Dr. Doris A. Taylor, Ph.D. is Chief Executive Officer of Organamet Bio Inc. (https://organametbio.com/) an early phase start-up committed to saving lives and reducing the cost of healthcare for those with heart disease. Organamet has a goal is to make personalized bio-engineered human hearts, available to all who need them, within 5 years, increasing availability and access to hearts, decreasing or eliminating need for immunosuppression, reducing total lifetime transplant costs, and improving quality of life. Dr. Taylor was previously the Director, Regenerative Medicine Research and Director, Center for Cell and Organ Biotechnology, at the Texas Heart Institute in Houston, Texas, where she worked on the integration of regenerative medicine and tissue engineering. Dr. Taylor has a Ph.D. in Pharmacology from UT Southwestern Medical Center, Dallas, Texas. She did her post-doctoral studies at Albert Einstein College of Medicine in the Bronx, New York, where she first worked with tissue engineering, growing heart muscle cells in the laboratory. Dr. Taylor was on the faculty of Duke University from 1991 to 2007, and then moved to University of Minnesota, where in 2008 her team published a landmark paper in Nature Medicine where they created new beating rat hearts using a combination of tissue engineering processes, first stripping the dead dying cells away from an existing heart (in a process called "de-cellularization") leaving behind the hearts extracellular matrix and then re-seeding the matrix by injecting new young rat stem cells. Dr. Taylor is also Co-Founder and original Board member of Miromatrix Medical Inc. Dr. Taylor's work has been published in Nature Medicine, Circulation Research, The Journal of Molecular Biology, The Journal of Biochemistry, Journal of the American College of Cardiology (JACC), Journal of the American Medical Association (JAMA), and other top-tier scientific journals. She holds a numDev InterruptedWhat the smartest minds in engineering are thinking about, working on and investing in.Listen on: Apple Podcasts Spotify Healthy Lifestyle Solutions with Maya AcostaAre you ready to upgrade your health to a new level and do so by learning from experts...Listen on: Apple Podcasts Spotify Stop Drinking and Start Living Podcast With Expert Holistic Alcohol Coach, Mary WagstaffPractical Tools & Strategies To Get Alcohol Out Of Your Way & Enhance Your LifeListen on: Apple Podcasts Spotify Tiny MattersA science podcast about the little things that make the big things—good and bad—possible.Listen on: Apple Podcasts Spotify
The role of genetics in both pediatric and adult epilepsies is expanding. Now, making a genetic diagnosis in epilepsy isn't just important for family planning and prognostication - these diagnoses can also improve patients' care starting at the moment of diagnosis. Our guest today, Ingrid Scheffer, is a leader in gene discovery in epilepsy. Dr. Scheffer is a Laureate Professor of Pediatric Neurology at the University of Melbourne, and she directs the Children's Epilepsy Research Center at Austin Health. She says while there's still a long way to go before precision medicine is available for the hundreds of known genetic epilepsies, her patients are already benefiting from genetic testing, in many ways. Dr. Scheffer was interviewed by ANA Investigates Producer and epileptologist Dr. Rohit Das of UT Southwestern Medical Center. Series 3, Episode 12. Featuring: Guest: Ingrid Scheffer, AO FRS FAA FAHMS, University of Melbourne Interviewer/Producer: Rohit Das, MD, UT Southwestern Disclosures: In the past 24 months, Ingrid Scheffer has consulted for Atheneum Partners, Biohaven Pharmaceuticals Inc, Care Beyond Diagnosis, Epilepsy Consortium and Zynerba Pharmaceuticals, has served as an investigator for Anavex Life Sciences, Cerebral Therapeutics, Cerecin Inc, Cereval Therapeutics, Eisai, Encoded Therapeutics, EpiMinder Inc, Epygenyx, ES-Therapeutics, GW Pharma, Marinus, Neurocrine BioSciences, Ovid Therapeutics, Takeda Pharmaceuticals, UCB, Ultragenyx, Xenon Pharmaceutical, Zogenix and Zynerba; received speaker honoraria from Biocodex, BioMarin, Chiesi, Liva Nova and UCB; received funding for travel from Biomarin, Eisai and UCB; and served on scientific advisory boards for Bellberry Ltd, BioMarin, Chiesi, Eisai, Encoded Therapeutics, Knopp Biosciences, Rogcon, Takeda Pharmaceuticals and UCB. Ingrid Scheffer may accrue future revenue on pending patent WO2009/086591: Diagnostic And Therapeutic Methods For EFMR (Epilepsy And Mental Retardation Limited To Females); has a patent for SCN1A testing held by Bionomics Inc and licensed to various diagnostic companies (WO/2006/133508); she has a patent for a molecular diagnostic/therapeutic target for benign familial infantile epilepsy (BFIE) [PRRT2] WO/2013/059884 with royalties paid.
即刻加入15Mins通勤學英語直播室，每週一9pm等你來說英文 : https://15minsengcafe.pse.is/46hm8k 每日英語跟讀 Ep.K440: How to Get Heart Patients to Take Their Pills? Give Them Just One. Heart disease kills more people than any other condition, but despite advances in treatment and prevention, patients often do not stick to their medication regimens. Now researchers may have found a solution: a so-called polypill that combines three drugs needed to prevent cardiovascular trouble. 死於心臟病的人比死於其他任何疾病的人都多，儘管在治療和預防上取得進展，患者往往不能堅守他們的藥物治療方式。現在，研究人員可能已經找到一個解決方法：一種混合三種預防心血管疾病所需藥物的所謂複方製劑。 In what is apparently the largest and longest randomized controlled trial of this approach, patients who were prescribed a polypill within six months of a heart attack were more likely to keep taking their drugs and had significantly fewer cardiovascular events, compared with those receiving the usual assortment of pills. 在明顯是這種方法規模最大、時間最長的隨機對照試驗中，心臟病發作後6個月內服用複方製劑的患者，跟服用常規藥物患者相比，更有可能繼續服用藥物，心血管事件明顯減少。 The participants also experienced one-third fewer cardiovascular deaths, although their overall risk of death from all causes was not significantly changed. 參與者因心血管疾病死亡人數也減少三分之一，即便他們因為各種原因死亡的總體風險沒有顯著改變。 The study of more than 2,000 heart patients, who were followed for three years, was published Friday morning in The New England Journal of Medicine, as the findings were presented at the European Society of Cardiology Congress in Barcelona, Spain. 這項研究對2000多名心臟病患者進行三年追蹤調查，研究結果周五上午發表在《新英格蘭醫學雜誌》，並在西班牙巴塞隆納舉行的歐洲心臟病學會年會上發表。 The study is the culmination of 15 years of work by researchers led by Dr. Valentin Fuster, director of Mount Sinai Heart at Mount Sinai Hospital in New York City and general director of the National Center for Cardiovascular Research in Spain. 這研究是紐約市西奈山醫院西奈山心臟中心主任、西班牙國立心血管研究中心總監瓦倫丁．福斯特博士帶領研究人員研究15年的結晶。 “Combination pills are easier for the physician and for the patient, and the data are pretty clear — it translates into a benefit,” said Dr. Thomas J. Wang, chair of the department of internal medicine at UT Southwestern Medical Center, who was not involved in the research but wrote an editorial accompanying the study. 未參與研究但為研究報告撰寫社評的德州大學西南醫學中心內科系主任湯瑪斯．王博士說：「複方藥物對醫生和病患來說更簡便，數據非常清楚，它轉化為一種好處。」 The polypill combines a blood-pressure medication, a cholesterol-lowering drug and aspirin, which helps prevent blood clots. 這種複方製劑結合了降壓藥、降膽固醇藥和阿斯匹林，有助防止血栓。 The polypill used in the study has not been approved by the Food and Drug Administration and is not available to patients in the United States right now. Fuster said the results of the new trial would be submitted to the agency shortly in an effort to obtain approval. 這項研究使用的複方製劑還未獲得美國食品藥物管理局批准，目前在美國還不能給患者使用。福斯特 說，這項新試驗結果很快會提交給該機構，以爭取獲得批准。 And since participants became even more likely to keep taking the polypill over time, he said, “The potential results could be even better with more follow-up.” Several studies have shown that only about half of patients, or even less, take all their medications as instructed. 他說，由於參與者會逐漸的更可能繼續服用複方製劑，「若有更多後續研究，潛在結果可能更好」。數項研究顯示，只有大約一半甚至更少患者按照指示服用所有藥物。 The new study, a randomized controlled clinical trial, enrolled just under 2,500 patients at 113 sites in Spain, Italy, France, Germany, Poland, the Czech Republic and Hungary. 這項研究是一項隨機對照臨床試驗，在西班牙、義大利、法國、德國、波蘭、捷克和匈牙利的113個地點招募到近2500名患者。Source article: https://udn.com/news/story/6904/6601708 歡迎留言告訴我們你對這一集的想法： https://open.firstory.me/user/cl81kivnk00dn01wffhwxdg2s/comments Powered by Firstory Hosting
Welcome to Strategy Skills episode 279, an episode with a practicing emergency physician at Mayo Clinic, Dr. Richard Winters. Get Dr. Richard's book here. As a physician, Dr. Richard shares how he managed, adapted, and remained calm during times of covid. He discussed some of the best practices that can be adapted from the medical field into the space of business. We speak about leadership, administration, and leveraging your expertise to be effective in your career. In this episode, we also discussed one of the traps that most leaders face today where they strive to become successful in their career, and groom and develop new leaders while taking into account the fear of being replaced. As director of Leadership Development for the Mayo Clinic Care Network, Dr. Winters facilitates retreats and delivers programs that train leaders at healthcare organizations worldwide. Dr. Winters graduated from the Mayo Clinic Alix School of Medicine in 1994. He is board certified and residency trained in Emergency Medicine from the University of California, San Francisco at Fresno. He graduated from the University of Texas at Dallas Executive and Professional Coaching Program and is a professional certified coach through the International Coaching Federation. He completed a Healthcare Management Executive MBA from the University of Texas at Dallas and UT Southwestern Medical Center. He obtained a Bachelor of Science in Biological Sciences from the University of Illinois at Chicago. Prior to his work at Mayo Clinic, Dr. Winters served as managing partner of a democratic physician group, chair of emergency medicine, president of an 800-physician medical staff, and CEO/founder of a managed care startup. He lives in Rochester, Minnesota with his family. Get Dr. Richard's book here: You're the Leader. Now What? : Leadership Lessons from Mayo Clinic. Dr. Richard Winters Enjoying our podcast? Get access to sample advanced training episode here: www.firmsconsulting.com/promo
What is the value of completion lymph node dissection for patients with melanoma with sentinel-node metastases? The Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1) confirmed that SLNB is an important part in the treatment of patients with melanoma, but what needed to be done beyond that in managing the axilla? Learning Objectives: In this episode, we review perioperative chemotherapy regimens for locally advanced, resectable Gastric cancer, standard of care, and the future role for immunotherapy. Hosts: Adam Yopp, MD, FACS (@AdamYopp) is an Associate Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a new Assistant Professor of Surgery at the University of Miami Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research. Papers Referenced in this Episode: Final Trial Report of Sentinel-Node Biopsy versus Nodal Observation in Melanoma Morton et al. https://www.nejm.org/doi/full/10.1056/nejmoa1310460 Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma Faries et al. https://www.nejm.org/doi/full/10.1056/nejmoa1613210 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our Journal Review Series here: https://behindtheknife.org/podcast-series/journal-review/
COR2ED Medical Education: In this podcast, liver cancer experts Prof. Amit Singal and Assoc. Prof Neil Mehta discuss recent advances in systemic and locoregional therapy for advanced and early stage hepatocellular carcinoma (HCC). They focus on the role of immunotherapy and review data from three major congresses in 2022 (ASCO, WCGIC and ILC) together with recent publications. Prof. Amit Singal is Director of Liver Cancer Program at UT Southwestern Medical Center, Dallas, TX, USA and Assoc. Prof. Neil Mehta is Director of Liver Cancer Program at University of California San Francisco, USA.
About Today's GuestUmar Latif, MD is a Fellow of the American Psychiatric Association and a Diplomate of the American Board of Psychiatry & Neurology with board certification in General Psychiatry, Geriatric Psychiatry, and Addiction Medicine. He was selected as a George W. Bush Institute Scholar as part of the 2021 Stand-To Veteran Leadership program in service of improving veteran outcomes.Dr. Latif currently serves as the National Medical Director of Help for Heroes, a multisite specialty program he helped design as co-founder, to meet the clinical needs of active-duty service members, veterans and first responders who are dealing with mental health and substance abuse issues. He also works as the Medical Director of Carrollton Springs Hospital and has a private practice at The Noesis Clinic: an adult and geriatric outpatient private practice that specializes in early detection of Alzheimer's dementia and TMS (Transcranial Magnetic Stimulation).For a decade prior to this, Dr. Latif co-founded and served as the Medical Director of Freedom Care at UBH Denton, which he helped develop. Under his leadership, this program grew into a multi-location inpatient psychiatry program specializing in PTSD and dual diagnosis treatment for active duty military members and veterans referred from 120 plus national & international installations.His other professional roles in the past have included the position of Medical Director of the Telepsychiatry program at Dallas VA Medical Center, and faculty appointment as Assistant Professor of Psychiatry at UT Southwestern Medical Center.Dr. Latif completed his residency training at Wayne State University in Michigan and postgraduate fellowship training at University of Texas Southwestern Medical Center in Dallas. He also earned a certificate in “Executive Healthcare Leadership” from Cornell University. Links Mentioned In This EpisodeHelp for Heroes ProgramPsychArmor Resource of the WeekThe PsychArmor Resource of the Week is the PsychArmor course Barriers to Treatment. In this course, you will learn how differences in military culture affect mental health and how to help service members or veterans overcome barriers to seeking treatment. You can find a link to the resource here: https://learn.psycharmor.org/courses/barriers-to-treatment This Episode Sponsored By:This episode is sponsored by PsychArmor, the premier education and learning ecosystem specializing in military culture content. PsychArmor offers an online e-learning laboratory with custom training options for organizations.Contact Us and Join Us on Social Media Email PsychArmorPsychArmor on TwitterPsychArmor on FacebookPsychArmor on YouTubePsychArmor on LinkedInPsychArmor on InstagramTheme MusicOur theme music Don't Kill the Messenger was written and performed by Navy Veteran Jerry Maniscalco, in cooperation with Operation Encore, a non profit committed to supporting singer/songwriter and musicians across the military and Veteran communities.Producer and Host Duane France is a retired Army Noncommissioned Officer, combat veteran, and clinical mental health counselor for service members, veterans, and their families. You can find more about the work that he is doing at www.veteranmentalhealth.com
One of the unwelcome surprises many people have in their 50s, 60s and beyond is a retinal tear. As Dr. Nikisha Kothari, Board-Certified Ophthalmologist and Retina Specialist at Texas Health Resources explains, it is akin to wallpaper being ripped off the wall. That can happen inside our eye. Dr. Kothari gives us a great education about how to care for our eyes, both preventively and should we have this happen to us. Dr. Glenn Hardesty, Emergency Medicine Physician at Texas Health Presbyterian Hospital Plano, returns to the Human Side of Healthcare with lots of tips to avoid common accidents he sees in the ER, especially during summer. Then, to close out the show, a special appearance from our friend Dr. Robert Haley, UT Southwestern Medical Center, and his very impactful story of the guinea pigs and masking as the Covid numbers begin to rise in North Texas following the Independence Day holiday. See acast.com/privacy for privacy and opt-out information.
ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. 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. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today's episode, 4 Cancer.Net Specialty Editors discuss new research in prostate, bladder, kidney, and testicular cancers presented at the 2022 Genitourinary Cancers Symposium and 2022 ASCO Annual Meeting. This episode has been adapted from the recording of a live Cancer.Net webinar held June 15th, 2022, led by Dr. Neeraj Agarwal, Dr. Timothy Gilligan, Dr. Petros Grivas, and Dr. Tian Zhang. Dr. Agarwal directs the Genitourinary Oncology Program at the Huntsman Cancer Institute at the University of Utah. Dr. Gilligan is an Associate Professor and Medical Oncologist at the Cleveland Clinic Taussig (TOSS-ig) Cancer Center. Dr. Grivas is the clinical director of the Genitourinary Cancers Program at University of Washington Medicine. He is also an associate member of the clinical research division at the Fred Hutchinson Cancer Research Center. Dr. Zhang is an Associate Professor of Internal Medicine at UT Southwestern Medical Center and a medical oncologist at the Harold C. Simmons Comprehensive Cancer Center. Full disclosures for Dr. Agarwal, Dr. Gilligan, Dr. Grivas, and Dr. Zhang are available at Cancer.Net. Greg Guthrie: Good afternoon, everyone. I'm Greg Guthrie, and I'm a member of the Cancer.Net content team. I'll be your host for today's Research Round Up webinar focusing on cancers of the genitourinary tract. Cancer.Net is the patient information website of the American Society of Clinical Oncology, known as ASCO. So today, we'll be addressing research from 2 2022 scientific meetings, the ASCO Annual Meeting held in Chicago in June and the Genitourinary Cancers Symposium held in San Francisco in February. Our participants today are all Specialty Editors of the Cancer.Net Editorial Board, and they are Dr. Neeraj Agarwal of the Huntsman Cancer Institute in University of Utah, Dr. Timothy Gilligan of the Cleveland Clinic Taussig Cancer Center, Dr. Petros Grivas of the Fred Hutchinson Cancer Research Center and University of Washington, and Dr. Tian Zhang of the University of Texas Southwestern Medical Center. Thank you, everyone, for joining us today. So starting us off today is Dr. Agarwal who will be talking about research in prostate cancer. Go ahead, Dr. Agarwal. Dr. Agarwal: Hi. Thank you, Greg. So I'd like to start with 2 studies. They both are in prostate cancer which will be followed by my colleagues presenting studies in other cancers in bladder cancer and kidney cancer. So I'll start with this abstract, which was highly discussed by the doctors at the ASCO Annual Meeting a few weeks ago, and it has a lot of relevance in our practice. So this is abstract #5000 presented by Dr. Michael Hofman, and this was the update on a clinical trial which compared lutetium PSMA-617, or lutetium PSMA, to put it simply, with cabazitaxel in patients with metastatic castration-resistant prostate cancer who had disease progression after receiving docetaxel chemotherapy. So, who were the patients who were enrolled on the study? These patients had, as I said, metastatic castration-resistant prostate cancer, who had disease progression after docetaxel chemotherapy, and who had to have high PSMA-expressing prostate cancer. And the way they assessed the presence of high PSMA expression was by using a specialized kind of PET scan known as Gallium 68 PSMA-11 PET scan. In addition, they made sure that these patients do not have another type of prostate cancer, also call it dedifferentiated prostate cancer, by making sure that those patients did not have a traditional PET scan-positive disease. So this was a highly selected patient population who were expressing PSMA on their prostate cancer. Prior to this presentation, the earlier presentation had shown that lutetium PSMA was superior to cabazitaxel as far as progression-free survival is concerned and also was associated with lower incidence of grade 3 or 4 side effects. In this update, after a longer follow-up of 3 years, Dr. Hofman and Dr. Davis, who is a senior author, they presented the data on overall survival, which was a secondary analysis, and overall survival was similar with cabazitaxel as well as lutetium PSMA in the range of 19 months. We did not see any new safety signal. So, what does it mean for us? What does this mean for our patients? My key takeaway message here is, lutetium PSMA is a suitable option for men with metastatic castrate-resistant prostate cancer who are expressing high PSMA on their prostate cancer after they had sustained disease progression after docetaxel. However, cabazitaxel is also a valid option in this setting. I would like to add my own view in addition to this because lutetium PSMA was better tolerated and was also associated with better progression-free survival. In my patients who are progressing on docetaxel chemotherapy, I would like to use lutetium PSMA first followed by cabazitaxel chemotherapy. So that would be my key takeaway from this abstract. Now we can move to the next abstract. This was also an update, a much longer update, on ENZAMET trial. If you recall, ENZAMET trial was one of those trials which established that deeper androgen blockade, or deeper androgen signaling inhibitors such as enzalutamide, apalutamide, or abiraterone, these trials were conducted in 2015 onwards, and all these trials showed that upfront using deeper androgen signaling inhibitors at the time of metastatic hormone-sensitive prostate cancer onset improved survival. So ENZAMET trial used enzalutamide, and it showed in the first analysis, which was presented by Dr. Davis and Dr. Sweeney in the 2019 ASCO Meeting Plenary session, that adding enzalutamide to androgen-deprivation therapy in patients with metastatic hormone-sensitive prostate cancer significantly improved survival. In this longer follow-up of 68 months, so we are talking about almost 6 years of follow-up, now, these investigators from ENZAMET trial, as presented by Dr. Davis, showed that the combination of enzalutamide with androgen deprivation therapy or testosterone suppression therapy continues to significantly improve survival in patients with newly diagnosed hormone-sensitive prostate cancer or metastatic prostate cancer. One interesting part of this unique aspect of this trial was that patients were allowed to receive docetaxel chemotherapy concurrently to the protocol treatment. And in this trial, 45% patients actually receive docetaxel chemotherapy. So 503 patients exactly out of 1,000-plus patients. So if you look at the subgroup analysis of those patients who received docetaxel chemotherapy, enzalutamide does not seem to benefit those patients from the overall survival perspective. So on the face of it, it looks like enzalutamide is not helping those patients who are receiving docetaxel concurrently. But there are some caveats with that kind of subgroup analysis. The first one is this is not a randomized assignment of docetaxel chemotherapy. Patients were determined to have docetaxel chemotherapy after discussion with their respective oncologist. This was not a prespecified analysis that so many patients with docetaxel will receive enzalutamide. Also, this was not a randomized assignment of docetaxel. And third, that I don't think this trial had enough power to look for that subgroup analysis. So my take on this trial is that updated results from this trial, almost 6 years of follow-up now show that enzalutamide continues to improve overall survival with a 30% reduction in risk of death in patients with metastatic castration-sensitive or hormone-sensitive prostate cancer. Furthermore, the effect of enzalutamide, in my view, on overall survival is independent of the receipt of docetaxel. If you look at the whole trial population for which the trial was covered for, enzalutamide improved survival for all patients. And based on these results, I feel more confident in saying that upfront intensification of treatment with deeper androgen inhibition remains a standard of care for our patients with metastatic hormone-sensitive prostate cancer and should be offered to all eligible patients with this condition. With that, I would like to wrap up the prostate cancer abstracts. Thank you very much. Greg Guthrie: And thank you, Dr. Agarwal. Next up, we will have Dr. Gilligan, who is going to be discussing testicular cancer. Dr. Gilligan: Thank you very much. So I have 2 studies I want to talk about and then just give a headline of some interesting things that I think are kind of coming down the road. Both of these abstracts have to do with improvement over time in specific patient populations we used to worry about. I'm not saying we don't worry about them anymore, but things are looking better now than they had 1 or 2 decades ago. So the first topic addresses late relapses in testicular cancer. And historically, we have been concerned that these patients did worse and had worse outcomes. And late relapse could variously be described as after 2 years or after 5 years. In the current study, they defined late relapse as being after 2 years and very late relapse as being after 5 years. And what was special about the study was that it captured the entire population of patients with testis cancer in Norway and Sweden so that it wasn't based on a center of excellence that gets selective referrals. It was actually a population-based study. And the key conclusion of the study was one I found, once again, that late relapses are rare. So for stage I patients, 2% of patients will relapse after 2 years, 1% after 5 years, and 0.5%, so 5 out of 1,000 patients, after 10 years. So if you're 2 years out, the likelihood of a relapse is quite low. And if you're 5 years out, it's half of that. In patients with metastatic disease, similarly, 3.6% relapse after 2 years, 1.6% after 5, and 0.8% after 10 years. And what was interesting to me was that if you looked at the more recent patients who were diagnosed after 1995 - I know that doesn't sound very recent, but they had even earlier patients also in the study - the very late relapse rate almost resolved and went away. It went from 2.2% all the way down to 0.8%. So I think with modern imaging, modern care patterns, we're seeing less of this than we used to. But overall, patients were doing better even if they do relapse late. One thing that was interesting in the study to me also was for stage I disease, we typically recommend surveillance rather than active treatment. So active treatment with non-seminomas would be a retroperitoneal lymph node dissection or more surgery or chemotherapy. With seminoma, it would usually be chemotherapy or radiation, although surgery is being investigated there now. And they did find that in men who chose surveillance, which we still recommend, the late relapse rate was a little bit higher, but it was still affecting a small percent of patients. So the relapse rate beyond 2 years was 4% rather than 1%, but out of 4,000 patients, there were only 3 deaths from late relapse. So this isn't changing the recommendation for surveillance, but it is an alert that patients who are on surveillance for stage I disease have a slightly higher risk of late relapse and that may affect how we follow them and specifically how long we follow them. One of the things that was interesting in the study is in the United States, we often stop scans at 5 years, but in the SWENOTECA countries, they continue scans all the way out to 10 years. I don't know that U.S. guidelines are going to change, but it was a provocative finding. The key thing, as I alluded to at the beginning, was that 61% of patients with late relapse were alive 10 years later, and while we would like that number to be higher, it used to be around 50% in older studies. So it's a significant improvement from where we were before. A particularly interesting thing to me was that patients relapsing 2 to 5 years out actually had the best prognosis. Patients who relapsed in years 1 to 2 had a worse prognosis and patients relapsing after 5 years had a worse prognosis, whereas the patients relapsing 2 to 5 years had a better prognosis. In the end, I think what this means for us is that patients are doing better. It's not going to really change our treatment patterns, but it's reassuring that we shouldn't be pessimistic about late relapses, and we still have a solid chance of curing them. So again, bottom line, most men with late relapse is cured and late relapse is less common now than it was earlier, particularly in non-seminomas. Let's go to the next study. So this is a different group of patients who had a particularly ominous prognosis historically and still we have a lot of room for improvement. These are patients with non-seminomas that start in the mediastinum. So in the chest, under the breastbone, under the sternum typically. And patients are treated aggressively upfront, they are considered poor risk at the initial time of diagnosis, and they're treated aggressively at the time with 4 cycles of BEP or 4 cycles of VIP chemotherapy. And then they go for surgery to remove any residual disease. And the hope is they're cured at that point because historically, if there was a relapse after chemotherapy and surgery, it was almost impossible to cure them. Indiana University published their results using high-dose chemotherapy in this population, and they reported that 30% of men who were treated with high-dose chemotherapy had no evidence of cancer after 2 years, and 35% were still alive. Obviously, we need longer follow-up, but most of the relapses you're going to see are going to be in the first 2 years. So while again, there is significant room for improvement here, this indicates that high-dose chemotherapy is a good option, and that has been a question. So this is reassuring in that regard. But it is a good option for men with relapsed mediastinal non-seminomas of the germ cell tumors. So there's hope there where in the past, this has felt a little bit helpless. The thing I wanted to also highlight was that there are 3 things I think are going to be interesting to keep an eye on over the next year. One is the use of surgery for early-stage seminomas. There are a number of papers out about that. I still think this is an investigational approach, and so I didn't want to go into great detail about it, but it is looking like that RPLND, or retroperitoneal lymph node dissection, will likely or may be an option for stage I and stage II seminoma in the future. We are getting more evidence for that. It's not quite as promising as we had hoped until there's more data that's needed, but it's looking like that will become an option. So for men with early-stage seminoma, at least raising the question whether surgery is an alternative to chemotherapy or radiation, is an important discussion to have with your oncologist. Secondly, MRI rather than CT scans for surveillance. So to keep an eye on men who have been treated or men who are just stage I and are being followed and typically come in routinely for CT scans, which expose people to ionizing radiation, which theoretically has a risk of causing cancer, there's more and more data that MRI is just as good as CT, and MRI does not use ionizing radiation. So there's probably going to be an expanding role for MRI as an alternative to CT scans. And lastly, the use of microRNA rather than just depending on serum tumor markers. So right now, we use the blood tests alpha-fetoprotein, beta hCG, extensively to monitor for relapse, and there's more and more evidence for using what we call microRNAs instead. It may be more accurate in multiple different settings. So it'll be interesting to see how that evolves and that's what I wanted to cover today. Thank you very much. Greg Guthrie: Thank you, Dr. Gilligan. And now we have Dr. Grivas, who's going to discuss some research in bladder cancer. Dr. Grivas: Thank you so much, Greg, and thanks Cancer.Net for the great opportunity to discuss this for our patients. We're very excited about the data from the ASCO Annual Meeting, and I would encourage the audience to review as possible other presentations as well. I'm going to cover 3 highlights. I'm going to start with the QUILT-3.032 study. This trial reported the final results of a clinical trial that took place in different centers and involved patients with what we used to call “superficial bladder cancer.” And the modern term is “non-muscle-invasive bladder cancer.” Bladder cancer that does not involve the muscle layers, not that deep in the bladder wall. Non-muscle-invasive bladder cancer is usually treated by our colleagues in urology with installation inside the bladder with an older form of immunotherapy which is BCG. And that's the most common way we treat this disease. And proportion of patients may have tumors that may not respond to BCG that may come back or persist despite the installation of the BCG in the bladder. And these patients usually have a standard of care of getting what we call radical cystectomy, meaning, removal of the bladder and the lymph nodes around the bladder, radical cystectomy and lymph node dissection. However, many patients may not have, I would say, the opportunity to get the surgery because the body may not be that strong to undergo that significant procedure. Very few patients may have that challenge because of other medical conditions or what we call poor performance status. Or some patients for quality-of-life reasons may try to keep their bladder as long as possible. And for some of those patients, that might be an option. And we have been looking for those options in the last few years. Intravesical, inside the bladder, installations of chemotherapy have been used with some positive results in some other studies. So that's an opportunity. We call this intravesical, inside the bladder, installations of chemotherapy, and the other option is an FDA-approved agent given intravenously inside the vein called pembrolizumab, which is in the form of immunotherapy. Of course, research continues. And this study I'm showing here from Dr. Chamie and colleagues, looked at this combination of BCG plus this molecule called N-803. This is another form of immunotherapy, and this was tested in patients who have this BCG-unresponsive, as we called it, non-muscle-invasive bladder cancer. The results were very promising. I would say impressive that it was a high response rate if we focus our attention on patients who had the superficial form carcinoma in situ, about 70% had no evidence of cancer upon further evaluation of the bladder. And in many of those patients that this response lasted for more than 2 years. 96% of patients avoided to have worsening of the bladder cancer in 2 years for those who had a response, and about 9 out of 10 avoided cystectomy again from those patients who had received the response. So it was 70% of all the population. And as you see, all patients, 100% were alive without dying from bladder cancer after 2 years, which again is a very promising finding. This combination, to conclude, this inside the bladder installations of BCG plus the N-803, looks very promising. For those patients with BCG-unresponsive non-muscle-invasive bladder cancer, that might be an option down the road, we have to see. Now I'm going to shift my attention to patients with metastatic or spread urothelial cancer. I want to point out that I'm a co-author in this abstract and I participated in that survey I will show you the results from. This is a population of patients who have spread cancer from the urinary tract, either the bladder was the most common origin or other parts of the urinary tract, for example, what we call kidney, pelvis and ureter, or rarely the urethra. The urothelial cancer that starts from those areas, again more commonly bladder, if it spreads, if it goes outside the urinary tract system, usually those patients get chemotherapy, what we call with an agent called cisplatin if they can tolerate that chemotherapy drug or carboplatin if they cannot tolerate the cisplatin drug. And usually either of these, cisplatin or carboplatin, is combined with a drug called gemcitabine. That's the most common chemotherapy used as initial therapy for patients with spread metastatic urothelial cancer. In this abstract, Dr. Gupta and colleagues tried to survey 60 medical oncologists, including myself, who treat urothelial cancer that considered experts in this disease type, to see if there are any features that could deter us from using chemotherapy in those patients. In other words, are there any features that may make us think that chemotherapy may be too risky for our patients and we should not do it? We should give immunotherapy instead. This is probably a small proportion of our patients, maybe 10 to 20% in our practice, may not be able tolerate that chemotherapy. And which are those features? Poor performance status, meaning the body is very tired and the patient is not moving too much, is confined in the chair or the bed most of the day, and rely on others on daily activities. This is what defines the performance status of ECOG 3. Peripheral neuropathy, meaning that there is numbness or tingling or weakness in the hands or the feet that impact the quality of life. And patients may have trouble buttoning buttons or tying laces, so impacting the quality of life. That's grade 2 neuropathy. Symptomatic severe heart failure, there is a grading system, like New York Heart Association Class III or IV that is significant, notable heart failure symptoms. And also, patients with kidney failure with what we call creatinine clearance below 30 cc per minute. That's a marker how we measure kidney function and the creatinine clearance more than 60 is usually close to normal. As the creatinine clearance drops and goes below 30, chemotherapy with these platinum agents may become a challenge by itself or if it's combined with the ECOG performance status of 2, which means more patients are not moving most of the day. So those features again have to do with the functionality of the day-to-day life. The presence of significant neuropathy, heart failure, and poor kidney function may potentially make the oncologist recommend immunotherapy versus the standard of care, which is chemotherapy, in those patients. And I would say if someone gets chemotherapy, which is the majority of patients, usually they may get immunotherapy later. So pretty much I would say discuss with the medical oncologist what is the right treatment for you. Most patients get chemotherapy up front, followed by immunotherapy. Some others may need to get immunotherapy, and those criteria help us make that patient selection for the right treatment at the right time. So I just alluded to you that most patients with spread or metastatic urothelial cancer, most of them receive chemotherapy. We discussed some criteria in the previous studies that we may use immunotherapy upfront instead of chemo, but for the vast majority of patients, chemotherapy is used upfront and that was based on the results of phase 3 clinical trial called JAVELIN Bladder 100. This was presented at the ASCO Annual Meeting in 2020 about 2 years ago, and it was published in a big journal. And that study showed that if you give chemotherapy upfront, those patients who can tolerate the chemotherapy, of course, who do not have the previously listed criteria, those patients benefit and live longer, so longer overall survival, meaning they live longer, and they have longer progression-free survival, meaning they live longer without worsening of the cancer if they get immunotherapy with, immunotherapy drug is given through the vein, called avelumab. If that is given after the end of chemotherapy for patients who have a response or stable disease, meaning no progression on chemotherapy. So if you get a complete response, meaning that the CAT scans look normal after chemotherapy as at least we can tell visually. Partial response, meaning that the CAT scans look better, but still we can see some cancer spots. Stable disease, meaning that the scans look stable compared to the beginning before we start chemotherapy. If someone has worsening of the cancer in chemotherapy, then the concept of maintenance therapy doesn't apply. So it's only for patients with complete response, partial response, or stable disease, SD. And the poster we had, and I can tell you - I was a co-author in the abstract and co-investigator in the trial, as a disclosure - was sort of the benefit of the patient with avelumab as maintenance therapy after chemotherapy was notable in patients with complete response, partial response, and stable disease. So in any of these 3 categories, avelumab immunotherapy should be offered as level 1 evidence and benefit patients in terms of overall survival and progression-free survival as long as there's no progression to the upfront initial chemotherapy of the patient with metastatic urothelial cancer received. Many other abstracts on these cancers were presented, and I would encourage you to look at them. Thank you so much for the opportunity today. Greg Guthrie: And thank you, Dr. Grivas. Next, we have Dr. Zhang who will discuss some research in kidney cancer. Dr. Zhang: Hi everyone, glad to be here today. I'll be discussing 2 highlights from ASCO 2022 in kidney cancer. The first one we wanted to highlight was a trial called EVEREST: everolimus for renal cancer ensuing surgical therapy, a phase 3 study. And in context, this study is a trial of evaluating everolimus, an mTOR inhibitor, in the post-surgical context. And we do have in the landscape 2 approved therapies, sunitinib and pembrolizumab. And as we have seen, some effective therapies in the refractory setting, many of these therapies are being tested in this postoperative space. So this particular study of EVEREST looked at patients with renal cell carcinoma who underwent resection for their primary nephrectomy and looking to evaluate postsurgical treatment. So everolimus has been approved as a treatment on its own in the refractory setting as well as in combination with lenvatinib. And so this question of whether everolimus alone could delay or prevent disease recurrence in the postoperative setting was tested in this EVEREST trial. The study ultimately enrolled more than 1,500 patients and assigned them to receiving either everolimus or placebo in the postoperative setting. Of these patients, 83% had clear cell kidney cancer and the remaining had non-clear cell kidney cancer. And the follow-up was quite long, over 5 years, and actually over 6 years, and the researchers looked at time until disease recurrence. And risk of recurrence was actually decreased by 15% in patients who were treated with everolimus compared to placebo. But the prespecified cut-off for a statistical significance was not quite reached, and the researchers took a specific look at a group of very high-risk patients defined by larger tumors, invasion of the perinephric fat in renal veins or invasion of nearby organs or known positive disease. And those patients with very high-risk disease had more benefit from everolimus compared to placebo. Of note, 37% of patients who were treated with everolimus had to stop treatment due to their side effects, and the most common severe side effects included mouth ulcers, high triglyceride levels, and high blood sugars. So ultimately this particular study did not show sufficient benefit of everolimus given the toxicity and lack of statistical significance. And so this is a balance between potential benefit in delaying recurrence versus treatment toxicities that we must have in this adjuvant setting. So what does this particular study mean for patients? Well, it was certainly a large phase 3 trial performed in the cooperative group setting and through the generosity of 1,500 patients and the principal investigators on the study, we learned this answer for a very important question of whether everolimus makes a difference in this postoperative setting. I think we're not using this in clinical context currently, but in this postoperative setting, we are always balancing this risk of toxicity with the potential for benefit and discussing the potential treatment options. I do not think this particular trial changes the standard of care in this adjuvant setting. And then I think finally for today's prepared talks, this abstract on depth of response and association with clinical outcomes with CheckMate 9ER patients treated with cabozantinib and nivolumab. So this was a post-trial analysis of patients who had kidney cancer with disease spread and treated with cabozantinib and nivolumab compared with sunitinib in the CheckMate 9ER study. And the context, this was the phase 3 trial in which the benefit of cabozantinib and nivolumab was established in the first-line setting and gained the registration and approval of this combination in the first-line treatment of metastatic kidney cancer. This particular analysis, presented at ASCO this year, was a post-trial prespecified analysis evaluating this depth of partial responses and associating those with clinical outcomes of time until disease progression as well as time until death. These depth of responses were defined as 80 to 100% for PR-1, 60 to 80% for PR-2, and then 30 to 60% as PR-3. And as we saw in this analysis, the deeper the responses on cabozantinib and nivolumab, the more correspondence with higher 12-month rates of disease-free progression compared with those same depths of responses from sunitinib. And there were similar 12-month overall survival rates for patients with similar depth of responses for either the cabozantinib and nivolumab combination compared with sunitinib. So I do think the degree of partial response in these settings is productive of time until progression and establishes further the efficacy and benefit of cabozantinib and nivolumab compared with sunitinib. And what does this trial mean for our patients? I think that early on, as we're looking for responses and radiographic changes for our patients on cabozantinib, nivolumab in the first-line setting, these deeper responses are associated with longer time until disease progression, and we can counsel patients, to discuss whether cabozantinib and nivolumab is working for them. This could be an early indicator for how patients will do overall on this combination. So with that I'd love to wrap up and turn it back over to you, Greg. Greg Guthrie: Thanks so much Dr. Zhang. And now it's time to move on into our Q&A session. This is for you, Dr. Agarwal. So the question is utility of triple therapy, ADT plus docetaxel plus ASI and metastatic hormone-sensitive prostate cancer given ENZAMET was inconsistent with PEACE-1 and ARASENS. Would you give ASI concurrent or sequential after chemotherapy for tolerability? I'm assuming ASI here is androgen suppression, correct? Dr. Agarwal: Yes. Great question. There are 2 questions here. Number 1, if I would use triplet therapy given the negative subgroup analysis of the ENZAMET trial, and number 2, what is the role of triplet therapy in general? The answer to the first question is ENZAMET trial, subgroup analysis is very different from preplanned, prespecified, well-powered analysis from PEACE-1 and the ARASENS trial. So yes, we saw discrepant results, but my impression from ENZAMET trial is enzalutamide is an effective option for all patients regardless of the receipt of docetaxel chemotherapy because that was a subgroup analysis. So I don't think it really affects negatively the results of the ARASENS and the PEACE-1 trial. But a bigger question here is triplet therapy versus doublet therapy? Is triplet therapy for all or doublet therapy for all? Answer is no. Triplet therapy trials only showed that adding a novel hormonal therapy or deeper androgen blockade to the backbone of ADT plus docetaxel improves survival. These trials did not answer the question, if adding docetaxel chemotherapy to ADT plus, for example, enzalutamide or darolutamide or apalutamide, will improve survival. We do not have that question answered by any of the trials and unlikely any other trial will answer that question. So my take ADT plus docetaxel is replaced by ADT plus docetaxel plus these deeper androgen blocker therapy. So wherever I was going to use docetaxel chemotherapy, so those are the patients with visceral metastases or in my practice, when I do comprehensive genomic profiling, I see those molecular aberrations which predict lack of response to deeper androgen blockade such as baseline AR variants. Or if I see 2 out of 3 mutations of p53, RB loss, p10 loss, if I see 2 out of these 3, I tend to think about docetaxel chemotherapy. So in those patients where I'm using ADT plus docetaxel, I would add another androgen receptor blocker such as abiraterone and darolutamide. But when I'm using enzalutamide or apalutamide which I use for majority of those patients, my patients with metastatic hormone-sensitive prostate cancer, I do not think about triplet therapy. Greg Guthrie: Thanks, Dr. Agarwal. We actually have a follow-up question, and this is, what is the role of oncology in low-stage early prostate cancer? Can neoadjuvant chemotherapy reduce the number of people who end up with metastatic prostate cancer? Dr. Agarwal: This answer is very simple. There is no role of neoadjuvant chemotherapy in high-risk localized prostate cancer or any localized prostate cancer setting. Greg Guthrie: Great. Thank you. Next question. I believe that this is for everybody. How long will it be until the information from the trials discussed will be used in the community clinics? What can patients do to bring this information to their less experienced doctors? Dr. Grivas: So, Greg, just to clarify the question, is it about the translation of the results of the clinic from ASCO to clinical practice, generically speaking, or any particular tumor type or any particular data results? Greg Guthrie: The way I read this question, it's more just kind of a broader scope question about just like, how long does the results of clinical trials make it to community practice, and what role can patients have in perhaps fostering this transmission of information? Dr. Grivas: Of course, I can start briefly, and then my colleagues can add. I would say the world we live in right now, the information travels very quickly. It's much faster compared to the past. And I think there is much more alignment, in my opinion, in terms of information access between academic oncologists and community oncologists. If, for example, a trial result comes at ASCO being presented, and then there's a follow-up approval authority from a regulatory agency, this agent may be accessible to both community and academic practices. Of course, there are always opportunities for education, and Dr. Agarwal is the director of the ASCO Daily News, and he knows that well to disseminate the information well, broadly, in an equitable manner across academic oncologist providers and community providers. And I think CME, continued medical education practices, can help in that regard. And obviously, the other aspect of that is the ongoing clinical trials and how we can do a better job disseminating the opportunity for equitable participation in clinical trials across racial groups, ethnicity groups, minority groups, to give them the chance to participate in ongoing clinical trials that may change the practice down the road, which are just early thoughts. But other colleagues can comment. Dr. Zhang: Yeah, if I could chime in. I think these continuing medical education programs, particularly in the context after large symposia like the ASCO Annual Meeting we just had, are particularly important. And the Best of ASCO series, as well as ASCO Direct Highlight series - I believe Dr. Grivas and I are hosting 2 of these - are very helpful, I think, to bring the latest findings from the ASCO Annual Meeting to our community colleagues. And they really are our colleagues. We work together with our oncologists within the community to take care of our patients, oftentimes for standard of care treatments. Patients can access them more in their backyards. And I think from a patient standpoint on the second part of the question, they're able to hear these from patient-friendly platforms and to bring that to the attention of their oncologist, wherever that may be. It all helps in the grand context of clinical care. So I hope that these trial results and the latest findings from ASCO can get inseminated very quickly. Dr. Grivas: And to also add very briefly, the role of patient advocacy groups, and in the bladder cancer work, there are many, for example, the Bladder Cancer Advocacy Network, World Bladder Cancer Coalition, and many others can help also in that regard and teaming up with all of us to disseminate information and also clinical trial access. Greg Guthrie: Great. Thank you, everyone. We have a question for Dr. Grivas. After the survey results in the study you described, is there any plan to make a guideline or tool to make sure we standardize the definition of cisplatin/platinum ineligibility? Dr. Grivas: Great question. Just 1 more thing on my prior answer, kudos to Cancer.Net for serving that mission, Greg and Claire in that-- or the previous question to have a complete answer. Answering this new question here, which is very important. I think the next step is to try to publish the results of the survey. The survey like the previous one done by Dr. Galski about 10 years ago-- it's a survey on expert oncologists, and it's a consensus-based definition. It's criteria that we came up with together. And I think the next step here is to publish this in a peer-review process. And our hope is by publishing these results, we can have a more formal definition to help guide our practices in academia, but also in the community oncology practices and make sure that we have a standardized way that we approach this therapy selection and of course, to help design clinical trials that for this particular patient population in order to improve outcomes in this setting. So hopefully publication will come soon. Greg Guthrie: Thanks, Dr. Grivas. I'll just drop a really quick pitch there. Here at Cancer.Net, we do have a very broad array of information on clinical trials. And patients can come visit us at Cancer.Net and learn about clinical trials, what they mean, and how they help advance cancer research. We now have a question for Dr. Zhang. Based on the results of EVEREST and other trials approved systemic therapies in the adjuvant setting like sunitinib and pembrolizumab, are there ongoing other trials in this setting and is risk stratification used? Dr. Zhang: The short answer is yes. There are ongoing adjuvant trials that build on pembrolizumab in the adjuvant setting. There's one that is looking at the addition of belzutifan with pembrolizumab in the adjuvant setting. So that trial is a global trial which is about to get started, if not enrolling already. And in the context of adding on in the adjuvant setting, I do think we really need to discuss with our patients how much of a benefit the treatment will have versus the real toxicity in the postoperative setting, many patients will not have symptoms from their cancer, so they may have some pain or healing side effects from surgery, but they won't have symptoms from cancer. So any toxicities from medications can be further amplified, so are we truly giving a lot of benefit in that context or not. So that's an individualized decision, and I do think conversations must be had to make that decision together. Greg Guthrie: Thanks, Dr. Zhang. I want to ask a question myself of Dr. Gilligan. You had mentioned that microRNA is an emerging field of study, and I've heard about this in other types of cancer as well. I wonder if you could discuss that a little bit more. Dr. Gilligan: Yeah, microRNA, the promise that holds is being a more accurate detector, specifically of testicular cancer. So the problem we have with alpha fetoprotein and beta HCG is half of the testicular cancers may not make 1 or both of those markers. So people can relapse without the markers going up, even though markers are most commonly what we see, there are a couple of different scenarios. Someone has stage I testicular cancer, which means their testicles removed and all their scans show no evidence of cancer. We know that 25% or so of non-seminomas and 20% or so of seminomas will relapse, even though we can't see what the cancer is, and the markers are negative in that situation. MicroRNA may be able to detect those people who still have cancer much, much earlier. So we know that they're, in fact, not stage I and that they need active treatment right away. So that's one place. Another place that we're seeing evidence is that men who've had metastatic testicular cancer. They go through chemotherapy, and they have residual masses. And we're wondering if there's cancer in those masses or is it all dead scar tissue or is it teratoma? MicroRNAs may be able to allow us to determine who needs additional treatment, who needs surgery without having it. Right now, we typically go in and operate just to figure that out. So there are a number of situations in which we could more accurately stage patients and figure out who's cured and who's not cured much earlier in the course of disease. And for a patient, this would be fantastic, because right now, if you've got stage I disease with non-seminomas and you go on surveillance and somebody says you have a 25% risk the cancer is going to come back, that's a 1 in 4 chance that at some point in the next 2 years, most likely, or longer, you're going to have to suddenly drop everything and go through months of chemotherapy. If we knew on day 1, it looks like you're cured, but in fact, there's cancer hiding there somewhere, and we need to treat you now, that would be helpful to know so they can get it over with. And the other men, we could say we're really extremely confident that there's not a 25% risk, it's a 5% risk or something much lower. So there are a number of ways, if this really gets proven and there's emerging data that's promising, I think we could reassure men, treat them more appropriately, spare them unnecessary treatment, and give them more peace of mind. Greg Guthrie: Great. Thanks, Dr. Gilligan. I think we have a question from Dr. Grivas now. Dr. Grivas: Thank you, Greg. This is a great panel. I like to learn from my colleagues here. One question for Dr. Zhang, you have done so much work in the field, leading the field there, Dr. Zhang. Any comments about the ideal end points in the adjuvant setting in kidney cancer, urothelial cancer, disease-free survival or overall survival? Would you comment about how we design trials, and what will be an acceptable benchmark? And what is meaningful for patients, too, in the adjuvant treatment after radical surgery for kidney cancer and urothelial cancer? Dr. Zhang: Oh, that's a great question, Petros. Thank you so much for asking. We have discussed this many times together because you and bladder cancer and myself and kidney cancer, we're thinking a lot along the same lines right as new immunotherapies get approved in the postoperative setting, so disease-free survival as an endpoint and recurrence-free survival as an endpoint is a valid endpoint. It's a direct result of the randomized treatment on the trial, so I do think that is the valid endpoint, and it's an endpoint that the FDA has approved the sunitinib and pembrolizumab indications in kidney cancer, nivolumab and bladder cancer. So I think it's certainly a valid endpoint to delay disease recurrence. How much of that is meaningful degree of improvement for an individual patient? Their own measure of recurrence is either yes or no. It's much more binary than population effects. So how much does that translate into benefits for the patient? I think that warrants deeper individualized discussion. But these disease-free survival endpoints in all of these studies is a valid endpoint to see whether the treatment is worthy in delaying disease recurrence in each of these disease types. Greg Guthrie: Thanks, Dr. Zhang. We have one last question here, and I believe this is a follow-up for Dr. Gilligan. And what is the time frame for the rollout of microRNA 371 to the community? Dr. Gilligan: I don't know the answer to that. I'm not sure that we have enough data right now that it's going to get approved. I think we're headed in the right direction, but it's very hard to know what the timing of that is. There are trials going on, so I don't know at the moment of exactly what the scenarios are in which people are going to be, which patient populations are going to be eligible, but there are trials going on. I think I'm hoping within the next 2 years or so, but I really don't know what the time frame is, unfortunately. Dr. Grivas: And if I may add a more generic comment to Dr. Gilligan's wonderful answer is that when we have what we call biomarkers that are like metrics that can give us information about how the patient does over time, it's important to tease out what we call prognostic, meaning how can this biomarker give us a sense of the chance of recurrence, as Dr. Gilligan said, or death from the cancer. But also, the bigger question is, is it going to give us information to predict benefit from an individual therapy? And that's a bigger question in oncology that is a harder one. This predictive question and try to identify biomarkers and validate them to make sure they have, they're clinically useful. They can help us make treatment decisions in the clinic. And I'm very excited about what Dr. Gilligan discussed about the promise in the future. But more trials are needed for many biomarkers. Dr. Gilligan: I think when we do this update next year, we'll have significantly more data then, I'm hopeful. Greg Guthrie: Thank you to you all. Thank you, Dr. Agarwal. Thank you, Dr. Grivas. Thank you, Dr. Gilligan. Thank you, Dr. Zhang, for sharing this great research with us, as well as your expertise. It's been a real pleasure this afternoon. And to all of our viewers, thank you for joining us. You can find more coverage of the research from ASCO Annual Meeting and other scientific meetings at the Cancer.Net blog, which is at www.cancer.net/blog. And if you're interested in more Cancer.Net content, please sign up for a monthly Inside Cancer.Net newsletter or follow us on social media. We're on Facebook, Twitter, and YouTube where our handle is always @CancerDotNet, with dot spelled out. Thank you all, and be well. Thanks. ASCO: Thank you, Dr. Agarwal, Dr. Gilligan, Dr. Grivas, and Dr. Zhang. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.
Dr. Jessica Lubahn is a board-certified Urologist with over a decade of experience in the medical field and creator of the first luxe line of incontinence underwear, ONDR. Tune into the conversation as she discusses pay discrepancies in the billing world, the lifestyle benefits of her surgical field, and the entrepreneurial hurdles she faced during the creation of her underwear line. Dr. Jessica Lubahn is a board certified Urologist residing in the Portland, OR area. She received her degree from the Washington University in St. Louis School of Medicine and completed her residency at UT Southwestern Medical Center in Dallas, TX. She's been practicing Urology for nearly a decade. With a heart for her patients' struggles and the desire to see practical change where she can affect it, she created a high quality line of incontinence underwear. With her free time, Dr. Lubahn enjoys spending time with her family, running her business, spending time outdoors, and working on her book about the often humorous and outrageous experiences as a urologist.
An interview with Dr. Tian Zhang from UT Southwester Medical Center in Dallas, TX, author on "Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline." Dr. Zhang reviews the guideline recommendations for the treatment and management of patients with metastatic clear cell renal cell carcinoma and it's implications for clinicians and patients. Read the full guideline at www.asco.org/genitourinary-cancer-guidelines. TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Tian Zhang from UT Southwestern Medical Center in Dallas, Texas, one of the authors on 'Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline'. Thank you for being here, Dr. Zhang. Dr. Tian Zhang: Absolutely. Thank you so much for having me, Brittany. Brittany Harvey: Great! First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Zhang, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Tian Zhang: Yes, I have received past research funding from Novartis, Merck, and Pfizer, as well as advisory board and consulting fees from Merck, Exelixis, Pfizer, BMS, Eisai, and Aveo. All of these industry partners have approved therapies in renal cancer. For the complete list, our audience can refer to the guideline's publication. Brittany Harvey: Great, thank you for those disclosures. Then starting off on the content of this guideline, can you give us an overview of the purpose and scope of this guideline? Dr. Tian Zhang: Sure. This is a guideline for recommendations for the treatment and management of patients with metastatic clear cell kidney cancer. ASCO gathered 14 colleagues, including myself, that were considered kidney cancer experts from around the world, and we performed a systematic literature review to guide treatment recommendations in metastatic clear cell kidney cancer. In the series of ASCO clinical practice guidelines for genitourinary cancers, we hope this guideline will provide recommendations for kidney cancer treatment with supporting data and evidence, particularly given the therapeutic landscape changes since about 2017. Brittany Harvey: Then I'd like to review those recommendations that you just mentioned of this guideline. So, this guideline covers six overarching clinical questions. So, I'd like to go question by question for our listeners, starting with how is metastatic clear cell renal cell carcinoma is defined and how is it diagnosed? Dr. Tian Zhang: In this portion, we recommended a gold standard of comparing metastatic tissue outside of the primary site to the primary tumor. We discuss adding in staining for PAX8 as well as CA-IX for clarity of clear cell histology. The timing is also pretty important in the timing of initial diagnosis and nephrectomy until the appearance of metastatic sites on scans, and radiographic diagnosis is therefore used in settings where prior diagnoses of clear cell kidney cancer has been established and when a metastatic lesion is not accessible for biopsy or when there's clear, measurable disease within a year of the initial diagnosis. Brittany Harvey: Understood. And then in the next section of the guideline, what is the role of cytoreductive nephrectomy in metastatic clear cell renal cell carcinoma? Dr. Tian Zhang: In this section, we recommend that cytoreductive nephrectomy should be considered for select patients who present with de novo metastatic clear cell kidney cancer to palliate hematuria or pain or to remove the bulk of tumor burden. We discuss some past trials in the settings of interferon alpha, and VEGF inhibitors and also recommend consideration of ongoing clinical trials in the era of immunotherapies. There are two such trials that are ongoing, PROBE and Cyto-KIK, that are actively accruing patients. Brittany Harvey: Great. And then the guideline goes into options for systemic treatment. So, what are the preferred options for first-line systemic treatment? Dr. Tian Zhang: This is probably our most extensive section, as first-line systemic treatments have changed and expanded greatly over the past five years. First, we recommend considering active surveillance for select patients with the following criteria: those who have IMDC favorable or intermediate-risk disease, those with limited or no disease-related symptoms, and also those with a long interval between nephrectomy and the development of metastasis. Second, we recommend IMDC risk stratification to then determine treatment selection. Those with IMDC intermediate or poor risk factors should be offered combination treatment with either two immune checkpoint inhibitors or an immune checkpoint inhibitor with an anti-angiogenic VEGF tyrosine kinase inhibitor. We provide strong level of evidence with the completed phase three trials in this first-line setting of ipilimumab and nivolumab, axitinib with pembrolizumab, axitinib with avelumab, cabozantinib with nivolumab, and lenvatinib with pembrolizumab. For patients with IMDC favorable-risk disease, we recommend an immune checkpoint inhibitor with a VEGF tyrosine kinase inhibitor which may be offered over VEGF TKI alone for those patients who are candidates for immunotherapy. In addition, VEGF monotherapy or an immune checkpoint inhibitor monotherapy may be offered for select patients who have certain coexisting medical conditions. In addition, we have discussed this long history of high dose interleukin-2 treatments and that this may still be considered in first-line treatments for certain patients while discussing the significant toxicity of IL-2 relative to the newer immunotherapy regimens. And finally, we encourage the participation and enrollment into first-line clinical trials when available. A couple of the current ongoing ones include PDIGREE and the LITESPARK-012 Trial. Brittany Harvey: I appreciate your reviewing those options and the level of evidence along with those ongoing trials for patients. So, then following those recommendations for first- line that you just went through, what is recommended for the second or later line systemic treatment? Dr. Tian Zhang: Subsequent treatment in later lines after initial treatment of refractory renal cell carcinoma depends largely on the initial treatment choices. We recommend nivolumab or cabozantinib for patients who had prior progression on a VEGF TKI alone based on the large phase three trials CheckMate 025 and METEOR respectively that gain the approvals for nivolumab and cabozantinib. For patients with disease progression on a combination immunotherapy, a VEGF TKI should be considered. Those who progress after initial combination therapy with a VEGF TKI and an immune checkpoint inhibitor should then be offered an alternative VEGF TKI as a single agent. And finally, for those who have limited sites of disease progression, local treatment with radiation, thermal ablation, or surgical excision could be offered with continuation of the immunotherapy. Brittany Harvey: Thank you for reviewing those second and later line treatment options. So, then following that, what did the panel recommend regarding metastasis-directed therapy? Dr. Tian Zhang: There have been some recent studies looking at metastasis-directed treatments, especially for patients with a low volume of metastases. These can include surgical resection, ablation, or radiation therapy. And surgical resection and radiation have not actually been directly compared. And so, for those patients, we would recommend a tailoring treatment based on sites of disease. For those patients who do have surgical resection, subsequent VEGF TKIs are not usually recommended based on a prior phase two trial. Brittany Harvey: Understood. And then this guideline addresses a couple special subsets of patients. And so, what are those subsets, and what considerations should be applied to the treatment of these special subsets of metastatic clear cell renal cell carcinoma? Dr. Tian Zhang: For the special subsets of patients, we considered patients with bone metastases, patients with brain metastases, and also patients with sarcomatoid features on histology. For those patients with bone metastases, we recommend bone-directed radiation as well as a bone resorption inhibitor with either a bisphosphonate or a RANK ligand inhibitor. We do not have a recommendation on optimal systemic treatments, although given the presence of the MET receptor on bone metastases, regimens containing cabozantinib, which targets the MET receptor in addition to other receptors, may be preferred. For those patients who have brain metastases, no definite guidance for treatment can be made given many patients with brain metastases were excluded from the initial trials. The overall efficacy of the systemic therapies is low for controlling metastatic kidney cancer in patients with brain metastases. We do recommend local treatment with radiation and or surgery to be undertaken based on the pattern of intracranial metastases. And we refer readers and the audience to a recent guideline from ASCO, ASTRO, and SNO on the management of brain metastases. And finally, for patients who have sarcomatoid features on pathology, an immune checkpoint inhibitor-based combination should be chosen in the first line setting. And this is based on multiple phase three trials that have shown improvement in clinical outcomes for patients treated with immunotherapy combinations compared to sunitinib alone. Brittany Harvey: Thank you for viewing all these recommendations. The guideline expert panel certainly covered a lot of questions on the treatment and management of metastatic clear cell renal cell carcinoma. So, then in your opinion, Dr. Zhang, what is the importance of this guideline and how does it impact clinicians? Dr. Tian Zhang: Sure. You know, in the past 10 years, our treatment options for metastatic kidney cancer have greatly expanded and multiple options are now available. For busy clinicians who may not treat kidney cancer, especially in the metastatic setting often or on a routine basis, this set of guidelines provides a high-level approach to the common management scenarios that clinicians are often faced with. My fellow committee members and I hope that these guidelines will provide a comprehensive one-stop document that is relevant and updated for the busy clinician taking care of patients with metastatic kidney cancer. Brittany Harvey: Great! And then finally, how will these guideline recommendations affect patients with metastatic clear cell renal cell carcinoma? Dr. Tian Zhang: The fact that our treatment options for metastatic kidney cancer have improved clinical outcomes, including extending the time until progression as well as overall survival, is truly wonderful news for patients who are diagnosed with metastatic kidney cancer today. If patients are directly reading these guidelines, they can also see whether overall recommendations align with their recommended course of treatment, with the caveat that every patient's care is tailored to them based on coexisting medical conditions and concurrent medications. But we hope these guidelines will be helpful for all of our patients. Brittany Harvey: Yes, it's great to see improved clinical outcomes for patients. So, I want to thank you for all of your work on this guideline and for taking the time to review the guideline recommendations and its impact. Dr. Tian Zhang: Sure. I really appreciate ASCO giving this time and opportunity, Brittany, and also the audience for their interest in the clinical guidelines for metastatic clear cell renal cell carcinoma. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline, go to www.asco.org/genitourinary-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines App available on iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. 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.
The Expert Series is happy to have Dr. Bonnie Bermas on our episode about fertility and reproductive health. Dr. Bermas is an internal medicine professor at UT Southwestern Medical Center focusing on rheumatology disorders. She was the Clinical Director of the Lupus Center and co-director of the Program in pregnancy and rheumatic diseases at Brigham and Women's and Harvard Medical School. Her research interests include pregnancy and rheumatic diseases, systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), and rheumatic immune checkpoint inhibitor adverse events. Below are resources from the National Resource Center on Lupus related to this episode Read about Lupus and women's reproductive health Read how six men are living with lupus Learn more to understand the role of how sex and gender play in lupus For more information on medication, read about Medications used to treat lupus. SUBSCRIBE to receive an email update when new episodes of The Expert Series are released.
Experiencing an unforeseen circumstance like cancer can cause your life to deviate from the path you had initially set out upon. This episode of Life on Pause discusses cancer's impact as a "fork in the road" and how it can significantly alter the lives of those who experience it. Life on Pause is a podcast created by and for young adults living with cancer. Within this episode, Penn State Medical Center's young adults are joined by young adults from UT Southwestern Medical Center whose lives have been impacted by cancer. They have come together to discuss the deeply personal ways that cancer has changed their life paths and their processes of coping with these events. Listen to young adults impacted by cancer discuss their "fork in the road" experiences: Topic and Guest Introduction (0:30) Our hosts introduce listeners to our guests, young adults from UT Southwestern Medical Center whose lives have been altered due to a cancer diagnosis. Each speaker shares their personal stories, thoughts, and experiences regarding their cancer journey. Silver Linings (12:59) While deviations from your intended life path can be challenging, they can sometimes provide benefits. Our hosts ask guest speakers about what positive differences they can identify when comparing their old routes to their new life courses after experiencing their cancer diagnosis. Some of the speaker's examples involve mended relationships, increased empathy, and new outlooks on life. Coming to Terms (21:52) When you experience an impactful event like cancer, it can take time to recognize and come to terms with the ways your life has changed. Guest speakers share their timelines of how long it took to reach the understanding that their life was significantly altered due to their cancer experience. This grieving process can be unique for everyone, and guest speakers share their own stories of how they reached this stage of their health journey. Closing Thoughts (31:40) Everyone's experience with cancer is personal, and it can be tough to share these experiences, as our guest speakers have done in this episode. However, hearing these stories can be impactful for others experiencing cancer. This final portion of the episode recognizes this episode's speakers for their vulnerability and bravery in exploring these topics on the Life on Pause podcast.
Today, Justin Beamis sits down with Dr. Benjamin Levi, M.D. to discuss his life, his research, and the incredible work he and his team at U.T. Southwest Medical are doing with the donations made by everyone who supports Sons of the Flag! Benjamin Levi, M.D., is an Associate Professor in the Department of Surgery at UT Southwestern Medical Center. He holds the Dr. Lee Hudson-Robert R. Penn Chair in Surgery and Plastic and Reconstructive Surgery and serves as Division Chief of Burn, Trauma, Acute and Critical Care Surgery. He specializes in acute and reconstructive burn surgery and scar reconstructive surgery. He is the author of more than 100 scholarly articles, including high-impact papers in Science Translational Medicine, Proceedings of the National Academy of Sciences, and Nature Communications, as well as chapters in a number of textbooks, including Greenfield's Surgery, Total Burn Care, Grabb and Smith's Plastic Surgery, and Trauma. He has delivered presentations worldwide, held numerous invited professorships, and serves as a permanent editor and ad hoc editor for journals in his area of research. Dr. Levi co-chairs the Reconstructive Special Interest Group of the American Burn Association. He is also a member of the American College of Surgeons, the American Council of Academic Plastic Surgeons, the American Society for Bone and Mineral Research, the American Society of Plastic Surgeons, the Association for Academic Surgery, the Reed O. Dingman Society, and the Plastic Surgery Research Council. Sponsored by Magnegrip and Tencate.
We are focusing on our kids for the first half of the show in light of recent events in Texas. Dr. Stevie Puckett-Perez joins us from Children's Health and UT Southwestern Medical Center to process many of the emotions our kids and teens are feeling as the 2022 summer break begins across North Texas. There is an easily-preventable cancer that many people get, but with a simple, early diagnostic procedure, can be completely removed at the time of the procedure itself. Yet, 30-percent of North Texans don't get this very important test. We are talking, of course, about colon cancer and colonoscopies. Dr. Amit Desai, Gastroenterologist at Texas Health Presbyterian Hospital Dallas stops by to give us valuable information on how this disease has become more wide-spread among the younger population, increasing the importance of beginning testing sooner. See acast.com/privacy for privacy and opt-out information.
About our Guest:Samuel Mandell, M.D., M.P.H., is an Associate Professor in the Department of Surgery at UT Southwestern Medical Center. He specializes in trauma surgery, surgical critical care, and comprehensive care of burn-injured patients. Dr. Mandell also serves as Burn Section Chief and Director of the Parkland Regional Burn Center in Dallas, Texas.How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:By the end of listening to this two-part series, learners should be able to:1. Describe the key elements of the initial evaluation and resuscitation of the burn injured pediatric patient.2. Recognize risk factors and clinical features of inhalation injury.3. Recognize risk factors and clinical features of carbon monoxide and cyanide poisoning.4. Estimate the total body surface area (TBSA) burned.5. Recall general indications for transfer to a specialty burn center.Support the show
CardioNerds (Amit Goyal and Daniel Ambinder), Dr. Ahmed Ghoneem (CardioNerds Academy Chief of House Taussig and medicine resident at Lahey Hospital), and Dr. Gurleen Kaur (Director of CardioNerds Internship and medicine resident at Brigham and Women's Hospital) discuss family history of premature ASCVD with Dr. Ann Marie Navar, Preventive Cardiologist and Associate Professor in the Departments of Internal Medicine and Population and Data Sciences at UT Southwestern Medical Center. They discuss the art of soliciting a nuanced family history, refining cardiovascular risk using risk models and novel markers, counseling patients with elevated risk, and more. Show notes were drafted by Dr. Ahmed Ghoneem and reviewed by Dr. Gurleen Kaur. Audio editing was performed by CardioNerds Intern, student Dr. Adriana Mares. For related teaching, check out this Tweetorial about CAC by Dr. Gurleen Kaur, the Family History of Premature ASCVD Infographic by Dr. Ahmed Ghoneem, and the CardioNerds Cardiovascular Prevention Series. CardioNerds Cardiovascular Prevention PageCardioNerds Episode Page Show notes - Family History of Premature ASCVD with Dr. Ann Marie Navar Patient summary: Mr. B is a 51-year-old gentleman who is referred to CardioNerds Prevention Clinic by his PCP. He does not have a significant past medical history. He is a former smoker but quit 2 years ago. His BP in clinic today is 138/84; he is not on any antihypertensives. His most recent lipid profile 2 weeks prior showed a total cholesterol level of 250 mg/dL, a TG level of 230 mg/dL, an LDL cholesterol of 174 mg/dL, and an HDL cholesterol of 30 mg/dL. He tells us that his father had a “heart attack” at the age of 52, and he would like to further understand his own risk. We calculate his ASCVD risk score, and it is 9.8%. 1. What constitutes a positive family history (FHx) of premature ASCVD? What is an approach to the art of soliciting the FHx from our patients? Definition of family history of premature ASCVD: the history of an atherosclerotic event (e.g., myocardial infarction or stroke) in a male first degree relative before the age of 55 or a female first degree relative before the age of 65. Dr. Navar's approach to soliciting a family history:Lead with a general question such as “what do you know about any medical conditions that run in your family?”.Then ask more specific questions about the parents and siblings, such as “Is your mother still alive? How long did she live? Has she ever had a heart attack or stroke?”If the answer is yes, ask about how old they were at the time of the event.A challenging aspect of the FHx can be eliciting the difference between atherosclerotic events and sudden cardiac death. While atherosclerotic diseases are a much more common cause of unexplained sudden death, it's important that we don't miss the opportunity to identify inherited cardiomyopathies, channelopathies, inherited aortopathies or other heritable SCD syndromes. 2. Is the “dose” of family history important (for example: the number of affected relatives, the closeness of those relationships, the age of onset)? While conducting studies to test this may be difficult, the few studies that have looked at the number of affected relatives have found a dose-response type relationship, where increasing number of relatives affected increases the risk of heart disease.1,2 3. How does a family history affect cardiovascular risk stratification? FHx of premature ASCVD does not improve the predictive ability of the Pooled Cohort Equations (PCE) at a population level. Therefore, it does not factor into the ASCVD risk calculation utilizing the PCE. However, it enhances the patient's risk at an individual level. The ACC/AHA guidelines recognize FHx of premature ASCVD as a risk-enhancing factor [together with CKD, chronic inflammatory conditions such as psoriasis, primary hypercholesterolemia, high-risk ethnicity such as South Asian ancestry...
Have you ever been to a medical appointment and had several other people see you who weren't your doctor? The different roles within a medical care team can be confusing for a patient! Dr. James Haddad is a gastroenterology fellow at UT Southwestern Medical Center. Today he's breaking down the different roles within your care team and also discussing the benefits of plant-based diets.
In the second of this two-part conversation Drs. Patrick Loehrer and David Johnson sit down with Dr. Deborah Schrag, the current Chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center to continue the discussion of her roles as a leader, researcher, oncologist, public health expert, and more. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at firstname.lastname@example.org. TRANSCRIPT Dr. Dave Johnson: Hi everyone, welcome back to Oncology, Etc. an ASCO educational podcast. My name is Dave Johnson. I'm at UT Southwestern Medical Center in Dallas. And I'm here with my good friend Dr. Pat Loehrer who serves as a director of Global Oncology and Health Equities at Indiana University. In the second half of our conversation with Dr. Deborah Schrag, the current chair of Medicine at Memorial Sloan Kettering Cancer Center in New York. In part one, we heard about Dr. Schrag's early life and background, as well as the importance of affordable cancer care and much more. Let's jump back into the conversation and hear about her current goals and initiatives at Memorial Sloan Kettering. I have a question for you. Jumping ahead a little bit. But I mean, you're such a role model for all of us. But you're now in a very powerful position as head of medicine at the preeminent cancer center in the world. So, I'd be interested in knowing what are your top initiatives? What did you come to this role wanting to do short-term and long-term? I'd be curious to hear from you about that. Dr. Deborah Schrag: Yeah. So, I have lots of specific initiatives, all the things that are probably very similar across medical cancer centers. We have to figure out the role of immuno-oncology. We have to figure out the role of CAR T-cell Therapy. There are lots of specific things, but let me tell you about three sort of overarching principles and things that I think we need to think about. So, one of the reasons why I decided to leave my job where I really focused on training researchers and building a research program to lead a department of medicine that has a mix of clinicians, educators, and investigators is that there's really a profound sense of exhaustion and disconnection. I'll use the word even burnout or people get the sense of losing the joy in the practice of medicine. And as corny as it sounds, and I know I'm going a little corny here, Dave. But I really want to help bring back and connect people to the joy in the practice of medicine. It's the joy that we experience when we crack a tough case, when we help a patient, when our patients make us laugh, when our patients and their families make us cry, when they drive us bananas, when they cook us food that is inedible, just reconnecting us to the joy, to the stories. I really wanted to try to be a different kind of leader because I felt that I could make a contribution to the field of academic medicine in general and oncology in particular, by working with faculty to set them up to tap into that joy, because I know they all started with it. I know they all went into medicine because they care about those human stories, because they do want to make a difference. This past week, a fellow intern of mine who you may know, passed away. His name was Paul Farmer. He was the head of Partners in Health and he was an infectious disease physician. There's a book about him by Tracy Kidder that's really moving. There's also a documentary about him called, Bending the Arc, which I would highly recommend. Paul was an incredible inspiration, just incredible, but he brought so much joy to the practice of medicine. I remember when Paul was going to some of the poorest places on the planet, specifically Cange, Haiti. He got an idea that he needed to bring chemotherapy because there were large cancers that were untreated. And he wanted to get leftover chemotherapy from the Dana-Farber. So, in the 1990s, when I was a fellow, he would ask me whether I could get him any leftover Taxol. I was like, ‘Paul, I can't do that. It's not safe. You can't take leftover Taxol to Cange'. And he said, ‘Deb, just wait, the drugs will be oral soon, and then I'll get it'. But guess what? Paul came back to me in 1999, and capecitabine had been approved. The oral equivalent of 5-FU. He held my feet to the fire. He said, ‘Every time you have a dead patient, if there's any leftover capecitabine, I want you to get it for me'. Inspirational leadership, connecting people to the joy in the practice of medicine. I would say that's number one. There's no one simple formula or way to do that. It's hard work. It requires a team I think a lot more teamwork into the practice of medicine. I think we're coming out of a hard two years where we've been confined to Zoom boxes. But it's a lot easier when we can sit together in a room and have a pizza and a beer on a Friday afternoon. But we have to figure this out, and we will, step by step. The other big thematic area, I think, has to do with the patient experience. Dave, I mean, when I started out as a fellow, patients with advanced lung cancer were living for 10 months, 10-12 months, that was a pretty good run with advanced metastatic non-small cell lung cancer. Well, these days, it's 2-3 years, and there's even quite a tale of patients who were living 4-5 years. And that is a long journey. It's no longer the 800-meter sprint, it's a half marathon, turning into a marathon and even an ultra-marathon. So, the way we deliver care needs to change. So, we're really rethinking here, how we deliver care. So, as an example of some, if you go back to the 80s and 90s, cancer chemotherapy was something that happened in the hospital. And in the last quarter century, we've transitioned that to an outpatient practice. I think in the next quarter century, we won't transition all of it, but we will transition a lot of it to home. As an example, I'm struck by when patients undergo IVF, they get handed some Lupron and are taught how to self-administer Lupron every day, so they can undergo a fertility cycle. But when those same women get breast cancer, they have to come into the clinic and sit and wait and take half a day off of work to get the same Lupron. The same is true for men with prostate cancer. Why is that? It's because of policies, and it's not safety, it's not patient-centered. So, I think we have an opportunity to change the patient experience. I think we'll be able to give immunotherapy at home, and HER-2 agents at home. We have to do the trials and make sure that it's safe, but we have to make cancer care more patient-centric and improve the experience. And that's just essential when it's a marathon that we're asking our patients to run, not these 12-month sprints. Families need this also. So, those are a few of the challenges that I want to take on. Joy in medicine, patient experience, and of course, the physician-scientist pathway needs to be strengthened. Dr. Pat Loehrer: I love it. You can imagine between Dave and me, I think that resonates so much about having joy in medicine. I've not heard other people talk about that, but I really think that's an important vocation. But I'm going to ask you something else too because, in the efforts of being joyful and being a role model for that, there's the other side of it, where you can't actually let your hair down, and really be depressed, if you will, or down because you can't let the other side see that. And so, who do you lean on if you will, your confessor that you can talk to when you're feeling down when you're trying to fight the anti-joy part of your job? Dr. Deborah Schrag: I have lots of friends outside of medicine. And I've always found that that's really helpful to make time for friends outside of medicine. They help connect me to humor and other things. I'm coming up on a big high school reunion. My high school classmates and I still meet for picnics in Central Park. And there are about 120 in our graduating class. And I think we'll have about 110 of us getting together. We still have picnics with 40-50 people attending. So, there's nothing like old friends from childhood who now do all kinds of different things. So, that's really helpful. But I've also found that my mentors and colleagues who trained me and who know me really well, are a great source of advice. So, leaders in academic medicine, and I've always found that I've been able to get advice from people who were senior and leaders, people such as Dr. Mayer, Dr. Benz, Dr. Jim Griffin, and also junior colleagues. I now increasingly as I get old, I rely more and more on my trainees and my mentees. So, some of the folks I know best are people who I trained. So, I'll just give you one example. Many of you may know Ethan Basch. We worked together when we were both just coming up. I was an assistant professor. He was a couple of years behind me. I mentored him. Well, he's now chief of the Division of Oncology at UNC. He and I have written lots of grants together. We're really partners now. But it's been a lifelong professional friendship. Sometimes when I just need to let my hair down, I get on the phone with Ethan, and yeah, there's a little bit of commiserating. But I'll give you an example that runs through Dave. Some really valuable experiences had to do with being asked to serve on committees. I think it's great. I just want to give a shout-out to ASCO. Some of my earliest professional relationships were with superstars that I met through ASCO. So, people like Joe Simone, reading his Simone's Maxims everyone needs to read Simone's Maxims if you haven't. There was a guy by the name of Christopher Desh, who sadly passed on. But he was an ASCO member who practiced at the Virginia Commonwealth University back in the late 1990s. Boy, did that guy understand the joy in medicine, some of the early folks who started QOPI. Being introduced to those individuals who practiced in different parts of the country and who had different kinds of challenges - having that sort of rich network has been incredible. At some point, I think through such a connection, maybe it was through Dr. Mayer, I was referred to Dr. Johnson, who was then running the American Board of Internal Medicine committee that wrote the oncology exam. I participated in that for a few years that was led by Dr. Johnson. And I met incredible people on that committee, including Dr. Johnson, just Dr. Johnson's stories could inspire anyone and get them back on track just in terms of the humor and the joy and the love, and really the pride in the profession. But I met Jamie Von Roenn that way, who's now leading educational efforts at ASCO, she was on that committee. Lynn Schuchter became a good friend of mine as a result of that. So, I would just say, sometimes you need to get out of your own space. And sometimes I need to get out of Dodge, as they say, I need to get out of New York, get out of Boston, and being connected to colleagues across the country has been so rewarding. I have a network of friends at other institutions who I rely on. Serving on external advisory boards is a great place to meet people. Study section, if anyone has the opportunity to be on study section. That's a fabulous opportunity. So, I think participating in peer review, showing up at meetings, serving on ASCO committees, or ASH or AACR. These are really important experiences. And I will say in my leadership role, I'm really trying to make it clear to faculty that I encourage them to take time to participate in these activities and attend these events and even travel because the traveling is important, too. I could not have gotten the same dose of Dave Johnson, if I had not actually gone to the meeting, spent all day writing board review questions, and then having a nice meal afterward. That was part of the experience. I don't know what you would say, Dave, but that was my view. Dr. Dave Johnson: So, one of the things that Osler talked about was the fellowship of the profession, and how important it is to have those relationships. Even if one can't physically be with that individual, developing that spiritual relationship is really critically important. I'm so glad you brought this up and expanded on it in the way you did because I think it's absolutely critical to retain the joy of medicine. It's our colleagues, as well as our patients that make it such a marvelous, majestic profession, in my view. Dr. Pat Loehrer: I was going to just add something if I could. So, Deb, replace me on the ABIM, just to let you know, because we had certain slots on there. One of the not sure if it was the rules or guidelines that were mandated is that everyone needed to take the oncology boards, even though we wrote the questions, we had to take the test. And you knew that and you had such unbridled enthusiasm for this. I still remember this deeply, and that not only did you recertify for the oncology board, but you also studied to take the medicine boards too. Your love of medicine is so contagious. And I'm sure everyone at Memorial benefits from this. Dr. Deborah Schrag: Thank you. That's very nice to say. I do, I love the stories. I've been rounding with the house staff on the inpatient service. I think both of you know, inpatient oncology, as we're able to do more and more in the outpatient setting, our inpatients are very, very sick. And we often get a front-row seat to what I would call the social determinants of health challenges. In other words, if you've got relatives and resources, you may be able to be at home. But if you have severe pain or symptoms, and you lack the relatives, or you live on a fifth floor, walk-up, or just don't have the resources to get the home care that you need, you're more likely to be in our hospital. But as I round with the house staff, I find myself asking them to tell me more about the patient stories. Because when I round and they tell me that it's a 74-year-old with peritoneal carcinomatosis, jaundice, and abdominal pain. I'm so old that I've seen so many hundreds of those patients and the management hasn't changed very much. But what's really the privilege is to understand the journeys that got people where they are, and to learn a little bit about who these people are. I try to do that when I round with house staff and I find that it makes the experience better for them. I have to say that I do worry about how we train young physicians in oncology because what they see on the inpatient side is really the hardest of the hard, that's obviously less true in a leukemia service, where they're delivering lots of curative therapy or a stem cell transplant service. But in solid tumor oncology, it's really hard. I think it's something we have to have to tackle. We have to rethink education and medical oncology. I'm hoping that we're going to do that. That's also on the bucket list, by the way. I think we have to do that as a profession. And I know both of you are passionate champions and advocates for education, as is ASCO. But I think it's really imperative that we do that if we are to keep attracting talent. And then I just want to make one more point, which is that New York City is one of the most diverse places in the United States. I don't know about the planet, because I don't know the whole planet. But in the United States, we are incredibly diverse. But the oncology workforce does not yet look like that. So, we have a lot of work to do to train a much more diverse workforce. We're doing well with respect to gender, very well. We're literally about 50/50, we may even have a little bit higher proportion of women on the faculty here at MSK. And I think that's true nationally as well. But with respect to Blacks and Hispanics, and other underrepresented communities, Native Americans, we've got a long way to go. And we have a pipeline problem. And that's going to be hard. But it's hard work that we have to do, and I know you guys are working on that in your own centers as well. Dr. Dave Johnson: Let me follow up on that. What attributes are you looking for in trainees and newly hired faculty? Whether they be junior or senior faculty? What are the characteristics or attributes you seek that you think predict, or certainly you want your individuals to possess? Dr. Deborah Schrag: We all want people who have everything, but I would say creativity, the willingness to take risks, and the ability to ask a question. I say this to the trainees, frankly, I say it to my own children as well. ‘It's okay, take a harder course. Yes, you may get a B minus by trying something new and different, that doesn't play to your strengths. But try something new. Take risks. Yes, the trial may fail. Yes, you may not get that grant.' But I think a willingness to take risks, a willingness to put yourself out there, a willingness to stretch. I'm also looking for people who can work in teams because there is no aspect of medical care that happens in MSK, I suspect that it's also true that maybe medicine in Antarctica, but even medicine in Antarctica is probably a team sport. Medicine has become a very complicated team sport. It's a very complicated dance with pharmacists, nurses, and APPs. It takes a village to give a course of immunotherapy. It is very complicated. And so, when people like to control things and like to do everything themselves, they're going to have a hard time. And that's true I find for teaching, laboratory investigation, wet lab, dry lab, most good, impactful, important science in oncology these days, clinical trials, wet, dry, all of it gets done in teams. Teams that have people with different levels of training, different skill sets, early stage, late stage, people who are quantitative, people who can write, people who can program, people who can do lab experiments, and people who know what an organoid is. People who know how to program an in R. All different kinds of skill sets but they have to be able to work in teams. People who can't do that are going to struggle to achieve maximum impact. I'm not saying that there isn't room at the end for the occasional genius person who likes to work solo. But that's not really what we need to move the needle. So, I need team players. I think there is a big emphasis on collegiality. Of course, we want smart and we want brilliance. But sometimes a drop less brilliance and a drop more collegiality and being able to work together in a team, it goes a long way and it's the difference between doing something impactful and not. That's what I look for. I also think that it takes all different kinds of people. And no one has to excel at everything, but it's great for people to be able to excel at something. So, passion, drive, and ability to ask questions, and not being afraid to occasionally fail and having some tolerance for that and trying to make sure that leaders are able to tolerate that, too. We have to be able to. Dr. Dave Johnson: Yeah, I think those are great suggestions. We're getting near the end of our time today, and we have a lot more questions to ask. But what's your biggest fear, as the head of the Department of Medicine, looking to the future, what causes you to lose sleep at night? Dr. Deborah Schrag: I think the business of medicine. If medicine turns into something that feels just like [inaudible] work, and losing physicians, if we don't respect physicians' need to take care of themselves, to take care of their families, and yeah, to find that joy, then we will not attract the top talents. I think we need great minds and great hearts and people from all walks of life to enter the profession, because that's the talent that we need, to quote my friend, Paul Farmer, ‘Bend the arc'. And you know, we need to bend Kaplan-Meier curves in the right direction. And we need the talent to come into the profession, and if they see that we are not happy and not thriving, the next generation is going to go elsewhere. I don't want to begrudge my wonderful endocrinology colleagues. We need people to tackle diabetes, and we need great surgeons and great anesthesiologists, too. So, it's not just oncology. In medicine, I'm responsible for all kinds of discipline. And boy, we need a lot of cardio-oncologists because we've created all kinds of new challenges. So, it's all of the sub-disciplines of medicine, but I think physician well-being and attracting talent to the field is really essential and making sure that the business side of medicine doesn't take over and destroy the core promise and premise of academic medicine. It is a spectacular profession and calling, and it has led to so many advances that have really changed the world. And we have to, I think, preserve the good in that. My fear is that that gets further eroded. Dr. Pat Loehrer: Just one last question from me. Thank you for all your wonderful comments. But I think I have to ask this because it's such an unusual thing as they brought up at the beginning that you're the first female Head of Medicine at Memorial and Lisa DeAngelis is the first Physician in Chief. And so, although there is gender equity in medicine, there is not gender equity and leadership around the academic world. And this is a very unique situation there. Can you reflect a little bit about the significance of this and perhaps, lessons learned, particularly if you're speaking to a younger version of yourself or a young woman who's thinking about a career? What are the lessons between you and Dr. DeAngelis mean? Dr. Deborah Schrag: I'm not sure I've been at it long enough to have lessons. I'm just so grateful. So, I'm not in the generation that was a trailblazer. I'm a beneficiary. So, I've had the privilege of being trained by Dr. Jane Weeks, by Dr. Judy Garber. I, myself, had so many great mentors who were women. I would say to women, that you can have it all. You just may not be able to have it all at once. Women and men have to make choices. Can you have a lab and be a laboratory investigator? Yes. Can you do that and have a family? Yes. I think running a high-power lab and having a gigantic clinical practice and running clinical trials, I think the three-legged stool and the so-called triple threat is really, really hard. But I think it's hard for women and men. What I would also say to women is you don't have to be the boys - be yourself. I think the best advice I can give to leaders is to be authentic. Because everyone, men, women, people smell a phony and no one likes to phony. So, I think if you know how to partner, you understand that it's a team sport. I think women do that really well. So, I think being authentic, and I think women need to hear that, you don't have to emulate male role models. You have to be yourself. I would love to emulate the two of you. I have to thank both of you because the Indiana Miracle and Dave from his Vanderbilt days, Vandy, as Dave likes to call it, from his Vanderbilt days to his Texas days, like, the two of you are such incredible thought leaders and inspirational leaders in oncology, but I can't be you. The best we can be is sort of the best version of ourselves but we can be inspired by the great qualities that we see in other leaders and carry a little bit of that with us. So, I think that goes for women and for men. Dr. Pat Loehrer: Thank you! Well said, and I appreciate the thoughts. We've kind of gone through this and we're going to have to wrap it up. One of the questions that we often times ask our visitors is if there's a book that they're reading, a documentary that they're watching, a movie they're seeing, or anything you'd recommend? Dr. Deborah Schrag: That's a good question. So, yes, actually. One of the ways that I learn about leadership that I find, actually a fun way that's both relaxing and educational, is to read a biography. I love reading biographies. I'm going to name two. And these are popular books - for scholars these may not be. First really fun book is ‘The Splendid and the Vile', by Erik Larson. It's a book about Winston Churchill in 1940, and how he has to try to persuade the United States to enter World War Two, but it's really about a particular year in history and Winston Churchill. Dr. Dave Johnson: It's a great book. Dr. Deborah Schrag: It's called, The Splendid and the Vile. I just learned so much about leadership from that book and the decisions that Winston Churchill makes in his bathtub. So, just read that book and think about what Winston Churchill does in his bathtub. I can't lead from my bathtub, I live in a New York City apartment, but that's one. Then more recently, I guess there's a little German theme happening here, is, The Chancellor. It's about the life of Angela Merkel. It's long, I haven't finished it yet. But it's incredible. What a story, East Germany, her leadership style, how she studies chemistry, how she rises. It's a fantastic book. It's called, The Chancellor. So, I will recommend that one. Then the last one, my beloved nephew who's like a son to me. He's about 36 years old, and he has ALS. And he's completely paralyzed. He is on a vent and he has two little kids. But he released a documentary that actually won at the Tribeca Film Festival called, Not Going Quietly, which is about a cross-country trip that he made. He's a pretty inspirational character, despite the fact that my nephew was completely locked in, he communicates only with his eyes. He is living a remarkable life. I think that documentay, I know this is a shameless plug for my nephew, but he's a pretty inspirational character. I don't necessarily agree with 100% of his policy prescriptions and recommendations. But there are lots of ways to make meaning in the world. So, that's another documentary. Dr. Pat Loehrer: That's incredible. Thank you so much for sharing that. I'm going to look it up. People think cancer is the worst thing you can get but there are worse diseases to have. Dr. Deborah Schrag: Yeah, I think this one might change your idea. And then I would also say Paul Farmer's Bending the Arc. I think for young physicians who haven't seen that movie, I would recommend Bending the Arc. Dr. Pat Loehrer: Thank you. Dr. Deborah Schrag: Thank you! It's been great to chat with you. Dr. Pat Loehrer: It's great. So, that's all the time we have for today. And I really want to thank you, Deb, for joining us and for all your insight. It's been wonderful. I also want to thank all our listeners for tuning in to Oncology, Etc. This is an ASCO Education podcast where we'll talk about just about anything and everything, if you've heard. If you have an idea for a topic or guest you'd like to see on the show or a host that you would like not to see on the show, just email us at email@example.com. Thanks again. And Dave, I just have a riddle for you here. How do you make an octopus laugh? Dr. Dave Johnson: Show him your picture. Dr. Pat Loehrer: Ten-tickles. That's all we have for today. You guys have a good evening. Take care. Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.
*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** How do you decide if a pancreatic head mass is resectable? Does vascular involvement matter? What impacts survival? Join the Surgical Oncology team as they dive into operative considerations when operating on borderline resectable and locally advanced pancreatic cancer. Break the nihilism and find out about the options available for patients with this dreaded malignancy. Learning Objectives: In this episode, we review the various definitions for resectability in pancreatic cancer, as well as the various prognostic markers and decision points to consider when deciding which patients may benefit from an operation. Hosts: Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center. Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
About our Guest:Samuel Mandell, M.D., M.P.H., is an Associate Professor in the Department of Surgery at UT Southwestern Medical Center. He specializes in trauma surgery, surgical critical care, and comprehensive care of burn-injured patients. Dr. Mandell also serves as Burn Section Chief and Director of the Parkland Regional Burn Center in Dallas, Texas.How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:By the end of listening to this two-part series, learners should be able to:1. Describe the key elements of the initial evaluation and resuscitation of the burn injured pediatric patient.2. Recognize risk factors and clinical features of inhalation injury.3. Recognize risk factors and clinical features of carbon monoxide and cyanide poisoning.4. Estimate the total body surface area (TBSA) burned.5. Recall general indications for transfer to a specialty burn center.Support the show
In this episode, we are fortunate to hear three interviews from guest experts in the field discussing occupational hazards in vascular surgery. We cover physical pain and discomfort with Dr. Max Wohlauer, radiation safety with Dr. Melissa Kirkwood, and pregnancy and radiation with Dr. Venita Chandra. Show Guests: Dr. Max Wohlauer (@doctormaxw) is an assistant professor at the University of Colorado School of Medicine, as well as an associate program director of their residency and fellowship. He founded the Vascular Surgery COVID-19 Collaborative (VASCC, https://medschool.cuanschutz.edu/surgery/divisions-centers-affiliates/vascular/research/vascc/vascc). He obtained his medical degree from the Albany Medical College and completed general surgery residency at the University of Colorado followed by vascular surgery fellowship at the Cleveland Clinic. Audible Bleeding with Dr. Samuel Money on Ergonomics in Surgery: https://www.audiblebleeding.com/money-ergonomics/ Physical discomfort, professional satisfaction, and burnout in vascular surgeons: https://doi.org/10.1016/j.jvs.2018.11.026 Physical pain and musculoskeletal discomfort in vascular surgeons: https://doi.org/10.1016/j.jvs.2020.07.097 Vascular surgeon wellness and burnout: A report from the Society for Vascular Surgery Wellness Task Force: https://doi.org/10.1016/j.jvs.2020.10.065 Dr. Melissa Kirkwood is an associate professor at the UT Southwestern Medical Center and chief of the division of vascular surgery. She completed her medical degree at Yale University School of Medicine, followed by a general surgery residency at The University of Chicago, and vascular surgery fellowship at the University of Pennsylvania Medical Center. One of her major research interests is radiation dose control and novel technology for decreasing radiation exposure. Dual fluoroscopy with live-image digital zooming significantly reduces patient and operating staff radiation during fenestrated-branched endovascular aortic aneurysm repair: https://doi.org/10.1016/j.jvs.2020.05.031 Disposable, lightweight shield decreases operator eye and brain radiation dose when attached to safety eyewear during fluoroscopically guided interventions: https://doi.org/10.1016/j.jvs.2021.11.067 Radiation brain dose to vascular surgeons during fluoroscopically guided interventions is not effectively reduced by wearing lead equivalent surgical caps: https://doi.org/10.1016/j.jvs.2017.12.054 Dr. Venita Chandra (@ChandraVenita) is a clinical associate professor at Stanford University as well as the program director for vascular surgery residency and fellowship. She obtained her medical degree from the University of Chicago followed by general surgery residency and vascular surgery fellowship at Stanford University. She also completed a technology development fellowship in the Stanford Biodesign Program. She is part of the SVS Wellness Task Force and has an interest in radiation safety in pregnancy. Monitoring of fetal radiation exposure during pregnancy: https://doi.org/10.1016/j.jvs.2013.01.052 Incidence of Infertility and Pregnancy Complications in US Female Surgeons: https://doi.org/10.1001/jamasurg.2021.3301 Host Introductions: Dr. Matt Chia (@chia_md) is in his 6th year in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine, and also holds a Master's in Health Services and Outcomes Research from Northwestern. Dr. Jessie Ho (@JessieHo_) is in her 4th year general surgery resident at Northwestern University. She obtained her medical degree from the Texas A&M College of Medicine, and is completing a Master's in Clinical Investigation at Northwestern. Authors: Matt Chia, MD, MS, Jessie Ho, MD, Janhavi Patel, BMSc Editor: Matt Chia, MD Reviewers: Sharif Ellozy, MD, Adam Johnson, MD
In this episode, Mitch Belkin and Daniel Belkin speak with Ben White about his background and reasons for selecting radiology. They discuss ways to improve radiology residency training and medical school education. They briefly touch on physician shortages, Dr. White's blogging at BenWhite.com, and his nano-fiction project (Nanoism).Who is Ben White?Dr. Ben White is a practicing neuroradiologist and an Associate Program Director at Baylor University Medical Center. Dr. White obtained his Medical Degree from University of Texas Medical School at San Antonio before completing a radiology residency and neuroradiology fellowship at UT Southwestern Medical Center. He's a prominent blogger at BenWhite.com, the editor of a nano-fiction website, and the author of three books, including a free book on student loans. References:Personal Blog: http://benwhite.com/Twitter: @benwhitemdNano Fiction Project: https://nanoism.net/Free Book on Student Loans______________________Follow us @ExMedPod, and sign up for our newsletter at www.externalmedicinepodcast.com/subscribeDaniel Belkin and Mitch Belkin are brothers and 4th year medical students. The External Medicine Podcast is a podcast exploring nontraditional medical ideas and innovation.
Dr. Kathleen Bell, Professor and Chair of the Department of Physical Medicine and Rehabilitation at UT Southwestern Medical Center, and Dr. Nahid Bhadelia, associate professor of infectious diseases at Boston University School of Medicine and founding director of the BU Center of Emerging Infectious Diseases Policy and Research, discuss the latest research and information on long COVID.
As our guest today, Dr. Madhukar Trivedi, says, depression and anxiety are pediatric illnesses. These are pervasive issues that affect a large number of children and teens. He has seen this not only anecdotally as many of us have, but in his distinguished career as a psychiatrist and researcher. Madhukar H. Trivedi, M.D., is Professor, Chief of the Division of Mood Disorders, and Director of the Comprehensive Center for Depression in the Department of Psychiatry at UT Southwestern Medical Center. Dr. Trivedi, holder of the Betty Jo Hay Distinguished Chair in Mental Health, is an established efficacy and effectiveness researcher in the treatment of depression. His research focuses on pharmacological, psychosocial, and nonpharmacological treatments for depression. Dr. Trivedi shares with us today many of his findings, as well as practical steps we as parents can take when we have concern for the mental health of our children.
Host, Dr. John Sweetenham, associate director of Clinical Affairs at UT Southwestern Harold C. Simmons Comprehensive Cancer Center, and Dr. Keith Argenbright, medical director of the Moncrief Cancer Institute, a non-profit, community-based cancer prevention and support center, discuss models of survivorship care, and likely challenges in addressing the needs of a growing population of survivors. Dr. Argenbright is also the chief of Community Health Sciences at UT Southwestern Medical Center. Transcript: Dr. John Sweetenham: Hello, I'm John Sweetenham the associate director for Clinical Affairs at UT Southwestern Harold C. Simmons Comprehensive Cancer Center and host of the ASCO Daily News Podcast. The number of cancer survivors in the United States is increasing each year, and this is a reflection of advances in cancer prevention and screening, as well as in cancer treatment. And the National Cancer Institute now estimates that there will be more than 22 million cancer survivors in the U.S. by the year 2030. Joining us to discuss the future challenges of providing care for this growing population is Dr. Keith Argenbright. He is the director of the Moncrief Cancer Institute in Fort Worth, and a professor at the UT Southwestern Simmons Comprehensive Cancer Center, and a colleague and friend of mine. My guest and I have no conflicts relating to our topic today. Our full disclosures are available in the show notes, and disclosures of all guests on the podcast can be found in our transcripts at asco.org/podcasts. Keith, thanks for being on the podcast today. Dr. Keith Argenbright: Thank you for having me, John. Dr. John Sweetenham: So, the growing population of cancer survivors presents major challenges for providers, health care systems, and other stakeholders. Could you talk to us a little about models of survivorship care that you think could potentially meet the challenges of caring for millions of survivors in the future? Dr. Keith Argenbright: Of course. I guess I'll start that response by recalling a meeting that I was at back in the 2008, 2009 timeframe, more than 10 years ago. And it was held in Washington D.C. and sponsored by Livestrong. And I think that that was the question that we were asking ourselves 10 plus years ago. What are these models going to look like to meet the challenge of the millions of cancer survivors in the future? And in some way, I think we've come a long way, and in other ways, I'm not so sure we have. Right now, I think we think of cancer survivorship maybe being delivered at an academic medical center and a structured model, maybe being delivered by a community physician in an informal way. I think that 1 thing that is for certain is that the models of care are going to reflect the reality on the ground. And that there won't be 1 single model of survivorship, but there will be multiple models of survivorship that are created at the local level that understand the resources as well as resource limitations for any given community, for any given oncology practice, for any given group of survivors. And I think that that was probably a conclusion that we reached 10 years ago. And I think that that still holds true now as well as in the future. Dr. John Sweetenham: Thanks, Keith. So obviously to your point, there are many models of survivorship and there clearly is not going to be a kind of 1 size fits all approach to how we address cancer survivorship. And maybe just to backtrack a little, 1 of the things that I should have said at the beginning of the podcast is that, although it's perhaps a little bit cliche to say this, I do think that now there is a widespread acceptance that cancer survivorship care begins from the day of diagnosis, and isn't something which kind of kicks in once cancer treatment is over. And to that point, I know that 1 of the models that you have adopted in Fort Worth has been to embrace primary care practice into the cancer center to assist with the survivorship and supportive care of patients. Could you just say a little bit about that model and talk to us a little about what you've experienced so far? Dr. Keith Argenbright: Yeah, for sure. And to your earlier point, we've made great strides in actually recognizing the value of survivorship. And I don't want to dismiss that. I recall again thinking back 10, 15 years ago, I think that a lot of us thought, "Well if you're cured, that's great. And so that's the end of our responsibility." And I think that the medical community and the oncology community have realized that a lot of these cures come at a price and we're recognizing that price in the form of survivorship and survivorship care. So I don't want to neglect the fact that I think that we've come a long way in a very short period of time in embracing the idea of survivorship. What we are doing at Moncrief Cancer Institute is we're bringing in additional specialties into the survivorship milieu. We talked about the numbers I think a little bit earlier in the podcast. Something like 17 million cancer survivors now with 13,000 practicing oncologists—there's just no way that our oncologists can or that they have the bandwidth, nor are they expected to be the only ones providing survivorship care. What we did here at Moncrief and at UT Southwestern is we are bringing in different clinical specialties to assist in this team-based approach to survivorship care. And that's been led by our family and community medicine department which has established a primary care clinic in our cancer center for cancer survivors. Patients with cancer are introduced to these practitioners very early in their treatment cycles. Sometimes in their first or second visit with their oncologist here. We will also introduce them to the primary care physician who might be taking care of them at the end of their treatment, even though that might not be for another 6 to 12 months. It's been very well received. Cancer survivors a lot of times don't even have a primary care physician, to begin with. And so sometimes this is their first experience with a true primary care physician. Oftentimes the primary care physician is able to look more comprehensively at some of the other issues that may or may not be cancer-related. It's been very well received. We bring in other specialties as well, physical medicine, rehabilitation, cardiology, psychiatry, and psychology. So it's something that we've been doing now for about a year. And we're very excited about the promise for a model like this in the future. Again, not all cancer centers or community practices have the ability to do this type of program but we're fortunate that we are. And hopefully, others will be able to take pieces of what we're doing and find them relevant and replicable in their situation. Dr. John Sweetenham: Yeah. Thanks, Keith. And I do agree. I think it's a great innovation. And your comments pick up on another very important point and that's the workforce issue, which I think we're challenged with. Because of course, with an anticipated 22 million cancer survivors by the end of the decade, we are going to need a significantly expanded workforce of health care professionals of various types to work with these patients. And in addition to that, of course, we're going to need to be able to deliver care in community settings. It can't all be done in big health systems and academic oncology centers. So accepting that that will be the case and that we are going to need to develop community-based cancer survivorship services, what do you think are going to be the most challenging aspects of building those services and sustaining them out in the community rather than in big centers? Dr. Keith Argenbright: Funding and reimbursement is always a challenge, right? Dr. John Sweetenham: Right. Dr. Keith Argenbright: A lot of these survivorship services, a medical visit with a practitioner, for instance, a visit with a psychologist or a psychiatrist regarding mental and behavioral health issues are reimbursable. But a lot of the things that we hear from our patients that they find most valuable in a survivorship program are not reimbursable. And I'm talking about things like nutritional programs, not just nutritional education, but an actual nutritional demonstration in cooking classes. Exercise programs are not currently reimbursable. The ability to speak with a financial counselor regarding the financial strain that has been placed on the patient with cancer and their family regarding the toxicity that they're left with after their cancer treatment. So these continue to be challenges for us, and I'm sure for the listeners of the podcast as well. These are challenges that are not easily overcome. We are fortunate that we have some philanthropic partners who support a lot of our programs, not everyone is as fortunate as that. So that's one of the barriers. One of the things though, John, that I'm really encouraged about is the new and innovative ways that we've been able to use telemedicine and video conferencing throughout the pandemic. I personally have been amazed at how quickly our providers and our patients have adapted to telehealth, telemedicine, and video visits. In our survivorship care, we've taken that to the next level and have delivered a lot of our survivorship care services through Zoom and other video and electronic means. And this has just been a game-changer for us, as well as the patients. A lot of our patients travel a great distance to us to get cancer care chemotherapy, for example, and there's no way to deliver that remotely. But we've become pretty adept at learning how to deliver a lot of this survivorship care by Zoom and a teleconference, and the patients just love it. They don't have to make the commute, they don't have to deal with our parking situation. So we're continuing to explore not only other ways and other cancer survivorship services to deliver through video and through remote means. But also, how to actually bring the team together so that it's not just the patient who is having a visit with a physician, but maybe the patient has a visit with the physician along with a nurse navigator, along with an exercise specialist altogether in real-time. And it's something that we're really excited about and exploring actively right now. Dr. John Sweetenham: Yeah. Thanks, Keith. And in fact, that sort of dovetails into the next question I had for you. And I think you've partially answered that. But I'd just like to extend that theme, that sort of telehealth and new innovations theme a little bit further if we can. Obviously, as our patients are living longer, we need better supportive care strategies for them because of the many experiences that they're going to confront. And you've already mentioned a number of those; infections, neuropathy, depression, [and] the financial stresses that they're going to encounter. And I think, as you point out, the telehealth opportunities have really been a tremendous innovation in helping us to deliver that care. In addition to that though, there clearly are many other aspects of cancer survival, which can impact a patient's wellbeing and compromise their adherence to long-term cancer treatments and subsequent follow-up. And we need other ways of influencing wellness and healthy behaviors both during and after treatment. So, in addition to the innovations that you've already mentioned of telehealth in our direct health care provider to patient interactions, do you see anything on the horizon in terms of technology or anything else, which is going to help us in the professional-to-professional communication space? And I guess what I'm thinking of particularly, is in making sure that our health care professional colleagues, let's say out in the community, are fully clued in, in terms of likely cancer recurrence, [and] what they should be looking for. They will all know which wellness and healthy behaviors they should be encouraging, but really in terms of providing some additional support and education for health care professionals in the community with respect to the needs of our cancer survivors. Dr. Keith Argenbright: Yeah. Great question. And I want to circle back to what we spoke about earlier about this primary care physician clinic or this primary care clinic being embedded within our current cancer center. In working with our family medicine and internal medicine colleagues, when we developed this, we realized that not only is this a great opportunity for our survivorship patients, not only is a great opportunity for our current oncologist to offload some of the survivorship care to a primary care clinic, this is a great professional education opportunity. This is still a young program and it's got a long way to go before it matures. But pretty quickly, we're going to start bringing some of our medical students, some of our family medicine residents into this clinic, because they need to know more about the long-term effects of the medications. John, we're all learning about these new medications, right? The CAR T therapies, the tyrosine kinase inhibitors, the antibody, we're all learning about this. And it's a focus of current oncology education so that the oncologist will understand these side effects and these late-term effects. We need to expand that education to our medical students, our residents, as well as in our community primary care physicians as well. As you know, I'm a primary care physician by training. And some of these drugs are very frightening to primary care providers because the oncologists are around these medications all the time, but not so much the primary care physicians. And so, we need to educate our primary care physicians, both at the beginning of their training, as well as throughout their training to understand the medications better, understand the side effects better, understand what they are able to take care of themselves in their own primary care clinics, what they need to be able to refer back either to an oncologist or potentially a cardiologist. So I know that ASCO is very interested in working with some of the other professional family medicine and internal medicine and pediatric societies in order to expand this education into the providers. And I think we need to continue to look at that and continue to have that our focus. Dr. John Sweetenham: Thanks, Keith. I think because as you were speaking, the other thing that does occur to me is, of course, that the communication piece, it's going to be so important that it's very much a two-way street. Because as you pointed out with a lot of these newer treatments, checkpoint inhibitors, and so on, we're going to see new toxicities, long-term toxicities emerge, one would anticipate, over the coming months and years. And making sure that there is two-way communication as community-based health care providers start to see some of these toxicities emerge, and making sure that we collect these data and ensure that we are keeping a very close eye on how this develops is going to be really important. So, I think two-way communication is going to be key. So, Keith, we, I think are just about at the end of our time. Thank you very much for coming onto the podcast today and sharing your insights on models of care of cancer survivorship. I think although we have many challenges ahead, as we try to support our patients and design care models for them in the future, I think maybe the take-home message has to be that we are in, I think in many ways, the fortunate position of being able to have this discussion because we have so many more cancer survivors than we had some years back. So greatly appreciate your thoughts today. And thanks again for joining. Dr. Keith Argenbright: My pleasure. Thank you, John. Dr. John Sweetenham: And thank you to our listeners for your time today. If you enjoyed this episode, please take a moment to rate and review us wherever you get your podcasts. Disclosures: Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness Dr. Keith Argenbright: None disclosed. 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.
In this episode we sat down withDr. Nneka Ifejika, Associate Professor of Physical Medicine and Rehabilitation and Section Chief of Stroke Rehabilitation at UT Southwestern Medical Center, following her Grand Rounds presentation, Stroke Recovery Throughout The Continuum of Care at McGovern Medical School. She has secondary appointments in the departments of Neurology, and Population and Data Sciences, and has both clinical and research interests spanning each of these fields. Outside of her numerous research accolades, Dr. Ifejika has exceled as a clinician, earning Texas Monthly's title of “super doctor” in each year from 2018 to 2021, and “Top Doctor” in Physical Medicine & Rehabilitation; awarded each by H Texas Magazine, Texas Monthly Magazine and Houstonia Magazine in numerous years from 2014-2018. She is beloved by her patients, and strongly missed by her colleagues here at UT Houston. Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ UTHealth Stroke Institute Vascular Neurology Fellowship https://www.uth.edu/stroke-institute/training/vascular-neurology-fellowship Dr. Nneka Ifejika https://utswmed.org/doctors/nneka-ifejika/ Hosts: Amy Quinn, Pam Zelnik Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke
In the second of our two-part interview, Oncology, Etc. hosts Drs. Patrick Loehrer (Indiana University) and David Johnson (University of Texas) continue their conversation with two physician astronauts. Hear the incredible stories of Drs. Robert L. Satcher (MD Anderson), Ellen Baker (MD Anderson), and their lives on and off this planet. If you liked this episode, please subscribe. Learn more at education.asco.org, or email us at firstname.lastname@example.org. TRANSCRIPT David Johnson (Dave): I'm Dave Johnson at UT Southwestern Medical Center in Dallas, Texas. I'm here with Pat Loehrer, my good friend who also happens to be the Director of Global oncology and Health Equity at Indiana University. Welcome back to Oncology, Etc. And part two of our conversation with Dr. Ellen Baker and Dr. Robert Satcher. Dr. Baker and Satcher are former NASA astronauts now practicing in Indiana Cancer Center in Houston. In Episode One, we learned about their time at NASA and some of their spaceflight adventures. In this episode, we will learn more about their post-NASA activities. We will rejoin the conversation with Pat asking Dr. Baker, how her work in space informed what she does now. Patrick Loehrer (Pat): I know Ellen, you do work with Project ECHO, which is doing work globally. Tell us a little bit about that if you could. Ellen Baker: You know NASA seems a million lenses away now. I sort of vaguely remember my flights which were a long time ago, more than 25 years now, but seems like yesterday. But you learn a set of skills that are transferable, I think. You come into NASA with some skills that are transferable and you leave with those. We did a lot of work with international partners, particularly in the 90s with the Russians. And I now do a lot of work with international colleagues, particularly in Africa, Central, and South America. I think that's one of my transferable skills, perhaps from NASA. And I don't know, Bobby, it's thinking on your feet and being adaptable and not getting flustered and compartmentalizing, and quite honestly, a lot of those are skills I think you develop in medicine as well. So, there are a lot of similarities and I think a lot of benefits flow in both directions. Dave: Could you elaborate a little bit on Project ECHO that you're involved in? What sorts of things are you doing with Project Echo? Ellen Baker: Project ECHO is very simple, it's a video conference where you connect specialists generally at academic institutions with medical providers in rural and underserved communities where perhaps specialists are not available. And the intent is to meet on a regular basis and provide assistance and support and patient care. So, providers in isolated or rural communities or underserved communities can care for their patients locally and patients then don't have to be referred to a tertiary care center, often very far away at great cost, etc. It was designed by a gastroenterologist at The University of New Mexico, Sanjeev Arora, who started the ECHO program, it stands for “Extension for Community Health Care Outcomes. In New Mexico, it was at a university in Albuquerque, there were maybe 30,000 patients around New Mexico who had hepatitis C, and were not being treated except perhaps in his clinic. And he partnered with about 21 providers in the community around the state and gave them the support they needed to be able to provide care for patients with hepatitis C, locally. This was back when the treatment was quite toxic. A lot of primary care providers didn't feel comfortable delivering this sort of care. That was sort of the beginning of ECHO, and it's since been applied to many different disciplines. At MD Anderson, we have, I don't know, I think maybe 13 Different ECHO programs for cancer prevention. That would be cervical cancer prevention, tobacco treatment, melanoma detection, also for treatment, primarily with partners who are international. We worked a lot with partners in Mozambique for the treatment of chronological cancers, breast cancers, and hematologic cancers, survivorship, palliative care, and even health care policy. So, that's sort of the ECHO in a nutshell, and we use it quite a bit at MD Anderson, but we're just one of the hundreds of different institutions that use the ECHO model for this. Pat: What I get from you, Ellen, though, is a sense of telemedicine and teamwork and collaboration, which is a lesson that you have to have, I think, as an astronaut to be able to do that. And Dr. Satcher, your extent and your thoughts now, how has that experience as an astronaut informed your current work? Robert Satcher: A lot of the skills are transferable. You come in with skills like medical training that you use and build upon when you become an astronaut. And then once you leave If you come back to the medical profession, there are a lot of skills that transferred to that field too. I see what I do is surgery, it's sort of an activity, which has a beginning and an end similar to spaceflight. And operationally, a lot of the skills that we learned as astronauts actually do transfer very well to doing surgeries. Now, one of the things that were more recently brought over is just the whole idea of a pre-brief and a debrief, which we do for surgeries now and that wasn't the case when I was training back in medical school. So, it's sort of a recent adaptation. But while I was at NASA, I would often think about that. Now, this actually would work really well, when doing surgeries, because it would help improve the process and actually make sure that you're making the best use of resources, people, etc, which they do a very good job of training you as an astronaut. The telemedicine aspect of being an astronaut and taking care of people that way, we finally are doing that at MD Anderson, reluctant adapters in the cancer world to using technology sometimes like that, although in the ER, we use a lot of technology, I think there's still this notion that there needs to be a real face to face connection between doctor and patient, very strongly rooted in the cancer world, for obvious reasons, in the past, being diagnosed with cancer, and certain types of cancer, certainly, was just amounted to a death sentence, because there weren't good ways of taking care of people. But now with advances and what we've been able to do, the outlook for cancer patients is much better now than it's ever been and continuously improving. And the pandemic is really the thing that forced this change in the cancer world and I was actually part of the effort introducing video visits at MD Anderson, which is part of something that it's going to be doing moving forward. Fortunately, the advantages of it are kind of obvious. You don't have to come into the institution for everything. It basically allows continuity of care and it potentially allows you to reach more people. That's something that makes cancer care more equitable, which is something that needs to happen similar to how becoming an astronaut needed to be more equitable. So, a lot of these kinds of things do carry over. The other aspect of training at NASA, which I think I can relate a lot to, was actually when I did the spacewalks and being focused on getting some specific tasks done. It felt the most like doing surgery and we were actually doing some repairs on the robotic arm because it was very technical, using these specialized instruments and having to be very careful. Dave: How do you keep from spinning off in space by using one of those ratchet tools? Like they put tires on NASA? Do you have to use something like that? Robert Satcher: Well, they thought of all of these things, of course. You have all of the foot restraints, other ways of stabilizing yourself. The foot restraint is one of the main ways you also have a restraint that's sort of like a, how do you describe it, it's like… Pat: A tether? Robert Satcher: There's the tether to keep you from floating away. But it's a restraint that's mounted on your belt, essentially. And it's sort of a screw mechanism that makes it flexible, then you can attach it to a rail or whatnot. And then you rigidize it by screwing in the opposite direction, which is a very clever device but it helps you to keep from spinning as you say. Dave: So, both of you have really gotten into global health in your own separate ways, I suppose. And maybe this seems obvious, but did your experiences looking back at Earth have any influence, or were you interested long before you began your NASA careers? Maybe we should start with Ellen. Ellen Baker: I think I was interested before my NASA career. I was actually one of the only members of my medical school class who did a rotation abroad, back when almost nobody did rotations abroad as a fourth-year med student, and I like to say, well, I kind of got distracted by this NASA thing. And after I finished with that, I came back to medicine and sort of rekindled my interest in global health. Dave: And Robert, what about you? Robert Satcher: Yeah, I did too. We traveled. When I was growing up, we spent six months in Uganda. That piqued my interest in traveling and then when I was in medical school, the rotation in Gabon as part of the Schweitzer fellowship, and then when I was in residency too, I did several trips and a couple of attendings in orthopedic surgery when I was doing these trips to South America. And that's when I did those, and, in fact, continued when I was a faculty member at Northwestern, doing some additional trips to under-resourced countries. So, that's been sort of my interest. Pat: Thank you for your work. It's incredible. We have a couple of questions. I wanted to talk for another couple of hours, but we weren't able to do that. Dave and I talked about books. What I do want to know from you is what is your favorite movie about space that you think is the most accurate one and maybe perhaps the best book or any other recent book that you've read? How about you first, Robie? Robert Satcher: I don't get any answer for the book because I haven't read a lot of Space books, but for the movie. 2001 Stanley Kubrick. Dave: Absolutely. Robert Satcher: At the time, they did that really well. And that was before I became an astronaut. When I go back and look at it now. I still think, yeah, just very intelligent. Obviously, it's a very thrilling movie too. Pat: I'm not saying that I'm old, but I remember in high school and grade school reading 1984 as a futuristic novel, and 2001 came out as futuristic and now it just blows your way that it's 40 and 50 years ago, that happened. Ellen, how about you? Ellen Baker: I have to say there are a lot of space movies out there that I don't like. I'm not a fan of space movies, where there are vehicles exploding and getting lost, and I find it a little bit offensive when the laws of physics are ignored. So, I would say there are some really good documentaries out there. And the real thing, I think, is at least as exciting as Hollywood. So, there are a couple of really good documentaries that are actually current right now. And in terms of Hollywood, I would say the Martian was pretty good and it was a bit classic in the astronaut office. I think they did try to obey most of the laws of physics. And there were one or two folks in the astronaut office who we thought could definitely be the Martian. Pat: That's a great book. It has the best opening line of any book ever written, which I am not going to repeat here, but if you're curious about it, pick up the book and just read that first line there, it says it all. Dave: Another question, we'd like to ask our guests, and we'll start this time with you, Ellen. If you could speak to your younger self, knowing what you know today, what advice would you give yourself at the beginning of your medical career that you didn't know then but you know now? Ellen Baker: I think when you're 25, you think you have all the time in the world. And as I got older, there was so much more I wanted to do in medicine and perhaps I would have focused a little bit more, and I wasted a lot of time. I had a lot of fun. But what seems the older I get, the more I've got to cram into the time that I have left. And maybe that's just life, that would be it, I think. Dave: I think that's an important point. I often tell residents and my colleagues that you can lose a lot of things and regain them, but you can't lose time and regain it. So, use it wisely. Robert, what would you tell your younger self? Rober Satcher: I'd probably say there's no such thing really as perfection that that shouldn't be something that you obsess with. Over the years, I've learned that and I saw an article recently about a surgeon talking about good enough is good enough and the enemy of good is better. I think that has a lot of practical ramifications in terms of how one should wisely spend their time. So, I would emphasize that to my younger self. Dave: So, thank you for that. I think both bits of advice are very helpful. Well, that's really all the time we have for today. We could go on, I'm sure for several more hours. I want to thank both Dr. Baker and Dr. Satcher for their participation in an incredible conversation. I also want to thank our listeners for tuning in on Oncology, Etc. This is an ASCO educational podcast where we'll talk just about anything. If you have an idea for a topic or a guest, please send us an email at asco.org. Pat, before we sign off, do you know why an astronaut would be a good spokesperson for the COVID vaccine? Pat: No, I don't, Dave. Dave: Come on! You got to know that they like booster shots. Pat: That's good. Dave: Alright guys, thanks a lot. Thank you for listening to the ASCO education podcast. To stay up to date with the latest episodes. Please click subscribe bribe? Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education that asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product service organization, activity, or therapy should not be construed as an ESCO endorsement.
In this episode of Entrepreneur Rx, John has the incredible opportunity of chatting with Erik Kulstad, a healthcare professional with an incredible background, co-founder of Attune Medical, and Associate Professor at UT Southwestern Medical Center. Attune Medical is a company that is committed to advancing temperature management therapy in all clinical contexts with three pillars in mind: clinical needs, the state of science, and patient safety. Together, they talk about the entrepreneurial path that Erik has taken, how he got into medicine after some years as an auto mechanic and chemical engineer, how the device they've created is helping patients, their pros and cons, and ultimately what else they're currently developing. Erik also covers a little bit of the story of the patent process and starting the company, how doctors worldwide have been using their technology and his piece of advice for newcomer entrepreneurs.
Caris Precision Oncology Alliance™ Chairman, Dr. Chadi Nabhan, sits down with Dr. Tian Zhang, Associate Professor at UT Southwestern Medical Center, to discuss the latest findings and top abstracts presented at this year's ASCO GU meeting. For more information, please visit: www.CarisLifeSciences.com