Dec 22, 2016
By Hilary Adams, Staff Writer
Simone M. Goldinger, MD, works out of University Hospital Zurich as a melanoma specialist. Later this year, she’s heading to London to visit a renowned cancer institute as part of her self-designed “exchange” program with melanoma centers all over the world. As part of this exchange, she has already visited melanoma centers in San Francisco, CA; Boston, MA; Lausanne, Switzerland; and most recently in Sydney, Australia.
How did you come up with the idea to develop your own exchange program?
SG: The world is becoming more and more interconnected, and so it is also for the melanoma community. In fact, clinical studies and translational research are increasingly carried out in cooperation among different health institutions across the globe, enhancing the perspectives of treatment for the patients.
My exchange program was essentially conceived in the spirit of (1) strengthening or establishing cooperation between my institution at the University Hospital Zurich and other centers of excellence in the world; (2) identifying the best practices applied by each center in the treatment of melanoma; and (3) considering, as appropriate, these practices in the treatments that we offer to our patients in Zurich. I have to say that this was also a very enriching personal and cultural experience.
What is your model for setting up these exchanges?
SG: I selected a certain number of centers of excellence for melanoma, each willing to welcome me for a couple of months. In doing so, I have tried to cover different regions of the world as well as different experts’ personalities. In fact, an important aspect of my exchange was to learn how colleagues cope with the fast-paced, challenging, and demanding world of melanoma research, both from a professional and personal perspective.
What benefit do you get from studying oncology in different countries?
SG: First of all, it is a priceless experience to have the opportunity to exchange ideas with key opinion leaders. This personal contact is very inspiring, as it allows for a different interaction than the reading of a publication.
Second, my daily activities within the centers give me the chance to receive valuable input from my colleagues on how they deal with issues or problems that are common in all melanoma centers. I gained significant knowledge in the treatment methods/processes and the different organizational models (e.g., nurse practitioners vs. nurse consultants); as a result, I now have a broader spectrum of the various possibilities available to handle melanoma-related matters.
Finally, since any such exchange provides for a break from daily business, I was able to put things into perspective and brainstorm on how I have been performing my job so far.
Can you share an example of a time during your exchange when you learned or experienced something valuable that you wouldn’t have if you had stayed in your home country?
SG: There have been so many occasions that I cannot recall one of them in particular. I think that the great value of my exchanges is the direct contact and interaction with professionals who carry out the same job but rely from time to time on different methods or approaches. This creates a constant dialogue that is at the same time challenging, inspiring, and enriching. Also, I could strengthen my national and international network, which is always of great help when, facing a patient’s complex situation, you can rely on colleagues’ previous experience.
What have you experienced that felt the most different from what you were used to or what you expected?
SG: I have experienced interesting differences on several occasions.
I realized, for instance, that the role of nurses in the treatment of patients with melanoma can vary from one center to another. Nurses are sometimes more integrated in the treatment processes and given larger responsibilities, which is a concept that I very much appreciate. In fact, at a time when immunotherapy (the side effects of which can occur at any time during the treatment) is becoming a standard-of-care treatment, I believe that the nurses are playing a key role in the treatment of patients and may be called to take on even more responsibilities in the future.
It was also very interesting to note how the decision on how to approach treatment may differ across the world. If all decisions are well considered and based on convincing rationale, they also reflect the physician’s inclination to innovate. While some physicians may prescribe a drug whose clinical results are not fully known yet, thereby believing in the added value of a new treatment, others may have the more conservative tendency to rely on existing, well-established treatments. Obviously, given regulation of other constraints, not all treatments are simultaneously available in all melanoma centers.
Although this is nothing new, I have on multiple occasions realized again how important the dedication of a full team of professionals is to achieve great results for the patients. Each member of the medical team, irrespective of its function and responsibilities, is key in the organization to create an environment where all activities required in a melanoma center (e.g., patients’ treatment, clinical studies, academic or administrative work) can be carried out in the best possible way to ultimately support patients’ needs.
Have you seen any constants that cut across cultures and geography?
SG: All the professionals that I met are very dedicated to their patients and are therefore well aware of the importance of integrating clinical and translational research in their daily practice. If each melanoma center has its own organization, almost all of them schedule regular team meetings to discuss research projects and patients’ treatment; these meetings allow for an efficient information flow and improve the quality of the patients’ care.
Many professionals do not consider their activities in the field of melanoma as a mere job; they are also sometimes motivated by the mission to “make the change” for the ultimate benefit of the patients. Such a commitment implies not only regular visits to patients but also spending a significant amount of time with academic or literature-related activities. One must be ready to continuously go the extra mile. In this respect, in all centers I met very charismatic and inspiring personalities; I was impressed both by their medical knowledge and their dedicated approach to their activities, in spite of the sacrifices at the expense of their private life.
Last but not least, patients are always placed at the center of attention, and great care and time is taken to inform and treat them, as appropriate. In all melanoma centers, clinical and translational research was considered as a good option to offer the best possible treatment to the patients.
What advice would you give to other oncologists who would like to participate in cross-cultural experiences?
SG: This tailor-made exchange program is an excellent opportunity to broaden your horizons, enrich your personal knowledge and your network within your field of competence, and to put into perspective your own systems and beliefs. As far as I am concerned, this experience would not have been possible without the support of my institution and my mentor, to whom I am very grateful. In fact, since I have been out of the office a few times for a period of approximately 2 months each, I could not handle all the duties that I would usually carry out on a daily basis in Zurich. I had the chance, however, to rely on supportive colleagues who have stepped in for me when needed. Therefore, any such short-term experience should be prepared well in advance and carefully organized with your institution.