Caring for, Learning From Every Patient: A Conversation With Dr. Monica M. Bertagnolli

Caring for, Learning From Every Patient: A Conversation With Dr. Monica M. Bertagnolli

Clifford A. Hudis, MD, FACP, FASCO

Aug 07, 2018

Editors note: Dr. Hudis hosts the ASCO in Action Podcast, which focuses on policy and practice issues affecting providers and patients. An excerpt of a recent episode is shared below; it has been edited for length and clarity. Listen to the full podcast online or through iTunes or Google Play.

I am really delighted to have as my guest ASCO's new president, Monica M. Bertagnolli, MD, FACS, FASCO. She is the chief of the Division of Surgical Oncology at the Dana-Farber/Brigham and Women's Cancer Center, a professor of surgery at Harvard Medical School, and an associate surgeon at Brigham and Women's Hospital and Dana-Farber Cancer Institute. In the past, she has served on the ASCO Board of Directors, the Cancer Prevention Committee, and was a member of the Strategic Planning Task Force, among many other volunteer roles. Our conversation focuses on her presidential theme and the goals she hopes to accomplish during the coming year.

CH: Given the breadth of efforts that you see at ASCO, how did you begin to prepare to both serve and succeed in this key leadership role?

MB: The goal of the ASCO president—the single job of the ASCO president—is to be the best possible voice for the organization. I tried during the [president-elect] year to think about how I could best use what I know to help the organization. It was wonderful to be able to participate in the strategic planning process of the Board. I looked at the vision of immediate past president Dr. Bruce Johnson, and his presidential theme, which was making precision medicine what it should be for all people with cancer. I thought about how the organization could continue that theme, but then expand it even further.

That's how my theme came to be “Caring for Every Patient, Learning From Every Patient.” The idea is that precision oncology is changing the way we care for our patients, but there are other precision aspects to caring for our patients, and those have to do with where our patients live. What kind of obstacles do they encounter? That might not necessarily be about unique biology, such as the conventional approach to precision medicine, but unique social factors that influence the way that we are able to care for our patients, and that our patients are able to survive and beat this disease.

CH: How are you integrating your prior roles and the time commitments of being ASCO president?

MB: My major time-consuming role is that I serve as the group chair of the Alliance for Clinical Trials in Oncology, which is one of the NCI-funded NCTN cancer network groups. I work with an amazing team, both internal to the NCI as well as fellow group chairs who run the other components of the network, to try to bring the best possible clinical trials to patients and doctors in the United States. That is a natural complement to the role that ASCO plays in several aspects. Research, to improve clinical care. Education, because that's a key part of everything that we do both in the NCTN as well as at ASCO. Finally, clinical care—if you're doing cancer research and clinical research, you're also intricately involved in clinical care. The three mission pillars of ASCO are represented in some of the work that's done with Alliance.

Alliance is a very strong organization with many leaders, who are able to keep the mission of the organization going while I'm serving ASCO in a different role. I'm very grateful to Susan George, the vice-chair of Alliance; Gini Fleming, head of the protocol office; and Trini Ajazi, our CEO; who are all keeping the organization going while I'm busy with ASCO this year.

CH: You bring, from that role, extraordinary experience to the role of president of ASCO. How do you see the complementarity in the other direction? What is it that ASCO will enable you to get done that isn't yet possible in the other systems in which you participate?

MB: It's very clear to all of us that we cannot transform care, health care or oncology care, without more knowledge. We desperately need more knowledge. There are many ways right now that we seek to gather knowledge that are challenging, cumbersome, and difficult. Nothing exemplifies that like the clinical trial system. It is a great time to rethink the clinical trial system, how we do that work to make it more effective, less expensive, more able to reach patients at all levels of our society. ASCO’s scope and ability to think about every single patient, not just through the unique lens of a clinical trial system, and to think about how that knowledge could extend to every single patient will have, I believe, overall benefits to how we do the work of the NCTN.

What it really boils down to is that there are so many different facets of the problem we're trying to tackle and all of our organizations tend to be rather siloed. That's the one thing ASCO seeks to do, essentially: to break down all those silos so that we can really innovate on all fronts.

CH: This brings us to your presidential theme, which is that every patient deserves equal access to the highest quality care, and the opportunity to participate in research. It's an aspirational vision. Can you talk a little bit more about why you chose that as your theme?

MB: I think it's a natural extension of where we were over the past year with Dr. Johnson's great vision for precision oncology, and bringing the very best, exciting new advances in oncology to all of our patients. To expand that, think about the fact that we live in a very, very diverse world. What we really need to do is to make sure that we have tools in the hands of the physicians who are caring for patients with cancer everywhere. Tools can be precision oncology, a new targeted drug. Tools can also mean access to basic care that not everyone has: prevention care, or the ability to come in to even see an oncologist.

Our patients range from Sidney, Montana, to Boston, Massachusetts, to Sao Paulo, Brazil, to Quanzhou, China. These are where patients with cancer live. ASCO needs to think about helping our physicians in these diverse locations find fit-for-purpose tools that will help them take care of their patients. It's going to be a very different approach in Quanzhou, perhaps, than it is in Boston. But that's part of what ASCO is here to do, to think about those patients in their unique environments, with their unique needs, and those doctors who are there to serve them. I understand it's a very big aspiration, but it's casting a lens on the fact that the world is a very big and very diverse place.

CH: What do you think is the single biggest barrier to achieving this vision of learning from every patient, caring for every patient? What is the thing we should do first?

MB: The essential feature that we should, and can, do first is to facilitate communication and understanding of this diversity. Our world has gotten much more connected with technology but we're still too siloed even in that technology. We can't have that in oncology. The first thing we need to do is to understand, to learn from our patients and our doctors. And there are many, many environments where even an organization like ASCO is not as familiar as we should be. The most important part of the mission is learning from every patient and that means everywhere that patients with cancer go. It's as simple as opening the communication lines to understand what challenges are being faced by this very diverse set of physicians and patients that we're here to serve.

CH: You grew up on a cattle ranch in Wyoming. You did some of the gritty day-to-day jobs that are required on a ranch. How did that background shape who you are today in your work as a surgical oncologist and as a leader?

MB: You're right about an approach to the way you handle challenges that comes from that kind of environment. When you grow up in a rural location, where there are big jobs to be done, the only way you get them done is by counting on your neighbors to help. The work of a cattle ranch is a lot of hard work during the year, but there are several times during the year where all the neighbors have to get together to do some big task. It's the traditional frontier barn-raising spirit; believe it or not, it's still very much active in these rural places in the United States. You understand that if you want to tackle something big, you've got to have neighbors and partners you can work with. They are generous to you, and you have to be generous to them. That is a central principle. The other is no one's going to solve your problems for you. You have to figure out how to solve them for yourself. Both of those things were the lessons that I learned on the cattle ranch that have served me very well in working in the other places my career has taken me.

CH: Can members of ASCO expect to see you in a cowboy hat at your presidential address?

MB: I'm not so sure on my cowboy hat, but I might be wearing my boots.

Listen to the full podcast online or through iTunes or Google Play.


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