Apr 07, 2023
By Emily A. Kuhl, PhD
During the 2023 ASCO Annual Meeting, Patrick J. Loehrer, MD, FACP, FASCO, will receive the ASCO Humanitarian Award in recognition of his work personifying ASCO’s mission and values as well as providing service and leadership both at home and abroad.
The award will be presented at the Mentorship and Career Development Roundtable: A Discussion With ASCO’s Special Award Recipients on June 4. Dr. Loehrer recently reflected on his career and shared his thoughts on the importance of pursuing humanitarian work in oncology. The interview was edited and condensed for clarity.
Much of your career has been devoted to establishing and advancing cancer care for patients in Kenya. How did you get started in this, and why did you feel compelled to pursue this work?
PL: My colleagues at Indiana University School of Medicine had been involved in Western Kenya for 3 decades through a program called AMPATH—Academic Model Providing Access to Healthcare. The AMPATH consortium is a unique partnership between more than a dozen North American universities led by Indiana University, Moi University, and Moi Teaching and Referral Hospital. Moi Teaching and Referral Hospital serves as the only tertiary hospital for the 25 million people living in Western Kenya.
After my first trip there over 15 years ago, I witnessed an incredible program addressing the medical, financial, and nutritional factors surrounding HIV/AIDS. But I also witnessed the abject neglect of men, women, and children with cancer. Whereas HIV was treatable, the common thought was that cancer was not. I was deeply moved by the sights of advanced Kaposi sarcoma; large, neglected breast masses; and huge masses from Burkitt lymphoma deforming the faces of infants and young children. I knew we could do better; I knew that we needed to do better.
When I came back home, I shared my story with one of my good friends from high school. He generously offered 1 year of support to pilot the provision of chemotherapy for patients with curable or highly treatable cancers. We subsequently received more financial support from industry, foundations, and our School of Medicine. AMPATH-Oncology was born.
When the program first started, the Kenyan physicians were seeing about 150 patients [with cancer] a year. A couple weeks ago, I witnessed 150 patients [with cancer] in clinic in a single day. Twenty years ago, they were giving rudimentary chemotherapy outside in a tent. Today, over 5,000 patients are treated with chemotherapy in the Chandaria Cancer and Chronic Disease Center that houses two linear accelerators and is overseen by multiple trained pediatric [oncologists], adult hematologists/oncologists, radiation oncologists, gynecologic oncologists, and surgeons.
Why do think oncologists should care about and make efforts to engage in global outreach and international cancer care?
PL: We are trained to help patients. During no medical school graduation is an oath taken by physicians to help patients "only if they live in your state or country." In the field of oncology, the world is our catchment area. Our duty is to eradicate cancer wherever it occurs. This is the basis of global oncology.
As 70% of new cases in cancer in the world are in low- and middle-income countries (LMICs), this is a good place to focus our work. The issues of access to care, fiscal toxicity, misinformation, and cultural beliefs are not unique in LMICs; they are global issues. This current generation of physicians is keen to do global work. My hope is that global oncology becomes a recognized discipline within our profession.
What challenges do you see to improving cancer care for under-resourced areas?
PL: The places where there are the greatest disparities is where one can make the greatest difference. For nearly every common cancer type in LMICs, the cure rates are 50% to 70% lower than they are in high-income countries. There may be some biologic explanations, but most reasons are socioeconomic. We have the capability to bridge this gap.
To address these issues, we need collaborative, multidisciplinary, and multicultural teams who also address the social determinants of health. The paucity of well-trained cancer personnel and access to high-quality cancer therapeutics, radiation, and supportive care needs to be addressed. We also need more job opportunities within the LMICs. Many of the cancers seen there are related to viral causes, which provides greater opportunities for prevention through vigorous vaccination campaigns, but even the modest cost of vaccinations is too big of a burden for many countries. This needs to be addressed with joint financial investments from industry; societies like ASCO, the American Cancer Society, and the European Society for Medical Oncology; and governmental agencies.
Can you talk a little about your humanitarian work here at home—namely, your efforts in founding the Hoosier Cancer Research Network contract research organization?
PL: During my fellowship at Indiana University, I was working with Lawrence (Larry) H. Einhorn, MD, of Indiana University Health, who was the master of clinical trials, but at the time, all of these trials were conducted at academic centers. One afternoon, Larry, Steve Williams, and I were reflecting on this, and the idea of a community-led clinical trials network arose. Before we even thought of how this might be structured, I knew its name—the Hoosier Oncology Group, or HOG. I was the chair of the HOG for 2 decades and had the joy of working with some incredible individuals in private practice who selflessly shared in the research mission.
As the years have gone by, we renamed ourselves the Hoosier Cancer Research Network (HCRN) and have grown to over 100 sites and enrolled thousands of patients on investigator-initiated trials. These investigator-initiated trials have not been designed by industry but rather conceived by members and presented to industry for support. The HCRN has provided administrative support for the Big Ten Cancer Research Consortium—which, like the HCRN, provides a unique opportunity for young investigators to pursue their creativity and become principal investigators of studies early in their careers.
What are some of the most important lessons being an oncologist has taught you?
PL: My definition of a hero is not someone who wears a cape and brandishes lightning bolts. Rather, I think of a hero as an ordinary person doing extraordinary things. Our patients are true heroes. Our patients are ordinary people who do extraordinary things every day. I have met people from all walks of life—whether physicians or nurses or technicians—and all of them understand humanity better by looking through the eyes of a patient with cancer. These patients, whether they are from California or Kenya, are our moral compass. I can’t think of a greater honor to serve humanity than through our chosen profession.