|Brian Issell, MD
Brian Issell, MD, is the Associate Center Director for Clinical Science and Translational Research at the University of Hawaii Cancer Center. He is responsible for the clinical programs of the cancer center, and has been affiliated with the center for over twenty years.
Your hospital is a National Cancer Institute-designated Minority-Based Community Clinical Oncology Program (MB-CCOP). What is a MB-CCOP and how did your organization decide to expand its research program to become a MB-CCOP?
A MB-CCOP is a grant provided by the NCI for community institutions that accrue at least 30% of patients with cancer from racial/ethnic minorities. Because our population in Hawaii is 75% minorities (non-white), the MB-CCOP is an ideal fit.
Before we became a MB-CCOP in Hawaii, we were participating in Cooperative Group trials, but in a very fragmented way. My job was recognizing the importance of a clinical trials program. I looked to NCI to see how we could enhance Hawaii’s participation in cancer studies. The Hawaiian population is particularly underserved; Hawaiians and Pacific Islanders typically have a higher incidence of cancer and worse mortality. In addition to treatment trials, we wanted to build a cancer prevention and control program with social scientists, who were particularly skilled at knowing what motivates people who are socio-economically disadvantaged.
For all these reasons, the MB-CCOP was a natural fit for us. Clinical trials are a way of guaranteeing that patients have the best care and access to new opportunities. Through the MB-CCOP, we had a more consolidated approach to clinical trials, more options of trials to choose from, and additional funding. We were also able to build up all the other components which help us access populations that have increased risk and burden of cancer.
Why should early-career investigators be interested in joining one? What advice do you have for investigators who are interested in expanding their programs?
What drove me to participate in research was the feeling that I had a greater impact on reducing the cancer burden on the local population. Clinical trials are good for patients, but they’re also beneficial for those who come after them. Community research is particularly important because practice is where it all happens – it is the real world of cancer. We need to translate knowledge into community practice. With our research at UH, we can apply everything immediately into community practice.
Your website notes UH Cancer Center's unique ability to take advantage of:
What unique opportunities and challenges do your location and patient population present?
- Hawaii's multiethnic population
- Medicinal properties of Hawaii's flora/fauna and
- International collaborations with your Pacific neighbors
We have the obvious challenges of our physical distance and isolation, but there are a huge number of unique opportunities in Hawaii. We call Hawaii a living laboratory because there is such great diversity and opportunity.
First, we have a unique population with different risks and outcomes. We get to identify why differences among people exist: how are people genetically different and how do environmental differences affect them? One example is the Japanese. Japanese in Japan have the lowest risk of colon cancer, but when they move to Hawaii, they have the highest risk. What causes this? We know their diet changes once in the United States, so that could be a factor. Understanding how genetic differences and environmental exposures (e.g.: exercise) interact can be profound, and it offers dramatic insight in how to personalize treatment and prevention for individuals. We have a tendency to lump everyone together, but we need to understand how people are different.
Second, Hawaii’s geographic isolation has spawned a plethora of unique flora and fauna. Many powerful drugs we already use come from plants, and we take advantage of the opportunity to study more. As an example, we have been examining the anti-cancer properties of the noni fruit. We began by studying its use in Hawaiian folklore and traditional healing, and now we are breaking down the chemical ingredients of the plant to better understand it. Some plants have had really profound influences on cancer treatments, and we have a great opportunity to examine more.
Lastly, we collaborate with neighboring Pacific islands, such as American Samoa, Guam and others in Micronesia. We have an NCI grant to develop cancer programs in Guam, and we work closely with investigators from Australia and the US mainland. We have access to have a large, rich cancer community.
How do you talk with your patients about clinical trials?
Our unique population in Hawaii is very willing to participate in cancer clinical trials. Our standard approach is to explain to our patients that everything we know has come from clinical trials and that they will receive, at least, the best standard care. We explain that there’s the opportunity that the care will be even better but also a chance that the experimental treatment may be worse. The most important thing we tell patients is that the information we learn from them is invaluable. This is critical because people want to help and make a contribution to others.
Additionally, because we have so many different cultures and languages, we have systems set up so that we have support through community groups and different agencies to make sure that all the different groups feel welcome. You have to involve the whole community to be successful. People also need to feel ownership of the enterprise. We have needed to pool a lot of resources to establish our program, but we are proud of what we have accomplished. We have so many native Hawaiians and Pacific Islanders in clinical trials that we now have an over-representation of these groups in trials.
What advice would you give to early career investigators?
My message, for any clinician, would be that you need to decide to what level you want to be involved in research. Participation can vary from accrual and enrollment to being a Group member. No matter what you choose, you need to make sure you are in a practice that can accommodate your research activities. Research is a collaborative effort. Researchers need to make sure that the people around them support their endeavors because it is too difficult to succeed alone. We collaborate with the people that came before us and with those that come after us to advance the field and improve the quality of care for our patients. If you are committed to making a difference and helping people, this is the way you do it.