served as emotional support for families, most of whom had or would lose their children. In time, the program transitioned from volunteers constructing frames to caregivers themselves making the frames together; they sat in open green spaces and connected, providing an organic social support system for one another. With the start of the COVID-19 pandemic, I returned to the United States to continue my training, and my colleagues in Malawi faced new challenges of their own. Just as staffing shifted at my home institution, so too were modifications made in Malawi to optimize patient and team safety. Although our framed photograph program paused similarly to many supportive care programs across the world, months later, my colleague shared a picture with me: a group of caregivers gathered on a lawn, a pile of frames and photographs scattered on the ground, the program restarted, and the memories being created and shared once more. Dr. Lidia Schapira: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, Associate Editor for Art of Oncology and a professor of medicine at Stanford University. Today, we are joined by Dr. Allison Silverstein, an Assistant Professor at the University of Colorado School of Medicine. In this episode, we will be discussing her Art of Global Oncology article, ‘Capturing Memories for Children with Cancer in a Low Resource Setting'. At the time of this recording, our guest has no disclosures. Allison, welcome to our podcast, and thank you for joining us. Dr. Allison Silverstein: Thank you so much for having me. Dr. Lidia Schapira: Allison, your essay captures an experience that you had when you were working in Malawi as a medical resident or pediatrics resident. Tell us a little bit about that. Dr. Allison Silverstein: Thank you. I participated in a four-year pediatrics global health residency where I completed three years of my residency in Houston, Texas, and one year of my residency abroad, working clinically in Lilongwe, Malawi. During that time, I split my time working with children who have HIV, as well as working in the pediatric hematology and oncology wards, both inpatient and outpatient. Dr. Lidia Schapira: Where did your passion for global health start, and where is it now? Where is it taking you? Dr. Allison Silverstein: I think I have always had a love of traveling and experiences, learning about new cultures, meeting new people. And when I was in medical school, I participated in a one-week more voluntourism-type trip, admittedly. And I remember handing a woman who had rheumatoid arthritis, like 30 pills of a medication, and leaving that encounter and feeling just gutted that either these medicines would work and in 30 days, she wouldn't be able to get more. Or they wouldn't work, and she wouldn't be able to follow up to try and help relieve her symptoms. And I came back from that trip and was just really excited to engage more in really sustainable practices. And so I've spent about two years cumulatively living abroad in a few different countries in Africa, and that has cultivated a passion for global work in terms of capacity building and policy, done some research, and then more recently, really engaging on a clinical level. Dr. Lidia Schapira: What was it like as a medical resident and practitioner in Malawi? Dr. Allison Silverstein: Gosh, I miss that time so much. Every day I was excited to go into work, and I felt this just passion and, truthfully, a personal value that I was a part of something really meaningful. I worked with just a group of incredible humans in all sorts of different disciplines, and being able to learn together and grow together was amazing. It was admittedly also scary at times. I was a resident and had to really acknowledge my limitations and what my comfort level was, coming from a very different setting. But I think I really ultimately embraced that and grew a lot throughout that experience. Dr. Lidia Schapira: So, in your essay, you describe meeting kids and families with cancer and introducing to them some new ideas. Tell us a little bit more about that. Dr. Allison Silverstein: I had a pretty decent camera, very point-and-shoot, knows more than I do about how to take pictures. And I remember participating in what we were calling a palliative care day, where children from their community and their families, as well as some within the hospital, were able to come and just create joy altogether. There was singing, there was dancing, and someone had asked if I would take some pictures to share with potential donors for the program. And, of course, I was ecstatic to get to join and be a part of things. And as I took pictures, I looked at them, and I just had this kind of an aha moment of this blossoming idea that the recipients of these pictures should really be the children and their families. Knowing that most of the children, especially the ones who were there for that particular day, ultimately would die. I approached a few of my Malawian colleagues who were so excited about this idea, and together we put together a project that I think we're all really proud of, as it has continued for now a few years and has impacted a lot of families. Dr. Lidia Schapira: Talk a little bit about this idea of memories and having a photograph that helps families who are grieving keep that memory of their child so present. Dr. Allison Silverstein: I think in general, in Western societies, within my family and my friends, pictures are such a common way to pay respects and to remember people. When I'm feeling nostalgic, I go through old pictures. I've lost all four of my grandparents and I'll look back at pictures that we took together and it just brings up a lot of memories and a lot of joy of the time that we spent together. With social media, people will post pictures of their loved ones after they die, and I think that's such an ingrained part of how we grieve and how we process during bereavement. And the idea to me that someone might not have a camera phone or a camera and therefore might not have any pictures of their loved ones when they die. That concept, when I first thought of it, very much shook me. It rattled me to my core thinking about how meaningful and important those things are for me. And it's such a small, simple thing that we absolutely take for granted. Dr. Lidia Schapira: When we think about resources and disparities or inequities in care, we don't usually think about it at this very granular level. I'm curious to learn a little bit more about how you develop this concept and transformed an idea into really a project and then how you got the project to continue even after you left Malawi. Dr. Allison Silverstein: It's a great question. I think in global work in general, it's really important to be intentional about surveying your community about what the needs are and not projecting from your internal opinions what those needs are. And so, of course, I took this picture, and there was this light bulb moment for me, and then I asked myself to step back and say, "Hey, is this truly meaningful? Is this truly valuable? And how can we create something that is sustainable?" So I asked multiple Malawian colleagues who kind of have different roles or disciplines on the team and said, "Hey, this is what I'm thinking. What do you think? What are your ideas?" And really work collaboratively, knowing I have different perspectives and resources and experiences, and we need to really make it, not me coming in and projecting those things. And so ultimately, everyone was very excited about this idea, and so we started tinkering with a design. Luckily, there was a Kodak store right next to where I got my groceries, and so I was able to print some photos very easily. And then in Malawi, there's something called Chitenge, which is this beautiful fabric that people will wear, and it will become different articles of clothing, and you can get yards of the fabric very inexpensively at a market. And so I took some scraps that I had and went to the pharmacy and got some cardboard boxes that were left over from prior delivery. So I was really trying to think about things that would be very low cost and repeatable and ultimately designed the first frame. After we had created this first prototype, we internally, the direct members of the team, were the ones who were making them initially, and we started training volunteers in the hospital. And ultimately, the current iteration is that guardians make their own frames, so they sit on a lawn together, and it serves as this opportunity for them to connect and share and serve as kind of a psychosocial support. This project, we started it towards the end of my time in Lilongwe and with COVID in March of 2020. I was not prepared to be coming back to the US. I was supposed to remain abroad for another month. And I remember getting a call saying, "You need to leave before there aren't any more flights." I said, "No, I can't. I haven't handed off this project yet." And so I met with our team. I created step-by-step instructions on how to make the frames and how to use a camera. They thankfully had a digital camera that they had used for some clinical work previously, and so got those nuts and bolts in place, and then I left. And it was about six months before I received a WhatsApp message from the social worker in Malawi saying, "Your dream lives on." I was at the airport. I don't remember where I was flying, and I just started crying. Because this was a project that I thought was valuable, and it was a project that I had engaged with colleagues and felt like they also thought it was valuable. But I wasn't sure until that moment that I received that message how meaningful and valuable it was perceived from the team and the families who were there. Dr. Lidia Schapira: Such a beautiful story, and I'm so glad that you chose to write and share it with your colleagues and that we were able to give it some exposure in the journal. I wonder if you can share with our listeners what other projects you might be involved with, now, again, thinking globally. Dr. Allison Silverstein: I am continuing to do some work with the team in Malawi and in Houston on a global scale. I did my fellowship training at University of Tennessee Health Science Center in Memphis and have done some global work with the team at St. Jude. And I'm now getting established in my new role at University of Colorado. And our pediatric palliative medicine team is exploring our ‘what's next' in terms of being leaders within the global health world. And so a lot of little things in progress and trying to figure out what's next. Dr. Lidia Schapira: What opportunities do you see for collaboration in the area of global health, especially global palliative medicine and oncology, the global health infrastructure? Dr. Allison Silverstein: The global health infrastructure is rapidly evolving. Even since I finished medical school until now, I've seen changes in resources and in opportunities, and it's really inspiring to see. A lot of that focus is on those medical interventions, and I think there's a lot of opportunities to think creatively how we can support families beyond just kind of curative or palliative treatment, beyond the medications, beyond the surgery, and think from a very holistic level of involving multiple disciplines and supporting families along their whole journey. Dr. Lidia Schapira: I wonder if during your time in Malawi and through this project of capturing the photos, framing, and then presenting them to families, you had any personal connection with members of families and if you can share with us perhaps some of their reactions or what they said to you. Dr. Allison Silverstein: I very much tried to be a support system for this program and not the face of this program, and so I tried to take a step back and empower my colleagues to really have an active role in the execution and the vision itself. I shared a couple of meaningful encounters in my narrative. I think one of the really special stories I have actually doesn't directly involve me, but I mentioned that I stay in close touch with a social worker in Malawi. And she recently went to a home for a bereavement visit after the passing of a child. And when they entered the home, there were three frames on the wall with pictures that they had taken while the child was alive. And seeing that picture, seeing that moment that the family had recognized the value and taken the initiative to not only accept and embrace these pictures and their frames, but to hang them in their home. That was a really special moment for me. Dr. Lidia Schapira: It sounds like it's been a very moving experience, very meaningful for you. And I wonder if you can reflect a little bit on how this experience perhaps has changed the way you think about palliative medicine and pediatrics. Dr. Allison Silverstein: I think I have realized how much of our role in medicine is about the little things and recognizing that the little things to me might not be little to someone else. And so taking that moment to listen and to hear a family's needs and think creatively and problem solve, no matter what they are articulating, this is something that I really try to practice both in my role in Denver and as I think of other roles that I fill and will grow into. And this project has really helped me frame some of my work in terms of those little things, as well as really enhanced my personal practice of gratitude and appreciation for the little things in my life. Dr. Lidia Schapira: Allison, thank you so much for your words, your wisdom, and the work that you're doing. I hope you continue to be inspired and creative, and I look forward to connecting in the future. Dr. Allison Silverstein: Thank you so much for having me today and letting me share about this project and my passions. Dr. Lidia Schapira: Until next time. Thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, and be sure to subscribe, so you never miss an episode. You can find all of the ASCO shows at asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Show Notes: Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio: Dr. Allison Silverstein is an Assistant Professor at the University of Colorado School of Medicine. See another article in the JCO Global Oncology, Art of Global Oncology section: Yuan Fen 緣份

Oncology, Etc. - Passion For Writing And Medicine With Dr. Lisa Rosenbaum

Play Episode Listen Later Mar 7, 2023 29:54

For some, pursuing a medical career is an all-consuming passion. What do you do if you have two? In this ASCO Education podcast, we look at the influences that propelled Dr. Lisa Rosenbaum to become a practicing cardiologist at Brigham and Women's Hospital in Boston and a national correspondent for the New England Journal of Medicine. Dr. Rosenbaum will explain the family legacy that impacted her choice to pursue medicine (1:46), her discovery of the love of writing (5:02) and what prompts her to write about specific topics (15:53). Speaker Disclosures Dr. Lisa Rosenbaum: None Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Resources: Gray Matters: Analysis and Ambiguity by Lisa Rosenbaum, MD Podcast: Oncology, Etc. - In Conversation with Dr. Peter Bach (Part 1) Podcast: Oncology, Etc. – In Conversation with Dr. Peter Bach (Part 2) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed in the podcast page. Pat Loehrer: Welcome to Oncology, Etc. an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: Hi, I'm Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of our podcast is to introduce listeners to interesting people and topics in and outside the world of oncology, hence the "etcetera" in our name. Today's guest is an example of the "etcetera" aspect of our podcast. Dr. Lisa Rosenbaum is a practicing cardiologist at the Brigham and Women's Hospital in Boston and a member of the Harvard Medical School faculty. She's a highly respected national correspondent for the New England Journal of Medicine. Dr. Rosenbaum began her writing career while she was still an undergraduate at Stanford. She later attended med school at the University of California, San Francisco, completed an internal medicine residency at the Mass General Hospital in Boston, and a cardiology fellowship at Weill Cornell in New York. She spent an additional year of fellowship at The New England Journal, where she learned about writing, reporting, and investigative journalism. Subsequently, she was hired for an academic position at Brigham and presented with an opportunity to write on a regular basis for The New England Journal. She's written on a whole variety of topics, ranging from physician burnout to cognitive bias, resident duty hours, conflicts of interest, vaccine hesitancy, and many other topics. So, Lisa, thank you for joining us today. We're very excited to have you on the program. Dr. Lisa Rosenbaum: Thank you so much for having me. Dave Johnson: Well, perhaps we could start by asking you to just tell us a little about your background and your family. Dr. Lisa Rosenbaum: I grew up in Portland, Oregon. My parents are both physicians. My father is a rheumatologist and my mom is a cardiologist, and now my sister is also an endocrinologist. And we have several family members who are physicians, including my grandfather, who was also a rheumatologist and a writer and played a pretty pivotal role in my life, both in terms of my decision to become a physician and also a writer. When he was in his 70's, he got laryngeal cancer and he was treated with radiation therapy and cured. But after, he wrote a book about the experience of being a patient called A Taste of My Own Medicine, which I think was published in the late 80's. It's an autobiography. And then in the early 90's, Disney bought the rights to the book and made it into the movie The Doctor, starring William Hurt. He has a cameo, actually, and apparently it took him like 17 takes just to get it right, to wave his hand when he's sitting in the waiting room. That was a pretty formative experience in my life, because basically he ended up, after writing that book and, you know, having a lot of success with it, wanting to write another book. And by then he was in his late 80's, and he ended up getting Parkinson's disease, which steadily progressed. He died at 94, so he lived a long, good life. But when I got into medical school, he decided he wanted to write a book with me and that it was sort of the follow up to A Taste of My Own Medicine, because he sort of recognized medicine's shortcomings in the book and asked a lot of questions, but he would always say, "I have more questions than I have answers." And when I got into medical school, he had this idea that we were going to come up with all the answers and make medicine as wonderful as it had once been for him. So obviously that was a big part of my life, both in terms of my career as a writer and also my career as a doctor. Though I think I really never questioned whether or not I wanted to be a doctor. That just sort of seemed so obvious to me as a kid that the work was so meaningful. And I don't know, there's something about growing up where everywhere you go, people tell you how one of your relatives made their lives better. That's pretty inspiring, as a kid. Pat Loehrer: It's interesting that both your parents were physicians, but you claim that your grandfather is the one that got you into medicine. But I think your early career, I think you were actually kind of focused on writing and writing creative fiction, and there was another event in your life that kind of turned you back over to medicine too, right? Dr. Lisa Rosenbaum: Right, right. And I don't want to not give credit to my parents. They played a huge, wonderful role in my life as well, and they still do. So anyway, I did take a detour in my career. So, in college I ended up, the fall of my junior year, taking a creative writing class. I'd done all the pre-med requirements by then and probably like many pre-meds, it felt very robotic to me. It's also, you're surrounded by all these people who are really ambitious, and you can feel like you're not very good, right? I remember I made a B-minus on my first organic chemistry exam, and I called my mom crying, and I was like, "I'm not going to be a doctor. This is a disaster." So all of a sudden, once I had gotten through those classes and I took this creative writing class, it was just this transformative experience for me because it was intensely creative. And I've always been just really interested in people, like what makes people do what they do, and character. I am just so fascinated by people's characters. But the other part of the creative writing classes that I loved so much was just the sense of community. So you go from this setting where you're all sort of pitted against one another in these classes, and then you're in this place where everybody's trying to help each other and you're learning about each other through writing because we're all really just like writing about ourselves, even when we pretend otherwise. And I made some of the best friends of my life who've gone on to have actually remarkable writing careers. So sort of on a whim because it was so enriching for me and I felt like I couldn't live without it, I applied for MFA's in Creative Writing in my senior year, and I got rejected everywhere but waitlisted at Columbia. And then I got in. So I moved to New York in 2001, basically a week before September 11th, and I truly fell apart. Not in a way that I regret at all now. I think that a lot of us, when we are not productive, feel like our time is wasted. And I don't think I wrote a word that entire year. Like, I got really depressed and I just spent a lot of time wandering the city and I ate a lot of bagels, but I was really sad. I spent a lot of time downtown, like, looking at the faces of all these people who had died. And it was so unfathomable to me. And I wasn't able to use writing to cope with it as I might be able to now. I think I was just too young. And I had challenges with my writing professor who sort of felt like we shouldn't be writing about that. And so I ran away from writing. I mean, I dropped out of creative writing school and went to medical school, and that was clearly the right move. More than anything in my life, I love being a doctor, so I don't regret that at all. And I think it actually was really helpful to me to recognize that I'm not cut out to just be a writer. I need to be inside people's lives, and there's no better way to do that than as a physician. And writing is this extra bonus that I have still that helps me just like it did when I was writing fiction, sort of try to understand the world. But I don't think I could function if I didn't get to take care of patients. And that became clear when I was 22 years old, essentially. Dave Johnson: So, Lisa, you did this fellowship at the New England Journal of Medicine. Can you tell us about that? What was that like? And how much influence did that have in your current position? Dr. Lisa Rosenbaum: It was awesome on so many levels. I think the first was that I really loved listening to people talk about science. That was new for me. And the rigor of the conversations at The Journal is really just hard to describe, and I just felt like I was like a kid in a candy shop. I'm interested in science, obviously, as a practicing physician, but I'm interested in science always in these meta ways. I'm interested in how we communicate science and the words we use and the conflicts that we focus on and those that we don't. And so much was always going on in my mind. ‘I was like, oh, my God, these are the data that are going to shape our practice. And then you have, like, a bunch of humans making these decisions.' And so that was inherently fascinating to me. And the other thing that was really transformative was just sort of watching Jeff Drazen, who was the editor in chief at the time, and just how he led was so amazing to me. And I still think about it because, you know, in an ideal environment, I mean, people study this their whole lives, you know, organizational psychology and things like that. But, you know, to create a work environment where you can have, like, all these brilliant people sort of have a conversation and argue with each other and still come out friends was really remarkable to me. I don't think I could ever tell you what the recipe for that is, but I loved watching Jeff do his thing. And then, of course, on the most personal level, it was eleven years after I had tried and failed to be a writer in New York and all of a sudden I had medical training under my belt and I had a lot I wanted to say and I was capable in a way that I wasn't before of spending my days writing. So it turned out that I was able to structure my time and not just fall into a deep depression. So that was really important to me in terms of shaping my ambition. I still didn't believe that it was possible to have a job as a doctor and a writer until I was actually offered that job. But at least I knew that I loved it as much as I ever had. They published what I wrote, and it's hard to describe, like, how that changes you in terms of realizing that, like, anybody might care what you had to say. You know, my experience until then had been writing this stuff with my grandfather, which was so inherently meaningful, but I could never get it published. I mean, the piece that I think that I'm still most proud of is what I ultimately wrote about my grandfather and this book project and it's called ‘The Art of Doing Nothing.' I had a knee injury at the time, and I was in med school, and I couldn't get the doctor to do anything about it. And I was really compromised. I couldn't walk, and I was going into internship. And the prospect that I wasn't going to be able to do what I needed to do as an intern was just so terrifying to me. And so it sort of goes back and forth between that experience and my grandfather's ambition for us to fix medicine and his sense that something so fundamental had been lost. And it ends—I'm going to start crying when I talk about this—it ends with his death and how I wasn't planning to speak at his funeral, but then I just remembered this sense of something pushed me to walk onto the pulpit after all the other eulogies had been given. And I remember feeling the sense like, ‘Okay, he spent the last seven years wanting me to tell these stories, and I'm never going to be able to convey what he means or the point of his stories. And I could never describe the way he touched people's lives.' And I just remember when I was standing up there, I looked out and there were hundreds of people, patients, their children, who had just come to celebrate his life. And then this feeling that I didn't have to say anything because everybody already knew. So ‘The Art of Doing Nothing' is this idea that we're so reliant now on all these things that we can do. And my sort of tension with my own doctor was wanting an MRI. And by the way, I completely believe in a lot of the things we can do. I don't see how you could spend a day in the hospital as a cardiologist and not feel some awe for advances in our technologies and what they can do for patients. But I do think a lot of it has come at the expense of our humanity, not by the fault of any physicians, but in a system that just doesn't allow us to give people our time, our attention, or make them feel how much we care about them. And so I think for me, the idea that my grandfather practiced at a time where he didn't have an MRI machine and he couldn't revascularize—I mean, he was a rheumatologist, but at that time, he would see patients having MI's and he did house calls and all these things, but that he could give them his love, for lack of a better word—it's a different type of love, but the love that we can give to patients, and that so many people then remembered him and showed up for him. Pat Loehrer: If I can speak on behalf of your grandfather, if he was here, he would say that you have honored him. Dave Johnson:Yeah, for sure. Dr. Lisa Rosenbaum: That's very kind. Dave Johnson: Lisa, you write about so many different things. They're all wonderful. I really appreciate your willingness to bear your soul, so to speak. And speaking of soul, one of my favorite pieces that you wrote was I think it was ‘Heart and Sole', where you talked about- Dr. Lisa Rosenbaum: -broke my feet? Dave Johnson: Yeah, your feet. That was great. You, in a sense, mentioned your father. And your father is also a Rheumatologist, actually, your father gave a grand rounds here about seven or eight years ago that was one of the best lectures I've ever heard on uveitis. Dr. Lisa Rosenbaum: No, my dad is also huge. I've talked about my mom. I've talked about my grandfather. My dad is a huge part of my life, too. I just love him a whole lot. Dave Johnson: Well, that came through in the article about your feet. What I wanted to ask you is obviously a lot of your ideas for writing come from personal experience, but you've also written about things like conflict of interest. You wrote a three-piece article in The New England Journal that actually generated some interesting conversation in the letters to the editor, including from former editors of The New England Journal. I wonder how you come upon these ideas. I mean, what prompts you to write about a particular topic? Dr. Lisa Rosenbaum: The two things in my life that like, drive my writing. I mean, I'm not talking about medicine specifically, but I'm extremely emotional. I feel things very intensely, and I think because of that, I've always been interested in the way emotions affect reason, because it's been clear to me for a long time that my emotions could get in the way of my ability to make good decisions. So then I became very interested in sort of the nature of how we make decisions and the role emotion plays in that. And so conflicts of interest were, like, the perfect example of this, both at a very individual level of the way emotion shapes reasoning, but also I'm very interested in sociology, how humans affect one another's perceptions. And I think that series was published in 2015, so it was sort of a little bit before social media became so much more pervasive in our lives, but this idea of sort of collective pile-ons and canceling people that hadn't picked up as much. But I was very interested in this tension between advancing care and how that had gotten lost in this sort of desire to vilify people who worked with industry, because it just seemed very obvious to me that we needed that. And I was perplexed as to why we sort of seized on this one aspect of bias when so many biases shape how we behave. And again, that goes back to the fact that I spend my entire life thinking about what is biasing my own behavior. And so I remember very clearly, and I tell this story in the series, in the second essay, how I used to get called when I was a cardiology fellow about transfers from other hospitals overnight and whether or not they should give TPA en route, because if you wait too long to revascularize them, at that time, people were getting TPA. I've only ever worked at a hospital where people get revascularized, so we don't really do it a lot. But anyway, I remember being so tired and so wanting to not go in that I would feel inclined to say, just give TPA, even though it would be better for the patient to get revascularized. And if they would get revascularized, it meant that I would be up all night, because after they would have, like, a sheath, and I would have to pull the sheath, and it was over. And so I remember thinking, like, ‘I'm making a decision out of, like, fatigue and laziness.' I mean, I didn't actually make decisions this way, but I remember how powerful those forces were in shaping my medical advice. And we all know when we practice in these busy hospitals that so many of our interactions are not about what the science says to do. There are other factors that come into play that are deeply embedded in sort of the sociology of medicine or people's feelings about one another or themselves. And so conflicts of interest was just like, at the nexus of all these things that fascinate me. And then the third one was about sort of moral outrage. And again, this was before our politics were as polarized as they are today, for instance. But this idea that when you feel moral outrage, that you lose the ability to weigh trade-offs was extremely interesting to me because, again, it seemed to be at the crux of what was happening in sort of our ability as a profession to talk about how to optimize our relationships with industry so that we could get our patients the best treatments. And that instead of vilifying scientists who either had unique expertise that could be shared with companies to develop treatments, or who were on FDA panels because they were the ones who knew the most, it just seemed to me kind of strange that we weren't able to have those conversations. And then when you mentioned all the blowback, I mean, that was the first time in my career, and I've since experienced it again and again. But that felt to me very much part of the problem in the first place, that that like, just saying that this was more nuanced than we were recognizing, you know, generated a lot of anger, and I was, like, totally okay with that, because it it was why I wrote it in the first place. And if I felt that in 2015, I feel that even more now, which is essentially you cannot write about anything interesting anymore without risking being canceled. Like, it's just things are so volatile, and everything I write, I think this might be the end of me. And you sometimes can't predict what is going to enrage people, but it feels, speaking of trade-offs, like a worthwhile trade-off for me because I could write what I know everybody wants to hear, or what they already know, and there's clearly a market for that. But that is so boring to me. And I don't learn anything, and I don't think readers learn anything, so that just doesn't feel like my role in this universe. Dave Johnson: When do you find time to read? Dr. Lisa Rosenbaum: I read like, every night, every afternoon. I mean, I'm constantly reading or listening to podcasts and thinking about what I'm writing, or I'm interviewing people. I read like, all the time. Pat Loehrer: What are you reading now that you would recommend it? Dr. Lisa Rosenbaum: The best books that I've read recently were Tomorrow, and Tomorrow and Tomorrow by Gabrielle Zevin. I don't know if you've read it. It's actually my computer is literally sitting on the book. She also wrote a book that has some oncology relevance. It's called The Storied Life of AJ. Fikry, I think. I finished it the night before I was going on the consult service, and for some reason I wept. There's a cancer part of the story, so you'll see when you read it, I don't want to give it away. But it was one of those moments I think I'll remember forever, just because even though I'm saying all these things about caring about humanity, I still lose it sometimes. And the consult service can be really hard because this goes back to this whole bias thing, because you're just going as fast as you can. It's not because you don't care, it's because there are ten people also who need to be seen. And so you're triaging your time, but also your emotional bandwidth, and you walk into the room and you just hope that you don't get asked a lot of questions and that you can move quickly so you can go see the next consult. And so I finished this book, and I hope it's not giving me too much away. But anyway, someone in the book has cancer and isn't treated very well by the medical system. And so it was like the night before I was going on consults, and it stayed with me in the same way my grandfather stays with me. Just like, take a deep breath, the week will end and you never get a second chance to see these people. So do it right. Pat Loehrer: I can't wait to read it. One of my residents, when I was an intern, I had a patient that died, and I was just really distraught, but she just quietly said that the beauty of medicine is that it has such a great joy, but it also has these downs, and that's unlike any other profession. And that's really what makes it such a marvelous profession, because of the feeling that you have. You're a physician writer. Which physician writers do you think are the most meaningful? Or which ones do you admire the most? Dr. Lisa Rosenbaum: I have to tell you, I teach a writing class. Pat Loehrer: It's you. Dr. Lisa Rosenbaum: For what? Pat Loehrer: You're the one that you admire. Dr. Lisa Rosenbaum: Oh, God, no. That wasn't what I was going to say. It's the opposite. So in the writing class, my editor of the journal and I teach a class to people, mostly to Brigham, but over the years, people from all over have started to join, and we do it on Zoom. And I have to say that there are some people in the class I just think are so talented. And what has struck me most about the experience beyond their talent, is just that physicians often just don't have an opportunity to get to write. And so I lucked out, like I really did. I lucked out in terms of having the opportunity to journal. I lucked out to grow up in a family that was just so loving toward me, telling me I could do whatever I wanted. But not everybody has that luck or privilege. And so to get to be in this writing workshop and see all these people who are just having their first chance to process what they've experienced and narrate it has been really awesome for me. And so they are not the people who are household names yet, but I have been struck by many of their talents. And also my editor and I taught one at Colorado this past summer, and there were some people who are just so equally talented. So that said, I think Gawande is like a masterful storyteller. He's able to sort of narrate in a way that is so accessible to people, and I think that is a mark of genius. So I do find myself studying his work. I have to tell you that I read mostly fiction, so I don't read a ton of doctor writers anymore. I used to when I was, before I was more established as a doctor writer, and I would do it to study them. But now I just find myself wanting to either read about culture or some sort of nonfiction that is unrelated to medicine or just read pure fiction. I'm mostly interested in how people tell stories and develop characters, and I could think about that forever. It never stops. Dave Johnson: What advice do you have, Lisa, for young physicians who may be contemplating a career with writing as a part of it? What advice do you have for them? Dr. Lisa Rosenbaum: When you write, you have to expect to fail. And I think that one of the hardest things about being within the institution of medicine and trying to be a writer is that we have these metrics for success that we're all so accustomed to in terms of publications and putting things on our CV and also how those are valued in advancing our careers. And if you really want to write, if it's really important to you, you have to let all of that go. And again, if people meet me at this moment in my life, they don't realize that I had this chunk of time for seven to ten years where I was writing and writing and writing, and I wasn't publishing anything, and I was getting rejected all over. And I did it because it meant so much to me and it meant so much to my grandfather. But if it becomes this thing that is meant to, like, advance your career, I think first of all, it becomes much more frustrating, but also you take away what makes it so meaningful, and I think that ends up detracting from the writing itself because it's just like the purity of it goes away. So I think that's one thing I would say. The other thing is if you want to write, you just have to write. There's no other way about it. It's not fun. I mean, I wish people could see how much of my writing gets thrown away. It's so bad. But if you think of it as an act of discovery, which it is, I never know what I'm going to say until I get there. Then you can sort of forgive yourself for all of that time wasted. But it's pretty empathetical to how we function as doctors. I mean, when I go into the hospital, it's like a switch flips in my brain. I move into this extremely efficient, concrete sort of way of existing, and it's just so different from the mode I'm in when I'm creating. Dave Johnson: That's extremely helpful. Thank you for that Lisa. We want to thank all of our listeners of Oncology, Etc. This is an ASCO educational podcast. This is where we will talk about oncology medicine and beyond. So if you have an idea for a topic or a guest you would like us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org. Thanks again. Pat Loehrer: Hey, Dave, I got something for you. Dave Johnson: A present? Pat Loehrer: No. A question for you. Which knight of King Arthur invented the roundtable? Sir Cumference. Doesn't get any better than that. Dave Johnson: No, the snail joke was better. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of Asco. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Oncology Etc: Dr. Miriam Mutebi on Improving Cancer Care in Africa

Play Episode Listen Later Feb 7, 2023 32:03

"Various places on the globe lack the proper knowledge, infrastructure and workforce to adequately treat cancer. In Africa, one doctor is focusing her efforts to change all that. This ASCO Education podcast spotlights Dr. Miriam Mutebi, the first female breast surgeon in Kenya. One of Dr. Mutebi's goals is to improve women's health and cancer care in Africa and includes attaining her pilot's license to reach remote areas of the continent. Dr. Mutebi reflects on her life growing up in Kenya (1:21) and her inspiration for getting into medicine and pursuing what was at the time a male-dominated specialty (5:07). She also details how cancer care has improved in Kenya in the last decade (12:49) while there are ongoing challenges of working in low-resource settings (23:25). Speaker Disclosures Dr. Miriam Mutebi: None Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Resources: ASCO Podcast: Oncology, Etc. – Global Cancer Policy Leader Dr. Richard Sullivan (Part 1) ASCO Podcast: Oncology, Etc. – Global Cancer Policy Leader Dr. Richard Sullivan (Part 2) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Pat Loehrer: Welcome to Oncology, Etc. an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: And I'm Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas. Pat, we have a terrific guest today that ties in very nicely with your interest in global health. I'd love for you to introduce her. Pat Loehrer: Thanks, Dave. Battling cancer is truly a global effort, both in research and in treatment. However, there are various degrees of quality in these fields, depending on the economic health of a particular region. Our next guest is trying to optimize cancer care in Africa. We're very excited to talk to her. Dr. Miriam Mutebi is one of the most prominent cancer doctors in Africa. Dr. Mutebi is the first female breast surgeon in Kenya, and she's currently assistant professor in the Department of Surgery at the Aga Khan University in Nairobi, Kenya. She's on the board of directors for the Union of the International Cancer Control. She has trained and studied at top hospitals in New York and South Africa. Dr. Mutebi is so focused on increasing women's health in Africa that she's trained to be an airplane pilot in order to connect with hard-to-reach areas. Disclosures for this podcast are listed on the podcast page. Thank you so much, Dr. Mutebi, for joining us from Kenya. Can you start off by telling us a little bit about what it was like growing up there? Dr. Miriam Mutebi: I grew up in Nairobi, which is a pretty urban setting to grow up in. So, most of my childhood was spent…I think it was probably a much simpler time where, you know, you would play in the street, go off to somebody's house, spend the rest of the day there and come back at the end of the day. But in terms of growing up, I think I was one of those super nerdy kids, for want of a better word. One of the sorts of things that got me interested in reading and learning and challenging myself was actually my dad. Because what would happen was we had to go to school, I would say almost about 30 kilometers bus ride, and my dad would be like, “Well, if you're on the bus for that long, you can as well, you know, carry a book and made it nice and exciting.” So I remember sort of discovering the library at my primary school and going like, “My word!” Because you get access to all these different experiences and worlds. I mean, you're going in and reading, you know, The Chronicles of Narnia, you're reading about Enid Blyton and different experiences, you're reading all these different worlds and getting to, you know, identify to some extent with the core values that exist. It doesn't matter where the books were centered. And so that for me was an almost, I would say, idyllic growing up, because for me it was like, “Yes, books, check; running around, check.” That's, I think, what I remember most about my childhood. Dave Johnson: It sounds like your father was a powerful influence in your youth. Can you tell us more about your father? Dr. Miriam Mutebi: Sure. My dad, how old is he now? He's going to turn 74. One of the things that he always says, “It costs you nothing to be kind.” And so he would generally– Sorry, I'm just going to stop a little bit. I'm getting weepy. Dave Johnson: I'm sorry. Dr. Miriam Mutebi: It's okay, it's okay. Shame. Dave, you pushed the button. Dave Johnson: It's not our intent to push a button. It sounds like your dad's a wonderful person. Dr. Miriam Mutebi: No, it's fine. Pat Loehrer: Both Dave and I have daughters, and we feel the same way. So as weepy as you're getting, I can guarantee you that he's going to feel the same way on the other end. Dr. Miriam Mutebi: No, it's just that he hasn't been well recently, so it's just– Dave Johnson: Oh, I'm sorry. Dr. Miriam Mutebi: Yeah. Okay, cool. Let me see if I can stop getting a little weepy. Yeah. So one of the things that he frequently says is that it costs you nothing to be kind, and I think that's one of the things that he sort of instilled in us that you need to think beyond yourself. You always need to sort of think about what is the other person going through and how can I help to make it better. Now, my dad, he has a really interesting sense of humor. I think it's where I get my cheesy humor from as well. But he always talks about what we call the 11th commandment, which is, don't take yourself too seriously. And so I think that was part of the grounding steps that he sort of helped to instill in us because he was working– I mean, sort of looking back, our parents, I would say, got married at a very young age and had several kids that they were raising. And sort of looking back, you're thinking they were probably just doing the best that they can, right? But I think he did a fairly decent job, I hope. Dave Johnson: So, Miriam, when did your interest in medicine begin, and who was the inspiration for that? Or if there was someone that inspired that? Dr. Miriam Mutebi: At the end of high school, I remember I wanted to do five or, rather, was it six different things. And so I wanted to do medicine, I wanted to write, I wanted to do architecture, I wanted to do law, I even forget what the other things were. There was like two other things on my to-do list. And I think part of the genesis of that was because, as part of the high school training that we go through, we had to do the international sort of baccalaureate, and what that entails is we have to do components of creativity, action, and service. And so at the end, I'm like holding back to father dearest, and I'm like, “Dad, I have six different things I want to do, and I don't really know about.” And he was like, “So why don't you spend a bit of time, sort of just going through each of those, like shadowing these different specialties?” And so we managed to track down his lawyer friend, spent time in the hospital, spent time in the pharmacy, just shadowing the pharmacist. I actually went to work briefly for a publication house. Eventually– Oh, yes, in architecture as well. So then I managed to narrow it down to, “Yes, okay, I want to do medicine, and I want to write.” And so I went back to my dad and said, “Dad, okay, I have two things I want to do.” And my dad was like, “Well, if you do medicine, you can write. But if you write, then you might not necessarily be able to do medicine.” So that's how I sort of wandered into medicine. Although I still say there's still the great African novel waiting to get out. But again, with medicine, I think I'm guilty of what we call ‘end of rotationitis', where at the end of the day, you finish a rotation, and you're like, “I can do this. I can do this.” So I think going through different rotations– I think for me, the drive– Well, the slow narrowing down to surgery was really around, unfortunately, the time when we were doing our rotations, and this was just really at the start of the 2000s in Kenya. And the challenge around that time was we're really just at the tail end of the HIV epidemic, and not everyone had access to antiretrovirals. And it was an incredibly harrowing time, I would say, for the healthcare profession, just because there was still a lot of stigma around HIV. And what was happening was that we would go to the wards and find patients had been abandoned. And there was a general sort of pervasive sense of hopelessness because people didn't have access to the medication, they'd been abandoned, and unfortunately, not much was being done in terms of active management to patients. Whereas then that was like on the 7th floor, and then you would go four floors down to the surgical ward where patients come in, they're bleeding; you take them to OR, they get better, you send them home. And so, for me, the timing was like, “I need to do this. At least I could see where I was making an impact.” And so that's sort of how I wandered into surgery. And I'm sure, as I said, with, of course, the developments now, the experience, of course, for medical rotations, they're entirely different, but that's how I sort of ended up in surgery. But then, how I sort of found myself in breast surgery was actually because– for me, what stood out about my breast rotation was really looking at what we were reading in the textbooks, which was breast cancers, the disease of the sixth and seventh decade and a “poster child” for this is the elderly nun who's never had any children, who's had this prolonged [inaudible]. And I'm sitting there and looking at the clinic, and I'm like, “These patients are in their 30's and 40's. All of these traditionally protected factors, like having multiple children, having breastfed, ticking all the boxes, but they're still coming in with these kinds of cancers.” And so just thinking this is totally different from what the textbook is saying, and somebody needs to get to the bottom of this, and that's how I found myself going in along breast cancer surgery and also research into women's cancers and things. Pat Loehrer: My sense is that Kenya and many African nations were male-dominated. I don't know what it was like for you going to medical school, but particularly in surgery, it tends to be a male-dominated field. What was that like as a woman? In many ways, I think you were breaking some glass ceilings. I'm sure other women are doing similar things, but tell me a little bit about that experience. Dr. Miriam Mutebi: I would say bewildering for both parties. Because we had to do several interviews just in different institutions before getting into a surgical residency, and I remember these senior professors sort of peering down their glasses and looking frankly bewildered and asking the most bizarre of questions, which I don't think anyone would sort of get away with in this day and age. I remember somebody asked me, and this one always stands out in my mind because somebody asked me on the interview route, “So what happens if you get a patient in ICU and you start to cry?” I'm like, “Well, first of all, I'm guessing that I am crying because I'm having a bit of empathy for the patient. And I think that actually probably makes me a better clinician because I am really truly seeing the patient rather than bed X with diagnosis Z. This is like Mary, mother of one, two, three, and whatever.” But it was really bizarre. Then somebody asked me as well, “Okay, so what happens when you're on call, and you have to breastfeed?” And I'm like, “Well, let's see. This is a tough one.” You could tell as well that they were really out of their depth. So, eventually I settled on the Aga Khan just because, in terms of the faculty and the interviews, I got a sense that they were a little more open to the idea. And that's because I think one of my earlier mentors, Prof. Raja, who is our former chair of surgery, had come in from the Aga Khan in Pakistan. And for him, it wasn't anything unusual to see women in surgery. So, like, “Yeah, come along. We'll train you and stuff.” And he was also pretty inspiring in terms of the decision to get into surgery because, for him, their approach to at least surgical training– and we always tease him and say, we all drunk the Kool-Aid because we kind of came back. Because it wasn't about just training surgeons for surgery's sake, it's about how do we become leaders, how do you impact care in your region. And so it was never about just learning surgery; it's how do you use the tools that you have in order to improve the health of those around you. In the Aga Khan, you're sort of, one would say, in a position of privilege. Just the backstory to those listening who might not know about the Aga Khan, it's a private university hospital. But I mean, as a private center, then, of course, I would say there isn't any difference, one would say, between the Aga Khan and most of the international hospitals anywhere in the world. But it was always sort of driven into us that this is a privilege that you're having. And how do you use this privilege to elevate the communities around you? Pat Loehrer: Let's talk about breast cancer, if you will, in Kenya. You mentioned it that when you first went into it, patients were coming in with advanced disease, they still do. But how has the field of medicine changed in Kenya during your professional lifetime as it pertains to breast cancer? Dr. Miriam Mutebi: While we still have the majority of patients diagnosed with advanced disease, the scenario ten years ago was that patients would get diagnosed with advanced disease and frequently would not complete their care. And if we did a deeper dive into the reasons behind this, we saw a constellation of factors. One being the fact that patients were having to pay out of pocket, resulting in financial toxicity, catastrophic health expenditure. And then the other major barrier was the health system itself. And again, to some extent, that still exists where we know, at least on average in sub-Saharan Africa, patients are going to see 4 to 6 healthcare providers before a definitive diagnosis of their cancer is made, which of course, again, translates into delays in ultimate treatment. Another area that we frequently don't necessarily talk about as much are the social-cultural barriers that exist and, to some extent, are still pervasive in some communities. What we see is, one, there's a lot of use of alternative therapies. There is still quite a bit of stigma around cancers. There is what we call collectivism, where we always say in Africa, ‘our community is our strength'. But sometimes, that sense of community is a double-edged sword because then, if the patient is losing agency, then that becomes a real concern. Because what we find, for instance– I'll give you an example, I'll have a patient come in and discuss, and maybe she has early cancer, and discuss the options of having breast conservation versus a mastectomy. And then you will find maybe she goes home to have a think, and then a couple of days or whatever later, there's a community gathering, and the clan elder is saying, “We have decided.” And I'm like, “Who's we? That's not your breast coming off. Like, what right do you have to decide on patient decision-making?” But you see, as much as we would like to sort of say have the patients have autonomy over the decision-making, it's really a question of equity and access to care. Because even if you're giving the patient autonomy, and she's saying at the end of the day, “Well, they're the ones paying for the treatment so let them decide what it is I'm going to have”, then we haven't really adequately empowered our women. And so those are some of the challenges that existed, I would say, about ten years ago. We're definitely seeing an improvement. One in the patient's ability to pay, and this, I think, has been a concerted effort by the government to come up with a National Health Insurance Fund, which initially wasn't covering cancer care but has definitely helped to ensure that the number of patients who actually complete their care or going through their entire cancer journey are probably more. I remember when I was doing my internship, there were like truly heartbreaking because, as interns, we would have the medical internists sometimes– and because there weren't that many medical oncologists– prescribe the chemotherapy and as interns, we were the ones who would administer the chemotherapy. And so, you would have a patient come in and it involves– Basically, we give the prescriptions like chemotherapy, but they'll also have to buy their own saline, the IV line, and everything else,,, and then they get the first cycle, and they just disappear. And then those were the times when mobile phones weren't that common. They literally just disappear. But then they come back six months later, and they're like super excited, and they're like, “Doc, we've raised enough money for the next cycle.” And we're like, “Well, it doesn't quite work like that.” So, with the National Hospital Insurance Fund, it's not perfect, but we definitely see more patients going through the entire care continuum, which is gratifying. I'm sort of putting on my [inadudible] hat as the chair of Kenya Society for Hematology and Oncology, and we've been working closely with the National Cancer Control Program, really to advise the National Hospital Insurance Fund on maybe getting more comprehensive covers. Because what was happening initially was, for instance, they would cover maybe four cycles of chemotherapy. Then the patient has to come up with the remaining four, for instance, and sometimes if they're not able to afford that, then you're sort of giving them the side effects without the therapeutic benefits of some of these. So they are currently in the process of really looking more at treatment plans, and that's also been, at least, a truly– And the fact that they are willing to listen has also at least been a huge stride. And then, of course, in terms of the real efforts, I would say by the National Cancer Control Program to ensure some of the decentralization of cancer services. Initially, we had only one radiotherapy center at the tertiary referral hospital in Nairobi that was having patients traveling from across the country, 400 kilometers or more, coming in. And you come in from a rural area, you come into Kenyatta and somebody tells you have to live there for a month, you have no family, nowhere to stay. People say, “You know what? I don't need to have this stage or rather have this additional treatment.” And so with the deliberate development of or decentralization of the radiotherapy services, we now have at least regional centers in planning and so really looking at how do we bring the services closer to people. And so, we now have, in addition to the tertiary referral centers, we now have two regional centers in Mombasa and in– Pat Loehrer: Eldoret. Dr. Miriam Mutebi: Yes. I think beyond Nairobi, Eldoret, we now have a comprehensive center in Mombasa. Nakuru's just launched a comprehensive center and Garissa as well, so really looking at enhancing our capability to bring these services closer. And there has also been the development of the chemotherapy units across the country that have at least tried to ensure that these services are more readily accessible to populations. And really just underpinning that with the support from the National Hospital Insurance Fund has helped to basically have more patients completing their care. One of the other things that I think deserves particular mention is really the grassroots advocacy that has really tried to increase awareness around cancers. And as a result, we definitely are seeing, as much as we are saying the majority of patients are still diagnosed with advanced disease, we are definitely seeing the entire continuum all the way from screen-detected tumors, early stage I, stage II cancers to more advanced tumors. So with that, it also really shows that there is a continuing consciousness that's really sort of driving these education efforts and awareness in the community. Of course, we definitely do need to do more because we still see that the advocacy's efforts sometimes tend to center largely around urban areas. And also, the question is how do we then sort of percolate that down to more rural areas? It's definitely something that's improved in the last ten years. And then, of course, we've also seen an expansion in the cancer workforce. And that, I think, has also been largely driven by the fact that we're having in-country training for clinical oncology, medical oncology, gyne-oncology, so we're really thinking about how to expand the workforce but– Of course, we are still looking at the patient-to-population ratios, those are still pretty low and we still recognize that there are deficits along the care continuum. But we're now having pharmaco-oncologists, we are having psycho-oncologists, increase in palliative care specialists. So there's definitely been an exponential growth of all the cadres of healthcare providers, whether it's oncology nurses and things. We've had an oncology nursing chapter now that's been developed. We really see the rise of the professional societies like the Kenya Society of Hematology and Oncology, and there is a lot of crosstalk between the academic institutions that are running the oncology training programs. So it's really a positive move in the right direction, but I think what needs to happen is, as I would say, more deliberate investment in the workforce. Because, again, even as we increase the spectrum of the oncology workforce, there's really a need to carry along the primary care providers because they invariably are the gatekeepers to access. And so unless the primary care providers are empowered and knowledgeable to facilitate early and timely diagnosis and referrals to the appropriate pathways, then it doesn't matter how many people or how much of a workforce you have on top of the pyramid. It just means you're invariably going to be still getting patients diagnosed at later stages. And so there's also been efforts around that to come up with, from healthcare provider courses to educating common signs and symptoms. This is something that the Kenya Society of Hematology and Oncology has been doing in collaboration with the National Cancer Control Program. There's a deliberate effort to come up with an online platform that are actually able to give real-time information to primary care providers. And so, I would say there are definitely steps in the right direction, but there definitely needs to be more investment in the entire spectrum of care. Dave Johnson: Miriam, what you've done is astonishing. What you've just described is an amazing infrastructure in a relatively short period of time. What you're talking about took us in the United States half a century. You're trying to do that in a matter of five to ten years. You've trained in both Kenya and in the United States. I wonder if you might just take a few moments to compare and contrast those experiences. Dr. Miriam Mutebi: In terms of working in different spaces and sort of working in the US, working in South Africa, working in Kenya, what you realize is perhaps a very different patient profile. Whereas in countries like the US, where you have vibrant screening programs, and you're definitely having a lot more discussions around 4-millimeter, 5-millimeter tumors that you are doing an MRI-guided biopsy for and maybe a lot more screen-detected tumors. Whereas working in settings, especially when you get out of the urban areas, whether it's in Kenya or South Africa, you find that you tend to have a lot more diagnoses of patients coming in with fungating tumors and advanced disease, and so it's really that spectrum. And that's what I'm saying in terms of the current state of flux that we're in. We're now, as clinicians, at least working in Nairobi, you're sort of seeing the entire spectrum and much less and less of the sort of fungating tumors. So I think in terms of the principles, and the good thing is that irrespective of where you are, principles do not change. But I think you sort of have to rapidly innovate and iterate in settings where you may not necessarily have a say, MRI to do an MRI-guided biopsy, but you also sort of look at what makes sense for the patient. Working in lower-resource settings, I think, is actually a good thing because it challenges you to constantly think about value-based care. People talk about value-based care as a concept, but you're doing it on a day-to-day basis, even between different patients in clinic, because you have to think about the cost and you have to think about how do I deliver care that's still of good quality, that's not necessarily going to break the bank. And so these are some of, I think, more challenging or at least questions that we have to think about deliberately. Whereas in the US, if you have insurance, then it's pretty much carte blanche, for want of a better word. Which we did realize, especially with COVID - and I'm sure Pat and Dave you can bear testament to this - these disparities exist globally. And so you'll find that in your patients who have no insurance or are underinsured, they're still coming in with the same, sort of, challenges. I was talking to my colleague at NYU who works at Bellevue. When she was giving me the profile of her patients, it was interesting to see that there wasn't really– and these are patients who don't necessarily have insurance, there really wasn't any difference in the images we are seeing from patient they're seeing and the patients we're seeing. So really it's an opportunity for us to sort of rethink collectively our approach to care and really thinking about how do we provide quality care. Pat Loehrer: I was in Washington this week, and President Biden had a three-day African US summit, and at the end of this, he basically pledged to spend $55 billion in Africa to help relations with them. We also had a discussion about the Moonshot 2.0, in which President Biden wants to end cancer as we know it, with a particular emphasis, I think, and now, in linking with LMICs. Briefly, what would you tell President Biden in terms of what would be very helpful for the United States to help with the cancer problem in sub-Saharan Africa? What would you say in a sentence or two? Dr. Miriam Mutebi: As we say, perhaps have the Moonshot, but stay grounded in the sense that– even before we think about complex molecules, we are still struggling as a continent with the basics of care. And so, investing in health systems and the basics will ultimately give more or improve outcomes rather than sort of focusing on specific molecules. So if we have the basics in place to deliver the basics of care, then that would go a long way toward shifting outcomes. The other bit that does need to happen is, again, with research because there is a paucity of cancer research. We did a recent bibliometric analysis and found that as a continent, we are only contributing to less than 8% of all sort of cancer research globally. And we do know that one, we have, I would say, the breadth of diversity in terms of genetic diversity. We do know that the responses to care and treatments are different. We do know that we do need to think about implementation science and what structures we can put into place, and what strategies. What works in different settings might not necessarily work in ours, and it does need to be backed by evidence. So there are opportunities to expand care and strengthen systems, but really do this in an evidence-based, pragmatic way that ultimately [inaudible] its own outcomes and outputs for the patient. Dave Johnson: Thank you for that, Miriam. Pat Loehrer: Well said. Thank you. Dave Johnson: Great advice. I hope the President is listening. Pat Loehrer: Dr. Mutebi, what was the first book that you remember that you really loved? Dr. Miriam Mutebi: I think it was actually The Lion, the Witch, and the Wardrobe. It was just the whole sort of just stepping into a different world. And then, of course, we all had crushes on Aslan, the lion, but it was more because he was like this sort of guy who would swoop in and was morally just and get to mediate the world. And so I went through the whole series, I just gobbled it down, and I think that's one of the things that really stands out for me as one of the books that I sort of remember early on. Pat Loehrer: It's such a great pleasure today. I'm really excited. We're typically talking about books. And here's a book, Dave, I know that you have not read; it's entitled 101 Things I've Learned in Engineering School. It was an interesting book. As you know, I'm an engineer background, but there were a few quotes in here that I– Dave Johnson: Pat, I live on Purdue Avenue, so I have some engineering background. Pat Loehrer: Oh, that's true. Good for you. So you might like this one, Dave. One of the quotes I have is: "Inventing is a mixing of brains and materials. The more brains you use, the less materials you need." And another one - do you know the difference between accuracy and precision? They're really different things. And so, the best example that came from the book, which I thought was interesting, was pi, so pi is what? Dave Johnson: Round. Pat Loehrer: Okay, this is going to be painful. Pi is 3.14. Right? So that's accurate. But if you say pi is 3.1415926535, that's accurate and precise. And if you said pi is 3.98, that's just inaccurate and imprecise. As I think about engineering as we move forward, I'm thinking about the Lung Pragmatic trial that has just been announced, where we're trying to do trials a lot more simply in which I think we can be accurate, but perhaps not as precise as we always deem to be important. And I think we're really excited about that and that project. Dave Johnson: Well, that's really all the time we have for today. And we really want to thank you, Miriam, for a wonderful interview. And knowing that you're up very late at home makes it all the more special. We also want to thank our listeners to Oncology, Etc. This is an ASCO educational podcast where Pat and I will talk about just about anything. If you have an idea for a topic or a guest you'd like us to interview, please email us at education@asco.org. Thanks again. Pat, I have an important question for you before we leave. What do you call a snail that's not moving? Pat Loehrer: You got me, man. Dave Johnson: Escarstay. Pat Loehrer: I love it. Miriam, Asante sana. Dr. Miriam Mutebi: Nime Shukuru. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Oncology Etc – Global Cancer Policy Leader Dr. Richard Sullivan Part 2

Play Episode Listen Later Jan 24, 2023 19:33

"Battling cancer takes place in many parts of the world and our next guest has led initiatives to do just that. In Part Two of this Oncology, Etc. Podcast episode, Professor of Cancer and Global Health at King's College London Dr Richard Sullivan shares with us his research into cancer care in conflict zones around the world (0:58), his thoughts on “colonial” cancer research (5:50), his advice to people interested in pursuing a career in global oncology field (10:08) and using “pooled procurement” as an innovative approach to cancer care (11:13). Participant Disclosures Dr. Richard Sullivan: Honoraria – Pfizer; Consulting or Advisory Role – Pfizer Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical If you liked this episode, please follow the podcast. To explore other episodes, as well as courses visit https://education.asco.org or contact us at education@asco.org. TRANSCRIPT The disclosures for guests on this podcast can be found in the show notes. Pat Loehrer: Hi. I'm Pat Loehrer, director of Global Oncology and Health Equity at Indiana University. I'm here with Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas, and a friend of mine. This is the second half of our Oncology Etc. conversation with the professor of cancer and global health at King's College in London and the director of the King's Institute of Cancer Policy and the co-director of the Conflict and Health Research Group, Dr. Richard Sullivan. In part one, we chatted with Professor Sullivan about his international travels as a child to his transition from biochemistry and finally to a great career in health policy and research. Today we're going to continue our conversation with Professor Sullivan by asking him about his insight into the current state of the progress in global health care. Richard Sullivan: Conflict and fragile populations around the world are sadly growing. They're unique ecosystems for a whole variety of reasons. I think fundamentally, though, to do research in those systems requires a huge amount of sensitivity and experience and expertise because you're dealing with the most vulnerable of the most vulnerable. And then, of course, whatever research you do, you're constantly thinking in the back of your mind how you then tie this into any form of impact. There is a tendency, often with research in these populations, that the research is just done for the researcher's sake rather than actually being utilized to help improve those lives you're actually involving and studying. But I admit it's a very tricky area to work in. Cancer in conflict populations, a particular interest is a relatively new domain. It's only really been around for the last eight to ten years for a variety of very understandable reasons. Let's be honest, 30 years ago, cancer was not a significant factor in humanitarian conflict operations. You were dealing with demographically untransitioned societies, much younger. Really the group one, infectious diseases, child and maternal mortality, et cetera, were the primary foci. That still is the case. But what we're seeing now is much more transitioned populations being impacted by conflicts. And you think about in Mexico, in the Narco Wars, Syria, Iraq, even Afghanistan, and all of those have changed dramatically the nature of how care is delivered and how patients move. And we call these new therapeutic pathways, and we consider them kind of post-Westfalian. We're not talking about cancer care anymore that's boundaried within nation states. Patients moving across national lines, we have patients moving in pathways which are absolutely unique and we've never experienced or seen before in the high-income West. And that means you have to have a different paradigm for care and a different paradigm for building cancer control systems. And I guess for the last ten to fifteen years that's what we've really been interested in is this dynamic of conflict populations and how you deliver care and who delivers it. And there, of course, you're talking with a very mixed act, a bunch: humanitarian organizations, the big NGOs, the ICRCs, Medecins Sans Frontières. You're talking about the militaries in many countries. The militaries are very powerful in many countries in terms of providing care. And then finally there is, of course, the health services or systems that exist to varying degrees in the individual countries infected by conflict. So our program really tries to understand how you strengthen health systems per se in these conflict populations. And obviously, my particular interest is in cancer and palliative care. But I'm going to be honest, for that we have a very large team, some remarkable colleagues I've worked with over the years, sub-Saharan Africa, the Middle East, and increasingly, there's a lot of leadership coming out from these countries taking these sorts of programs forward. It's an important time, and I think Ukraine has taught us as well that if you don't think about, for example, cancer care within humanitarian operations, within UNHCR, you can end up in serious trouble in terms of planning, financing, sustainability. So I think Ukraine is going to be an interesting turning point in generally thinking about cancer care and conflict and humanitarian operations because it's really illuminated to everyone very clearly in Europe and the USA, what cancer and conflict really is, because I think the Middle East has felt a little bit far away, and it's been quite difficult selling all that kind of policy and work. But Ukraine is really having a dramatic impact and I think it's producing a lot of learning points. Dave Johnson: You recently published, along with colleagues, I thought, a very provocative paper in JAMA Open Network about the participation of lower and upper middle-income countries in oncology clinical trials led by high-income countries. You made the point, be sure to correct me if I'm wrong on this, that first of all, Ukraine and Russia are actually two of the top participants in these kinds of trials. Number one. Number two, the question is, is it exploitative of the higher-income countries to be conducting these trials in these two countries and then more particularly, what the recent conflict in Ukraine has done to the participation of patients? And I wonder if you might comment on those points. Richard Sullivan: I'll maybe talk to the last point first. The conflict has been devastating for recruitment. It's also important to realize a lot of these sorts of clinical trials are funded by industry and they've been the backbone of funding research and also to a greater degree also access to certain types of medicines in these countries. Is it exploitative? I think it's a very hard judgment call to make and I think if you ask my Ukrainian colleagues, the answer is no. We know exactly what we were getting into. When companies work in these places, they pay and they pay properly. The difficulty I think is, generally speaking, there is obviously this discussion now ongoing about neocolonialism and exploitation of low middle-income settings more generally. It's very hard, all the research we've been doing, it's very hard to make generalizations. There is absolutely no doubt. I want to recognize right up front that there has been some appalling exploitation and what I would consider to be colonial cancer research going on over the last 20 years. And it's blindingly obvious when you read papers, when you look at authorship, when you undo this sort of analysis, that there has been a lot of exploitation where high-income countries are parachuted in. Investigators have taken whatever they needed data, samples, interview data, made good careers on the back of it and good research funding, and not really put much back into the ecosystem they've been working with. So that's absolutely clear up front. Then we have this other problem, as well as research funding generally, because if you step back and look at the data, and this is something we've published on, actually, with Julie Gralow, and ASCO, we talk the talk about funding global cancer, that's big, high, powerful, wealthy, high-income countries. But when you actually look at the data and you ask that question, of all the cancer research publications, how many from the USA, the UK, the Frances, the Germany are actually with lower middle-income countries, you barely get above 4%. It doesn't take a rocket scientist to realize we taught the talk here, but we're not walking the walk. The money is not being provided to do genuinely equal collaborative work. We've not built capacity and capability in many countries in terms of clinical research methodologies and strengths. We failed to back up a lot of the rhetoric. We talk about global cancer with actually proper cancer research system strengthening. And I think there's that realization, and there's been that realization over the last five or six years that that's been the case. And when you take countries like India who kind of realized, you know, maybe ten to fifteen years ago this was the case, they've obviously gone themselves and driven their own agenda. So the National Cancer Grid of India, the development of Credo, the methodology workforces led by Dr. C.S. Pramesh from the Tata Memorial Centre, has been absolutely superb work. I mean, it's been amazing. A real master class in national development. But I think we do, as high-income countries have to think, look ourselves in the mirror and ask the question, is this what we mean by global cancer? Are we really putting enough money in? And are our research priorities right? You've heard me argue about this enormous amount, about how much money goes into discovery science and biopharmaceuticals. Where's the money going into implementation science, health services research, social science research, health economics, all the stuff that actually leads to direct improvements by strengthening cancer systems. It's a drop in the ocean compared to the billions and billions a year that have been spent in these other areas. So I think the agenda is unbalanced. But I think when you talk about exploitation, you have to be kind of more nuanced about that argument. Pat Loehrer: Richard, we were just at the World Cancer Congress and it was heartening to see all these wonderful young people from around the world thinking about global oncology and various different aspects of things. But I'm thinking about Brexit. I'm thinking about some of the issues going on in our country in which we are hunkered down to issues in our own country. P30 grants for the cancer centers are focused on issues in our catchment area. They have an illusion of global stuff, but it's really not a priority. What would you say to young people who are interested in pursuing a career in global oncology? Is this something that's worthwhile for them to do, and what would you advise them? Richard Sullivan: Yes, it's absolutely worthwhile to do. And I think two pieces of advice I would have is develop, first of all, your interests with friends. The work we do around the world is with friends. These are close colleagues. This is not some instrumental transactional research program of sending your samples to a genome lab for them to sequence it and send back to you. These are really long-term true friendships. That's what makes the difference, is that long-term commitment, year after year, decade after decade. So find out where it is and what it is you're really passionate about. Make those friends and then develop the suite of knowledge that you're going to require to do the kind of research. I mean, the thing with global cancer is it requires a very broad outlook. It doesn't matter what you are the master of; whether you're an epidemiologist or social scientist - mixed methods is absolutely the way to go. What you have to be able to do then is sort of think more broadly about other sorts of disciplines to bring out, because most of the really complex problems require a very transdisciplinary approach methodologically, and that takes a few years to build the insight into these other disciplines and also to make research relationships. And again, there is no substitute for experience in terms of going to places, working with people, working on projects. And of course, with that comes the advocacy. Cancer crosses borders, the advocacy for global cancer. You need people who are going to be passionate about this, who are really going to stand up and shout from the rooftops what's really needed and change, I think, the minds of both national and the philanthropic funders, which, as you said, Pat, you're spot on, are still very, very insular, very inward looking in terms of how they see the world of cancer research. And I think it needs a bit of a sea change. But the opportunities are out there. There's some, as we know, wonderful, wonderful people working all over the world on really, really different problems. Building capacity in surgery in Zambia is not the same as building capacity in surgery in one of the states in India, for example. So there's an incredible richness and diversity. It's a really, really important area. And I think younger crowds don't get put off because there's no clear pathway and there's a reason there's no clear pathway. It's so diverse, but it's absolutely worth it. And there's plenty of us, I think, out there now that can help. There's some great conferences like the Word Cancer Congress, amazing regional conferences like AORTIC, which is happening in Senegal next year, the big conferences in India. Absolutely superb. Just go immerse yourself in this. Dave Johnson: You've talked about a lot of different innovative approaches to cancer care and lower- and middle-income countries. One thing that I read that you'd written about was something that I had never thought about. I think you called it pooled procurement. Can you talk about that? Where maybe two countries can join together? It seems irrational to me that we could expect something like that to happen. Are you aware of any examples? Richard Sullivan: It's interesting because I've the pleasure of working with a lot of colleagues over the years on access to essential cancer medicines. And it's interesting because we're now getting into a domain in global health, which again is very rich for more learning, for more people coming into which is the political economy of cancer. Because this is where the disciplines of health economics, decision procurement, logistics, all kind of fuse together, as well as an understanding of power and decision making in individual countries. So, in and of itself, procurement is where groups of countries or centers within a particular country will come together to create sufficient volume to negotiate with suppliers for a particular consumable. And that drives down the prices. You become much more powerful in negotiating prices if you can all get together. One of the biggest problems, and again, there's some amazing work that's been done, for example, by Chai on this, who have really innovated in the pool procurement medicine space. But we've also seen pool procurement as well for radiotherapy. If you can come together as large groups with common needs, you've got a lot more power to negotiate prices with individual suppliers. And more importantly, one of the problems with suppliers, whether it's essential medicines or other sorts of consumables, is if the market is too small, if you're trying to negotiate on a center by center basis, it's often it's just not worthwhile for the supplier to come to attend a deal with you. They don't want to contract with you because the volumes are too small and the margins are therefore too small. So pooled procurement is one way of getting around this. But I speak very easily about something that's actually a very complicated and complex subject. There's a lot of law involved in this, there's a lot of economics in this, there's a lot of business work in this. Again, it's one of those areas of research and expertise in the cancer area that's really quite thin and really needs to be bolstered. And here we're talking about the second translational gap is you've got the Essential Cancer Medicines list - how on Earth do you deliver that in an equitable and affordable manner to population X and country Y? That is in of itself a research question, that falls under the political economy of cancer in terms of research, but again, also falls out with most research funding organizations who don't quite know how to handle supporting this sort of research and capacity building. But as you can see, absolutely crucial. Great. You've invented the drug, you've invented the new surgical technique, or the new form of radiotherapy. It delivers clinically meaningful benefits. So how on Earth do you embed that in a sustainable manner in a health system? And that is a big missing gap in the global research agenda. Pat Loehrer: You can have all the drugs and radiation equipment in the world, but if you don't have the healthcare professionals trained to give it, it's worthless. I think one statistic was that there's 176 physicians in the United States for every one in Uganda. And how do you deliver cancer care by trained oncologists? It's getting more and more complex for us, too. But this has been just a wonderful discussion. Just as a quick question, though, Richard, Dave mentioned his book. Anything you're reading right now or anything of interest? Richard Sullivan: Yeah, yes, I've just started reading a fascinating book called Dadland by Keggie Carew. And it's fascinating because this is a marvelous piece of work, actually. And this is a daughter trying to make sense of her father's life. And she really sort of spends years patiently collecting all these details of her father's life and growing up with it. And she sort of takes, juxtaposes– when she starts the book, he's got dementia. But this is a man who in his early days was in Jedburgh, was a Special Operations executive, fought behind enemy lines in France in D-Day, went to the Far East in Burma. And there's this extraordinary pathos and sensitivity in this book about watching his decline with dementia, as she puts it, as he slowly disconnects from reality and then he disconnects from himself, and trying to make sense of it with the individual he once was and the kind of individual. And through that, she gets to explore all the kind of boxes of letters and things that were all stuck in the attic. Memento mori, essentially, of his time in Burma and France. But it's very, very touching, and I would really recommend your listeners to read it because it unpacks dementia in a way I've never seen a book unpack before in terms of the impact it makes to an individual. And it asks that question about - what makes you you? And when this father, he dies, is he still the same man who jumped out of airplanes in the middle of the night in France? Is he still the same man as he was in Burma? It's very touching. It's one of the most impressive books of exploration into human nature and an identity that I've read for a long time. So, yeah, Dadland, excellent. Pat Loehrer: I'll get it. Dave Johnson: Absolutely. Sounds great. Well, that's all the time we have for today, and I want to thank Richard Sullivan so much for joining Pat and me. This has been a fascinating conversation and you're to be congratulated on all of your many accomplishments and all the things that I'm sure you'll do in the future. I want to take the opportunity to thank our listeners for tuning in to Oncology, etc. This is an ASCO Educational podcast where we'll talk about almost anything and everything. So if you have an idea for a topic or a guest you'd like to hear on our show, please email us at education@asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.

Oncology, Etc. – Global Cancer Policy Leader Dr. Richard Sullivan (Part 1)

Play Episode Listen Later Jan 10, 2023 25:18

Battling cancer takes place in many parts of the world and our next guest has led initiatives to do just that. In Part One of this Oncology, Etc. Podcast episode, Dr. Richard Sullivan, Professor of Cancer and Global Health at King's College London, shares with us his intriguing life trajectory, encompassing a childhood in various parts of the world, aspirations for a veterinary career that turned to basic science, medicine, health policy (4:27), and even a long-term stint with the British Army Intelligence (12:22). Dr. Sullivan, who served as Director of Cancer Research UK for nearly a decade also discusses traits he looks for in a cancer investigator (19:21), and how to be happy (21:16)! Guest Disclosures Dr. Richard Sullivan: Honoraria – Pfizer; Consulting or Advisory Role – Pfizer Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical If you liked this episode, please follow. To explore other episodes, as well as courses visit https://education.asco.org. Contact us at education@asco.org. TRANSCRIPT Pat Loehrer: Hi, I'm Pat Loehrer. I'm director of the Center of Global Oncology and Health Equity at Indiana University Cancer Center. Dave Johnson: And I'm Dave Johnson at UT Southwestern in Dallas, Texas. Pat Loehrer: And this is Oncology, Etc. Dave, what book have you read this last month? Dave Johnson: I have one I wanted to recommend to you. It's very interesting. It's by Steven Johnson, not of the syndrome fame. It's entitled Extra Life: A Short History of Living Longer. You may have heard of this because PBS made a special documentary about this particular book. But in it, Johnson talks about the remarkable increase in human lifespan, especially over the 20th century, and the various factors that contributed to increased years of life from on average in the United States of about 48-49 in 1900 to just about 80 in the year 2000. So that beats anything in the history of mankind before. And he has a chapter about each of the factors that contribute to this, and some of which I think we all recognize. Things like antibiotics playing a role, but some of the things that I hadn't thought about were improved drug regulation and the development of randomized controlled trials, which all of us have participated in. How important that is. He also talked about, at least in the United States, the importance of automotive safety. And I'm sure some of us on this podcast are old enough to remember cars that did not have safety belts and certainly not other safety maneuvers that have really improved lifespan in that regard. So I found it a fascinating book. I think our listeners who are interested in medical history would also enjoy this text. Pat Loehrer: Did he mention this podcast? Dave Johnson: No, actually it wasn't mentioned, and I thought that was a tremendous oversight. So, I've sent him a letter and recommended that he add it. Pat Loehrer: We may not live longer, but it just seems like we're living longer. When you listen to this podcast, time stands still. Pat Loehrer: Well, it's my real great pleasure to introduce our interviewee today, Richard Sullivan. I met Richard several years ago through the late Professor Peter Boyle in Leon, and it's one of the greatest highlights of my life to be able to know Richard. Professor Richard Sullivan's Research Group studies health systems and particularly chronic disease policy and the impact of conflict on health. He's a professor of cancer and Global Health at King's College in London and director of the Institute of Cancer Policy and Co-director of Conflict and Health Research Group. As well as holding a number of visiting chairs, Richard is an NCD advisor to the WHO, a civil military advisor to the Save the Children Foundation, and a member of the National Cancer Grid of India. His research focuses on global cancer policy and planning and health system strengthening, particularly in conflict ecosystems. He's principal investigative research programs ranging from automated radiotherapy planning for low resource settings to the use of augmented or virtual reality for cancer surgery through the political economy to build affordable equitable cancer control plans around the world. Richard has led more Lancet Oncology commissions than anyone else. In fact, Lancet is talking about calling it the Sullivan Commissions. He's led five Lancet Oncology commissions and worked on four others. He's currently co-leading the Lancet Oncology Commission on the Future of Cancer Research in Europe and Cancer Care and Conflict in the conflict systems. His research teams have had major programs in capacity building in conflict regions across the Middle East and North Africa. He's done studies on the basic packages of health services in Afghanistan and worked in Pakistan, Syria, and the Democratic Republic of Congo. He's been a member of the British Army, intelligence and security, and in that capacity he's worked many years in biosecurity and counterterrorism issues. I think in some ways, this is the most interesting man in the world, and it's our pleasure today to have Richard join us. Richard, thank you for coming. Richard Sullivan: Pat, Dave, you're really too kind. Marvelous to be with you. Thank you for the invitation. Pat Loehrer: Can you tell us a little about your upbringing and early life before you became Dr. James Bond? Richard Sullivan: I'm not sure that's anywhere close to the truth, sadly. But, yeah, I have had a very interesting, eclectic life. I was born in Aden just on the cusp of where the British Aden Protectorate met a country which actually no longer exists, the People's Democratic Republic of Yemen. Because after the British left Aden, essentially the East Germans, and what was then the Soviet Union took over southern Yemen. So I was born in a very unusual part of the world, which sadly, since then has just deteriorated. I spent many years of my life with my parents, who were in the diplomatic service and doing other things, wandering around the globe, mainly in the Middle East and East Africa. We spent quite a lot of time, strangely enough, we washed up on the shores in the USA once as well. Dayton, Ohio, and eventually- Pat Loehrer: Not to interrupt you, Richard, there are no shores in Dayton, Ohio. So just correct you there. Richard Sullivan: That is so true. My memory - cornfields everywhere. I had a wonderful dog then, that's how I remember it so well. And I didn't really come back to the UK until, oh, gosh, I was nearly 10-11 years old. So, coming back to the UK was actually a bit of a culture shock for me. And then relatively classical in terms of the UK, sort of minor public school and then into medical school. In the old days when it was in the 80's. I had a fabulous childhood, going all over the place, seeing lots of things, being exposed to lots of different cultures. I think it remained with me all my life. I never really feel a foreigner in a foreign land. That's nice. That's really unique and it's been marvelous being able to tie in the passion for global health with my upbringing as well. So, yeah, I had a wonderful childhood. Dave Johnson: Would you mind expanding on your medical training, Richard? Tell us a little bit about that. Richard Sullivan: Yeah, so when I, when I went to medical school in the UK, we were still running the old system. And by the old system, I mean, you know, these small medical schools with entries of, you know, 70, 80 individuals, particularly in London, you had that St. Mary's Hospital Medical School, which is where I went, Charing Cross, Guy's, St. Thomas', and they were all individual medical schools. Now, most of these now have merged together into these super medical schools. But certainly when I went to medical school, I'll be absolutely honest with you, I wanted to be a vet to begin with, but actually discovered I wasn't bright enough to be a vet. It was harder to become a vet than it was to become a doctor. In my day going into medicine, and people listening to this, or some people who understand the A level system in the UK will recognize if you're offered a BCD, that's quite low grades to get into medical school. So I went to Mary's, to be absolutely honest with you, because I heard that they took people that played rugby, and I came from a rugby-playing school. And sure enough, 90% of the interview was based on my rugby prowess, and that was St. Mary's Hospital Medical School. So it was wonderful. And we'd already had people going there who were big rugby players. And again, it was, I remember thinking to myself, am I making the right decision here? But it was interesting, as soon as I went into medical school, I realized that was the life for me. I had done myself a favor by not going into veterinary science, which I would have been awful at. We had six years of very, very intensive pre-medicine, the classical medical rotations, and then that movement into the old schools of pre registration house officers, registrar jobs. We were quite an early stage. I kind of slightly went off-piste and started doing more academic work. Interestingly, most of my academic early days academic work was not in health policy and research. It was actually in very hard core cell signaling. So my doctorate was in biochemistry, and we worked on small GTPases, calcium-sensing proteins. There were some really extraordinary heady days, and I'm talking here about the early nineties and the mid-nineties of tremendous discovery, real innovation. I was at UCL at the time, but mixing and matching that up with a sort of surgical training, and again, surgical training in those days was pretty classical. You went into your general surgery, then sort of specialized. It was really, really interesting but it was full on. I mean, you spent your entire life working. Morning to night so these were the days of 100 hours week rotations. You were doing one in twos, one in threes. That's every other night and every other weekend on call. It was incredibly intense, but there was a lot more diversity and plasticity in those days. You could dip in and out of medicine because of the way you were chosen and how you were recruited. So it suited my personality because I liked moving around and doing different things and that sort of took me through, really until the late 1990s. Pat Loehrer: You became a urologist, right? Richard Sullivan: That's right. Exactly. So I trained up until the late 1990s, it was all pretty standard, I would say. And then I decided I was bored and moved into the pharmaceutical industry and I went to work in for Merck Damstadt at the time, which was relatively small. I was going to say family owned, but it was quite family-owned pharmaceutical company that was just moving into oncology. And because I'd done the background in cell signaling and cell signaling was really the backbone of the new era of targeted therapies, this seemed like a great move. To be absolutely blunt with you, I didn't last very long, less than a couple of years, I think, mainly because I just found the whole environment way too constraining. But what it did provide me with was a springboard to meet the wonderful late Gordon McVie, who I met at a conference. And he said to me, ‘You're absolutely wasting your time and life by staying in the pharmaceutical industry. Why don't you come out, get an academic job at University College London and become my head of clinical programs?” - for what was then the Cancer Research Campaign. This Cancer Research Campaign and the Imperial Cancer Research Fund were the forerunners of Cancer Research UK. So, you know, this was an offer that was too good to be true. So I jumped ship immediately, went back into academic life and joined CRC. And really the next ten years was this extraordinary blossoming of the merger of CRC with the Imperial College Research Fund, the creation of Cancer Research UK, and that was Paul Nurse, and obviously Gordon and me, bringing that all together. And it was the heady days of that resurgence of cancer, the importance of cancer care and research in the UK. And coupled with that, of course, it was the blossoming of my interest, really then into the global health aspects of cancer, which really, Gordon, people like you mentioned already, the late, wonderful Peter Boyle, all those individuals were already engaged in and they were the ones that really kind of catapulted me into a more international scene. Dave Johnson: Did you know Dr. McVie before you met him at this conference, or was it just a chance encounter? Richard Sullivan: No, he actually met me via John Mendelson, because John had picked up a paper I'd been writing on basically the very early versions of Rituximab that we were working on and we were looking for pharmacodynamic endpoints. And of course, one of the things I noticed with the patients is they were getting all these skin rashes on their faces, and I thought, that's terrific. Just seemed to be the skin rashes seemed to be together with those individuals that had better responses. And I remember writing this paper for Signal, which was a kind of relatively minor journal, and I think it was John Mendelson who picked it up and must have mentioned something to Gordon. Gordon hunted me out down at a particular conference, said, "How on earth do you know about this, that you're not anything more than a surgeon?" He was absolutely right about, goodness sake, what do you know about pharmacodynamic endpoints, and I kind of had to sort of confess that I've gone kind of slightly off-piste by doing biochemistry and cells signaling and working with these extraordinary people. And that's how I essentially met Gordon. He was very good for spotting slightly unusual, eclectic human beings. Pat Loehrer: I'm very curious about the intersection of your work and how you got into the British Army and Intelligence with medicine and how that even may continue even today. So explain that story, that part of your life a little bit to us. Richard Sullivan: Yeah, it was very early on, as I went into medical school, one of the key concerns was making money. I looked around for ways of doing something interesting to make money, and most of the jobs on offer were bar jobs, et cetera. Then I thought, what about the Territorial Army, which, in the early days of the 1980s, was, and still is, a very large component of the UK Armed Forces. So I actually joined the Royal Army Medical Corps, as you would expect for someone going into medicine. I thought, okay, I'll join the Royal Army Medical Corps, and I was a combat Medical Training Technician, et cetera. So I went along, signed up, and I think I was about three months into training when I was at a place called Kew Barracks and some chap came up to me and handed me a little bit of paper. It said "Intelligence Security Group" and gave a phone number. He said, "This is more your line of work. Why don't you give them a ring?" It was interesting because, in those early days, they were looking for analysts who could work on lots of different areas. In those days, most of the work was domestic.. Of course, there was counterterrorism with Northern Ireland, but there was also the Soviet Union, and the fallout from the Warsaw Pact, so they were still actively recruiting into that area. There are lots of details I can't talk about, but it was relatively, to begin with, quite hard work and low level. It was a lot of learning foreign equipment recognition. It was what we consider to be standard combat intelligence. But the more time you spend in it, the more interesting it gets. One of the areas they were looking to recruit into, which I didn't realize at the time but only later, was bioweapons and biosecurity. They needed people who understood biotechnology and the language of science, and who could be taught the language of infectious disease on top of that. That is quite a difficult combination to find. It's very easy to teach people trade craft and intelligence, it's very hard to teach them subject matter expertise. And they were really missing people who specialized in that area. It was interesting because it was still a relatively open domain. There was still a lot of work going on in the counterterrorism front with biological weapons, and a lot around the Verification of the Biological Weapons and Toxin Convention. And it was an interesting, and I'd almost say parallel life. But your medical knowledge and the scientific knowledge I had already gained and was gaining was what was being looked for. So that was very early on and it has expanded over the years. More and more now we talk about health security and intelligence so that goes beyond what you would consider classic medical intelligence or Armed Forces - this is more about putting together the disciplines of intelligence with the securitized issues of, for example Ebola. That is a classic example. The big outbreaks in West Africa, the DRC, these are sort of the classic security intelligence issues - even COVID 19 for example - and mostly around the world, what we've seen is the intelligence apparatus taking front and center in that, whether you're looking at states like South Korea, et cetera. So I've moved more into that, and we do a lot of work and research into this as well. So we look at, particularly now, how to improve human intelligence in this area, the pros and cons of signal intelligence collection. And we go as far as to kind of ask sort of deep ethical and moral issues, for example, about how far should these sorts of apparatus of state be applied to public good issues like health. Because at the end of the day, when you're talking about the armed forces security sector, their primary job is for defense of the realm. So applying them in other areas obviously comes with a whole load of moral and ethical challenges. So, yes, it's been a fascinating journey, which, as I said, it extends all the way back to the late 1980s. It's been both complementary and different. Dave Johnson: So, Richard, there's so many things in your resume that warrant exploration, but you served as Clinical Director of Cancer Research UK for nearly a decade. What was that experience like, and what accomplishment are you most proud of? Richard Sullivan: It was an enormous privilege. In your life, you always look at some jobs and you think, “How lucky I was to be there at that time with those people.” I think, first of all, enormous respect for the people that ran both Cancer Research Campaign, Imperial Cancer Research Fund – I mean, Paul Nurse and Gordon McVeigh, Richard Treisman – I mean, some extraordinary people who were leading both of these charities. And so to be there at that moment when they both came together, but more importantly as well, they had this most amazing global network of literally the illuminati of cancer research, spanning from basic science all the way through to epidemiology, public health, health systems. And in those days, of course, those individuals would come on site visits to the UK to look at the different units and evaluate them. So you can imagine when you're bringing those sorts of individuals across, you get a chance to go out with them, go drinking, talk to them, learn about their research, and also learn about the extraordinary breadth of research that was there in the UK. So you're condensing almost a lifetime's worth of learning into a few years. It was an absolute privilege to have been able to serve the community like that. What I'm most proud of? Gosh, I like to think I suspect that most proud of trying to help a lot of the fellows get through to where they were going to actually get the most out of their careers. When I look back, there are lots and lots of names of people who started at a very early stage with funding from Cancer Research Campaign or the Imperial College Research Fund, who are now very, very senior professors and global research leaders. And I like to think that we did a little bit to help them along that way and also help to support individual research programs actually reach their full potential. Because I think research management and planning is often overlooked. People think of this as very transactional – it's not transactional. It's an incredibly important, serious discipline. It requires very careful handling to get the very best out of your research ecosystem. You've really, really got to get under the skin and really have a clear view of how you're going to help people. So I think that's what I'm most proud of – is the individuals who made it all the way through and now these great leaders out there. But it was also, let's be honest, it was halcyon days. Great innovations, great discoveries, new networks growing, incredible expansion of funding in the UK, in Europe, in the USA. They were very, very good days. And it was, as I said, it was a real privilege to be there almost at the center for nearly a decade. Dave Johnson: Let me follow up on that, if I may, just for a moment. You have had such an incredible influence. What characteristics do you think are most desired in a cancer investigator? What sorts of things do you look for, especially when you're thinking about funding someone? Richard Sullivan: Creativity. I think creativity is really important. We talk about the word innovation a lot, and it's an interesting engineering term, but creativity is that spark that you can see it in people, the way they talk about what they're doing. They have this really creative approach. And with that, I think you have to have the passion. Research careers are long and difficult, and I'd probably suggest there's probably more downs than there are ups, and you have to have that passion for it. And I think along with that passion is the belief in what you're doing – that first of all, you have that belief that actually drives you forward, that what you know you're doing is good work, and that you're really dedicated to it. But obviously, hand on heart, when you're looking at researchers, it's that passion and that creativity. I think it's a brave person to judge how any person's career or program is going to go. I don't think any of us are prophets. Even in our own land. We might be able to see slightly into the future, but there are so many elements that make up “success”. It's funny when I look back and I think those who've been successful, it's people who've also been generally happy in their lives. They've found their careers in whatever shape or form, fulfilling, and they've generally been happy human beings, and they've managed to create a life around research which has given them meaning. Pat Loehrer: Richard, you have reinvented yourself a number of times – this transition of going from like a basic scientist, a surgeon, moving into public policy and global policy. Tell me a little bit about the journey that's been in terms of academics. How do you learn? What were the transition points in each of these things to get you now to be, as I mentioned before, kind of the key person for Lancet's commissions to somebody who was a rugby player? Richard Sullivan: I suppose if you're being mean, you say, he clearly gets bored easily. But it's not that. Actually, I'm not very instrumental about life either. I mean, there are many people you will meet who have got their lives and strategies mapped out. They know they're going to do X next year, Y the following year. And for me, it's never been like that. For me, it's that excitement, that creativity of working on new and interesting things, but also knowing when you've run out of road in a particular area, where it no longer gets you out of bed in the morning, where you no longer feel happy, where you no longer feel you're contributing. All of us talking today have the great privilege of having choice about our lives, about what direction our lives should take. And it's not a privilege one should squander lightly because many people do not have choices about their lives. It's all about chance. And having that choice to be able to move into different areas is really important because I said you can stick in the same thing because you think you have to. And you can become an unhappy, miserable human being. And that makes you a miserable researcher to be around. It makes you a terrible doctor. Probably makes you a terrible person, actually, generally, if you're having a miserable life. So finding new things, that really you're passionate about how you do it, there's no shortcut in this. It's hard work. Readily admit I went back to law school of economics, retaught myself lots of things. There are no shortcuts for. Deciding if you're going to a new area is learning, learning, practice, practice, practice, and just doing the hard work. I think that's an ethos that was probably drilled into us quite early anyway in medical school, because that's how you approach medicine. That's how you approach science when I was growing up. And it was that idea of humility that you can never have enough learning, you will always learn off other people. That's probably what drove me and how I've managed to change and as I say, who knows what the future is? I don't know. Maybe one day I'll think about doing a bit of poetry. Dave Johnson: Your comments about happiness and work resonate with Pat and me. I think we both feel like humor is really important for happiness and career success. And, you know, Osler once said, “The master word of medicine is work.” You can't get around that. It is what it is. And I think you just reaffirmed that. Well, this concludes part one of our interview with Richard Sullivan, professor of Cancer and Global Health at King's College, London and director of the King's Institute of Cancer Policy and co-director of the Conflict and Health Research Group. In the second part of this episode, Professor Sullivan will speak about the progress of global health, especially in conflict areas, and the need for young people to enter into the world of oncology and oncology research. Thank you to all of our listeners for tuning into Oncology, Etc. This is an ASCO educational podcast where we will talk about just about anything and everything. So if you have an idea for a topic or a guest you would like us to interview, please email us at education@asco.org. Thank you again for listening. Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at education ASCO.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.

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Oncology, Etc. – HPV Vaccine Pioneer Dr. Douglas Lowy (Part 2)

Play Episode Listen Later Dec 13, 2022 15:47

Vaccine development is a tremendous scientific breakthrough. In Part Two of this ASCO Education Podcast episode, Dr. Doug Lowy, Principal Deputy Director of the National Cancer Institute describes overcoming the hesitancy of taking vaccines in the era of Covid (:57), the scientific impacts of other nations like China (3:54), the importance and the standing of the NCI (5:10) and the future of oncology (10:36). If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. TRANSCRIPT Pat Loehrer: Hi, I'm Pat Loehrer, Director of Global Oncology and Health Equity, at Indiana University. I'm here with Dave Johnson, a colleague and friend, and Medical Oncologist at the University of Texas Southwestern in Dallas, Texas. This is the second half of our Oncology, Etc., conversation with Principal Deputy Director of the NCI, and Chief of the Intramural Laboratory of Cellular Oncology in the Center for Cancer Research, Dr. Doug Lowy. In part one, we chatted with Dr. Lowy about his interest in cancer, which was developed through his personal academic experiences, including that of his parents, as well as his groundbreaking work on the HPV vaccine with Dr. John Schiller. Today, we're going to continue our conversation with Dr. Lowy by asking him about overcoming the hesitancy of taking vaccines in the era of COVID. Dr. Doug Lowy: Pat, it's very difficult. There was some vaccine hesitancy when the HPV vaccine was introduced initially. My view is that the people you want to speak to and with, are the people whose minds can be changed. So, I don't try to change the minds of people who are opposed to vaccination for one reason or another, but instead, try to talk with people about evidence, but directing it towards those people whose minds potentially can be changed. A big advantage with the HPV vaccine is that this has been going on over a number of years. With COVID, everything happened in a greatly truncated way. So, the vaccine was introduced less than a year after the pandemic. But concomitant with that was a lot of vaccine hesitancy, and I think that that's going to be difficult to overcome. What I have really worried about is whether the vaccine hesitancy associated with COVID might extend to other vaccines and not just to the HPV vaccine, but to childhood vaccines, et cetera. The national data for 2020 and 2021 for HPV vaccination is almost counterintuitive and provisionally reassuring, both. Compared to 2019, the last full year without the pandemic, the number of people being vaccinated with the HPV vaccine went up between '19 and '20, and between '20 and '21, went up again. So, at least by that metric and through that time, it doesn't look as though the vaccine hesitancy associated with Covid is extending to the HPV vaccine, at least in the short term. So, what we've seen between 2019 and 2021 is that HPV vaccine uptake among teenagers actually has gone up each year. So, at least in the short term, the vaccine hesitancy associated with the Covid vaccine does not seem to have extended to the HPV vaccine. Dave Johnson: So, Doug, I'm going to shift gears just a little bit. I read recently, in Science, that China had overtaken the United States in terms of scientific publication and impact; and I'm wondering what you think about that, and what we need to do to retain our longstanding leadership in that role. Or does it really matter? Dr. Doug Lowy: If China's research, if their quality is outstanding-- I mean, there's nothing wrong with another country making important contributions to biomedical research. I don't see this, per se, as a competition. Perhaps, it's because I'm just looking at it through the lens of cancer research, and we think that cancer research is much too big to be done exclusively through support of NCI, exclusively in the United States, et cetera. So, to me, if other countries are doing high-quality research that can help people all over the world with regard to cancer- Pat Loehrer: -Let me ask you this, Doug, you've been at the NCI for 50 years. And I calculated that you've served under nine presidents, and of the NCI's 16 directors, you've served with 10 of them- Dr. Doug Lowy: Really ancient. Thank you. Pat Loehrer: -so, with all that, what do you think; one, about the importance of the NCI, and then also, we'll ask you a little bit about the reflections of the directors, and lessons learned from them, and maybe, some good stories. So, where do you think the NCI stands, and why is it important for the world, and for the country? Dr. Doug Lowy: What's really important is the funding from Congress. It is long-term and sustained. Cancer research can't be done in two or three years. It just takes a while to do really high-quality cancer research. And what really counts, from my perspective, is you can rely on the government to be strongly supporting cancer research through the NCI. In other words, private philanthropy is very important, but private philanthropy can decide, "Tomorrow we don't want to be doing what we have been doing." It's very much like pharmaceutical companies - they can decide that they're not going to be doing it. But it's almost impossible for us to say, "We are no longer going to support basic science research. Okay? We're not interested in investigator-initiated research," because, of course, we are. And that's the bedrock of development. We can't say, "We're no longer interested in doing clinical trials," because, of course, we are, because we can't make the progress that we need to make without clinical trials. We can't say, "We're not interested in doing implementation research," because it's one thing to have a new approval, it's something else to have it widely and equitably disseminated, and doing some kind of research with implementation. Science is critically important, and this applies for prevention, screening, diagnosis, treatment, survivorship, all of these areas that NCI supports, and will continue to support. The proportion may vary from one year to another, from one director to another, but all of those areas are going to continue to be supported. Dave Johnson: So, Doug, during your various tenures as the interim director, what program or programs are you most proud about? Dr. Doug Lowy: Instead of programs that I'm most proud of, I would say that working with NCI staff is what enables the achievement. The mission of the NCI is just incredible, and virtually everyone on the staff buys into the mission; which is, to help people live longer and healthier lives through research-related advances in cancer. That's what people do. And the first time when I was Acting Director, was the first Cancer Moonshot, so I was involved in that. But tremendous amount of credit needs to go to the Obama administration for wanting to do it, to the Congress for its strong bipartisan support for the initial Cancer Moonshot, and to my NCI colleagues, and then extramurally, for everybody who really got on board and tried to do things. So, this is very much a team effort, and it's not limited to NCI, you know, extramural colleagues are critically important to everything that we do. Pat Loehrer: Doug, you've alluded to the fact that you've served under so many different presidents and directors, and they all have different leadership styles. If you were gonna be a mentor on leadership, what advice would you give to the listeners as to what makes a good leader, and perhaps, what makes a not-so-good leader too? Dr. Doug Lowy: I think that there is a spectrum - there are some people who lead by intimidation, and some people who lead by example; and all of them can be effective leaders. My own view is that I like to lead by example because I really feel that that leads to very high morale. People who lead by intimidation may get a lot of work out of people, but it is nowhere near as satisfying as knowing that you are an extraordinarily, highly-valued member of a team and that the whole is greater than the sum of its parts. So, I think that having tremendous admiration and respect for the people that you work with, is absolutely number one, and number two, is listening to them. You don't always need to do what they advise, but people really thrive on being listened to, and everybody wants to make a difference. And so, help them to achieve that goal. When they look good, you'll look good. Dave Johnson: So, Doug, I'm attending on the general medical wards right now. Just got asked today by the medical students to give them some advice about the future of Oncology, and where did I think it was going. Before I go back and meet with them, I'd love to get your thoughts. Dr. Doug Lowy: Well, the future of oncology is extraordinarily bright. On the one hand, we've made tremendous progress. On the other hand, there are still 600,000 people dying every year in the United States from cancer, and worldwide, the problem is even greater. But what's going to happen in the future is, we will understand the causes of cancer better, and so, that will enable us to prevent more cancers. I think there's going to be an enormous increase in the opportunities for screening, and to reduce either the incidence of cancer or increase the outlook for people with cancer, because asymptomatic cancer will be diagnosed at a substantially earlier time point. And then when it comes to treatment, my view is, we've barely scratched the surface. With the opportunities for making drugs, immuno-oncology, and who knows what other areas lie in front of us, are almost limitless. The Biden administration has a goal for the reignited Cancer Moonshot of decreasing the mortality rate over the next 25 years by 50%. What I think we need to do is to decrease mortality over the next 25 years by even more than that, and in addition, to make progress against those cancers where progress thus far has been limited. Take pancreatic cancer as a specific example; 10 years ago, the RAS oncoproteins were thought to be undruggable targets. But last year, we had the first approval from the FDA of a RAS-specific inhibitor. The good news is, that can target about half of lung cancer that has mutant RAS. The bad news is, it targets very few people with pancreatic cancer who have mutant RAS. On the other hand, there now are G12D inhibitors where there's excellent preclinical data and hopefully, sometime next year, be starting clinical trials. G12D mutations account for about half of people with pancreatic cancer. If the success there mirrors the success that we've seen thus far with lung cancer, it means that we are potentially on the way to actually making a difference in outlook for people with pancreatic cancer. But I just see this as one of many opportunities as time goes forward. Pat Loehrer: You did, this week, something that no one has done, and that is, to turn the reins of the directorship of the Cancer Center, over to the first woman director, Monica Bertagnolli. What was in your letter that you left on the desk that you gave her? What kind of advice did you give her? Dr. Doug Lowy: My advice that I gave her was really, "How can I help you the best and the most?" Dave Johnson: That's awesome advice. No doubt about it. It's a really historical moment, and of course, we, who are members of ASCO, are particularly proud that Monica has taken the reins, as a former ASCO president. And Doug, we really appreciate you taking the time to spend with us. It's been incredibly interesting, and congratulations on an amazing career. Pat Loehrer: Absolutely. Dave Johnson: And also, thanks to our listeners for tuning in to Oncology, Etc. As you know, this is an ASCO Educational podcast, where Pat and I will talk about just about anything. If you have an idea for a topic or a guest you'd like us to interview, please by all means email us at: education@asco.org Thank you for listening to the ASCO Education Podcast. To stay up to date with the latest episodes, please click, "subscribe". Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center, at: education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.

Oncology, Etc. – HPV Vaccine Pioneer Dr. Douglas Lowy (Part 1)

covid-19 united states director university texas children new york city science technology washington americans phd professor innovation seattle german medicine barack obama chief institute partnership vaccines stanford costa rica austria fda aids yale bronx physics nyu pioneer ev new york university horn deputy director indiana university medal hammond national academy nih internal medicine oncology hpv art history american cancer society microbiology dermatology health equity ras cancer research schiller czechoslovakia asco amherst college acting director pasteur national cancer institute glaxosmithkline national medal dave johnson translational research nci federal employees hpv vaccine education podcast arrowsmith lowy ut southwestern medical center gardasil public service award kaposi kruif principal deputy director papillomavirus scientific information global oncology cervarix

Play Episode Listen Later Dec 6, 2022 21:05

Vaccine development is a tremendous scientific breakthrough benefitting countless human lives. In Part 1 of this ASCO Oncology, Etc. Education Podcast episode, you will hear from the pioneering co-developer of the HPV vaccine Dr. Doug Lowy who serves as Principal Deputy Director of the National Cancer Institute , He speaks about how he got into the cancer field through the influence of his parents (4:49), the path that led him to focus on HPV (8:04), and his collaborative professional partnership with fellow HPV vaccine developer Dr. John Schiller (9:31). He also discusses his ongoing trial of one-dose administration, which promises to boost HPV vaccine uptake and reduce the burden of cervical cancer globally. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. TRANSCRIPT Pat Loehrer: Hi, I'm Pat Loehrer. I'm Director of the Center of Global Oncology and Health Equity at Indiana University. Dave Johnson: I'm Dave Johnson. I'm a Professor of Medicine at UT Southwestern Medical Center in Dallas, Texas. Pat Loehrer: And this is Oncology, Etc. Dave, what have you been reading lately? Dave Johnson: Well, you and I have talked about a couple of books, but I thought in light of our guest today, I would mention a book I actually read probably nearly 60 years ago called The Microbe Hunters by Paul de Kruif - very interesting book, written, if memory serves me correctly, in the '30s, about many of the early bacteriologists and physicians who were interested in microbes; Pasteur, for example, and others. And I don't remember all the details, but it certainly was one that was influential for my choice of Medicine as a career, much like Arrowsmith. It was a really impactful book. I doubt many of our listeners today would've read that book, but if one is interested in the history of Medicine, it's a really interesting book to read. Pat Loehrer: You said 60 years ago. Okay, when I was reading books back then, it was about Dick and Jane. Dave Johnson: It's my understanding that you're not past Dick and Jane yet. Pat Loehrer: Good, good point. Good point. Well, it's such an incredible honor today, we have Dr. Doug Lowy as our interviewee today. Doug is the Principal Deputy Director of the National Cancer Institute and Chief of the Intramural Laboratory and Cellular Oncology Program at the Center for Cancer Research. He has served as Acting Director more than any other person - he served as Acting Director between April of 2015 and October of 2017, between April of 2019 and October of 2019, and most recently, he served as an Acting Director until Monday of this week, October 3rd. I had a chance of seeing Doug, I think, about a year ago, a week after he took over, and this is great to have that bookend here. He has had this title of Principal Deputy Director since July of 2010 and he leads many of the NCI's key scientific initiatives. He graduated from Amherst College, I think in Art History, I may be wrong on that, received his medical degree from New York University School of Medicine, trained in Internal Medicine at Stanford, and did a Dermatology Residency at Yale. His focus has been on papillomavirus and the regulation of normal and neoplastic growth. The papillomavirus is in close collaboration with Dr. John Schiller with whom he's co-authored 150 papers over the last 25 years. In the 1980s, he studied the genetic organization of papillomaviruses and identified oncogenes that were encoded by the virus, and he's been integrally involved and instrumental in the development of the papillomavirus vaccine. His laboratory did work with the RAS gene family and other suppressor genes, and as you can guess, he's just one heck of a smart guy. For his body of work and together with Dr. Schiller, they received the Federal Employee of the Year Award in 2007 and the Partnership for Public Service Award, the Dorothy P. Landon American Association for Cancer Research Prize for Translational Research, the Albert B. Sabin Gold Medal in 2011. In 2007, he got the Medal of Honor for basic research from the American Cancer Society, and President Obama awarded him the National Medal of Technology and Innovation in 2014. And in 2017, he received the Lasker-DeBakey Clinical Medical Research Award, which is considered one of the most prestigious honors in biomedical research. He is listed in the Institute of Scientific Information as one of the most highly-cited authors in Microbiology, and obviously, he's a member of the National Academy of Science and the National Academy of Medicine. Although these are notable honors, I'm told that none of them match the opportunity to speak with Dave and I today, and we really thank you so much, Dr. Lowy, for joining us. Thank you. Dr. Doug Lowy: Pat, I am speechless. Pat Loehrer: I so wish that Dave Johnson was, but could you tell us a little bit about your upbringing and your early life? Dr. Doug Lowy: Sure. I grew up in The Bronx, in New York City. I'm the younger of two boys. My brother is two and a half years older than I am. Both of my parents were general practitioners. My parents were both Americans, but my father had a classic sophomore slump when he was an undergraduate and was unable to get into a medical school in the United States. And so, he actually went to medical school in Austria, in the University of Vienna, and needed to learn German in order to go to medical school. But my parents were both very successful private practitioners. They had separate practices but practiced in the same office, and I learned about medicine, in large part, through them. They would go to lectures, and from the time I was probably nine or 10 years old, they would be telling me about cancer, and I became interested in that area. And then, when I was 16, my mother developed a deep melanoma on her leg, and so, cancer literally came home. And luckily, she had very good surgical treatment and lived for almost another 40 years - she lived until she was 80 and actually died of metastatic stomach cancer. But I got involved in thinking about cancer really through my parents. They talked with me about the role of tobacco in the development of lung cancer, and I heard about the Hammond and Horn report from the mid-1950s when it came out. Pat Loehrer: That was when Dave was reading the Microbe Hunters. Dr. Doug Lowy: I was reading it at about the same time. I must say that, although I found it very interesting, it didn't really speak to me, and now that's what I need to go and do. Although, in retrospect, that's what I've ended up going and doing. Pat Loehrer: Was it because of your mother that you had an interest in dermatology? How did you swing into there? Because we think of you mostly as a translational researcher. Dr. Doug Lowy: The dermatology was really when I was at NYU. I worked in the laboratory of Jan Vilcek, who had recently come from Czechoslovakia to NYU, and in his lab was Alvin Friedman-Kien, who was a dermatologist. And Alvin subsequently was among the first people to identify the AIDS epidemic through the Kaposi sarcoma. But Alvin talked with me about dermatology, and potentially, this might be an interesting field for me to go into. And then, when I went to Stanford, I did Internal Medicine for internship and a year of Medicine, and I did a rotation in Dermatology. And I was very impressed that the people who smiled the most were the dermatologists. And they had time also to think about what was going on with patients. And since I was at Stanford, it was a tertiary care facility and so we were taking care of people who were terribly sick, largely people with lymphoma and other types of cancer. And I thought that I might be better suited to taking care of people who were less sick than that. Dave Johnson: Is that where your interest in Papillomavirus started? Dr. Doug Lowy: Well, that was indirect. I first went into dermatology and then said, "Well, I want to be doing research. What can I do in research that might be connected both with dermatology as well as with cancer?" And the closest that I was able to come was Papillomaviruses. And when I started working on them, they were not yet clearly associated with cancer the way they are today. It was known that they were associated with an uncommon condition called Epidermodysplasia Verruciformis or EV and this is a condition where people have widespread HPV infection. And on sun-exposed areas, a subset of them develop skin cancer, but it's distinctly uncommon. The real interest, if you will, came from the identification of HPV infection and cervical cancer, which is one of the more common cancers, especially on a worldwide basis. And that was really the link with cancer. Pat Loehrer: You had an incredibly long-term collaboration with John Schiller, and as I mentioned, you published more than Dave and I have written letters to our wives with this man. Tell us a little bit about that relationship, that friendship, and that professional partnership. Dr. Doug Lowy: John, actually, he was at the University of Washington in Seattle doing his PhD, and it was so long ago that he sent me a letter, and I had been doing research on retroviruses. He sent me a proposal that he was doing his PhD in bacterial genetics, but he wanted to learn about mammalian viruses and so was writing to me about doing work with retroviruses. I wrote back to him and said, "That's very interesting, but I had just started working on papillomaviruses." And I thought the room for development and learning more was even greater there than with mouse retroviruses, which is what I was working on and what he was proposing to do some post-doctoral research on. Of course, he had never heard of papillomaviruses, so he had to look them up. But he developed a project with papillomaviruses and was able to get an NIH award to come as a postdoctoral fellow to work in my lab, and he actually did the research that he proposed, and it led to our improved understanding of the genetic organization of papillomaviruses. But then, it was clear that John and I got along very well, and it looked like both of us might be able to work together. So, he ended up getting tenure after he had been at NIH for about 10 years. And it's just been an amazing collaboration for me because John knows a lot of things that I don't know, and he thinks that I know some things that he doesn't know. And working together has been terrific, really, because when one of us doesn't want to do anything about something, the other one tends to step in. And so, it's been an amazing partnership that we have had for this time. Dave Johnson: This is really important. One of the reasons we agreed to do this podcast is to provide insight to up-and-coming faculty and fellows about mentoring and partnerships. What is the most important aspect of your partnership with Dr. Schiller? Dr. Doug Lowy: I think treating him as an equal colleague from day one, that probably is important. And then, since I was senior and he was junior, trying to make sure that he got credit when discoveries were made because the default, otherwise, was going to be that it was Doug Lowy who was doing things, whereas it was very clear that John was a key part of this collaboration. Dave Johnson: Now that your relationship is a long-lasting and mature one, how do you make those decisions now? Dr. Doug Lowy: Well, we've just worked together for a long time, and we enjoy talking, and actually, over the last few years, we are collaborating less rather than more. We're still very close colleagues, and we're in the same lab. But since I've been Deputy Director, especially during the last seven and a half years, I've been Acting Director for about three and a half out of the last seven and a half years, and there just isn't enough time to devote to the lab. And it would've been inappropriate for me to have been considered a co-principal investigator with John, who has gone off and done a lot of amazing research, more or less independent of me. Like everything else in this world, it develops, it continues to evolve, but we still are very close colleagues. As Pat was mentioning, this is my first week in several months not being Acting Director, and yesterday, John and I simply reveled in the opportunity to talk informally for 30 minutes without having to look at my watch because I needed to go someplace else. Dave Johnson: I'm glad you've reviewed that. I think a lot of junior faculty and fellows think that being in a leadership position is a cush job, and I'd tell them that it defies the laws of Physics because all poop flows uphill in this setting, and you have to deal with it. Pat Loehrer: I do want to spend some time talking about the NCI and your role there, but talk a little bit about how you have seen and where you envision that vaccines, particularly, HPV and maybe hepatitis vaccine - where you see it's been, and where it's going, and the impact that this potentially has on cancer worldwide? Dr. Doug Lowy: Well, one of the areas that John and I are continuing to work on closely is more research on the HPV vaccines. We noticed, quite a number of years ago, that the HPV vaccine performance was quite different from that of other so-called subunit vaccines. So, this is not an attenuated live vaccine, but instead is a subunit - it's just made up of one protein of the papillomavirus, the protein that gives rise to the outer shell of the virus. And what we noticed in a clinical trial that we were doing with colleagues in the intramural program, but who are medical epidemiologists - they are the leaders of the research, and what was happening was that although everyone was supposed to get three doses, there were some young women who were getting either two doses or one dose, in the trial, and this is in Costa Rica, where historically, cervical cancer has been the number one cancer of women. And it turned out that there was no difference in level of protection whether the women got one dose, two doses, or three doses. And even more surprising was that the antibody levels over the first few years were remarkably stable. And this led John and me to wonder whether it might be possible to get away with just a single vaccine dose. So, a lot of the research that we have been doing with our colleagues over the last few years is to develop stronger evidence that one dose of the vaccine would be sufficient to confer strong protection that's long-lasting. We've now carried out the studies in Costa Rica, with the initial trial to more than 10 years, and the antibody levels continue to be very stable, and the protection does not seem to have waned. Because this was not a pre-specified outcome, it's not enough to change standard of care. So, we and our colleagues are conducting a non-inferiority efficacy trial that is comparing two doses versus one dose of two different FDA-approved vaccines. One, GARDASIL 9, which is the HPV vaccine that's available for sale in the United States. But also Cervarix, which is made by GlaxoSmithKline, it's approved by the FDA, but it's no longer sold in the United States. And we anticipate that the results will read out in another couple of years. And if the results show that one dose and two doses are pretty comparable, we're expecting that this will lead to a worldwide change in recommendations for the HPV vaccine. So, whether you are in a high-income country or a low or middle-income country, that one dose is what will end up being recommended. Pat Loehrer: They could almost completely eradicate this disease, the most common cancer around the world. It's huge. Dr. Doug Lowy: So, Pat, the problem is that although the vaccine was approved 15 years ago, only about 10% of eligible young women in low and middle-income countries have actually been vaccinated up to now. And we think that the logistics and the cost of one dose could really be transformative, especially for those young women. It also would save the United States a great deal of money because needing only one dose would be far less expensive, and the government actually pays for about half of the HPV vaccine that is delivered to teenagers through the Vaccines for Children program. Dave Johnson: Well, this concludes part one of our interview with Dr. Doug Lowy, Principal Deputy Director of the National Cancer Institute and Chief of the Intramural Laboratory of Cellular Oncology in the Center for Cancer Research. In the second part of this episode, Dr. Lowy will give his insight to vaccine hesitancy in the COVID era and the evolution of accomplishments over the past 50 years working at the National Cancer Institute. We want to thank all of our listeners for tuning in to Oncology, Etc. an ASCO Educational podcast, where we will talk about just about anything and everything. So, if you have an idea for a topic or a guest you would like for us to interview on the show, please email us at: education@asco.org. Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click, Subscribe. Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center, at: education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.

Oncology, Etc. – In Conversation with Dr. David Steensma (Part 2)

Play Episode Listen Later Nov 15, 2022 18:01

In Part Two of this Oncology, Etc. episode, hosts Patrick Loehrer and David Johnson continue their chat with hematologist-oncologist Dr. David Steensma. They explore his views of key opinion leaders and a lifelong passion – collecting rare stamps, including medical stamps. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. TRANSCRIPT Pat Loehrer: Hi, I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. I'm here with Dave Johnson, a Medical Oncologist from The University of Texas, Southwestern in Dallas, Texas. Welcome to the second half of our Oncology, Etc. conversation with Dr. David Steensma. He's a highly accomplished physician and scientist in the field of Hematology/Oncology. In the first part of this episode, Dr. Steensma told us about his Dutch immigrant roots, and how a single college biology course changed his career interests from astronomy into medicine. Today, we'll explore his views on Key Opinion Leaders and another passion of his, and an interest of ours - collecting rare stamps, including medical stamps. Dave Johnson: So, David, in addition to your scientific writing, you've been a prolific writer in many other sort of viewpoints and opinion pieces. There's a lot to choose from, but I know you've been interviewed in the past about your column called ‘The Raven', which I won't ask you about, as an Edgar Allen Poe fan. You also wrote a wonderful piece called, ‘Key Opinion Leaders', which I thought might be quite interesting to ask you about, now that you might be calling upon KOLs. Do you want to tell us a little about that? Dr. David Steensma: Yeah, that's not my favorite term. Thought Leaders is another kind of silly term, but we know what we mean when people are talking about it. Yeah, I've had a chance to write on a lot of different things over the years, and that's been great fun. And when I first heard that term, I couldn't figure out what it meant, KOL. And then, a pharmaceutical representative actually accidentally left a list of KOLs in my office and I realized that not only are KOLs cultivated very carefully, those relationships, but there's a hierarchy of KOLs. They were people who influenced the local formulary and local practice at the institution, there were those who had a regional impact, and then there were those who were on the NCCN guideline committees, and had, you know, much broader impact that they really wanted to make sure to influence the heart and minds of-- in my interactions now, this opinion piece was a sort of tongue-in-cheek about Key Opinion Leaders and Thought Leaders. And with Thought Leaders, I was reminded of Sherlock Holmes's brother Mycroft Holmes, who, by Conan Doyle's fiction, was a brilliant man, but unwilling to stir his ample backside from his Chair in the Diogenes Club to actually get out there, and do some real work, and solve mysteries. And so, it fell to his slightly less brilliant brother, Sherlock, to become the consulting detective. So, that was fun. Now, we're sort of on the receiving end of wisdom from people who are experts in the area. And it's very important what doctors think, and in different geographies about how they think their patients will be potentially treated in a year or two, five years down the road, what the issues they have with current approaches are, where they see opportunity for some of our new compounds, for some of those of other companies, and it's different in Europe versus the US versus Australia. And so, there's a lot that we gain from advisory boards. There's an arc to an advisory board. You don't want to convene an advisory board when there's no data, because then, everybody is just speculating. You don't want to do it too late after something is already on the doorstep of FDA approval because then not anything can be changed at that point. So, you know, doing it at an in-between point where there's some initial data, but where we can really be guided by academic, clinical, and other experts, is really helpful. Pat Loehrer: I'd encourage people to pull this article out. It is really, really good. 2015, I think it came out there. The end of it, I also love it. You're talking about Kanti Rai who came up with the Rai classification and he was at this Meet the Expert session at the ASH meeting, and he said at the meeting, and this is your quote from it, and I love it, he said, “I don't like the name of this session because no one's an expert in chronic lymphocytic leukemia. I've been studying this disease for decades, and still too many of my patients die. If I was truly an expert, the disease would've been cured by now." I just love it, but it's a great read. Dave Johnson: Let me ask you, very seriously, if a younger colleague were to come to you, David, what advice would you give him or her about being invited to be on an advisory board? We'll skip the term KOL or Thought Leader. What advice would you give him or her, and what should they look for, and how should they prepare for that activity should you think they should do it? Dr. David Steensma: Well, I think getting back to imposter syndrome, people should feel, if they're invited to be in such a meeting, that they're there for a reason because their opinion does matter. And sometimes, younger physicians are reluctant to speak up in this setting, especially when there maybe leaders in the field there that have been doing it for decades, and may have very strong opinions. So, not being afraid to share their perspective and realizing that they're invited for a reason. On the other hand, I found it very helpful when I was a young faculty member and, on these panels, to listen to how colleagues were assessing data, and the recommendations they were making, and their perspective. And I learned a lot from some of those advisory boards earlier on. Many of the people who are the senior leaders in leukemia and MDS, you know, Rich Stone, Peter Greenberg, you know, John Bennett, in MDS, Marty Tallman, Hagop Kantarjian, Clara Bloomfield, just people who had decades of experience. And in part, I think it's some of my comments at advisory boards that helped get me my job at Dana-Farber, because I'd been in a number of meetings with Rich Stone, and he apparently liked some of the things I'd said about approaching patients. And so, you know, when a faculty position came open, he invited me out to come visit. And so, they can have benefits that you don't anticipate. Dave Johnson: Yeah, I would definitely agree with that. And there's pros and cons to being involved in those activities, but there are an awful lot of good that comes from it. And I think you've just touched on some of those. I'm going to shift gears a little bit because Pat has been waiting anxiously to hear all about your stamps. So, out of the many, many things that you've done and written about, I would say you've got close to 100 publications on medical stamps. It's an extraordinary productivity, David. So, tell us a little about your interest in medical stamps. How did you get involved in this, and where do you find time to write about them, and how do you decide which ones you're going to write about? Dr. David Steensma: Yeah. Bob Kyle, is really the driver on that, and we continue to do these together. Bob turned 94 this year, and he continues to be intellectually engaged. He's fun to talk to, if it weren't for COVID, he'd still be traveling and coming into the office, you know, which he was doing until just a few years ago. So, I met Bob as an intern when I was at Mayo. Somebody said, "Oh, you should meet this guy, he's really fun to talk to." And we just hit it off. And when I was a boy, my grandfather and my great-grandfather had collected stamps. And my grandfather really got me interested in it, partly given our family history, those of The Netherlands and former colonies, but also just more generally. And then as often happens, I got to be a teenager and other things took over in terms of interest, and there was less time, so, I had fallen away from it a bit. But somehow in this conversation, Bob had mentioned this, and that they were looking for someone younger who had this kind of background, to help with this series that has been running. Initially, it was running in JAMA with a guy named John Mirt, beginning around 1960, and then about a decade later, moved to the Mayo Clinic proceedings when they published six stamp vignettes on medical science per year, and Bob has done over 500 of these going back decades. And so, I got involved in that, and writing about-- thus far, it's mostly focused on individuals, but I have done a few also about more general trends in Philately. I will say that there are fewer of us, certainly those under 50, who are involved in the hobby. There's so much other distractions, but I still find it interesting and fun. And I've learned a lot, putting those vignettes together. Pat Loehrer: I started collecting stamps when I was young, I still have my Scott's album down. And now it's not stored, in properly, but I remember US Number One, I could have bought for $35, but I was only like 10 years old, and that was, you know, like $500 to me. So, I still regret that. Are you collecting stamps yourself now, still that you've resumed the collection part of it? Dr. David Steensma: Yeah. I would say, only a little bit. So, my Netherlands and Colonies collection is now actually complete, except there's one elusive. There's always one, right? Can't find this thing, even at auctions and such. And I also collected coins as a kid, and you know, still have some involvement in that. It's hard to find the time because I do do so many other things, and my wife and I have children, they're now college and PhD age, so I do woodworking, I have a telescope, so I never lost the love of astronomy. It seems like there's always other things to do. But I still have my collection over there on the shelf. Pat Loehrer: Did you inherit it from your grandfather too? Dr. David Steensma: Some of it I did. Yep. The core of it, I inherited from my grandfather and my great-grandfather. And then once I paid off my substantial medical school debt to the University of Chicago with the help of, in part, from advisory boards, but also mostly from moonlighting in emergency rooms around rural Minnesota-- during fellowship, I was like a full-time ER doc who happened to be doing a Hem/Onc Fellowship on the side, and finally got it paid off and then I could start on filling in some of the gaps. Pat Loehrer: Before we change this thing, what is your most cherished stamp that you own? Dr. David Steensma: Oh, my most cherished stamp is not a Dutch one. It is a set of national park stamps from 1934, authorized by James Farley, who was the Postmaster General at that point. 10 stamps, different colors about, you know, Zion and Acadia-- and it was my grandfather's favorite, and he was a big fan of the national parks, took two big trips there back in the '50s out West. And so, at his funeral, I put together a little display of those hanging with the photographs of other things from his life. I have that display, it's very meaningful to me - it's a connection with him. He was certainly very influential in my life. I never imagined I'd be working for a Basel-based pharmaceutical company, like he did for his whole career. Never thought that that would happen, but life has some unexpected twists. He worked for Roche in Nutley, New Jersey for much of his career as a research chemist. And ironically, when my grandmother was diagnosed in the 1990s, pancreatic cancer, and she saw the oncologist and was offered a 5-FU infusion after surgical, he said, "5-FU. I worked on that in 1959, 1960, that's still the best that we have to offer?" He was shocked by that. I was a fellow at the time. I said, "We need better drugs." Dave Johnson: For sure. So, do you have a favorite medical stamp, David? Dr. David Steensma: A favorite medical stamp? Gosh, that one's I think a little bit harder. I certainly have medical stamps that have piqued my interest. One of the sort of most moving is one of the US stamps that came out in the 1950s that has the Sir Luke Fildes' ‘The Doctor', on it. You know, with this concerned physician at the bedside of a young boy, and I actually wrote a vignette about the history and background there, and I think that connection with patients at the end of the day when we don't have good drugs, that connection with patients is still so meaningful, isn't it? As you guys really know. So, and as many of our listeners know, and so much of what medicine remains despite the molecular glue degraders and CAR T and gene therapy, is still that human connection, and being there for our patients. And so, I would say that that is probably one of the most meaningful. There's some real quirky ones, too. Austria's come out with some stamps in the last few years; one made of toilet paper, when the toilet paper shortage was happening, another, made of the mask material and the shape of the mask to remind people to mask up. You know, there's been a lot of creativity. And the Dutch are very good about design. They come up with just some brilliant innovations in postage stamps. Dave Johnson: I mean, stamps are really quite artful, by the way, the Fildes painting hangs on the wall of my office. You can't see it, but it's on the wall. And then behind me, you can perhaps see a couple of framed stamps that are some of my favorites. One was a gift to me from a former Group of Chief Residents, of an Osler stamp that Canada put out, and the other is one I received actually as a gift, as part of an award. It's the first cancer stamp that was produced in the United States. So, I love them both. They're quite nice. The Fildes stamp is actually my favorite of all, so I think that's a great stamp. Pat Loehrer: I have actually looked behind me. I've got a stamp collection on the frame that was given to me too that I love. It's stamps of medicine. There was one, a Dag Hammarskjöld stamp, that was famous because they printed it upside down when they put the color in, and I think it created a huge controversy from-- you know this better than I do because they decided then just to overprint them. Instead of making a few sheets that were incredibly valuable, they ended up printing out thousands of these things, which I have one now. It's only worth 7 cents, but at the time, it seemed really cool to have a misprinted stamp in your collection. Dr. David Steensma: Dag Hammarskjöld, there's an interesting connection with what I was talking about a little bit earlier with St. Elizabeth's Hospital. So, this relatively small teaching hospital had, at one point, a very strong hematology research program led by a guy named Fred Stallman. And in 1974, Fred Stallman, who was coming back from ISH, International Society Hematology, which was in Tel Aviv that year, and his plane exploded somewhere over the Aegean Sea, ultimately thought to be related to the PLO, and so he died. There was a big painting on the wall, in the hospital of him. And Dag Hammarskjöld also, at the peak of his career, you know, as the UN Secretary-General, was killed in a plane crash. But the interesting thing about Fred Stallman is, here, you have somebody who was so important in hematology. None of the fellows had any idea who he was or their connection to hematology. You know, it shows how fleeting fame is, unless you're an Einstein or Babe Ruth level. So, that was a good thing to keep in mind as well. Pat Loehrer: We could talk for another hour or two on this. Dave, we really appreciate it. But unfortunately, this is all the time we have for today. And I really want to thank you for joining us, Dave. This has been a wonderful conversation. I also want to thank all our listeners for tuning in to Oncology, Etc. This is an ASCO Education broadcast where we will talk about anything and everything, as you can imagine. If you have an idea for a topic or a guest you'd like to see on the show, just email us at: education@asco.org. Thanks, again. And, Dave, I've got a quiz for you here. Do you know why pirates don't take a shower before they walk off the plank? Dr. David Steensma: I do not. Dave Johnson: I have no idea. Pat Loehrer: It's because they wash up on shore. Dave Johnson: Oh boy. Thank you for listening to the ASCO Education podcast. To stay up-to-date with the latest episodes, please click, "Subscribe." Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at: education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.

Cancer Care in Botswana Part 2

Play Episode Listen Later Nov 8, 2022 19:50

The Oncology Podcast - Delivering Oncology News DifferentlyWelcome to Episode 11 in our Experts On Point podcast series brought to you by The Oncology Podcast. Have you wondered what it is like to practice radiation oncology in Botswana? How can technology and smartphones be used to optimise cancer care?In today's episode Rachael Babin speaks to Surbhi Grover, Associate Professor of Radiation Oncology at the University of Pennsylvania and Adjunct Senior Lecturer at University of Botswana. They're joined by Givy Dhaliwal, Founder & CEO of ONE BCG, the company behind the OP Care app.Surbhi and Givy collaborated on a smartphone app to optimise the care of gynaecological patients and remove common barriers to treatment success. This is the second special episode of Experts on Point focused on cancer care in Botswana. In the first episode, Hans Prenen spoke to Peter Vuylsteke about his experiences practicing medical oncology.For news and podcast updates subscribe to The Oncology Newsletter, a free weekly publication for healthcare professionals with an interest in oncology. Click here to subscribe.PART OF THE ONCOLOGY NETWORK... Join Us

ceo university founders pennsylvania associate professor botswana sub saharan africa cancer care radiation oncology smartphone apps surbhi gaborone lmics adjunct senior lecturer global oncology

Oncology, Etc. - In Conversation with Dr. Peter Bach (Part 2)

Play Episode Listen Later Oct 4, 2022 17:16

"In part two this ASCO Education Oncology, Etc. podcast, healthcare policy expert, pulmonary physician, epidemiologist, and writer Dr. Peter Bach shares what it was like to face his wife Ruth's cancer and eventual passing − as a husband and as a doctor. The episode also explores delivering difficult news to patients. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. Resources: Cancer Topics - Delivering Serious News" The Day I Started Lying to Ruth by Peter Bach, MD After a Cancer Diagnosis, Wishing for a Magic Number - The New York Times TRANSCRIPT Pat Loehrer: Hi, I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. I'm here with Dave Johnson, a Medical Oncologist at The University of Texas Southwestern in Dallas, Texas. This is the second half of our Oncology, Etc. conversation with health policy and payment expert, pulmonary physician, epidemiologist, and writer, Peter Bach. In part one, we chatted with Dr. Bach about his upbringing, the trajectory of his career from English Literature to Medicine, and from academia to industry. We also explored his seminal work on drug pricing and improving health equity. Today, we're going to continue our conversation with Dr. Bach by asking about something deeply personal: his wife, Ruth, who sadly passed away from cancer at the age of 46. Probably about seven or eight years ago, you wrote a wonderful article in The New York Times, and there was another article you wrote, but the one that I liked reading was called, “The Day I Started Lying to Ruth”, and this is where cancer stabbed you very personally. Can you tell us a little bit about that, and tell us a little bit about your wife, Ruth? Peter Bach: So, it was in New York Magazine, just to give credit where it's due, I'm very grateful to them for running it. I wrote that after she died, and it followed on a series I had in The New York Times called, The Doctor's Wife, which I wrote while she was getting her initial treatment for breast cancer, and then I walked through the steps of adjuvant therapy that she received, in my experience. And then the piece in The New York Magazine talks about her last months basically, and my experiences then. The story goes that she was tragically taken from us and tragically taken from my son when he was very young, and my experience being at her side-- and I think I was a good husband, I was present -- was an alarmingly dissociative experience along every dimension. You know, I'd go to her appointment, I would swipe in with my badge. You know, this was my place, and the doctor who took care of her is and was a dear friend, and so were the other doctors in most cases. And the visits, you know, I had nurses and people in the hall would say "Hi" to me. And then I was going through this absolutely devastating experience, you know, tearing apart the sort of prevailing narrative and experience and structure of my life and our family. And so, for whatever reason, it was this out-of-body experience where I could see stuff very, very clearly. Not only clinical realities, like I knew what was happening, but also the mechanics of healthcare, the interactions, and I felt like I should journal it, if you will. And then when I journaled it, I thought I should publish it, and so I wrote about what it was like to stand there when my friend, Chip Cody, the surgeon said, "This is cancer, I can feel axillary lymph nodes, you've got cancer." And what that morning was like between the-- look, most people have a lump, what's the big deal? We'll go, we'll deal with it. She's young. She had just had a mammogram actually, to that. And then the experience of, you know, and I was in Biostat at MSK. So, I'd sat for a gazillion protocol reviews, I'd read a gazillion informed consent forms, and then there was one in front of her for a randomized trial for adjuvant therapy. I mean, it was Avastin versus placebo versus a longer period of Avastin, if I remember correctly, and ultimately a negative trial I saw at ASCO. But sitting there and actually thinking about like, "What is this like for somebody who doesn't know all of this stuff?" And my wife was way smarter than me, that you guys know me, that is the least surprising fact ever. But it was still dizzying for her. And so, I wrote about that, like, hawt was our conversation like that night after that whole, like, “Do you want to join this trial?" And her peppering me with questions, like, essentially, “What the hell is wrong with you guys? Why don't you know these answers?" And it was sort of like, "Okay, this is why we do randomized trials, this is why we have placebo. This is–” And she's smart, not irate. She was much more relaxed and philosophical through the whole thing up until the day she died, or a few days before, than I ever was. So, I wrote about that. Like, what was that conversation like? What was she being asked to do, and how important was it that she did it? And I remember sitting in the room when that trial was presented, and The Kaplan-Meier overall survival curves, and I was pretty sure I saw the step in that curve. I'm pretty sure I saw her on that graph. And it made me-- obviously, I'm desperately sad that she's gone - but it made me proud that she had contributed to it, even though, you know negative studies are important, too. So, I wrote about those things, and I wrote about prognosis and what it was like to have a conversation when she asked about prognosis, and in an article called ‘Waiting for a Magic Number', where I described her oncologist saying, "Fine, I'll tell you what are your chances of living five years, you tell me what's the cut point. Essentially, above or below, what number are you going to change things in your life? When you tell me that number, I'll tell you whether you're above it or below it." And it was like, "Wow, philosophy from an oncologist, fantastic." Really sunk in with both of us, and that was it. We never asked that question again, he never gave us a number. And I've been greatly rewarded over the years to run into people from here and there who say, "You know, I always hand my patients that article to put that in perspective." And then when she died, I wrote about the sheer horror of what was happening to me. And the title wasn't mine, but it was worked right on point. I found myself in a situation where I didn't want to reveal to her just how bad things were, and it was terribly weak of me. And ultimately, and I describe it in the article, got to a point where I just was ready for it to be over, before it was. And I think it's actually not that hard, to be honest, after you've gone through something like this like I don't really care what people think of me. I went through something really hard. And again, I'm someone with resources, I'm someone with knowledge, I could call her oncologist at two in the morning and he'd answer, that's not something normal people get. And you know, even for me, like this was completely disorienting. And so, that article was very rewarding to write because it allowed me to put it somewhere where I've gotten to revisit it. A couple of years ago, of course, he was young when I published it. He said he had read it; he liked the part about the dog. But I got a lot of notes afterwards from strangers saying that it provided them some comfort that even someone like me went through basically the same experience they went through. And look, this whole, like, "even something like me” seems odd, but I think to the external world, somehow, we're like, "You know, we get those white coats. Stuff is different for us," and of course, it isn't at all. Since that time, and we're all in the same world, so we have the same sets of friends. We probably have many of our overlapping friends who we know have lost spouses. In recent years, I routinely get phone calls from folks like, "I'm going through this, what's the first step?" You know, and it's about everything. "How do I deal with my kid? Should I go dating?" Stuff like that. Dave Johnson: You know, Peter, that article should be required reading for every Oncology fellow. I think it was beautifully written, clearly from the heart. I think your undergraduate degree shows in terms of your writing style, but to write that, I'm sure was emotionally challenging and difficult. In fact, Pat mentioned at the start of our podcast, Trillin's book, About Alice. In a book review that was written in The New York Times, About Alice, Trillin made a comment similar to the one you just made, where people that he didn't even know wrote letters in which they conveyed to him a sense of knowledge of Alice, even though he knew they had never met Alice. And I think your article about your wife conveyed that same sense to anyone who did not meet her. And I think you memorialized her in ways that are really fantastic. But I want to just read something from an article in The New York Times, and this is quoting Trillin. He says, "They may not have known her, but they knew how I felt about her." And he went on to say, "Yes, I got a lot of letters, like the one from a young woman in New York who wrote that she sometimes looked to her boyfriend and thought, "But will he love me like Calvin loves Alice?" I think the same could be written about your relationship with Ruth. And thank you for sharing that. I can't imagine how challenging that must be even all these years later, and I'm glad your son had the opportunity to read that. He should be proud of both his mother and his father. Pat Loehrer: It was a gift to all of us and mankind. You know, again, as I saw that article, there's a photo of you and Ruth on your last vacation. I think it was from Versailles, and I think you were in the Hall of Mirrors. And I think there's a poignant metaphor there about the reflection of your lives and being with her at that time, and we really thank you. We have all experienced this and it's so powerful there. There's this time when you get a result of a test of someone that you know and love and there's this limbo between, they're so naive and life is good, and it really is a time between heaven and hell in which you're the only one there, in which you know that you're going to go in the room now and change their lives forever by sharing this news. And we've been there and we pause, and again, you talked about that - I think being in a car looking at the x-ray. And that's the essence of when you said, the day you started lying to them, which is understandable because you just don't want to shatter that moment there. You know, we pause and reflect on that enormity of the moment there and I thank you deeply for sharing that with us because it's something that we physicians find, and this uniqueness of being a physician, and having someone you care about and knowing something that they don't quite know yet. Thank you for all of that. Peter Bach: The important message is that to patients, it's very isolating. And part of what I think the article did, and this was the message I got at least, was, send a message to other people that you're not alone. That others are going through it, others have gone through it, and I don't know what "it" is in that context, but loss. And there's that wonderful article in The New Yorker called ‘The Aquarium', which is by man who had a sick child-- and I don't remember all the details, but the aquarium metaphor is, I can't remember if he's in the aquarium and the rest of the world's outside or the other way around, but it's that isolation that is particularly frightening. And when I talk with my friends who've gone through it, it's part of it. As I just said, you know, there's a lot of us out there. I don't know if it gives so much reassurance. You know, 40,000 women die a year of breast cancer, so there's a lot of people out there. Dave Johnson: Pat, you had, I think, a final question? Pat Loehrer: Briefly. You know, now I'm asking to be an academic person there, but if you had a young medical student and you were going to try to give them one lesson about communicating bad news to patients, what would that be? Peter Bach: I've obviously been in this situation many times. I'm a Pulmonary Critical Care doc, so I've watched bad news be delivered many, many times. And the first mistake I see people make is trying to fill the silence with words, and I think I made earlier reference to it. One of the key skills doctors need to develop is the ability to listen. And sometimes listening to silence is a version of listening, but it's delivering what you have to say without euphemism, with directness. Not everyone's enamored with it, I am. But then giving time to listen, even just space for people to feel safe, that that communication is part of a relationship, not a sort of text message. You know, in today's metaphor, right, that just arrives and the person moves on. That is really hard for people to do; not experienced doctors, for trainees because it's frightening for a lot of reasons. Over my career, I've certainly rehearsed it many times with people. I made the mistake myself too, of just sort of talking over the thing in the room to avoid, you know, just sort of as you said, the enormity of what you just communicated. Dave Johnson: So, Peter, I think you're right on. I think that's one of the most difficult things to do, is to allow that pause to take place. And so many, even highly experienced physicians attempt to fill that void when it doesn't need to be filled. Been there, done that, been on the receiving end as well as the delivery end of that. It's always challenging. You know, we're out of time, and I'm sad about that because we could go on, I'm sure for quite a long time. Want to end this by asking you, Peter, we talked about a book on the front end, both Pat and I love to read, and we share recommendations all the time. I wonder, is there a book or a podcast, or anything that you think we should read or you think our listeners should know about? And by the way, you can include anything that you wrote if you'd like. Peter Bach: Yeah, it'd be very au courant to pitch my own stuff here, I would never do that. I like to read as well. And so, I just finished Rules of Civility by Amor Towles. Of course, there's a few health events in it, but it's not to do with anything, but, you know, it's a book about New York. I live in New York, so I just enjoyed every single word of it. I'm newly married- Dave Johnson: Congratulations. Peter Bach: -thank you. I feel very lucky. And my wife has noted that I often like to read nonfiction at night. Typically, books about how the world is just going completely to hell. And she's noted that outrage is my happy place, that I sleep extremely well if I read something that's absolutely infuriating. So, the other thing I'll recommend is the book about the Department of Justice has essentially lost its mojo when dealing with corporate crime. If your best soporific is being absolutely furious, it's right up there with a full dose of Ambien. So anyway, those are my two recs. Pat Loehrer: I love it. Yeah, Dave and I both love non-fiction. We love that. So, it's great. Dave Johnson: We've come to an end of another podcast, and we want to thank our listeners for tuning in. We really appreciate your participation. Remember, Oncology, Etc. is an ASCO Educational podcast, where we'll talk about virtually anything and everything. So, if you have an idea for a topic or a guest you'd like for us to interview, please email us at: education@asco.org. Thanks again. You know, speaking of interesting nonfiction, Pat, if ‘pro' and ‘con' are opposite, what's the opposite of progress? Pat Loehrer: Oh, I love that - Congress. Dave Johnson: Yes, Congress. I knew you would get that. Peter Bach: That is a ‘Dad joke' if I ever heard one. Dave Johnson: We don't have good jokes on this show. Pat Loehrer: We're going to have to redo the ending to this because, Dave, you said this was an ASCO Education Podcast. I'm not sure we've taught anybody anything on this one. Dave Johnson: Now, Peter has taught us a lot. Pat Loehrer: That's for sure. Thank you so much, Peter, for a wonderful interview. Dave Johnson: Absolutely perfect. Wonderful. Peter Bach: Thanks for the privilege. It's wonderful seeing you both. Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click, "Subscribe." Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at: education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.

IJGC Editor-in-Chief Summer Podcasts: ConCerv Trial with Kathleen Schmeler

IJGC Podcast

Play Episode Listen Later Aug 2, 2022 48:04

In this rebroadcasted episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Kathleen Schmeler to discuss the ConCerv Trial. Dr. Schmeler is the lead author of “ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer,” which was the Lead Article of IJGC's October 2021 issue. Dr. Schmeler is a Professor in Gynecologic Oncology at The University of Texas MD Anderson Cancer Center. She provides care to women with gynecologic malignancies including surgery, chemotherapy and preventive services. Dr. Schmeler is also the Executive Director of Global Oncology for the MD Anderson Cancer Network. Her research interest is in cervical cancer prevention and treatment, particularly for resource-constrained countries and medically underserved communities in the US. Original release date: October 4, 2021 Highlights: - The ConCerv trial is the first prospective study of conservative surgery in women with low-risk cervical cancer. It included 14 sites in 9 countries. - Findings from the ConCerv Trial offer prospective data supporting a more conservative approach to low-risk patients, sparing them the early and late morbidity associated with radical procedures. - It will also allow for safer cervical cancer surgery in low- and middle-income countries, where the burden of cervical cancer is highest. - In our study, conservative surgery was associated with a 3.5% recurrence rate in women with low-risk cervical cancer. In addition, the rate of positive lymph nodes was 5%, with lymph node assessment recommended in this low-risk population. - Further study is needed to determine long term outcomes and optimal pathologic criteria for conservative surgery.

university podcasts professor executive director chief original trial findings texas md anderson cancer center gynecologic oncology editor in chief dr global oncology lead article

Oncology, Etc. - In Conversation with Dr. Richard Pazdur (Part 2)

Play Episode Listen Later Jun 28, 2022 20:18

In part two this ASCO Education Podcast episode, hosts Dr. David Johnson and Dr. Patrick Loehrer continue their conversation with Dr. Richard Pazdur, director of the U.S. Food and Drug Administration's Oncology Center of Excellence, focusing on his leadership and vision for improving cancer care worldwide. The conversation includes reflection on drug toxicities, approval processes, and complexity of clinical trials. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. TRANSCRIPT Dr. Pat Loehrer: Hi. I'm Pat Loehrer, the Director of Global Oncology and Health Equity at Indiana University. Dr. Dave Johnson: And hi. I'm Dave Johnson at UT Southwestern in Dallas, Texas. Dr. Pat Loehrer: This is the second half of our Oncology, Etc. conversation with Dr. Rick Pazdur, who's the director of the FDA's Oncology Center of Excellence. In Part 1, we chatted with Dr. Pazdur about his upbringing and his early career. Today, we're going to focus on his leadership and vision for improving cancer care worldwide. But first, we'll discuss how cancer has impacted his life personally. I want to flash-forward. I had the pleasure of knowing Mary. And there was no question, if you had a problem in oncology, you would go to Mary and not Rick Pazdur when you were a house staff member. But moving forward a bit, I'm not sure if all the listeners know that Mary came down with ovarian cancer. Dave himself had cancer. My wife had breast cancer. It is incredibly hard to be an oncologist I think when your spouse or someone who's close to you has cancer, and particularly, being married to a medical oncology nurse. Maybe just share a little bit about that journey of being a husband of a- Dr. Richard Pazdur: Yeah. It is interesting because going back to the Rush story, the first patient that my wife and I had in common, and this is so ironic, was a patient with ovarian cancer. The last patient that we had in common was her, which is some ironic fate, so to speak. And the story began of her illness was right around Labor Day. We had gone to Chicago in February driving back from Chicago. I noticed that she kept on taking a whole bunch of Tums and then saying - Oh, I just got a lot of GI symptoms, and she went to see her gastroenterologist or GP and he said, ‘Oh, this is just, you know, indigestion.' And two weeks after that or not even that, she was in the hospital with a massive amount of ascites, needed an intensive care unit. It was readily apparent just on getting her CA 125 what she had and she wound up one day in debulking surgery and then IP chemotherapy, etc. I think something that I learned, and I think we knew from the very beginning that this was not going to be a curable illness, and how to deal with that on an emotional level. And I have to give my wife credit. She spared me a lot of the emotion because she was such a strong person. She made all of her own calls as far as what she wanted. She would ask me what I thought, but she would do her own research, she would go to her own doctors' appointments. She said, ‘You don't really need to come with me. I'm self-sufficient.' She was very much interested in helping other cancer patients, and after she died, I think one of the most cherished conversations I had was a group of women that came to me and said how much she helped them during their support group because she was a nurse. She knew she was dying. She had emotional maturity not to fall apart but to accept the inevitable in a very strong way. My wife was a very religious person, had gone to Catholic schools, really embraced religion during those terminal years basically. And I think that was a great sense of comfort to her. But it did teach me a lot of lessons when you take care of somebody that has cancer, and that is, what a bad job we do with drug toxicities. Drug toxicities to medical oncologists and especially the people at the FDA are numbered, Grade 3, Grade 4, Grade 1. These toxicities are tolerable, tolerable to who, so to speak. And how to manage these toxicities and how they interrupt your life is one of the lasting experience I have, which I always will remember. And that has been one of my roles recently is forming several programs that we have in the OCE to look at dosing, to look at what is this definition if the drug is tolerable or well-tolerated or if the toxicities could be managed. I always say, yeah, every toxicity could be managed, even death. You call the undertaker to manage it. So what do you really mean by that statement. But I think the issue of toxicity is an important one. And then also going on clinical trials and having people considering what you want to go on, what risk you want to take, and what is actually in the informed consent and how meaningful that is. Dr. Dave Johnson: Really glad you brought that up, Rick. That matches my own experience with lymphoma and going through chemotherapy. And as an oncologist, one would think I would know what the side effects are. I'd recounted them dozens and dozens of times to people over the years, but until you've actually experienced them either personally or up close as you did with Mary, it's impossible to fully understand. I'll give you one example. Fatigue. Everybody thinks they know what fatigue is, but until you've had chemotherapy-induced fatigue, the fatigue that never abates, you just don't understand what it is. It's debilitating in ways that are unimaginable to most people. So I'm sure that experience certainly shaped your view and your role at the FDA. Dr. Richard Pazdur: Correct. Dr. Dave Johnson: I wonder, if you might share, you initiated a number of programs recently, including programs to try to improve coordination and co-operation amongst the pharmaceutical companies. Could you speak to some of those programs for us? Dr. Richard Pazdur: I think one of my favorite programs is Project Orbis. Project Orbis is an idea I had when I was walking down the street. It just hit me. When I came to the FDA, one of the things I rapidly noticed is how isolated the FDA was, even from the rest from the regulatory agencies throughout the world. There was very little cross-fertilization there. So one of the very first things that I did was set up a monthly tele-conference first with the EMA, the European Medicines Agency, and then we ended on Health Canada, Australia, Japan, Singapore, you name it. And one of the things that became really apparent to me, we at the FDA got applications always first—always. That's obvious. You know why they had given it to us first? The money. That's where the finances are going to be. So we got the application first, and it could be 2 years, 18 months, 12 months, that these other countries, Canada, Australia, Switzerland, and Brazil, Israel, would get these applications. And I said, well, this isn't right, really, because these people, they have cancer. They have every right to get these medications as soon as possible, and also we have such a large agency. We have 80 to 100 oncologists that work there, and most of these agencies have one or two oncologists. So our expertise in oncology at the FDA is so much greater than these other regulatory agencies. How can we leverage that to help these other countries? So we started Project Orbis, and what it was is that companies come in and they submit an application and they simultaneously submit the same application to the countries that want to participate in the program. They are all preselected and have confidentiality agreements with each other. And we worked together on the applications, basically reviewing the applications. So we had many meetings, tele-conversations, telephone conversations with countries. So that expedites these drugs. This has really had a lasting impact because from a worldwide perspective, it's really promoted more rapid development of drugs and rapid approval of drugs, and that's important because that establishes sooner new standards of care that will impact future trials. So in addition to the humanitarian issue of improving healthcare for patients in these countries, it has an impact on the global clinical trial system by having new standards approved much faster and accepted by world authorities. Dr. Pat Loehrer: Let me just jump on that for a second, just to make a comment. Back when we were growing up, there would be like three to five drugs approved- Dr. Richard Pazdur: Yeah. Dr. Pat Loehrer: And today, it's like once a week, there's a new indication for oncologists. Dr. Dave Johnson: Our listeners have another question that might be appropriate to ask at this time. What is the most common mistake that drug companies make in their applications to the FDA or in the process of trying to get their drug approved? Is there a frequent mistake that you can advise them? Dr. Richard Pazdur: Well, they don't come and talk to us. That's number one. They want, not necessarily what the best registration pathway is, but what the quickest registration pathway is. And sometimes the quickest registration pathway, especially single arm trials, are not the best registrations pathway. So my advice is rather than playing games with the FDA, to put it in the vernacular, just do the right thing and say, what is the optimal information that patients need when I develop this drug. We're seeing a lot of problems now with various drugs where people are developing in a refractory disease setting a drug, and they plan on getting accelerated approval on a response rate. So they push and push the dose. And with a single arm study, you can't really evaluate safety that well. Everything is attributed to the drug, and they want to get the highest response rate. And they get it, and there's a confirmatory study, and the arm of the confirmatory study, the control arm may not be as toxic as theirs, and we're seeing a wave of drugs that now have inferior survival compared to controls, which probably is predicated upon, they got the wrong dose. And I think that is one of the major programs that we have, that we need to address is dosing in oncology, this ‘More is better, more is better,' and ‘Let's push the dose as high as possible.' More isn't even probably good in cytotoxic days, but certainly, not a good idea in targeted therapies and certainly not a good idea in biological therapy. So we've really got to think about dosing more, penetration of targets, what's the optimal dose rather than what's the highest dose. You know as well as I do, pharmaceutical companies want to go with the highest dose because the major hurdle is the demonstration of efficacy, even in a randomized study. So nobody wants to be blamed by saying, well, you spent $100 million on a Phase 3 study and it's negative because you used too low of a dose. But then at the end of the day, we don't have a really good tolerable dose, and it's really hard to go backwards and look at dosing after a drug was already approved because the efficacy study has already been done. Dr. Pat Loehrer: The other aspect of drug companies is not only getting the dosage there, but also the duration. There is motivation for money, and so patients are going to and- Dr. Richard Pazdur: Oh, count on that. Dr. Pat Loehrer: So it begs a question, and I know the FDA can't do this, but in other countries, there is a monetary review together with the toxicity review. Can you reflect a little bit about that to the best of your ability? Dr. Richard Pazdur: Well, even within our simpler agencies, they may communicate more than we do with CMS, but all oncology drugs that when they're approved are then paid for by CMS, okay? In these other countries, that is not so. They may get approval and then they have to go to these health assessment agencies that will decide and argue with the companies what the pricing of the drug is. I think it's a mistake, honestly, for the FDA to get into pricing. We have a hard enough time with efficacy and safety, and pricing is a very ephemeral concept because it could change on a dialing. Somebody could promise you, you should approve their drug because it's much cheaper on Monday, and on Friday, they could say, 'Oops, we made a mistake. We really think that this dose has to be X number of dollars.' And you could see competition hasn't worked well in oncology with seven PD-1 drugs approved, pricing has not really been of any movement here. Dr. Pat Loehrer: I'm sorry. Dave may have another question, but let me ask you this. Going back to the clinical trials and what industry asked you- the complexity of clinical trials is going up logarithmically compared to the way they were in the ‘70s and ‘80s. In many of the trials where we have to get all this data in order to soothe the FDA, what are your thoughts about simplifying clinical trials? Dr. Richard Pazdur: Oh yeah. I'm for it. I am for it. If you really look at it, these are not FDA requirements for the most part. The companies want them, all of this data because it's controlled. They don't want to be blamed at the end of the day for not capturing this data or that data. They have developed complicated bureaucracies, going back in my sociology days there, complicated bureaucracies to gather all of this data, the whole CRO industry to go out and pester you guys in practice by doing site visits. It's a complicated situation and it's really predicated a lot on the history and bureaucracies that have been built up and not money to strip away those bureaucracies for fear of failure, so to speak, of not catching something. Dr. Dave Johnson: So Rick, we're coming to the end of our time that we've scheduled. I actually have two questions for you. We've asked all of our previous guests, the first of which would be if you could talk to your 21-year-old self today, what advice would you give yourself? After you've done that, we'd like to know what books have you been reading lately or is there some documentary that you've seen that you would recommend to us and our listeners? Dr. Richard Pazdur: I would tell myself, when I was 21 years old, relax and be less anxious. All things pass. I think we get so anxious when we're young about relatively small things. I remember my first ASCO presentation, I was petrified. My heart was beating out of my chest. I was sweating. And like relax. It's one of a thousand presentations at ASCO. We tend to magnify things, and I think age puts things in perspective. This in the reality of the world is a small thing, and people probably won't even remember it. Dr. Dave Johnson: Excellent advice. Dr. Richard Pazdur: My favorite author that I'm reading now for the last couple of months is a presidential historical author, Doris Kearns Goodwin. I think many of you know, she's written many books. I love her writing style. And I like non-fiction. I like biographies and I like history books, history stories rather than mysteries or things like that, fantasy books. The two books that I really enjoyed, the first one was No Ordinary Time: Franklin and Eleanor Roosevelt: The Home Front in World War II. I don't know if anybody's read that. It's an excellent book. Most of our attention in World War II is directed toward Europe and what was going on in Europe, the battlefields, etc., which I'm not a big fan of reading about battles and stuff, but this was what was going on in The White House and the relationships of all of the people that came there. It was like a hotel almost with the personalities that were flowing through including Churchill and various princes and queens, etc. But also the interesting relation, the fascinating relationship that Eleanor and Franklin Roosevelt had, I don't know how to describe the relationship. It truly was an unconventional relationship based on some past history that they had of affairs etc., but it was just a fascinating one. The best book, though, again I'm reading now, is written also by Doris Kearns Goodwin, and it is Lyndon Johnson and the American Dream. Doris Kearns Johnson was his biographer and spent a great deal of time with him in The White House as well as when he left The White House. But it's an excellent book on management and reading people, success. One of the things that is most interesting about Lyndon Johnson, and especially when he was running the senate before he became president, was his ability to know what motivated people and how to use that to form a consensus. Does this person want to go on this trip. I'll give it to him and then he could help me with this. Does this person want to go to this party or get on this position in congress? So it was really a skillset that he had, which I think most leaders need to know. You have to motivate people. You can't lead by an autocratic masthead, but you've got to lead from what do people want and to make sure that they feel you have a personal relationship with them. As I say to my staff, everything in life is personal—everything. Dr. Dave Johnson: Well, it's been a great session, Rick. We so much appreciate your willingness to spend time with us. We wish we had twice as much time. I'm sure we could go on for hours. Thanks again, and we appreciate all you do at the FDA. You've been a fabulous leader, and we hope you continue on for many years to come. Dr. Richard Pazdur: Thank you so much, Dave, and thank you so much, Pat. Dr. Pat Loehrer: Great to see you. Dr. Dave Johnson: Pat, before we leave, any idea why our patients seem to get sick on Saturday and Sunday? Dr. Pat Loehrer: I have no clue. Do you know the answer, Dave? Dr. Dave Johnson: Yes. They have a weekend immunity. Thank you for listening to the ASCO Education Podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Oncology, Etc. – In Conversation with Dr. Richard Pazdur (Part 1)

Play Episode Listen Later Jun 14, 2022 25:33

In part one of this ASCO Education Podcast episode, director of the U.S. Food and Drug Administration's Oncology Center of Excellence Dr. Richard Pazdur talks with hosts Dr. David Johnson and Dr. Patrick Loehrer about his upbringing in Indiana, his family, and his circuitous route to oncology. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. TRANSCRIPT Dr. Pat Loehrer: Hi, I'm Pat Loehrer. I'm the director of the Center of Global Oncology and Health Equity at Indiana University. Dr. David Johnson: I'm Dave Johnson at UT Southwestern in Dallas, Texas. Pat, great to be back with another episode of Oncology, Etc, an ASCO educational podcast. We have a very special guest today, Dr. Richard Pazdur, from the FDA Oncology Center of Excellence. I'm really looking forward to this conversation. Dr. Pat Loehrer: This will be terrific. Dr. David Johnson: Yeah. You were telling me before we got started about a little event that occurred this week, maybe you want to elaborate on that for us. Dr. Pat Loehrer: Yeah, we always start out this by talking about books, and one of the books I'm drawn to today is a book called, The Emperor of All Maladies, which was written by Dr. Mukherjee several years ago. I want to read a little bit from this because it has pertinence. This is about a guy named John Cleveland. Dr. Mukherjee writes, he goes, ‘In 1973 Cleveland was a 22-year-old veterinary student in Indiana. In August that year, two months after his marriage, he discovered a rapidly enlarging lump in his right testis. He was whisked off to the operating room for surgery and returned with a scar and he was diagnosed with metastatic testis cancer. This was right around the time that Larry Einhorn came to Indiana University where he was treated with a three-drug cocktail of actinomycin-D, bleomycin, and oncovin ABO. And then he had a brief remission progressing and was treated with mithramycin mithrymicin. And then in October of 1974, he once again developed progressive disease, and Larry approached him about a new cocktail with the drug cisplatin, that had never been used before in combination, and Larry's thought was to put it together with another couple of drugs.” So, I'll just finish reading this. “In October 7, 1974, Cleveland took the gamble, he enrolled as patient zero for BVP, an acronym for the new regimen containing Bleomycin, Vinblastine and cisplatin. 10 days later, he returned for routine scans and the tumors in his lungs had vanished. He was ecstatic and mystified. He called his wife from the hospital phone. I can't remember what he said, but I told her the results. So, John was the first one cured of testis cancer. Back then it was a 5% cure rate. Today, it's 95%. He is really the hero of heroes. Last week, at this time, John had asked me to come to his hospital room because he was diagnosed with metastatic cancer of a different type. He knew that this was basically the final hours of it. And so he wanted to say goodbye to me, and it was the most touching reunion I had. Two days ago, John passed away. So, my thoughts are with him, especially his family. But also, when we think about heroes, John was one of them, and if it wasn't for him, and his first treatment, Larry might not have gone on and treated other patients with this regimen. This drug cisplatin was experimental back then it caused a lot of nausea and vomiting and didn't work in many tumors, but this was a drug that was really highlighted and approved for the treatment of bladder cancer so Hubert Humphrey could get treated, and then in testis cancer, and it's really one the really success stories of all success stories in terms of oncology, and it started out with this experimental drug from the NCI that was approved by the FDA.” So, this leads us to our guest today, Rick Pazdur who I've known for many years. He grew up in Calumet City, Illinois, which is famous as the home of the Blues Brothers and Rick Pazdur. He got his bachelor's degree from Northwestern, his medical degree from Loyola Stritch Medicine, and then did his hematology-oncology fellowship, initially his oncology fellowship at Rush Presbyterian St. Luke's, where I first met Rick, and then later finished his Heme-Onc fellowship at the University of Chicago. From there, he went to Wayne State, served on the faculty there for about five or six years, and then joined the faculty at MD Anderson. He was there from 1988 to 1999. Then, we'd like to hear about this, but for some reason, it got in his head that he wanted to go to the FDA and so he moved to the FDA where he was Director of the Division of Oncology Drug Products, from 1999 to 2005, when they created the Office of Hematology Oncology Products, and he became the Director of this. More recently, he's been made the director of the FDA's Oncology Center of Excellence. He still serves as the acting director for this OHOP. Rick is an extraordinary individual. He's been awarded a number of awards. From ASCO, he got the Service Recognition Award and the Public Service Award in 2013. And the AACR also awarded him the Public Service Award in 2015. He's received numerous awards and he is probably one of the most respected oncologists that I know in this society. It's such a great pleasure to have you here today, Rick. Dr. Richard Pazdur: My pleasure, Pat. My pleasure entirely. I look forward to the conversation. Dr. David Johnson: Pat, you left out one award. He got so many awards that you can't list them all, but I was impressed that he got this award for the Massachusetts General Hospital Cancer Center's – The 100 list. Dr. Pat Loehrer: Yeah, we made the cut-off. Dr. David Johnson: I have no idea what that is. Dr. Pat Loehrer: We were on the 1001 list. We made that one. The only thing I want to throw into is that when I first met Rick, when I was a resident or an intern, I think, he was on the service with Phil Bonomi, who is very important for me for my thymoma research, but there was an oncology nurse on the service, Mary Lind, who was a terrific oncology nurse as they all are. But it turned out there was more chemistry that went on. So, Rick ended up marrying Mary, and I'm sure he'll tell some stories. We'll come back to that in a little bit, too. Dr. David Johnson: Yeah, this is really exciting. So, let's get started. Rick, maybe you could tell us a little bit about your background and what got you into medicine in the early part of your career. Dr. Richard Pazdur: I had an interesting story. Pat had mentioned Calumet City home as a Blues Brothers. That was the orphanage in the movie. It was located in Calumet City. But what you don't know about Calumet City is that the real kind of nickname for Calumet City in the 50s 60s 40s was 'Sin City'. It has the honor of having the greatest number of liquor licenses in the United States. And in Calumet City, which was on the border of Hammond, Indiana, and Calumet City, they're kind of Sister Cities. They're one in Illinois, Calumet City. And Hammond is in Indiana, obviously, there was this strip, and it was called ‘The Strip' and it had all of these bars and floor shows with Sally Rand and gambling. If you walk down there, which I never did as a kid, but drove down there with my father some time just traversing the city, those lights were so bright, it was just like Las Vegas, basically. So, you had that Strip and that went on for maybe three, four, or five blocks. And then you have the rest of the city that I grew up in, which was primarily a Polish Catholic city, which I am kind of a representative of being 100% polish. There were scattered bars throughout the city. In fact, my fondest memory is sleeping in bed at 3 o'clock in the morning or 2 o'clock in the morning, awakening to people running out of a bar, which was 50 feet or 100 feet from my bedroom window. They were screaming and yelling and cursing and everything and throwing beer bottles at each other. And in those days, obviously, as you remember, in the 60s, there was no air conditioning. So, the bar was called The Tropical Inn. Let me tell you this, there was nothing tropical about it and there was nothing 'in' about it. Dr. David Johnson: That background might have driven…. Dr. Richard Pazdur: That was not what I would call a highbrow area, but I enjoyed it. It was a fabulous childhood that I had. Most people don't know this. So, I will share this with you because it really had an indelible mark on my life and something that really transformed my childhood and my high school years and my college years, and my medical school years. When I was about in seventh or eighth grade, my father who was basically a blue-collar factory worker, developed glaucoma, and he went blind at a very early age. And that threw the family into not only emotional turmoil but also economic turmoil. I survived basically by getting Social Security dependent income and had to work at a very early age. I started as a dishwasher. My mother lied about my age so I could start working at a crummy restaurant in Calumet City as a dishwasher and I worked throughout school, but that experience really made me grow up really fast if I could say so. You didn't have a childhood, you had to be responsible because there was really no security blanket to fall back on. Although my parents didn't have a lot of money, they really had very good emotional support for me and both my father and my mother came from very large, Polish families. My mother had nine children in her family. She was right in the middle. And so, I had many cousins and many aunts and uncles and my father had seven children in his family and he was the oldest boy. So, there was a lot of support there, but obviously not a lot of financial support. So, it really made me grow up relatively quickly and really come to some of life's lessons, relatively fast like discrimination against disabled people, which I will always remember. When I was a boy, I remember going with my father walking and obviously he had a white cane, but walking down the street, people would actually cross the street to avoid us. They just didn't want to confront that anxiety. I don't know if it was discrimination or if they just felt uncomfortable dealing with it. When you go to a restaurant, people raise their voices, like the man was mentally impaired and that wasn't the case. Dr. Pat Loehrer: I'm sorry to interrupt you just for a second because I read this somewhere and I think it's important to throw in. So, you graduated from high school in three years? Dr. Richard Pazdur: Yes, that's what I was gonna say. I graduated and I worked during that time also. These jobs were not like jobs that kids have now as consultants or internships, these were like real jobs as a janitor, a gardener, or a packer in a grocery store. You had to do it and you had to compartmentalize your life to get things done, basically. But you were driven to do things and I'm thankful for that experience really. I even use it now when I'm facing turmoil in my life. I look back at that time and say to myself, Rick, if you did it then as a 12-year-old kid, a 14-year-old kid, you could do anything. So, it really fostered a sense of responsibility, self-awareness, and the need to do things for yourself and get going on yourself. because nobody's going to help you in a sense. I'm very grateful for that. Dr. David Johnson: Rick, at what point did you decide to become a physician? How did that experience really drive you into that field? Dr. Richard Pazdur: Well, I spent a great deal of time in the lobby of the University of Chicago hospital with my father. I was the primary caregiver and went with him to his doctor's appointments. I can't tell you the number of hours I spent in the lobby of that hospital. I was very interested in science. I was very interested in really helping people because of that background. I really had a great deal of clarity, though. I remember, when I was maybe a freshman or sophomore in high school, I wrote for the Northwestern Medical School catalog, because I thought I would be going to Northwestern undergraduate, I already decided in my own mind that that's where I wanted to go. I just got their medical school catalog and I was thumbing through it, and I remember this vividly sitting on my bedroom floor next to the window that was 50 feet away from the bar, basically, and was looking through the medical school catalog and seeing all these names of this doctor, head of neurology, assistant professor, associate professor. I said, “Hell, if I'm going to be a doctor, I want to be one of these people. I want to be the best doctor. I want to be teaching the physician here and doing research.” So, unlike most kids today that have to find themselves, like, ‘I'm going to take 8 years to complete college or something like that and take a year off to find myself.' I had to be very, very focused on what I wanted to do. So, I really worked very hard during it through time. I don't regret it, as I say. I went to Northwestern undergraduate and had a fantastic experience there. I graduated in three years as I mentioned. I had a special interest there that most people don't know about. The people at the FDA know about it. I did these pre-med courses but I had a really special interest in the field of sociology, and actually was toying with the idea if I didn't get into medical school to pursue a Ph.D. in Sociology and become an academic sociologist. If you remember and both of you are of this age. Dr. Pat Loehrer: David is, not me. Dr. Richard Pazdur: Okay. David might know of the Vietnam War. This was right around the time of Kent State and closing down the schools, I'm sure you remember that, for the colleges, etc. Nobody went into business or anything like that. It was a sociology, psychology, and anthropology type of things people were interested in. My love was this field, and I did a lot of research on it. I remember one of the professors that probably had the most influence on me, a woman called Zena Smith Blau, who was a sociologist, and I did multiple research projects and independent studies. The first thing when I took her first course, she assigned us a paper and she said, write about yourself, ‘What makes you unique? I went to see her and I said, ‘I really don't know exactly what you mean by this.' She said, ‘Well, how different are you?' And I said, ‘Well, my parents are children of Polish immigrants, and I really know the Polish community in Chicago fairly well.' She said, ‘That's it Rick, that's what your specialty will be.' I did multiple research projects on this area with her. Some of them were like the assimilation of Polish immigrants with regard to urban-rural origin. Another one was working-class youth in Chicago, and mobility based on education and high school part-time employment. So, that was a fantastic experience that is totally outside of what I did in my future. Dr. David Johnson: We asked our listeners to submit questions because we knew you were coming on. We did get a question that perhaps is appropriate to ask at this time. It comes from a younger trainee, who wants to know what advice you would give to a trainee aspiring to have a clinical investigative career in oncology? What sort of preparation should they have? Obviously, you've got to learn all of the techniques of clinical trial designs, statistics, etc. But what other advice would you give a trainee hoping to pursue a career in clinical investigation? Dr. Richard Pazdur: I think one's career always has to go back to the basics and have a patient focus. So, what is your interest in the patient, so to speak? And that is what advice I would give them. Are you interested in a supportive care issue? Are you interested in a specific disease? I think you have to follow a passion and that is what is most important to me. What is your passion in life? Because as physicians, we spend a great deal of time preparing for our careers and then subsequently afterward, in our designated careers, and you really can't approach this as a job. It has to be a passion. So, if you do have this, what are the questions that you really want to answer? What is the field that you want to go into and make an indelible mark in? So, that's what I come from, and that's something that I tell our staff is: what do you really want to do? What makes you happy? What would make you a success in your mind? Not defining yourself by somebody else. Dr. Pat Loehrer: Finish the story a little bit. Was it a patient then that turned you on to oncology? What brought you into oncology? Dr. Richard Pazdur: I had a very circuitous circular route to oncology. Oh my God! I don't know if you have enough time to hear this story, but let me start though. I originally went to medical school because of my background in sociology. I wanted to become a psychiatrist because here again, I thought psychiatry, sociology, and psychology, these are kinds of things I was interested in until I took my first rotation in psychiatry. It was nothing like I thought it was going to be. I saw my first patient that got ECT (Electroconvulsive Therapy) and I said, 'I ain't doing this.' So, I was then interested in cardiology. Loyola at that time where I was going to medical school and where I did my internship and residency, had a huge cardiology program that was like CAST city, USA. Everybody was just coming into the hospital getting CAST and going out of the hospital. Dr. Pat Loehrer: [Unintelligible 18:13] was there, right? Dr. Richard Puzdar: Yes. Mary Kate [Unintelligible 18:18]'s father was the head of medicine there. And it had a huge cardiology program and an excellent cardiology program. I really did like Clinical Oncology, and I was all signed up for a cardiology fellowship, the Ts were crossed, the dots were placed, the contract signed, and everything. And somebody said, ‘Rick, why don't you take a rotation while you're a resident in the cath lab? We have an opening and this would be a great time and opportunity for you to jumpstart your fellowship. So, you can come and work for us in the middle of your third year of residency for about two or three months.' So, I did that and I hated it. I just dreaded it. I couldn't stand it. It was the most boring thing. I would think of every opportunity to escape the Cath lab. It was the same thing over and over and over again, inject the dye, turn on the [Unintelligible19:16] machine, and follow the coronary arteries. So, I happened to go to a community hospital, St. Francis in Evanston, Illinois, and I met an oncologist there that had just finished her fellowship. I really was very impressed by her clinical skills. She had finished her fellowship at the University of Chicago and worked with her there and was just amazed by really the quality of care that the oncologist gave patients with cancer. Previous to that, I had an interest also in oncology. At Loyola at that time, we had an oncologist his name was Ketty Badrinath, and he was an excellent clinical teacher. Now that I decided that I'm not going into cardiology, the first problem I have is to find a job and to find a fellowship in oncology. So, I started investigating oncology programs at St. Francis Hospital there. I went down to the gift shop and I said, I want $10 worth of quarters. I went to a payphone, closed the door of the payphone, dialed information, and got every oncology program that I could think of from Mayo Clinic to all of the programs in Chicago. One of my last phone calls was to Rush Presbyterian. I found that program director, Jules Harris, I don't know if you remember him, and he said, “We have an opening.” So, I accepted the position. At the end of June, whatever it was, June 27, 1979. I started my oncology fellowship program. Now Oncology at that time in Chicago, to give you a picture of it, the largest program in oncology was at Rush. It had a total of 12 people. And the therapy started at Rush around solid tumors really in the endocrine therapies of prostate cancer and breast cancer. So, it was a different program than most programs throughout the United States that were offshoots of Hematology programs and the treatment of acute leukemia and lymphomas. So, it had a really kind of different orientation. So, I started my fellowship. And on the first day, I met Phil Bonomi, who had a tremendous influence and still has an influence over me. I know no doctor that I respect most more than Phil. I think the greatest compliment that one could give a doctor is to refer your own family to him. And I've done it on numerous occasions with various cousins and aunts and uncles, etc. But as you mentioned, Pat, I also had the opportunity to meet my wife. And I met her and at first, we were very good friends and there was no romantic relationship. And then, as time proceeded, we knew that there was something special there. My wife was just a wonderful person. Like myself, my wife was pretty much a self-made person. She was one of eight children, the oldest daughter. As the oldest daughter, she had to assume a lot of childcare responsibilities, cooking, etc, for all of her brothers and sisters and took care of the younger children. But she was an excellent student. She graduated first in her class. She was a national merit finalist. I often asked my wife, ‘Mary, you're a nurse, are you interested in going into medicine? I'll be happy to work with you to get you into medical school.' And she said, ‘No, you want to go into medicine, I want to go into nursing.' That was her orientation toward other people. It wasn't about the buck. It wasn't about the title. It was about the work of helping other people. I really have to honor her mother and father who gave her that orientation. Of interest, all of her sisters are nurses. Her mother was actually a school nurse, and an original graduate of Rush. She went to Rush Nursing School in the 50s but had to leave because at that time in the 1950s, if you got married, you can't be in nursing school, they kicked you out. So, it shows you how times have changed. Dr. Pat Loehrer: Well, this concludes part one of our interview with Dr. Richard Pazdur who is the director of the US Food and Drug Administration's Oncology Center of Excellence. Stay tuned for part two of this conversation where we'll hear how cancer has touched his life personally and will explore the initiatives and programs, he started to improve patient care globally. Thank you to all of our listeners for tuning into Oncology, Etc. This is an ASCO education podcast where we'll talk about just about everything and anything. If you have an idea for a topic or guests you'd like to see on the show, please email us at education@asco.org. Have a good week. Unknown Speaker: Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes. Please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org. The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Oncology, Etc. – Rediscovering the Joy in Medicine with Dr. Deborah Schrag (Part 2)

Play Episode Listen Later May 17, 2022 30:03

In the second of this two-part conversation Drs. Patrick Loehrer and David Johnson sit down with Dr. Deborah Schrag, the current Chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center to continue the discussion of her roles as a leader, researcher, oncologist, public health expert, and more. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. TRANSCRIPT Dr. Dave Johnson: Hi everyone, welcome back to Oncology, Etc. an ASCO educational podcast. My name is Dave Johnson. I'm at UT Southwestern Medical Center in Dallas. And I'm here with my good friend Dr. Pat Loehrer who serves as a director of Global Oncology and Health Equities at Indiana University. In the second half of our conversation with Dr. Deborah Schrag, the current chair of Medicine at Memorial Sloan Kettering Cancer Center in New York. In part one, we heard about Dr. Schrag's early life and background, as well as the importance of affordable cancer care and much more. Let's jump back into the conversation and hear about her current goals and initiatives at Memorial Sloan Kettering. I have a question for you. Jumping ahead a little bit. But I mean, you're such a role model for all of us. But you're now in a very powerful position as head of medicine at the preeminent cancer center in the world. So, I'd be interested in knowing what are your top initiatives? What did you come to this role wanting to do short-term and long-term? I'd be curious to hear from you about that. Dr. Deborah Schrag: Yeah. So, I have lots of specific initiatives, all the things that are probably very similar across medical cancer centers. We have to figure out the role of immuno-oncology. We have to figure out the role of CAR T-cell Therapy. There are lots of specific things, but let me tell you about three sort of overarching principles and things that I think we need to think about. So, one of the reasons why I decided to leave my job where I really focused on training researchers and building a research program to lead a department of medicine that has a mix of clinicians, educators, and investigators is that there's really a profound sense of exhaustion and disconnection. I'll use the word even burnout or people get the sense of losing the joy in the practice of medicine. And as corny as it sounds, and I know I'm going a little corny here, Dave. But I really want to help bring back and connect people to the joy in the practice of medicine. It's the joy that we experience when we crack a tough case, when we help a patient, when our patients make us laugh, when our patients and their families make us cry, when they drive us bananas, when they cook us food that is inedible, just reconnecting us to the joy, to the stories. I really wanted to try to be a different kind of leader because I felt that I could make a contribution to the field of academic medicine in general and oncology in particular, by working with faculty to set them up to tap into that joy, because I know they all started with it. I know they all went into medicine because they care about those human stories, because they do want to make a difference. This past week, a fellow intern of mine who you may know, passed away. His name was Paul Farmer. He was the head of Partners in Health and he was an infectious disease physician. There's a book about him by Tracy Kidder that's really moving. There's also a documentary about him called, Bending the Arc, which I would highly recommend. Paul was an incredible inspiration, just incredible, but he brought so much joy to the practice of medicine. I remember when Paul was going to some of the poorest places on the planet, specifically Cange, Haiti. He got an idea that he needed to bring chemotherapy because there were large cancers that were untreated. And he wanted to get leftover chemotherapy from the Dana-Farber. So, in the 1990s, when I was a fellow, he would ask me whether I could get him any leftover Taxol. I was like, ‘Paul, I can't do that. It's not safe. You can't take leftover Taxol to Cange'. And he said, ‘Deb, just wait, the drugs will be oral soon, and then I'll get it'. But guess what? Paul came back to me in 1999, and capecitabine had been approved. The oral equivalent of 5-FU. He held my feet to the fire. He said, ‘Every time you have a dead patient, if there's any leftover capecitabine, I want you to get it for me'. Inspirational leadership, connecting people to the joy in the practice of medicine. I would say that's number one. There's no one simple formula or way to do that. It's hard work. It requires a team I think a lot more teamwork into the practice of medicine. I think we're coming out of a hard two years where we've been confined to Zoom boxes. But it's a lot easier when we can sit together in a room and have a pizza and a beer on a Friday afternoon. But we have to figure this out, and we will, step by step. The other big thematic area, I think, has to do with the patient experience. Dave, I mean, when I started out as a fellow, patients with advanced lung cancer were living for 10 months, 10-12 months, that was a pretty good run with advanced metastatic non-small cell lung cancer. Well, these days, it's 2-3 years, and there's even quite a tale of patients who were living 4-5 years. And that is a long journey. It's no longer the 800-meter sprint, it's a half marathon, turning into a marathon and even an ultra-marathon. So, the way we deliver care needs to change. So, we're really rethinking here, how we deliver care. So, as an example of some, if you go back to the 80s and 90s, cancer chemotherapy was something that happened in the hospital. And in the last quarter century, we've transitioned that to an outpatient practice. I think in the next quarter century, we won't transition all of it, but we will transition a lot of it to home. As an example, I'm struck by when patients undergo IVF, they get handed some Lupron and are taught how to self-administer Lupron every day, so they can undergo a fertility cycle. But when those same women get breast cancer, they have to come into the clinic and sit and wait and take half a day off of work to get the same Lupron. The same is true for men with prostate cancer. Why is that? It's because of policies, and it's not safety, it's not patient-centered. So, I think we have an opportunity to change the patient experience. I think we'll be able to give immunotherapy at home, and HER-2 agents at home. We have to do the trials and make sure that it's safe, but we have to make cancer care more patient-centric and improve the experience. And that's just essential when it's a marathon that we're asking our patients to run, not these 12-month sprints. Families need this also. So, those are a few of the challenges that I want to take on. Joy in medicine, patient experience, and of course, the physician-scientist pathway needs to be strengthened. Dr. Pat Loehrer: I love it. You can imagine between Dave and me, I think that resonates so much about having joy in medicine. I've not heard other people talk about that, but I really think that's an important vocation. But I'm going to ask you something else too because, in the efforts of being joyful and being a role model for that, there's the other side of it, where you can't actually let your hair down, and really be depressed, if you will, or down because you can't let the other side see that. And so, who do you lean on if you will, your confessor that you can talk to when you're feeling down when you're trying to fight the anti-joy part of your job? Dr. Deborah Schrag: I have lots of friends outside of medicine. And I've always found that that's really helpful to make time for friends outside of medicine. They help connect me to humor and other things. I'm coming up on a big high school reunion. My high school classmates and I still meet for picnics in Central Park. And there are about 120 in our graduating class. And I think we'll have about 110 of us getting together. We still have picnics with 40-50 people attending. So, there's nothing like old friends from childhood who now do all kinds of different things. So, that's really helpful. But I've also found that my mentors and colleagues who trained me and who know me really well, are a great source of advice. So, leaders in academic medicine, and I've always found that I've been able to get advice from people who were senior and leaders, people such as Dr. Mayer, Dr. Benz, Dr. Jim Griffin, and also junior colleagues. I now increasingly as I get old, I rely more and more on my trainees and my mentees. So, some of the folks I know best are people who I trained. So, I'll just give you one example. Many of you may know Ethan Basch. We worked together when we were both just coming up. I was an assistant professor. He was a couple of years behind me. I mentored him. Well, he's now chief of the Division of Oncology at UNC. He and I have written lots of grants together. We're really partners now. But it's been a lifelong professional friendship. Sometimes when I just need to let my hair down, I get on the phone with Ethan, and yeah, there's a little bit of commiserating. But I'll give you an example that runs through Dave. Some really valuable experiences had to do with being asked to serve on committees. I think it's great. I just want to give a shout-out to ASCO. Some of my earliest professional relationships were with superstars that I met through ASCO. So, people like Joe Simone, reading his Simone's Maxims everyone needs to read Simone's Maxims if you haven't. There was a guy by the name of Christopher Desh, who sadly passed on. But he was an ASCO member who practiced at the Virginia Commonwealth University back in the late 1990s. Boy, did that guy understand the joy in medicine, some of the early folks who started QOPI. Being introduced to those individuals who practiced in different parts of the country and who had different kinds of challenges - having that sort of rich network has been incredible. At some point, I think through such a connection, maybe it was through Dr. Mayer, I was referred to Dr. Johnson, who was then running the American Board of Internal Medicine committee that wrote the oncology exam. I participated in that for a few years that was led by Dr. Johnson. And I met incredible people on that committee, including Dr. Johnson, just Dr. Johnson's stories could inspire anyone and get them back on track just in terms of the humor and the joy and the love, and really the pride in the profession. But I met Jamie Von Roenn that way, who's now leading educational efforts at ASCO, she was on that committee. Lynn Schuchter became a good friend of mine as a result of that. So, I would just say, sometimes you need to get out of your own space. And sometimes I need to get out of Dodge, as they say, I need to get out of New York, get out of Boston, and being connected to colleagues across the country has been so rewarding. I have a network of friends at other institutions who I rely on. Serving on external advisory boards is a great place to meet people. Study section, if anyone has the opportunity to be on study section. That's a fabulous opportunity. So, I think participating in peer review, showing up at meetings, serving on ASCO committees, or ASH or AACR. These are really important experiences. And I will say in my leadership role, I'm really trying to make it clear to faculty that I encourage them to take time to participate in these activities and attend these events and even travel because the traveling is important, too. I could not have gotten the same dose of Dave Johnson, if I had not actually gone to the meeting, spent all day writing board review questions, and then having a nice meal afterward. That was part of the experience. I don't know what you would say, Dave, but that was my view. Dr. Dave Johnson: So, one of the things that Osler talked about was the fellowship of the profession, and how important it is to have those relationships. Even if one can't physically be with that individual, developing that spiritual relationship is really critically important. I'm so glad you brought this up and expanded on it in the way you did because I think it's absolutely critical to retain the joy of medicine. It's our colleagues, as well as our patients that make it such a marvelous, majestic profession, in my view. Dr. Pat Loehrer: I was going to just add something if I could. So, Deb, replace me on the ABIM, just to let you know, because we had certain slots on there. One of the not sure if it was the rules or guidelines that were mandated is that everyone needed to take the oncology boards, even though we wrote the questions, we had to take the test. And you knew that and you had such unbridled enthusiasm for this. I still remember this deeply, and that not only did you recertify for the oncology board, but you also studied to take the medicine boards too. Your love of medicine is so contagious. And I'm sure everyone at Memorial benefits from this. Dr. Deborah Schrag: Thank you. That's very nice to say. I do, I love the stories. I've been rounding with the house staff on the inpatient service. I think both of you know, inpatient oncology, as we're able to do more and more in the outpatient setting, our inpatients are very, very sick. And we often get a front-row seat to what I would call the social determinants of health challenges. In other words, if you've got relatives and resources, you may be able to be at home. But if you have severe pain or symptoms, and you lack the relatives, or you live on a fifth floor, walk-up, or just don't have the resources to get the home care that you need, you're more likely to be in our hospital. But as I round with the house staff, I find myself asking them to tell me more about the patient stories. Because when I round and they tell me that it's a 74-year-old with peritoneal carcinomatosis, jaundice, and abdominal pain. I'm so old that I've seen so many hundreds of those patients and the management hasn't changed very much. But what's really the privilege is to understand the journeys that got people where they are, and to learn a little bit about who these people are. I try to do that when I round with house staff and I find that it makes the experience better for them. I have to say that I do worry about how we train young physicians in oncology because what they see on the inpatient side is really the hardest of the hard, that's obviously less true in a leukemia service, where they're delivering lots of curative therapy or a stem cell transplant service. But in solid tumor oncology, it's really hard. I think it's something we have to have to tackle. We have to rethink education and medical oncology. I'm hoping that we're going to do that. That's also on the bucket list, by the way. I think we have to do that as a profession. And I know both of you are passionate champions and advocates for education, as is ASCO. But I think it's really imperative that we do that if we are to keep attracting talent. And then I just want to make one more point, which is that New York City is one of the most diverse places in the United States. I don't know about the planet, because I don't know the whole planet. But in the United States, we are incredibly diverse. But the oncology workforce does not yet look like that. So, we have a lot of work to do to train a much more diverse workforce. We're doing well with respect to gender, very well. We're literally about 50/50, we may even have a little bit higher proportion of women on the faculty here at MSK. And I think that's true nationally as well. But with respect to Blacks and Hispanics, and other underrepresented communities, Native Americans, we've got a long way to go. And we have a pipeline problem. And that's going to be hard. But it's hard work that we have to do, and I know you guys are working on that in your own centers as well. Dr. Dave Johnson: Let me follow up on that. What attributes are you looking for in trainees and newly hired faculty? Whether they be junior or senior faculty? What are the characteristics or attributes you seek that you think predict, or certainly you want your individuals to possess? Dr. Deborah Schrag: We all want people who have everything, but I would say creativity, the willingness to take risks, and the ability to ask a question. I say this to the trainees, frankly, I say it to my own children as well. ‘It's okay, take a harder course. Yes, you may get a B minus by trying something new and different, that doesn't play to your strengths. But try something new. Take risks. Yes, the trial may fail. Yes, you may not get that grant.' But I think a willingness to take risks, a willingness to put yourself out there, a willingness to stretch. I'm also looking for people who can work in teams because there is no aspect of medical care that happens in MSK, I suspect that it's also true that maybe medicine in Antarctica, but even medicine in Antarctica is probably a team sport. Medicine has become a very complicated team sport. It's a very complicated dance with pharmacists, nurses, and APPs. It takes a village to give a course of immunotherapy. It is very complicated. And so, when people like to control things and like to do everything themselves, they're going to have a hard time. And that's true I find for teaching, laboratory investigation, wet lab, dry lab, most good, impactful, important science in oncology these days, clinical trials, wet, dry, all of it gets done in teams. Teams that have people with different levels of training, different skill sets, early stage, late stage, people who are quantitative, people who can write, people who can program, people who can do lab experiments, and people who know what an organoid is. People who know how to program an in R. All different kinds of skill sets but they have to be able to work in teams. People who can't do that are going to struggle to achieve maximum impact. I'm not saying that there isn't room at the end for the occasional genius person who likes to work solo. But that's not really what we need to move the needle. So, I need team players. I think there is a big emphasis on collegiality. Of course, we want smart and we want brilliance. But sometimes a drop less brilliance and a drop more collegiality and being able to work together in a team, it goes a long way and it's the difference between doing something impactful and not. That's what I look for. I also think that it takes all different kinds of people. And no one has to excel at everything, but it's great for people to be able to excel at something. So, passion, drive, and ability to ask questions, and not being afraid to occasionally fail and having some tolerance for that and trying to make sure that leaders are able to tolerate that, too. We have to be able to. Dr. Dave Johnson: Yeah, I think those are great suggestions. We're getting near the end of our time today, and we have a lot more questions to ask. But what's your biggest fear, as the head of the Department of Medicine, looking to the future, what causes you to lose sleep at night? Dr. Deborah Schrag: I think the business of medicine. If medicine turns into something that feels just like [inaudible] work, and losing physicians, if we don't respect physicians' need to take care of themselves, to take care of their families, and yeah, to find that joy, then we will not attract the top talents. I think we need great minds and great hearts and people from all walks of life to enter the profession, because that's the talent that we need, to quote my friend, Paul Farmer, ‘Bend the arc'. And you know, we need to bend Kaplan-Meier curves in the right direction. And we need the talent to come into the profession, and if they see that we are not happy and not thriving, the next generation is going to go elsewhere. I don't want to begrudge my wonderful endocrinology colleagues. We need people to tackle diabetes, and we need great surgeons and great anesthesiologists, too. So, it's not just oncology. In medicine, I'm responsible for all kinds of discipline. And boy, we need a lot of cardio-oncologists because we've created all kinds of new challenges. So, it's all of the sub-disciplines of medicine, but I think physician well-being and attracting talent to the field is really essential and making sure that the business side of medicine doesn't take over and destroy the core promise and premise of academic medicine. It is a spectacular profession and calling, and it has led to so many advances that have really changed the world. And we have to, I think, preserve the good in that. My fear is that that gets further eroded. Dr. Pat Loehrer: Just one last question from me. Thank you for all your wonderful comments. But I think I have to ask this because it's such an unusual thing as they brought up at the beginning that you're the first female Head of Medicine at Memorial and Lisa DeAngelis is the first Physician in Chief. And so, although there is gender equity in medicine, there is not gender equity and leadership around the academic world. And this is a very unique situation there. Can you reflect a little bit about the significance of this and perhaps, lessons learned, particularly if you're speaking to a younger version of yourself or a young woman who's thinking about a career? What are the lessons between you and Dr. DeAngelis mean? Dr. Deborah Schrag: I'm not sure I've been at it long enough to have lessons. I'm just so grateful. So, I'm not in the generation that was a trailblazer. I'm a beneficiary. So, I've had the privilege of being trained by Dr. Jane Weeks, by Dr. Judy Garber. I, myself, had so many great mentors who were women. I would say to women, that you can have it all. You just may not be able to have it all at once. Women and men have to make choices. Can you have a lab and be a laboratory investigator? Yes. Can you do that and have a family? Yes. I think running a high-power lab and having a gigantic clinical practice and running clinical trials, I think the three-legged stool and the so-called triple threat is really, really hard. But I think it's hard for women and men. What I would also say to women is you don't have to be the boys - be yourself. I think the best advice I can give to leaders is to be authentic. Because everyone, men, women, people smell a phony and no one likes to phony. So, I think if you know how to partner, you understand that it's a team sport. I think women do that really well. So, I think being authentic, and I think women need to hear that, you don't have to emulate male role models. You have to be yourself. I would love to emulate the two of you. I have to thank both of you because the Indiana Miracle and Dave from his Vanderbilt days, Vandy, as Dave likes to call it, from his Vanderbilt days to his Texas days, like, the two of you are such incredible thought leaders and inspirational leaders in oncology, but I can't be you. The best we can be is sort of the best version of ourselves but we can be inspired by the great qualities that we see in other leaders and carry a little bit of that with us. So, I think that goes for women and for men. Dr. Pat Loehrer: Thank you! Well said, and I appreciate the thoughts. We've kind of gone through this and we're going to have to wrap it up. One of the questions that we often times ask our visitors is if there's a book that they're reading, a documentary that they're watching, a movie they're seeing, or anything you'd recommend? Dr. Deborah Schrag: That's a good question. So, yes, actually. One of the ways that I learn about leadership that I find, actually a fun way that's both relaxing and educational, is to read a biography. I love reading biographies. I'm going to name two. And these are popular books - for scholars these may not be. First really fun book is ‘The Splendid and the Vile', by Erik Larson. It's a book about Winston Churchill in 1940, and how he has to try to persuade the United States to enter World War Two, but it's really about a particular year in history and Winston Churchill. Dr. Dave Johnson: It's a great book. Dr. Deborah Schrag: It's called, The Splendid and the Vile. I just learned so much about leadership from that book and the decisions that Winston Churchill makes in his bathtub. So, just read that book and think about what Winston Churchill does in his bathtub. I can't lead from my bathtub, I live in a New York City apartment, but that's one. Then more recently, I guess there's a little German theme happening here, is, The Chancellor. It's about the life of Angela Merkel. It's long, I haven't finished it yet. But it's incredible. What a story, East Germany, her leadership style, how she studies chemistry, how she rises. It's a fantastic book. It's called, The Chancellor. So, I will recommend that one. Then the last one, my beloved nephew who's like a son to me. He's about 36 years old, and he has ALS. And he's completely paralyzed. He is on a vent and he has two little kids. But he released a documentary that actually won at the Tribeca Film Festival called, Not Going Quietly, which is about a cross-country trip that he made. He's a pretty inspirational character, despite the fact that my nephew was completely locked in, he communicates only with his eyes. He is living a remarkable life. I think that documentay, I know this is a shameless plug for my nephew, but he's a pretty inspirational character. I don't necessarily agree with 100% of his policy prescriptions and recommendations. But there are lots of ways to make meaning in the world. So, that's another documentary. Dr. Pat Loehrer: That's incredible. Thank you so much for sharing that. I'm going to look it up. People think cancer is the worst thing you can get but there are worse diseases to have. Dr. Deborah Schrag: Yeah, I think this one might change your idea. And then I would also say Paul Farmer's Bending the Arc. I think for young physicians who haven't seen that movie, I would recommend Bending the Arc. Dr. Pat Loehrer: Thank you. Dr. Deborah Schrag: Thank you! It's been great to chat with you. Dr. Pat Loehrer: It's great. So, that's all the time we have for today. And I really want to thank you, Deb, for joining us and for all your insight. It's been wonderful. I also want to thank all our listeners for tuning in to Oncology, Etc. This is an ASCO Education podcast where we'll talk about just about anything and everything, if you've heard. If you have an idea for a topic or guest you'd like to see on the show or a host that you would like not to see on the show, just email us at education@asco.org. Thanks again. And Dave, I just have a riddle for you here. How do you make an octopus laugh? Dr. Dave Johnson: Show him your picture. Dr. Pat Loehrer: Ten-tickles. That's all we have for today. You guys have a good evening. Take care. Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.

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Oncology, Etc. – Rediscovering the Joy in Medicine with Dr. Deborah Schrag (Part 1)

Play Episode Listen Later May 3, 2022 27:10

In part one of a two-part conversation, Drs. Patrick Loehrer and David Johnson sit down with Dr. Deborah Schrag to discuss her roles as a leader, researcher, oncologist and public health expert. The current Chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York, Dr. Schrag discusses the joy and passion she has found throughout her career, and more. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. TRANSCRIPT Dr. Pat Loehrer: I'm Pat Loehrer. I'm the Director of the Center of Global Oncology and Health Equity at Indiana University. Dr. David Johnson: Yes. And hello, I'm David Johnson. I'm at UT Southwestern in Dallas, Texas. Dr. Pat Loehrer: And welcome to another version of Oncology, Etc. Dr. David Johnson: Yeah, great guest today, before we get started with our guests, though, Pat, what are you reading these days? What can you recommend to me? Dr. Pat Loehrer: Well, I'm reading Jamie Raskin's book, which is about his son and about the insurrection. It's really a wonderful read so far, particularly I think about the family nature and how much he deeply respected his son who unfortunately committed suicide. Dr. David Johnson: Right before one of the impeachment trials as I recall, right? Dr. Pat Loehrer: It was right before the January 6 insurrection. Dr. David Johnson: Yeah, terrible situation. I have a book I've been meaning to recommend for a while. It's one that I've given to all the chief residents I've worked with over the last several years. And today's guests made me think about this book. It's entitled, Osler: Inspirations from a Great Physician. It's written by Charles Bryan, who's the former Chair of Medicine at the University of South Carolina in Columbia. Dr. Pat Loehrer: You trained with Osler, didn't you? Dr. David Johnson: I was a couple of years behind him. He was my senior resident. For anyone who's an Oslerphile, it's a great book to have. But even if you're not, it's got some wonderful lessons to be learned about how to interact with one's colleagues, and a lot of information about leadership, which is why it made me think of today's guest, Dr. Deborah Schrag who we're really excited to welcome to Oncology, Etc. Dr. Schrag is the Chairman of the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York. She's a highly accomplished healthcare leader, clinician-researcher, and expert in public health and population science. Deborah received her medical degree from Columbia University and completed her residency in internal medicine at Brigham and Women's. She obtained her medical oncology training at Dana-Farber in Boston and also received an MPH degree from the Harvard School of Public Health. After a brief stint on the faculty at DFCI and Brigham and Women's, she joined the division of gastrointestinal Oncology at Memorial Sloan Kettering, where she was an associate member and Associate Professor of Public Health and Medicine. In 2007, I believe it was, she returned to Dana-Farber and Brigham, where she continued her work focused on improving the delivery, quality, and effectiveness of cancer care. While there, she served as chief of the Division of Population Sciences until this past year when she returned to Memorial to chair the Department of Medicine. I also think she's the first woman to hold this position, but we'll learn about that momentarily. Deb is internationally recognized as a pioneer for her work engaging patients in reporting outcomes as a way to improve care. She has led pragmatic trials using informatics strategies to optimize patient and clinician wellbeing, efficiency and quality, and equity of care. In short, she's a true superstar, leading the department, the major department, in one of the world's foremost Cancer Institutes. Deb, welcome to Oncology, Etc. Thank you so much for accepting our invitation. This is a relatively new oncology podcast, but already, we're known for our incisive, deeply penetrating questions. So, I have a question for you to start off. Do you have any carpentry skills? Dr. Deborah Schrag: Absolutely none whatsoever, Dave. None. Dr. David Johnson: I'm disappointed. It's my understanding that Schrag is German for cross or a slant and people who build cross-legged tables. So, I was hoping, my house was destroyed recently, and I'm looking for replacement furniture, and I was hoping you might be able to help me. Dr. Deborah Schrag: I apologize. But I'm not going to be able to help. The name, you're correct, though, David, is a German name. So, my family does hail from Germany and they made malt, which is the major ingredient in beer. I'm not sure where the name comes from. But they ran malt factories and shipped malt all over to all the beer, before there were craft beer distilleries, that's what they did. Dr. Pat Loehrer: That may come in handy by the end of this podcast, by the way. Dr. Deborah Schrag: Could be. Dr. David Johnson: Well, speaking of your family, tell us a little bit about your background and where you were raised, and your family members. Dr. Deborah Schrag: Sure! I'm glad you asked that because I really have been very influenced by where I grew up. And as I think about it, experiences that go back to first grade got me where I am today. So, I am from New York City. I grew up in Manhattan in the 1970s. And as you may know, that was a pretty rough time in the history of New York, what's often referred to as the 'bad old days', although it didn't feel that way to me. But I started out attending New York City public schools. And at that time in my neighborhood on the Upper West Side of Manhattan, my first-grade class had about 45 students, and one teacher, there were about five or six of us who spoke English, and everyone else was a recent Puerto Rican immigrant. I pretty much sat in the corner and read to myself. Now I didn't stay in the public school system for long, but I saw in first grade, how things weren't fair. And I saw and felt my own privilege, acutely. And even as a little kid, I had that sense. Eventually, my parents transferred me to private school later on. And there were kids in the neighborhood who didn't have the same privileges that I did. But living in New York, you walk around, you're confronted with disparities every day. We still see it today with homelessness on the streets. At that time, there was a lot of alcoholism and the use of drugs. And they were two blocks north that were safe to walk and two blocks east that were not safe to walk. So, this really stuck with me from a very early age. As a student in summer jobs, I worked lots of interesting jobs. I started at 14 scooping ice cream at Baskin Robbins, I worked at a famous Deli in New York called Zabar's, selling coffee. Lots of interesting jobs that I worked during holidays and vacation times. But one of my first jobs was working in an organization called the Floating Hospital, which was a big old ferry boat that circumnavigated Manhattan, and it provided a summer camp. And we would take 1800 people on a boat around Manhattan every day. And my job was to do lead testing. And I learned how to stick kids, test them for lead because there were incredible amounts of lead poisoning in New York City in the early 1980s. And then we would work on tracing the kids and these were toddlers, two-year-old, three years old. There were many families who were living in homeless shelters in New York City in the early 1980s. And that was really the beginning of my interest in public health and inequities. And really the marriage of medicine and public health. That had a deep and long-lasting impression on me and really stayed with me throughout my career. That early experience, I think it propelled me into medicine and to medical school and also to marry medicine and public health. Dr. Pat Loehrer: Tell me a little bit, Deb, about your parents. Dr. Deborah Schrag: Sure! My mother was born in the United States. She was a teacher who many years later after having three children went to law school and she became a litigator. And actually, her boss was Rudolph Giuliani. My father is a child of World War II. He was a child of German Jewish parents who had to flee the Nazis. Probably the most interesting story is that my paternal grandfather was an OB-GYN. So, I am a fifth-generation physician. My paternal grandfather was an OB-GYN at Charité, which is a very famous Hospital in Berlin. He was the head of OB-GYN there in the 1930s. But he had, I think he was half Jewish, and the Gestapo asked him to leave and he had to leave. He was an expert in version, which is essentially flipping babies and the setting of placenta previa. He then left for Lebanon, where he was in the French Resistance and had a thriving OB-GYN practice in Beirut, Lebanon, during World War II. And at night, there was a curfew, and he was part of the resistance and passed secrets around from the Russians to the French, so very dramatic. My father was born in this setting, and arrived as a new immigrant to the United States in the 1940s, where it was very hard to be a child whose parents had a German accent, given the prejudice against Germans at that time, but also went to New York City public schools, had a tremendous opportunity. It's really kind of the classic New York immigrant success story. You know, arrived in the United States with the shirts on their back and managed to work their way to a better life and achieve success and good education through public education for all their offspring. I will also say that my father had a public health stint. He worked in North Carolina as an alternative to going and serving in the Vietnam War, he was in the Public Health Service. And he worked in North Carolina in the textile mills and worked on a disease called byssinosis, which is also known as the brown lung. It's an occupational health disease that affects textile mill workers. As a child, I spent many dinners, hearing about byssinosis and brown lung, and black lung. I think at an early age I really came to understand how the world wasn't fair, and how it was instilled in me early on that it was important to work to try to make things better, particularly for people who didn't have privilege. And I think when you come from an immigrant family, and you realize how much privilege has been bestowed on you, that really leaves an indelible mark. I have to say, as Chair of Medicine at MSK, it is staggering to me the proportion of faculty here at MSK, but also at Dana-Farber, where I worked previously, we have lots and lots of immigrants who've been able to accomplish just amazing things through just motivation and drive and energy and creativity. And so, I'm a big believer in how much immigrants have powered this country. Dr. Pat Loehrer: Deborah, are your parents still alive? Dr. Deborah Schrag: My parents are still alive. They're both in their early 80s. And they both still live on the Upper West Side of Manhattan. So, I'm very privileged and fortunate to have living parents. Dr. Pat Loehrer: I can imagine the pride that they have for you. Dr. David Johnson: I just want to jump in and let our listeners know that Deb mentioned Charité in Berlin. That's the home of multiple Nobel laureates that all of us would know like Ernst Chain, who was one of the individuals involved in the development of penicillin, but Paul Ehrlich, Robert Koch, Hans Krebs, and for cancer doctors, Otto Warburg, among others. So, it truly is a world-renowned institution. Dr. Deborah Schrag: Well, my paternal grandfather was famous for this technique called version, which essentially involves putting your stethoscope next to the uterus, figuring out where the placenta was, and then essentially trying to flip the baby without disrupting the placenta or causing any harm, which required incredible skills with a stethoscope because you had to appreciate, I guess, the placental vessels. I'm not aware that this skill is still in existence, it was an important skill to have in the 1930s. When, if you did a C-section, there was a high probability of endometritis. So, you could save the baby, but you would often lose mom to endometritis. Or you could save mom, but you might not save the baby. So, at that time it was a big deal, but thankfully no longer. Dr. David Johnson: This is why we call it an Oncology, Etc. Our listeners didn't know that we're gonna get OB information in this particular podcast. Dr. Deborah Schrag: Or a digression on the history of medicine. I do find that, you know, I am inspired by the generations that came before me. I think it's also true that there are many physicians who are first-generation physicians in their families and some of us are privileged to have lots of healthcare professionals and sort of feel it as a calling. Dr. David Johnson: I think of you with many, many talents. But one of the things that I think stood out to me is, many years ago, you were in the van, talking about the financial cost of health care. I remember a very influential paper you wrote in the New England Journal, talking about the cost of treating GI cancer, colon cancer in particular. But where did your interest in that particular aspect of health care begin? What was the stimulus there? I mean, obviously you had a lot of stimulus from your family. What else? Dr. Deborah Schrag: That's really interesting. This is a little bit of a history of oncology. At that time, I was an assistant professor and assistant attending in the GI oncology service, seeing lots of patients with colorectal cancer. And we were working on a clinical trial of a drug called ImClone C225. And that was the name of the protocol. And we were putting patients in that clinical trial. And you know what? This drug was working. We were getting excited and the drug was moving ahead. We looked at the Phase 1 data and we launched Phase 2. We had meetings with the research protocol nurse and the research assistants, team meetings, and I would say there were about 50 people who were aware between the GI oncologists and the nurses and all the research assistants. You guys know that it takes a village and even though the villages were smaller then and it wasn't a particularly large trial, there are many, many people involved and everyone had the sense that this drug might be working. Just for context for our younger listeners, this is back in the early aughts, and basically, the drug that we had to treat colorectal cancer was 5-FU in many different formats and Irinotecan. And that was it. Some people thought mitomycin might work a little bit, but it was so horrible that it really barely worked. But that was what we had in our bag of tricks. So, the fact that we had this ImClone drug that eventually came to be known as Cetuximab, was remarkable. So, here's what happened. It turned out that this is the drug made by the company ImClone. And there were some shenanigans, some insider trading. And one of the people caught up in insider trading, in addition to some people involved with the company itself was none other than Martha Stewart, sort of the famous homemaker who still publishes magazines to this day. And you may know that she actually did some time in federal prison as a result of insider trading on this drug. I remember being a junior attending, and all the people involved in the trial and all the cancer professionals, we all knew this was working. But everyone respected the confidentiality of the situation, of the patients, and all the integrity that goes into academic medicine. And I remain inspired by the integrity of all the professionals, the doctors, the residents. These were not affluent people. I can tell you. we were not paying research assistants a whole hunk of money. They investigated every trade made by this company. There were absolutely no shenanigans or improprieties from the hard-working folks who helped bring this drug to market. So, as this was going on, we had many patients who were not eligible for the trial who were interested in getting the trial. So, of course, we followed as this drug got FDA approved and came to market. You could check me but I believe it was February 2004, it was FDA approved. It came out with a huge price tag. It was approximately $10,000 per month. I was mad because I was taking care of regular New Yorkers at that point. I had public school teachers, I had patients on Medicare and they couldn't afford the 20% copay. Because $10,000 a month for Cetuximab, if you have a 20% copay and you're New York City, public school cafeteria worker, is not yet eligible for Medicare with a typical plan that a New York City public school system employee would have, that was $2,000 a month. And that did not work for one of my patients who is essentially what we used to call a lunch lady. I was so mad that I decided to channel that anger into writing what I think is a perspective for the New England Journal called, “The Price Tag on Progress”. I wrote that piece. I know that many, many people and many of my esteemed colleagues have continued to work in that area and do research on the economics of drug pricing and there are many, many experts. I didn't stick with that. Not that it's not interesting, and not that it's not important. It's incredibly interesting and important, but I felt that the solution needed to happen in the legislature, state legislature, federal legislature. I think that this is about social policies, and we need to advocate for appropriate health insurance programs to make it possible for people to get coverage when they have catastrophic illnesses, and we need to think about the entire approach to drug pricing in this country. I still think that's important. I'm not convinced that what we need is more research on the topic. I think we need more policymaking and laws on the topic. I think we're still dealing with this. I'm sad to say that it's been nearly 20 years since I wrote that perspective. But I think it was motivated by frustration, not being able to get my patient what she needed, and many patients thereafter. And just the incongruity between some people benefiting from insider trading and all the good people who were doing the right thing. Dr. Pat Loehrer: I just want to throw in one thing if I can. Len Saltz, who's one of your partners, it was a piece of that trial that he presented at ASCO talking about ImClone C225. And ironically, it had a 22.5% response rate. And Len said, it's a bummer that ImClone didn't call it C995. Dr. Deborah Schrag: You have no idea how often we used to talk about that, joke about that in the clinic. I have another good story about that drug, which I think really illustrates something I believe and I think it's actually something that Osler said but it's also something I have to say I learned from both of you. And it has to do with listening to your patient. So, I had a patient named Matthew, who was a young man, 34 years old. He walked into my clinic with a diagnosis of diffuse metastatic colorectal cancer with multiple bilateral pulmonary metastases, which came to light when his tennis game was off. He was, at that time, an early employee of a newly started company called Google. And he was working on advertising algorithms, and Matt got the drug Cetuximab. And unfortunately, he was on it for quite some time. He was on it for about five or six months. But eventually, it was pretty clear that we were coming to the end of the road. And he and his wife planned a vacation. This was part of his end-of-life process planning. It was their fifth wedding anniversary in the Berkshires. We worked so hard to get Matt to the Berkshires to a beautiful inn, and on Saturday night, my pager goes off, and Matt cannot sit up. He's weak. And he'd been complaining of terrible fatigue for weeks, to me, and I really hadn't quite figured out why Matt was so fatigued. I mean, I just didn't understand it. And we get into this inn and I get a call from the Berkshire Medical Center, a small community hospital, 'Dr. Schrag, your patient is here. He's so weak and he can't sit up.' 'What's going on?' The ER doctor says, 'Well, he has a Chvostek sign', which is a sign of severe hypocalcemia. 'So, call me back with the calcium.' The calcium is low. Well, I think those of your listeners who are closer to medical school know that when the calcium is low, you have to check the mag. And Matt's magnesium was 0.2. And he got some magnesium in the Berkshire Medical Center. And all of a sudden, he felt great. He was able to go on and enjoy the second half of his fifth anniversary weekend at the Berkshire Inn and he came back. And I felt terrible because he'd been complaining to me of fatigue for six weeks and I hadn't checked his magnesium. I was like, 50 bilateral pulmonary metastases on chemotherapy. That's a fatigue explanation. Suffice it to say that we went on to start checking magnesium on everyone getting Cetuximab. Now mind you, the drug is FDA approved and FDA labeled at this point. So, we started checking magnesium, and we find that it was low. I start getting on the phone and calling my mentors. I called Dr. Bob Mayer, who was the head of my fellowship director and was like a revered mentor to me. 'Hey, Bob, does anyone up there in Boston have low magnesium from Cetuximab?' 'We don't check magnesium.' I said, 'But can you check?' I started calling around and that's a great example of the community of oncology. We are a community. I just started working the phones and calling friends and saying 'You guys checking magnesium for any of these folks on Cetuximab?' Suffice it to say, we figured out that their EGFR receptors in the ascending loop of Henle - so, again, back to biology and pathophysiology - the drug Cetuximab was blocking reabsorption of magnesium in the kidney, and it was Cetuximab that caused a terrible magnesium wasting. Oral magnesium did not work. You had to give it intravenously, repeatedly. And we helped eliminate fatigue for a bunch of patients. About six months later, I showed up at ASCO with these little cardboard slides and a little poster back in the corner and put up our little case series, very little. But I'm proud to say that we changed the label of Cetuximab and it's now on the label that it causes hypomagnesemia. It might be one of my more cited papers, paradoxically. But I think it's a principle that really has stuck with me, and I've tried to impart it to all the students and residents and fellows, 'Listen to your patients because - I think it comes from Osler- they're telling you something. We have to pay attention.' Again, I have never forgotten that. But really listening and trying to figure out how we can use our understanding of pathophysiology and what our patients tell us to ask questions and not just accept dogma and try to figure out what we can do. And you know, I couldn't have figured that out on my own. I happened to find a really smart nephrologist who happened to be able to sort of go to animal models and knew the right studies and the right people to talk to. Dr. David Johnson: It's one of the reasons why we are a multidisciplinary specialty. And we use the expertise of our colleagues. I think that's such a wonderful example of listening to one's patient and it really profoundly impacted our understanding of how that drug works and renal physiology, actually. That wraps up part one of our interview with Dr. Deborah Schrag, Chair of Medicine at Memorial Sloan Kettering Cancer Center. We hope you've enjoyed learning about her background and her early career. In part two of our conversation, Dr. Schrag will discuss her programmatic goals at Memorial Sloan Kettering, the importance of mentorship and leadership, and what it means to have joy in the profession of medicine, and, frankly, much more. So, please be sure to join us. As always, we want to thank you for tuning in to Oncology, Etc. an ASCO educational podcast, where we will talk about just about anything and everything. So, if you have an idea for our topic or a guest, please email us at education@asco.org. Unknown Speaker: Thank you for listening to the ASCO Education Podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.

united states women new york director university texas new york city english google french germany german russian er north carolina medicine berlin jewish hospitals progress world war ii nazis south carolina manhattan phase columbia associate professor columbia university public health fda ob memorial lebanon medicare nobel vietnam war gi beirut drs mph oral ob gyn indiana university rediscovering puerto rican rudy giuliani new yorkers martha stewart oncology deli brigham suffice health equity new england journal gestapo david johnson price tags asco upper west side harvard school great physician charit berkshires memorial sloan kettering cancer center baskin robbins msk jamie raskin french resistance egfr german jewish memorial sloan kettering paul ehrlich osler robert koch ut southwestern public health service dana farber zabar otto warburg schrag henle population sciences cetuximab global oncology bob mayer irinotecan berkshire medical center transcript dr ernst chain hans krebs

The OJC Meets Sanchia Aranda

ceo heretic aranda intending global oncology

Play Episode Listen Later Apr 7, 2022 39:49

The Oncology Podcast - An Australian Oncology PerspectiveThe Oncology Podcast, brought to you by oncologynews.com.au, is proud to present the latest episode in our ‘The OJC Meets…' series.In this episode, Craig Underhill speaks candidly with Professor Sanchia Aranda AM.You may know Sanchia from her long-accomplished career in cancer nursing and key leadership roles such as the CEO of Cancer Council Australia. She is a nurse, professor, researcher and influencer.Sanchia shares insights from her early days when she left banking to take up nursing training. Intending to nurse burn victims, she instead found herself working alongside the ‘witch doctor' otherwise known as the oncologist.It's a fascinating listen charting the beginnings of the oncology specialty. We explore Sanchia's entry into academia, the taboo of friendship with patients and her incredible work in global equity.You'll also find out why she is still a proud heretic.As always, you'll find links to the papers, resources, bios and twitter handles in the notes on our website. For the latest oncology news visit www.oncologynews.com.au and for regular oncology updates for healthcare professionals, please subscribe to The Oncology Newsletter.

Oncology, Etc. – Mr. Paul Goldberg: Interviewing the Interviewer (Part 1)

Play Episode Listen Later Apr 5, 2022 17:35

Drs. David Johnson (University of Texas) and Patrick Loehrer (Indiana University) host the first of two Oncology, Etc. episodes featuring Mr. Paul Goldberg, book author, investigative reporter, and Editor and Publisher of The Cancer Letter. In part one, Mr. Goldberg reflects on his two main interests − human rights and cancer, and his early career as a journalist and novelist. If you liked this episode, please subscribe. Learn more at education.asco.org, or email us at education@asco.org. TRANSCRIPT Dr. Pat Loehrer: Hi I'm Pat Loehrer, I'm the director of the Center for Global Oncology and Health Equity here at Indiana University. Dr. David Johnson: Hello, my name is David Johnson. I'm at UT Southwestern in Dallas, Texas. And we've got a great guest today and we're excited about the interview. Dr. Pat Loehrer: Yeah, it's very timely too, I think it's terrific. Before we go on to that, are there any recent books that you've read that you want to recommend? Dr. David Johnson: Yeah, actually, I do. It's somewhat related to our topic today. I just finished a book entitled, Presumed Guilty by Erwin Chemerinsky, who's the Dean of the Law School at the University of California, Berkeley. It's actually recommended to me by a lawyer friend. I think most of our audience knows the fourth, fifth, and sixth amendments to the Constitution are the ones that provide protection for people accused of crimes. And I think most of us are familiar with the Warren Court in the 50s and 60s, which seemed to be a very, quote-unquote liberal court that provided many of the protections that you see on TV shows, police TV shows de including the Miranda protections, but as Chemerinsky points out in his book, that really is a historical aberration, that the Supreme Court from its founding really right through today is then on the opposite side of the fence in terms of protection to the accused can many landmark rulings over the last several years, including Terry versus Ohio and City of Los Angeles vs. Ryan, have actually provided protection and sanction stop in frisk activities, limited suits against police departments to institute reform, and even provided some benefit for the use of so-called lethal chokeholds. Smaller than I think, in light of what's happened over the last several months, really provided some insight, to me at least, about how the Supreme Court looks at the protection of the accused. I thought it was a very interesting book to read. And Chemerinsky does a great job of explaining these landmark cases in a way that simpleton like myself can understand them. So, I recommend it to you. I think you'd enjoy it. Dr. Pat Loehrer: Yeah, there's a book called “Just Mercy” by Bryan Stevenson. I'm not sure if you've ever had a chance to read that. It is an outstanding read. They made a movie out of it but if you get a chance to read the book, it's really terrific. Again, it talks a lot about the inequities in terms of how our court systems have prosecuted people of color for minor crimes compared to people that are in the majority here. But I think both of those would be great reads. Dr. David Johnson: Yeah, I haven't read it, but I will. Dr. Pat Loehrer: Yeah, it's terrific. Go for it. Going ahead in getting started, it's our great pleasure to have Mr. Paul Goldberg join us today. Anyone in oncology knows him. He is the editor of the Cancer Letter. Interestingly, he was born in Moscow and emigrated here to the United States at the age of 14, where he went to Virginia. He got his undergraduate degree at Duke in economics. And shortly thereafter, he worked in a newspaper in Reston, Virginia, where he met his future wife. I think from there, they went to the Wichita Eagle in Kansas. His wife was actually the daughter of the founder of what was to become the Cancer Letter, Jerry Boyd. He rose to associate editor and finally editor in 1994, and publisher and editor about a decade ago. The Cancer Letter is the go-to newspaper for us in oncology. Over 200 institutions subscribe. There's not a cancer center director in the country that does not look forward every week. One is to see if it's in there, you hope it isn't. And then if it is, you hope that there are really some platitudes in there about how wonderful you are, and then you can go ahead and read the rest of the article. The New York Times once said that everybody who's anybody in the cancer field reads this newsletter. He's won a number of awards, including the Washington DC professional chapter of the Society of Professional Dermatologists and some Gerald Loeb awards. His investigative work has uncovered some extraordinary events, including the Duke scandal with genomics, the ImClone scandal, as well as some of the workings of SIPRAD and MD Anderson, and I think he is really a flashlight that looks in the dark corners of our world, but also is there also to cheer on some of the accomplishments in oncology, and he knows Brawley and have written a book together, How We Do Harm. They're also doing the history of oncology together. He's a novelist. He's a nonfiction writer, and he's an extraordinary individual. And I think we're really looking forward to spending a few minutes with you here, Paul, thank you for joining us. Paul Goldberg: Thank you for inviting me. This is really a pleasure to spend some time with friends. Dr. Pat Loehrer: Well, by the time this gets aired, hopefully, the crisis in Ukraine will be over. But just last week, the Russians invaded Ukraine, and I think it's very timely to hear more about this and the fact that you grew up in Moscow and Russia. Tell us a little bit about your early life, your upbringing, your family background, and what prompted your family to immigrate here to the United States? Paul Goldberg: Well, it suddenly became possible and it was something that my father wanted to do. So, we just sort of ran as soon as we could, and certainly, I had kind of a fascinating time that I've been chewing on for many years as a novelist. In fact, they've just turned it into a novel, which will be published not this coming summer, but the following summer, it's called The Dissident. It's about the Soviet human rights movement and it's set in 1976. By then I was here, actually. But it's kind of like material that found me and really weirdly, it's also why I'm in oncology, where I'm covering oncology. My material kind of found me when I was in college, my drinking friend's mother, Ludmila Alexeiava was one of the founders of the Moscow Helsinki group. Interestingly, also, my first book was about the Moscow Helsinki watch group, which is really the beginning of human rights monitoring, which is really a staple, let's say the beginning of the NGOs. It's a staple of world order to rely on people within the country that it's being written about covering themselves in a way. It's kind of like free social media. And then, of course, enhanced greatly by social media. That was my beginning, but what was also interesting is that being a writer, and I really wanted to be a novelist, I did not want to then write nonfiction, but the material was so good that I had to jump in. Then I also had to, like, temporarily at least, make a living doing something else. So, my former father-in-law, my dad at the time, my father-in-law, now my late former father-in-law, terrific guy, Jerry Boyd, just hired me to do some work for him. I started some stuff and he used to brag that he's the only guy who's ever made money off son-in-law. Dr. David Johnson: But Paul, I'd be really interested to know, where did your interest in cancer begin? Was it with the Cancer Letter or had there been some interest prior to that? Paul Goldberg: Well, when I was working for the Wichita Eagle, I kind of got interested, I always gravitated towards stories about things like insurance, for example, the value of life, anything that had to do with these sorts of very complicated philosophical questions. That was kind of the beginning of my interest. That's why I didn't say, oh, no, this is too wonky. I don't want to have anything to do with this. Also, when people realize, it's always interesting, there's a fair amount of that in oncology. So, I was trying to find that, and just the complexity and the characters. You'll run into characters in oncology that you kind of wish to run into because you can have half an hour-long conversations or two-hour-long conversations or three-hour-long conversations with a lot of folks without really getting off-topic. I mean, I get a lot of criticism from the kids and my staff telling me that I'm nonlinear in my thinking, but that's linear in this field. It's also once you get into questions like ethics, that's really the fundamentals of oncology, and that's also the fundamentals of my other interest, which is human rights. It's also the artistic potential of this field is incredible. It just kind of grew on me but basically, it all began as a kind of a way to make up for unevenness in cash flow from writing books. And then it just became so great. If you want, I can tell you what the actual events were that made me just say, this is my field. Dr. David Johnson: Yeah, I'd love to hear that, tell us. Paul Goldberg: Two early ones. One of them was the beginning of the National Breast Cancer Coalition. I was initially taking a nap at the Senate hearing. I was editing a manuscript that was around 1992. I was editing a manuscript that got a little bit boring for me to just sort of listen to most things and I just fell asleep. And then I heard Fran Visco's voice booming through and I had no idea who Fran Visco was, nobody had any idea who Fran Visco was. He was giving her “Men in Suits” speech, which is like the beginning of the patient's movement in breast cancer. I kind of woke up and I pushed the button on my tape recorder and I got it. It was just unbelievably cool. I said, okay, so conversations that they had in the kitchens, wherever, there are these people who are talking about setting up a public movement, because there was never a public movement really of patients in oncology. For the most part, it just felt a little bit boring. I started working around the corners of oncology around 1985-86, really, 5 or 6 years later, I was writing other books. And I was bored a little bit because there were a bunch of white guys making decisions behind closed doors. They stopped smoking a few years before, but there were still white guys behind closed doors. Suddenly, this was something completely different. This was a public movement. And I could recognize the public movement because I'd seen them, I'd written about them, I did a story about them. So, there was that. Then came up about that very same time, really roughly the same time came the NSABP scandal. The Cancer Letter was writing fairly short stories. Now, it has been around since 1973. So, there's just this incredibly rigorous device for monitoring the history of oncology, you can just crack the thing. But it was different because Jerry didn't write 5000-word stories. Sometimes he did but mostly he didn't. But I can't really express myself briefly, I kind of have to go, and so, I started realizing that I could just return to this story over and over and over till I understood it, until everybody else got, so because of drilling, probably I must have written 40 stories on NSABP, maybe more. I don't know, over the years, maybe I'd written, but they just sort of said to me, hey, this is a field that's now politicized in a way that kind of sustains journalism. Controversy is unbelievably cool with this because here's a group of patients who are saying, we don't really care about NIH funding, in this case, but we care about just funding for breast cancer, and we want to do it our way. Let's do it through DOD. That was an amazing story to cover. Then there's the story of Bernie Fisher, who was like the great man of oncology, getting kind of pulled through the wringer on this thing, and it was awesome. Then another thing started happening. I started going to the meetings, mostly I loved ODAC. I always loved ODAC and I still love ODAC. I haven't missed an ODAC for maybe 40 years or something. And the same goes of course, for NCAB. Basically, here is a discussion as a spectator sport. Oh, wow! I kind of got passionate about this whole thing. Like, covering ODAC like Dave Johnson's ODAC was hilarious. It was a comedy show. Basically, Dave was doing some really cool stuff. Really good material, not really quotable because the jokes were a little loud. Schilsky was hilarious in the ODAC. Raghavan was really funny on ODAC. And then there was Sledge. It was also very, very funny. So, there was this sort of a discussion of this very complicated stuff that I just started quoting. I think I must have quoted Dave's joke. I think you learned from your grandfather, a box turtle on top of a fencepost didn't get there by accident. Dr. David Johnson: It's correct. Paul Goldberg: Yeah, it became an obsession to just follow the characters. Dr. Pat Loehrer: But by the way, Paul, we did interview Rick Pazdur a short time ago, and Rick did not say that Dave was funny. I just want to let you know. There was no comment about that at all. So, there's just another side to this story. Paul Goldberg: Well, the funniest bit was when Derek Raghavan once asked, we need a translator here for southern English, why does it need a box turtle on a fence and it gets there by accident? I don't think Dave explained that that time, but I have to look at my story because I would just get into these digressions of this. I think that was also where Rich Schilsky invented the term, toxic placebo. Dr. David Johnson: Yes, we had a study, we had to review that showed, frankly, that the placebo was actually better in some ways than the actual alleged, like the drug but with a lot of side effects. So, Paul, you've been in the midst of a lot of really interesting stories, some would say controversial ones. ImClone, Pat mentioned earlier, the Duke scandal, where do you get your information? Without divulging. Paul Goldberg: Well, some of them I can't really divulge. But some of them I can. The beauty of the internet now is that people can come up with an email address and send me stuff and I can actually communicate with them, and I don't even have to protect my source because I have no idea who my source is. There was one of these stories you've mentioned, I'm not going to say which one where I could just sort of dial in the question. Like, I could just email this person whose nickname could be Mickey Mouse. I mean, I think that was Mickey Mouse. So, I can just send the question to Mickey Mouse, what happened at XYZ? I'd like to see a picture of XYZ, and then Mickey Mouse would send me something. Dr. Pat Loehrer: This is like all the president's men? Paul Goldberg: It's a lot like that. It's much easier because you don't have to count back or whatever and hang up, although I've done that it's kind of funny. Yeah, sometimes things show up anonymously. Dr. Pat Loehrer: Well, that concludes part one of our intriguing interview with the cancer letter Editor Paul Goldberg. Stay tuned for part two of this conversation, where we'll learn more about the literary works of Mr. Goldberg, who's developed these works outside of the Cancer Letter. We'll see and hear about his incredibly important insight into the Russian Ukrainian conflict and much more. Thank you to all our listeners for tuning into Oncology, Etc. This is an ASCO education podcast where we will talk just about anything and everything. If you have an idea for a topic or a guest you'd like to see on the show, please email us at education@asco.org. Thank you for listening to the ASCO education podcast. To stay up to date with the latest episodes. Please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education that asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO the mention of any product service organization activity or therapy should not be construed as an ASCO endorsement.

Oncology, Etc. - Out of this World: Astronaut Physicians (Part 1)

Play Episode Listen Later Mar 1, 2022 22:08

In part one of a two-part conversation, Oncology, Etc. hosts Patrick Loehrer (Indiana University) and David Johnson (University of Texas) have a blast speaking with two physician astronauts. Hear the incredible stories of Drs. Robert L. Satcher (MD Anderson), Ellen Baker (MD Anderson), and their lives on and off this planet. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. TRANSCRIPT Patrick Loehrer: Hi, I'm Patrick Loehrer. I'm Director of Global Oncology and Health Equities at Indiana University. Dave Johnson: My name's Dave Johnson. I'm at UT Southwestern in Dallas. Patrick, we're excited to be back for another segment of ASCO's Educational Podcast, Oncology, Etc. We have two very special guests today, Drs. Ellen Baker and Robert Satcher, oncologist and former astronauts. So I predict this will be an out of this world segment. Patrick Loehrer: It's starting out pretty slow right now, with that one. Thank you though. Dave Johnson: Well, listen, this should be a great segment. But before we get started, do you have a favorite astronaut book? Patrick Loehrer: Well, the one I read this summer was called American Moonshot by Douglas Brinkley, and it basically took the story of John F. Kennedy and how the space race happened from 1960 and actually earlier than that, into getting onto the moon. It was really, I thought very extraordinary. Dave Johnson: So, I haven't read that yet. My favorite would be Rocket Boys by Homer Hickam. I thought that was a fantastic book about his life growing up in West Virginia and ultimately, becoming a NASA engineer and rocket scientist. So that was really great. Patrick Loehrer: I read that several years ago after you recommended it. They made a movie out of that. Dave Johnson: Yeah, I think October Sky was the name of the movie. Yeah. >Patrick Loehrer: Yeah, it's a terrific book. Dave Johnson: Well, why don't we introduce our guests? You want to start with Dr. Baker? Patrick Loehrer: Oh, sure. It's my pleasure to introduce Dr. Ellen Baker. I have known Ellen over the years through interactions in global oncology. She was born in Fayetteville, North Carolina, graduated from Bayside High School in New York, got a bachelor of arts degree in geology from the State University at Buffalo. A doctorate in medicine for Cornell, masters in public health at UT Public Health, and then trained in internal medicine at UT San Antonio. And during her residency, she decided to join in the NASA program as a medical officer. And it was actually, she did a residency around the same time I did, and I remember the space call for astronauts at that time. She was selected as an astronaut in may of 1984, had a variety of jobs. She's logged more than 680 hours in space and has been a mission specialist. She retired from NASA in 2011 and is Director of the MD Anderson project, Echo Program in which he does projects in rural Texas, as well as Zambia, Mozambique, in Central and South America. It's such a great pleasure to have you here today, Ellen. Dr. Ellen Baker: Thank you, Patrick. Dave Johnson: Our other guest is Dr. Robert Satcher, currently an Associate Professor in the Department of Orthopedic Oncology Division of Surgery at MD Anderson, as well. Dr. Satcher grew up in Hampton, Virginia. He's the son of a university professor and English teacher, so I'm sure they made him do all of his homework. He received a bachelor degree, as well as a PhD in chemical engineering from the Massachusetts Institute of Technology and received his MD degree from Harvard. By the way Patrick, Dr. Satcher enrolled at MIT at age 16 and graduated at the top of his class. Later, we'll find out what you were doing at age 16? Patrick Loehrer: I do have to interject that I was a mechanical engineer at Purdue, and it's like being in high school compared to chemical engineers. Dave Johnson: Yeah, there's a hierarchy in the engineering world for sure. Dr. Satcher's medical degree was followed by internship and residency in orthopedic surgery at the University of California, San Francisco. In addition, he did a post doc research fellowship again at MIT and University of California, Berkeley. And completed a fellowship in muscular skeletal oncology at the University of Florida, before joining the faculty at Northwestern in Chicago. You guys have a lot of connections it seems? Not satisfied with that massive amount of education and training, Dr. Satcher went on to NASA to train as an astronaut, culminating in a flight aboard the space shuttle Atlantis in November of 2009. Apparently, he got a little bored cooped up in the shuttle because he took a couple of space walks, which I'd like to know more about. In fact, I read on NASA's website that he did some lubricating on one of his walks. I'm not sure what that's about, but I assume there's not a lot of gas stations in space. I also read that he repaired one of the robotic arms, which seems perfect appropriate for an orthopedic surgeon. You'll have to tell us more. Anyway, while these achievements would be enough for most people, it only begins to scratch the surface of the many accomplishments of Dr. Satcher's career to date. I really can't cover it all, but our audience should know that Dr. Satcher's has been involved in a number of community activities, as well, ranging from his involvement in Big Brother for Youths at Risk, counseling program, to serving as a lay minister in his church. He's also undertaken a number of medical mission trips to underserved areas in countries, such as Nicaragua, Venezuela, Nigeria, and Gabon, where he once served as a Schweitzer fellow at the Albert Schweitzer Hospital in Lambaréné. Dr. Satcher, welcome to Oncology, Etc., we very much appreciate your joining us. Dr. Robert Satcher: Thanks Dave. Glad to be here. Dave Johnson: Perhaps I'll start by asking the two of you, if you could give us just a little bit about your background, other than what we've stated and what got you interested in medicine and how you got interested in space? Dr. Baker, maybe we'll start with you? Dr. Ellen Baker: I've always been interested in space. I was a child of the '60s, and I think one of the very memorable parts of the '60s was the US Space Program. It was a fairly tumultuous decade in the US, I think otherwise, and the space program was really literally a shining star. However, there were no girls in the space program at that time. Right? There were no girl astronauts and so I thought about it, but it didn't seem like it was even possible. I come from a family of medical people. My mother was a nurse, my father was a doctor, my brother is a doctor, and so that had a lot of influence, I think, in my choosing to go into medicine. And in fact, my brother is an oncologist and though I am actually not an oncologist, I've been hanging around with him long enough that some people think I'm an oncologist. So I think that's what got me pointed in that direction. Dave Johnson: Your brother is Larry Schulman, by the way, right? Humanitarian of the Year Award from ASCO, a couple years ago. Dr. Ellen Baker: It is, yes, and he is a great humanitarian. I was actually at my last year of medical school when I saw a little article in the New York Times that NASA was selecting new astronauts and women and minorities were urged to apply. And I kind of filed that away and went off to do my medicine residency and at the end of my residency, I applied to work for NASA as a physician. And that's how I got to Houston and to Johnson Space Center. Dave Johnson: Dr. Satcher, what about yourself? Dr. Robert Satcher: I got interested in space and being an astronaut when I was a kid too, and I was watching astronauts land on the moon. And I was sitting there listening what Ellen was saying and yeah, it was a time where all the astronauts were of course, white males and I didn't see myself there walking on the moon, but I knew it was something that I would really like to do, but didn't really see a way either, at the time. So it really was with the shuttle era that women, people from underrepresented groups finally had the opportunity to become astronauts. And right around the same time too, was when I was starting as an undergraduate at MIT and had the good fortune of meeting Ron McNair, who got his PhD from MIT. And that was the first time I ever saw someone who looked like me, who was an astronaut and that planted the seed that maybe I could do that one day. I also come from, as you mentioned, a family that values education and we've got a number of physicians in our family. Most famously my uncle, Dr. David Satcher, who was Surgeon General of the Clinton Administration. And I always remember, this is a funny story I like to tell if he's listening. When I was going around getting advice on whether or not I should stick with medicine or think about applying to become an astronaut, he advised me just to stick with medicine. So didn't take his advice, this is the one time I didn't, but I did take his advice, in terms of going to medical school. And I wound up applying to become an astronaut, right actually, before the Columbia accident and so they actually paused taking astronauts for a number of years. And in those years, actually that's when I went to Northwestern and was on faculty there. So they opened it up again and that's when I submitted my application and I was in Chicago and was selected from there. Dave Johnson: There's a number of questions that spill off from that. You guys may know David Wolf, who's an astronaut, who's from Indiana University. I had him in my clinic when he was a medical student and as I always do, I basically say, "What do you want to do when you grow up?" And he said, "I want to be an astronaut." And I just smiled and I don't think I ever went back in the room with him, I just figured, "This guy is a flake, what's going on with him?" And I think he's logged more space miles than just about anybody, he's an incredible human being. And again, if he's listening, you're terrific. David. Patrick Loehrer: I just have to ask this as a boyhood thing, because I did contemplate being an astronaut because I was an engineer and MD just like you were Ellen and so were you Bobby. But it hit me, one is, you have not to be afraid of heights, I think. And then, you have to be willing to go around in a circle a thousand times a minute and not throw up. But in the training there, did any of that stuff bother you or was this no big deal? Dr. Ellen Baker: That sounds a little like Hollywood and not so much like the real thing, actually. In the early days of the space program, they did put astronauts in rotating chairs. I'm not exactly sure why? But we don't do that anymore. I would say that the training is rigorous, but it's not unreasonable. I don't know what you think, Bobby? It's fairly predictable. And I will put a little shout out for Purdue, which maybe has one of the highest number of astronauts of any university outside the military academies. I don't know if that's true now, but 10 or 15 years ago, we just had a large number of engineers from Purdue who were in the astronaut office. Dr. Robert Satcher: I agree, the training is not quite how it's portrayed sometimes in the media. The question I get asked from my doctor friends a lot, "I guess you can't be claustrophobic going into space because you're in the space capsule." And that really does deter a significant number of people, probably more than myself or Ellen appreciate because I'm always surprised when I get that question. Dave Johnson: But I'm 100% sure I couldn't be an astronaut if claustrophobia is an issue because I can't stand to be in an elevator. Dr. Ellen Baker: Let me step back a little, I don't want anybody to get discouraged. But you'd be surprised at how many pilots have a fear of heights if they're not encased in an airplane. So fear of heights is not necessarily something that you might worry about if you're an astronaut. And I disagree with you Bobby, I don't think space vehicles are claustrophobic. It's not like being in a submarine, which I would find very claustrophobic. Particularly in the shuttle because we actually had great windows and great views and we didn't feel confined. I don't know what you think Bobby, but I didn't think it was like being in a cave or closet or a submarine. Dr. Robert Satcher: Yeah, I definitely agree with that, the views are spectacular. Patrick Loehrer: So William Shatner just went up and had a brief stint in space and is now considered an astronaut, but he came back with such a sense of awe. Can you describe a little bit what it's like, the view from up there and how does it leave you, particularly your first time up in space? Dr. Robert Satcher: The words don't completely capture it. The colors are so vivid, the view is so breathtaking. It's really impressive seeing the Earth, not only at daytime, but at nighttime and it goes beyond. It's one of a few things I always tell people, that really exceeded my expectation, in terms of what my preconceived notion of what it would be. And ever since going, that's what's so addictive about going into space, it makes you want to go back just to see that again and experience it again. The closest that I've come to seeing anything like that is, they have these new virtual reality experiences, where they actually got footage that they shot in high-def on the space station, outside the space station. It comes close, in terms of the look but it still doesn't fully capture it because the colors and everything, aren't as clear and crisp as it is when you're there. Because you're in the vacuum of space and there's nothing interfering with it and it's just spectacular. Dr. Ellen Baker: Yeah. I'll jump in here too and I absolutely agree with Bobby. And the other thing is, you orbit the Earth every 90 minutes, so you cover a lot of ground and you see a lot of the planet and in that one orbit, you get a sunrise and a sunset. So you orbit the Earth 16 times a day and get 16 sunrises and sunsets, so every 45 minutes the sun is either coming up or going down. It's really hard to know what time of day it is, in terms of your work day in orbit, but it's just magnificent. And it did give me a sense that we're all from the same planet and of course, it makes me wonder why we can't all get along better? Patrick Loehrer: I think people our age remember a few things, we remember the day Kennedy was shot. We remember the landing on the moon with Neil Armstrong. We also sadly, also remember the Challenger disaster and where we all were at that point in time. Ellen, you were an astronaut at that time. Dr. Ellen Baker: I was. Patrick Loehrer:> Can you reflect a little bit about that, if you can? I'm not sure I could do it without getting emotional, if I was there. Dr. Ellen Baker: Yeah, I was actually at work of course, and watching the launch and it was just devastating. Obviously, I knew everybody on board, I knew their families very well. And I have to say, we knew flying in space was risky, but we were still pretty unprepared for Challenger and for Columbia. It is something that I still think about. As weird as it might sound, I actually rescued the plant from Dick Scobee's office. He was the Commander of Challenger and I still have it growing. So it's a reminder that he was a good friend and a good colleague, it was a terrible blow, as was the Columbia accident. In that same tradition, I have African violets by my sink that were in Laurel Clark's office and Laurel was a physician who was aboard the Columbia, as well as Dave Brown, who was also a physician on the Columbia. Dave Johnson: That's an amazing tribute to both of your colleagues. It's very touching to hear that. I wonder if the two of you could share with us, what you actually did on your missions scientifically? How did you use your medical knowledge, if at all? And Robert, what about your oncologic knowledge, was that useful at all? Dr. Robert Satcher: Fortunately, no use for the oncology training in space. I got to use the orthopedic training. One of the most common problems is back pain the first few days when you're in space. We attribute it to, you're going into weightlessness and all of a sudden, there's these fluid shifts, you get more fluid in your inner discs, everybody gets taller. Dave Johnson: Well, let's send Patrick to space. Patrick Loehrer: We need to get up there soon, Dave. Dr. Robert Satcher: Yeah. Actually, during our visit, we measured everybody's height just so that we know what that change was and we did do a experiment actually, that my background came very useful for. We were looking at the effects of bisphosphonate on bone loss. So bisphosphonates, well, everybody knows, this is ASCO, a class of drugs, anti-absorptives, used in patients with bone metastasis. It was actually being tested in rats, thinking about countermeasures for keeping people from losing bone in long duration, space trips. Unfortunately, bisphosphonates come with a lot of effects. But it did seem to work, in terms of the bone mass, which is induced by weightlessness in rats. And then finally, I was the crew medical officer for my group because I was the only MD up there in our crew. Ellen probably was the same in hers. So, what that involves is, NASA was one of the first places to pioneer use of telemedicine. So, you're basically, communicating with the flight surgeons on the ground every day, talking about what sort of medical issues there are with the crew and getting their recommendations for dealing with whatever it is. So yeah, being a doctor actually came very much handy. Dave Johnson: I was going to ask both of you. During your flights, did you encounter any medical emergencies without violating HIPAA? I mean, did you have to do an appendectomy? Dr. Ellen Baker: No appendectomies and fortunately, no emergencies, astronauts are pretty well scrutinized and examined before flights. And I think the best insurance against a medical problem in space is to send crews that are really fit and really healthy. And of course, there's always the risk of things like trauma, but the risk is actually fairly low. So no emergencies on my flight. Patrick Loehrer: There's no RVUs up there are there, that you have to worry about billing or no? Dr. Robert Satcher: No, we didn't have to deal with third-party payers. Patrick Loehrer: This is looking more and more like a job I want to pursue here, I'm going to be taller and there's no billing. This is great. Dave Johnson: I want to hear from Ellen, what sort of experiments she was involved in and how her medical background helped her assist with that? Dr. Ellen Baker: Yeah. People think, "Gee, if you're a doctor and you're an astronaut, they selected you to be a doctor in space." But in fact, astronauts are selected sort of generically. So once you come into the office, you're trained as an astronaut and Bobby and I were both mission specialists, as opposed to astronaut pilots. And so we received training on all sorts of different things. Bobby did a space walk. I trained for space walks, but never did one. We trained on the remote arm. We trained how to fix things when they were broken. I was actually a flight engineer on one of my flights. But that aside, I was also the crew medical officer and on every flight astronauts participate in medical experiments, because we are trying to gather lots of information from very few people on the physiologic effects of space flight, particularly looking towards longer flights, perhaps back to the moon or to Mars. So I did participate as a subject, I was an operator in a few medical experiments, but the bulk of my responsibilities actually were not medical. And I think Bobby, maybe you would agree with that? We did have some flights that were designated as what I would call, space life sciences flights, but there was only a handful of them and I was not a crew member on any of those flights. Patrick Loehrer: Boy, I could spend another three hours on this and would love to hear more stories. Dave Johnson: This concludes part one of our interview with former NASA astronauts, Drs. Ellen Baker and Robert Satcher. Please be sure to tune in to part two of the interview, where we will learn more about the incredible work they're doing in their post NASA careers. Thank you for tuning in to Oncology, Etc., an ASCO Educational Podcast. If you have an idea for a topic or guest you would like us to interview, please email your suggestion to education@asco.org. Thank you for making Oncology, Etc. a part of your day. Announcer: Thank you for listening to the ASCO Education Podcast. To stay up to date with the latest episodes, please click subscribe, let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at education.asco.org. Announcer 2: The purpose of the as podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guests statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy, should not be construed as an ASCO endorsement.

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33. Zsuzsanna Devecseri - Vice President & Head of Global Oncology Medical Affairs at Sanofi

Healthcare and Higher

Play Episode Listen Later Feb 18, 2022 61:51

Dr. Zsuzsanna Devecseri is the Vice President and Head of Global Oncology Medical Affairs at Sanofi. She leads a team of experts responsible for regulatory submission strategy, scientific communication, and innovative approaches to curing prostate and genitourinary cancer. Dr. Devecseri has held several prominent positions within the organization including Senior Director, Global Medical Lead of Pompe Disease and Director of Medical Affairs, Strategic Planning and Operations. Prior to joining Sanofi, she served as the Director of Client Services for ABN AMRO Life and Pension Insurance Company. Dr. Devecseri earned her medical degree from Semmelweis University and her MBA from Corvinus University of Budapest. She has also gone on to earn 4 certifications, including a Certificate in Health Economics and Outcomes Research from the University of Washington. Learn more about Dr. Devecseri at https://atchainternational.com/healthcare-and-higher-podcast-ep33-zsuzsanna-devecseri/ Are you a healthcare professional or healthcare executive looking to advance your career, build a better brand, or create a leadership legacy? Iqbal can help! Schedule your FREE CONSULTATION today at https://atchainternational.com Connect with Iqbal on: - Linked at https://www.linkedin.com/in/iqbalatcha/ - Instagram at https://www.instagram.com/iqbalatcha1 - Twitter at https://twitter.com/IqbalAtcha1 Join us next week for another exciting episode of the "Healthcare and Higher" podcast! #HealthcareAndHigher #IqbalsInterviews Song Credits: "Life Is A Dream" by Michael Ramir C. "Stay With Me" by Michael Ramir C. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/iqbal-atcha/support

Oncology, Etc. - Female Leadership in Practice: Two ASCO Leadership Development Program Success Stories

Play Episode Listen Later Feb 1, 2022 33:42

In this Oncology, Etc. episode, Drs. Patrick Loehrer and David Johnson Speak with Drs. Lecia Sequist (Massachusetts General Hospital) and Melissa Dillmon (Harbin Clinic) on how ASCO's Leadership Development Program (LDP) has taken them down varying paths, as well as the ways it has influenced their lives, careers, and the lives of those around them. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air Date: 2/1/22 TRANSCRIPT [MUSIC PLAYING] PAT LOEHRER: Hi, I'm Pat Loehrer. I'm director of the Center of Global Oncology here at Indiana University. DAVID JOHNSON: And hello. My name is David Johnson. I'm at UT Southwestern in Dallas, Texas. So Pat, we've got a couple of really great guests today. PAT LOEHRER: Yeah. I'm really excited. I've been looking forward to this. DAVID JOHNSON: So have I. Listen. Before we get started, I have a book I want to recommend to you. This one I got over the holidays and just finished it recently. It's called The Doctors Blackwell by Janice Nimura. So as many of our listeners know, Elizabeth Blackwell was the first female physician in America. Her sister Emily also followed her into the medical profession. Nimura really writes, I think, a fascinating biography about both ladies, particularly Elizabeth. And one point she made, and I think it's interesting, it's not really clear why Elizabeth went into medicine. Certainly at the point that she did in the mid-1800s wasn't a profession of great reputation at that time. And, in fact, Nimura describes Elizabeth as, quote, "lacking a caring instinct," which I thought was an interesting characterization of the first female physician. And she indicated that she was hardly a feminist. She was actually opposed to Women's Suffrage, for example. According to Nimura, she became a doctor largely just to show that she could. And then, really, the rest of her career I won't give away. The subplot is really quite interesting. I think you would find it most interesting to recommend to you and our listeners who have a particular interest in medical history. PAT LOEHRER: Actually, I've ordered the book. I can't wait to read it. DAVID JOHNSON: Excellent. PAT LOEHRER: I got a book for Christmas, Lyrics by Paul McCartney. And I read through that. That's fascinating, actually. So 158 of his songs were detailed and the backgrounds for it. So that was kind of fun. We're excited today because we're going to talk to a couple of graduates of our Leadership Development Program. That was a program of ASCO that was conceived a little over a decade ago. It's been, to my mind, one of the best programs that ASCO has done. It has taken younger faculty and oncologists from around the country, and Dave and I were among the first leaders of the program as mentors. I think that was one of the bigger mistakes ASCO has ever done. But despite that, we have a lot of fun. There were 12 graduates each year. They all had projects they presented to the board of directors. There were, if you will, classes and lectures throughout the year on leadership. And they all had projects. And for me, it was the best three years of my life, I think, through ASCO. It was just a lot of fun. And part of it was getting to know a lot of people, including Melissa and Lecia, who are with us today. Lecia is a Professor of Medicine at Harvard and Mass General Hospital. She did her medical school at Harvard, residency at Brigham and Women's Hospital, fellowship at Dana-Farber. She is currently the co-leader of the Cancer Risk Prevention and Early Detection Program at Dana-Farber and director-- I think I want to hear more about this-- she's the director of the Center for Innovation in Early Cancer Detection at MGH. Melissa, she went to Converse College in Spartanburg, South Carolina, went to medical school at Wake Forest. Then did her internship and residency at UAB. She did her fellowship at UAB. And she now serves as the Chairman of the Department of Oncology and the Board of Directors at the Harbin Clinic. And we're so excited to have both of you here. DAVID JOHNSON: Yeah. Very much so. And why don't we get started by just getting a little background information. Melissa, let's start with you. Can you tell us a little bit about how you got into medicine and, more specifically, why did you choose oncology? MELISSA DILLMON: That's a great question. I was a political science major at a women's college in South Carolina and was destined for the State Department. And we used to have January terms. And I mistakenly got put with-- and I don't think it's a mistake-- former graduate of Emigre Medical School, who is a medical oncologist in Greenville, South Carolina, for a six-week term and fell in love with medicine, fell in love with the ministry that he provided to his patients, and followed him to Bowman Gray and went back years later and told him thank you for changing my life. So that's how I got interested in medicine. I come from a long line of accountants and engineers. There is no person in my family in medicine. PAT LOEHRER: I was an engineer. Some of the best people in life are engineers. DAVID JOHNSON: I didn't know you drove a train. [CHUCKLES] PAT LOEHRER: Eat your heart out. DAVID JOHNSON: So Melissa, before you leave, I actually grew up very close to where you practice. How did you end up in Rome, Georgia? MELISSA DILLMON: Well, my dad and his twin are proud graduates of Georgia Tech. So he found me a job. And I said, well, I'm grown up. I was going to stay on faculty at UAB but came to Rome, Georgia and really was excited about the multispecialty group that I ended up joining. There's about 250 of us now. And kind of had the feeling of a university but in a small town. Kind of best of both worlds. Neither of my two daughters have gone to Georgia Tech. One of them is at Georgia. Just won that national championship. But my third one, we're hoping maybe she'll be the one that goes to Georgia Tech. PAT LOEHRER: So you stayed up and watched the game. I have to ask this, right? MELISSA DILLMON: I did. I stayed up to the very end. PAT LOEHRER: And so who are cheering for? Alabama or Georgia? MELISSA DILLMON: Definitely Georgia. PAT LOEHRER: Interesting. Good. Good. DAVID JOHNSON: And Lecia, why don't you tell us about your background and how you got interested in oncology. And let us know if MGH has a football team. [CHUCKLES] LECIA SEQUIST: Oh, sure. Thanks for having me here. This is going to be a fun conversation. So I grew up in the Midwest, in Michigan. But I've been on the East Coast now for the majority of my life. And when I was a resident, I was actually in a primary care track residency program, because I thought I wanted to be a primary care physician. And I really liked the idea of sticking with people, getting to know them over long periods of time, and kind of standing by them through the highs and the lows of their lives. Well, I was finding out in residency that primary care wasn't really like that. That was for television shows. People change primary care doctors and move around so much, it's rare that you actually do get to take care of people for a long time, at least in a big city. And I also found that, for me, primary care was a lot of asking people to do things they didn't want to do-- exercise, lose weight, stop smoking, do this, do that. And I always felt that I was at odds with my patients or nagging them. And then, when I would be in the hospital on oncology rotations, trying that out, I really felt like I was allied with my patients and not nagging them or pushing them, but really here we were together against this fight against cancer. And cancer was what we were fighting together. And I just fell in love with that. So much to the disappointment of the residency program that was really trying to get people to go into primary care, I said, I've got to be a specialist. And here I am. PAT LOEHRER: It's interesting, though, that you do risk reduction and prevention. So you're back to telling patients to lose weight and exercise again, you know? [CHUCKLES] LECIA SEQUIST: Yeah. I guess, in some ways that's true, although I'm not really taking care of primary care patients. But after spending a lot of years doing a more traditional medical oncology track of drug development and targeted therapies, the last five years I have switched my research over, kind of a midlife crisis situation, where I said I've got to do something different. I'm in a rut. And I started looking at new technologies for early detection. And I really enjoyed it because it's something different. For one thing, I just felt like I was in a rut. But it's really a way to be a lot more proactive with the community and to work on issues of social justice, thinking about cancer screening, and who has access and who doesn't, and what can we do better. So I'm really enjoying that in this phase of my career. PAT LOEHRER: Terrific. The four of us are linked because of this Leadership Development Program that the American Society of Clinical Oncology put together. And I think Dave and I are really curious whether, here it is many years later now. It's been almost 9 or 10 years later now. As you reflect on the LDP, what are some of the highlights? What did you learn about yourselves and was the program worthwhile for you? MELISSA DILLMON: Well, I'll start. I was part of the class, 2010-2011, best class ever. And it was the second class in the Leadership Development Program. I applied for the first year's class and didn't get it. And one of my friends and partners, a radiation oncologist, who was very involved in ASCO, encouraged me strongly. Said, don't give up. Try again. And I did. And it was instrumental in developing both my career within ASCO as well as pushing me to leadership positions in my own clinic and in my own state. And helped develop a lot of skills that have made me successful in pushing state legislative efforts. My political science background did not go away, just like her primary care roots. And so I think that the program also made friends with Pat and with Dave and with my co-classmates. And as the years have gone by, and I've gone to ASCO, when you see that LDP ribbon on somebody's tag, you immediately have a connection with them and know that you've been through a similar experience. So I think it's been really instrumental in developing my career. And I'm currently serving as a mentor for the leadership program. So I'm living your life 10 years ago, Pat and Dave, and it's great. DAVID JOHNSON: Oh, I'm sorry. PAT LOEHRER: Terrific. DAVID JOHNSON: [INAUDIBLE] LECIA SEQUIST: I would echo what Missy was saying about how much it's influenced my career. I was in the 2011 class. So I think the year after she was. And I also applied multiple times, and I always tell people who are thinking of applying that it often does take multiple attempts to get in and not to lose faith. The selection committee does like to see that persistence. So definitely apply more than once. I learned so much about what leadership is. I thought it was about being the best in a group of people. So then, being selected to have a certain title. And I just really learned so much during that year, that it doesn't really have anything to do with a title, although that can be a part of it for some people. But it's just more about a style, an approach to your profession, and that you can be a leader if you are the designated head or chief of something, but you can also be a leader if you don't have that designation. And there are many different styles and ways to lead and to help people to ultimately get a group to do the very best that they all can together. And the friends that I made that year from my co-classmates as well as you guys and Jamie, who are our leaders, are just lifelong friends and mentors. And you know, I think it really got me thinking seriously about my choices in my career too and not to just kind of cruise through a career and see what happened and where life took you, but to really plan and to chart your own course and to make sure to reevaluate. And if it's not going the way you want it to, to rechart and replan. DAVID JOHNSON: We had a bunch of different lectures on different topics. Was there one of the lectures or areas that was particularly beneficial to you? PAT LOEHRER: I can think of one. I'll start out by doing this. We threw this in the second year, just for the heck of it. We did this personality testing. And I thought it was fascinating because, in my group, there was a little bit of conflict going on with one of the people in my group. And I realized that we were both acting out our personalities. I like to look at the big picture, and he liked to just zoom in the middle one. And the other thing that I do remember is that we showed the profiles, and it turned out Dave and I were exactly opposite. And then we both said at the same time, we should be married. [CHUCKLES] MELISSA DILLMON: One lesson that stands out in my mind was the press preparation lesson that we received from Press Relations group at ASCO. And I think that was essential for developing skills with regards to preparing for difficult conversations and being able to redirect questions that were difficult. I use that as leader of the Government Relations Committee oftentimes. I will also say that the other lesson that stands out in my mind is conflict resolution because, at the time, I was not chair of my department and was having significant conflicts with the current chair of my department. And that lesson helped me to go back week after week and more constructively work towards a solution and then eventually became chair of that department. So I think those two lessons gave me lifelong skills that I've used in all my leadership roles. LECIA SEQUIST: Yes, it's amazing how 10 years later, we can still remember the specific lectures and specific comments that people made. I remember those that you were talking about Melissa, but yeah, before you had said yours, Pat, I was going to say the same thing, that personality test was extremely helpful. And I certainly don't remember all of the different initials of the personality types. But just to understand that concept that people have different emotional skills and blind spots that very much influence how they deal with others in the workplace. And to be able to think about that when you're having conflict with someone and think about how to take that into a strategy where you can kind of play to their strengths and understand where they're coming from, that was extremely helpful. And then, I also think that talking in small groups with our teams about specific problems we were having or obstacles that we were facing and getting advice from others on how to overcome them, that really started me on a recurrent mission to find friends who I could share that with outside of my institution, over the course of my career. I think that was a real exercise in how valuable that could be. It's so critical to have peer mentors that you can talk to and strategize with and get advice about how to handle something that you're struggling with at work and have people that aren't in the same room full of people or aren't living in it. So they're a little bit more objective. DAVID JOHNSON: Let me ask a question of the two of you. Do you think your home institutions in your case, Lecia, MGH and in your case, Missy, Harbin Clinic, valued that training that you received? Did they recognize it as something that was worth the time that you spent or do you think it just something that happened and they didn't really take notice? MELISSA DILLMON: I learned in LDP that institutions don't love you back. PAT LOEHRER: They don't love you to begin with. Joe Simone. Joe Simone. DAVID JOHNSON: So I take that as a no. Your institution really said, eh, OK, great. We're glad you did it, but so what? LECIA SEQUIST: I wouldn't say that. I don't know that they said, so what? I just, I'm not sure that they-- there was no rolling out the red carpet, thank goodness you did this. But I do think it's had an institutional impact in that I have since encouraged other people to apply from my institution. And I think that only strengthens the institution, to have multiple people going through that program. MELISSA DILLMON: So my clinic, being private practice, when I take time out, it is just a cut from my salary. There's no support given from the institution. But in order to be in positions of leadership, department chair or on the board of directors, which I later was elected to of the clinic, you have to have completed a leadership development program. And the clinic will pay for you to go do those things. But my participation in Leadership Development Program met all those criteria. So my clinic highly values professional development classes or meetings or programs and encourages that. Even if there's no financial support necessarily, it is encouraged, if you want to assume positions of leadership within our clinic. And so I think that it's important for institutions, whether they're private practice or university, to recognize the benefits that come from participation in a program like this. And it was interesting as a mentor this year, we did a personality test, but this time they did an interesting look at what our priorities, our top five priorities or values are. I think it was values. And it was a list of 300 things basically you go through. And you listed your top five values. And then you listed the values of your institution or employer. And then you wanted to look at, did they match? And did your university value what you value? And that was a really interesting exercise to go through because a lot of these young leaders who are taking their time out to do this program did not feel that support necessarily for them seeking out this program. PAT LOEHRER: It's no coincidence that Dave and I asked both of you to join because you both come from different places, if you will. And I think, Melissa, you've just been a rock star in terms of the community practices and so many things that you have done in the leadership roles. And Melissa's, you can't get any more prestigious in being in one of the Boston medical schools and particularly at Mass General. But the other reason we wanted to have you come in is to talk a little bit about your perspective as women and women in leadership roles. And if you could maybe share a little bit about your thoughts and perspectives of gender leadership and what you have noticed in men in leadership roles and women and what lessons you might give to other people, particularly other women in this capacity. MELISSA DILLMON: Well, I think we both were trained in a day. And I might be speaking for you, but when there were, at least here at the institutions where I trained, not that many women in internal medicine. Medical school was probably 45% female by the time I was in medical school. But when you look at the faculty of those medical schools that I went to and trained at, there were very few women in positions of leadership. And so there weren't very many role models. My dean of students at Wake Forest was a female nephrologist. And so she was a huge role model for me. And then I went to UAB, and I remember being asked in my interview, are you OK with being in a male-dominated program? Because you will be in a male-dominated program. I think there were 45 of us in my intern class, and eight of us were female. And I said, that's fine. But I had gone to a women's college, where obviously there were only women leading. So it was a big change for me to go back into a situation where I had to assert my unique female leadership qualities, which are different, and still use those in an effective way to lead. Right now, I'm serving as a mentor also for a small liberal arts college, primarily those interested in going into medicine or nursing, and usually most of those have been female. And so it's been a really great opportunity, because I've had very few mentors who were female, who were positive role models for me. So I think Leadership Development Program, one of the things they taught me was to go back and say thank you to your leaders and to be a leader for others. And specifically, as a female leader, I think that has been an important call for me. After leaving Leadership Development Program, I went back and ran for the board of my clinic as the first female to be on my board. My clinic was started in the 1860s, I think right after the Civil War, and I'm still the only female on that board. And I feel that it's important for me to stay there or to promote up more females within my clinic to be on that board because I think that having a diverse board helps in bringing different skill sets to the table. So I think Leadership Development Program gave me that courage to step up. LECIA SEQUIST: That's inspiring. Congratulations on being the first woman and may there be more soon. Yeah. I don't know that I've felt that I was in as much of a male-dominated field up in Boston. But certainly, leadership in my hospital and in my cancer center has been more male-dominated. And I think as I'm getting older now, I definitely appreciate-- of course, every individual has different leadership style. So you can't just paint a broad brush and say men are this type of leader and women are that type of leader. Everyone's a little bit different. But in general, I think women do tend to have a different leadership style and one that is maybe, present company not included, one that's less talking and more listening. And I think, when I was younger and trying to become a leader, I really felt out of peer pressure that I needed to talk more and sort of demonstrate more what a good leader I could be or what great thoughts I had. And I've really come to embrace a more listening type of leadership, which I have been happy to say that younger women that I work with have come up to me privately and thanked me for. And so I do think it's important to have all different types of role models for our junior faculty and all different types of styles, sort of on display and doing their best so that people can find something that matches with their own unique style to emulate. PAT LOEHRER: One of the lessons I learned a long time ago from someone, and I loved it, a great leader is one that changes the conversation. And to your point of listening, but it's really changing the conversation, deflecting it around it so that other people are talking. But you have a little role in moving that around. And I always liked that. MELISSA DILLMON: Today, I was listening to the National Press Conference, and I heard a definition of leadership that disturbed me. And I thought, I don't think that's my definition of leadership. So I think that defining what your type of leadership style is, is something that leadership development helped me with. And then, once I knew what my leadership style was, then using those skills to pull together a team and achieve a goal, a common goal, not the description of leadership today, which was pushing something up a mountain and rolling over boulders and doing whatever you had to do to get your way. I thought, well, that's not leadership, not my leadership. So I think that that was something that Leadership Development Program help me do is identify what my leadership style is and what kind of leader I want to be. DAVID JOHNSON: So I want to follow up on a point that both of you are making in a slightly different way. And that is, who are your role models? I mean, apart from Pat and me, but who are your role models? [CHUCKLES] LECIA SEQUIST: I've had lots of role models over the years, and I think at the beginning, my role models were really people that I wanted to emulate and be just like them. And that probably started with Tom Lynch, who was my initial research mentor when I started in lung cancer. And a lot of it was just the way he was with patients. I wanted to have that ability to make a patient feel just right at home from the first minute they walked in the door, which Tom is a master at. But over time, I think my mentors or my heroes have more become people that are different than me. And I'm not trying to be like them. But I appreciate the ways in which they lead or in which they conduct something, like balancing their home life and their professional life in a way that's just different but I appreciate. And that, in lung cancer, I would say another real big influence on my career has been Heather Wakely. She really has been my main female role model in my career. And she's given so much of her time to me and to so many to kind of sit and have personal talks and pep talks and strategies about what we're doing in our home institutions. DAVID JOHNSON: Missy, what about you? MELISSA DILLMON: So I would say from a professional standpoint, someone I respect and see as a mentor is actually now the female CEO of my clinic, who has been with my clinic for 20 years and worked her way up. And I think that's because she has retained her femininity, but she is recognized as a tiger that no hospital or other clinic wants to make mad. So she has a way of leading and listening that is unique. And I have learned a lot from her over the years and watched her rise in her leadership skills as I have alongside of her. And then, I will say from a personal perspective, one of the books I have enjoyed reading recently really talks a lot about servant leadership. And so I've really tried to identify servant leaders in my community and why it is that they're able to weather the storms of the last couple of years, for instance, and why their teams rally behind them and support them. And they're successful. And my husband is a restaurant owner times three, opening two of those, one right before COVID and one during COVID and yet has been able to mobilize a team. And that's because he's a servant leader that will get back in the kitchen and make pastry cream if that's what needs to be done or make reservations. And so I think during the last two years, what I have learned from that is to be a servant leader in the tough times has really helped rally my team and my clinic to be better and to continue to work, despite the challenges for our patients, for the bigger goal. PAT LOEHRER: Love it. We recently had a guy give a talk here at IU, and the lecture was on being a visionary leader. And to be honest, it was fine. It was good, but being a servant leader and being part of a group is more important than being the one right up in front. And it's good to be a follower too as a leader. So I really appreciate those comments. Just in a couple of sentences, I don't know if you guys could do this and reflect a little bit about your younger self. Say you're 21, and you could give yourself some advice now, what would those pieces of advice be? LECIA SEQUIST: I think one thing, and that's the common thread I've heard among a lot of more senior people in medicine, or in any profession probably, is that the things that you think are disappointments at the time often turn out to be some of the greatest opportunities that you're faced with. You plan and you think things are going to go a certain way, and then something doesn't work out, and you're very disappointed. But it's usually that process of how you deal with that disappointment that actually brings so much opportunity back to you. You can't see it at the moment. All you see is the disappointment. But I think that's a big lesson. PAT LOEHRER: Terrific. MELISSA DILLMON: So kind of similar to that, Lecia, doing our personality test this time, I wish I had done that same exact test 10 years ago, because I'd like to see what my leadership personality was 10 years ago versus now. I would not have scored as high in certain areas that I think I do now. And I think that one of the biggest things I have learned is, I'm very much a person of tradition. And I like things to continue the way I expect them, and I like things to be planned and done in medical school in four years, done with fellowship. So I like a regimen and a routine. And I have learned over the years to be comfortable with change. And I wish I had learned that earlier and to be open to change and listening to new ideas. I think that probably for the first few years of my practice and training, I was very much, this is the way it's done. And I think that that expressive part of my leadership had not developed yet. And I think that being open to change and looking at things in new ways, I wish I had learned that earlier. DAVID JOHNSON: So we only have a few minutes left. And what we have done in previous episodes, we like to ask our guests to tell us the book they've read recently or maybe a documentary or something they've watched recently that they would recommend to our listeners. LECIA SEQUIST: I really enjoyed the book The Four Winds by Kristin Hannah. That is a historical fiction about the Great Depression and the Dust Bowl and the migration of farmers from the Central Plains out to the West. And it was a really captivating book with a female protagonist. I enjoyed it quite a bit. MELISSA DILLMON: It's funny. I read that one just a few months ago. I love historical fiction, but I would say recently, and I know it's not a new book, Andre Agassi's Open, his autobiography, I found fascinating. I love sports, but it was very interesting to me to see how someone who's thrown into the limelight at a very early age and the pressure put on him by his parents and how that affected the course of his life. I found it a fascinating book and very insightful. And I like to play tennis, but I'm not a tennis player. But I found it interesting as a parent, who's got several sports-minded children, it gave me some lessons about parenting and how to just raise your children and where the focus should be. DAVID JOHNSON: Both my wife and daughter had been tennis players. I'm sure they would both love reading that book. Thanks for that recommendation. LECIA SEQUIST: It's a great book. DAVID JOHNSON: Well, that's really all the time we have for today. And Pat and I want to thank both of you, Missy and Lecia, for joining us. It's been a terrific conversation. Thank you so much for what you do. You're both, in our minds, fantastic leaders. You were when you arrived, and you certainly have been ever since. So thanks so much for that. I want to thank all of our listeners for tuning in. This is Oncology, Et Cetera an ASCO Educational Podcast. And we really have talked about anything and everything. And we'd like to continue to do so. So if you have an idea for a topic or a guest, please email us at education@asco.org. Thanks again for tuning in. And Pat, I just wanted you know I've ordered a chicken and an egg from Amazon. [CHUCKLES] PAT LOEHRER: It's because you couldn't quite make up your mind which was going to come first. I love it. I love it. You're the best. Thanks for doing this. And Dave, it's good to see you, as always. Take care. DAVID JOHNSON: Thank you so much. We really, really appreciate it. LECIA SEQUIST: Thank you. MELISSA DILLMON: Great to speak with you. Bye. [MUSIC PLAYING] SPEAKER 1: Thank you for listening to this week's episode. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive e-learning center at elearning.asco.org. [MUSIC PLAYING] The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING]

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Oncology, Etc. - In Conversation with Dr. Quyen Chu

Marketing BS with Edward Nevraumont

Play Episode Listen Later Jan 4, 2022 27:17

This episode features Dr. Quyen Chu, Chief of the Division of Surgical Oncology at Louisiana State University. A prominent surgeon, humanitarian and writer, Dr. Chu shares his life stories, from fleeing Vietnam as a young child, to finding his calling, and giving back through work in impoverished U.S. communities and war-torn regions, including Iraq, Kurdistan and Vietnam. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air Date: 01/04/22 TRANSCRIPT [MUSIC PLAYING] SPEAKER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING] PAT LOEHRER: Hi. I'm Pat Loehrer and director of the Center for Global Oncology and Health Equity, Indiana University. And welcome to another episode of Oncology Etc. DAVE JOHNSON: And hello. I'm Dave Johnson at University of Texas Southwestern in Dallas. Pat, great to have another session today. PAT LOEHRER: It's good to see you again, Dave. I'm really excited about our guest today. And I think both of you and I were talking about this book that came to mind when we thought about having Quyen here. But it's a book by Abraham Verghese entitled My Own Country. And we hope to have Abraham on in another session of ours. You know, Abraham's story of growing up in Africa, and moving to the United States, and moving to the South in Tennessee in a time of HIV was really an extraordinary journey for him. DAVE JOHNSON: Yeah, an amazing story, settling in East Tennessee in the Appalachian Mountains, and then going to the Northeast to do additional training, and then returning to that part of the country during the height of the AIDS epidemic-- really a remarkable story. For those who have not read it, we both recommend it very highly. Today's guests we're incredibly excited about both. Dave and I met Quyen Chu in the Leadership Development program for ASCO. He was in the first class. He's currently the professor of Surgery and chief of the Division of Surgical Oncology and holds the Edward and Frieda Green Professorship in Surgical Oncology at LSU in Shreveport. He earned his MB degree at Brown Medical School in Providence, trained in general surgery in Massachusetts at Springfield and at St. Elizabeth's Medical Center, and then did his fellowship training at Brown University under the mentorship of Dr. Hal Wanebo, who was a wonderful surgeon and very active in ECOG in the Southeast group. Dave and I knew him. He's authored-- or co-authored more than 178 publications, a number of book chapters, a couple of books, including translating one of the surgical textbooks into Vietnamese. He has been an extraordinary human being. And one of the things we want to explore is his journey from childhood until now. In 2013, he was appointed by President Barack Obama to the board of Vietnam Education Foundation. He has worked in impoverished areas in Louisiana but also in the war-ravaged parts of the world, including Iraq, Kurdistan, Vietnam. He is truly a special breed of humanists who-- I think he looks back at his roots. he sees the bright possibilities of the future and reflects on what he can do to make a difference. It's just a great pleasure to have you, Quyen, to join us today. QUYEN CHU: Thank you very much, Pat, for that great introduction. It is very heartwarming, and I look forward to this podcast. DAVE JOHNSON: So Quyen, why don't we start a little bit-- I mean, Pat's mentioned your background. Tell us a little about how you got here and about your family and their journey from Vietnam to the United States. QUYEN CHU: Sure. I immigrated to the United States in 1975 right after the fall of Saigon at the end of the Vietnam War. My father was a South Vietnamese officer in the army, which means that he fought alongside with the Americans so that when the Americans pulled out, South Vietnam fell. And so because he was an officer, we were-- basically had no choice but to leave the country. Otherwise, he would be in a re-education camp, which might mean that we would never see him again. So we left Vietnam in '75. I was seven. We left on a ship, and then we also left-- then we transitioned to boats, and then we went to the Philippines for several months. And then we finally got sponsored by a church in Florida. So then we stayed at Eglin Air Force Base for several months before we actually went to our home in Florida. I grew up there and basically was-- grew up in a very impoverished area. It was-- basically it's a rat-infested home that we lived in. My father was an officer. He was a captain. But coming over to the United States, you have to learn English. You have to try to get a better education. And he finally realized that he had to support a family of six, and he took on being a barber. So he was a barber for most of his-- the rest of his career, really, raising a family of six. And I was there just to do the very best that we could. Throughout it at all, we knew that we were in the right place. And we knew that America doesn't give everything out for free, but we also know that it's a great, great land of opportunity. The philosophy is that if you apply yourself, do the very best, follow the rules and regulations or laws, you know, abide by their laws, that you can do great things. And that is a great opportunity. So that was embedded in me and my sisters, and those philosophies have stood the test of time thus far. PAT LOEHRER: You know, I read a little piece when-- you told a story about arriving here in Florida and a police car pulling up to your house. Can you relate that story? QUYEN CHU: It's the memory that I will never forget. And in fact, I remember it every Thanksgiving. So it was around Thanksgiving. We really didn't know what it was. We just moved into a new house. And it's funny because when we drove by the new house, we saw the garage. And we felt, oh, my god, we're going to live in that garage. This is great. This garage is going to be our house. This is great. There's so much space. And I remember when we asked the driver, the driver goes no, no, no, no, that's where you park your car. The whole house is yours. And we were just amazed. But anyway, so around Thanksgiving, we saw-- a police car drove up to our parkway. And I saw, and I was scared. And then I called out my dad. And I said, Dad, there's a police car here. What did we do wrong? And he was so scared. And he said, Son, you know, I will take care of this. So the police came and knocked on the door. And when my dad opened the door, he claps his hand, and he just bow, just like this, several times to the policemen and say, we're-- in broken English, we're sorry. We know English. We did not mean to break any laws. Forgive us. And the police just smiled. And he says, no, no, no, no. We're here to greet you as a new neighbor. And it's Thanksgiving, and we want to give you a turkey. Then he waved to the other police to come over, and then the other police came out with a big old turkey. And they hand it to us, and they said, welcome to the neighborhood. And we were so happy. My mom-- just about to cry. And we felt that, hey, this is now our new home, and we felt that this is not going to be a strange land, that we're going to create a life for ourselves here. DAVE JOHNSON: It's a remarkable story, Quyen. That type of story just makes it even more special. You mentioned that you had several siblings. Where do you fall in the hierarchy? And what are your siblings doing? QUYEN CHU: So I'm a second-oldest. So my oldest sister-- she went to Cornell, and she is now a full professor of biochemistry at Union College. My younger sister, who's a year younger than me-- she graduated from Dartmouth, and she is now working at industry and also, in the medical field. She holds a PhD from Columbia. And then my youngest sister graduated from Oberlin College, and she is now working in the hotel business. So we're very blessed. We feel very excited about the opportunities. And we look back at our lives every Christmas when we get together as a family, and we reflect back at the lives that we've gotten. And we also feel bad about family members who couldn't make it over here and wonder what their lives would have been like had they come over here. And then we also wonder what life for us would have been like had we not come over here. And through it all, we felt that we really, really hit the jackpot in life and that all of us were very, very lucky to have this life that we have. PAT LOEHRER: I can't imagine the pride that your parents have of all of you and how much pride you have for him. I mean, it's extraordinary. Can you just because I've never-- none of us have been through this, what you've been through. But what was it like being seven years old in the middle of this war in Vietnam? What memories do you have of that? QUYEN CHU: Yeah. I remember when I was playing with my cousins. And of course, in Vietnam, we live under a house full of cousins, aunts, and the extended family. I remember leaving them, and I felt very lonely in America. Of course, each family has its own separate family. And I just felt like it was not-- it was very lonely. But we did have very nice neighbors. We did have great people that really was very supportive. Of course, as a young seven-year-old, the neighbor's daughter was around my age. She was cute, so, of course, I'd find every reason to visit them and say hi to them. But other than that, it was a very nice place to grow up. They have their challenges, obviously. What I remember as a second grader-- I saw all the boys. To me, I thought they were all brothers because they were all Caucasian. They all have blond hair. I couldn't tell the difference who's who, but I thought they were all related. But they were very nice, of course. There were curiosity between us. I've never seen African-Americans until I came over here. And I befriended a Hispanic guy, as well as an African-American, as well as my best friend. To this day his name I still remember. It's Jeff. He was very friendly. Of course, I experienced some racism, but I think that's expected because I look very different. There were a lot of mixed messages coming out of the Vietnam War. But I think that through it all, the challenges, I realized, that there are more good people than there are bad people and that people who were bad-- probably because they were insecure, or they just didn't know me. And then there were those who did finally get to know me. They turned out to be great people. I've learned throughout my 53 years on this earth that people have so many things in common that when we do have conflict, it's probably stemmed from insecurities rather than pure hatred. DAVE JOHNSON: Yeah. You went to undergraduate at Dartmouth. Is that right? QUYEN CHU: Yes. sir. DAVE JOHNSON: So I seem to recall-- maybe you told us this in the LDP program, but you had an interesting experience when you showed up on campus at Dartmouth. QUYEN CHU: Yeah. DAVE JOHNSON: Can you relate a little bit of that to us, as well? QUYEN CHU: Sure. So, again, coming from a family where your dad is a barber, I had limited means. So I basically had, I think, one tote bag that I packed together. I took a Greyhound two day's trip to Dartmouth. And I got there on the campus. It was a beautiful green campus. And I was a little bit hesitant, a little bit reserved because there were a lot of Caucasians and whatnot. And I was a little bit, you know, introvert somewhat. And when I got there, I saw a Frisbee flew by me. And I grab it, and then the guy goes, hey, you want to come and play with us? And I'm like, well, sure. And next thing you know, we hit it off like a bunch of 18-year-old kids-- no worries in our mind, just glad to be on campus. And we hit it off. And I realized that, hey, you know, my reservations were basically based on my own biases rather than the reality. And then I've realized that the reality is that a lot of the kids there are just like me-- just want to find friends, just want to hang out, just want to have a good education. And they weren't being judgmental about anything, and that made me really-- it felt really good. DAVE JOHNSON: Frisbee diplomacy, I guess, is we should call it. Maybe we should throw a Frisbee to Putin. I don't know. QUYEN CHU: That's right. PAT LOEHRER: Tell us a little bit about your journey to become a surgeon. QUYEN CHU: OK. So my dad and mom instilled with me the importance of education. They told me, now listen, you have a choice-- either be in the same rut as us now, or get a good education and get out of this rut. So I really didn't have any choice but to study hard. And I studied hard, and I got an opportunity to go to Dartmouth. I felt very, very lucky with that. They gave me a full scholarship. They believed in me. They saw something in me that I was very happy that they saw. And then I applied to medical school at my sophomore year at Dartmouth, and I got in. I was very excited about that. And I started off wanting to be a pediatrician, but then I realized that what I had to turn in my sheet of the patients that I saw, everything had to do with procedures and techniques. I wrote down there I did a spinal tap, I did a chest tube, I helped intubate, I did all of that. And it was really my pediatric mentor who says, it sounds like you should be a surgeon, not a pediatrician. And that kind of got me thinking about it. And then I rotated a service with Dr. Wanebo and really fell in love with surgery. It was tough. It was rough. But I felt that this is my calling. I felt very fortunate looking back at only the number-- maybe they admitted 100 students. And I felt very fortunate that I was among those. And I knew that it was an opportunity that I did not want to waste, that I did not want to take for granted. I wanted to do everything I can to make sure that I learn as much as I can and hoping that in the future, I would give back to the country, the community that gave me a life. DAVE JOHNSON: Yeah, my mentors suggested that I should be a forest ranger as opposed to a physician. [LAUGHS] PAT LOEHRER: Yeah I think I shared before I got, on one of my medical-school applications, they not only rejected me, but they said, good luck in whatever career you decide to go into. [LAUGHTER] I was going to be a pediatrician, too, but I envisioned all these kids just laughing and having a great time. But they were all crying, and the parents didn't like me either. And so I decided to find a different life. You have had this extraordinary journey of giving back, as I mentioned at the onset, and not only going back to Vietnam but also, going to Iraq and going to many other countries here. And about five years ago, you received the ASCO Humanitarian Award, which was so deserving for you. DAVE JOHNSON: Very deserving. PAT LOEHRER: But tell us a little bit about these efforts. What has pulled you or driven you to do so much of your humanitarian efforts around the world? QUYEN CHU: Well, first of all, I want to credit my wife Trina, who's been there for me. She's basically the backbone of my life, allowing me the opportunity to pursue my passion. She's a lawyer. She put her career in the back seat so that I can have a successful career. So I want to make sure that I acknowledge her sacrifice and her love. Because of her love and her understanding, I was able to pursue my passion, which is giving back. My colleague, Dr. Gazi Zibari is from Kurdistan. And one day, he showed me pictures of the Kurds, and he gave me the history of the struggle the Kurds. And it was reminiscent of the struggles of the Vietnamese, so it resonates with me. And I said to him one day, hey, listen, when you do go, I would love to join you. And so I did. And from that point on, I returned, I think, four or five additional times. We did not return last year or so because of COVID, but we're planning to return again to Kurdistan and Iraq. But it was an opportunity for me to really give back what I wanted to do all along, which is to render care to the less-fortunate individuals of our lives. I also went to Vietnam, Nicaragua, Honduras, and also on those different mission trips. And, you know, Dr. Zibari and I have gone together for many of these trips. And we come to realize, you know, what-- the great thing to do is capacity building. In other words, we should visit these countries not just once but several times to make sure that the surgeons there feel comfortable with the procedures that we taught them and that, hopefully, that they will also teach the other surgeons the procedures, the techniques that we taught them. And we were very pleased when we went back to see that these surgeons were very adept in what they were doing-- Whipples, liver resection. They were doing phenomenal things. In fact, I think the greatest sense of pride in me was to see a young surgeon in Kurdistan who did a laparoscopic right-liver resection bloodless. We felt very proud because-- I was looking at Dr. Zibari, and I said, you know what-- I can't even do that. And it's amazing to see how they have not only learned our skills, but they exceeded us. And isn't that what we all want, that our mentees to be better than us? And so to me, that was a great sense of pride. At the end, the young man came up to me and says, mentor, I hope I did it right. Did I make any mistake? And I chuckled. And I said, no. I could not have done what you've done. You have done amazingly. And he was so happy. He was so proud. He says, I'm so glad that I make you proud of me, Dr. Chu. So to me, that's probably the greatest thing is to see your mentee better than you and still see that respect that you got from them. DAVE JOHNSON: We're really happy you mentioned that because one of the themes of our podcast has been mentor and mentor relationships. And you had a remarkable relationship with Dr. Wanebo. Would you like to expand on that somewhat or tell us about that relationship? QUYEN CHU: Sure. Dr. Wanebo-- I always joke around. I said, Dr. Wanebo, you're a gifted surgeon with an internal-medicine demeanor. He is just so nice. He never loses his cool. And the great thing about him is that every time I have an idea, he would always push me to pursue it. There's never been a, no, it can't be done. No, that's not how-- you will never get it done-- never like that. It's always, this is a great idea, Quyen. Why don't you pursue it. And in fact, he would give me deadlines and say, why don't you get back to me in two weeks and see where we go with that. I remember visiting him in his very busy clinic. And his PA would always trying to brush me aside because they were so busy. And he would always say, no, no, no, come on, Quyen. What do you have for me? What do you need? He would always make time, even in this busy clinic, to help mentor me. And then whenever I'd write a paper or abstracts, he would look at it. He would fix it, and he would send it back to me and ask me to work on it. So he's been a great mentor, just a great person all around. PAT LOEHRER: Quyen, if you could think about a young professional or young student right now and give them some advice, what would it be? QUYEN CHU: I think the best advice is that you pursue your passion. I know it sounds so trite, but pursue your passion. Seek out mentors who believe in you, and avoid those naysayers because I think that young people have so many insecurities. And they're great people. They're so naive, and they're so fresh. They're not tainted with all of the flaws of the world. And I always worry that when they encounter negative people, it fills their mind with negativity. And that, to me, is not very constructive. So I would advise young people to seek out optimistic, idealistic people to be mentors. And then I think the rest will follow. And they will learn what can be done, what can't be done. Obviously, you need a mentor to advise them so that they don't fall into your trappings of making major mistakes. But I think that mentors should be someone who is inspiring, who is positive, who can tell them that, hey, you can do it. And if you fail somewhat, it's not the end of the world. Seek out your passion, and never give up. DAVE JOHNSON: That's great advice, Quyen. I have just one more question I wanted to ask and perhaps should have asked a bit earlier. How did you end up in Louisiana? QUYEN CHU: That's a great question. So at the end of my fellowship, I had opportunities to stay up north. Then I got a call from my previous partner to say, hey, listen, I'm in Shreveport. Why don't you come by. In fact, it's funny because when I heard the word "Shreveport," it sounds, to me, Chinese. And I said, why would I want to go to China to practice? I didn't know where it was. And then they said, no, no, this is in Louisiana. And I really thought about, nah, I don't want to go. But my wife said, listen, why don't you just go down there and take a look so that at least you won't offend the person who asked you to come down. So I went down there for an interview. And it really resonates with me about the needs, that patients there did not have, in my opinion, good surgical oncology care. There was a huge need. I saw the mortality for esophagus, gastric cancer. They were high. I saw a lot of cancers that were neglected. And the chair there, Dr. Turnage, was wonderful. And he said, listen, Quyen. Nobody's going to compete against you. We just got a huge need. I think that you would find a niche here, that you can really, really develop a practice here, and then I can mentor you for the academic part. So I thought about it. And then I talked to Trina, my wife. And I said, this is what I wanted to do. I wanted to give back. I didn't want to be just another spoke on the wheel. I wanted to make a difference. I think I can do this here. And so we took a chance, and I think that we're very happy with that decision we made. PAT LOEHRER: Well, Quyen, I just, as I reflect on this and think about that leadership-development program, there are many different kinds of leaders, but I can't think of a person who serves as a better example as a servant leader than you. You have given of yourself in so many ways. In this particular past few years. Where there's been so much angst and polarization in this country, and even consideration of isolationism and not having immigrants come into the country, I hope people listen to this, the podcast, and realize what the impact was of a man and a woman who decided to bring their kids over here. And he became a barber, which is not that prestigious of a job, if you will. But his impact on this country is huge. Mark Twain had a little quote. He said, "The two most important days of your life are the day that you were born and the day you find out why." And when you guys were born in Vietnam, you had no clue what was going on, but you are one of the fortunate people who know why you're here, and that's to make a difference. And I just want to tell you that you have. Thank you so much for your time with us today. DAVE JOHNSON: Yeah, it's been great. QUYEN CHU: Thank you very much. DAVE JOHNSON: Quyen, this has been marvelous, and we're both great admirers of yours. And I could not agree more with Pat about the impact that you've had. One thing we like to do with our guest at the end is ask you if there's something you've read recently, or a documentary, or something, a movie or something you've seen that you would recommend to us and to our listeners. Is there something special that you've read recently or maybe seen that you'd like to recommend? QUYEN CHU: Yes. So there's a book by Mr. David Epstein called Range. It's a phenomenal book. It's a book that contrasts Malcolm Gladwell's philosophy about 10,000 hours to be an expert. Mr Epstein took a different approach. He took the approach that you have to be a generalist. In other words, you have to do many things in life before you can hone in on one particular skill set to become an expert in that. So to me, that book, Range, is a fascinating book. I'm midway through. And it's just-- it's a beautifully written book, and it just gives a different perspective of life. I've always loved books that give a different perspective for a particular topic. And I would highly recommend our readership to read Range by David Epstein. DAVE JOHNSON: Yeah. I also read that, and it is a fabulous book. I couldn't agree more. QUYEN CHU: Yeah. DAVE JOHNSON: Well, we've come to the end of our session. And I really want to take this opportunity to thank our listeners and thank Quyen for joining us. It's been a marvelous session. QUYEN CHU: I appreciate it. Thank you, David, and thank you, Pat. DAVE JOHNSON: Thanks for tuning in. This is an ASCO educational podcast, where we will talk about anything and everything, really. We really will. So if our listeners have any ideas for our topic or guests that you'd like to hear, please email us at education@asco.org. Thanks, again, and remember that November 9 is National Louisianan Day. And Pat, just so you know, November 16 is National Indiana Day. I'm sure you already knew that. PAT LOEHRER: I love it. Every day's Indiana Day. DAVE JOHNSON: No, every day is Texas Day. PAT LOEHRER: Thanks, guys. [MUSIC PLAYING] SPEAKER: Thank you for listening to this week's episode. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive eLearning center at elearning.asco.org.

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2022 Global Oncology Site Solutions Summit Preview

SCRS Talks

Play Episode Listen Later Dec 20, 2021 10:14

Sandy Smith, Senior Vice President of Clinical Solutions and Strategic Partnering at WCG Clinical and SCRS Global Oncology Summit Chair shares what she is most excited about for this year's Oncology Summit, including some of the hot topics we will cover at the Summit. Learn what attendees can expect from the Summit and how to maximize your experience!Learn more about the Global Oncology Summit and register today at https://oncologysitesolutionssummit.com/

summit senior vice president sandy smith clinical solutions global oncology

ConCerv Trial with Kathleen Schmeler

IJGC Podcast

Play Episode Listen Later Sep 29, 2021 48:04

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Kathleen Schmeler to discuss the ConCerv Trial. Dr. Schmeler is the lead author of ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer, which is the Lead Article of IJGC's October 2021 issue. Dr. Schmeler is a Professor in Gynecologic Oncology at The University of Texas MD Anderson Cancer Center. She provides care to women with gynecologic malignancies including surgery, chemotherapy and preventive services. Dr. Schmeler is also the Executive Director of Global Oncology for the MD Anderson Cancer Network. Her research interest is in cervical cancer prevention and treatment, particularly for resource-constrained countries and medically underserved communities in the US. ( https://ijgc.bmj.com/content/early/2021/09/06/ijgc-2021-002921.share ) @kmschmeler @MDAndersonNews Highlights: •The ConCerv trial is the first prospective study of conservative surgery in women with low-risk cervical cancer. It included 14 sites in 9 countries. •Findings from the ConCerv Trial offer prospective data supporting a more conservative approach to low-risk patients, sparing them the early and late morbidity associated with radical procedures. •It will also allow for safer cervical cancer surgery in low- and middle-income countries, where the burden of cervical cancer is highest. •In the our study, conservative surgery was associated with a 3.5% recurrence rate in women with low-risk cervical cancer. In addition, the rate of positive lymph nodes was 5%, with lymph node assessment recommended in this low-risk population. •Further study is needed to determine long term outcomes and optimal pathologic criteria for conservative surgery."

university professor executive director trial findings texas md anderson cancer center gynecologic oncology editor in chief dr global oncology lead article

Interview: Vineet Mehra -- Former CMO Walgreens; Chief Growth + Experience Officer Good Eggs -- Part 1

Play Episode Listen Later Sep 8, 2021 22:02

I delayed this week's edition on the hope I would spend Tuesday after the long weekend completing a briefing. I have a ton of great stuff to share with you all, but the time to write it all down did not happen. Instead I want to share with you a great interview I did with Vineet Mehra. In part one we talk about Vineet's big break to a head of marketing role in his early 20s, and how he leveraged that into the career he has today. Lots of great stuff in here on how to think about things like “General Management roles” vs. “Functional Area Leadership”. Part Two will cover some of the fascinating work he did at Walgreens. As always you can listen to the interview in any podcast player (click on the link next to the imbedded audio for the links.TranscriptEdward: My guest is Vineet Mehra, Chief Growth and Experience Officer at Good Eggs. Today, we're going to cover Vineet's path to CMO: P&G, General Mills, Novartis, Avon, and Johnson & Johnson. He was a CMO of Ancestry, CMO of Walgreens, and now at Good Eggs.Vineet and I worked together two decades ago at Procter & Gamble. Super pumped out on the show today.Vineet, let's start off: You've had a killer career, but I'd love to talk about a few of the big leaps that you had. If you want to start, in 2008, you went from a Marketing Manager at General Mills, and then you took on the Head of Marketing job for all of Canada for Novartis. Talk to me a little bit about how you made that transition happen.Vineet: First of all, Ed, thanks for having me. Obviously, it's so great to see you after almost two decades. I remember us playing foosball in a room as account managers trying to grow our businesses at retail over there in Canada. It was a real highlight of my career, I remember. It's great to see everything you've done as well.I have definitely had a couple of leaps that have happened. This specifically that you're talking about—going from General Mills over to Novartis Consumer Health in Canada where I had the opportunity to run that business—was honestly a little bit of good luck and a little bit of knowing the right people at the right time, which truthfully, if anyone tells you anything differently, that's how a lot of us get our first big leaps.In this case, there was actually a headhunter or a recruiter in Canada who knew me from the time when I was an assistant brand manager. She happened to be doing this search and just thought, hey, why not? Why don't I just throw his name in the hat? It's a long shot, but you know how recruiters need to build this portfolio of candidates—the young up-and-comers, the established players, and the people in the middle.I think I was just thrown in as the young up-and-comer. Like yeah, we'll just give you the high-energy 20-year-old and see what happens. It just so happened that the President of Novartis, Canada at that time—who, by the way, is still at the company, running the Global Oncology business now, he's an unbelievable talent—took a liking to me. We met a couple of times. One way or another, the headhunter's long shot, 20-year-old candidate ended up getting the job. There I was, I ended up becoming the Head of Marketing for Canada.For those of you that are Canadian listeners, Novartis has brands like Buckley's, NeoCitran. These are just unbelievably Canadian brands.It was such a great opportunity to spread my wings for the first time. But knowing the right person, luck, and just going for it (I guess) played a big part in that leap.Edward: I definitely have been in places like that where the headhunter brings you on and you're like, I am clearly not the right person for this role. You totally have me there so that you can show them a balance of range of, hey, here's the person that's much less experienced than the person you need and here's the person who's much more experienced but way too expensive. Let me just show you what they're like out there so that when I show you what you really need, you actually jump at it. They're almost giving you people that they know you're going to reject because they know you want to reject somebody. They make it a lot easier themselves.Vineet: There you go. It's like going around and looking at houses with real estate agents where they take you into the cheap house to the expensive house that you can't afford. I was definitely the cheap house that she didn't think anyone would want, but also, I wouldn't harm the process or her reputation as we were going along. That's definitely what I was. There's no doubt about it.Edward: That's how you got in front of him. Apart from just being personable, why did he take you versus the one that she was trying to sell him on?Vineet: I think energy is everything. I really do. I'm a big believer in positive energy and connecting with people through energy. You see a lot of books, and I'm not saying these are wrong around things like active listening and all these tools to connect with humans. You need to do those things. Those are important, of course. But in this case, I was just really excited. I was the underdog. I was just excited to even have a chance to talk to someone like this.I think that energy just rubbed off on him. He very much took a chance. It's a true story I'll never forget. Even though there's always a gap between when you get the job and when you start on the job, there's always a little bit of space there.I remember that the head of HR at that time had told me that when my name was announced to the organization, because I was essentially the youngest person in the marketing organization as the head of marketing at that time, people went to the CEO of Canada and said, is this what it takes to be the head of marketing of Canada? They looked at my resume, saw how short it was, and were like, I can't believe that this is who you choose.I remember him telling me in a conversation later on, he said to me, I just told them do you not trust me? It was an amazing thing where this is totally a thing of him taking a chance and him believing in the energy I had to really make a difference. I think he saw in me a desire to make an impact and grow the business. It just came down to him making a bet on frankly, my excitement, my energy, and the impact that I could make. It was really that.Edward: When you came into that interview, how did you prepare for that interview? Did you give him like, hey, here's my five-year plan for how I'm going to run marketing for Canada, given that you've never run marketing before?Vineet: I wouldn't have even known how to do that. I could do that for a brand or two, but I wouldn't have known how to do that for an entire department. There were a couple of things. There was a brand in Canada—which you'll remember well, Ed—called Buckley's. The tagline was "It tastes awful. And it works." It was this huge cough syrup in Canada.I remember growing up with that. I told him a story—I still remember this—about my experience with Buckley's when I was a kid. My dad was a pediatrician. He used to give it to me, and it was the nastiest thing I'd ever had. I told him some ideas I had which was specifically, hey, why don't we turn the bad taste—if I just get technical for a second—into a reason to believe in the product as opposed to making that benefit?We talked about that a little bit. We just went deep. We talked about what a creative campaign could look like. From there, we just connected and we actually ended up doing that. Buckley started growing crazy. That all came out of that conversation in the interview.Some of these brands I have deep familiarity with, we did some riffing on what these brands could be and how we could position them. That's pretty much as much prep as I need to do because you got to remember that at that stage, all I really knew was brand management, not necessarily department leadership. I stuck to what I knew, and we did that.Edward: You come on, and you take on this role of running marketing for Canada. What did you not know that you had to pick up on the job?Vineet: I didn't know anything. Edward: You knew how to run brands. You've been a brand manager. Now, effectively, you've moved from running a brand to running all the brands.Vineet: Yeah. Even more than that. I had people that were running those brands. Actually, what I didn't know is how to onboard onto a business. Onboarding as a department head is very different from onboarding as a person taking over those brands because the last thing those folks wanted to see was I was going to come in and do their jobs for them. These are smart, empowered folks that I had to figure out how do I onboard and set the right tone appropriately? That was a big part for me.The second part that I didn't know was the role of a department head across a company in terms of creating followership, not just inside your department but across the company. That's another really misunderstood thing that you don't see. When you're growing up, you don't realize that the department head has to create followership, not just from within marketing but IT and all the other functions that need to support customer-centric growth of a business.Frankly, I had to learn a lot about hiring and making the right talent decisions. I made some early mistakes because I just hadn't hired at that level before, and I was looking for the wrong things. In that job, while in the end, we were very successful, we had great business success, and it took me around the world—that opportunity at Novartis—initially, I'll tell you that that year was tough. I was working tons of hours and I thought that outworking everyone would solve my problems. What I learned really early was that it wasn't about the work. It was what I was focused on, the talent I was bringing in, and how I was leading. I learned a lot in that first year.Edward: How did you learn that? Did you have a mentorship? The CEO that brought you on, did he sit you down and say, hey, Vineet, you know what, for the first month, I need you to go have lunch with all these people so that you can build your relationships? Oh, by the way, I want you to talk to the head of HR about how to hire people. How did you pick up those two skills?Vineet: It's really interesting. I didn't really have mentorship because frankly, I didn't have a network at that stage in my career that was "high-powered" enough where I could just call people and say, how did you do this? Actually, this CEO or president of the Canadian business was very high-performing and team-oriented.What I mean by that is we would do all these high-performing team sessions where we would go offside, give each other candid feedback, and do these round robin-style feedback sessions. I'm sure you've been in those before. I got my butt kicked in those sessions. I would literally go through these sessions and my peers actually would just give me feedback. Vineet, I know the business is growing, but stop doing this. They were brutal with me. I was 10, 15 years younger than everyone, and they just let me have it.I tell you, in many cases, I thought it was inappropriate—the way they were giving me feedback—but at the same time, it's entirely warranted. To be honest, Ed, it was situational. Again, a little bit of luck, a little bit of me being really open to listening, but I happened to be on a team where high-performing team norms, feedback, and candid peer feedback were a core part of how this leadership team ran.If it wasn't for that, I'm not sure I would have learned lessons as early as I did in my career. I'm not perfect by any means at this stage as well, but man was that a crash course.Edward: It's interesting. I came from the consulting world where you receive harsh feedback all the time. There were times when I was at McKinsey where I'd come home and I'd cry. It was so brutal. But as terrible as that was, you're still forced to learn even from some of the bad feedback I was given at McKinsey.One time, I had a partner that told me that my notebooks were too small. He was very insulted by my small notebooks. I think even in situations like that, you can say, hey, even if I don't buy his feedback, I can still understand that now, I know that somebody thinks small notebooks are inappropriate. Now, I have that piece of information in the back of my head.I wonder, in the situation like you're in where all your peers are maybe a little bit threatened by you because you're 15 years younger than they are and you're all reporting to the CEO, they feel like, hey, I can be negatively constructive on this guy because I'm not threatened by him in the same way that it would be with a similar-age peer. While it becomes negative and hard on you, it allows you to learn at a faster rate than you otherwise would from people who are more polite.Vineet: I think you're right. It was well said, Ed. The other part is what people don't always internalize, which I learned in that. We talked a lot about deep, personalizing feedback. That was huge to the point where it's like, this is feedback. It's not an insult. As a young kid in your mid to late 20s—I think I was 26 or something—that's a hard thing to figure out. To this day, many of those peers of mine on the leadership team are still dear friends, and I would have had it no other way.Edward: I want to talk a little bit as you're moving on through your career. You spent a lot of time in marketing in packaged goods, but you also had some GM roles. If at all, how did you think about managing your career moving back and forth between pure marketing roles and general management roles in terms of advancing?Vineet: My whole career theory is all about chasing experiences, not necessarily titles or pay. What I mean by that is if you dug one layer deep into my career, I've taken three pay cuts in my career. I've just been chasing experiences.To me, those general manager types of roles—my biggest one was later in my career where I became the Global President of the baby care division for J&J, that's a big role—were just about continuing to learn and continuing to grow. That's really how I thought about it.I'd be lying to you if I would say I was playing this perfect chess game where I perfectly planned it. I was literally just chasing learning. I was always curious. If general management was the thing that was going to teach me a lot at that moment, that's what I was going to do. If going international was the thing that was going to teach me a lot at the moment, that's what I was going to do. That's essentially how I played that.Now, in hindsight, general management teaches you amazing skills because by definition, as a general manager, you're not an expert at really much of what you're leading and you have to rely on others. It teaches you a lot. I was just really simply chasing experiences as a curious person.Edward: Is a lot of that being opportunistic about pull opportunities? A recruiter comes to you, and you say, hey, you know what, that's too similar to what I've been doing before. I'm not that interested. Oh, that's really different. Let me go, throw my hat in the ring, and jump for that.Was it even more aggressive where it's like, hey, if I want to advance my career, I need an international opportunity, so I'm going to go out and look for one?Vineet: It wasn't really that aggressive. People say, hey, what's the secret? How do you get a good career? How do you move quickly through your career? I know it sounds cheesy, but I just answer by staying curious and exploring learning. A lot of my moves were internal moves. The company would take me international or give me a general management assignment after a marketing assignment. In other cases, it was a recruiter or a headhunter giving me a call. In both cases, those were enabled because my curiosity led me to build a network, to ask people for help, and to be really open-minded to things that others wouldn't be open-minded to.Ultimately, it came down to not necessarily chasing things, but definitely chasing experience. I wasn't actually chasing an international career because that would unlock a move or two moves from now. I was definitely paying checkers, not chess. I guess that's the way to put it.Edward: Sure. But even with those international opportunities, was it a matter of you saying, hey, current manager, for my next role, I'd really like to do something international? Or was it a matter of Emma's going to nail this role, this international opportunity comes up, and they say, Vineet, would you be interested?Vineet: It happened one time in my career when I was an intern where I asked for an international assignment. That was at P&G, I recall. I went to India with P&G. I was just like, hey, can I do something international because I had nothing to lose. I was a university kid on my second internship with P&G.Every other role was happenstance. When I went to Europe for the first time with Novartis, there was a new CEO who had come in. She saw me in a meeting and said, Vineet, I need you to go to Europe. My story was I literally bought a house with my family, my first house in New Jersey. We never even moved into the house. Two weeks before closing, I moved to Switzerland. I was definitely not planning to buy a house. We moved to Switzerland two weeks before that. My wife was pregnant. I got asked. I got tapped on the shoulder. This is what has happened constantly in my career.I think it's just that energy. It's the focus on impact. It's just being open-minded—when someone asks you that question—to say yes. I think people would be surprised how many times where if you really look at it, you might have had an opportunity that you just might not have been listening for. That's an important thing to think about.Edward: I love that. That's really great. Vineet, what are the biggest failure points in your career? Where did things not go as expected?Vineet: We've all had plenty of those. I would say for me, I already told you the Novartis story, that hard lesson of learning to be a department head and a leader. That was honestly a really tough time in my career. Because my career was moving so quickly, that happened multiple times in my career. I had to take 6–12 months and really just make that work. I went to Switzerland. I became the head of marketing for Europe there. Big job. I was 29 years old at that time. I'll never forget that I had onboarded with my team. I was living in Switzerland trying to lead an organization, all of whom are sitting in their countries. I was sitting in Switzerland by myself, so it's remote leadership for the first time. I really struggled with that as well. I'd say in my first six months, I got pretty challenging feedback on how I was leading remotely and how I was connecting with folks in terms of just not being able to make the same connection I could in person.I had a boss who (today) is a great friend. At that time, I thought I was going to lose my job in my first six months over there in Switzerland. Again, it just came down to that side of it.I've also had really challenging moments during business and brand launches, product launches, and things like that where things don't go the way you want in your first six months. You're literally fearing for your job because at a certain point—and you know this Ed—you're paid to deliver. There's nothing like feeling when you're going out in the world, trying to deliver on your business, and essentially, you just don't hit the numbers. I've had moments like that through my career as well. You just learn from each and every one of them.Edward: It's interesting. One of my early managers told me to think of your career as two-year chunks where you come into a new job, you spend a year really learning the job, then a year delivering on the fact that you figured out how to do it, and then you move on to your next thing. Looking at your LinkedIn profile, it seems you've done a lot of that. These two-year chunks where you come in, the first six months challenging and trying to do the job or you're going to get fired, the next six month learning the job, getting better at it, spend the next year delivering, and then you go and repeat the process again.Vineet: It's just been the way it's been. I was at P&G for eight years. I was at Novartis for seven or eight years. I was at J&J for four years. It just so happens that every company, every two years, they were either moving me or I got pulled into my next challenge. It actually has worked out that way.Every couple of years, I've been in a new role because the company sees the impact exactly like you said in that second year. They're like, hey, can you do it in another spot in this company, and someone pulls you on the other side. The faster you can get up that learning curve in those first six months, the more impact you can have at speed. That's really what I focus on, the learning curve which again goes back to that notion of curiosity and just being willing to listen.Edward: Vineet, do you have any productivity tricks? Do you have things that you do to be productive that most people don't do?Vineet: Yeah. I'm really fanatical about productivity. I have one mindset and one trick, I would say. I'm sure one of your listeners have listened to this and have experienced this idea of energy for performance. I definitely do not focus on managing time. I focus on managing energy. It really is this idea of being a corporate athlete. How do I feel about myself? What do I eat? When do I eat? How do I sleep?One of my most productive uncertain tasks—which is a very different way of managing things than managing just a calendar and your time—is I'm very focused on managing energy and managing the different roles in my life, whether that's being a father, a husband, a leader in a company, an advisor, or a board member. I've had all these different roles that I have and I think about how do I keep my energy high for all those things? That's the mindset.In terms of actually managing and hacking a calendar, for a lot of your listeners who have either admins or their own processes for managing things, I read this book that changed my life. It's called Getting Things Done. I'm sure many of your listeners have listened to that. There's this total tactical hack here, this app called To-Do. Shameless plug for the app. I am relentless. Any time I ask for a follow-up, any time I want to book a meeting, everything goes into that place. What it does is it clears my brain. Everything is in that place. A lot of people work off lists. I don't have lists. If I have something to do, I'll put it on the date that I think it needs to be done. A lot of people will put it today. I'll put it two weeks from now. I open up my app and it's staring in front of me like, oh, I have to get that done. I never feel this burden every day of looking at a giant list and checking things off. It's much more planned and I don't get overwhelmed by the day.The second hack is that my admin has the same app. We have this amazing system where she has the same view that I do, so she knows exactly which codes are hers to take care of and which codes are mine. She takes care of all of that. We're almost in-sync with each other without thinking. That's a huge part of it. I've seen a lot of people bring in admins and executive assistants into their lives as they get more senior and they're just ineffective with that person beside them. That's another thing. Find someone you appreciate, show them tons of respect, and create a system that is invaluable. As you get more senior in your career, that also matters.Edward: Vineet, this is great. We're going to pick it up with part two shortly.Vineet: Let's do it. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit marketingbs.substack.com

Oncology, Etc. - In Conversation with Dr. Otis Brawley (Part 1)

Play Episode Listen Later Sep 7, 2021 21:57

In this two-part episode of Oncology, Etc., hosts Dr. Patrick Loehrer (Indiana University) and Dr. David Johnson (University of Texas) speak with Dr. Otis Brawley, a Bloomberg Distinguished Professor of Oncology at Johns Hopkins and former Executive Vice President of the American Cancer Society, about his incredible life and career. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air Date: 9/7/2021 TRANSCRIPT SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. No mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. PAT LOEHER: Hi. I'm Pat Loeher. I'm director of the Centers of Global Oncology and Health Equity at Indiana University Melbourne and Bren Simon Cancer Center. DAVID JOHNSON: And good morning. I'm Dave Johnson. I'm professor of Internal Medicine Oncology at the University of Texas Southwestern in Dallas. We're really excited to be back with the second episode of our ASCO Educational Podcast Oncology, et cetera. And I don't know about you, but my arm's really sore from entering all the fan mail we got from the first episode. Either that or maybe it was that shingles shot I got last week I don't know. PAT LOEHER: No, I agree. I really appreciate Bev. Your wife just kept texting me how wonderful I was, and it was-- I enjoyed it. DAVID JOHNSON: Well, I'm glad you mentioned that, because I wanted to read this one fan mail. It says, dear, Dave. Thanks for carrying Pat [INAUDIBLE]. I don't know who that is, but I appreciate it. PAT LOEHER: Yeah, it works both ways. Works both ways. So what have you been reading lately, Dave? DAVID JOHNSON: Well, as you know, I love to read. And actually what I'm reading right now is The Howe dynasty by Julie Flavell. It's about the brothers Howe that were involved in the Revolutionary War. But the book I finished just prior to the one I'm reading now is Adam Grant's Think Again, which I really enjoyed. It made me think again. What about you? PAT LOEHER: How many times have you read the book by the way? DAVID JOHNSON: Again. Twice. PAT LOEHER: Think again. Yeah. There was the book that's called The One Thing. I know if you saw that book which I read a while back. It took me, like, a year to do it, because I just kept doing other things while I was reading it. I felt so guilty about it. I did read the book Caste recently, and it was on Oprah Winfrey's list. Barack Obama picked it. And actually read that on my way to Kenya a couple of months ago and found it very fascinating actually. You know, the notion of the juxtaposing of Nazi Germany, of the caste system in India, and the racial struggles that was going on here in this country. And I thought it was a very well written book. DAVID JOHNSON: Yeah. You mentioned that book to me, and I finished reading it a couple of weeks ago. I agree with you. I enjoy it very much. I learned a lot. We want to introduce today's guest. We're really, really fortunate to have with us today Dr. Otis Brawley. Dr. Brawley Is the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University. He's a graduate of the University of Chicago School of Medicine. He completed a residency in Internal Medicine at the University Hospitals in Cleveland Case Western Reserve and did a Fellowship in Medical Oncology at the National Cancer Institute, where he spent a good portion of his early career. In the 2000s, he relocated to Atlanta, where he became medical director of the Georgia Cancer Center for Excellence at Grady Memorial Hospital. One of the really most famous safety net hospitals in America. He was deputy director of Cancer Control at the Winship Cancer Institute of Emory University. And then he moved on to really a significant role. He became the chief medical and scientific officer and executive vise president of the American Cancer Society from 2007 to 2018, and we'll have a chance to perhaps query him about that. Currently, he leads a broad interdisciplinary research program on cancer health disparities at the Bloomberg School of Public Health and the Johns Hopkins Kimmel Cancer Center. Dr. Brawley has received innumerable awards. It would take the whole podcast to list them all. But among them are the American Medical Association Distinguished Service Award, University of Chicago Alumni of Professional Achievement Award, and-- one that I think is particularly poignant for ASCO members-- the Martin D. Abeloff Award for Excellence in Public Health and Cancer Control. In 2015, Dr. Brawley was elected to the National Academy of Medicine and well deserved. So just welcome to oncology, et cetera. Thank you so much for taking the time to be with us today. OTIS BRAWLEY: Thank you for having me. It's a pleasure to be with you and Pat. DAVID JOHNSON: Well, it's great to have you. I can tell you that. So let's just start with just a little background. Why don't you tell us about yourself? Where are you from? Where did you grow up? OTIS BRAWLEY: I grew up in Detroit. I grew up in one of the automobile worker neighborhoods, a blue collar neighborhood, and went to the Catholic schools there. The nuns in grade school pushed me toward the Jesuit school for high school, and the Jesuits in high school taught me how to think and really propelled me. And indeed much of my career, much of my writings, my philosophy toward medicine was really influenced by early education with the Jesuits. DAVID JOHNSON: Wow. PAT LOEHER: Hey, Otis. I just want to throw in-- in terms of books that we've read, one of the other books that I want to give a shout out is the book you wrote called How We Do Harm, which was really a wonderful book. I think it was several years in the making. Would love to hear how you made that. But I do-- while you're talking about your background, speak a little bit about Edward McKnight Brawley and Benjamin. OTIS BRAWLEY: Oh, OK. Benjamin Brawley was my grandfather's brother, and Edward McKnight Brawley was my grandfather's father. They're both ministers in the Methodist Church, the AME Church. Benjamin Brawley was dean of Morehouse College back in the 1920s, and he was the first Brawley to graduate from the University of Chicago. He got a PhD from the University of Chicago back during the 19-teens. And those are just a couple of my relatives. If you go to Morehouse, you'll find that the English building is Benjamin Brawley Hall, and Edward McKnight Brawley was his father and was a free Black back before the Civil War, and a minister before, during, and after. PAT LOEHER: Incredible legacy. Incredible legacy. DAVID JOHNSON: Those were your relatives from the South from the Georgia area? OTIS BRAWLEY: Well, my father grew up in Northwestern Alabama. An area called Leighton, Alabama. It's near Muscle Shoals. So those of us who remember the Beverly Hillbillies. My mother is from the middle of Arkansas. She's from Pine Bluff, Arkansas. And they met in Detroit. They were part of that northern migration in the early 20th century, where a large number of Blacks left the rural South and went up North to get jobs primarily in the industrial North. My father arrived there right after World War II. He served in World War II, got discharged, and went to Detroit. My mother actually went to Detroit really early on during World War II and worked in an airplane factory during the war. Then the two of them met. My father was a janitor at the Veterans Hospital in Detroit, and my mother worked in the cafeteria there. And that's how they met. They had my older sister, who was 8 years older than me, who became an attorney. And my younger sister was a certified public accountant. PAT LOEHER: What a remarkable story for your parents. And tell us a little bit about your journey to become a physician. How did that happen? OTIS BRAWLEY: It was very interesting. In high school, I was very talkative. I was very interested in policy. I did debate. It was very not a sciencey kind of person. In college, I became very interested in Chemistry and for much of College. I was going to go to graduate school in Chemistry. And luckily, when I was in college, I came under the influence of an infectious disease doc named Elliot Kieff. And he and I became very good friends. He was chief of infectious disease at the University of Chicago at that time. And over about two years, Elliott convinced me to drop the Chemistry thing and go to Medical school. And I applied to Medical school late, because I was so late in making that decision. I got into the University of Chicago and stayed there because my support system was there. And then in Medical school came across another gentleman. I've been very fortunate to have good mentorship and good people. They influenced me over the years. John Altman, who was one of the original medical oncologists back in the 1950s when there was arguments about how we should be staging people. Should there be four stages or three stages, and that sort of thing is when John really cut his teeth in Oncology. He became a great lymphoma doc. John took me under his wing while I was in Medical school, and pretty much open the world up to me, and explained to me how the world rotates in Medicine. And that heavily influenced me. Told me to go into Oncology because I still had an interest in Policy. And he said there's going to be a lot of policy in oncology in the future, and the best way to get involved with it is to get your credentials as a medical oncologist. And in many respects, I think in the early 1980s, John was thinking I was going to be chief medical officer of the American Cancer Society, which I obtained in 2007. PAT LOEHER: Wow. Yeah. We want to hear more about that. I just have to throw this in parenthetically that one of the things I did here is that I applied late to Medical school and got into the University of Chicago. I just wanted to know that I applied early, and there was a lesser known school in Chicago that sent me a rejection letter. And not only did they reject me, the last line of it says, good luck in whatever career you decide to go into, meaning that, if you can't get into our school, there's no way you'll be a physician. So I really admire you. DAVID JOHNSON: Yeah. I applied late too and-- PAT LOEHER: Got into Vanderbilt. DAVID JOHNSON: No. No. No, no. I didn't go to Vanderbilt. I only got into accepted to one medical school, and it was late. I was just like my career as a chief. And I was, like, the last person admitted to my class in med school. That's unbelievably interesting. Tell us, was John your influence to go to the NCI? Or what prompted you to choose the NCI for your medical oncology training? OTIS BRAWLEY: Actually, John was very influential in that decision. I told him I wanted to go into medical oncology when I was a resident in Cleveland. And he said, Otis, in his Austrian accent, I have been expecting this phone call. And he then told me where I was going to apply and gave me a list of nine places to apply. He told me I would get an interview at every one of those places. And as I was going place to place, I should rank them one, two, three, four. And so I called them with his ranking. And my first choice was not the National Cancer Institute. At which point he told me, if you go to that place, I will never speak to you again. PAT LOEHER: Oh wow. OTIS BRAWLEY: And I said, but you told me to go there to interview. He said, I wanted you to interview there, but I don't want you to train there. And I said, well, my first choice is the National Cancer Institute. And he said, fine. And a couple of days later, I got a phone call from the National Cancer Institute, and I got hired. And I will also tell you I called John up. And he says, Otis, I have been expecting this phone call. And then he said, now I want you to realize something. There is an old boys network, and your job is to get more Blacks and women into it. That's how you will thank me. PAT LOEHER: Wow. Wow. DAVID JOHNSON: So you were at the NCI at a period of time where many people would say it was the heyday of the NCI. I think it's still the heyday now, but tell us about your experiences there. What was it like? OTIS BRAWLEY: It was fascinating. It was when Vince DeVita was still the director. I was there for the transition. Eli Glatstein was the chair of Radiation Oncology. It was an amazing group of people. Dan Longo was there doing lymphoma. Marc Lippman was still there doing breast. It was just an amazing group of people when I applied, and interviewed, and when I first got there. And there was still a lot of excitement. We were still heavily involved in chemotherapy. Of course, I was up on the 12th and 13th floor building 10. Down on the second and third floor was Dr. Rosenberg doing his immunotherapy work, which of course, has now paid off dramatically. Some of the old monoclonal antibody work that led to a number of wonderful drugs was being started at that time in the mid to late 1980s. And so it was still a very, very exciting time at the National Cancer Institute. And in many respects, we were still on that burst of optimism that started with Nixon's war on cancer in 1971. It was still felt almost 20 years later at the National Cancer Institute. DAVID JOHNSON: And you linked up with an old friend of mine from the old Southeast Cancer City, a gentleman by the name of Barry Kramer? OTIS BRAWLEY: Yes. DAVID JOHNSON: What a wonderful relationship. So how influential was Barry in your involvement? OTIS BRAWLEY: Barry was incredibly influential. As I said, I have been very fortunate that along the way I have come under the influence of some amazing physicians, and I've had amazing mentorship. And that's actually, I think, important for all of us in oncology. Barry and I got to work together for quite a long while. Barry influenced me and literally taught me epidemiology. Got me some major opportunities at the National Cancer Institute and really was influential in promoting me and boosting my career. PAT LOEHER: I want to move you a little bit longer in your career and talk about the ACS and a little bit your experience there, Otis. And then with that, actually, maybe the secondary question is, a commentary on the leaders over the years that you have had-- the aspects of good things about leadership and the poor things. And obviously, you have certainly much to share on that. OTIS BRAWLEY: Yeah. Well, as I devote my career at the National Cancer Institute, I went to the Division of Cancer Prevention and Control. Under Barry, learned a lot of epidemiology, and learned a lot about screening, learned a lot about treatment outcomes, got very involved with some of the disparities or minority health issues. And then I was very fortunate to be detailed to work in the surgeon general's office and work with David Satcher when he was surgeon general. He's the one who started using the words, health disparities. Prior to that, we called it minority health or special populations. He used health disparities. And I was able to use some of my epidemiologic talents to develop some of those arguments using science to show. And actually some of the things that we had to show, believe it or not, was we had to show that equal treatment yields equal outcome amongst equal patients, because a lot of people, especially the politicians we need to deal with, were really hung up. And we still see this to this day that people are hung up that Black biology is different from white biology. Even in breast cancer today I hear that even though I like to point out there are now six states where the Black death rate for breast cancer is the same as the white death rate for breast cancer. And there are 12 states in the United States where white women have a higher risk of death from breast cancer than Black women in Massachusetts. But anyway, we got into this biology thing. And so I was very fortunate again to work for David Satcher and had some exposure to Tuskegee syphilis trial and the president's apology for that. So I was really involved with a number of things. And then the Jesuits still back there-- always think, always be contemplative, always reflect on what you're doing, always question what you're doing. Father Pawlikowski's maxims, which Dick Cheney sort of preferred is a few years later. And that is there are things you know, things you don't know, things you believe. Question what you know more so than anything else. And so that's really how I develop my concerns about orthodox use of Medicine. And using the science and applying it in a very Orthodox way, I started realizing that a lot of the disparities were due to wasted resources with people being non-scientific especially in the era of the 1990s, where everybody was doing prostate cancer screening, and there was not a single trial to show that prostate cancer screening saved lives. Yet all the resources were going into that, and people were literally-- I was able to go to various safety net hospitals and see all the resources being diverted away. People would shut down cervical cancer screening programs to do prostate cancer, which just didn't make sense. So I got very interested in how you practice medicine. Went to the Emory in 2001, because I wanted some practical experience outside of government. And had a wonderful opportunity to go there. Work at Emory. Work at one of the largest safety net hospitals in the country. Learn a little bit about the practical application of Medicine and some of the problems that people at safety net hospitals encounter. Worked with the School of Public Health and folks who did health education to learn how to convey messages. And then I was very fortunate. You know, the American Cancer Society is right down the street from Emory University. And I had met the chief medical officer of the American Cancer Society, Harmon Eyre, back in the 1990s when I was at the National Cancer Institute. And again this sort of mentoring thing comes up again. Harmon called me up one morning and said, why don't we go to lunch? And so we went to one of the student cafeterias at Emory and had lunch. And he essentially said, you know, I'm 67 years old. I've had this job for 20 years. I'm tired of it. Why don't you take it? PAT LOEHER: Wow. OTIS BRAWLEY: And so I applied to be chief medical officer of the American Cancer Society and got to know John Safran, who, at that time, was the CEO, who was a wonderful man with incredible vision. Again, this mentorship thing comes up again. PAT LOEHER: Well, Dave we had a lot of information here. We're going to carry this over. This concludes the first part of our two-part interview with Dr. Brawley. And our next episode will air on October 5. We'll talk a little bit more about Dr. Brawley's life experiences and particularly his work with the American Cancer Society NCI. He's been an incredible individual, and we look forward to finishing up this conversation. Thank you to all our listeners for tuning in to Oncology Et Cetera an ASCO Education Podcast, where we'll talk about anything and everything. If you happen to have an idea for a topic or guest you'd like to see on the show, please email us at education@ASCO.org. Thanks again. And remember Dave has a face for podcast. SPEAKER: Thank you for listening to this week's episode of the ASCO eLearning weekly podcast. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive e-learning center at elearning.asco.org.

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Oncology, Etc. - Introducing Oncology, Etc.: Friendship, and the Majesty of our Profession

university health science education medicine pennsylvania cancer physicians abroad oncology telemedicine nudge aggarwal shulman physician burnout global oncology

Play Episode Listen Later Aug 3, 2021 24:04

Oncology, Etc. is a monthly ASCO Education podcast exploring topics in oncology through interviews with emerging thought leaders, physicians, and innovators. In this episode, hosts Dr. Patrick Loehrer (Indiana University), Dr. Jamie Von Roenn (ASCO), and Dr. David Johnson (University of Texas) discuss the importance and impact that friendship has made on their careers. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: elearning.asco.org | Contact Us Air Date: 8/3/2021 TRANSCRIPT [MUSIC PLAYING] SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. PATRICK LOEHRER: Hi, I'm Pat Loehrer. I was born in Chicago, moved to Indianapolis when I was in high school, went to Purdue University, went to Rush Medical College, came here to Indiana University. And I've been on faculty ever since. I'm now a distinguished professor and the former head of our Cancer Center and Director of our Centers for Global Oncology. JAMIE VON ROENN: So hi, I'm Jamie Von Roenn. I'm a medical oncologist and trained at Rush with Pat and subsequently stayed in Chicago at Northwestern and came here to ASCO as the VP of Education about eight years ago. DAVID JOHNSON: Hi, I'm Dave Johnson. And I'm in Dallas, Texas. I'm a medical oncologist originally from Georgia, spent a large part of my career on the East Coast and in Tennessee before relocating to Dallas to become Chairman of Medicine in 2010. I stepped down from that position last year and now serve as an elder statesman [INAUDIBLE]. So we are excited to be here today for a new endeavor sponsored by ASCO, a podcast entitled Oncology, et cetera and with a heavy emphasis on the et cetera. We are here to talk with thought leaders, physicians, authors, innovators in oncology and beyond. To be honest with you, we have a lot of interests. And so I'm going to turn to Jamie and ask Jamie, why are we doing this? Jamie is the instigator behind this. So Jamie, why are we doing this podcast? JAMIE VON ROENN: So I think the primary reason we did this is to remind people why they chose oncology, that all three of us are people who are super excited about this profession, about what we've learned and what we've given and how we've shared it with each other and with the profession in general, that it's the science. It's the relationships. It's change. And it's incredibly fulfilling on all of those levels. DAVID JOHNSON: Yeah, Pat, what are your thoughts? PATRICK LOEHRER: When Jamie asked us to do this, this was something that we jump at. I love Jamie dearly. Dave and I both share this mutual admiration society. I deeply admire Jamie. And, to do something with Dave who is one of my closest professional friends, this was just a great opportunity. We thought in our conversations, though, as we talked with other people, that it would be good just to talk among ourselves and particularly about the notion of friendship and what it means to each of us personally with the idea that maybe those listening might reflect on that in their own lives. DAVID JOHNSON: Yeah, so you mentioned-- you made a distinction there, Pat. I'd like to know what that distinction represents. You said you had your personal friendships and your professional friendships. How do those differ? PATRICK LOEHRER: Well, you know, I'm not sure how it is for you, but my wife is outside of medicine. I've known her. I had my first date with her 50 years ago. And I have friends that I really don't like to talk about business with. I just talk about other things, our kids, family, whatever. Our friends in medicine are a little different. We have deeper conversations about our work. And there are certain aspects of our work that I think touch us personally. We have patients that we've become close to that are rough. And, many times, I don't share those interactions with my friends at home because it's just not important to them. So I treasure especially you guys, I treasure deeply. We've shared a lot over the years. JAMIE VON ROENN: So it seems to me that friendships in general are built on shared experiences and that the experiences in medicine are so different from anything else. And, if you don't have friends in your profession, you may not actually have the opportunity to share and sort of have a sounding board for how difficult things are sometimes in spite of how inspiring it is. DAVID JOHNSON: Yeah, I think I like your distinction. Both of you pointed out the shared experience. The world of an oncologist, viewed from the outside, may appear to be a rather morbid specialty, but, in fact, it's one that I personally find incredibly rewarding. But there are those moments that are challenging and difficult-- patient encounters, professional setbacks, et cetera. And it's nice to have someone within the profession itself that can relate to those experiences, especially failure. I know, Pat, you've had lots of failures. [LAUGHTER] JAMIE VON ROENN: I think we all have. PATRICK LOEHRER: Thank you. Just as a background, there have been, in this group, five runs for ASCO presidency. And only one of them has been successful. So yeah, we know failure, Dave. JAMIE VON ROENN: But I think it's important because no one is successful all the time. And it's your friends who actually get you through that and let you see, OK, yeah, I'm still OK. And I think it's the other side of that too. Everyone who's honest has suffered from the imposter syndrome. And it's your friends you can openly share that with. And it helps you go the next step when you're struggling. DAVID JOHNSON: So you mentioned that the two of you met during your residency training. What prompted that friendship then? And how has it been sustained over the last many years? I won't say the number of years, but a lot of years. JAMIE VON ROENN: So we actually met when I was a medical student, and Pat was my intern who I worked with. And then, when I was an intern, Pat was the resident. DAVID JOHNSON: So that accounts for all your problems in the medical field? JAMIE VON ROENN: It accounts for how well trained I am. DAVID JOHNSON: I see. JAMIE VON ROENN: But I think it was the sense of joy in the profession that probably connected us and a love of people. I don't know. Pat, what would you say? PATRICK LOEHRER: Well, it was a special time back then in medicine. Our particular hospital was a resident-run hospital. I think we acted first and then asked permission from the attendings later on. And it was really very special. There's a lot of people from Rush who have gone into oncology in many different areas. And so it was very special. Jamie I knew. We really did not keep in touch until she gave a plenary paper at ASCO. And I remember writing her a note. And I was so proud to see her up there. And I wrote that in a note. And we started, basically, communicating and getting together regularly. And so, each year at ASCO, as you know, we get together, the three of us, collectively or individually, and have a dinner. It's really the highlight of the meetings for me. DAVID JOHNSON: Yeah, I mean, I had the good fortune of Pat and I coming together, I think, shortly after I completed my fellowship. And Pat and I were both starting our academic careers, he at IU and I at Vanderbilt at the time. And we interacted through one of the major NCI cooperative groups that, unfortunately, no longer exists. It may have been due to our work, Pat, that caused the Southeast group to divide. But it was through Pat that I met Jamie. And so that's been really one of the most rewarding relationships that I've had professionally over the last, now more than 40 years. I mean, it's been a long time really. PATRICK LOEHRER: And we were on the ABIM together, the three of us, which was a riot. It's another one that seems like a thankless position, but we realized how hard it is to write very good questions. And we would spend a lot of time together doing this. I learned tremendously from the two of you and the others around the ABIM. JAMIE VON ROENN: Yeah, that was a remarkable experience for us because it's a small group of people putting their ego outside the door and working together. DAVID JOHNSON: And the challenge of maintaining one's knowledge base, I mean, honestly, I hadn't thought that much about it until I was invited to join the ABIM. And thank you, Pat, for making that possible. I consider it one of the highlights of my professional career is being a part of that. And I realize how controversial the work that ABIM is doing today, but, still, I think it was a wonderful experience. JAMIE VON ROENN: We've been pretty lucky to share multiple professional activities. I mean, when you were president, Dave, I was on the board. We shared ABIM. We shared some ECOG work way back. It's been a lovely crossing of paths beyond friendship . DAVID JOHNSON: Yeah, I mean, I think one piece of advice that I give to residents, and especially those who are interested in heme-onc fellowship, is find a friend. It's really important that you do so. I was fortunate to have the two of you and some other friends during the course of my career. And I must say, turning to a friend for advice, for assistance, for mentorship-- I can't remember who said it first. Having a friendtor is really, really important in the course of one's professional development. JAMIE VON ROENN: It's an important message because it takes time. When people are in training, they often think they don't have time, but this is a value on every level. It's more than worth the time. PATRICK LOEHRER: I just want to jump on that friendtor. We all have had people that we work closely with. In Indiana, it's been Larry Einhorn who was a role model for me when I was a medical student and then became a mentor when I was a fellow at a junior faculty. And he is, again, one of my closest friends. And he is one that gives me advice, but also just listens. And, similarly, he'll come in and ask me advice, which was mind boggling that someone of his stature would lean on us. But I was trying-- I was just going to put a caveat or a corollary to your statement about finding a friend. Dave, what I tell people, I think it's more important to be a friend than to have them. I think, if you get into the habit of helping other people and being a friend, you'll collect people close to you down the road, but, boy, it's not a one-way street. It really has to be the best friendships in which you give and you also happen to receive, but it's really a nurturing process. It just doesn't happen by chance. It happens because the people make an effort in it. JAMIE VON ROENN: Absolutely. DAVID JOHNSON: So what do you look for in establishing those friendships, Pat? What attracts you to an individual to even consider establishing a friendship? PATRICK LOEHRER: Well, I like to have friends who are dumber and uglier than I am. And that's why I really migrated to you. I mean, I think, when I looked around the room, I said, this guy could be my friend. DAVID JOHNSON: It's amazing. I saw myself in the mirror when I saw you. JAMIE VON ROENN: So I'm going to take that more seriously and say I think what we have done with each other is looked for people with values that connect and that, in the end, whatever those values are, that's what makes the friendship last. PATRICK LOEHRER: Well, it's interesting. As we talk about, in academics, one might think that you become friends with people in your own disciplines, but Jamie was a age researcher in palliative care. Dave, you were a thoracic oncologist. And I was a GI. And the loneliest friendship would be with thymoma people. But none of us really merged together because of our own professional disciplines. It really was something else. I think there was a higher power that pulled us together. DAVID JOHNSON: Oh, I think Jamie touched on it. I mean, it's the values that we share, I think. And I'll go back to something we talked about earlier, which is our shared love of the profession itself. I think I was 10 years old when I first seriously thought about being a physician. You may argue that a 10-year-old can't think seriously about anything, but, throughout my youth, all the way through college and, ultimately, medical school, medicine was my goal. And I've never regretted making that decision. I know there's a lot of unhappiness in the medical profession in this day and age and a lot of talk about burnout. One recent study actually even suggested that over half of all physicians would not recommend medicine to their children as a profession. I find that disheartening. I'd be delighted if my child were to choose such a profession. She didn't, but I would have been delighted had she done so. And I know, Pat, you have children who have pursued medicine as a career. PATRICK LOEHRER: Yeah, I was-- actually, at my son's graduation, I was up in the balcony away from everyone else taking photos, but I did find myself with a tear coming down my eye watching him just because it was an affirmation that my life was something that didn't steer him away from medicine. I think he did find, in my life, the joy that you can find in this profession. I want to change this a little bit to you guys, Dave, because you talked about the profession. And, several years ago, well, you both have had some really tough episodes in your life, but, Dave, you came down with lymphoma many years ago. And I do remember an ASCO presentation that I think Jamie helped put together in which there were several of you. I think Nick Vogelzang and Sandra Horning were up there. And you shared your experience of having cancer and shared some of the stories, I think, of friendship. But I do remember the phrase that you used at the end of the talk about how you had a deeper appreciation about the majesty of our profession. That's always touched me, but can you reflect a little bit about your illness and having lymphoma as a cancer doctor and what you learned in terms of this topic of friendship? DAVID JOHNSON: Well, we, as oncologists, think we know what it's like to have a serious illness. And I certainly was no different than most oncologists. But, when I myself was diagnosed with a malignancy, I must say, I had many of the emotions that I've witnessed in my patients. And, also, suddenly, my brain went completely blank. I couldn't think about what it was that needed to be done. And I, like most patients, began searching for the perfect answer. How would I deal with this? But I was also curious because, a few years prior to my own diagnosis, another faculty member at the institution where I was at the time had been diagnosed with ALS. And he wrote a very personal and moving piece that was published in The New England Journal about his experiences at that institution and how he was treated by his fellow physicians. And, actually, what he had to say was not all that complimentary in some instances. And I wondered myself how I would be dealt with by my fellow physicians. And I must say, my experience was virtually the polar opposite. I was surprised, honestly, at how heartfelt the good wishes were, the way that my colleagues went out of their way to try to make sure that I was successfully treated, was dealt with appropriately, even colleagues at my institution that I had not known that well finding excuses and reasons to drop by the office that seemed manufactured, quite frankly, but were clearly, again, intended to lift my spirits and make me feel positive about my future. It really made me realize just what a special profession we're in and then, to have friends that I could turn to, such as you and others, who really did a lot to lift my spirits. So, when you see that, you can't help but be really moved by the men and women who come into this profession and particularly those who choose oncologist as a specialty. PATRICK LOEHRER: I had a colleague who succumbed to glioblastoma. And he was-- when he was first diagnosed, he told me there were three kinds of friends, he realized. There were the long-lasting friends that he's always had. There were people who he thought were friends who kind of just faded away, mainly because they didn't know what to say. And then the third group were these unexpected friends, people that he didn't really know that very well, but came into his life and really made a difference. It was very insightful. DAVID JOHNSON: Yeah, I mean, that's exactly the experience I had as well. And the group that unexpected was perhaps the most surprising to me, but really I came to appreciate greatly. PATRICK LOEHRER: Many years ago, when we were doing the board questions, Jamie was not able to come because her husband Kelvin had been diagnosed and then, shortly thereafter, passed away from cancer. I knew him when I was a resident. He was a feared neurosurgeon. He made Ben Casey look like Dr. [INAUDIBLE] He was an incredibly intense, wonderful man, but I've not talked much deeply about that. And, with some reluctance, Jamie, I don't know if you want to share a little bit about how you felt as a palliative care doctor, and then here's your husband who's dying of cancer. JAMIE VON ROENN: Sure. And it kind of echoes what both of you have said. Here I was, a palliative care doc. And I thought I understood what death and dying was about. And, after Kelvin died, I was blown away. And I recognized, I said the right things, but I never really understood them. And it changed the way I talked to patients forever. And I too had the same experience of friends who are new, old, and otherwise, those that disappeared because they were too uncomfortable. And I was shocked that there were partners, oncologists, who could never ever say anything to me because they were too uncomfortable talking about death. And here it was something they were supposed to be trained to deal with. And, in fact, I remember, many times, Pat, you calling and checking in on me. And I remember in particular one day when I was down, and you said, wow, you are in a dark hole. And I was. And it took a long time, but it's friends that get you through and the ability to talk about what nobody wants to hear that helps you recover ultimately and move on. And those are life friends, but there's something different about people like the two of you who understand these experiences from a different perspective. DAVID JOHNSON: Yeah, I mean, I think these shared experiences, they're not shared in the sense that we experienced it personally, but the fact that we were able to relate to one another and share those very personal moments only fortifies and solidifies an existing friendship. And there are a lot of people I would not have that discussion with, but there are a few. And you are certainly among those two that I would. PATRICK LOEHRER: Well, I mean, you guys mean a lot. And I know-- I'm trying to think of the time. Back when I was thinking about becoming a heme-onc division chief. I gave Dave a call. Dave was head of heme-onc at Vanderbilt, I think, for 68 years or something. I can't remember. You were there for a long time. And I called him up. And I thought for sure there would be this, yeah, Pat, you'd be great. You'd be a wonderful division chief, but there was just this silence. It was like, I don't know, about 90 seconds of just pure silence. And then you said, yeah, it's mostly a good job. Then you reflected a little bit about this. And, in terms of this rejection, I think the other thing you taught me is it's OK not to be the first choice. But I can't remember. What choice were you for the division chief? DAVID JOHNSON: 11. PATRICK LOEHRER: 11. Yeah, I love that. I love that. DAVID JOHNSON: That's true. I mean, they interviewed 10 people before I was offered the job. So I knew I was in the top of all candidates. PATRICK LOEHRER: Top hundred, huh? This is like Rock and Roll Hall of Fame [INAUDIBLE]. DAVID JOHNSON: They ran out of candidates. PATRICK LOEHRER: Well, you know, that part, I've got to be honest with you. The stories with you guys have helped me out quite a bit because junior people would look up and say, oh, look at these guys. Aren't they successful? But they don't realize that we have stumbled and failed over the years in many things. And the best thing you can do is just laugh about it when you try. But, going back to the notion of friendship, there is no greater joy than I have is to see you guys, who are my friends, succeed. And a definition, I think, of a friend, at least a minor definition, is, when someone gets an award, that you find greater joy in them getting the award than you would if you got it yourself. If you find yourself kind of jealous and wondering, well, I wish I had that, probably, it wasn't your friend then. But I've gotten so much joy in watching you guys succeed. JAMIE VON ROENN: So I think there's a corollary to being a good mentor, which is, when your mentees surpass you, then you were successful. And it's the same with friendship. PATRICK LOEHRER: I'm one of the most successful people in the world then. DAVID JOHNSON: I was getting ready to say, I think we've all succeeded wildly then. [LAUGHTER] JAMIE VON ROENN: But that is the goal. I mean, what's the point of being able to help people if you don't make them the next set of stars? DAVID JOHNSON: We've been lucky to have a lot of really terrific men and women who we've been able to work with over the years and call them mentees, but, in reality, we've been their mentees. They've been the ones that have taught us so much. I'm very proud of all of them. JAMIE VON ROENN: Yeah, I think that is something to be proud of. And, when I look back, it's those things that make me most excited about what I've accomplished. PATRICK LOEHRER: Well, I think, every good relationship, you really get more out of it than you get into it. Even as we have our heart to hearts with our patients and having end of life discussions, I usually get so much out of that in a reflection of their own personal love for each other and their family and what they treasure in life. But, again, with you guys, unabashedly, I'll say this in public. I love you deeply. And I appreciate your friends. CS Lewis had a book called The Four Loves in which the most unnatural of the four loves was friendship, but it's what he actually thought was probably the most important one because it's so unique. And it's not expected, but you guys, I think, are an important part of my life. And I thank you for that. JAMIE VON ROENN: I love you both and feel the same. It's the luckiest thing there is. DAVID JOHNSON: Yeah, absolutely, absolutely. Thank you so much for that. Well, I think our time is about up for today. I want to thank all the listeners. I'm sure there's tens of thousands listening to this. Well, I just called Pat's friends and told them listen. So we plan to do this monthly. We already have a scheduled guest for our next podcast. It'll be Dr. Otis Brawley who I think many of you know by reputation, one of the leading luminaries in oncology in the United States. He's now at Johns Hopkins. I think it'll be a really enlightening and fun conversation to hear what Otis has to say about the current state of oncology in this country. So, with that, we'll sign off until next month. Thanks, everybody. [MUSIC PLAYING] SPEAKER: Thank you for listening to this week's episode of the ASCO eLearning weekly podcast. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive eLearning center at elearning.asco.org.

Dr. Larry Shulman, on Telemedicine at Home and Abroad, Physician Burnout, and Global Oncology | BTJ-020

Beyond the Journal

Play Episode Listen Later Jul 27, 2021 41:51

Dr. Larry Shulman of University of Pennsylvania meets with hosts Charu Aggarwal & Jack West to discuss the promise & challenges of telemedicine in the US & internationally, physician burnout, & the critical value of building programs for global oncology.

Assessment of Adult Women with Ovarian Masses and Treatment of Epithelial Ovarian Cancer Resource Stratified Guideline

ASCO Guidelines Podcast Series

Play Episode Listen Later Jun 29, 2021 15:22

An interview with Dr. Zeba Aziz from Hameed Latif Hospital in Lahore, Pakistan, Dr. William Burke from Stony Brook University Hospital in Stony Brook, NY, and Dr. Keiichi Fujiwara from Saitama Medical University International Medical Center in Saitama, Japan, authors on "Assessment of Adult Women with Ovarian Masses and Treatment of Epithelial Ovarian Cancer: ASCO Resource Stratified Guideline." This guideline provides recommendations in three resource-constrained settings on diagnosis and staging of adult women with ovarian masses and treatment of patients with epithelial ovarian (including fallopian tube and primary peritoneal) cancer. Read the full guideline at www.asco.org/resource-stratified-guideline. TRANSCRIPT ASCO: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines podcast series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at podcast.asco.org. My name is Brittany Harvey, and today, I'm interviewing Dr. Zeba Aziz from Hameed Latif Hospital in Lahore, Pakistan, Dr. William Burke from Stony Brook University Hospital in Stony Brook, New York, and Dr. Keiichi Fujiwara from Saitama Medical University International Medical Center in Saitama, Japan, authors on Assessment of Adult Women with Ovarian Masses in Treatment of Epithelial Ovarian Cancer: ASCO Resource Stratified Guideline. Thank you for being here, Doctors Aziz, Burke, and Fujiwara. First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline and the Journal of Clinical Oncology, Global Oncology. Dr. Burke, do you have any relevant disclosures that are directly related to this guideline topic? DR. WILLIAM BURKE: I do not. BRITTANY HARVEY: And Dr. Fujiwara, do you have any relevant disclosures that are related to this guideline topic? DR. KEIICHI FUJIWARA: Yes. I have the consultancy for the PARP inhibitors development. BRITTANY HARVEY: Thank you. And then Dr. Aziz, do you have any relevant disclosures that are related to this guideline? DR. ZEBA AZIZ: No, I don't. BRITTANY HARVEY: Thank you. OK, so first, Dr. Burke, can you give us a general overview of what this guideline covers? DR. WILLIAM BURKE: Sure, Brittany. The purpose of this guideline is to provide expert guidance in treatment of adult women 18 years and older with epithelial ovarian cancer, including fallopian tube and primary peritoneal cancer, to clinicians, public health leaders, patients, and policymakers in a resource-constrained setting. To do this, ASCO has established a process for development of resource stratified guidelines, which includes a mixed methods of evidence-based guideline development, adaptation of the clinical practice guidelines to other organizations, and formal expert consensus. This guideline summarizes the results of this process and presents resource-stratified recommendations. The recommendation of this guideline centers around the four key clinical questions pertaining to the care of women with ovarian cancer. BRITTANY HARVEY: Great. And then, as you just mentioned, this is a resource-stratified guideline. So Dr. Fujiwara, can you tell our listeners about the four-tier resource stratification used for the development of this guideline? DR. KEIICHI FUJIWARA: Oh, yes. So we have the four tiers resource stratification, which were basic, limited, enhanced, and maximum. So for the basic, it's the core resources or fundamental services that are absolutely necessary for any public health or primary health care systems to function. So the basic levels of this typically are applied in our single clinical interactions. For the limited, so this is the second tier resources or services that are intended to produce major improvements in outcomes such as, for instance, cost-effectiveness, and are attainable with a limited financial means and modest infrastructures. So the limited level of service may involve single or multiple interactions. And the third tier is enhanced. The third tier resources or services that are optional, that are important, enhance the level of resources should produce further improvements in the outcome and to increase the number of the quality of options in the individual choices. Lastly, the fourth tier is a maximal, so high-level or state of the art resources, or services that may be used or are available in some high-resource countries, and/or may be recommended for the high resource setting guidelines that do not adapt to resource constraints, but that nonetheless should be considered for a lower priority than those resources or services listed in the other categories on the basis of extreme cost and/or impracticality for the broad use of the resource-limited environment. BRITTANY HARVEY: Great. Thank you for going over those. So next, I'd like to review the key recommendations of this guideline. This guideline addresses four overarching clinical questions. So first, Dr. Aziz, what are the key diagnostic and staging recommendations for patients with symptoms of epithelial ovarian cancer? DR. ZEBA AZIZ: Thanks, Brittany. Basically, as pointed out, we have three levels. The basic level usually involves one or two encounters, and at the basic level, the doctor makes a clinical assessment of a suspected ovarian mass, takes a good history and physical, and the family history is also important at the same time. At the basic level, one can do a chest X-ray and an ultrasound to confirm the suspicion, and then the doctor should ideally send the patient to a limited or an enhanced level-- wherever the patient can go. At the limited and enhanced level, again, you have to do diagnostics, which include a CT scan and an MRI if it's available and feasible. You can do the biomarker studies for CA125 and CEA level, and to make a diagnosis, you can do a CT-guided biopsy. You can also do a cell cytology and if a cell block preparation can be made through cell block. Very rarely, if need be, and if you think that you need to make a diagnosis and you can't do anything else, laparoscopy can be done. Once the diagnosis is made, you then go for staging. And the staging is usually done when you're doing a CT scan and you do an abdominal and pelvic CT scan. You do a CT scan of the chest if you think it's needed. Otherwise, a chest ray will suffice. And then you go forward and get a diagnostic workup done and send it to the surgeon for either and decide on a multidisciplinary with a neoadjuvant or surgical assessment testing. BRITTANY HARVEY: Great. Then so next, Dr. Fujiwara, what are the overarching recommendations for surgery with women with stage one to four epithelial ovarian cancer? DR. KEIICHI FUJIWARA: Yes. So the purpose of the surgery is to diagnose, stage, and/or for treatment. So we strongly recommended the ovarian cancer surgery should be performed by trained gynecological oncologists or surgeons with oncologists' surgical expertise. If it is not suitable, we strongly recommend to refer those patients to the highest-resourced level center with an oncology surgical care capacity. For the staging purpose, where the feasible patients with a presumed early stage ovarian cancer should undergo surgical staging by train surgeons. In basic setting, surgical staging is not feasible. Thus, it is not recommended. For the treatment purpose of the women with advanced ovarian cancer, which is a stage three or four, should receive optimal surgical debulking to remove all visible disease to improve overall survival by trained surgeons. BRITTANY HARVEY: Great. And then Dr. Burke, what are the key recommendations for optimal adjuvant and systemic therapy for patients with stage one to four epithelial ovarian cancer? DR. WILLIAM BURKE: Sure. Well, one of the most important things is that access to appropriate evidence-based chemotherapy agents, contraindications to chemotherapy, and potential side effects of chemotherapy should be evaluated and managed in every patient. Basic resource settings that most likely lack the capacity to provide safe administration of chemotherapy should refer patients to a higher level center for evaluation. Limited settings without skilled capacity should refer patients to settings with access to specialized care. Some other notes include that clinicians should be able to document pathology and stage to determine eligibility for adjuvant chemotherapy. If pathology confirmation is not possible due to patient or resource limitation, alternatives can be discussed. Clinicians should not administer systemic treatment, adjuvant chemotherapy, to patients with ovarian low malignant potential tumors or early stage, microinvasive borderline tumors, independent of stage. Combination chemotherapy with paclitaxel and carboplatin is the standard of care for adjuvant therapy in ovarian cancer. However, single agent carboplatin may be utilized due to resource limitation or patient characteristics. Only in enhanced settings, highly selected cases can be assessed for appropriate evidence based intraperitoneal chemotherapy following optimal debulking, where there are resources and expertise to manage the toxicities. BRITTANY HARVEY: Great. And then the last overarching clinical question-- Dr. Aziz, what is recommended for patients with recurrent epithelial ovarian cancer? DR. ZEBA AZIZ: You know, with recurrent ovarian epithelial cancer is a tough option, especially in patients residing in the low-middle income countries. Supportive care treatment should be started together with whatever we have to do. So there are three options. There's one patient who presents with a rising CA125 with no evidence of disease and asymptomatic. We can elect to follow these patients, and it's easier to follow them until they become symptomatic or they have evidence of disease. If you have small volume disease which is resectable, you send them to an enhanced level setting, ideally where surgery can be done. Then you also look at patients and divide them into platinum resistant or platinum sensitive. If they're platinum sensitive, you can give a platinum-containing regimen, but if they're platinum resistant, you can put them on a non-platinum chemotherapy-- a single agent or whatever-- but these patients are tough to manage in that part of the world. BRITTANY HARVEY: Definitely. Well, thank you all for reviewing each of those key recommendations. The full recommendations are available in the guideline, but those are some important highlights. Thank you very much. So Dr. Burke, in your view, what is the importance of this guideline, and how will it change practice? DR. WILLIAM BURKE: Sure. Well, I think the importance of this guideline is that it globally targets health care providers, including gynecologic oncologists, surgeons, nurses, and palliative care clinicians, as well as non-medical community members, including patients, caregivers, and members of advocacy groups, providing them with resource-stratified clinical guidelines, recommendations that can be implemented across many health settings. The guideline will hopefully raise awareness among frontline practitioners, and provide guidance to provide adequate services in the face of varied and sometimes limited resources we see throughout the world. BRITTANY HARVEY: Great. And Dr. Aziz, how do you envision that these guidelines can be applied in low and middle income regions? DR. ZEBA AZIZ: These are extremely important guidelines for our part of the world. Remember that there are about 70 low-middle income countries, and all these countries-- and within each country-- there's marked variability in training of physicians who encounter cancer patients. There's also difficulty by the patients in accessing a few tertiary care centers, cancer care centers which are present, and most of all, financial implications, because you have to go there, you have to stay there, you have to get your chemotherapy, and this is true for the marginalized population. You also have to remember that more than 50% of our patients are treated in a limited resource setting, and the availability of enhanced resources are very difficult for them. And these limited settings are in public sector hospitals, where the doctors-- some of the doctors are very good, but the physicians or surgeons are overworked. They have resources ranging from minimal to moderate, depending on the funds available. And because they're overworked and there are few working hours, detailed counseling of the patient is infrequent because there are a large number of patients there. And the majority of surgeries, which is the cornerstone of ovarian cancer, is done by the postgraduate fellows who are there. Sometimes the senior consultants do surgeries, but most of the time, it is done by them. First time chemotherapy is easier to deliver because it does not have any expensive medicines. There are a lot of generics for carboplatin and taxanes regimen available, so it's not a major problem. But treating the side effects, again, becomes very expensive, and the patients have to come back and forth. The relapsed disease is very difficult to treat because we don't have too many options there and it is expensive. We've also seen that patients who are treated at an enhanced level do much better. Their survival outcomes are better, the supportive care treatment is better, and the progression-free survival is also better. BRITTANY HARVEY: Great. Thank you for reviewing that information. And then finally, Dr. Fujiwara, Dr. Aziz touched on this a bit on how it impacts patients, but how else do you view that these guideline recommendations will affect patients? DR. KEIICHI FUJIWARA: Yes. As Dr. Aziz said and Dr. Burke said, this guideline is written for the patients around the world in a different medical environment. So I think that it is very useful resource of information for patients to receive the best ovarian cancer treatment that suits the actual situation of each country or regions. BRITTANY HARVEY: Great. Well, thank you all for your work on these important guidelines. It sounds like they're going to have a real impact globally, and so I really appreciate both all of your work on these guidelines, and also for taking the time to speak with me today, Dr. Aziz, Dr. Burke, and Dr. Fujiwara. DR. ZEBA AZIZ: Thank you, Brittany. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast Series. To read the full guideline, go to www.asco.org/resource-stratified-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO guidelines available on iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode.

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Addressing Gender Disparities In The Global Oncology Workforce and Sexual Harassment

ASCO Daily News

Play Episode Listen Later Jun 29, 2021 13:48

On today's episode, Dr. Pamela Kunz, director of the Center for Gastrointestinal Cancers at the Yale School of Medicine, and vice chief of Diversity, Equity and Inclusion for Medical Oncology at Yale, discusses compelling sessions from the 2021 ASCO Annual Meeting that addressed gender disparities in the global oncology workforce and sexual harassment experienced by oncologists. Transcript: ASCO Daily News: Welcome to the ASCO Daily News Podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. My guest today is Dr. Pamela Kunz, an associate professor of medicine in the division of oncology at the Yale School of Medicine where she also serves as the director of the Center for Gastrointestinal Cancers. Dr. Kunz also serves as the vice chief of Diversity, Equity, and Inclusion for medical oncology at Yale. Today, Dr. Kunz will highlight strategies to dismantle gender disparities in the global oncology workforce featured at the 2021 ASCO Annual Meeting. She will also tell us about the first study in oncology to systemically characterize the incidence of sexual harassment experienced by oncologists. Dr. Kunz reports no conflicts of interest relating to our discussion today and her full disclosures are available on the transcript of this episode. Dr. Kunz, welcome back; it's great to have you on the podcast again. Dr. Pamela Kunz: Thank you so much. My pleasure to be here. ASCO Daily News: The theme of the 2021 ASCO Annual Meeting was Equity. Every Patient. Everyday. Everywhere. Equity issues also apply to the oncology workforce and there were some very interesting discussions at the meeting on workplace disparities and harassment. You chaired an education session on dismantling gender disparities in the global oncology workforce. This session brought together a really interesting and diverse panel of experts in medicine. They discussed compelling data around gender disparities and steps to diversify leadership in medicine. They also looked at the role of male allies and how allies and advocates can support all women, and shared strategies on how to activate and empower female leaders. Can you tell us more about this session? ("Dismantling Gender Disparities in the Global Oncology Workforce Together"). Dr. Pamela Kunz: Sure. This was--thank you for asking about that session. I think that really the theme of equity permeated so many different aspects of this Annual Meeting. And I think it was really inspiring and I think incredibly helpful to think about really reimagining how we provide cancer care. And I think I really like to think of workforce disparities as the other side of the same coin of patient disparities or inequities in patient care. I think that in order for us to provide equitable patient care, we really have to provide and create a diverse, inclusive, and equitable workforce. And so this is really one aspect of that is around gender disparities or, of course, other disparities in the workforce. And we actually do touch on that in one of the talks. So we put together a diverse panel that represents a number of different viewpoints. They were not all oncologists. In fact, I was the only medical oncologist on. Dr. Reshma Jagsi is a radiation oncologist. And Dr. Hannah Valentine is a cardiologist who was previously at the National Institutes of Health (NIH) and the inaugural director of their diversity program. Dr. Leon McDougle also spoke. He's a family medicine physician, the current president of the National Medical Association. And Mrs. Dee Anna Smith is the CEO of Sarah Cannon Research Institute. So we had this really incredibly diverse group of perspectives. And as you mentioned, we really touched on a whole variety of topics. I think it's also worth just mentioning kind of the scenes for this. This session originated well over 2 years ago. And I think that the timing of this now happening in 2021 following the pandemic I think was really incredibly important. I think we didn't really recognize it at the time. We were supposed to do this session last year in 2020. And it was really the 2020 planning committee that approved the session with Dr. Howard Skip Burris and Dr. Tatiana Prowell and Dr. Melissa Johnson. We had all these conversations of how do we get men in the room to talk about gender disparities? And we really crafted this panel to try to address a diverse audience and get everyone in the room. And then it was really so well timed with Dr. Pierce's ASCO theme of equity for every patient, every day, everywhere. It really just tied in nicely. ASCO Daily News: Excellent. What are the key takeaways here for oncologists? Dr. Pamela Kunz: Sure. I can add some of that. I think that the first--and this was really addressed by Dr. Reshma Jagsi--is that we need to collect the data. We need to measure evidence of disparities at our institutions, in our organizations in order to really know where we're starting and in order to know how we're getting better. We have a lot of objective data already. But I think that I want to challenge all of our listeners to think about how can we be better about collecting that data in our own institutions. I think that the takeaways from Dr. Valentine's talk were some really wonderful concrete solutions to diversify the workforce. She took some lessons learned from programs she initiated at the NIH. And I'd like to specifically highlight a program at the NIH called the Scientific Workforce Diversity Toolkit. And in that, they instituted a program for cohort hiring in the Distinguished Scholars program. And this was bringing together a diverse group of underrepresented minorities and women into this scholars program. And they demonstrated really increased rates of female tenure track investigators. And I think that we can all do that in our institutions and organizations by instituting cohort hiring. From Dr. Leon McDougle's talk, he really highlighted this concept of intersectional feminism. And this term was coined by Kimberle Crenshaw. She's a professor of law at Columbia University. And it speaks to the fact that many marginalized characteristics or people who are in underrepresented groups may have characteristics that intersect. So that includes gender, age, sexuality, education, race, culture, ethnicity. And if any one person has a number of these characteristics, they may, in fact, increase the burden on that individual and may increase their risk for discrimination and for disparities. And I think it's recognizing the intersection. Intersectionality happens. And our women of color and our women who may have these other marginalized characteristics may be especially at risk. He also talked about a program at the Ohio State where he is on faculty entitled Advocates and Allies. And it's a National Science Foundation-funded program that trains men how to be advocates and allies. And then lastly, Miss. Dee Anna Smith spoke about creating a tapestry of allyship. She had this beautiful visual metaphor of really bringing together not just mentors. It's sort of modernizing the idea of mentorship and to really thinking more about allyship and how our trainees need to bring together, yes, perhaps mentors, but that allies really can represent an alternative to mentorship and a tapestry meaning that you need more than one person to serve as an ally for you. So I think those were--it it truly was--I moderated. I think these folks did all of the work in presenting. But it was really inspiring and I think very solution focused. ASCO Daily News: Well, you were also the discussant of session that addressed a new study, Abstract 11001 on sexual harassment of oncologists. Now, few studies have used comprehensive validated measures to investigate the incidence and impact of workplace sexual harassment experienced by physicians and none, according to the authors of this study, by oncologists. So this is really important. What can you tell us about it? Dr. Pamela Kunz: Yes, absolutely. And I think the points that you made already really make this important and validate it. And I think the findings then in and of themselves are quite striking. So this group of authors led by Dr. Ishwaria Subbiah conducted a study. It was a cross-sectional survey of ASCO's research survey pool. And they then used the sexual experiences questionnaire, which is a validated questionnaire, as you mentioned. And this is really I think a real strength of the study. And they examined various aspects of sexual harassment. I think it's important for our listeners to understand the definition of sexual harassment. So this includes gender harassment, unwanted sexual attention, and sexual coercion. And gender harassment includes things that if we use the iceberg analogy, which they included in their presentation and was so nicely described in the NASEM, the National Academies of Science Engineering and Medicine report from 2018, the iceberg really underneath the surface contains many of these aspects of gender harassment that go unnoticed and unrecognized and include things like microaggressions. And in this study, they evaluated four downstream domains impacted by workplace sexual harassment including mental health, job satisfaction, sense of safety at work, and turnover intentions, meaning if an individual planned on leaving that specific job. And they looked at incidents of sexual harassment both by perpetrator, so institutional insiders or patients and families, and then by type of sexual harassment. So they received about a 30% response rate. They had 304 practicing oncologists access the survey link. And 273 provided responses. And I'll just hit some of the take-homes. So I think what I was struck by is the high rate of sexual harassment when the perpetrator is an institutional insider. So those are peers or supervisors. 70% of physicians reported one or more incidences of sexual harassment. This was higher in women. So, 80% of women reported sexual harassment compared to 56% of men. So, that was statistically different. But I was really struck by the fact that men were experiencing this as well. And then in terms of sexual harassment incidents when the perpetrator was a family or patient, 53% of physicians reported one or more incidences of sexual harassment. And this was 67% for women and 35% for men, also statistically significant. In terms of that difference. And then really a significant downstream impact from these experiences both for physicians who experienced this harassment from institutional insiders or from patients and families. And I think that we saw that really across the board for mental health, workplace safety, job satisfaction, and turnover intentions. And I think the take home for our listeners is that this can really lead to a significant loss of talent. And I think that if we are really hoping to--see, this is me editorializing. We are hoping to improve the diversity of our workforce because we know that that leads to better patient care and better patient outcomes. This is really important for our workforce to try to tackle and solve this problem of sexual harassment. ASCO Daily News: Absolutely. Well, thank you, Dr. Kunz, for highlighting some really important issues in oncology today. Dr. Pamela Kunz: Thank you so much. ASCO Daily News: Our listeners will find links to the two sessions discussed today on the transcript of this episode. And thank you to our listeners for joining us today. If you enjoyed this episode, please take a moment to rate and review us wherever you get your podcasts. Disclosures: Dr. Pamela Kunz Stock and Other Ownership Interests: Guardant Health Consulting or Advisory Role: Ipsen, Lexicon, SunPharma, Acrotech Biopharma, Novartis (Advanced Accelerator Applications) Research Funding (institution): Lexicon, Ipsen, Xencor, Brahms (Thermo Fisher Scientific), Novartis (Advanced Accelerator Applications) Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Women in Global Oncology: Maria Bourlon

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Play Episode Listen Later Mar 17, 2021 28:32

Celebrating Women in Global OncologyWelcome to the second episode in our new podcast mini-series Women in Global Oncology.In these intimate interviews, Eva Segelov and guests delve into the challenges and joys of oncology practice and research in Brazil, India and Mexico. This week we are learning about oncology practice and clinical trials in Mexico City, Mexico, with Maria Bourlon.If you missed the first episode you can click here to learn about oncology practice in in Sao Paulo, Brazil, with Rachel Riechelmann.For more information, bios and links, please visit our website.For podcast updates and for the latest oncology news, subscribe to The Oncology Newsletter for free here.The Oncology Podcast - An Australian Oncology Perspective

Women in Global Oncology: Rachel Riechelmann

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Play Episode Listen Later Mar 7, 2021 33:35

In celebration of International Women's Day - Women in Global Oncology Welcome to the first episode in our new podcast mini-series Women in Global Oncology. We've released this first episode on the 8th March to coincide with International Women's Day. This series is our small contribution to the international women's day movement and a celebration of women around the globe practicing oncology. In these intimate interviews, Eva Segelov and guests delve into the challenges and joys of oncology practice and research in Brazil, India and Mexico. We begin by learning about oncology practice in Sao Paulo, Brazil, with Rachel Riechelmann. For more information, bios and links, please visit our website.For podcast updates and for the latest oncology news, subscribe to The Oncology Newsletter for free here.The Oncology Podcast - An Australian Oncology Perspective

Communities Conquering Cancer: Exploring Global Oncology Trends

Project Oncology®

Play Episode Listen Later Mar 1, 2021

Host: Jacob Sands, MD Guest: Lawrence Nathan Shulman, MD How do challenges in our healthcare system and disparities in access to care impact cancer patients within our communities? Dr. Jacob Sands and Dr. Lawrence Shulman continue their important conversation on oncology around the world.

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Dr. Julie Gralow, on Integrating Advocacy and Global Oncology with Cancer Care Leadership | BTJ-007

Beyond the Journal

Play Episode Listen Later Jan 26, 2021 47:22

Drs. Aggarwal and West host Dr. Julie Gralow, Director of the Breast Cancer Program and incoming CMO of ASCO to discuss balancing efforts in advocacy, global oncology, and addressing disparities in access with academic pursuits and clinical research.

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Global Oncology with Ben Anderson, MD

Oncology Overdrive

Play Episode Listen Later Aug 31, 2020 57:56

In this episode, Benjamin O. Anderson, MD, FACS, creator and chair of The Breast Health Global Initiative at Fred Hutchinson Cancer Research Center and Consultant for Cancer Control to the WHO, shares how his passion for patient care dovetailed into a career in global oncology. Intro :14 About Anderson :20 The interview 2:16 How did you end up in breast cancer care and how did it evolve into global oncology? 2:27 How do you utilize these criteria and protocols and tailor it to each of the countries that come with their own challenges? 11:39 Jain on the importance of global medicine 16:39 Where have you found that implementation of this has been most successful so far? 22:44 Have you seen these protocols used for treating other cancers? 25:50 Have you seen, through your global health work, any cool innovations that have come out of unique situations? 30:57 Going to all these different institutes in different countries, have you found anything that you thought was really amazing and that should be brought stateside? 37:10 Anecdote on the need to find better ways to documentation for billing and its relation to physician burnout 42:10 Jain anecdote on the need for a healthy balance to reduce risk for burnout 45:30 Anecdote on the importance of physicians taking on leadership/government roles 49:20 Have you seen a major change in health care delivery or global oncology navigating through the pandemic? 52:40 Anderson’s one pearl 56:40 How to find Anderson 57:00 Benjamin O. Anderson, MD, FACS, is professor of surgery and global health medicine at the University of Washington, chair and director of The Breast Health Global Initiative at Fred Hutchinson Cancer Research Center, and consultant for cancer control to the WHO. We’d love to hear from you! Send your comments/questions to Dr. Jain at oncologyoverdrive@healio.com. Dr. Anderson can be reached at bhgi.org. Follow us on Twitter @HemOncToday @ShikhaJainMD Disclosures: Jain reports she is a paid freelance writer for Lippincott. Healio was unable to confirm Anderson’s relevant financial disclosures at the time of posting.

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EP289: The Right Amount of Oncology Screening and Care—In a Pandemic and Not in a Pandemic, With Bishal Gyawali, MD, PhD

Relentless Health Value

Play Episode Listen Later Aug 20, 2020 35:52

You may or may not know (I don’t know why you would, honestly), but I speak Swedish. I mention this because there’s this famous and really culturally emblematic Swedish word which is this: lagom. It means “the exact right amount.” In Swedish culture, the exact right amount deserves its own word. For example, “Did you have enough watermelon?” “Why, yes, I had half a slice. It was lagom.” Lagom has no direct translation in US English because, in the United States, we don’t need a word for “the exact right amount.” Why? Because the exact right amount already has a word: the most. More. More is always better. I think this shows up in health care in this country, and it definitely showed up in my conversation with Dr. Bishal Gyawali in this health care podcast. There’s this cultural bias in this country that more is better. The point I’m making is that there’s a sort of fundamental belief that aggressive therapy—the most aggressive therapy—is the best therapy and conservative therapy, or following the treatment pathway that works for the majority of patients, is kind of like a surrender. It’s not about being pro or anti anything. It’s about being data driven. It’s about finding the “lagom” amount of care that the data suggest is the best amount of care and not immediately assuming that if something isn’t done that it’s been a subpar outing. In this health care podcast, I’m talking with Bishal Gyawali, MD, PhD. Dr. Gyawali is a practicing oncologist; assistant professor at Queen’s University in Kingston, Canada; and he has studied and worked in Nepal, Japan, and the US, and now in Canada. He’s a thought leader in studying the data impartially and finding ways to help patients and oncologists systematically make the best decisions toward high-value oncology care that is not financially toxic. You can listen to Dr. Gyawali sum this up in his own words or read his paper on the topic, but here’s his top-line suggestions: Follow NCCN and ASCO guidelines. Payers: Negotiate drug prices based on clinical benefit—and this means you, too, Medicare. Hospitals: more price transparency up front but also for the doctors. Financial toxicity is a thing. It’s been shown that patients who are suffering from financial toxicity die earlier. So, this is definitely data that a doctor needs to know as much as some kind of clinical decision-making factor. Hospitals: Have a financial advisory desk. Correct the misincentives at the physician/patient level (ie, all that’s going on with “buy and bill”). You can read Dr. Gyawali's published paper in JAMA and connect with him on Twitter at @oncology_bg. Bishal Gyawali, MD, PhD, is a medical oncologist with work experience in various low- and high-income countries. He graduated medical school in Nepal with seven gold medals and received his PhD from Nagoya University, Japan, as a MEXT scholar. He then practiced as a medical oncologist at Civil Service Hospital, Kathmandu, Nepal. He currently works as a medical oncologist and scientist in the Division of Cancer Care and Epidemiology at the Queen’s University Cancer Research Institute in Kingston, Ontario, Canada, where he is also an assistant professor of public health sciences. He was a research fellow at PORTAL (Program On Regulation, Therapeutics And Law) from 2018-2019. He also serves as a medical consultant for the not-for-profit Anticancer Fund, Belgium, and as editorial board member for the Journal of Global Oncology and ecancer. His clinical and research interests include cancer policy, global oncology, evidence-based oncology, financial toxicities of cancer treatment, clinical trial methods, and supportive care. Dr. Gyawali is an advocate of the “cancer groundshot,” a term he coined to imply that research investment should be made on known high-value interventions in cancer care that are affordable and easy to implement globally. Dr. Gyawali is active in the oncology and clinical research communities on Twitter. 03:18 Oncology decisions on the individual level and oncology policy decision making. 05:10 Reverting to the mean. 06:29 “We’re assuming … more care is good care, which is not necessarily true.” 06:49 “What we need to focus on is above-average level of health outcomes.” 07:55 “Sometimes we forget the goal, and we get so entangled in the path itself that we forget the destination.”11:19 Cutting out low-value care during the pandemic. 12:09 Reevaluating cancer screens and looking at the evidence for appropriate use cases. 13:24 Distinguishing the term “survival” from “mortality.” 16:34 “If a person dies, it does not matter what the person died of.” 17:26 “A lot of the things that we do routinely in medical practice need to be reevaluated.” 18:53 The FDA approval of oncology agents and things that make a difference. 20:37 “What exactly are we gaining from these drugs?” 20:53 EP282 with Aaron Mitchell, MD, MPH.23:15 Dr. Gyawali’s advice to policy decision makers. 23:42 Policy decision-making interventions that are possible. 24:50 “The problem with these guidelines … is that a lot of these people who are on these guidelines, they have huge conflicts of interest to the industry.” 26:58 How to pay less for low-value care. 27:42 A better path forward to pay for value. 31:02 Ways to help on the individual level. 32:07 “At the end of the day, the ultimate use of an intervention happens in the clinic.” 34:24 “We should never be pro or anti anything; we should just be pro-data.” You can read Dr. Gyawali's published paper in JAMA and connect with him on Twitter at @oncology_bg. Check out our newest #healthcarepodcast with @oncology_bg as he discusses #oncologyscreening and #oncologycare. #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “We’re assuming … more care is good care, which is not necessarily true.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “What we need to focus on is above-average level of health outcomes.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy What’s the difference between “survival” and “mortality”? @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “If a person dies, it does not matter what the person died of.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “A lot of the things that we do routinely in medical practice need to be reevaluated.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “At the end of the day, the ultimate use of an intervention happens in the clinic.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy “We should never be pro or anti anything; we should just be pro-data.” @oncology_bg discusses #oncologyscreening and #oncologycare. #healthcarepodcast #healthcare #podcast #oncology #digitalhealth #healthcarepolicy #oncologypolicy

Reflections on a Career in Global Oncology with Dr. Gilberto D. Lopes

ASCO Daily News

Play Episode Listen Later Mar 24, 2020 25:07

In this special podcast series, guest host Dr. Miriam Knoll, radiation oncologist at the John Theurer Cancer Center at Hackensack Meridian Health, interviews a wide range of oncologists who reflect on their diverse experience, greatest challenges, and the unforgettable moments that have shaped their careers. In this episode, Dr. Knoll speaks with Dr. Gilberto D. Lopes of the Sylvester Comprehensive Cancer Center about his inspiring career that has taken him across the globe. TRANSCRIPT Dr. Miriam Knoll: Welcome to the ASCO Daily News Podcast. I'm Dr. Miriam Knoll, and I'm delighted to be the Daily News guest host for this special podcast series that will explore the spectrum of oncology careers. I'm a radiation oncologist, and I'm an early career oncologist, and I'm really interested in interviewing oncologists from a variety of oncology careers. In this series, you'll hear from a wide range of guests about their diverse experience, greatest challenges, and the unforgettable moments that shaped their careers. In today's episode, I'm thrilled to welcome Dr. Gilberto Lopes, a medical oncologist and the Medical Director for International Programs and Associate Director for Global Oncology at the Sylvester Comprehensive Cancer Center. He's also an associate professor of clinical medicine at the University of Miami Miller School of Medicine. Dr. Lopes and myself report no conflicts of interest relevant to this podcast. Full disclosures relating to all Daily News Podcast can be found on the episode page. Dr. Lopes, welcome to the podcast. Dr. Gilberto Lopes: Hi, Miriam. It's great to hear from you. How are you? Dr. Miriam Knoll: Good. So of course, you and I met for the first time on Twitter. Dr. Gilberto Lopes: We did. And then we met in real life. Dr. Miriam Knoll: Yep. Yep, which is always amazing. I always find, I don't know if you agree with this or not, but I'm always surprised when I meet someone that I first met through Twitter that you really feel like you know them, like you really know them, like, it actually is a real relationship. Isn't that amazing? Dr. Gilberto Lopes: It is. It is amazing, and it is true, because we tend to share so much similar medical Twitter accounts that it is like you actually have been part of our lives. Dr. Miriam Knoll: Exactly. Exactly. I find the only thing that surprises me always is I'm always surprised by someone's height. No matter what, I thought they're either taller or shorter in real life. Dr. Gilberto Lopes: I love that. I really love that. Dr. Miriam Knoll: Right? And it's not like I remember thinking, like, hmm, I thought that person was tall or short. It's always taller or shorter than whatever it is I had in my head. Dr. Gilberto Lopes: And I was going to say that's not the type of social media we actually disclose that type of information. Dr. Miriam Knoll: Exactly. Exactly. So today, I wanted to talk to you about your career and what advice you have for really, anyone that's listening, all of our ASCO members, but also specifically for trainees and early career oncologists. So, my first question is, what advice would you have for someone who's interested in getting involved in global oncology? And maybe you could also give us a short intro into what global oncology is. Dr. Gilberto Lopes: Absolutely. And this is something that a few years ago we wouldn't have anybody asking us about. And we are extremely happy that it is becoming an area of academic interest, and it is becoming an area where not just ASCO, but also the NCI and a number of academic institutions have actually been putting a lot of effort and also money in so that we can continue to develop global oncology. So global oncology is actually a very broad term. We had the challenge of actually trying to define exactly what global oncology is for ASCO. We were part of a task force that was called the Academic Global Oncology Task Force, which actually tried to make sense of what it is. And I'm going to quote, and I'm going to actually get the formal definition that we came up with so that I do not deviate from what the group actually came up with. And Julie Gralow was the chair for that task force, and we actually do have those coming out in a forthcoming issue of the Journal of Global Oncology. And we do have some of it already out in ASCO Connection if people want to check it out. And the gist of it is that global oncology is the discipline that actually studies all worldwide aspects of cancer care. And here we, of course, always mention delivery of care implementation science related to being able to deliver the best cancer care possible in resource-constrained settings. But we also like to remember particularly that global oncology is also about learning the biological differences in between cancers that we see in developed countries and developing countries. So why is it that yes, cancer patients do better in certain parts of the world and worse in others? Why it is that we have so many gall bladder cancers in the Andes region, in the Americas, and also in Asia. So, these are all the important and interesting questions. Of course, it does intersect with policy, with health economics, pretty much with anything that has to do with delivering cancer care around the world. Dr. Miriam Knoll: And what advice would you have for someone who's interested in getting involved, who hears about what you're sharing with us and thinks, wow, that's fascinating, I want to do that, I want to be a part of that? Dr. Gilberto Lopes: It absolutely helps to find a mentor. And we had a survey of NIH-funded institutions in NCI-designated Cancer Centers, and more than half of the centers actually had somebody working in international projects and works in projects that we would classify as having to do with global oncology. So, reaching out to somebody in your institution would be a great way to start. And if you don't, as I mentioned, it's very easy to find many of us on the Twitter, of course, and on other social media. I have always been surprised in my career, especially when I started more than 20 years ago, how the people who tend to be the most active are also the nicest. And it was extremely rare that I would reach out to someone by email—when I started there was no such thing as a Twitter or Facebook, and we reached out to people by email. And actually, I even had a period in my career where you reached out to people by letter or phone. And I just dated myself, no? But it is something that you can do. So, reaching out to somebody that works on it always helps. But one big piece of advice—whenever you reach out to somebody, come in with an idea. If you just reach out to people and say, I want to do work in global oncology, it really doesn't get you to move much because people are busy. And even though most of us would love to help, it's extremely hard to just come up with some project out of nothing. So always think about those things that your strengths are, where you're from, where you have contacts, where you have worked, and what is it that you can do in that environment, what is that you can do with the specific strengths that your institution has? So always try to think about the issue a little bit before you actually move forward. So, for instance, in Miami, we do have a large population that has migrated from the Caribbean, from Latin America. And that has helped us actually ask a number of interesting questions. What are the differences in epigenetics, for instance, of Haitian patients were diagnosed in Miami versus patients in Caribbean? So, we have a number of projects that have come out of the curiosity that we had for seeing things that we're seeing on a daily basis. So always think about the strengths you have in your center and what it is that you're curious about that you would like to try to do. Dr. Miriam Knoll: Yeah, I absolutely agree, and I think that's great advice. I don't know if you read Sheryl Sandberg's book Lean In. Dr. Gilberto Lopes: I did. Dr. Miriam Knoll: Yeah, so you know how she says there the way that you get a mentor is not by asking someone, can you be my mentor, right? So, mentorship is an organic process. It's something that happens over time. It's a relationship that you develop with someone. Let's say someone says they are interested in global oncology - and I - Dr. Gilberto Lopes: That's right. Dr. Miriam Knoll : —don't know anything about that person, and it's really easy to sort of forget to write back because you don't even know where to start. That's very, very different than an email from someone that says, hi. I'm a third-year medical student. I'm really interested in this and this, and I'd like to do a review of this topic. Do you have time to talk? That's an email that's— Dr. Gilberto Lopes: Absolutely. Dr. Miriam Knoll: —a whole lot easier to respond to. Dr. Gilberto Lopes: It's very hard to say no to an email that actually comes with an idea. Dr. Miriam Knoll: Right. Amazing. So, such great advice, thanks so much. And I also wanted to ask you about your MBA. When and why did you get an MBA? And do you feel that that's a degree that has helped you in your career? Dr. Gilberto Lopes: I get that question a lot, and it definitely has. So, I was in my second year of post-fellowship when I got my MBA. I was in Singapore, and I did my MBA at a British school that actually had a overseas campus in Southeast Asia. And the reason I thought I needed to do it is because in medicine we learn nothing about the world. We pretty much just learn about medicine as we train. And we learn nothing about how things are run. We learn nothing about how to manage people. We learn nothing about finance, how to do budgets, how to invest. So, we pretty much see not at all from all those aspects that are extremely important when you start actually having a career in academic medicine. As you move from just being a physician, which is extremely important and many of my brightest colleagues just want to do that, they just want to be physicians with patients, but if you do intend to have a career in any institution that is larger than just a small physician group, it is extremely interesting and important if you want to be in a leadership position to consider doing an MBA or any other types of programs that will give you a little bit of the background, the vocabulary. And it helps you learn about the language of management and business. So, I realized that for me to continue growing in academic medicine, I wanted to become a director for clinical trials first and then a medical director for a cancer center. Eventually, I actually became chief medical and scientific officer for the largest practice in Brazil. So, I was in Singapore after finishing fellowship for about seven years. And I actually thought, at some point, that I would never come back to the West. And I got this invitation from a growing group in Brazil that eventually became one of the largest practices not just in Latin America, but also around the world. Today, there's more than 450 oncologists in the group. And they invited me to come in and be their chief medical and scientific officer because I had a background in both being a clinician, doing research, and also in management. So, it has been invaluable for me to learn a number of things that I had no idea about to actually get the MBA. And people do MBAs for different reasons. So, one of the main reasons people do MBAs are for the networking, for the people that you meet that can then help you in consulting ventures, and business ventures, and so on. For me that was never the most important thing. For me it was really learning about how to manage people, how to make sure that your budgets make sense, how investments work, how you actually get people to put money in different endeavors, and things of that sort. So, it is absolutely a must if you intend to be in leadership positions in any institutions that has thousands of people. Dr. Miriam Knoll: Great. That's really a very interesting perspective. And I love how what you're saying is that you want to continue working with patients and being an oncologist, and that the MBA— Dr. Gilberto Lopes: Absolutely. Dr. Miriam Knoll: —really helped with that. Dr. Gilberto Lopes: It did. And I can't imagine myself not seeing patients. Actually, that was one of the main reasons I moved back to the US from Brazil because here at the University of Miami, I have actually what I see as the perfect balance in my activities. I see patients about 45% to 50% of my time, and the other 50% I'm now dividing between global oncology and clinical research as well as the fellowship program. I became the director for our fellowship program on January 2. And everything that I learned in the MBA has been extremely useful helping develop careers of young oncologists and hematologists as well. Dr. Miriam Knoll: Well, congratulations on becoming the program director. That's amazing. Can you tell us about—actually, a different position that I wanted to ask you about— Dr. Gilberto Lopes: Sure. Dr. Miriam Knoll: —is that you're editor-in-chief of the Journal of Global Oncology. So how does one become an editor-in-chief? I think that's something that a lot of trainees and early career oncologists look at and say, wow, I want to be an editor. How do I do that? So, was it something that you always wanted to do? And what was the path for you? And what could the path be for someone else? Dr. Gilberto Lopes: I don't think anybody finishes medical school or high school thinking, someday I'm going to be editor-in-chief of a medical journal. But it is something that does come with the career, and it is something that is fascinating. We actually all get involved in things that eventually are basically to become an editor-in-chief. So as soon as we start in academic medicine, we start reviewing works of our colleagues. So, whenever we actually publish an article anywhere, you start getting invitations from that journal, usually, to become a reviewer. And that's actually the first step for you to have a career in editorial boards and as editor of medical journals. And that becomes a very interesting endeavor as well. It's a great way of actually seeing what your colleagues are working on, sometimes months before they come to the forum. And there's different ways of preparing. So, at ASCO, and especially at the Journal of Global Oncology, we created a new program called the Editorial Fellowships. And this is a very competitive process. We get hundreds of applications for between one and five positions every year. We started that as a pilot at the Journal of Global Oncology. We got something called a PROSE award for innovation based on having the program, and the idea of the program was to train people to become better reviewers so that they could actually start that process of eventually becoming a member of an editorial board, and hopefully in the future also editors in chief for not just ASCO, but different international oncology journals as well. The program has been going on for a few years, and we now actually have five fellows, one for General of Global Oncology and four that are shared work from one of the other ASCO journals. Also, good moment to remind everybody that ASCO journals now have a common name. They're all Journal of Clinical Oncology. Of course, we have the original JCO. And we now have JCO Global Oncology, JCO Precision, and JCO Clinical Informatics, as well as Practice, which used to be the JOP. So, this is a path that a number of colleagues have taken in the past. What used to happen is that your mentors actually get you to meet people, and then you did more reviews. And if you do actually generate quality reviews, often you get involved in more reviews, and then you get invited to be part of an editorial board. And for the JGO, JCO GO in particular, this was a global process. ASCO created a search. I was one of the original associate editors, so I was relatively young. I wasn't out of fellowship that long when I became associate editor. And then when Dr. Kerr, who was the original editor-in-chief for the JCO GO had to leave, there was a search. And ASCO selected me as the second editor-in-chief for what was then JGO, and is now JCO Global Oncology. And I have just started the beginning of my second term. The second term is a five-year term, so I should continue being the editor-in-chief for five more years. And then it's time to pass the ball to the next generation. Dr. Miriam Knoll: Great. So, what's the worst career advice that you've ever gotten? Dr. Gilberto Lopes: Don't go to Singapore. That was the worst—that was the worst career advice I ever got. When I decided to move to Asia, it was such an easy decision to me. So, I had come from Brazil to the U.S. as a sixth-year medical student. Then I went back home, graduated, studied, worked a little bit so I could actually make enough money to take the steps. Then I took the similar steps one and two. At the time, we didn't have the clinical skills assessment part of it. And then I applied to one place for residency because that's what I had money to travel to—I had money to travel from Brazil to Miami. And as I had spent time here as a student, I knew that this was the place I had the best chance of getting an internship in the U.S. Dr. Miriam Knoll: Wow. Dr. Gilberto Lopes: And I came to Miami as an intern, did my residency here. I was the chief resident. And then for fellowship, I did have a number of different options. My wife's job was here and was not quite portable, so we decided to stay in Miami for fellowship as well. And when I finished, I actually had a J-1 visa, so I either had to go back home for a few years, 2 years to be exact, or I needed to go to some area that would be considered underserved and through which I could get a waiver to stay in the U.S. And I did have a few options, and I got an offer from Penn. I had a potential offer from UT at Southwest here in Dallas. But the potential to go to Singapore was actually the most interesting one. So, Hopkins had had a cancer center in Singapore and research labs for a few years, and they were looking for somebody to help develop their clinical trials program. And my wife is of Chinese origin, so she always had the curiosity to live in Asia for a while. Then we decided to apply for it, and we went for an interview in Singapore. Loved the place, and then just decided, well, it was just such an easy decision to make that even though more than one person actually told me, don't go to Singapore, stay in the U.S. somewhere, it was definitely a very, very easy decision, and it's certainly a decision that I see today as being the beginning of my academic career. And it was certainly a great beginning. I have a lot to thank Singapore and Hopkins for. Dr. Miriam Knoll: So, was that unsolicited advice that you got? Dr. Gilberto Lopes: In a way, it was. But when I discussed plans in general with colleagues who were graduating fellowship or with mentors, there was actually only one who clearly saw that that was easy, very easy to decide and that was the best option for my career then. This was one of our breast cancer oncologists, Dr. Stefan Gluck. He was the one who actually was the only one who said, I have no doubt that this is the best option for you right now, and you should go and not think twice. And now— Dr. Miriam Knoll: Was it hard to reject everyone else's, quote, "advice?" Dr. Gilberto Lopes: Actually, it wasn't because in my mind, it was such an easy decision to make that I pretty much ignored everybody who was a naysayer about going to Singapore. Dr. Miriam Knoll: Great. Well, it definitely sounds like you're—at that time and now, that it was the right decision. Dr. Gilberto Lopes: Mm-hmm Absolutely. Dr. Miriam Knoll: What was the best career advice that you've ever gotten? Dr. Gilberto Lopes: Oh, there's a lot. So, there is something that everybody should read if you haven't read, and I think this was published back in 1999, and they're now known as the "Simone Maxims" for anybody working in academic centers. Joe Simone was and is an oncologist who has had a very big role in managing and developing people as well, and he came up with his maxims that everybody should try and read. And I think it came out in Clinical Cancer Research more than 20 years ago or so. And these were things like the first one is the one that I always remember the most, and its institutions don't love you back. And that is something that is a little bit cynical, but it makes a lot of sense. Any place you work for, even though sometimes you think that that's your whole life, it has a different time horizon. They are going to be there when you leave, so you always have to think on what's best for yourself. So, I grew up in medicine in a time when Brazil was coming out and was living its transition from dictatorship to democracy. And we were infused with a sense of public service and an ethos of serving the collective rather than the individual. And to me, it was always hard to realize that we have to be well, and we have to take care of ourselves so that we can actually serve. And that was one of the maxims that helped me realize that as I was becoming a little bit older. But to finish just in terms of what the best career advice is, is that oncology is a team sport. You do not accomplish anything alone. So, you need to make friends. You need to collaborate. You need to help other people's projects so that you can actually further your own. And that is the single most important advice I've gotten in terms of becoming an academic oncologist. And that advice I got from Caio [Max Sao Pedro] Rocha Lima, who used to be a GI oncologist in Miami when I was a fellow and who now works at Wake Forest. Dr. Miriam Knoll: And you mean working with other oncologists and colleagues with their projects? Dr. Gilberto Lopes: With colleagues in every arena, so not just oncologists, not just medical oncologists, with radiation oncologists. Collaboration is the only way we actually do anything that is worthwhile. Dr. Miriam Knoll: Wow. That's great advice. So, what advice would you give to trainees and early career oncologists? Dr. Gilberto Lopes: Get out there. Do everything that you can. Go to meetings. Get to see people. Get to know your fellow colleagues. They often will be partners for projects for your whole life. Get to meet people in different institutions. Just get yourself out there. It's amazing how people will help you if you have an interest and if you show that you can actually get things done. Dr. Miriam Knoll: Well, Dr. Lopes, thank you so much for this insightful and candid discussion. And thanks so much to our listeners for joining us for this special episode of the ASCO Daily News Podcast. We'd really love to have your feedback, so feel free to email us at DailyNews@asco.org. And of course, don't forget to rate and review us on Apple podcasts. Dr. Lopes, of course, can be found on Twitter @glopesmd. And I can be found on Twitter, too, @MKnoll_MD. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Dr. Christian Rolfo: Living and Working in 3 Continents, Now Working on Early Therapeutics, Liquid Biopsies, & Global Oncology

West Wind (Audio)

Play Episode Listen Later Mar 23, 2020 42:31

Dr. Christian Rolfo, now at University of Maryland after training in Argentina, Italy, & other parts of Europe, speaks with Dr. West about his focus on phase I clinical trials & liquid biopsies, and having close connections with people around the world.

university europe west italy argentina maryland liquid therapeutics continents biopsies global oncology

Global Oncology

Play Episode Listen Later Jan 26, 2020 29:00

Global Oncology with guest Dr. Donna Spiegelman January 20, 2020 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Global Oncology

Play Episode Listen Later Jan 26, 2020 29:00

Global Oncology with guest Dr. Donna Spiegelman January 20, 2020 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Global Oncology

university journal md lopes gilberto global oncology

Play Episode Listen Later Jan 26, 2020 29:00

Global Oncology with guest Dr. Donna Spiegelman January 20, 2020 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

The Global Oncology Agenda With Gilberto Lopes

Outspoken Oncology

Play Episode Listen Later Jan 13, 2020 59:27

Gilberto Lopes, MD, editor-in-chief of the Journal of Global Oncology and creator of a global oncology program at the University of Miami Sylvester Comprehensive Cancer Center, discusses the intersection of globalization and localization of cancer care and measuring success in a global oncology program, among other topics.

Dr. Gilberto Lopes Highlights Key Presentations from ASCO Breakthrough

ASCO Daily News

Play Episode Listen Later Oct 23, 2019 9:57

ASCO Daily News: Welcome to the ASCO Daily News Podcast. I'm Lauren Davis. And joining me today is Dr. Gilberto Lopes, a medical oncologist and Medical Director for International Programs. He's also the Associate Director for Global Oncology at the Sylvester Comprehensive Cancer Center. And he's an Associate Professor of Clinical Medicine at the University of Miami. Dr. Lopes has also served as co-chair of the organizing committee for ASCO Breakthrough, an event that brought together innovators in evolving science, technology, and research. Dr. Lopes, welcome to the podcast. Dr. Gilberto Lopes: Thank you, Lauren. It's a pleasure to be here. And it's a pleasure to discuss all the findings that we had in Bangkok last week. ASCO Daily News: We're glad you're here. Overall, how was the inaugural ASCO Breakthrough meeting? Dr. Gilberto Lopes: It went as well as we could have expected. We had a wonderful meeting. And our co-hosts at Thai Society of Clinical Oncology did a superb job of making sure that everything worked on the ground. And all of our presenters, moderators, and panelists did a superb job about bringing to the fore things that will be in the reality of oncology in the next few years. ASCO Daily News: So specifically drilling down into sessions, what did you find during ASCO Breakthrough that was really compelling? Dr. Gilberto Lopes: Lauren, in reality, every section was really compelling, starting with the opening session by Dr. Steven Yang from WuXi AppTec. He actually kind of painted the general picture of what we wanted to discuss in the meeting. He talked about all of the innovations that we have already seen in cancer diagnosis and treatment over the last couple decades, with some emphasis on the beginnings of immunotherapy, kinase inhibitor, and target agents, but specifically talking about what we're going to see in the next five to 10 years, and what are the technologies that will help us truly have new breakthroughs in the management of cancer so that we can improve outcomes for our patients in years to come. He very specifically emphasized the number of cancer drug targets that we have now in 2019 compared to just two years ago, 2017. While we had 263 targets in the pipeline two years ago, this year, we have 468 targets in the pipeline. So that's a number that is mind-boggling and shows us how fast the field of cancer drug development is actually moving forward. And in terms of the numbers of immunotherapy trials, since 2014, the number has actually skyrocketed as well. In 2014, we had barely a little bit more than 200 trials with immunotherapy agents. And in 2018, we had more than 800. So it's amazing to see how the volume of new trials and new discoveries seem to be accelerating as we move forward. Beyond his general session and general discussion, he also mentioned the technologies that are likely to help us move forward, including artificial intelligence, the use of telemedicine, use of new preclinical models to develop new cancer drugs. And he didn't forget to mention one of the main issues that we have moving forward, which is how sustainable we can actually be in our health care systems, as the cost of these medications can now easily reach $500,000 to $1 million per patient. Dr. Gilberto Lopes: So these are all issues that were truly discussed at length in most of our subsequent sessions from the opening. And that opening talk pretty much gave us a very good start to see what we would expect. We had sessions that were discussions. And these were TED-like talks in which presenters would show us what they're working on and discuss and review aspects of technology and innovation that are coming into oncology, including artificial intelligence and telemedicine, social media. And we also had abstract sessions as well. And there's variety and always done in a way that the audience could have discussions-- this was a very open talk-type meeting, which is quite different than what we're used to seeing at the annual meeting. So we had enough time for the discussions to be quite deep and broad in each of these subjects. So in general, as an example, most sessions get about 30 to 45 minutes in discussions and 30 to 45 minutes in open questions and participation from the audience as well. So this was a very, very interactive meeting. And we hope that that's going to be reflected in future ASCO meetings as well. ASCO Daily News: That's great. It sounds like this new format's really working. Did you hear any practice-changing results from the studies? Dr. Gilberto Lopes: We had a few abstracts that are actually hopefully going to be practice-changing in the next couple years-- nothing that truly changes the way we practice today. But again, this is a meeting for innovations that are on the horizon, not really for innovations that we can apply in clinic on Monday after the meeting ended. But a few things should definitely be mentioned. So the use of plasma cell-free DNA methylation patterns as a way of detecting cancer early with a single blood sample, especially for cancers for which we don't have good screening, was one of the most important abstracts. That was an abstract represented by Dr. Ochsner with number 44. But what's fascinating about this abstract that we should just mention quickly is that this is a study of more than 15,000 patients. And these 15,000 patients had blood samples, tissue samples, and were followed up for more than five years. And the investigators were able, using machine learning algorithms, to find patterns of methylation that were very interestingly useful in the diagnosis of cancers across stages from one to four. And using a specificity of 99.3%, they were able to actually take about 55% of cancers with a simple blood test. So this is something that, of course, needs a lot more work, and we'll need prospective clinical trials for us to be able to bring to the clinic. But this is certainly one of the most exciting abstracts we had presented. And this is certainly one of the most exciting innovations that we hope to have in the next few years, which might be an amazing blood test to screen for cancers in the general population. ASCO Daily News: That's very exciting. So based on the meeting, what do you think is on the horizon for artificial intelligence and machine learning in oncology? Dr. Gilberto Lopes: So there's a broad use of machine learning and artificial intelligence across every aspect that is important in cancer today. We have studies looking into machine learning and pathology in specifics about molecular analysis to find factors that maybe predict the prognostic in specific malignancies. And we also have other areas, including drug development. But I think that the area that seems to be the most advanced, and we will likely start seeing tools coming into the clinic in the next year or two, are radiology-related artificial intelligence advancements. We had another interesting abstract that was presented on deep learning in the detection of lung nodules in patients who have been screened for lung cancer. So this is one of the most underused screenings that we have approved in the US today. Fewer than 5% of patients who are actually eligible for low-dose computed tomography screening in the country are actually getting those screens done. And our colleagues in China were able to access that very large database of imaging scans. And with that, they were able to use artificial intelligence to actually detect these nodules automatically. And while the results are not yet good enough for us to be able to use this as a tool, they do show that there is proof of concept. And I think that's the level where we are for machine learning and artificial intelligence in general in oncology today. I think we have a number of studies in radiology and pathology and in other areas showing that we have proof of concept for the use of artificial intelligence. We now need to continue developing this technology so that it can become useful in clinic. The discussions centered around if this is something that would substitute for the work of physicians. But it's more likely that these new technologies will be able to actually enhance what we do as clinicians. ASCO Daily News: That's terrific. It sounds very exciting for the future of oncology care. Dr. Gilbert Lopes: Absolutely. ASCO Daily News: Again, today, my guest has been Dr. Gilberto Lopes. Thank you so much for being on our podcast today. Dr. Gilberto Lopes: My pleasure, and I encourage everybody who's listening to actually access the meeting presentations from ASCO's website, which will give you a much, much broader and deeper view of everything that we discussed in Bangkok. Thank you very much for listening. ASCO Daily News: And to our listeners, thank you for tuning into the ASCO Daily News Podcast. If you're enjoying the content, we encourage you to rate us and review us on Apple Podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

15. Food is Medicine: Promoting nutrition in global oncology with Nyi Nyi Kyaw and Erin Gordon

Global Health & Childhood Cancer

Play Episode Listen Later Sep 23, 2019 39:34

Food is Medicine: Promoting nutrition in global oncology Studies show that children with cancer who are well nourished have better treatment outcomes than those who are malnourished. Unfortunately, many children in developing countries are malnourished even before they are diagnosed with cancer, their nutritional status only worsens due to the combined effect of the disease […]

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Dr. Gilberto Lopes (Pt 2): The Growing Momentum of Global Oncology

West Wind (Audio)

Play Episode Listen Later Aug 22, 2019 24:15

Dr. Gilberto Lopes, medical oncologist at Sylvester Comprehensive Cancer Center, chats with host Dr. Jack West about the growth of global oncology as a field, new training programs, and his role as Editor-in-Chief of ASCO’s Journal of Global Oncology.

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Episode 83 - Alex Kazberouk

The Afflatus

Play Episode Listen Later Aug 9, 2019 34:12

Alex Kazberouk is a primary care/internal medicine resident physician at the University of California San Francisco. He is interested in designing new models of primary care for medically and socially complex patients, creating incentives to improve patient care, and improving end of life care. Prior to his graduate education, he was a consultant at McKinsey and Company, working with healthcare clients on topics such as hospital operations and pharmaceutical launches in developing markets. Alex has also volunteered with Global Oncology to deliver palliative care training and education in the Republic of Belarus. He holds a B.Sc. Biology from Yale University, an M.D. from Harvard Medical School, and an M.B.A. from Harvard Business School. In this episode, Alex talks about delivering primary healthcare, the notion of branding in medicine and the importance of storytelling. Consider becoming a Listener Supporter. Be a part of the Afflatus community and enjoy exclusive membership rewards. Full details here: https://bit.ly/2PFDUS8 Subscribe here: https://anchor.fm/theafflatus/support Follow The Afflatus: www.facebook.com/aalok.rathod www.facebook.com/unciafilms www.instagram.com/al_rathod Follow Alex: https://www.linkedin.com/in/alexander-kazberouk-014a8326/ --- Support this podcast: https://anchor.fm/theafflatus/support

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KEYTRUDA Approved for First-Line Treatment of Stage 3 Non-Small Cell Lung Carcinoma

Health Professional Radio - Podcast 454422

Play Episode Listen Later Jun 9, 2019 9:06

Dr. Gilberto Lopes, Associate Director for Global Oncology at the Sylvester Comprehensive Cancer Center at the University of Miami, discusses the recent (Apr 2019) FDA regulatory update that approved KEYTRUDA for the first-line treatment of patients with stage III NSCLC (non-small cell lung carcinoma). Visit www.hpr.fm to listen to more interviews about healthcare and research findings.

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Breaking Down Walls: The Role of Global Oncology

Cancer Grand Rounds Lectures from the Norris Cotton Cancer Center Podcasts

Play Episode Listen Later Apr 10, 2019 59:30

Norris Cotton Cancer Center Grand Rounds April 9, 2019 Patrick J. Loehrer, Sr., MD Director, IU Simon Cancer Center Indiana University Melvin and Bren Simon Cancer Center

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Dr. Gil Morgan (Part 1): Social Media & Digital Education Cultivating a Global Oncology Community

West Wind (Audio)

Play Episode Listen Later Apr 2, 2019 22:42

Dr. Jack West & Sweden-based Dr. Gil Morgan reflect on how social media are forging new conversations & educational opportunities for the global oncology community, as well as the marked differences in cancer care & medical practice in the US vs. Sweden.

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Dr. Gil Morgan (Part 1): Social Media & Digital Education Cultivating a Global Oncology Community

West Wind (Video)

Play Episode Listen Later Apr 2, 2019 22:42

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Global Oncology: Lessons from the Field

Cancer Grand Rounds Lectures from the Norris Cotton Cancer Center Podcasts

Play Episode Listen Later Mar 12, 2019 59:30

Norris Cotton Cancer Center Grand Rounds March 12, 2019 Lori Buswell, NP, MSN Executive Director, Center for Global Cancer Medicine, Dana Farber Cancer Institute

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Episode 8 - Global Oncology News

Cancer Docs Talk

Play Episode Listen Later Mar 4, 2019 20:28

Podcast host Dr. Gilberto Lopes, associate director of global oncology at Sylvester, talks about two new resource-stratified guidelines on early detection for colorectal cancer and treatment of early stage patients published in ASCO’s Journal of Global Oncology.

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Episode 35: Getting Involved in Global Oncology Nursing

The Oncology Nursing Podcast

Play Episode Listen Later Feb 7, 2019 24:29

Jean Rosiak, DNP, RN, AOCNP®, CBCN®, former ONS director-at-large and currently a nurse practitioner at Aurora Medical Group in Wisconsin, joins ONS's Barbara Lubejko, MS, RN, oncology clinical specialist, to discuss ONS's international nursing efforts, her experiences working in other countries, how nurses can get involved globally, and much more. Music Credit: "Fireflies and Stardust" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0 Episode Notes: Check out these resources from today's episode: The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities. ONS Global Initiatives ONS Global Nursing Community Building Collaboration, Education With Oncology Nurses in Malawi ONS Members Share Education, Resources in Peru Brazil's Inaugural Oncology Nursing Conference Reminiscent of ONS's Own Beginnings

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Pharmapills puntata n.70. Pubblicato il report Global Oncology Trends 2018 di Iqvia

PharmaPills - Pillole dal farmaceutico

Play Episode Listen Later Aug 29, 2018 8:39

PharmaPills - Pillole dal farmaceutico: Novità, Curiosità e Lavoro dal mondo del farmaceutico. A cura di Stefano LagravineseIn questa puntata parliamo di:Aziende: Gilead Sciences, Sierra Oncology, Novo Nordisk, Ziylo, FDA, MSD, GSK, IQVIA.Persone: Nick Glover (Sierra Oncology), Vincenzo Palermo (Gilead).Nuove terapie: momelotinib, nivolumab, rilpivirine, cabotegravir.Patologie: cancro, tumore al polmone, AIDS.Lavoro: CRA II, Senior CRA, CRA.Il mercoledì alle h 12.00 su Spreaker.com e iTunes.Seguici su: www.telegram.me/pharmapillswww.facebook.com/pharmapills/

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Pharmapills puntata n.70. Pubblicato il report Global Oncology Trends 2018 di Iqvia

PharmaPills - Pillole dal farmaceutico

Play Episode Listen Later Aug 29, 2018 8:39

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Lung Cancer

Catalog of Interviews and Bits

Play Episode Listen Later Jun 27, 2018

Gilberto Lopes (pronounced: lopes like ropes) MD, MBA, FAMS, a medical oncologist, is the medical director for international programs and associate director for Global Oncology at the University of Miami Sylvester Comprehensive Cancer Center and associate professor at the Miller School of Medicine. Maria Elena Uruza is a non-smoker, who was diagnosed with lung cancer at 46.

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Episode 1: ASCO 2018 Preview

Cancer Docs Talk

Play Episode Listen Later May 26, 2018 21:05

ASCO 2018 Preview: Cancer Docs Talk is hosted by Dr. Gilberto Lopes, associate director of Global Oncology at Sylvester Comprehensive Cancer Center. In this episode he is joined by Dr. Calmen Calfa, a breast medical oncologist . They discuss two major studies to be presented at ASCO Plenary Session on Sunday June 3rd.

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Integration of Palliative Care into Oncology Guideline

ASCO Guidelines Podcast Series

Play Episode Listen Later Apr 18, 2018 10:17

An interview with Dr. Betty R. Ferrell of City of Hope Medical Center on the guideline "Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update" which provides evidence-based recommendations to oncology clinicians, patients, family and friend caregivers, and palliative care specialists on the integration of palliative care into standard oncology care for all patients diagnosed with cancer. A guideline on palliative care in the global setting is currently in press with the Journal of Global Oncology and there will be an episode on this topic when it publishes. Read the full guideline at www.asco.org/supportive-care-guidelines

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Shawn Goodman, Head of Global Oncology, Corporate Communications | Impacting the Future of Cancer Research: Takeda Pharmaceuticals International Co.

What2Know - a Marketing and Communications Podcast

Play Episode Listen Later Nov 16, 2017 18:04

Shawn Goodman, Head of Global Oncology Corporate Communications discusses his career journey and touches on a very important topic - the future of cancer research.

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Global Oncology

Play Episode Listen Later Feb 19, 2017 29:37

Global Oncology with guest Dr. Edward Trimble February 19, 2017 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Global Oncology

Play Episode Listen Later Feb 19, 2017 29:37

Global Oncology with guest Dr. Edward Trimble February 19, 2017 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Global Oncology