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Volume 7 • Issue 4, 12.15

Why You Shouldn’t Pursue a Surgical Oncology Fellowship!

(And Why, Maybe, You Should)

Choosing a Research Mentor During Fellowship

Apps for the Healthcare Professional

Bringing the Oncology Community Together

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A Second ChanceTailoring your approach to how you interact with a patient can be beneficial

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OncLive.com Oncology Fellows • 12.15 | 1

Interested in contributing to Oncology Fellows? If you’d like to submit an article for consideration in an upcoming issue, please e-mail Jeanne Linke at [email protected].

Table of Contents

2

Volume 7 • Issue 4, 12.15

Feature

Departments

President, Healthcare Specialty Group and Oncology Specialty Group Mike Hennessy, Jr

Editorial & ProductionSenior Vice President, Operations and Clinical AffairsJeff D. Prescott, PharmD, RPh

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Project CoordinatorJen Douglass

Associate Editor Jeanne Linke

ProofreadersMaggie ShawGriselda Demassey

Senior DesignerMelissa Feinen

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Director of SalesRobert Goldsmith

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National Accounts AssociatePhil Conover

Sales & Marketing CoordinatorJessica Smith

Director, Strategic Alliance ProgramFrancine Durcan

National Accounts Manager, Strategic Alliance PartnershipHeather Shankman

Operations & FinanceGroup Director, Circulation and ProductionJohn Burke

Director of OperationsThomas J. Kanzler

ControllerJonathan Fisher, CPA

Assistant ControllerLeah Babitz, CPA

AccountantTejinder Gill

CorporateChairman and CEOMike Hennessy, Sr

Vice Chairman Jack Lepping

Chief Operating Officer and Chief Financial OfficerNeil Glasser, CPA/CFE

Executive Vice President and General ManagerJohn C. Maglione

Vice President, Digital Media Jung Kim

Chief Creative OfficerJeff Brown

Human Resources Director Shari Lundenberg

For more articles, go to www.OncLive.com/publications/ oncology-fellows

A Second ChanceTailoring your approach to how you interact with a patient can be beneficialChristopher Dittus, DO, MPH, shares a personal account of how he managed a patient through her treatment and reduced her fears by tailoring his approach to interaction with her.

6

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A Word From Your Fellows10 Choosing a Research Mentor

During Fellowship Choosing a research mentor is one of the

most important steps when beginning a successful academic research career. Amer Zeidan, MBBS, MHS, advises new fellows on how to select the right mentor.

Online Oncologist14 Mobile Medicine

Apps for the healthcare professional.

By the Numbers15 The Importance of Discussing

Prognosis With Patients With Advanced Cancer

Conference Center16 2015/2016 Oncology &

Hematology Meetings

Scan with a QR code reader to visit OncLive.com, the online home of Oncoloy Fellows®.

Why You Shouldn’t Pursue a Surgical Oncology Fellowship!(And Why, Maybe, You Should)Christopher B. Allard, MD, discusses some of the factors that one must consider if interested in pursuing a career in surgical oncology and explains why he opted to enter the field.

FEATURE

2 | Oncology Fellows • 12.15 OncLive.com


Sharon was a 40-year-old female patient, and she did not want chemother-apy. As a first-year hematology-oncology fellow, it was my job to convince her otherwise. Sharon was initially diagnosed with early stage, estrogen-

receptor–positive breast cancer 2 years before my first visit with her. At that time, she was advised to have surgery, as well as hormonal therapy and, possibly, chemotherapy. Surprisingly, Sharon refused surgery and all adjuvant treatment. After multiple failed attempts to convince her otherwise, she agreed to be fol-lowed very closely by her medical team with breast exams and mammograms. As expected, her cancer progressed. She was ultimately diagnosed with stage 3A breast cancer several months prior to my initial evaluation.

As I sat across from Sharon during our initial visit, I was first struck by her eyes. Penetrating and defiant, they seemed to reject my recommendations be-fore I spoke. I then noticed that her mouth was fixed in a scowl, and it looked as though this was its normal position. Lastly, her sharp cheekbones were framed by straight, long, brown hair. Her face seemed to warn the world that she was formi-dable and anyone seeking to interact with her should be forewarned.

As I began to interact with her, I was careful not to dwell on the past. I did not want to appear accusatory and knew that, despite saying otherwise, she under-stood that her life was in jeopardy because of a poor decision she had made years earlier. Immediately, I realized that my initial impression was correct—she had a particularly guarded and defensive demeanor. Later, I learned that she was fright-ened and angry about her diagnosis. She was also vain and having had a mastec-tomy the month prior, she was particularly focused on her appearance.

By Christopher Dittus, DO, MPH


A Second Chance

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Tailoring your approach to how you interact with a patient can be beneficial

Later in the encounter, I was able to delve deeper into why she had initially deferred therapy. Sharon had deeply held beliefs regarding her ability to “self-heal” and she was highly suspicious of the modern medical system. To her, the intensive treat-ments we use in oncology were the worst of all. She felt that chemotherapy was poi-son, hormones would cause additional cancer, and sur-

gery and radiation were horribly disfiguring.Over the course of my interaction with Sharon,

I found that she appreciated succinct, direct lan-guage. Knowing that her prognosis now depended on my ability to develop a meaningful rapport with her, I firmly, but sincerely, asked her if she wanted to live. At first she was surprised by my directness, but her scowl soon softened and she responded that, yes, she did want to live. I told her that I could not promise her a cure because of the extent of her disease, but that if she trusted me and the medical system, we would give her the best chance of cure. She replied that she was ready to listen.

Because Sharon already had a mastectomy, she would now need intensive chemotherapy to kill any remaining cancer cells. Many of her questions fo-cused on practical issues. She wanted to know if she would lose her hair. I replied that, yes, she would most likely lose her hair, but we would arrange for her to wear a wig until it grew back. Feeling dis-figured, she wondered if she could go to the beach after having had a mastectomy. Yes, I replied. I reas-sured her that we would order a post-mastectomy swimsuit for her to wear. Lastly, she had a new job as a dental hygienist and wondered if we could schedule her treatments around her schedule. I re-sponded that, yes, we could arrange for her to arrive and leave early in the day.

After thinking about it overnight and asking sev-eral more questions, Sharon agreed to initiate dose-dense doxorubicin and cyclophosphamide followed

by weekly paclitaxel. Despite pretreatment anxiety and many work-related obligations, Sharon did well throughout her intensive chemotherapy regimen. Toward the end of her treatments, I broached the topic of radiation therapy. Sharon’s major concern was that she would not be able to have breast recon-struction surgery afterward. This common miscon-ception was dispelled after a visit to both the radia-tion oncologist and the breast surgeon.

When I returned to Sharon’s hospital after ro-tating at another hospital for 6 months, she had completed her radiation therapy. Her formerly long brown hair was in a short pixie-cut, further defining her angular cheekbones. Sharon told me she liked her hairstyle and would keep it short, at least for a while. After spending some time catching up, our discussion turned to the hormonal therapy that I knew she needed, but did not want. Anticipating re-sistance, I had printed out information from an on-line prognostic model. After reviewing the evidence in favor of hormonal therapy and taking it home to discuss with her family, Sharon ultimately agreed to take these important pills.

Despite her initial misgivings, Sharon has suc-cessfully completed surgery, chemotherapy, and radiation therapy. Additionally, she is adherent with her ongoing hormonal therapy. Sharon may not be cured, but she now has a second chance at life. n

FEATUREFor more articles, go to www.OncLive.com/publications/ oncology-fellows


Christopher Dittus, DO, MPH, is a hematology and medical oncology fellow at Boston Medical Center.

ABOUT THE AUTHOR

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FEATURE


You probably shouldn’t pursue a surgical oncology fellowship. You have spent a grueling half-decade of residency acquiring and honing the physical and mental skills necessary for surgical

competence. After a lifetime of education, you will finally be deemed a “real” surgeon, on par with your mentors. You now have the opportunity to make a good income and start paying down your debt. Isn’t it time to get on with your life?

You probably shouldn’t even consider a surgical oncology fellowship. Think how far you’ve already come. Remember how you used to doubt yourself and wonder if you had what it takes? Remember struggling through basic subcuticular stitches—hand shaking and brow sweating? Remember saying “yes” but thinking “no” when the attending physician asked if you understood the surgical anatomy? Remember how everything on the laparoscopic monitor looked like nondescript fat? All that has fi-nally changed! Seize the moment—put your hard-earned skills to practice. You’re a “cutter” now, and you always will be.

Many surgical oncology fellowships include a research year. Do you really want to lay down the scalpel and pick up the books for a whole year? And why oncology, of all disciplines? You are already capable of performing multiple oncologic surgeries, which are a component of many non–fel-lowship-trained surgeons’ armamentariums. If a patient presents with an overly complex malignancy, you can always refer the patient to a sub-specialist. Those cases tend to be exhausting anyway.

Then again, maybe you like the idea of being that subspecialist to whom complex patients are referred. Perhaps you find challenging cases to be the most intellectually stimulating. You have spent years developing pro-cedural memory for routine cases, yet you relish the opportunity to exer-cise your intellect by solving unanticipated problems. You enjoy thinking


Christopher B. Allard, MD, is a urologic oncology fellow in the Harvard program in Urology for Massachusetts General Hospital and Brigham and Women’s Hospital of Boston, MA.

ABOUT THE AUTHOR


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FUTURE/FIRST-YEAR

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Why You Shouldn’t Pursue a Surgical

Oncology Fellowship!(And Why, Maybe, You Should)

By Christopher B. Allard, MD

FEATURE


on your feet (literally) and inventing approaches to novel chal-lenges as they arise.

Maybe you see value in spending time in a center of excellence and observing similarities and differences with your own train-ing institution. You might consider it an honor to be trained by some of the most esteemed surgeons in your field. As a future surgical oncologist, you hope to broaden your scope of knowledge by working closely with leaders from complementary disciplines, including radiation and medical oncology. You know that new experiences in a novel setting are inherently rewarding and any additional skills acquired will be icing on the cake.

These are the rewards I’m seeking as I enter the second year of my urologic oncology fellowship. During my research year, I learned more than I ever thought I’d know about biostatistics and research methodology—knowledge that will provide a solid foundation for future research endeavors. I have contributed to oncologic literature, and I’m optimistic these contribu-tions will have a meaningful impact on patients. I feel better equipped to interpret and apply the oncologic literature to my own patients. Most importantly, I have formed relationships with inspirational clinicians and researchers with whom I hope to collaborate throughout a productive career.

Additional voluntary training is a major commitment with a significant opportunity cost. I wondered if my contemporaries had similar reasons for pursuing fellowship training.

“My decision to pursue additional training in surgical oncology was multi-factorial. I had a strong interest in oncology throughout resi-dency and felt that additional training would afford me the opportu-nity to enhance and expand my technical skills while concurrently expanding my knowledge base to better understand disease process-es—with the end goal of providing top quality care to my patients...”— Dr Jasmir Nayak, Urologic Oncology Fellow, University of Wash-

ington, Seattle, WA

“A surgical oncology fellowship was an opportunity for me to not only continue developing skills in complex oncologic operations, but also to learn the comprehensive multidisciplinary approach to cancer care.”— Dr Alan Thong, Urologic Oncology Fellow, Memorial Sloan Ket-

tering Cancer Center, New York, NY

Although every physician’s reasons for pursuing a surgical oncology fellowship are unique, we clearly share similar val-ues. So, if you don’t want to maximize your training such that you can confidently approach the most complex of cancer pa-tients—in the clinic and in the operating room—then you prob-ably shouldn’t consider a surgical oncology fellowship. But if you do share these values, then maybe you should! n

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A WORD FROM YOUR FELLOWS



You are so lucky! You have just matched in your top-choice hematology/oncology fellowship program at a great university. You have always wanted to become an academic investigator and contribute to help move the field forward, and, finally, you have the chance to do so. You may think it is too early to consider finding a men-tor; that you may, instead, wait until you have completed your first clinical year of fellowship. Big mistake!

It is never too early to start thinking about your research mentor. Choosing a research mentor is one of the most important steps when beginning a successful academic re-search career. Therefore, selecting a mentor should be done in a very thoughtful and deliberate manner, and should not be taken lightly or done in hasty fashion.

Whereas some fellows may have taken part in an accelerated MD/PhD track program, earned a PhD, completed several years of full-time research (whether clinical or laboratory research), decided to remain as fellows in the same institutions where they are fin-ishing their internal medicine residency, formulated a clear idea about what type of research career they want, and connected with the mentor with whom they will be training (and may even have worked with al-ready), the majority of fellows probably are not so pre-pared. A majority of fellows do not have an extensive amount of prior research experience when they match in a new program in a new city where they don’t know

many people. Many enter this new role without a plan as to whether they want to work in academia, private practice, or industry; let alone have they thought about seeking a research mentor.

Just a few years ago, I was in the second category (the less prepared). I had just joined a prestigious fellow-

ship program at a top-notch university with a worldwide reputation in cancer research, but I didn’t know anyone in the city or even in the university. Although I knew I wanted to have a career in hematologic oncology research, I was not sure whether I wanted to do laboratory or clinical research. Also, I had not yet identi-

fied a particular cancer area to study or a mentor with whom to work. With agoniz-ing uncertainty, I remember spending long weeks and months trying to figure out where my future would take me career-wise and stressing about how to find a mentor who would fit my personality best and offer me the finest opportunity to become an independent researcher.

Looking back at those days, I thought I would share with you my experience in finding the right mentor and what

By Amer Zeidan, MBBS, MHS

Amer Zeidan, MBBS, MHS, is an assistant professor in medicine (hematology) at Yale University.

ABOUT THE AUTHOR

Choosing a Research Mentor During Fellowship

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A WORD FROM YOUR FELLOWS

time taught me in tackling this process. I should note here that before moving to the United States to pursue resi-dency and fellowship for early phase clinical/translational research in hematologic malignancies, I had obtained my medical diploma in another country. Although my experi-ence may vary from that of others who have finished medi-cal school in the United States, have done basic laboratory research, or are interested in pure oncology research, I believe that the general thoughts and principles I high-light can apply across this entire spectrum.

Start Looking as Early as PossibleDo not wait until you are about to begin the research por-tion of your fellowship to start looking for a mentor. This is likely to be a long and a time-consuming process in which you will talk to many different people and assess multiple prospective mentors. It is wise to start seek-ing a mentor as early as possible. You may even want to consider looking for a mentor as soon as you know which institution you have matched with (before you even start your fellowship).

Find Your PassionYou probably have heard that being an oncologist is a lifestyle, not just a career. Well, that is absolutely true and even more so for a clinical researcher in oncology. Not only will you conduct clinical research, but you will need to be an excellent and devoted physician to your patients. Your work is not likely to end when you go home. Rather, you will likely find yourself busily writing manuscripts, revising grants, preparing presentations, and calling re-ferring community oncologists, among other tasks, after your regular work hours, on weekends, and even while you are away at conferences or on vacation.

As you read this, you may be wondering what this has to do with finding a mentor. Well, choosing a mentor before you know what you want to do is like putting the wagon in front of the horse. Whether you want to spend years using pipettes and injecting mice or feel that your niche may be in clinical research and direct patient care, you need to make a decision about your career goals early. No mentor will find your passion for you.

There is often a requirement or pressure to do labora-tory research during a fellowship program. This opportu-nity might be beneficial to you, as it can help you to figure

out if you like working in the lab or at least confirm that you don’t belong behind the bench. Keep in mind, though, that this lab-based knowledge will help your clinical re-search career, as well.

At the end of the day, remember that your future career is YOUR choice. You should not bow to pressure from oth-ers to do something you do not like. You will be doing this for many years, and you have to be conscious of what the lifestyle of a researcher entails and be comfortable with how it affects your personal life.

Consider the Experiences and Involvement of the MentorNow that you have figured out the type of cancer that you want to study and treat and have decided whether you en-vision yourself as a lab-based scientist or a clinical/trans-lational researcher, it is time to try to find the researcher (ie, your mentor) who will help you achieve the ultimate goal of research independence. It is very important to select a mentor based on your assessment of your experi-ence in research and your current needs. Although many fellows have the natural tendency to seek a very well-known, successful researcher in their area of interest, keep in mind that such a person is likely to be very busy with his or her own lab, grants, papers, personnel, com-mittees, frequent trips for presentations and meetings, and administrative responsibilities. This individual may not have enough time to adequately and comprehensively supervise and mentor you. If you have a lot of experience and feel that you need only limited guidance and mentor-ship, this arrangement might work for you.

On the other hand, if you are relatively new to the research environment and think you may need a lot of hands-on training and supervision, finding a mid-level faculty member who is not as well known in the field and has more time to devote to you makes more sense. In many institutions, your fellowship program director will have excellent knowledge of the faculty and can discuss who may be a good fit for your research interests. Some institutions even have a research committee that can help with mentorship decisions. At the end of the day, remem-ber that this is a 2-way process: the mentor will also need to feel that you will be a good fit in terms of your needs and his or her time availability.

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Talk to Prior MenteesTalking to prior mentees is a very important step when searching for a suitable mentor. Former mentees can pro-vide you with their perspectives about what worked well and what didn’t, whether they felt they received adequate supervision, and if any unexpected problems arose. How the previous mentees are doing in terms of academic and research achievements, publication and grant records, and successful academic employment are all very impor-tant indicators. Your fellowship program should be able to link you with previous fellows who were mentored by your prospective mentor. Additionally, faculty usually keep a mentorship record because a successful mentor-ship typically is one of the criteria assessed for academic promotions. These faculty will most likely be more than happy to share that list with you.

Personality MattersAcademic and research achievements of any prospective mentor are very important; however, it is vital for you to understand whether their personality is fit for a success-ful mentorship. Someone can be a successful researcher, very difficult to work with, a poor educator or communi-cator, or have a temper. Your program director and past mentees may alert you to such issues.

Figure Out Your Research Plan and the Available TimelineYou may have an uninterrupted 2-year period of dedicated research time or have blocks of several months that are interrupted by clinical rotations. This can make a huge difference in the type of research you do and the degree of success you can achieve. Your research plans should take into account your availability and clinical duties, and be doable within the available timeframe. Do not be unre-alistic or overly ambitious. These factors, in turn, should influence your choice of a mentor, as the mentor should be willing to accommodate your clinical duties and the nature of your training schedule. Discuss this very early on with prospective mentors to avoid any false expectations or mis-understandings that could lead to major problems later on.

Set Your Expectations and Goals with Your Mentor Early OnYou should formulate a clear plan with your prospective mentor detailing your time commitment and expectations in terms of outcomes, benchmarks for presentations and

publications, and applications for grants. Arrange to meet regularly and frequently with your mentor, and make sure you feel adequately supervised and supported. To avoid po-tential conflicts, it is important that you and your prospec-tive mentor align in terms of goals and expectations for your research training. Having a research or mentorship committee of 3 or 4 faculty members that meets every 4 to 6 months and is not directly involved in your research, but provides oversight on your research progress, can be very helpful to make sure things remain on track.

When to Jump ShipDespite being very diligent at choosing your mentor, sometimes things just do not work out for one reason or another. You might realize after spending a few months in the laboratory that you hate bench work and prefer clinical research. You might find out that your mentor is very busy and unable or unwilling to provide you with the adequate mentorship or supervision that you need. If you feel things are not working as you hoped, address this issue as early as possible and work with your mentor on a plan to fix the issue. If the relationship becomes strained beyond repair, talk to your program director about ways to resolve the situation. At the end of the day, it is much better to switch mentors and research projects halfway through your research training than to remain in an un-productive and broken mentorship. n


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MOBILE MEDICINE: APPS FOR THE HEALTHCARE PROFESSIONAL


To access interactive learning modules, visit onclive.com/

interactive-tools

ON THE WEB

Oncology Fellows • 12.15 | 15

A recent multisite, prospective study of pa-

tients with advanced cancer was designed

to evaluate patients’ willingness to have

discussions about their prognosis with their

healthcare professionals. The results of the

study revealed that patients who discussed

their prognosis with their physicians had

more realistic expectations about their life

expectancy than those patients who did not

discuss their prognosis.1

For example, patients who reported hav-

ing had discussions with their physicians

about their prognosis were more likely to

acknowledge that they were terminally ill

(60% vs 28.7%). In addition, life expectancy

self-estimates were shorter for patients who

had discussions with their physician com-

pared with those who did not.1

The analysis further showed that although

patients’ willingness to discuss life expec-

tancy varied, conducting these discussions

did not have a damaging effect on patients’

emotional well-being or affect their relation-

ships with their physicians.1

Although these new findings suggest the

importance of patient-physician discussions

about prognosis, strikingly, the results of the

study showed that the majority of patients

and physicians do not have such discussions.

The results revealed that although 71% of

patients interviewed reported wanting to be

told their life expectancy, only 17.6% noted

having had a previous discussion about their

prognosis.1 This suggests an unmet need in

oncology care and highlights the importance

of discussing prognosis with patients with

advanced cancer.

REFERENCE1. Enzinger AC, Zhang B, Schrag D, Prigerson HG. Outcomes of prognostic disclosure: associ-ations with prognostic understanding, distress, and relationship with physician among patients with advanced cancer [published online Octo-ber 5, 2015]. J Clin Oncol. 2015.

The Importance of Discussing Prognosis With Patients With Advanced Cancer

BY THE NUMBERS

Only 17.6% of advanced cancer patients note having had a previous discussion about life expectancy with a healthcare professional.1

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ON THE WEB ON THE WEB

We welcome submissions to Oncology Fellows, a publication that speaks directly to the issues that matter most to hematology/oncology fellows at all stages of training. Oncology Fellows aims to provide timely and practical information that is geared toward fellows from a professional and lifestyle standpoint—from opportunities that await them after the conclusion of their fellowship training, to information on what their colleagues and peers are doing and thinking right now.

Oncology Fellows features articles written by practicing physicians, clinical instructors, researchers, and current fellows who share their knowledge, advice, and insights on a range of issues.

We invite current fellows and oncology professionals to submit articles on a variety of topics, including, but not limited to:

• Lifestyle and general interest articles pertaining to fellows at all stages of training.

• A Word From Your Fellows: articles written by current fellows describing their thoughts and opinions on various topics.

• Transitions: articles written by oncology professionals that provide career-related insight and advice to fellows on life post training.

• A Day in the Life: articles describing a typical workday for a fellow or an oncology professional post training.

The list above is not comprehensive, and suggestions for future topics are welcome. Please note that we have the ability to edit and proofread submitted articles, and all manuscripts will be sent to the author for final approval prior to publication.

If you are interested in contributing an article to Oncology Fellows, or would like more information, please e-mail Jeanne Linke at [email protected].

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With CancerCare, the difference comes from: • Professional oncology social workers• Free counseling • Education and practical help• Up-to-date information • CancerCare for Kids®

For needs that go beyond medical care, refer your patients and their loved ones to CancerCare.

CancerCare’s free services help people cope with the emotional and practical concerns arising from a cancer diagnosis and are integral to the standard of care for all cancer patients, as recommended by the Institute of Medicine.

makes all the difference

®

1-800-813-HOPE (4673)

www.cancercare.org

Help and Hope

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