Alan Lyss, MD, is the Director of the Cancer Research Program of Missouri Baptist Medical Center in St. Louis. He is Associate Professor of Clinical Medicine at Washington University School of Medicine and is Associate Clinical Professor at the University of Missouri School of Medicine. Dr. Lyss is the Principal Investigator for Heartland Cancer Research, a designated Community Clinical Oncology Program of the National Cancer Institute. His research interests are directed toward finding improvements in the supportive care of patients who suffer from cancer-related symptoms and increased access to innovative cancer care for under-served populations.
What was your fellowship experience and how did that translate into you becoming a community-based investigator?
My fellowship experience did not lead me to a career in clinical research, but it helped me identify what I enjoyed about the academic setting. My hematology/oncology fellowship at the University of Pennsylvania followed a traditional organization with the first year dedicated to clinical training and the remaining two spent in a laboratory working with an investigator on endothelial cell research. I enjoyed my training but decided that I did not want take my career in that exact direction. Having experienced the flavor of dynamicity of academic research in my training, I knew I wanted to retain it in my future career.
In looking for jobs after my fellowship, I looked for opportunities to see patients, teach, and participate in clinical research (even though I hadn’t directly trained in this area). The position I ultimately took was at Washington University and involved developing a new clinical trials program. It was a blank slate for me, which was at first intimidating but also very exciting.
Do you have advice for investigators interested in starting up a clinical research program?
If a young physician wants to participate in clinical research, he or she should not be dissuaded from taking a position at a practice without a research program. It is worthwhile to lay the groundwork for a new clinical research program because it helps you forge an interesting career and helps you share in realizing a shared vision with potential co-investigators in your community.
In my own experience, I began by engaging with surgeons, radiation oncologists, medical oncologists, and administrators at my hospital to secure the interest and support I needed. With the approval of my division chief, I hired a full-time clinical research associate to head up the research office. I reached an agreement with interested physicians to establish a minimum accrual standard for participation. Our program grew from there.
Your hospital is a National Cancer Institute (NCI)-designated Community Clinical Oncology Program (CCOP). When and how did your organization decide to expand its research program to become a CCOP?
At Missouri Baptist, we considered applying for CCOP status years before actually applying. The CCOP grant application was overwhelming. Finally, propelled by a desire to move our program to another level of service to the community, we decided to partner with another community research program to apply for the grant. Since both our organizations treat patients in rural settings we felt that a CCOP grant would help us expand clinical research opportunities in those communities, in addition to our primary service area in suburban St. Louis. Our application was successful.
What are the benefits of working at a CCOP that early-career investigators should know about?
Working at a CCOP has also enabled us to expand the scope of our research activities. For instance, we now participate in prevention and cancer control trials. We were not doing that to the same extent prior to attaining CCOP status.
Do you have advice for investigators who are interested in expanding their programs?
You also need to win over support and commitment from other members of your own organization and make sure you can get the protected time you need for administrative work. I spend at least 25% of my time attending to CCOP administrative duties as a Principle Investigator (PI). Before applying, it is also important to verify that your organization is invested in publically-funded research. The grant may not advance your organization’s financial standing or replace industry-generated income.
Secondly, it is important for investigators to realize that they can, and should, pair up with other programs in their catchment areas to apply for CCOP status. If you can do so successfully, you have the opportunity to really enhance cancer care and access to clinical trials for your community. It augments that chances that patients in your community will hear the message about the value of clinical trials more consistently and have better access to trials near where they live and work.
As a last word of advice for investigators seeking CCOP funding: it takes a lot of energy and time as a PI to set up your CCOP, but it also takes energy to maintain your heightened standards and accrual numbers. I may have underestimated this commitment at the beginning – but it is tremendously rewarding to know that I have helped create a positive legacy in my community.
How is research incorporated into your practice?
I’m fortunate to incorporate research into every aspect of my practice. I wear a button on my lapel that reads “Research Cures Cancer” because I want my patients to think about research as soon as I enter the room. We have posters about clinical research in every elevator and framed testimonials in every exam room. I let every patient know if they are eligible for a clinical trial. If they aren’t now, they may be at a later time.
I also get to attend scientific meetings and surround myself with smart, creative people. They offer me intellectual stimulation and resource networks. If one of my patients moves to Scottsdale, Arizona, I can seamlessly refer them to physicians I know personally. Similarly, if I have questions about a patient with a rare form of cancer, I can call up a specialist I know through ASCO committee work. Staying connected with the larger oncology community is another way research is incorporated into my professional life.
How do you talk with your patients about clinical trials?
When patients visit an academic center, they expect to hear about clinical trials. When patients come to community practices, they’re not expecting to hear about research, randomization, etc. This makes my conversations challenging. For patients in rural Missouri, the notion of clinical research is especially foreign. The conversation varies with each patient, but I begin every conversation by pointing to my button and acknowledging research as a treatment option. I let them know that I’ve been fortunate to witness a complete transformation of cancer care during the course of my career. The standard treatments available today are the results of clinical research. I tell them about their standard care options, expected outcomes and where I think the next frontier for treatment lies.
What professional development activities would you suggest for early-career investigators?
One cannot read oncology research literature without getting excited about the field. I always counsel students to keep up with their reading. I also encourage them to attend “Meet the Professor” sessions on developing clinical research programs at ASCO Annual Meetings and to attend NCI Cooperative Group meetings. Trainees and fellowship program graduates will get a good sense for how clinical trials are hatched at Cooperative Group meetings. They should be sure to step up to the microphone, ask questions and feel the power and excitement in being involved in the process.