Jan 10, 2020
Patrick J. Loehrer, MD, FASCO, is the director of the Indiana University Melvin and Bren Simon Cancer Center and associate dean for cancer research at Indiana University, roles which he has held for 10 years. Previously, he was the director of the Division of Hematology-Oncology at Indiana University. Dr. Loehrer has served in numerous ASCO volunteer roles, including the Cancer Communications Committee, Career Development Committee, Professional Development Committee, Annual Meeting Education Committee, Leadership Development Program, and ASCO Board of Directors. In 2017, he received the inaugural Allen S. Lichter Visionary Leader Award from ASCO for his extraordinary leadership.
How did you initially choose your current career path? Were there any unexpected detours along the way?
PL: I would like to say that my career path picked me. I did an elective as a medical student at Indiana University when Larry Einhorn was an assistant professor. He had recently published his pioneering work in metastatic testicular cancer. I knew after that rotation that this is what I wanted to do. Larry became not only a role model but later a mentor for clinical trial development. The success of my early trial efforts with ifosfamide hooked me. I became avid in the promulgation of clinical trials and co-founded the Hoosier Oncology Group with a community oncologist, and served as chair for two decades. A few years ago, it was renamed the Hoosier Cancer Research Network (HCRN) and is still going strong.
Fifteen years ago, I made my first trip to western Kenya to evaluate the AMPATH program that was started by my colleagues at Indiana University as a partnership with Moi University School of Medicine, prior to the subsequent HIV/AIDS crisis. Patients were packed two to a cot in wards of 20 patients with HIV/AIDS, hemoglobin levels of 3 gm, meningitis, and infections from bugs that I had read about in medical school but never thought I would ever see.
The emerging crisis for cancer was dwarfed by HIV/AIDS, but was dramatic in its presentations with far-advanced cases, no real treatment, and no trained physicians at any level. On the surgical ward I met a woman who had advanced head and neck cancer that replaced the side of her head. She covered her head with a blanket as she did not want to frighten the other patients or physicians. A few minutes later, I saw a young boy with advanced Burkitt lymphoma who was destined to die in a few weeks. By an accident of birth, these patients were born in a place without radiation, without chemotherapy, without trained oncologists who could have diagnosed their cancers earlier and cured them. I knew then that we needed to change the narrative. We needed to make a difference.
This became a calling. My role as division director and later as cancer center director afforded me an opportunity to invest and recruit talent to build capacity and cancer care delivery within the infrastructure of an inter-institutional and international partnership.
What are the unique concerns of a global oncologist, as compared to a disease- or modality-specific career path?
PL: Is there job security? Will institutions support such activities or just consider them as a hobby? Can one have an academic career in global oncology or will it just be an avocation? In order to be impactful, a global oncologist needs to spend substantial time in other countries, but keep the work relevant in our own. The truth is that global oncology transcends countries in that it is a discipline that works to address disparities that are common to underserved populations locally and internationally. This is important, as the causes of cancer disparities, such as access to care, income inequality, workforce inadequacies, cost of medications and fiscal toxicity, education, and the conduct of clinical trials, are seen across the globe in the inner city and rural sites in high-income countries, as well as in the villages and cities in low- and middle-income countries.
Describe your typical work day.
PL: I have clinic three half-days a week. Like all clinicians, completing dictations and orders takes up several hours a week. As cancer center director, I have numerous administrative responsibilities and meetings related to the cancer center and the school, and education forums to which I attend.
If you have to pick one aspect, what part of your job is your favorite? What part is the most challenging or frustrating?
PL: I like seeing patients—I love talking with them and getting to know them in the most challenging times of their lives. I like “building things,” whether that’s building through education by mentoring students, fellows, and faculty, or building through collaborative programs such as the HCRN, AMPATH-Oncology, or the Big Ten Cancer Research Consortium.
I share concerns with all clinical oncologists in that the most frustrating aspect is the time demands from dictations, documentation, and administrative duties surrounding clinical activities, rather than just seeing patients.
What do you wish you had known before you chose your career path?
PL: It is okay to admit you don’t know, but it is not okay to say you don’t care.
What advice would you give to someone starting out in oncology?
PL: Find good mentors, carve out protected time to read, pick out three areas to invest your time (e.g., short-term goals, median returns, and long-term impact), and get involved in societies such as ASCO. Publish early and often.
What kind of person thrives in this professional environment?
PL: You need to be emotionally mature, meticulous, and fun-loving. This is a tough business and it is easy to become burnt out, so it’s good to be grounded by activities and friendships beyond your circle at work.
Global oncology is in many ways an emerging field. What advice would you offer to oncology trainees who want to pursue global oncology but may not see a clear or established path to follow?
PL: Make your own path. Seek mentors and look to matriculate to institutions that are invested in global health. Establish yourself early by working to get extramural funding and publications, but seek impactful work with collaborative partners with whom you can share credit.