How I Became a Pediatric Oncologist and Endocrine Late Effects Clinical Researcher

Jul 19, 2019

Sogol Mostoufi-Moab, MD, MSCE, is an assistant professor of pediatrics in the Divisions of Endocrinology and Oncology at the Children’s Hospital of Philadelphia, Perelman School of Medicine (a role she has held for 8 years), and director of the institution’s Endocrine Late Effects After Cancer Therapy Program. After completing a dual fellowship in pediatric endocrinology and hematology/oncology, she was an instructor in the division of pediatric oncology at the Children’s Hospital of Philadelphia before transitioning to her current faculty position in 2011. Dr. Mostoufi-Moab is a 2018-2019 participant in ASCO’s Leadership Development Program.

How did you initially choose your current career path? Were there any unexpected detours along the way?

SM: I grew up with physician parents and from an early age developed a realistic fascination with medicine. Dinner conversations at home were usually filled with medical stories and events that my parents recounted after a hard day at work. In medical school, I took a year off to pursue clinical research in heart failure medicine, with the goal of pursuing a career path in cardiology (my father is a cardiologist). However, during my third year of medical school, I unexpectedly fell in love with my pediatric rotation, which left a lasting impression. After completing all my required third-year clerkships, I chose to do an elective in pediatric intensive care.

That month solidified my decision to pursue pediatric medicine. I knew I wanted to care for very sick pediatric patients, and would have no difficulty spending hours in the hospital providing medical care to this population. To this day, I never dread being on call and look forward to my time on service or in clinic with my patients. There is something absolutely beautiful about pediatrics and the privilege as a physician to care for the developing body and mind of a pediatric patient. Rounding on the oncology wards, I love watching kids play in their room with myriad toys, in the hallways being pushed by parents in red wagons (even riding the IV poles when the adults are not watching), or active in the playroom despite NG tubes, central lines, or chemotherapy-associated alopecia. I cherish examining stuffed animals to gain the trust of a young child who is terrified of medical providers.

In the world of pediatrics, patients will still enjoy playing superheroes and stay true to being a child if they feel well, regardless of platelet counts and scan results. It is a great source of inspiration and a way to put everything in perspective.

Describe your typical work day.

SM: During my inpatient weeks, I care for the pediatric patients on the solid tumor service. The day starts with inpatient sit-down rounds where the team reviews all inpatient data for the past 24 hours on each patient. We subsequently start walk rounds where each patient is seen, examined, and I spend a fair amount of time discussing medical treatment plans with patients and their parents/families. Sick patients are often prioritized.

I really enjoy the challenge of inpatient pediatric oncology, as patients are in general sicker, have multiple active medical issues, and provide ample opportunity to teach the house staff. New diagnoses are always a welcome challenge and require intense team effort to ensure all medical issues are addressed, diagnosis established, and treatment initiated in a timely manner. One of the most rewarding aspects of my job as a pediatric oncologist is to emotionally support parents in the most challenging time of their life, at the time of their child’s cancer diagnosis.

When not on the inpatient wards, I spend the majority of the week participating in clinical research, writing grants, meeting with research team members, and ensuring successful execution of active research studies in my portfolio. I conduct clinical research with the goal of understanding the mechanisms of and treating endocrine and metabolic late effects after cancer therapy. Endocrine late effects are the leading cause of morbidity and late effects in childhood cancer survivors, particularly after radiation and chemotherapy and more recently with the advent of immune therapy.

I spend two days per week seeing patients in the outpatient clinic addressing endocrine late effects after cancer therapy. I also treat pediatric patients with endocrine tumors such as thyroid cancer or adrenal tumors. I am one of two main providers at our institution to deliver care for pediatric, adolescent, and young adults with thyroid cancer. My clinics are often very busy and very interesting as the topic can vary from one patient to the next! This keeps me on my toes and in general very popular with residents and fellows for the learning experience. There is never a dull moment or routine in my clinic.

If you have to pick one aspect, what part of your job is your favorite? What part is the most challenging or frustrating?

SM: Without a doubt, the most amazing part of my job as a pediatric oncologist is caring for pediatric patients and getting my source of inspiration from their strength and ability to overcome the challenges of cancer therapy. At the same time, the most humbling aspect of my job as a pediatric oncologist is to watch cancer progression in cases where, despite every effort and offering various combinations of treatment regimens, we are unable to deliver a cure.

What do you wish you had known before you chose your career path?

SM: Despite the passing years and wisdom of experience, it is still very difficult to lose a child to cancer. Nothing is more heartbreaking than to watch parents say goodbye to a dying child. It is the most emotionally challenging part of my job as a pediatric oncologist. One of my cherished mentors taught me that even when there is no hope in cure, there is always hope in comfort—something I work hard to deliver even for patients when cure is no longer an option.

Why would you recommend this career to someone starting out in oncology?

SM: Pediatric oncology is an incredibly rewarding profession but requires dedication, hard work, and patience, particularly as it entails working with anxious parents! However, mastering the art of oncology comes with experience, great listening skills, and hard work. There is nothing more rewarding than helping a sick child overcome their diagnosis of cancer and watching that child grow to become a survivor of childhood cancer.

What kind of person thrives in this professional environment?

SM: Pediatric oncologists are hard-working, passionate, dedicated, perfectionist, and accomplished physicians who never cease advocating for their patients (and their parents) regardless of time of day or holiday. There is no such a thing as a 9-to-5 job in the world of pediatric oncology!

Can you share a personal experience that shaped your professional journey and led you to where you are today?

SM: I rotated through oncology as a pediatric intern. During my month on the oncology ward, I cared for a 4-year-old boy with relapsed acute myelogenous leukemia. He had cytarabine-associated conjunctivitis. I bought him these enormous yellow sunglasses I found in a local toy store, which were a huge hit, and we instantaneously became “best friends”!

Over the course of the month, I got to spend countless hours caring for his complications and playing with him when he felt well. He had the wisdom of an 80-year-old in his little body and always made everyone laugh with his precocious comments. Through my interactions with him and his family, I learned about the Jewish Orthodox faith and he even taught me how to pronounce and write his Hebrew name.

Our bond became so strong that I continued to visit him almost daily even after I finished my oncology rotation. He went on to receive a sibling-matched allogeneic peripheral stem cell transplant but developed many dreaded complications, including grade IV graft vs. host disease. Despite the many challenges, he still had his spunk and his blue eyes would always light up when I came for a visit. I always looked forward to these visits, even if post call from other residency responsibilities.

Sadly, he died from respiratory complications from disseminated fungal infection when I was away on vacation. I received a phone call from the BMT attending on service who knew how much I cared for this child. I was far away at the time and unable to say goodbye to him or his parents. As a token of their gratitude, his parents left his favorite stuffed animal, a black dog, for me with a beautiful letter expressing their thoughts and emotions. Caring for this patient was one of the main reasons I chose to become a pediatric oncologist. To this day, I keep a picture of him on my desk, and I cherish the black lab, “Blackie,” who is still in perfect condition.

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