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On the inaugural episode of ASCO Education: By the Book, Dr. Nathan Pennell and Dr. Don Dizon share reflections on the evolution of the ASCO Educational Book, its global reach, and the role of its new companion podcast to further shine a spotlight on the issues shaping the future of modern oncology. TRANSCRIPT Dr. Nathan Pennell: Hello, I'm Dr. Nate Pennell, welcoming you to the first episode of our new podcast, ASCO Education: By the Book. The podcast will feature engaging discussions between editors and authors from the ASCO Educational Book. Each month, you'll hear nuanced views on key topics in oncology featured in Education Sessions at ASCO meetings, as well as some deep dives on the advances shaping modern oncology. Although I am honored to serve as the editor-in-chief (EIC) of the ASCO Educational Book, in my day job, I am the co-director of the Cleveland Clinic Lung Cancer Program and vice chair for clinical research for the Taussig Cancer Center here in Cleveland. I'm delighted to kick off our new podcast with a discussion featuring the Ed Book's previous editor-in-chief. Dr. Don Dizon is a professor of medicine and surgery at Brown University and works as a medical oncologist specializing in breast and pelvic malignancies at Lifespan Cancer Institute in Rhode Island. Dr. Dizon also serves as the vice chair for membership and accrual at the SWOG Cancer Research Network. Don, it's great to have you here for our first episode of ASCO Education: By the Book. Dr. Don Dizon: Really nice to be here and to see you again, my friend. Dr. Nathan Pennell: This was the first thing I thought of when we were kicking off a podcast that I thought we would set the stage for our hopefully many, many listeners to learn a little bit about what the Ed Book used to be like, how it has evolved over the last 14 years or so since we both started here and where it's going. You started as editor-in-chief in 2012, is that right? Dr. Don Dizon: Oh, boy. I believe that is correct, yes. I did two 5-year stints as EIC of the Educational Book, so that sounds about right. Although you're aging me very clearly on this podcast. Dr. Nathan Pennell: I had to go back in my emails to see if I could figure out when we started on this because we've been working on it for some time. Start out a little bit by telling me what do you remember about the Ed Book from back in the day when you were applying to be editor-in-chief and thinking about the Ed Book. What was it like at that time? Dr. Don Dizon: You know, it's so interesting to think about it.  Ten years ago, we were both in a very different place in our careers, and I remember when the Ed Book position came up, I had been writing a column for ASCO. I had done some editorial activities with other journals for sure, but what always struck me was it was very unclear how one was chosen to be a part of the education program at ASCO. And then it was very unclear how those faculty were then selected to write a paper for the Educational Book. And it was back in the day when the Educational Book was completely printed. So, there was this book that was cherished among American fellows in oncology. And it was one that, when I was newly attending, and certainly two or three years before the editor's position came up, it was one that I referenced all the time. So, it was a known commodity for many of us. And there was a certain sense of selectivity about who was invited to write in it. And it wasn't terribly transparent either. So, when the opportunity to apply for editor-in-chief of the Educational Book came up, I had already been doing so much work for ASCO. I had been on the planning committees and served in many roles across the organization, and editing was something I found I enjoyed in other work. So, I decided to put my name in the ring with the intention of sort of bringing the book forward, getting it indexed, for example, so that there was this credit that was more than just societal credit at ASCO. This ended up being something that was referenced and acknowledged as an important paper through PubMed indexing. And then also to provide it as a space where we could be more transparent about who was being invited and broadening the tent as to who could participate as an author in the Ed Book. Dr. Nathan Pennell: It's going to be surprising to many of our younger listeners to learn that the Educational Book used to be just this giant, almost like a brick. I mean, it was this huge tome of articles from the Education Sessions that you got when you got your meeting abstracts book at the annual meeting. And you can always see people on the plane on the way out of Chicago with their giant books. Dr. Don Dizon: Yes. Dr. Nathan Pennell: That added lots of additional weight to the plane, I'm sure, on the way out. Dr. Don Dizon: And it was not uncommon for us to be sitting at an airport, and people would be reading those books with highlighters. Dr. Nathan Pennell: I fondly remember being a fellow and coming up and the Ed Book was always really important to me, so I was excited. We'll also let the listeners in on that. I also applied to be the original editor-in-chief of the Ed Book back in 2012, although I was very junior and did not have any real editorial experience. I think I may have been section editor for The Oncologist at that point. And I had spoken to Dr. Ramaswamy Govindan at WashU who had been the previous editor-in-chief about applying and he was like, “Oh yeah. You should absolutely try that out.” And then when Dr. Dizon was chosen, I was like, “Oh, well. I guess I didn't get it.” And then out of the blue I got a call asking me to join as the associate editor, which I was really always very thankful for that opportunity. Dr. Don Dizon: Well, it was a highly fruitful collaboration, I think, between you and I when we first started. I do remember taking on the reins and sort of saying, “You know, this is our vision of what we want to do.” But then just working with the authors, which we did, about how to construct their papers and what we were looking for, all of that is something I look back really fondly on. Dr. Nathan Pennell: I think it was interesting too because neither one of us had really a lot of transparency into how things worked when we started. We kind of made it up a little bit as we went along. We wanted to get all of the faculty, or at least as many of them as possible contributing to these. And we would go to the ASCO Education Committee meeting and kind of talk about the Ed Book, and we were thinking about, you know, how could we get people to submit. So, at the time it wasn't PubMed indexed. Most people, I think, submitted individual manuscripts just from their talk, which could be anywhere from full length review articles to very brief manuscripts. Dr. Don Dizon: Sometimes it was their slides with like a couple of comments on it. Dr. Nathan Pennell: And some of them were almost like a summary of the talk. Yeah, exactly. And so sort of making that a little more uniform. There was originally an honorarium attached, which went away, but I think PubMed indexing was probably the biggest incentive for people to join. I remember that was one of the first things you really wanted to get. Dr. Don Dizon Yeah. And, you know, it was fortuitous. I'd like to take all the credit for it, but ASCO was very forward thinking with Dr. Ramaswamy and the conversations about going to PubMed with this had preceded my coming in. We knew what we needed to do to get this acknowledged, which was really strengthening the peer review so that these papers could meet the bar to get on PubMed. But you know, within the first, what, two or three years, Nate, of us doing this, we were able to get this accepted. And now it is. If you look at what PubMed did for us, it not only increased the potential of who was going to access it, but for, I think the oncology community, it allowed people access to papers by key opinion leaders that was not blocked by a paywall. And I thought that was just super important at the time. Social media was something, but it wasn't what it is now. But anybody could access these manuscripts and it's still the case today. Dr. Nathan Pennell: I think it's hard to overstate how important that was. People don't realize this, but the Ed Book is really widely accessed, especially outside the US as well. And a lot of people who can't attend the meeting to get the print, well, the once print, book could actually get access to essentially the education session from the annual meeting without having to fly all the way to the US to attend. Now, you know, we have much better virtual meeting offerings now and whatnot. But at the time it was pretty revolutionary to be able to do that. Dr. Don Dizon: Yeah, and you know, it's so interesting when I think back to, you know, this sort of evolution to a fully online publication of the Ed Book. It was really some requests from international participants of the annual meeting who really wanted to continue to see this in print. At that time, it was important to recognize that access to information was not uniform across the world. And people really wanted that print edition, maybe not for themselves, but so that access in more rural areas or where access in the broadband networks were not established that they still could access the book. I think things have changed now. We were able, I think, in your tenure, to see it fully go online. But even I just remember that being a concern as we went forward. Dr. Nathan Pennell: Yeah, we continued with the print book that was available if people asked for it, but apparently few enough people asked for it that it moved fully online. One of the major advantages of being fully online now is of course, it does allow us to publish kind of in real time as the manuscripts come out in the months leading up to the meeting, which has been, I think, a huge boon because it can build momentum for the Education Sessions coming in. People, you know, really look forward to it. Dr. Don Dizon: Yeah, that was actually a concern, you know, when we were phasing out Ed Book and going to this continuous publication model where authors actually had the ability to sort of revise their manuscript and that would be automatically uploaded. You had a static manuscript that was fully printed, and it was no longer an accurate one. And we did have the ability to fix it. And it just goes to show exactly what you're saying. This idea that these are living papers was really an important thing that ASCO embraced quite early, I think. Dr. Nathan Pennell: And with the onset of PubMed indexing, the participation from faculty skyrocketed and almost within a couple of years was up to the vast majority of sessions and faculty participating. Now I think people really understand that this is part of the whole process. But at the time I remember writing out on my slides in all caps, “THIS IS AN EXPECTATION.” And that's about the best word I could give because I asked if we could make people do it, and they were like, no, you can't make people do it. Dr. Don Dizon: So right.  Actually, I don't think people are aware of the work on the back end every year when I was on as EIC, Nate and myself, and then subsequently Dr. Hope Rugo would have these informational sessions with the education faculty and we would tout the Ed Book, tout the expectation, tout it was PubMed indexed and tout multidisciplinary participation. So, we were not seeing four manuscripts reflecting one session. You know, this encouragement to really embrace multidisciplinary care was something that very early on we introduced and really encouraged people not to submit perspective manuscripts, but to really get them in and then harmonize the paper so that it felt like it was, you know, one voice. Dr. Nathan Pennell: I consider that after PubMed indexing, the next major change to the Ed Book, that really made it a better product and that was moving from, you know, just these short individual single author manuscripts to single session combined manuscript that had multiple perspectives and topics, really much more comprehensive review articles. And I don't even remember what the impetus was for that, but it was really a success. Dr. Don Dizon: Yeah, I mean, I think in the beginning it was more of a challenge, I think, because people were really not given guidance on what these papers were supposed to look like. So, we were seeing individual manuscripts come forward. Looking back, it really foreshadowed the importance of multidisciplinary management. But at the time, it was really more about ensuring that people were leaving the session with a singular message of what to do when you're in clinic again. And the goal was to have the manuscripts reflect that sort of consensus view of a topic that was coming in. There were certain things that people still argued would not fit in a multidisciplinary manuscript. You know, if you have someone who's writing and whose entire talk was on the pathology of thyroid cancer. Another topic was on survivorship after thyroid cancer. It was hard to sort of get those two to interact and cover what was being covered. So, we were still getting that. But you're right, at the end of my tenure and into yours, there were far fewer of those individual manuscripts. Dr. Nathan Pennell: And I think it's even made it easier to write because now, you know, you just have to write a section of a manuscript and not put together an entire review. So, it has helped with getting people on board. Dr. Don Dizon: Well, the other thing I thought was really interesting about the process is when you're invited to do an Education Session at ASCO, you're either invited as a faculty speaker or as the chair of the session. And the responsibility of the chair is to ensure that it flows well and that the talks are succinct based on what the agenda or the objectives were as defined by the education committee for that specific group. But that was it. So really being named “Chair” was sort of an honor, an honorific. It really didn't come with responsibility. So, we use the Ed Book as a way to say, “As chair of the session, it is your responsibility to ensure A, a manuscript comes to me, but B, that the content of that paper harmonizes and is accurate.” And it was very rare, but Nate, I think we got dragged into a couple of times where the accuracy of the manuscript was really called into question by the chair. And those were always very, very tricky discussions because everyone that gets invited to ASCO is a recognized leader in their field. Some of us, especially, I would probably say, dating back 10 years from today, the data behind Standards of Care were not necessarily evidence-based. So, there were a lot of opinion-based therapies. You know, maybe not so much in the medical side, but certainly some of it. But when you went to, you know, surgical treatments and maybe even radiotherapy treatments, it was really based on, “My experience at my center is this and this is why I do what I do.” But those kinds of things ended up being some of the more challenging things to handle as an editor. Dr. Nathan Pennell: And those are the– I'll use “fun” in a broad sense. You know, every once in a while, you get an article where it really does take a lot of hands-on work from the editor to work with the author to try to revise it and make it a suitable academic manuscript. But you know what? I can't think, at least in recent years, of any manuscripts that we turned down. They just sometimes needed a little TLC. Dr. Don Dizon: Yeah. And I think the other important thing it reminds me of is how great it was that I wasn't doing this by myself. Because it was so great to be able to reach out to you and say, “Can you give me your take on this paper?” Or, “Can you help me just join a conference call with the authors to make sure that we're on the same page?” And then on the rare example where we were going to reject a paper, it was really important that we, as the editorial team, and I include our ASCO shepherder, through the whole process. We had to all agree that this was not salvageable. Fortunately, it happened very rarely. But I've got to say, not doing this job alone was one of the more important facets of being the EIC of ASCO's Educational Book. Dr. Nathan Pennell: Well, it's nice to hear you say that. I definitely felt that this was a partnership, you know, it was a labor of love. So, I want to go to what I consider sort of the third major pillar of the changes to the Ed Book during your tenure, and that was the introduction of a whole new kind of manuscript. So up to, I don't know, maybe seven or eight years ago, all the articles were authored just by people who were presenting at the Annual Meeting. And then you had an idea to introduce invited manuscripts. So take me through that. Dr. Don Dizon: Yeah, well, you know, again, it went to this sort of, what can people who are being asked to sort of lead ASCO for that year, what can they demonstrate as sort of a more tangible contribution to the Society and to oncology in general? And I think that was the impetus to use the Ed Book for everyone who was in a leadership position to make their mark. That said, I was here, and I was either president of the society or I was Education Program Chair or Scientific Program Chair, and they got to select an article type that was not being covered in the annual meeting and suggest the authors and work with those authors to construct a manuscript. Never did any one of those folks suggest themselves, which I thought was fascinating. They didn't say, “I want to be the one to write this piece,” because this was never meant to be a presidential speech or a commemorative speech or opportunity for them as leaders. But we wanted to ensure that whatever passion they had within oncology was represented in the book. And again, it was this sort of sense of, I want everyone to look at the Ed Book and see themselves in it and see what they contributed. And that was really important for those who were really shepherding each Annual Meeting each year for ASCO that they had the opportunity to do that. And I was really pleased that leadership really took to that idea and were very excited about bringing ideas and also author groups into the Educational Book who would not have had the opportunity otherwise. I thought that was just really nice. It was about inclusiveness and just making sure that people had the opportunity to say, “If you want to participate, we want you to participate.” Dr. Nathan Pennell: Yeah, I agree. I think the ASCO leadership jumped on this and continues to still really appreciate the opportunity to be able to kind of invite someone on a topic that's meaningful to them. I think we've tried to work in things that incorporate the presidential theme each year in our invited manuscript, so it really allows them to put kind of a stamp on the flavor of each edition. And the numbers reflect that these tend to be among our more highly read articles as well. Dr. Don Dizon: You know, looking back on what we did together, that was something I'm really, really quite proud of, that we were able to sort of help the Educational Book evolve that way. Dr. Nathan Pennell: I agree. You brought up briefly a few minutes ago about social media and its role over time. I think when we started in 2012, I had just joined Twitter now X in 2011, and I think we were both sort of early adopters in the social media. Do you feel like social media has had a role in the growth of the Ed Book or is this something that you think we can develop further? Dr. Don Dizon: When we were doing Ed Book together, professional social media was actually a quite identified space. You know, we were all on the same platform. We analyzed what the outcomes were on that platform and our communities gathered on that platform. So, it was a really good place to highlight what we were publishing, especially as we went to continuous publishing.  I don't remember if it was you or me, but we even started asking our authors for a tweet and those tweets needed work. It was you. It was you or I would actually lay in these tweets to say, “Yeah, we need to just, you know, work on this.” But I think it's harder today. There's no one preferred platform. Alternate platforms are still evolving. So, I think there are opportunities there. The question is: Is that opportunity meaningful enough for the Ed Book to demonstrate its return on an investment, for example? What I always thought about social media, and it's still true today, is that it will get eyes on whatever you're looking at far beyond who you intended to see it. So, you know, your tweets regarding a phase 3 clinical trial in lung cancer, which were so informative, were reaching me, who was not a lung oncologist who doesn't even see lung cancer and getting me more interested in finding that article and more and more pointing to the Educational Book content that speaks to that piece, you know. And I think coupling an impression of the data, associating that with something that is freely accessed is, I think, a golden opportunity not only for our colleagues, but also for anyone who's interested in a topic. Whether you are diagnosed with that cancer or you are taking care of someone with that cancer, or you heard about that cancer, there are people who would like to see information that is relevant and embedded and delivered by people who know what they're talking about. And I think our voices on social media are important because of it. And I think that's where the contribution is. So, if we had to see what the metric was for any social media efforts, it has to be more of the click rates, not just by ASCO members, but the click rates across societies and across countries. Dr. Nathan Pennell: Yeah, social media is, I mean, obviously evolving quite a bit in the last couple of years. But I do know that in terms the alt metrics for the track access through social media and online, the ones that are shared online by the authors, by the Ed Book team, do seem to get more attention. I think a lot of people don't like to just sit with a print journal anymore or an email table of contents for specific journals. People find these articles that are meaningful to them through their network and oftentimes that is online on social media. Dr. Don Dizon: Yes, 100%. And you know what I think we should encourage people to do is look at the source. And if the Ed Book becomes a source of information, I think that will be a plus to the conversations in our world. We're still dealing with a place where, depending on who sponsored the trial, whether it was an industry-sponsored trial, whether it was NCI sponsored or sponsored by the National Institutes of Health, for example, access to the primary data sets may or may not be available across the world, but the Ed Book is. And if the Ed Book can summarize that data and use terms and words that are accessible no matter what your grade level of education is. If we can explain the graphs and the figures in a way that people can actually easily more understand it. If there's a way that we structure our conversations in the Ed Book so that the plethora of inclusion/exclusion criteria are summarized and simplified, then I think we can achieve a place where good information becomes more accessible, and we can point to a summary of the source data in places where the source is not available. Dr. Nathan Pennell: One of the other things that I continue to be surprised at how popular these podcasts are. And that gives you an opportunity pretty much the opposite. Instead of sort of a nugget that directs you to the source material, you've got a more in-depth discussion of the manuscript. And so, I'm delighted that we have our own podcast. For many years, the Ed Book would sort of do a sort of a “Weird Al takeover” of the ASCO Daily News Podcast for a couple of episodes around the Annual Meeting, and I think those were always really popular enough that we were able to argue that we deserved our own podcast. And I'm really looking forward to having these in-depth discussions with authors. Dr. Don Dizon: It's an amazing evolution of where the Ed Book has gone, right? We took it from print only, societally only, to something that is now accessed worldwide via PubMed. We took it from book to fully online print. And now I think making the content live is a natural next step. So, I applaud you for doing the podcast and giving people an opportunity actually to discuss what their article discusses. And if there's a controversial point, giving them the freedom and the opportunity to sort of give more nuanced views on what may not be something that there's 100% consensus over. Dr. Nathan Pennell: Yes. Well, I hope other people enjoy these as well. Just want to highlight a few of the things that have happened just in the couple years since you stepped down as editor-in-chief. One of them, and I don't know if you noticed, but last year we started adding manuscripts from the ASCO thematic meetings, so ASCO GI and ASCO GU, something we had certainly talked about in the past, but had lacked bandwidth to really do. And they seem to be pretty widely accessed. Dr. Don Dizon: That's fantastic. Yes, I do remember talking about the coverage of the thematic meetings and you're right, this takes a long time to sort of concentrate on the Annual Meeting. It may seem like everything happens in the span of like eight weeks. Dr. Nathan Pennell: It does feel like that sometimes. Dr. Don Dizon: Right? But this is actually something that starts a year before, once the education program is set. We're in the room when they set it. But then it's really chasing down manuscripts and then making sure that they're peer reviewed because the peer review is still really important, and then making sure that any revisions are made before it's finalized and goes to press. That is a many months process. So, when we're trying to introduce, “Oh, we should also do ASCO GU or-,” the question was, how do you want to do that given this very, very involved process going forward? So, I'm glad you were able to figure it out. Dr. Nathan Pennell: Well, it's challenging. I don't think people realize quite the compressed timeline for these. You know, the Education Session and authors and invited faculty are picked in the fall, and then basically you have to start turning in your manuscripts in February, March of the following year. And so, it's a really tight turnaround for this. When we talk about the ASCO thematic meetings, it's an even tighter window. Dr. Don Dizon: Right, exactly. Dr. Nathan Pennell: And so, it's challenging to get that moving, but I was really, really proud that we were able to pull that off. Dr. Don Dizon: Well, congratulations again. And I think that is a necessary step, because so much of what's going on in the various disease management sites is only covered cursorily through the Annual Meeting itself. I mean, there's just so much science breaking at any one time that I think if we want to comprehensively catalog the Year in Review in oncology, it kind of behooves us to do that. Dr. Nathan Pennell: Some other things that are coming up because we now have manuscripts that are going to be coming in year-round, and just to kind of make it easier on the editorial staff, we're going to be forming an editorial board. And in addition to our pool of reviewers who get ASCO points, please feel free to go online to the ASCO volunteer portal and sign up if you are interested in participating. So, moving forward, I'm really excited to see where things are going to go. Dr. Don Dizon: Well, that's great. That's great. And I do remember talking about whether or not we needed to have an editorial board. At least when I was there, having this carried by three people was always better than having it carried by one person. And I think as you expand the potential for submissions, it will be very helpful to have that input for sure. And then it gives another opportunity for more members to get involved in ASCO as well. Dr. Nathan Pennell: Absolutely. People want involvement, and so happy to provide that. Dr. Don Dizon: Yes. Dr. Nathan Pennell: Is there anything we didn't cover that you would like to mention before we wrap up? Dr. Don Dizon: Well, I will say this, that ASCO and through its publications not only has had this real emphasis on multidisciplinary management of cancers, especially where it was relevant, but it also always had a stand to ensure representation was front and center and who wrote for us. And I think every president, every chair that I've worked with naturally embraced that idea of representation. And I think it has been a distinct honor to say that during my tenure as EIC, we have always had a plethora of voices, of authors from different countries, of genders, that have participated in the construction of those books. And it stands as a testament that we are a global community and we will always be one. Dr. Nathan Pennell: Well, thank you for that. And I'm happy to continue that as we move forward. Well, Don, thank you. It's been great speaking with you. You played such a pivotal role in the Ed Book's evolution and I'm so glad you were able to join me for our inaugural episode. Dr. Don Dizon: Well, I'm just tickled that you asked me to be your first guest. Thank you so much, Nate. Dr. Nathan Pennell: And I also want to thank our listeners for joining us today. We hope you'll join us again for more insightful views on topics you'll be hearing at the Education Sessions from ASCO meetings throughout the year, as well as our periodic deep dives on advances that are shaping modern oncology. Have a great day. 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. 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. Follow today's speakers:   Dr. Nathan Pennell  @n8pennell @n8pennell.bsky.social   Dr. Don Dizon @drdondizon.bsky.social  Follow ASCO on social media:   @ASCO on X (formerly Twitter)   ASCO on Bluesky  ASCO on Facebook   ASCO on LinkedIn   Disclosures:  Dr. Nathan Pennell:      Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron     Research Funding (Inst): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi  Dr. Don Dizon: Stock and Other Ownership Interests: Midi, Doximity Honoraria: UpToDate, American Cancer Society Consulting or Advisory Role: AstraZeneca, Clovis Oncology, Kronos Bio, Immunogen Research Funding (Institution): Bristol-Myers Squibb          

When Stephanie Graff was a breast oncology fellow in 2010, one of her patients brought a marked up copy of “Dr. Susan Love's Breast Book” to an appointment. “One of my patients had brought it in and was using it almost as her cancer notebook, and had pages flagged and said, 'Well, what about this? What about this? It says here…,'” Graff, director of Breast Oncology at Lifespan Cancer Institute and medical advisor for the Dr. Susan Love Foundation for Breast Cancer Research, said to The Cancer Letter. It was the first time that the book, written by Susan Love, a breast cancer surgeon, activist, and founder of the Dr. Susan Love Foundation for Breast Cancer Research, had shown up on Graff's radar. “Dr. Susan Love's Breast Book” was first published in 1990. Now, Graff is a contributing author of the seventh edition, the most recent version of the book published in 2023. Graff spoke with Alexandria Carolan, associate editor of the Cancer History Project. A full transcript of this conversation, including how Graff came to know and work with Susan Love, appears on the Cancer History Project.

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Stephanie Graff, MD Guest: Pavani Chalasani, MD, MPH When treating patients with metastatic breast cancer, it's important to repeatedly conduct liquid biopsies to look for acquired ESR1 mutations when patients progress after endocrine therapy, even if initial testing was done. That's why Dr. Charles Turck is breaking down best practices for utilizing liquid biopsies to detect ESR1 mutations with Drs. Stephanie Graff and Pavani Chalasani. Dr. Graff is the Director of Breast Oncology at the Lifespan Cancer Institute in Providence, Rhode Island, and Dr. Chalasani is the Division Director of Hematology-Oncology at the GW Cancer Center in Washington, DC.

In this episode, hosts Shikha Jain, MD, Douglas H. Jones, MD, Amy Comander, MD, Dagny Zhu, MD, Don Dizon, MD, and Mark A. Lewis, MD, discuss the new social media platform, Threads and how physicians can use it for their practice. •    Welcome to another exciting episode of Oncology Overdrive :57 •    The topic 1:10 •    How many have created a profile on Threads? Why or why not? 2:59 •    Dr. Jain has a Thread profile but is unsure how to get more engagement 3:20 •    Dr. Lewis has convinced coworkers to use social media but has not used Threads yet 4:54 •    Dr. Dizon has a Thread profile but notes that leaving other platforms is leaving those communities and starting all over on a new platform 6:25 •    Giving Threads more time to pick up followers and engagement 11:18  •    Dr. Zhu has a Thread profile and found it easy to create but engagement is not the same as other platforms 12:17 •    Tips and tricks to sharing content on socials, especially Threads 14:33  •    Trouble with other social media platforms 17:55 •    Tips and tricks to building a community on a social media 20:20 •    The power of social media platforms and engagement in established communities 22:30 •    Fighting misinformation 25:13 •    Platforms versus audience 27:15 •    How would you like to see Threads change as a platform? 31:21 •    What is the power of TikTok in terms of getting movement among communities? 33:31 •    How do you create a profile on Threads? 40:30 •    Level of engagement: Twitter vs. Threads 43:31 •    The overwhelming number of platforms 52:29 •    What is the best platform for physicians to use? 53:41 •    Sharable content to post across other platforms 55:34 •    Final thoughts 58:09 •    Thanks for listening 1:02:13 Douglas H. Jones, MD, is the cofounder of Global Food Therapy, cofounder and president of Food Allergy Support Team and director of Rocky Mountain Allergy at Tanner Clinic. You can follow him on Threads @drdouglasjones. Amy Comander, MD, DipABLM, is director of breast oncology and survivorship at the Massachusetts General Hospital Cancer Center in Waltham and at Newton-Wellesley, and medical director of the Massachusetts General Hospital Cancer Center in Waltham. She is director of the Lifestyle Medicine Program at the Massachusetts General Hospital Cancer Center. She is also an instructor in medicine at Harvard Medical School. You can follow her on Threads @dramycomander. Shika Jain, MD, FACP, is an associate professor of medicine with tenure in the division of hematology, oncology and cell therapy at the University of Illinois Cancer Center in Chicago. She is the director of communication strategies in medicine and associate director of oncology communication and digital innovation. She also is consulting editor for Healio Women in Oncology, as well as host of Healio's Oncology Overdrive podcast. You can follow her on Threads @shikajainmd. Dagny Zhu, MD, is a cornea, cataract, and refractive surgeon and medical director and partner at NVISION Eye Centers in Rowland Heights, CA. You can follow her on Threads @dzeyemd. Don S. Dizon, MD, FACP, FASCO, is head of community outreach and engagement at the Cancer Center at Brown University and head of the breast and pelvic malignancies program at Lifespan Cancer Institute. You can follow him on Twitter (X) and TikTok @drdonsdizon. Mark A. Lewis, MD, is the director of gastrointestinal oncology at Intermountain Healthcare in Murray, Utah, and a medical oncologist specializing in cancers of the gastrointestinal tract and accessory organs. You can follow him on Twitter (X) @marklewismd. We'd love to hear from you! Send your comments/questions to Dr. Jain at oncologyoverdrive@healio.com. Follow Healio on Twitter and LinkedIn: @HemOncToday and https://www.linkedin.com/company/hemonctoday/. Follow Dr. Jain on Twitter: @ShikhaJainMD. Disclosures: The moderators and panelists report no relevant financial disclosures.

Discussing Breast Cancer ASCO 2023 Highlights, focusing on practice-changing studies with Dr. Stephanie Graff, Director of Breast Oncology, Associate Professor of Medicine, Lifespan Cancer Institute, Brown University. Covering three important studies: - NATALEE Phase III study of ribociclib (RIBO) + endocrine therapy (ET) in HR+ patients - SONIA challenging the need for first-line use of a CDK4/6 Inhibitor in HR+ advanced breast cancer patients - X-7/7 trial evaluating fixed-dose capecitabine compared to standard dose capecitabine in metastatic breast cancer

Today we are introducing the new Oncology Times Editorial Board Chair: Stephanie L. Graff, MD, FACP. In her new role, Graff will help Oncology Times continue to provide essential clinical news and analysis for the cancer care community. Graff is Director of Breast Oncology at Lifespan Cancer Institute and Assistant Professor of Medicine at Brown University. Oncology Times contributor Catlin Nalley sat down with Graff to discuss her career path and oncology care philosophy.

Join me for a deeper understanding of breast cancer, with Dr. Stephanie Graff, a medical oncologist who specializes in breast cancer.   Dr. Graff sheds light on what breast cancer is, why it's such a diverse disease, and the role of genetic and lifestyle risk factors. We also discuss the rise of "expert patients" and the challenges and opportunities of navigating cancer in today's complex information environment.   Dr. Graff cares for breast cancer patients at the Lifespan Cancer Institute in Rhode Island, where she is Director of Breast Oncology. She is also actively involved in cancer research and clinical trial design, and is Assistant Professor of Medicine at Brown University. Dr. Graff is passionate about empowering patient advocates, and serves as a medical advisor to the Dr. Susan Love Foundation for Breast Cancer Research.   Connect with Dr. Graff: Twitter @drsgraff: https://twitter.com/DrSGraff Brown University: https://vivo.brown.edu/display/sgraff Lifespan Cancer Institute: https://www.lifespan.org/providers/stephanie-l-graff-md Publication - The Rise of the Expert Patient in Cancer: From Backseat Passenger to Co-navigator. https://pubmed.ncbi.nlm.nih.gov/35344398/   Resources: Cancer.Net - Oncologist-approved information about cancer (by American Society of Clinical Oncologists) https://www.cancer.net American Cancer Society Breast Cancer Resources https://www.cancer.org/cancer/breast-cancer.html Project LEAD - Science training for advocates (by National Breast Cancer Coalition): https://www.stopbreastcancer.org/what-we-do/education/project-lead/ Dr. Susan Love Foundation for Breast Cancer Research https://drsusanloveresearch.org

Host: Jennifer Caudle, DO Guest: Stephanie Graff, MD Guest: Pavani Chalasani MD, MPH Given the challenges and unmet needs associated with the current treatment options for ER+/HER2- advanced breast cancer, what strategies can we use to optimize our approach? Here with Dr. Jennifer Caudle to share their perspectives are Dr. Stephania Graff from Lifespan Cancer Institute and Dr. Pavani Chalasani from the University of Arizona Cancer Center.

Host: Jennifer Caudle, DO Guest: Stephanie Graff, MD Endocrine resistance and toxicities are just a few of the many challenges facing clinicians who treat patients with ER+/HER2- advanced breast cancer. So what strategies can we use to better address these challenges and unmet needs? Joining Dr. Jennifer Caudle to share her approach is Dr. Stephanie Graff, Director of the Breast Oncology Program at Lifespan Cancer Institute in Providence, Rhode Island.

Discussing new SERDs in Hormone Receptor Positive (HR+) from SABCS 2022 - Practice changing studies with Dr. Stephanie Graff, Director of Breast Oncology, Associate Professor of Medicine at Lifespan Cancer Institute, Brown University; Medical Advisor, Dr. Susan Love Foundation CME information and credit available at: https://integrityce.com/courses/clinical-updates-from-san-antonio-her2-advanced-breast-cancer-heavily-pretreated-patients/ Website: http://www.oncbrothers.com/ Twitter: https://twitter.com/oncbrothers Contact us at info@oncbrothers.com  

Dr. Shannon Westin and Dr. Stephanie Graff discuss a revision to the famous "Simone's Maxims" and the broader nature of intersectionality. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, where we get in-depth on articles that have been published in the Journal of Clinical Oncology. I am your host, Shannon Westin, a GYN Oncologist, and Professor at MD Anderson Cancer Center, and I'm honored to serve as the Social Media Editor of the Journal of Clinical Oncology. Today, we're going to be discussing the very important work called “Understanding Modern Medical Centers: Beyond Simone—Intersectional Maxims for a New Era.” And this was published online in the JCO on September 27th, 2022. And joining me to discuss this important work is Dr. Stephanie Graff, who is the Director of Breast Oncology at the Lifespan Cancer Institute at the Warren Alpert Medical School, Brown University. Welcome, Dr. Graff. Dr. Stephanie Graff: Thanks so much for having me. It's going to be fun to talk about this piece with everyone. Dr. Shannon Westin: Yeah. It's a great piece of work. And before we start, I will just note that all participants have noted no conflict of interest for this manuscript. So, let's get down to it. I want to level set. What were Simone's Maxims, that you just revised, and why did they matter? Dr. Stephanie Graff: Yeah. So, Dr. Joseph Simone, who is a legend in oncology, and our revision of his work is truly in respect of what he did, not in any way meant to be anything less than that. So, in 1999, Dr. Simone published, in Clinical Cancer Research, this piece that would famously come to be known as Simone's Maxims, and the official title was, “Understanding Academic Medical Centers.” And that list of, you know, sayings and circulated truths have really sort of been this commonly quoted list of things that people talk about in medicine as just the truth of what it takes to sort of cut it, if you will, in the world, especially in academic medicine, but just medicine in general. Like, one of the famous ones is "Institutions don't love you back." And I think that you've probably heard these and maybe not even realized that you were quoting or hearing Simone's Maxims, but they're pretty ubiquitous in the world of academic medicine and, in particular, oncology, because Joseph Simone was an oncologist. He actually went on to write a book. There's a text called Simone's Maxims as well that's much longer than the Clinical Cancer Research piece. We didn't have a book in us yet, so we just started with updating the original manuscript. Dr. Shannon Westin: That's so great. And it's so funny when I was younger--I don't know if I'm still young or not, but there was things that we said, and I had no idea where they came from. So, I bet that a lot of our listeners are saying the same things, like, "Oh, that's a Simone's Maxim." So, I guess the question is now why did your group set out to update these? Dr. Stephanie Graff: I think if you look at the list of authors, a bunch of the authors have had recent career changes. And so, it actually started as just sort of this casual conversation about how for many of us who have recently undergone career changes, that some of these maxims don't hold true for us. The list of authors is a group of very intersectional physicians in our identities--and I know you'll ask me a question in a moment here about what exactly intersectional means. But, you know, I think that Dr. Simone wrote Simone's Maxims at a time when Medicine was more homogeneous, and so, some of the Maxims that he wrote represent the more traditional values of medicine, what medicine looked like in 1980, in 1990. And I think medicine in 2022, 2023, 2033 is just continuing to evolve and change shape. And so, it's important that we reframe the truths of what it takes to foster a successful career, create successful working environments for the modern workforce. Dr. Shannon Westin: I think this is so critical, and we're seeing it across a number of different fields, not just medicine. We're seeing it in politics and policy and other places. So, why don't you just make sure that all our listeners do understand this concept of intersectionality and how it applies, you know, in medicine and feminism and other areas? Dr. Stephanie Graff: Yeah. And that--shout out to our co-author Edith Mitchell. Dr. Mitchell very quickly said, "Well, we have to start the manuscript by defining intersectionality if we're going to include it in the title because a lot of the readers won't even be familiar with the concept of intersectionality." So, it's included there in the maxims. Intersectionality was first introduced in 1989, and the definition is this nature of social categories, like race and class and sex and gender and the way that they overlap, so that I'm not just white or Christian or a farmer's daughter or a woman, but I'm all those different things, and that creates my intersectional identity. And obviously, there are millions of different intersectional identities, because we have all of these different facets of our personality, of our identity, that come together. And as medicine gets more diverse, which I believe makes us stronger, we'll see more and more complexity in the intersectional personalities, intersectional identities, of the people working in healthcare. Dr. Shannon Westin: Thank you. I couldn't have said it better myself. You know, the other question that comes up as we start seeing more diversity in our workforce, and I mean, frankly, in our patient population, how do you think that that understanding about diversity and the accentuation of our diversity helps improve the success of medical organizations? Dr. Stephanie Graff: Oh, gosh. There's like a million examples. I think that-- ah, Shannon, there's so many different examples I can quote. So, I think that you know, there's a study that looked at patients coming into the emergency department having heart attacks. And if they were female patients cared for by female doctors or female patients cared for by male doctors, that had an impact on their risk of death. Not surprisingly, it was the women patients cared for by male doctors that were the most likely to die and the female patients cared for by the female doctors that were the most likely to live, telling us that when there's this concordance, this understanding between patient and physician, that it improves outcome. But that could be corrected if the male physicians had more female partners. So, just that understanding of relationships, that exposure to more people, more female physicians, increased male physicians' ability to care for female patients or communicate with female patients, it just increased confidence, our collective confidence. And that's been proven in other settings too. But that's just one sort of great example. The McKinsey group has shown how financial performance improves with gender diversity and ethnic diversity. And that's been shown, not just in healthcare, but in numerous different business environments. And if we think about, you know, as an oncologist, as a clinical researcher, if I imagine that innovation is improved by diversity, imagine that translating into better clinical trial outcomes with a more diverse workforce. And the outcomes that the McKinsey group show, ethnic diversity drove a 35% improvement in financial performance, which is huge. And again, that's at a time when the oncology workforce is really struggling with everything from, you know, recruitment to trials, staffing, revenues. That would be enormous if we could derive that sort of performance. So, I think that there's a million different ways to illustrate what diversity could do, whether it's make us better or stronger or more confident or provide better care, and it's been shown in a million different ways, in a million different contexts. Dr. Shannon Westin: Well, you're convincing everyone, I know. I think we'll get into some of the kind of more nitty-gritty details of the manuscript. I want to be very clear; I think all our listeners should absolutely 100% read the entire manuscript because it's so critical. But let's try to hit some of the major high points. And I say this all the time, and I'm going to take your line, but which one's your favorite? What do you think is the most important one? Just like you would totally tell me which of your children is your favorite, right? Dr. Stephanie Graff: I can't possibly pick a favorite. That's completely impossible. I really like--one of the Maxims that we have is, "Everyone's time and voice is valuable. Institutional leaders must respect time and encourage diversity of thought." Originally, Dr. Simone had a maxim that said, "Members of most institutional committees consist of about 30% of people who work despite other pressures and 20% who are idiots, status seekers, and troublemakers." And we changed that to say, again, "Everyone's time and voice is valuable. Institutional leaders must respect time and encourage diversity of thought," as a way of saying that, you know, I think that in 2022 and beyond, we're getting to a place where it's important that we find better labels for people than idiot and troublemaker and that we reach beyond that to identify how we can help everyone find an environment to be successful and that we fill the working corners of our cancer centers, the working corners of our hospitals, healthcare systems, clinics, with the people that are excited about the work that needs to be done. And, you know, not all of us are gonna want to run clinical trials. Not all of us are going to want to do quality improvement projects. Not all of us are going to want to do five straight days of clinic. Not all of us are going to want to do--insert the day-to-day grind of whatever it is that needs to get done to make a cancer center function. But somebody somewhere loves that little thing. And it's important that we work together to accomplish what needs to be done for best care of the patients that we're honored to take care of. And so, we have to respect that time, respect that voice, and work to connect people with the thing that drives them. Dr. Shannon Westin: I think that one, how you just ended there, kind of touches on one of the ones that really grabbed my attention, which was the original maxim that was, "Leaders are often chosen primarily for characteristics that have little or no correlation with successful tenure as a leader." And instead, as an intersectional maxim, you all changed it to, "Leaders should be chosen for their ability to inspire." That really spoke to me because it's exactly what you said.  That leader has to work to inspire people to do what they love within each piece of that, you know, department or division or hospital or organization or whatever. You can't expect everybody to do the same cookie-cutter thing, but help inspire people to be behind the mission and do what they love as part of moving that hospital organization forward. I thought that was really perfect. Dr. Stephanie Graff: Yeah. And we've too often seen, you know, in academic medicine especially, that we equate a really high h-index or a really successful history of grant funding with leadership. And those aren't the same skills, right? Like, you could be a really fantastic researcher and not a really great person at organizing a team of people to run a cancer center. And you might have both skills, in which case, wow, congratulations. But I think that it's important that we look at the job in front of us and select for that, rather than assuming that all of the same skills fill every single job because that's just not true. Dr. Shannon Westin: I think that, again, I know I said this already, listeners, but please, please run, don't walk, to read the whole paper and get more information. On our last note, one of the things I really loved about this paper was you really provided some clear reforms really to help improve physician wellness. Can you maybe summarize some of those reforms that could improve intersectionality within healthcare organizations? Dr. Stephanie Graff: Yeah. Those are all in Table 2. So, again, I hope you guys all grab the paper and give it a download and pin them up somewhere and think about them. I think that some examples are, you know, to really promote intersectionality, which means that you've got a lot of diversity in characteristics across your cancer center, which is going to be things like gender, race, introverts, extroverts, researchers, clinicians. You really have to have very clear metrics that are shared and discussed. And so, you might need to publish benchmarks for things like median RVUs or come up with a group incentive structure, so that whether you're a person who is in clinic less and publishing more or in clinic all the time and publishing less, you can work together to be flexible collectively, and then everybody can be contributing to that greater team environment. I think it's really important that if you want to grow intersectionality, that your search committees and your leadership interview strategy undergoes unconscious bias training. There's still not really great strategies to make sure that we're 100% pursuing a no-bias environment in our workplace, but there is evidence that unconscious bias training can be effective to help us recruit a more diverse workforce. And that's the simplest strategy - is if you're going to be putting a search committee together, have everybody do an implicit bias training and work together to select candidates that don't necessarily fit what feels like your traditional mold, and then find strategies, once you've hired into your organization, to partner your new employee, new physician, new hire, for maximum success in that workplace. Another important thing is, as you're growing diversity in your organization, is to make sure that you're creating opportunities to give everybody a voice. You should be looking at who's being invited to speak and making sure that that's representative and diverse. You should be considering changing up strategies. One of the examples I often give is that, when we have a problem and we do brainstorming, where you bring everybody in a room and they shout out, "This is what I think we should do," what happens is you get the loudest extrovert or the most powerful person at the table who just gets their way. And it's far more effective to do brain writing, where you have everybody write down the three or five or 10 things that they think might work, and then you read those out in a neutral way, because then, everybody's voice and everybody's idea gets equal play in a neutral way that allows you to elevate those ideas independent of the other bizarre, irrelevant hierarchies that may exist in your system and can really elevate some of those diverse voices and ideas in your organization. Those are just some of the examples that are listed. Dr. Shannon Westin: Yeah. Listeners, there's a ton of very clear frameworks that you could potentially implement tomorrow in your organization if you want to strive to improve the intersectionality. Well, the time always goes so fast. It has been so great to speak with you, Dr. Graff. Thank you so much for being here. Dr. Stephanie Graff: It's such an honor. I hope everyone gives it a read and comes up with the next iteration and update together with us. Dr. Shannon Westin: Perfect. So, again, readers and listeners, this was, “Understanding Modern Medical Centers: Beyond Simone—Intersectional Maxims for a New Era,” published online in the Journal Clinical Oncology, on September 27th, 2022. And we are so thrilled that you came to listen to JCO After Hours. Please go check us out on the website and see what other podcasts you've missed.   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.  

How many people diagnosed with breast cancer think about clinical trials or being part of one? In this episode of the DiepCJourney podcast we are going to discuss the importance of patients asking about participation in clinical trials and studies to improve the lives of breast cancer patients. My guest is Stephanie Graff, MD, FACP. She is the Director of Breast Oncology at the Lifespan Cancer Institute and Professor of Medicine at Brown University. Dr. Graff is passionate about connecting with her patients for personalized care and advancing breast cancer research, and breast cancer prevention. Our interview includes the process and steps involved for patients who sign up for clinical trials and studies. There are benefits for patients and Dr. Graff examines the processes. Her hope is this becomes standard of care for physicians to tell patients about clinical trials available and encourage them to sign up if they qualify. Dr. Graff is also involved with the American Cancer Society in Kansas City, The Susan Love Research Foundation, the American Society of Clinical Oncology, and other prominent organizations. She is a published author of several research papers. She was named “Woman Disrupter of the Year” at the 2022 American Society of Clinical Oncology Conference. Dr. Graff obtained her medical degree at the University of Missouri-Kansas City School of Medicine. She is active on social media sharing tweets about her research and work. We are both Kansas City Chiefs fans and occasionally share our love of the #ChiefsNation on Twitter. You can find out more about her work and interest in clinical trials and research on LinkedIn at: Stephanie Graff, MD, FACP

Discussing the management using the algorithm of Hormone Receptor Positive Breast Cancer - with Dr. Stephanie Graff, Director of Breast Oncology, Associate Professor of Medicine at Lifespan Cancer Institute, Brown University; Medical Advisor, Dr. Susan Love Foundation.

Listen to ASCO's Journal of Clinical Oncology essay, "People Like Us," by Dr. Stephanie Graff. The essay is followed by an interview with Graff and host Dr. Lidia Schapira. Graff reflects on her life experience as a female physician, farmer's daughter, mother, and pie connoisseur to connect and help her patients get through a life-altering diagnosis. TRANSCRIPT Narrator: People Like Us, by Stephanie Graff, MD (10.1200/JCO.22.01835)   I was standing in the dining room on the 15-year-old burnt sienna carpet, so heinous that it could have only been chosen because it was on sale. I remember the afternoon light from the western windows falling across the oak dining table which matched my mother's brusque, wooden tone. She remembers nothing. She does not remember saying the words that I have so often replayed, pondered. I was stung by the interaction in a way that rendered me speechless, in a way I now recognize too often in my approach to conflict in adulthood: silence assumed to represent understanding, consent, or complicity.   Weeks earlier, this same woman drove all over our small town hoping to catch the mailman before driving to my track and field meet 30 miles away. I was waiting for word from the University of Missouri-Kansas City (UMKC) School of Medicine, and I think my mom was as anxious to hear as I was. Conveniently, her brother (my uncle) was our mailman. When she arrived at the track meet, she handed me the large envelope proudly bearing the school's logo in the return address. I tore it open sitting with my boyfriend on the bleachers, seeing my prayers answered in black and white before my eyes. There is a photograph of this moment, so I can describe perfectly what I am wearing: my royal blue and white track uniform, my sprinters spikes and—I am sorry to tell you—a neon green hair scrunchy. This photograph also proves, in that instant, my mother understood that what was unfolding was a milestone moment in my life. I remember asking her later when I discovered she tracked the mailman around town to get the mail what she would have done if I had not been accepted. She replied that she knew I had gotten in from the size of the envelope, so she never had to think about it. I like to imagine my mom also had faith in me that led to the wild goose chase for the mailman, even before she saw the envelope.   Within the envelope, in addition to the acceptance letter and glossy brochure telling me all about my wonderful new life as a UMKC medical student, was a parental consent form. The 6-year combined BA/MD program at UMKC was far from inexpensive, and, as a minor, I would need my parents to sign this letter stating that they agreed that we would pay the tuition. Of course, by we what was really meant was I would be taking out student loans to cover every single cent of tuition, room, and board. But the letter, with a DUE BY date ticking ever closer, had been sitting on our dining room table since the day the acceptance arrived, unsigned. My father signed things like this. Never my mother. My mother would not even broach the subject with him. Nice families in rural Missouri just do not talk about money or politics. So, there it sat, a white paper elephant in the room.   “Mom, when is dad going to sign my acceptance letter? The deadline is soon, and we still have to mail it back,” I pleaded with her that afternoon. She turned to look at me, en route from the dining room to the kitchen and said, “Stephanie, people like us don't go to medical school.” People like us? Who is this us? Women? Mid-Missouri farmers? People from small towns? Our family specifically? Poor people? I may forever regret not asking. I may forever regret that moment of stunned silence where I only wondered if she had just said no to my dream and considered my next move very carefully so as to not make it worse or potentially close a door forever. By the time I asked her, years later, what she meant in that moment, my mother had no memory of saying it to me. This innocuous phrase, “people like us” that haunted me for most of medical school.   Eventually, of course, my father signed it. Only a day or two before the deadline as my memory recalls. He sat me down and told me it was a lot of money and asked me if I was serious about this whole doctor thing. I assured him that the one and only thing I had ever wanted to be had not changed in 10 years, after a short-lived dream of being a country western singer and that it was unlikely to change now. Then, he had signed the consent, which I had taken immediately to the post office before anyone could change their mind.   Yet, those words kept bubbling up. When I struggled with a test or subject, I wondered if people like us always had a hard time with organic chemistry or neuroanatomy. When my classmates talked about their exotic travels to tropical getaways or international hotspots, I sheepishly admitted people like us do not travel much. When patients assumed the female medical student was a nursing student rather than a medical student, I assumed that was just what happens to people like us. When I mispronounced something or exposed my total ignorance into the broader process of step examinations, residency, the road to physicianhood, I figured it was just the sort of thing people like us cannot help.   Then one day, a patient newly diagnosed with melanoma shared with me that he was worried about how treatment would interfere with farming. “Well, what kind of farming are we talking about?” I probed. He raised cattle, had some corn and hay fields. “Oh really? What breed? How many head?” We fell into the easy talk of farm life, and he shared his current toils of repairing his tractor. When he left, his wife pulled me aside and confided, “It really is nice to know that his doctor is one of them.” When I start to write a prescription, I often stop to think about the cost, about how $20 US dollars is a big deal to people like us, and I talk to patients about what is financially possible, what help they need, what resources we have. One of my breast cancer survivors always framed her chronic lymphedema symptoms in terms of how much or how little it held her back from baking pies. We shared recipes of her grand champion state fair pies and my mom's own grand champion pecan pie. I could understand the flurry of activity and pressure to bring your freshest, most beautiful pies to the fair because I shared that lived experience. Patients like this, one by one, started me thinking that maybe more people like us should be in medical school. I know the statistics for my own field of medical oncology, and few oncologists practice in rural areas, despite the community needs. I have no statistics for how many of my colleagues grew up farming or preparing for state fairs every summer. But, I have answered phone calls from my mom, asking advice about what aspects of farming are safe when you are neutropenic or how best to plan Moh's surgery around harvest. People like us are necessary to fill those gaps.   As a woman in medicine, numerous women have reached out to me to ask me questions about the duality of medicine and mothering or the intersection of work and sex. My emails, text messages, and social media feeds are filled with threads on breastfeeding at work, daycare solutions, unique challenges in leadership for women, and advice on career growth. These conversations ring with the chorus of someone like me as we connect over similarities. My mom recognizes this version of like me as well, handing out my phone number to women in the intervening years from my hometown applying to my alma mater or medicine in general. If community and connection with other women improves career experience for women in oncology, I am glad there are people like us.   And as much as I see a need in medicine for people like me, I also see all the ways I represent privilege—which of course means that there is ample space in medicine for people not like me. If the numbers of rural or female oncologists are low, the numbers of Hispanic/Latino, Black/ African American oncologists are startling. How can we collectively provide culturally and linguistically competent care if our workforce does not share the same diversity as our patients?   So, mom, 25 years later, I think we have both grown to understand medical schools need people like us, people like all of us. I think you have felt that as much as I have over the years in your own connections with doctors caring for members of our family or in the health questions you save for me. When I sit with a patient as their doctor, I am also there as a woman, farmer's daughter, mother, writer, baker of pies, and so much more. Each time one of these versions of me creates connection with a patient or colleague, my care improves. Each of our unique gifts and experiences help us connect with our patients in ways both big and small. Medicine needs people like us.   Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, brought to you by ASCO Podcasts, which covers a range of educational and scientific content, and offers enriching insight into the world of cancer care. You can find all ASCO shows, including this one at: podcasts.asco.org.   I'm your host, Lidia Schapira, Associate Editor for Art of Oncology, and Professor of Medicine at Stanford University. Today, we are joined by Dr. Stephanie Graff, Director of Breast Oncology at Lifespan Cancer Institute, and Assistant Professor of Medicine at Legorreta Cancer Center, at Brown University. In this episode, we will be discussing her Art of Oncology article, 'People Like Us.'   Our guest's disclosures will be linked in the transcript.   Stephanie, welcome to our podcast and thank you for joining us.   Dr. Stephanie Graff: Thanks so much for having me.   Dr. Lidia Schapira: It is our pleasure. So, I like to start the show by asking our authors what they are currently reading and would recommend to listeners.   Dr. Stephanie Graff: I am currently reading The Power Broker, which is kind of a funny book to be reading. It's obviously an older book, and it's the story of Robert Moses who famously, or infamously, perhaps, built New York City, and sort of wrote the power structure of city government or state government and politics in New York, and it's written by Caro and is a Pulitzer Prize winner, and I just have never read it. It's quite the tome, so it's hard to power through, but it's excellently well-written, and really insightful into political culture and the history of New York. So, I'm finally working my way through it. I'm not sure that I would recommend it for the average reader. I just finished The Sentence, by Louise Erdrich, and, Unlikely Animals, by Hartnett, and both were delightful reads.   Dr. Lidia Schapira: You are a gifted storyteller. I wonder if you could tell our listeners and share with us a little bit about your process and when you write, how you write, and what inspires you to write.   Dr. Stephanie Graff: When I write and how I write, I think the answer is, all the time. You and I may have talked about this before. I feel like writing is often how I decompress, and I find that I'm often writing in my head all the time. So, when I'm walking my dog, when I'm driving my car, when I have downtime, I'm sometimes turning over ideas or events and looking for the thread or the storyline there. I write poetry, actually mostly for myself as my form of journaling, or meditation, or rage, or sadness, whatever it is I might be feeling. And sometimes that then turns into something narrative, and that's a habit that I've had for a very long time, even as early as middle school and high school, it was a habit that I've always had. In terms of then turning that into something narrative or publishable, I think that that's more of an ‘aha' moment where an idea that I've been turning over for a while finally feels like there's a unifying theme, or thread, or a particular patient encounter, or a funny thing that one of my children said inspires it to become this sort of 360 moment that makes it feel more like thematic story that can be told.   Dr. Lidia Schapira: So, given your expertise with stories, and your appreciation of literature, and the fact that you've now lived in the world of Oncology for quite a while, what is your opinion of the role of stories and narratives in our culture and our approach to training others, and sort of sustaining that sense of vocation I think that drove us all to choose a specialty in the first place.   Dr. Stephanie Graff: Yeah. I think that story is so important for how we relate to one another, and how we relate to our patients because I think that, you know, if we're just talking to patients about a phase III randomized clinical trial and throwing at a patient a bunch of statistics, or metrics, or guidelines, it's not digestible, or understandable, or relatable. And so, being able to talk about what we do at the story is what makes that understandable, memorable, digestible for patients, but also for our colleagues, and our students, and residents, and fellows, staff, everyone that we interact with in our day-to-day experience. And so, I think that really thinking about The Art of Oncology, the practice of what we do day-to-day as parables, and stories, and looking for ways to turn that science, that data into little anecdotes is really so central to understanding.   Dr. Lidia Schapira: Let's talk about the story that you so beautifully wrote, ‘People Like Us'. Thank you for sharing that and sending it out to the world. I assume this is something that you've been thinking about for decades, and I, since you don't look like a teenager waiting for mom and dad's approval to go to med school. You know a good story, Stephanie, I'm sure you agree, allows the reader to project into, and imagine things. And there were two big themes for me, and one of them had to do with the mother-daughter relationship. So, can you talk a little bit and share with us a little bit about that aspect of the story of the words that your mother said at a very tender age that sort of stuck with you and kept on giving?   Dr. Stephanie Graff: So, for those listening, the story is that my mom said to me after I had been accepted to medical school and was kind of waiting for my parents to sign the acceptance letter, I went to the University of Missouri, Kansas City six-year program, so I got accepted to medical school, straight out of high school. And because I was 17, they had to sign this parental consent in order for me to actually start. And so, this letter was like sitting like the elephant in the room on my dining room table for, I don't know, two weeks or something, waiting for them to sign it. And my mom one day, in a moment, that to her was, I mean, she doesn't remember it.   So, like to her clearly, it was like this nothing-passing comment, like, you know, "Pick up your shoes." She said “People like us don't go to medical school.”   And at the time, I was so struck by it, but I have no idea who this "us" was that she was referencing. And I have spent decades wondering, in retrospect, "Oh, why didn't I ask questions?" You know, my mom actually was this amazing hero to me in my childhood. You know, she was a Girl Scout leader, and I got my Girl Scout Gold Award, she created all these opportunities for leadership and engagement in my community. She taught Sunday school. She graduated high school but just has a high school degree. She never went to college herself, because she was actually told by her parents that girls don't go to college, that girls get married and stay home. And so, though she wanted to go to college, her parents closed that door for her, and so she worked a factory job to earn extra money to help support the things that my siblings and I all wanted to do that, you know, kids' activities get pricey. Eventually, the factory job was physically demanding on her as she aged, and she ended up applying to become a paraprofessional in the schools, and so spent the second half of my childhood working as a para in our schools, which actually also ended up being a very physically demanding job. But really all kind of just out of determination and passion to create opportunities for us as children. So, in no way is this story meant to be a shot at my mom. She's been a really, really great mom. And again, she has no memory of saying this thing to me that has stuck with me so harshly, perhaps over the last several decades. But she said it, and at the time I was kind of like, "What does she mean by this?" I mean, obviously, I already had a lot of doubt about whether or not medical school was going to be right for me or if I was gonna fit in there, and for her to say that, I was kind of like, "Oh gosh, maybe people like me don't go to medical school." And then as I entered medical school, medical school was hard. It was hard as an 18-year-old. I struggled in classes, there were lots of moments where my peers were just more worldly than me. They had traveled, they came from backgrounds where most of their parents-- I had so many classmates whose parents were both physicians, and so they didn't struggle with the language of Medicine, the career paths of Medicine in the same way that I did. You know, my mom's words just kept coming back - people like us don't go to medical school. It was something that just sort of kept coming up over my career.   Dr. Lidia Schapira: So, who are those "People Like Us"? Have you figured it out? I certainly enjoyed reading all of the possible spins of People Like Us - people who come from farm backgrounds, people who aren't rich and worldly, perhaps women. Who are these "People Like Us?"   Dr. Stephanie Graff: Well, at the end of the day, I think all of us are People Like Us because you know, if anything I've learned in my last 20 years of this, is that everybody has those feelings of self-doubt, and feelings like, "we don't fit in." And hopefully, those are coupled with moments of feeling like you do belong, and hopefully, everybody has a network of belonging. But we're all periodically thrust into times where we don't feel like we fit in, and we don't feel like we belong. And there's so much that can be drawn from those moments. So, whether it's that you are from an underrepresented group, from your ethnic or cultural background, your socioeconomic background, your gender, your sexual identity, you know, no matter what that is, your parents' occupation, if you're the first person in your family to go to college, you are going to bring the tapestry to Medicine that helps us kind of richly relate to our patients in a way that's so cool. One of my favorite studies that I've seen in the scientific literature is actually not an Oncology study, it's a Cardiology study that looked at patients presenting to emergency departments with heart attacks, and it was a gender inclusion study. And what it looked at is in patients that have heart attacks in the emergency department, if the cardiologist caring for the patient is matched gender, like a man caring for a male heart attack patient, they have a better outcome. But if that cardiologist has a partner that is of the same gender, so like if the male cardiologist has female partners, their care of female heart attack patients improves, and that patient's cardiac mortality improves, which was so fascinating that like just having a greater exposure to female cardiologists helped male cardiologists provide better care to female patients. So, I do think that just gathering experiences of the people not like me, that surround me all day, help me relate better to my patients. There's certainly so many cultural celebrations, travel experiences, world celebrations, that I better understand through my classmates, peers, colleagues, friends, that I have encountered in Medicine, that help me connect and relate to my patients in ways that I previously didn't have access to. And there's ways that I'm sure me as a Midwestern farmer's daughter have helped my colleagues understand some of the things that our patients cope with.   Dr. Lidia Schapira: You make a brilliant case for diversity, and of course, for inclusion, which is something that everybody is really keenly trying to think more deeply about these days. And that brings me to another question or follow-up, and that is the role of empathy in communicating with people who are not like you. One of the most beautiful parts of your essay, I thought, was when you take us into the exam room with a patient, and you're actually giving us some examples of how your lived experiences as a farmer's daughter allowed you to connect with people who work the land, or who depend on the land or women who bake pies. Tell us a little bit about that - the role of the connection with a patient, and empathy, and compassion in helping us create a more welcoming environment, both for our colleagues and for our patients.   Dr. Stephanie Graff: I think everybody has had that experience before where a patient asks us, as their Oncologist, if while they're undergoing chemotherapy, undergoing radiation, if they're still going to be able to like [insert their passion here]. You know, as I reflect over my lifetime of patients, I've had patients who are professional poker players. I had a professional accordion player. I've had figure skaters. I've had everything, right? And I don't know the first thing about professional poker, okay, I would be a terrible professional poker player. But I could imagine what skills are needed to be a professional poker player and answer that question. But every once in a while, a patient asks me if they're still going to be able to do X, and whatever they fill in that blank is something that so deeply relates to my childhood experiences, that it becomes this bonding moment with my patient. So, some of the ones that I shared in the essay is a patient who spent every summer baking pies for the State Fair. For those of you who don't know, at the State Fair, you can enter your pies, cookies, baked goods, canned goods, decorated cakes, pretty much anything you can imagine, breads, and they're judged, and the winner gets ribbons - red, white and blue, and grand champion, and reserve grand champion that come with cash prizes, it's bragging rights. If you happen to also own like a bakery, or decorate wedding cakes, for example, that's something that's then marketing material, advertising material for your company that you're the Missouri Grand Champion of wedding cake decorating for 2022, or whatever it might be. So, this is a big deal, and people in my community talked about it and joked about it. And you would, at the church picnic when you're picking which pie, you know whose pie was the grand champion pie. So, she told me going into her chemotherapy, that it was really important to her that she could do the pies. We laughed, because my mom is the grand champion pecan pie baker for our county, and my mom makes a, pardon me, damn good pecan pie, I would say.  So, that patient and I spent a lot of time talking about how her pie baking was going. And I will say that the summer that she was on chemotherapy, she said that it was really fatiguing and hard for her. And so, that next year when it came time to pie season, she was really excited to tell me that like she entered two more pies than she had the prior year because she had that extra energy to like get up on the morning of the fair, and bake the extra pies, and spending all the extra time on making the crust beautiful. And I know what that's like because I've seen my mom get up at four o'clock in the morning to make a beautiful, perfect pie, and have it ready to enter at 8:00 AM when the fairgrounds open. That's so unique to perhaps rural Missouri, or the Midwest, or fair culture, and I guess probably not a lot of Medical Oncologists know what that's like. I had another patient who was, when I was still early in my career and was caring for things other than just breast cancer, who had a melanoma, and his wife asked me a lot of questions about how it was going to impact his farming. And we had this really lovely conversation about what kind of farming, and how many acres he had, and how many head of cattle, and what crops, and they were shocked at the depth of my knowledge about farming, and my ability to answer their questions in detail about what would be safe, and what would not be safe. And when they found out that it's because that's what I was raised doing, and that's what I did when I went home on weekends to visit my family, it was help out on the farm and do many of the same things that we were talking about. They saw me in this completely different light. Then they had seen me as this high-heeled wearing, white coat dawning Medical Oncologist, and it, I think helped them feel so much more comfortable in their cancer treatment, knowing that I understood where they were coming from.   Dr. Lidia Schapira: I have to ask you this question. Have you shared the essay with your mom?   Dr. Stephanie Graff: I have not shared it with her yet. I will when it comes out in print.   Dr. Lidia Schapira: What do you think her reaction will be?   Dr. Stephanie Graff: I think that she'll think it's lovely. We've had this conversation about how annoyed I am that she doesn't remember saying it, and how -- I guess it's weird because, you know, she said it and at times in my life I would say that it was hurtful that she said that people like us don't go to medical school, and that probably is the right language at different time points. I don't know that today I would describe it as a hurtful comment because I know what it was. It was just words that came out of her mouth whilst she was busy doing 100 other things, right? She doesn't remember it for a reason, which is that it wasn't a big commentary on me, or my life, or my choices. It was just words coming out of her mouth as she was going from one thing to another. So, I don't think that she'll find any hurt, or ill will in it at all.   Dr. Lidia Schapira: She may respond with a comment about what it's going to be like for you when you're in that situation with perhaps your children, and perhaps, at that point, make a comment that to you, may be forgettable, but makes a deep impression and a lasting impression in their young minds.   Dr. Stephanie Graff: That's actually something that I've spent a lot of time thinking about, both as I reflect on the comment, and, you know, at the very beginning of this, we talked about when I'm writing, and I said, always. I think about that comment a lot in the context of so much that I do - in my own parenting with my children, things that I say to them, and how those words might impact them. Things my husband says to them, and how those comments might affect them. But also, in the larger work of DEI, and how "jokes", or jabs, or sarcasm, things that aren't necessarily meant as true, can cut wrong. And that's why we have to be thoughtful, and careful because you never know who is listening, and how words are going to hit somebody on any given day.   Dr. Lidia Schapira: On that beautiful note, I want to thank you for sending us your work. Please continue to write, and I look forward to reading future stories, maybe even a poem, sometime. 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 wherever you listen. Be sure to subscribe so you never miss an episode.   JCO's Cancer Stories: The Art of Oncology, is just one of ASCO's many podcasts. You can find all of the shows at: podcasts.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.   Show Notes: Like, share and subscribe so you never miss an episode and leave a rating or review.   Bio: Dr. Stephanie Graff is the Director of Breast Oncology at Lifespan Cancer Institute, and Assistant Professor of Medicine at Legorreta Cancer Center, at Brown University.

While the DESTINY-Breast04 trial, which earned a standing ovation as a practice-changing study for treatment of HER2-low MBC garnered most of the headlines from the ASCO (America Society of Clinical Oncologists) annual meeting in June, it was not the only reason for optimism.  In this episode, the first of a two-part series, Our MBC Life's Victoria Goldberg and Lynda Weatherby continue to explore what the research shared at ASCO means for us, the patients living with MBC.  You'll hear from preeminent oncologists Stephanie Graff, Director of Breast Oncology at the Lifespan Cancer Institute at Brown University  and Hope Rugo (Professor, Department of Medicine (Hematology/Oncology) and Director, Breast Oncology and Clinical Trials Education, UCSF) in this deep dive into two critical studies: DESTINY-Breast04 and TROPICS-02. The latter examined a potential new line of treatment for heavily pre-treated HR-positive, HER2-negative MBC patients.  ENHERTU (trastuzumab deruxtecan) and TRODELVY (sacituzumab govitecan), the two drugs at the heart of these two trials, are both representatives of a relatively new class of drugs: Antibody Drug Conjugates—ADCs. ADCs are a class of drugs that links a potent chemotherapy drug with an antibody. Unlike traditional chemotherapy, ADCs are intended to target and kill tumor cells while sparing healthy cells. They are a kind of “smart bomb” for cancer treatment—and an extraordinarily promising development for patients.Our wide-ranging conversations with Dr. Graff and Dr. Rugo cover not only the results of these two trials, but their implications for treatment and the future of breast cancer research.More info about the show and past episodes is available on our website: www.ourmbclife.orgGot something to share? Feedback? Email: ourmbclife@sharecancersupport.orgFollow us on Facebook, Instagram, and twitter @ourmbclife

Key takeaways: The changing role of the Oncologist - Starting as the Sherpa, transitioning to a mentor, and then breaking up! Awareness of barriers the LGBTQ community faces in accessing healthcare The distinction between addressing reproductive health and sexual health in cancer care About Dr. Don Dizon: Don S. Dizon, MD, FACP, FASCO, is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital. He is also a professor of medicine at The Warren Alpert Medical School of Brown University. His research interests are in novel treatments of women's cancers and issues related to survivorship, particularly as they relate to sexual health after cancer for both men and women. He is a prolific researcher and writer, and he has authored hundreds of publications, including peer-reviewed articles, books and book chapters. He is an active member of the American Society of Clinical Oncology, SWOG cancer research network, and the National Consortium of Breast Cancers, of which he has served as both vice president and president. Key moments: 12 minutes 27 seconds That person may be more interested in symptom control, in which case they would find more affinity in a metastatic brain tumor group. But they also may want to see people that look like them, that are like them who are going through this experience because of the threats metastatic brain cancer has on people's sexual health. 14 minutes 35 seconds It's what makes cancer care so multifaceted today. There's no one person who can really manage all the aspects of cancer care. By that, I mean whole-person cancer care. It really brings in the importance of having a team approach. 21 minutes 8 seconds There's a relationship between medical oncologists and their patients that is very difficult to walk away from for a lot of people. It almost feels like severing a relationship and it's quite an unsettling thing. Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions. --- Support this podcast: https://podcasters.spotify.com/pod/show/manta-cares/support

This episodes discusses the role of social media in patient care with Dr. Don Dizon. Dr. Dizon is the Director of the Pelvic Malignancies Program at Lifespan Cancer Institute, Head of Community Outreach and Engagement at The Cancer Center at Brown University, and Director of Medical Oncology at Rhode Island Hospital. Living with melanoma is emotionally stressful, no matter which side of the challenge you are on. Melanoma has more than a physical impact when living with the disease. It's also a significant source of emotional distress, anxiety, and depression—both during treatment and after. Our new program, “Beyond the Clinic: Living Well With Melanoma,” will feature topics seldom discussed in the exam room but essential to patients and their families during and beyond treatment. Led by the Director of Cancer Survivorship for Kaiser Permanente San Francisco, Raymond Liu, M.D., Beyond the Clinic: Living Well With Melanoma is a monthly live webinar designed to support patients' and families' emotional needs. --- Support this podcast: https://anchor.fm/aimatmelanoma/support

This week, CancerNetwork spoke with Don Dizon, MD, about certain unique challenges LGBTQ+ patients face when navigating through their cancer journey, and how providers can improve these experiences. The director of women's cancers at the Lifespan Cancer Institute, director of medical oncology at Rhode Island Hospital, and professor of medicine at the Warren Alpert Medical School of Brown University in Providence, touched on overcoming barriers in clinical cancer research, creating a gender-affirming environment for patients, and other important topics for treating LGBTQ+ patients with cancer. Don't forget to subscribe to the “Oncology Peer Review On-The-Go” podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

In this episode, Christine Hodgdon and Julia Maués, co-founders of Guiding Researchers and Advocates to Scientific Partnerships, and Stephanie L. Graff, MD, FACP, discuss the organization's mission and the importance of patient advocacy. Intro :01 Welcome to another exciting episode of Oncology Overdrive :13 Guest introduction :23 About GRASP :28 About Maués :36 About Hodgdon 1:07 About Graff 1:40 Can you tell us a little bit about GRASP? 2:21 Julia, what was your journey to get into this process? 5:47 Graff how are you involved with GRASP? 9:26 How was something like GRASP not already implemented? 13:30 Julia and Christine, did you have any scientific background before you started doing this? 16:48 Why is advocacy so important? 19:12 Have you guys had any negative responses with this whole patient advocate title? 24:58 Sometimes women's symptoms and concerns are written off or ignored … Julia is that something you've personally experienced or seen? 29:59 Hodgdon's one pearl 39:08 Maués' one pearl 39:56 Graff's one pearl 40:59 How to contact Graff 42:23 How to contact Maués 42:38 How to contact Hodgdon 42:57 Thank you so much for your time 43:27 We'd love to hear from you! Send your comments/questions to oncologyoverdrive@healio.com. Follow us on Twitter @HemOncToday, @ShikhaJainMD, @christeeny513, @itsnot_pink, @DrSGraff and @GRASPtweets. Stephanie L. Graff, MD, FACP, joined Lifespan Cancer Institute at Brown University in Providence, Rhode Island as the director of breast oncology in the summer of 2021. Prior to joining the team at Lifespan/Brown, she was director of both the breast program and clinical research at the Sarah Cannon Cancer Institute at HCA Midwest and associate director of the Breast Cancer Research Program at Sarah Cannon Research Institute and national breast lead for the Sarah Cannon Cancer Network's clinical programs. In addition, Graff serves as a medical advisor to the Dr. Susan Love Foundation for Breast Cancer Research. Christine Hodgdon, is a co-founder of GRASP. Julia Maués is a co-founder of GRASP. Disclosures: Graff, Hodgdon and Maués report no relevant financial disclosures. Jain reports she is a paid freelance writer for Lippincott.

In recognition of Breast Cancer Awareness Month, Caris Precision Oncology Alliance™ Chairman, Dr. Chadi Nabhan, sits down with Dr. Stephanie Graff, Director of Breast Oncology at the Lifespan Cancer Institute at Brown University. Together they discuss the latest advances in breast cancer. For more information, please visit: www.CarisLifeSciences.com

A small regulatory protein can be found not only in all humans, animals, plants and fungi, but in each and every eukaryotic cell. Following the discovery of these ubiquitous proteins in 1974, researchers aptly named them ubiquitin. Enzymes and/or ligases (enzymes that catalyze the formation of chemical bonds), allow ubiquitins to bind to substrate proteins. This process, known as ubiquitination, can initiate or prevent protein interactions, denote them for degradation and alter their activity and cellular location. Aberrant ubiquitination may play an important role in tumorigenesis. At the core of solid tumors, hypoxia-inducible factor 1α (HIF-1α) is induced (by hypoxia) and allows cancer cells to adapt to the lack of oxygen. The accumulation of HIF-1α can also transcribe a number of genes well-known to be involved in cancer. Therefore, HIF-1α is an attractive, albeit difficult-to-pinpoint, therapeutic target in cancer. Researchers—from Brown University and ​​Lifespan Cancer Institute—previously observed the stabilization of HIF-1α by the protein coding gene cyclin-dependent kinases CDK1. They further proposed that CDK4 may also be an HIF-1α stabilizer. However, the mechanism of HIF-1α's regulation by CDK4 has yet to be fully elucidated. “Till now, development of therapies targeting HIF-1α remains hindered. Therefore, it is imperative to explore the mechanism of HIF-1α regulation in cancer cells and investigate new possibilities to therapeutically target HIF-1 signaling.” In 2021, the same team conducted a new study further investigating the molecular mechanisms of HIF-1α destabilization by CDK1 or CDK4/6 inhibitors in colorectal cancer. Their priority research paper was published as the cover of Oncotarget's Volume 12, Issue 20, and entitled, “Identification of Smurf2 as a HIF-1α degrading E3 ubiquitin ligase.” Full blog - https://www.oncotarget.org/2021/09/30/new-study-protein-analysis-reveals-novel-role-of-enzyme-in-cancer/ Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28081 DOI - https://doi.org/10.18632/oncotarget.28081 Full text - https://www.oncotarget.com/article/28081/text/ Correspondence to - Wafik S. El-Deiry - wafik@brown.edu Keywords - Smurf2, CDK4/6 inhibition, HIF1alpha, hypoxia, cancer therapy About Oncotarget Oncotarget is a bi-weekly, peer-reviewed, open access biomedical journal covering research on all aspects of oncology. To learn more about Oncotarget, please visit https://www.oncotarget.com or connect with: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ Twitter - https://twitter.com/oncotarget YouTube - https://www.youtube.com/c/OncotargetYouTube/ LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Oncotarget is published by Impact Journals, LLC please visit https://www.ImpactJournals.com or connect with @ImpactJrnls Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

Fred J. Schiffman, MD, is a Hematologist/Oncologist and the Associate Physician-in-Chief at The Miriam Hospital, the Medical Director of the Lifespan Cancer Institute, the Sigal Family Professor of Humanistic Medicine and the Vice-Chairman of the Department of Medicine at the Warren Alpert School of Medicine at Brown University. Dr. Schiffman is a graduate of NYU Medical School. He completed his residency in Internal Medicine and fellowship in Hematology/Oncology from Yale New Haven Hospital. Dr. Schiffman has published extensively in hematologic malignancies and on a variety of subjects regarding the education of students and house staff. He has received numerous teaching awards, including the Charles C. J. Carpenter Award for excellence in the specialty of Internal Medicine, and the Human Dignity Award given by Home & Hospice Care of Rhode Island. “At the end of the day, when you're off the clock, go to the patient's room. Ask about their day; answer their worries; reassure them of your support; give them your undivided attention; clear your mind of all distracting thoughts, and just be there for the patient.” Today we listen to Dr. Fred Schiffman share his journey, reflecting on our broader role as physicians in treating illness, not just disease. “Cure sometimes, relieve often, and comfort always” is one of Dr. Schiffman's many mantras, encouraging us to allow our humanistic side to shine through as we care for our patients. Pearls of Wisdom: 1. The secret to dealing with learners that have difficulty is to capitalize on their strengths, and to never criticize the person, only the incorrect method or behavior. 2. Be present with the patient. Give them your undivided attention. When you are off the clock at the end of the day, spend five minutes to ask about their day. 3. As our career progresses, we often forget the compassion and love that inspired us to enter the field of medicine. To reconnect with the warmth of those ideals, simply take five minutes to reflect on what you would want if you were on the other side of the stethoscope.

In this episode, Stephanie Graff, MD, FACP, shares the details of her new role at Lifespan Cancer Institute at Brown University, how social media has impacted her career and the importance of fostering relationships with patients. Intro :13 About Graff :18 The interview 2:09 How did you end up in medicine and oncology? 2:32 How did this opportunity come about, and how did you make the decision? 6:47 How do you advise folks regarding career transitions or first jobs out of training? 16:45 How do you think social media has impacted your career? What do you say to the naysayers? 22:14 How have you utilized ASCO throughout your career? 32:24 What do you hope to accomplish at Brown? 37:14 Graff's take-home message 41:13 How to find Graff 42:18 Stephanie Graff, MD, FACP, joined Lifespan Cancer Institute at Brown University in Providence, Rhode Island as the director of breast oncology in the summer of 2021. Prior to joining the team at Lifespan/Brown, she was director of both the breast program and clinical research at the Sarah Cannon Cancer Institute at HCA Midwest and associate director of the Breast Cancer Research Program at Sarah Cannon Research Institute and national breast lead for the Sarah Cannon Cancer Network's clinical programs. In addition, Graff serves as a medical advisor to the Dr. Susan Love Foundation for Breast Cancer Research. We'd love to hear from you! Send your comments/questions to Dr. Jain at oncologyoverdrive@healio.com. Follow us on Twitter @HemOncToday @ShikhaJainMD. Dr. Graff can be found on Twitter @DrSGraff.  Disclosures: Graff reports no relevant financial disclosures. Jain reports she is a paid freelance writer for Lippincott.

“I don't have time to do this.” “I don't want to risk patient privacy.” “I'm concerned about the legal issues.” When asked why they aren't active on social media, oncology professionals often have objections like these. But Dr. Don Dizon thinks that ignoring social media simply isn't an option anymore. And he's taking huge steps to remedy the disconnect. Dr. Don Dizon is a Professor of Medicine at Brown University and the Director of the Breast and Pelvic Malignancies Program at Lifespan Cancer Institute. He also formed a crowdsourced organization called Collaboration for Outcomes Using Social Media in Oncology (COSMO). Some might call him a social media “power user” — and for good reason. He's active on multiple platforms, and he's on a mission to highlight the dangers of misinformation online, and how healthcare professionals can help change those narratives and sculpt conversations around health and research. And of course, there are the wonderful benefits of a social media presence, like personal branding, thought leadership, and networking. Don't miss this one! Here are the show highlights: - One of the most crucial lessons to take away from this whole conversation (7:10) - Join the fight against misinformation and false narratives (16:31) - Here's the first step to finding the right social media platform and getting started (24:40) - There's a niche for everything. Learn how to filter down tweets to find content you're interested in (26:35) - Why you need more “Twiends” (Twitter friends!) (30:35) Stay connected with Working in Oncology on Apple Podcasts, Spotify, or our podcast website.

Caris Precision Oncology Alliance™ Chairman, Dr. Chadi Nabhan, sits down with Dr. Don Dizon, Director of Women's Cancers at Brown University's Lifespan Cancer Institute. Together they discuss precision oncology and the impact of genomic profiling and sequencing in the management of women with various gynecological malignancies. For more information, please visit: www.CarisLifeSciences.com

Don Dizon, MD, FACP, is Professor of Medicine at Brown University and a medical oncologist with research interestes in novel therapies of breast and pelvic cancers (e.g. ovarian, uterine, cervical cancers), survivorship particularly as it pertains to sexual health for men and women with cancer, and social media. He is the Director of the Breast and Pelvic Malignancies Program at Lifespan Cancer Institute and Director of Medical Oncology at Rhode Island Hospital. Additionally, he is the Chair of Digital Engagement for SWOG Oncology Research Network. Co-Chief Medical Officer at the Global Cancer Institute, and serves on the Board of The Hope Foundation and Young Survival Coalition. He is a prolific author and writes columns for multiple sites, including the professional journal, The Oncologist, ASCO's networking site, Connection, and for Medscape. Dr. Dizon is on social media on Twitter, Facebook, Instagram, and TikTok as @drdonsdizon.

Dr. Theresa Graves, director of the Breast Cancer Center of the Lifespan Cancer Institute in Rhode Island, discusses breast-cancer awareness and monitoring, care and treatment, and the advances research has brought as national Breast Cancer Awareness Month begins. She also talks about two of her patients, one from 20 years ago and another more recently: Lucia and Jennifer Cornwell, mother and daughter, now both healthy survivors. @gwaynemiller #podcast for @projo -- story and video at providencejournal.com See omnystudio.com/listener for privacy information.

Don Dizon, MD, is an innovator in oncology and an expert in social media. In this episode, we discuss the importance of authenticity and how platforms like Tik Tok have helped him engage with patients. Intro :04 About Dizon :17 The interview 1:29 How did you get to where you are from your beginnings? 1:39 How were you able to navigate around the ideology of sub-subspecializing and do all of this exciting and innovative stuff? 5:45 The importance of giving support to faculty members in trying new innovations 10:20 How has your social media life been viewed? How did you become this social media expert and have that be accepted, even lauded by the people you work with? 12:09 How does your social media presence and content provide accessible information to patients while showing a human side? 18:35 How and why did you choose the platforms you engage on? 20:38 How do you come up with content for your TikTok videos? 23:11 What types of things have you done academically that have helped your career and the academic world? 27:55 What are some other pitfalls you’ve noticed with social media? 34:30 If people are interested in doing something off the beaten path … where can they go to get guidance and help? 40:41 Dizon’s one pearl 45:22 How to find Dizon 45:51 Don Dizon, MD, is a professor of medicine at Brown University and is a medical oncologist specializing in the care of women with breast or gynecologic cancers, survivorship, particularly as it pertains to sexual health for men and women with cancer, patient engagement and social media. He also serves as the director of men’s cancers and director of hematology/oncology clinics at Lifespan Cancer Institute in Rhode Island. We’d love to hear from you! Send your comments/questions to Dr. Jain at oncologyoverdrive@healio.com. Dr. Dizon can be reached on Twitter, Instagram and TikTok at @drdonsdizon. Follow us on Twitter @HemOncToday @ShikhaJainMD Disclosures: Jain reports she is a paid freelance writer for Lippincott. Healio was unable to confirm relevant financial disclosures for Dizon at the time of posting.

Dr. John Sweetenham, medical oncologist at the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern Medical Center and chief editor of the ASCO Daily News, and Dr. Don Dizon, head of Women’s Cancers at Lifespan Cancer Institute in Rhode Island and editor of the ASCO Educational Book, discuss the extraordinary breadth of issues in oncology that are covered in this year’s Educational Book, which is a continuing resource for the seminal ASCO20 Virtual.    Transcript Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, a medical oncologist at the UT Southwestern Simmons Cancer Center, and chief editor of ASCO Daily News. I'm pleased to be the guest host of the podcast today and to welcome my colleague, Dr. Don Dizon. He's head of women's cancers at Lifespan Cancer Institute in Rhode Island, and editor of the ASCO Educational Book. We'll discuss some of the compelling articles that have been published in the Educational Book, some of which are also going to be featured during the ASCO20 Virtual Education Program, and I'd also like to chat about important topics that perhaps aren't being covered during the program, but certainly deserve our attention. My guest and I report no conflicts of interest relating to the issues discussed in the podcast. Full disclosures relating to all Daily News podcasts are available on our episode pages. Don, it's great to have this opportunity to speak with you today. Dr Don Dizon: I'm really happy to be here. Thanks a lot. Dr. John Sweetenham: The ASCO Educational Book covers such an extraordinary breadth of issues from health services and quality improvement to symptom control, survivorship, and more. Can you tell us a little about what ASCO members can expect in the Educational Book this year? Dr. Don Dizon: Sure. I'm always happy to speak about the Educational Book. At its most germaine, what I think we have attempted to do is really live up to our ASCO President Skip Burris' vision of the approach to oncology, which is not approaching cancer with an individual's perspective, but really to bring in the multiple voices that are seminally important in everyone's experience with cancer. So we have strived very much, and our authors were exceptionally participatory in providing multidisciplinary articles on multiple cancer topics, as you just mentioned, so that the reader, who is importantly across the globe because the ASCO Educational Book is a free resource, can get that multiple perspective view on the topic related to malignancies. Dr. John Sweetenham: Can you tell us a little about some of the issues that maybe are not going to be covered in the program, but you believe are going to be very relevant to what we experience as oncologists today? Dr. Don Dizon: I think across the Educational Book, the topics that we dealt with are pretty detailed. Some of the ones that I think are of importance is a whole aspects of antibody drug conjugates, for example, which is covered in the developmental therapeutics track of the Educational Book, and there are multiple perspectives going from the basics of ADCs, all the way up to the clinical application of, not only FDA approved ones, but others that are in development. So that's very important, I believe. Global oncology is also covered, and although most of us are practicing perhaps in the United States, we have attempted to bring in multiple voices internationally because we recognize that ASCO serves an international audience, and its members are not limited to the United States. In the area of breast oncology, we attempted to really cover multiple topics that are relevant across the continuum of breast cancer, really paying attention to what subgroups are guiding therapy these days, whether that be the hormone positive subset, triple negative, the role of the immunotherapy, but also the approaches to metastatic breast cancer. So I believe that all throughout the Educational Book, you will find topics that are relevant, not only to the specialist, for a more contemporary view of where the field is at, but also very relevant for our folks who are in practice in our communities. Dr. John Sweetenham: Great, thank you, and I think one of the real strengths of the Educational Book is that it covers many of those topics that I would say we think about some of the time, but maybe we should be thinking of a little bit more. I'm thinking specifically of adolescent and young adults with cancer, fertility problems associated with cancer and its treatments, and then some of these 'softer issues,' such as communication with our patients, and more primary palliative care. Can you comment on some of those areas that are going to be covered in the Educational Book this year? Dr. Don Dizon: Yeah, absolutely, I think you had mentioned the issues concerning adolescents and young adults (with cancer), and certainly there are topics that are relevant for folks that we are hoping to cure and potentially are going to be alive for many, many decades. And I think for those folks, we do want to question the importance of addressing issues when we first meet them, rather than saving them for end of treatment, or even four or five years later. A classic example of that is fertility preservation, but equally important is the topic of sexual health in these patients, and I am very fortunate that our AYA topics did deal with these issues that aren't routinely discussed, but hopefully, this will really push our colleagues to embrace that these are important aspects. Same thing goes with palliative care, and the role of the oncologists in the delivery of care, particularly for patients who are not dealing with curative intent illness. And so I think the Educational Book, not only summarizes the field, but with multiple people generating that manuscript really drives home an action item, which again, is one of the things we were pretty cognizant about because at that end of the day, it's nice to have a summary, but it's more important to provide guidance. Dr. John Sweetenham: One of the other aspects of the Education Program as a whole that I really like this year is that I think that you and ASCO are tackling some issues which are a little more almost edgy and controversial, and I'm thinking in particular around issues such as disparities in access to care, gender disparities in the oncology workforce, which I think is a really interesting subject to address, and then some of my own kind of pet controversies, I guess, such as the use of real world data and cancer center advertising, which I think are all intriguing subjects to be covered in the Education Program. Can you comment just a little on how you decided to include those topics this year? Dr. Don Dizon: You know I will credit the Education Committee for branching out just beyond the science of oncology and really going into the practice, as well as the art of oncology. The Educational Book and the topics we cover are only as reflective of what the society feels is important for that annual meeting. And I think in this regard, leadership really did embrace a broad range of topics and tried to achieve one important aspect across all of them, health equity and the approach to patients no matter who they are and who they love and how they identify themselves in terms of health equity, it was all about achieving balance, in terms of who was invited to speak, who wrote articles for and with us, and also the way the language of the Educational Book was structured is very deliberate. We wanted to make a stance that there is a better way to write about oncology, and there's a better way to speak with each other. And I think you'll see this reflected, not only in the Education Session virtually, but hopefully you'll see that also approach in the Educational Book. So the book is a continuing resource, I think, for this seminal Education Program that was put together for 2020. Sadly, circumstances today led to the cancellation of the in-person meeting, but I think the Education Program virtually is going to be reflective of this exceptionally all encompassing view of oncology practice. Fortunately, the Education Program will live on for 2020 within the Educational Book. Dr. John Sweetenham: All right, thank you. You mentioned this extraordinary time. The moment in August of 2020. It's difficult to talk about oncology and not bring up the issue of COVID-19 and the pandemic. Can we expect to see that addressed in the Education Program this year? Dr. Don Dizon: The answer shortly is yes. The fact that the Education Program really worked to identify and address very contemporary issues is an important aspect of how reactive the program has had to be. So there are two sessions in the Education Program which are going to be really important, I think, for all of us. One from the trainees perspective and how programs are managing COVID-19's presence as we train the next generation of oncologists in our fellowship programs, this has, I'm sure, John, you feel the same.  It did impact the program here at Brown University, as it did, I'm sure, all across the country, and it's impacting how we select fellows for the coming year. Given that not everybody is able, willing, or should travel to meet with programs. So virtual interviews are on the horizon, and I think hearing from program directors about how they are going to manage that virtual aspect of interviewing, and more importantly, advice to people who are interviewing is going to be as important. I think one of the quickest collaborations in the history of medicine, especially oncology, was around COVID-19 and cancer, and there will also be a roundtable on that specific issue that is going to be a part of the Education Sessions this year. Dr. John Sweetenham: Yeah, I guess I hadn't really thought of it so much, but I guess that virtual interviews may require a very different skill set from the ones we use for our in-person interviews, right? Dr. Don Dizon: I think it will be. I'm a big advocate for social media, for example, but people have critiqued your background. Where you are selecting to do the interview might be important for program directors to get a better sense of who you are, but it also behooves us as clinicians to appear professionally as well when we're representing our programs.  Dr. John Sweetenham: Right, absolutely. Well, it's difficult to believe, but I think that we are just coming to the end of our time. Don, thank you for your time. It's been a real pleasure listening to you, and I just want to say congratulations on what I think is an outstanding Education Program. Very, very, very broad, and I think we're all going to learn a lot this year. Dr. Don Dizon: Thank you so much, John. It's always a pleasure to speak with you. Hopefully, next year we'll be in person. Just one other shout out that for the Education Program, just for everyone who's attending, 74% of the sessions that are going to be presented have a companion Educational Book article, and I'm exceptionally proud of that. Thank you very much, John. Dr. John Sweetenham: Thank you. That's outstanding, and thanks to our listeners for joining us today. Please take a moment to rate and review us on Apple Podcasts. Thanks again, and goodbye. 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.   COI Disclosures: Dr. John Sweetenham Honoraria: Seattle Genetics Dr. Don Dizon Stock and Ownership Interests: InfiniteMD, NeuHope Consulting/Advisory: i-Mab, Clovis Oncology, AstraZeneca, Regeron, Tesaro, Merck, Sharp & Dohme, Bristol-Myers Squibb, Kazia Pharmaceuticals

Oncologist Don S. Dizon, MD, joins the podcast to discuss how the COVID-19 pandemic has affected him personally and professionally. Dr. Dizon is the director of women’s cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital, both in Providence. Dr. Dizon tells host David H. Henry, MD, how COVID-19 affected his patients, colleagues, and research as well as his personal life. Dr. Dizon chronicled some of these developments in a series of columns published on Medscape. Disclosures: Dr. Dizon has relationships with Regeneron, Astra-Zeneca, Clovis, Bristol-Myers Squibb, and Kazia. He is a columnist for Medscape, which is owned by the same parent company as MDedge News. Dr. Henry has no relevant disclosures. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

Today's guest is Dr. Don Dizon, a renowned oncologist specializing in women's cancers and affiliated with a handful of top medical institutions including Lifespan Cancer Institute, Rhode Island Hospital, and Brown University. Don and I met in 2017 when we were both speaking at a patient experience conference held by Teva Pharmaceuticals in Barcelona. Like discovering a lost sibling we were joined at the hip the entire conference, and have been friends ever since. This conversation is full of fascinating twists and turns. We discussed how Don created a balance between his beautiful family and a prestigious career, why he believes all medical professionals should be embracing social media, and of course, Don shares his story of a chance encounter with lasting impact. Our interview was scheduled for the day of crazy snowstorm, so Don ended up calling in from his home office, which means you might hear a bit of his family jostling around in the background. As far as I'm concerned, it made the conversation that much more relatable. Show Notes Don's ASCO column Follow Don on Twitter and Instagram @drdonsdizon

Mary Lopresti, DO, is a hematologist oncologist with the Lifespan Cancer Institute, where she treats patients who have breast and gynecologic cancers. Most of her patients are younger than 42 years.  Welcome to the ASCO Daily News podcast. I'm Lauren Davis. And joining me today is Dr. Mary Lopresti, a hematologist/oncologist with the Lifespan Cancer Institute, where she treats patients who have breast and gynecologic cancers. Most of her patients are younger than 42 years. Dr. Lopresti, welcome to the podcast. Oh, thank you so much, Lauren, for having me today. We're glad you're here. Today we're talking about issues around fertility and how cancer can present challenges to women who want to be able to get pregnant and grow their families. Because you treat younger patients, at what point in the diagnosis process do you mention fertility options such as egg freezing? Well, we've made it our practice at Lifespan to discuss this at the first touch point with the patient. So our young women who are newly diagnosed with breast cancer will come in to a multidisciplinary clinic, and so they'll need a breast surgeon, medical oncologist, radiation oncologist. And besides from talking about their new diagnosis and management, at that point, we'll also ask them if they plan on growing their family or having another baby or a baby. And at that point, we'll ask them if they would desire fertility preservation. And so we really from day 1 of meeting them will explore that option. What are some of the struggles in helping patients navigate cancer care when they also have to decide whether or not they want to preserve their fertility? I think this biggest struggle is timing, trying to help this woman decide on her breast surgical options, discuss genetic testing. And many of these young women have aggressive breast cancers requiring chemotherapy, so it's the timing of when we give the chemotherapy. And then if we are planning to give chemotherapy, how does fertility fit in? Many times, I think physicians shy away from mentioning fertility because there's a delay in chemotherapy, which is so important. And so we've tried to get that timing down a little bit better by developing an algorithm to get that woman to a fertility specialized in a streamlined manner, and that has helped us navigate these young women a little bit better. What advice do you have for physicians who ideally would mention fertility preservation but sometimes leave it out because of the patient's need to start treatment such as chemotherapy as you mentioned immediately? Well, I think that it's very understandable for an oncologist to feel like they need to leave it out if a young woman has large tumor burden and they're very worried about starting systemic therapy. But yet, I think it's really up to us as physicians to make sure that the patient has informed consent. And ASCO has published guidelines for preservation so that we can help educate our patients on what options that they have. And I think we need to continue to try to do that and put our own worries aside. Are there patients for whom you do not recommend fertility preservation? And how do those conversations go? I'd say in general, no. I think we offer it to anyone who desires to have a pregnancy in the future. Again, there's always a worry in a woman who has an estrogen positive breast cancer, a large tumor, bulky lymph node disease to recommend fertility preservation because the concern has generally been that you could stimulate very high levels of circulating estradiol level with preservation. But now with letrozole, which is an aromatase inhibitor, and tamoxifen, there are ways to decrease the estradiol level and still get mature follicles as well. So I think that we do recommend fertility preservation everyone. And then just moreover on that point is that there was a recent study by Rodriguez-Wallberg and colleagues. It was a Swedish match cohort trial. And so they looked at women undergoing fertility preservation compared it to age match controls, and there was not an increase in the risk of recurrence with fertility preservation. So it's a generally safe and can be done in about a two-week period. That's wonderful. What do you see for the future of cancer care in oncofertility? I think our knowledge will continue to increase as newer drugs come on the market. I think we should all be concerned about fertility because we're not going to know how they affect fertility in the mechanisms there. So I think as physicians, we have to become more educated, and I think we're going to see more physicians talking to their patients. I think we're going to see more patients having access to educational materials or looking on social media for decision trees to help them with fertility preservation. I think we're going to know more about other methods of fertility preservation like ovarian tissue retrieval, which has been largely experimental, but there has been more and more done with that. And then there's pre-implantation genetic testing which is being done. And we're going to be hearing more about that in the future as well. That's exciting. Again, today my guest has been Dr. Mary Lopresti. Thank you for being on our podcast today. Thank you. And to our listeners, thank you for tuning in to the ASCO Daily News podcast. If you're enjoying the content, we encourage you to rate us and reviews on Apple Podcast.

Trags welcomes in three special guests to the podcast this week, as former Patriots Wes Welker, Rob Ninkovich and Sebastian Vollmer take some time at the Leonard Hair Transplant Associates "Young Fight Strong" event at Lifespan Cancer Institute in Providence, R.I. to discuss their former team. The guys talk about life after football, including Welker's transition to coaching, Ninkovich's thoughts on possibly returning last season and Vollmer's weight loss (75 pounds), in addition to looking ahead to the 2018 version of the New England Patriots. 1:30 - Former Patriots wide receiver Wes Welker 3:00 - Welker's transition from NFL player to NFL coach 5:00 - Comparing Houston Texans head coach Bill O'Brien and Patriots head coach Bill Belichick 7:30 - Thoughts on Houston Texans QB DeShaun Watson as a player 11:00 - Former Patriots defensive lineman/linebacker Rob Ninkovich 13:30 - Brian Flores taking over as Patriots defensive coordinator 15:00 - Will Trey Flowers have a breakout season in 2018? 18:00 - The culture of winning with the New England Patriots 20:30 - Former Patriots offensive lineman Sebastian Vollmer 22:30 - Vollmer adjusting to retirement after leaving in 2016 24:00 - How the Patriots offensive line going to play after losing left tackle Nate Solder 27:00 - Reacting to Germany's loss in the 2018 World Cup 28:00 - What it was like playing for Bill Belichick and playing with Tom Brady

Dr. Steven Toms of Rhode Island Hospital and the Lifespan Cancer Institute joins Steve Klamkin to discuss Senator John McCain's brain cancer diagnosis