From Laboratory to Patient; From Theory to Cure

Less than a year ago, I packed my belongings into my MINI and drove towards the Pacific Ocean to begin a three-year fellowship in gynecologic oncology. I passed through the diverse landscapes and cultural environments of the South, Midwest and West to arrive at my final destination – a cancer research laboratory.

Within a month, I went from meeting the needs of ill patients to studying a single protein on the surface of an organelle inside of a microscopic cancer cell. Lab meetings, where PhDs rattled off molecular mechanisms in jargon and abbreviations that were a foreign language for me, replaced clinical rounds. One year of lab research is required of all ‘gyn onc’ fellows. The certifiers at the American Board of Obstetrics and Gynecology believe fellows need to investigate cancer at all levels to become well-equipped specialists.

Perhaps it was for the best that my first in vitro experiments failed over multiple tries during the early months. Because without having the preliminary data this work provided, I could not graduate to animal experiments. The few times I visited the “mouse house” with the lab technician, I found myself worrying more about the living conditions of the genetically-engineered mice than about their potential to elucidate the causes of cancer. Clearly, I had no future in in vivo studies. I couldn’t bring myself to master the skill of sacrificing these obliging creatures in the name of science.

Despite avoiding one mousetrap, I found myself fully entrenched in the rat race of academic research. The desire to generate reproducible, relevant data was constantly overshadowed by the pressure to publish quickly and often. How many projects are you working on? How many abstracts will you be presenting at the national meeting? Is it an oral presentation or just a ‘science fair’ poster? Are you the first author on your publications? These were the stresses of scientists seeking tenure positions and federal grant funding. Learning the art of translating data into items on the résumé was key to holding onto coveted lab space.

Amidst the politics of ascending the academic ladder, I started to miss my patients. Outside the lab, I wondered to fellow clinicians how research translated to actual benefits for people suffering with cancer. Most cancers don’t give us decades to find a cure. They claim their victims while researchers are organizing figures and tables to present to their colleagues at professional meetings.

Attending the recent national conference for gynecologic oncologists reminded me that the last notable victory in advancing patient therapy occurred way back in the 1990s when a specific, 2-drug chemotherapy regimen showed obvious efficacy. More contemporary agents have proven to be too toxic, unaffordable, or lacking the required survival benefit to gain government approval for human use. Circulating within the ivory towers are many promising theories and billions of taxpayer dollars to test those theories. However, I feel frustrated by how long it takes for useful information to be generated and then trickle down to patients to improve their lives.

I have started to question the structure that measures academic value by quantity, more so than quality, of publications. Thousands of journals now house hundreds of thousands of manuscripts, most of which will never be read by other researchers. In fact, the literature review, in which a PhD candidate or junior instructor summarizes the available data on a topic, has become its own genre and résumé-builder. Concentrating on the hard numbers seemed superficial and shortsighted to me, given the ultimate mission to cure cancer. How did volume translate into impact? Where was consideration for the patient in this paradigm?

To be fair, scientific discovery is a long, grueling journey, filled with more crushing failures than laudable successes. I have great respect for the brilliant minds that have devoted a lifetime to adding to our knowledge of disease and treatment. Even those who haven’t directly participated in the rare breakthroughs have contributed with their negative results by steering us down more productive paths. However, I craved a closer connection between science and the patient. I need to look back on my lab year and see more than an esoteric journal citation. I want to be able to say to my next dying patient and her family that we don’t have all the answers yet, but there are meaningful, immediate ways to alleviate the suffering because of the societal investment we’ve made in research.

Serendipitously, I found the way to link my research to the frontlines of patient care, not at a medical convention, but at a birthday party. Over Korean BBQ and loud music, the friend of a friend of a friend, an artist-physician, asked me about my work. I shared that one project focused on health care utilization of cancer patients one year before death. His face lit up and he said, “My friend directs the palliative care and hospice department at your hospital. She could really use your data to change the culture of cancer care there. She’s been wanting to speak to the administration for years, but never had the resources to collect evidence to make her case.”

I leaned in eagerly to hear her name. Having a year of research time suddenly seemed much more worthwhile.