Tag Archives: cancer

Grateful non-patients

One of the great privileges of my job is talking to grateful patients and their families. It is hard to imagine anything more rewarding than hearing a heart-felt thank you from a patient impacted by cancer who has returned to a healthy, happy and productive life due to progress made possible by the research being conducted at Holden and delivery of state-of-the-art cancer care. Such conversations help many of us keep going despite the many challenges we face working in such a difficult field. In addition, support from grateful patients and their families provides us with philanthropic resources that are vital to accelerating progress in areas as diverse as pilot research projects, recruitment of new faculty, education for oncology nurses and patient amenities. Such grateful patients are vital partners in our efforts to reduce the burden of cancer even further.

Well, on second thought, I said “it is hard to imagine anything more rewarding,” when in truth I can imagine something more rewarding. That would be knowing that our efforts had prevented cancer from occurring in the first place. Solid research indicates reducing use of tobacco, encouraging healthy diet and exercise, increasing rates of HPV vaccination, limiting both natural and artificial exposure to harmful UV rays, testing and mitigating radon exposure and helping patients obtain screening for both pre-cancerous lesions and early cancers all contribute to reducing the burden of cancer by preventing it from occurring in the first place.

Cancer prevention and cancer therapy are alike in that we have considerable progress in both areas, yet there is much more we need to do. However, cancer prevention and cancer therapy are very different in that cancer prevention is unlikely to lead to grateful patients saying thank you. Individuals whose cervical cancer was prevented by the HPV vaccine or lung cancer avoided because they paid attention to anti-smoking messages they heard as teenagers are not cancer patients and go about their lives without ever knowing the impact cancer prevention efforts had on their lives. You and I, as well as our loved ones, may well have benefited from such cancer prevention efforts.

So, next time you think about our past, current and future efforts to reduce the burden of cancer, think about the vital role cancer prevention plays in that effort. If you see a scientist, physician or public health worker dedicated to cancer prevention, give them a big thank you. You never know whether you owe them a huge debt of gratitude. Those of us who are fortunate enough to not have been diagnosed with cancer should consider ourselves “grateful non-patients” who, due to cancer prevention efforts, did not develop cancer in the first place. Finally, support for ongoing cancer prevention efforts from both grateful patients and grateful non-patients is needed to assure we succeed in tipping the balance towards more grateful non-patients in the years ahead. It truly is hard to imagine anything more rewarding than that.

The War Metaphor

I often start talks I give on cancer research with a discussion of the war on cancer. To be honest, I have a very mixed relationship with this metaphor.

The concept of the war on cancer was first popularized in 1971 by President Richard Nixon and used in a more nuanced manner more recently by Vice President Biden. This metaphor emphasizes how working together against a formidable foe will improve our lives and those of future generations. It speaks to the need for immense dedication, focus, sacrifice and persistence to achieve a noble goal. The war on cancer implies a need for teamwork by multiple sectors of society, including civilly minded citizens, government, academia and the private sector. It also implies there is an identifiable enemy, and that total victory is possible. This last point is where the metaphor of the war on cancer starts to break down. In 1971 our knowledge of cancer was quite primitive. We thought of cancer as a single disease where a single approach to victory was possible. We now know that cancer is not a single disease but multiple diseases. Indeed, every cancer is unique and personalized approaches are required for success. In other words, in the war on cancer, there is no single and simple way to target and defeat the enemy.

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Cancer medicine in 2043

Last month I gave a presentation on cancer medicine and cancer research to a sophisticated group of non-scientists and was asked to predict what cancer medicine would look like in 25 years. This made me think back on a talk I gave in the late 1990s on that very topic. Thankfully, I no longer have the slides I used for that talk! I do recall a couple of items that were a focus of that presentation – one where I missed the mark and another where I was more on target.

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Build it, run it and move on.

I heard a talk on leadership during a commencement address many years ago that has stuck with me. The esteemed speaker, a nationally known, highly successful businessman, spoke about what it took to be a successful leader. One theme of his talk was that successful leaders should not hesitate to switch jobs. His approach throughout his own successful career was to “build it for 3 years, run it for 3 years, then move on.”

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Patients Enhancing Research Collaboration at Holden (PERCH)

A key role of the Holden Comprehensive Cancer Center is to collect and provide information about cancer that our researchers can use to find better ways of reducing the burden of cancer. This includes information on underlying genetics and lifestyle of patients. It includes analysis of cancers removed from patients so we can evaluate the genetic, molecular and cellular makeup of the cancer. Finally, it includes information on the response to cancer therapy including clinical response, side effects of therapy and quality of life. Given the complexity of cancer, robust information from a large number of patients is needed so we can conduct research that helps us determine what is best for each individual patient. Doing such research requires a partnership between researchers and patients who are willing to fill out surveys, provide blood samples and give us permission to use their cancer tissue and clinical information in research .

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Putting a patient “on trial?”

Last week, I had the pleasure of giving a talk on cancer at the University of Iowa Carver College of Medicine Mini-Medical School, a series of presentations provided to the lay public to introduce them to a topic in medicine. Every time I give a talk to a lay audience, I think back to a wonderful woman I had as a patient when I was doing my oncology training in the 1980s. She was a retired English teacher who took pleasure in gently ribbing me about the words I selected when I spoke with her (once a teacher, always a teacher). I recall one time when I suggested we consider putting her “on trial.” Her response – “Put me on trial? What a strange phrase. I certainly wish getting cancer was against the law! Why do you want to put me on trial?” That lead to an animated conversation about not only that phrase, but how doctors use expressions when talking to each other that are interpreted differently by patients. While I don’t recall which additional specific phrases we discussed back then, that conversation had a long lasting effect on me, and the phrases I use when I speak to patients, families and the public.

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Strategic Planning (no eye rolling please)

There may be no better way to get the members of any organization to roll their eyes and groan than to say “we are going to develop a new strategic plan!” Most of us have been through this before. At its worst, strategic planning begins with the hiring of an expensive consultant, followed by endless hours of meetings dedicated in large part to educating the consultant about the organization. The result is often a “plan” that states the obvious. This is then formalized into a slick, glossy document that sits on the shelf until the next time someone says “we are going to develop a new strategic plan!”

Given this perspective, who would have thought it would be me who, a few months back, said “we are going to develop a new strategic plan” for the cancer center. Indeed, it took some self-reflection before I was able to suppress my own eye rolling and groaning . This decision was based on the timing and value of such a process.

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Changing the environment of cancer from the inside and the outside

Last month, I attended back-to-back meetings in Washington D.C. Both had a cancer focus, but otherwise it appeared there was little in common. The first was a meeting of the Society for the Immunotherapy of Cancer where the latest scientific and clinical advances in cancer immunotherapy were discussed. The second was a meeting of the National Cancer Policy Forum that included a workshop where we discussed approaches to helping cancer patients navigate the complexities of the health care system.

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Hit me with your best shot – External Advisory Boards

It is difficult for all of us to identify and address, on our own, those areas where we should and can do a better job. Sometimes dealing with day to day challenges limits our ability to step back and look at the big picture. Sometimes we might see an issue that needs to be addressed but hesitate to do so because of concerns about unintended consequences we know or suspect might result from implementing a solution. Sometimes we might not realize there is a better way. Sometimes we might see a better way, but are simply unable to implement the needed change on our own. This certainly is true for a complex organization such as a comprehensive cancer center where we are working to reduce the burden of cancer across the spectrum of clinical care, research and education – where opportunities and challenges are ever present and ever changing.

Achieving our potential requires we ask ourselves whether we are we doing our best to…

  • Identify and support the most promising cancer research.
  • Recruit and retain the best faculty, staff, students and volunteers.
  • Bring advances from the research lab to where they help patients as quickly as possible.
  • Provide state-of-the-art, personalized clinical care and service to every patient.
  • Educate the next generation of cancer researchers and caregivers.
  • Work within our community and across the state to disseminate advances so they help as many people as possible.
  • Collaborate optimally with other units within our own institution (departments, colleges, the hospital, etc).
  • Collaborate optimally with outside institutions (referring physicians and medical centers, other cancer centers, the National Cancer Institute, etc).
  • Structure our own efforts to be as efficient and effective as possible to facilitate our ability to do all of these things well.

In addition to self-reflection and internal discussion, it helps to ask outsiders to take a fresh look and advise us on how to improve. One of the most forward-thinking aspects of the National Cancer Institute (NCI) Cancer Centers Program is the requirement that every cancer center have a yearly visit from an External Advisory Board (EAB) composed of experts from other cancer centers. Making optimal use of an EAB requires the hosting cancer center be totally open. We do not try to hide or paper over our major challenges when our EAB visits. Instead, we put them front and center. For the EAB to do its job and help us improve, it needs to be highly critical. As Oscar Wilde said “true friends stab you in the front.” Having an EAB say “keep it up, you are doing an excellent job,” just doesn’t cut it. We need the EAB to tell us how we can do better. Our EAB will be visiting next month and our presentations to them will include a discussion of what we are doing with a particular focus on where we feel we can improve. We will put down our armor, show them our soft underbelly, and say “hit me with your best shot.”

I have the privilege of serving on the EABs of nine other NCI-designated cancer centers and chairing five of them. I have no doubt participating on these boards helps me do my job at Holden more effectively. I get to see how other cancer centers handle particularly difficult issues. Sometimes I return home with a new idea of how we can address a gnarly challenge.   Just as commonly, I return home after seeing a cancer center’s approach to dealing with a problem, grateful for the team we have at Iowa and the solution we have found to a problem that another center is struggling to address.

Sometimes it feels a bit awkward being on an EAB when I beat up on my colleagues and friends, and am rewarded for doing so by a nice meal and a sincere “thank you.” When our EAB visits next month, I am sure they will return the favor. I will say “hit me with your best shot,” and when they happily (and hopefully ruthlessly) comply, I will feed them and express my deepest appreciation.

Cancer Genetics – it’s complicated – and exciting!

Incredible advances in cancer genetics have revolutionized how we think about cancer. These advances are now being applied to patient care. A brief response to the question “how is our growing knowledge of cancer genetics impacting on cancer research and cancer medicine?” is to say “it’s complicated – and exciting!” That is not a very helpful answer. Here, I will summarize the big picture with the understanding that this brief summary will not even touch on some of the rapidly evolving, nuanced, yet very exciting concepts in cancer genetics.

Let’s start out with a review and discussion of why the genetics revolution in cancer is so important.

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