The Future of Cancer Care: The Next Generation of Oncologists

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is provided by Smilow Cancer Hospital.
00:17 --> 00:18the battle to fight cancer.
00:22 --> 00:24Tonight, we have a conversation
00:24 --> 00:24that,
00:25 --> 00:26in many ways is forward,
00:27 --> 00:29looking because we're going to be
00:29 --> 00:30talking to
00:31 --> 00:31doctors
00:32 --> 00:34who are the next generation
00:34 --> 00:36of cancer doctors.
00:37 --> 00:39Cancer care is evolving rapidly,
00:40 --> 00:41and as most of us
00:41 --> 00:42know with
00:42 --> 00:45advances in precision medicine, immunology,
00:46 --> 00:48and innovative approaches,
00:48 --> 00:50the way we take care
00:50 --> 00:51of cancer today
00:51 --> 00:52may be very different
00:53 --> 00:54from the way we take
00:54 --> 00:55care of cancer a few
00:55 --> 00:57years from now. And I
00:57 --> 00:59can tell you all with
00:59 --> 00:59certainty
01:00 --> 01:02that the changes just over
01:02 --> 01:04the past ten to fifteen
01:04 --> 01:04Years
01:05 --> 01:06are really enormous.
01:07 --> 01:09Tonight, I'm really excited to
01:09 --> 01:12be speaking with two
01:13 --> 01:15relatively young,
01:16 --> 01:17cancer physicians,
01:18 --> 01:19doctor Nicole
01:19 --> 01:21Casasante and doctor Etienne
01:22 --> 01:22Levielle
01:23 --> 01:24both of whom,
01:24 --> 01:27are clinical fellows at the
01:27 --> 01:28Yale School of Medicine in
01:28 --> 01:29in the,
01:30 --> 01:30cancer center.
01:32 --> 01:33As fellows,
01:34 --> 01:36both Nicole and Etienne and
01:36 --> 01:38their colleagues, because there are
01:38 --> 01:40ten fellows every year,
01:41 --> 01:42spend time
01:42 --> 01:44taking care of patients
01:44 --> 01:45with
01:45 --> 01:47various types of cancer.
01:48 --> 01:50They do that for roughly
01:50 --> 01:51a year and a half
01:51 --> 01:52and then spend
01:52 --> 01:54a year and a half
01:54 --> 01:55and frequently longer
01:57 --> 02:00doing research, either clinical research
02:00 --> 02:01or laboratory research
02:02 --> 02:03to get
02:03 --> 02:06training that extends beyond the
02:06 --> 02:06clinical training.
02:08 --> 02:08First,
02:09 --> 02:11maybe I can just ask
02:11 --> 02:12each of you, and I'll,
02:12 --> 02:14I'm going to flip flop back
02:14 --> 02:15and forth, but I'll start
02:15 --> 02:16with Nicole, and then I'll
02:16 --> 02:17turn to Etienne.
02:18 --> 02:20What made you want
02:20 --> 02:20to pursue
02:21 --> 02:23a career in cancer medicine?
02:24 --> 02:25You know, there are lots
02:25 --> 02:26of different
02:26 --> 02:27areas to pursue.
02:28 --> 02:29There are
02:30 --> 02:31cardiologists
02:31 --> 02:34and infectious disease experts
02:34 --> 02:35and
02:36 --> 02:37obstetricians.
02:38 --> 02:39But,
02:39 --> 02:40but you've chosen to do
02:40 --> 02:42cancer medicine. Why?
02:43 --> 02:44Yeah. I think
02:44 --> 02:46being an oncologist and working
02:46 --> 02:47in cancer medicine is really
02:47 --> 02:49the best job. But for
02:49 --> 02:51me, it started in college.
02:51 --> 02:52I was really fascinated
02:52 --> 02:55studying cell and cancer biology.
02:56 --> 02:57So then in medical school,
02:57 --> 02:58I,
02:58 --> 03:01sought out working with, clinical
03:01 --> 03:01oncologists.
03:01 --> 03:03I ended up working with
03:03 --> 03:04a breast oncologist
03:04 --> 03:05in clinic and also on
03:05 --> 03:07some research projects.
03:07 --> 03:09She really introduced me
03:10 --> 03:11to clinical oncology and how
03:11 --> 03:13we can ask really important
03:13 --> 03:15research questions that impact our
03:15 --> 03:16patients in the clinic.
03:17 --> 03:18And my
03:18 --> 03:20area of interest specifically is
03:20 --> 03:21breast oncology,
03:21 --> 03:22which,
03:23 --> 03:24I'm biased, but I think
03:24 --> 03:26is is the most interesting
03:26 --> 03:27area of oncology.
03:28 --> 03:29You know, there's so many
03:29 --> 03:31different subtypes of breast cancer.
03:31 --> 03:32We have so many different
03:32 --> 03:35targeted therapies, and we don't
03:35 --> 03:35have to give all of
03:35 --> 03:36our patients chemotherapy.
03:38 --> 03:40So it's a really inspiring
03:40 --> 03:41area to work in.
03:41 --> 03:43Well, as many people who
03:43 --> 03:45are listening tonight know, I
03:45 --> 03:47have spent my career being
03:47 --> 03:49a breast cancer doctor, and
03:49 --> 03:50so I have to say
03:50 --> 03:52I agree with you. And
03:52 --> 03:54to this day, there's never
03:54 --> 03:55a new patient I see
03:56 --> 03:57who I'm not excited about
03:57 --> 03:58seeing.
03:58 --> 03:59And
03:59 --> 04:01I should add that,
04:01 --> 04:03Nicole, you're somebody who's interested
04:03 --> 04:04in clinical research.
04:05 --> 04:06In contrast,
04:06 --> 04:07Etienne
04:09 --> 04:09is,
04:10 --> 04:11someone interested
04:12 --> 04:13in a different type of
04:13 --> 04:14research
04:14 --> 04:16in laboratory research.
04:17 --> 04:18And in many ways,
04:19 --> 04:22laboratory research doesn't look that
04:22 --> 04:24different depending on different areas
04:24 --> 04:25that you go into.
04:26 --> 04:28So, Etienne, I'm gonna guess
04:28 --> 04:29you could have gone into
04:29 --> 04:31a number of different specialties.
04:32 --> 04:33But what made you choose
04:33 --> 04:34cancer, and
04:35 --> 04:35what,
04:36 --> 04:38makes that work with the
04:38 --> 04:39laboratory interests you have? Mhmm.
04:39 --> 04:41That's a that's a great
04:41 --> 04:42question. So
04:42 --> 04:43I came to medicine
04:44 --> 04:45with the ambition. It's a
04:45 --> 04:46and it's really a lifelong
04:47 --> 04:48journey to understand
04:48 --> 04:49human health
04:49 --> 04:51and its full spectrum.
04:51 --> 04:53That starts at the molecular
04:53 --> 04:54level, how cells
04:54 --> 04:56grow and communicate with one
04:56 --> 04:57another
04:57 --> 04:58all the way to
04:59 --> 05:01patients and how they live
05:01 --> 05:01with disease
05:02 --> 05:03and how we can make
05:03 --> 05:04their their lives
05:04 --> 05:06better and and longer.
05:07 --> 05:08And I wanted to really
05:08 --> 05:09bridge those two ends of
05:09 --> 05:11the spectrum together. So using
05:11 --> 05:12knowledge
05:13 --> 05:14of biology
05:14 --> 05:16and medicine to
05:16 --> 05:17have new treatment for for
05:17 --> 05:18patients.
05:18 --> 05:20And I really want Yes?
05:20 --> 05:21No. I was just gonna
05:21 --> 05:22say, in the area of
05:22 --> 05:24cancer you're interested in Mhmm.
05:26 --> 05:27Is Yes. I work with
05:27 --> 05:27lymphoma,
05:28 --> 05:29which is a type of
05:29 --> 05:31cancer derived from immune cells.
05:33 --> 05:34So the immune system needs
05:34 --> 05:35to to develop
05:36 --> 05:38and be able to train
05:38 --> 05:40itself to fight infections. And
05:40 --> 05:41sometimes, unfortunately, that can go
05:41 --> 05:42wrong and that can give
05:42 --> 05:44rise to leukemias and lymphomas.
05:45 --> 05:47So by studying these diseases,
05:47 --> 05:49you can learn about cancer
05:49 --> 05:49and how to treat it,
05:49 --> 05:50but you can also learn
05:50 --> 05:52about the immune system so
05:52 --> 05:53that it has many potential
05:53 --> 05:54applications. And
05:54 --> 05:56the the reason why I
05:56 --> 05:58chose this discipline is to
05:58 --> 05:59me, it was the the
05:59 --> 06:00most representative
06:00 --> 06:01of medicine,
06:01 --> 06:03meaning that oncology is deeply
06:03 --> 06:03rooted
06:04 --> 06:06in science and and biology.
06:07 --> 06:08And also, it's also profoundly,
06:09 --> 06:11a UN experience to to
06:11 --> 06:12have cancer, and it's a
06:12 --> 06:14very challenging,
06:15 --> 06:16thing. And and you you
06:16 --> 06:18need someone who's empathetic and
06:18 --> 06:19able to
06:20 --> 06:21help you through that experience.
06:21 --> 06:22So that for me, that
06:22 --> 06:23was very the most rewarding
06:23 --> 06:24part, and that's why I
06:24 --> 06:24chose oncology.
06:25 --> 06:27Was there a time in
06:27 --> 06:27either
06:28 --> 06:30medical school or before medical
06:30 --> 06:31school or in residency
06:32 --> 06:33that
06:34 --> 06:36it just dawned on you
06:36 --> 06:37that that this is the
06:37 --> 06:38area you wanted to go
06:38 --> 06:40in, or was it really
06:40 --> 06:42just a gradual process or
06:42 --> 06:43something that, in in many
06:43 --> 06:45ways, you just sort of
06:45 --> 06:46always knew before then? Mhmm.
06:46 --> 06:48I think it was a
06:48 --> 06:49little bit of both.
06:50 --> 06:51Throughout my my medical training,
06:52 --> 06:53I had a natural inclination
06:54 --> 06:56towards oncology and always knowing
06:56 --> 06:57what it is like for
06:57 --> 06:59the patient to live with
06:59 --> 07:00that illness, but also to
07:00 --> 07:01understand how does that work
07:02 --> 07:04at the at the cellular
07:04 --> 07:05level and how can we
07:06 --> 07:07use that to go back
07:07 --> 07:08to the patient and and
07:08 --> 07:09make them better. There there
07:09 --> 07:10was also a lot of,
07:11 --> 07:12very formative mentors that I've
07:12 --> 07:14met that were tremendous physicians
07:14 --> 07:16that represented every everything I
07:16 --> 07:17aspire to be. They were
07:18 --> 07:19extremely smart, knew all the
07:19 --> 07:21details of how the the
07:21 --> 07:22cancer
07:22 --> 07:24developed, but most importantly, were
07:24 --> 07:26really great human beings and
07:26 --> 07:28really supportive for their patients.
07:28 --> 07:29And even in their
07:30 --> 07:31very difficult moments, they were
07:31 --> 07:32able to make
07:32 --> 07:34their patients feel better. And
07:34 --> 07:35that was very inspiring for
07:35 --> 07:36me.
07:36 --> 07:37Yeah. You know, listening to
07:37 --> 07:38the two of you makes
07:38 --> 07:40me remember back
07:41 --> 07:43just a few decades ago
07:43 --> 07:44when I was choosing to
07:44 --> 07:45be an oncologist,
07:46 --> 07:46and
07:47 --> 07:49I thought about all sorts
07:49 --> 07:50of different fields. In fact,
07:50 --> 07:52I was initially gonna be
07:52 --> 07:53a psychiatrist, and then I
07:53 --> 07:55decided to train in internal
07:55 --> 07:57medicine and had to pick
07:57 --> 07:59a specialty. And everything seemed
07:59 --> 08:00interesting.
08:01 --> 08:03But I found even then
08:03 --> 08:05when our treatments were so
08:05 --> 08:06much more rudimentary
08:06 --> 08:07than they are today,
08:09 --> 08:10that oncology
08:10 --> 08:12was the most compelling. And
08:13 --> 08:15little did I know, although
08:15 --> 08:17I certainly hoped that treatment
08:17 --> 08:19would evolve the the way
08:19 --> 08:21it has, not that we've
08:21 --> 08:23by any means, come close
08:23 --> 08:24to answering all the questions.
08:25 --> 08:25So,
08:26 --> 08:27Nicole,
08:28 --> 08:30what what in terms of
08:31 --> 08:32research findings,
08:33 --> 08:34in terms of advances,
08:36 --> 08:37have most excited you
08:38 --> 08:39in the
08:39 --> 08:41somewhat limited time you've been
08:41 --> 08:42following this. But I have
08:42 --> 08:44to say even in the
08:44 --> 08:44past
08:45 --> 08:47three or four years, we've
08:47 --> 08:49seen the development of multiple
08:49 --> 08:49new
08:50 --> 08:52drugs and new approaches for
08:52 --> 08:52breast cancer.
08:54 --> 08:55Yeah. I think
08:55 --> 08:56in in a field like
08:56 --> 08:58oncology, there's so many new,
08:59 --> 08:59you know,
09:00 --> 09:01like, advances. So it's a
09:01 --> 09:03tough question. But I think
09:03 --> 09:05that the advent of antibody
09:06 --> 09:08drug conjugates that are essentially
09:08 --> 09:10smart drugs that recognize a
09:10 --> 09:11protein on the surface of
09:11 --> 09:14cancer cells and deliver chemotherapy
09:14 --> 09:16directly to the cancer cells
09:16 --> 09:17really have revolutionized
09:17 --> 09:19the field of oncology in
09:19 --> 09:19many
09:20 --> 09:21different, disciplines.
09:21 --> 09:23Now we have multiple of
09:23 --> 09:25these drugs approved to treat
09:25 --> 09:25our patients,
09:26 --> 09:28but there's still many open
09:28 --> 09:30research questions, you know, regarding
09:30 --> 09:32which patients should receive them
09:32 --> 09:33and in which order.
09:35 --> 09:36Yeah. And and just so
09:36 --> 09:38our audience is,
09:39 --> 09:39clear,
09:40 --> 09:43antibody drug conjugates are sort
09:43 --> 09:44of what they sound like.
09:44 --> 09:45They're antibodies,
09:46 --> 09:47and it's the antibody that
09:47 --> 09:48detects,
09:49 --> 09:49proteins
09:50 --> 09:51on the surface of the
09:51 --> 09:52cancer cell.
09:52 --> 09:54And they're
09:54 --> 09:56linked with a so called
09:56 --> 09:57linker
09:57 --> 09:59to, in fact, a little
09:59 --> 10:01tiny dose of chemotherapy
10:02 --> 10:03acting a bit like a
10:03 --> 10:05Trojan horse and and sneaking
10:05 --> 10:07in there and delivering that
10:07 --> 10:08dose of chemotherapy.
10:08 --> 10:10But it turns out it's
10:11 --> 10:12much more complicated than the
10:12 --> 10:14simple way I explained it,
10:15 --> 10:16and I only understand
10:17 --> 10:17a
10:18 --> 10:19piece of it. But these
10:19 --> 10:21these drugs are here and
10:21 --> 10:21here to stay.
10:22 --> 10:23And, Etienne, what what about
10:23 --> 10:25you? What's what's been the
10:25 --> 10:26most exciting in in either
10:26 --> 10:29lymphoma or or leukemia or
10:29 --> 10:30or one or for that
10:30 --> 10:31matter, myeloma, any of the
10:31 --> 10:32hematologic malignancies?
10:33 --> 10:34Mhmm. I think there's a
10:34 --> 10:35lot of things,
10:36 --> 10:37that are very exciting.
10:37 --> 10:39And I think blood cancers,
10:41 --> 10:42I've really been at the
10:42 --> 10:44forefront of new therapeutic advances
10:45 --> 10:46for for many reasons. But
10:46 --> 10:48if you if we take
10:48 --> 10:49a a step back, the
10:49 --> 10:52first antibody treatment were in
10:52 --> 10:53lymphomas with with the advanced
10:53 --> 10:55fritoximab not not more than
10:55 --> 10:57two decades ago. And then
10:57 --> 10:58we we've been able to
10:58 --> 10:58pioneer,
10:59 --> 11:00a new
11:01 --> 11:01disease
11:01 --> 11:03treatment changing therapies like,
11:04 --> 11:05CAR T cells, which
11:06 --> 11:07are essentially the on patient
11:07 --> 11:08T cells
11:08 --> 11:10that we take out of
11:10 --> 11:11their body,
11:12 --> 11:13with a a blood draw,
11:13 --> 11:14and then we're able to
11:14 --> 11:16modify them in the lab
11:16 --> 11:17and and essentially supercharge
11:17 --> 11:19them to target
11:19 --> 11:21specifically their cancer. We and
11:21 --> 11:22then we we put them
11:22 --> 11:23back, and those have tremendously
11:23 --> 11:25improved outcomes of patients with
11:25 --> 11:26lymphoma and myeloma.
11:27 --> 11:29There's also new therapies,
11:29 --> 11:30called BiTEs,
11:31 --> 11:33or bispecific t cell engager
11:33 --> 11:34that are essentially,
11:34 --> 11:36bringing your immune cells in
11:36 --> 11:37proximity to the to the
11:37 --> 11:39cancer cells and are able
11:39 --> 11:40to help your own immune
11:40 --> 11:41system
11:41 --> 11:43eliminate the the cancer. So
11:43 --> 11:44those therapies have as I
11:44 --> 11:46said, I've really changed the
11:46 --> 11:48paradigm for us, and I'm
11:48 --> 11:49hopeful that in the future,
11:49 --> 11:51they will apply to other
11:51 --> 11:52cancers as well.
11:53 --> 11:54Yeah. No. It's it's you
11:54 --> 11:56know, all of these treatments
11:56 --> 11:58are things that we really
11:58 --> 11:59couldn't have imagined
11:59 --> 12:01thirty and forty years ago.
12:01 --> 12:02And, you know, with with
12:02 --> 12:04CAR Ts, I'm I'm always
12:04 --> 12:06I'm always sort of amazed
12:06 --> 12:08by the whole technology and
12:08 --> 12:09the way we can,
12:09 --> 12:11in my mind, educate a
12:11 --> 12:12t cell
12:12 --> 12:14to make it an a
12:14 --> 12:16a weapon against the cancer.
12:16 --> 12:17No. It's truly amazing. I
12:17 --> 12:18mean, every
12:19 --> 12:20every time I see patients,
12:21 --> 12:22I explain it to them.
12:22 --> 12:23And as I'm explaining it,
12:24 --> 12:25I almost have trouble believing
12:25 --> 12:26that we're able to do
12:26 --> 12:28that. It's truly amazing. And
12:28 --> 12:29we we take it for
12:29 --> 12:31granted sometimes, but when you
12:31 --> 12:32take a step back, it's
12:32 --> 12:33fascinating, the things we're able
12:33 --> 12:34to do. And it can
12:34 --> 12:35only make us so excited
12:35 --> 12:37for the future as well.
12:37 --> 12:39And I I think you've
12:39 --> 12:41been talking about two treatments
12:41 --> 12:43that clearly have
12:44 --> 12:46major implications for the treatment
12:46 --> 12:46of cancer,
12:47 --> 12:49but increasingly for other types
12:49 --> 12:51of diseases as well.
12:51 --> 12:52Rituximab,
12:53 --> 12:53which was developed
12:54 --> 12:55initially for the treatment of
12:55 --> 12:56lymphoma,
12:57 --> 12:58is used in some non
12:58 --> 13:00oncologic conditions
13:00 --> 13:01as well today.
13:01 --> 13:03And there's a lot of
13:03 --> 13:05interest in using these cellular
13:05 --> 13:06therapies like CAR Ts
13:07 --> 13:08in the treatment of a
13:08 --> 13:10whole range of different diseases.
13:10 --> 13:11So, you know, what we're
13:11 --> 13:12learning in cancer
13:13 --> 13:13may
13:14 --> 13:16have very, very broad implications.
13:17 --> 13:18Well, we're gonna have to
13:18 --> 13:20take just a,
13:20 --> 13:22brief break. And when we
13:22 --> 13:24come back, I will continue
13:24 --> 13:24my conversation
13:25 --> 13:27with two of our,
13:27 --> 13:28extraordinarily
13:28 --> 13:29talented,
13:30 --> 13:30hematology
13:31 --> 13:34oncology fellows at Yale and
13:34 --> 13:35hear more about
13:35 --> 13:36their thoughts about
13:37 --> 13:39training and the future of
13:39 --> 13:40cancer research.
13:41 --> 13:43Funding for Yale Cancer Answers
13:43 --> 13:44comes from Smilow Cancer Hospital,
13:45 --> 13:47where a multi specialty team
13:47 --> 13:48is dedicated to managing the
13:48 --> 13:49diagnosis,
13:49 --> 13:51evaluation, and treatment of prostate
13:51 --> 13:53cancer and other urologic
13:53 --> 13:53cancers.
13:54 --> 13:55Learn more at smilocancerhospital
13:56 --> 13:57dot org.
13:59 --> 14:00It's estimated that over two
14:00 --> 14:02hundred and forty thousand men
14:02 --> 14:03in the US will be
14:03 --> 14:05diagnosed with prostate cancer this
14:05 --> 14:07year, with over three thousand
14:07 --> 14:08new cases being identified here
14:08 --> 14:09in Connecticut.
14:10 --> 14:11One in eight American men
14:11 --> 14:13will develop prostate cancer in
14:13 --> 14:14the course of his lifetime.
14:15 --> 14:16Major advances in the detection
14:16 --> 14:18and treatment of prostate cancer
14:18 --> 14:20have dramatically decreased the number
14:20 --> 14:21of men who die from
14:21 --> 14:22the disease.
14:22 --> 14:24Screening can be performed quickly
14:24 --> 14:25and easily in a physician's
14:25 --> 14:27office using two simple tests,
14:28 --> 14:29a physical exam and a
14:29 --> 14:30blood test.
14:30 --> 14:32Clinical trials are currently underway
14:32 --> 14:34at federally designated comprehensive cancer
14:34 --> 14:36centers, such as Yale Cancer
14:36 --> 14:38Center and its Milo Cancer
14:38 --> 14:38Hospital,
14:39 --> 14:40where doctors are also using
14:40 --> 14:43the ARTEMIS machine, which enables
14:43 --> 14:45targeted biopsies to be performed.
14:45 --> 14:47More information is available at
14:47 --> 14:47yalecancercenter
14:48 --> 14:50dot org. You're listening to
14:50 --> 14:51Connecticut Public Radio.
14:52 --> 14:54Welcome back to Yale Cancer
14:54 --> 14:56Answers. I'm Eric Wiener. And
14:56 --> 14:57tonight, I've been speaking with
14:58 --> 15:00two of our Yale clinical
15:00 --> 15:01fellows,
15:02 --> 15:03who work in the cancer
15:03 --> 15:03center,
15:05 --> 15:07doctor Nicole Casasanta and doctor
15:07 --> 15:08Etienne
15:08 --> 15:09Lavay,
15:11 --> 15:12they are in their
15:13 --> 15:13respectively
15:14 --> 15:15second and third years of
15:15 --> 15:17a three year fellowship,
15:17 --> 15:19which involves both clinical care
15:19 --> 15:21and, in research.
15:22 --> 15:23So I wanna turn to
15:23 --> 15:25a very different topic for
15:25 --> 15:26a few minutes
15:27 --> 15:30and talk about medical training.
15:30 --> 15:32We hear a lot,
15:33 --> 15:35and we've heard a lot
15:35 --> 15:36over the last decade
15:37 --> 15:37about
15:38 --> 15:39burnt out physicians
15:40 --> 15:41and other health care workers,
15:41 --> 15:42about the challenges
15:43 --> 15:44of being a physician,
15:45 --> 15:48the challenges sometimes associated with
15:48 --> 15:49training. At the same time,
15:50 --> 15:51medical school applications
15:52 --> 15:53are about as high as
15:53 --> 15:54they've ever been,
15:54 --> 15:56and it's
15:56 --> 15:58extremely difficult to get into
15:58 --> 15:59medical school these days.
16:01 --> 16:03Maybe you could each share
16:03 --> 16:05a little bit about,
16:06 --> 16:06your experience
16:07 --> 16:08with training
16:09 --> 16:10and the
16:10 --> 16:12sort of highs and and
16:12 --> 16:13and lows and what you
16:13 --> 16:16would tell somebody who's thinking
16:16 --> 16:17about a career in medicine.
16:18 --> 16:19Who wants to go first?
16:20 --> 16:21I I can go. Okay.
16:21 --> 16:22There you there you go.
16:22 --> 16:23And and and and I
16:23 --> 16:25should say, Etienne, you're Canadian.
16:25 --> 16:26So Yeah. Yeah.
16:27 --> 16:29And and maybe you could
16:29 --> 16:30also just reflect a little
16:30 --> 16:32bit on whether you think
16:32 --> 16:34the the Canadian system
16:34 --> 16:35or the
16:35 --> 16:37versus the US system are
16:37 --> 16:38very different.
16:38 --> 16:39Mhmm. Yeah. I did my
16:39 --> 16:41medical training at McGill University
16:41 --> 16:42in Montreal
16:43 --> 16:43in Canada.
16:44 --> 16:46I think I cannot say
16:46 --> 16:48exactly how medical school is
16:48 --> 16:49here, although I've mentored a
16:49 --> 16:51lot of medical students. I
16:51 --> 16:53think it is mostly similar.
16:53 --> 16:54So what else I I
16:54 --> 16:56think is applicable to both
16:56 --> 16:56scenarios, but
16:57 --> 16:59it it's not always easy,
16:59 --> 17:00but for me, it's been
17:00 --> 17:01an incredibly
17:01 --> 17:02rewarding,
17:02 --> 17:04fascinating, and life changing experience.
17:04 --> 17:05And I went I would
17:05 --> 17:07do it a thousand times
17:07 --> 17:08over again.
17:09 --> 17:11You know, some sometimes we
17:11 --> 17:11hear
17:11 --> 17:13a lot tougher colleagues say,
17:13 --> 17:14oh, because we work a
17:14 --> 17:15lot as people might know.
17:15 --> 17:17People say, oh, I have
17:17 --> 17:18no life because I study
17:18 --> 17:19all the time. But for
17:19 --> 17:21me, that that was what
17:21 --> 17:23my life is about, and
17:23 --> 17:24I think there's no better
17:24 --> 17:26life than learning about health,
17:26 --> 17:28disease, medicine, and how we
17:28 --> 17:29can
17:29 --> 17:31create new knowledge to help
17:31 --> 17:32patients. And
17:32 --> 17:33and and you learn a
17:33 --> 17:34lot about yourself as you
17:34 --> 17:36go through that journey.
17:36 --> 17:38And sometimes you see older
17:38 --> 17:40people, younger people that that
17:40 --> 17:41have illnesses, and it
17:42 --> 17:44it's profoundly unfair, and it
17:44 --> 17:44helps you
17:45 --> 17:46reflect on how you can
17:46 --> 17:48be a better person for
17:48 --> 17:49person for yourself, but also
17:49 --> 17:50for your
17:51 --> 17:52patients. And in terms of
17:52 --> 17:53what's more difficult, there's a
17:53 --> 17:54lot of,
17:54 --> 17:55pressure that we put on
17:55 --> 17:57ourselves, I think, because we
17:57 --> 17:58wanna be the best,
17:59 --> 17:59doctor
18:00 --> 18:01for our patients. So that
18:01 --> 18:02can come with a lot
18:02 --> 18:02of,
18:04 --> 18:05self doubt and and hardship.
18:05 --> 18:07But all things considered, it's
18:08 --> 18:09a great experience, I would
18:09 --> 18:09say.
18:10 --> 18:11And Nicole?
18:12 --> 18:13Yeah. I I agree with
18:13 --> 18:15Etienne. I would do this
18:15 --> 18:16all over again, and I
18:16 --> 18:17would not choose another career.
18:17 --> 18:19I can't think of a
18:19 --> 18:20a more
18:20 --> 18:22meaningful and impactful career than
18:22 --> 18:24to get to work with
18:24 --> 18:25patients every day and, you
18:25 --> 18:27know, do research and try
18:27 --> 18:29to answer questions that that
18:29 --> 18:30really change people's lives.
18:32 --> 18:34I did my training, you
18:34 --> 18:35know, here in the US,
18:36 --> 18:38and I think it's similar
18:38 --> 18:39to Etienne's experience.
18:39 --> 18:41You know, you start out
18:41 --> 18:42in college being interested
18:43 --> 18:44in
18:44 --> 18:46in medicine. You apply and
18:46 --> 18:47go through four years of
18:47 --> 18:47medical
18:48 --> 18:49school. You do a residency
18:49 --> 18:51after you graduate with your
18:51 --> 18:53MD degree. And then,
18:54 --> 18:56you know, if you wanna
18:56 --> 18:56subspecialize
18:57 --> 18:58like we are, we become
18:58 --> 18:59fellows.
19:00 --> 19:01I think the most impactful,
19:02 --> 19:04I think, experience and training
19:05 --> 19:06is really in residency and
19:06 --> 19:08fellowship when you're on the
19:08 --> 19:09ground working with the patients,
19:09 --> 19:11getting to see them, and
19:11 --> 19:13learning directly from them. And
19:14 --> 19:15I think the most meaningful
19:15 --> 19:17aspects of this are really
19:17 --> 19:19talking with our patients and
19:19 --> 19:20and hearing what their lives
19:20 --> 19:21are like outside of the
19:21 --> 19:23clinic or outside of the
19:23 --> 19:24hospital, hearing their successes,
19:25 --> 19:25and,
19:26 --> 19:27really getting to know know
19:27 --> 19:29their families as well.
19:30 --> 19:30Well,
19:32 --> 19:32you know,
19:33 --> 19:35I trained at a time
19:35 --> 19:35when,
19:36 --> 19:37we worked
19:38 --> 19:38exceedingly
19:39 --> 19:39long hours,
19:41 --> 19:42hours that would not be
19:42 --> 19:44allowed by regulations today.
19:45 --> 19:47I'm not someone who says,
19:48 --> 19:50gee, people today need to
19:50 --> 19:51work more. I thought that
19:51 --> 19:53the way it was back
19:53 --> 19:53then
19:54 --> 19:55was just a little too
19:55 --> 19:56arduous.
19:57 --> 19:58That said,
19:59 --> 20:01I often say that my
20:01 --> 20:01best performance
20:02 --> 20:04in any job ever in
20:04 --> 20:05my life was when I
20:05 --> 20:06was an intern.
20:06 --> 20:07And
20:08 --> 20:10although the hours were exceedingly
20:10 --> 20:11long, and again, I don't
20:11 --> 20:12want anyone to have to
20:12 --> 20:13do that,
20:13 --> 20:14it was
20:15 --> 20:15incredibly
20:16 --> 20:16rewarding.
20:18 --> 20:19And, you know, to this
20:19 --> 20:21day, I still
20:21 --> 20:22love
20:22 --> 20:25practicing medicine, doing medical research,
20:26 --> 20:26and,
20:27 --> 20:28you know, I feel like
20:28 --> 20:29such a doctor.
20:30 --> 20:31But,
20:31 --> 20:32you know, I think the
20:32 --> 20:34three of us are among
20:34 --> 20:36the lucky ones. And, you
20:36 --> 20:37know, there are people who
20:37 --> 20:39do this and they end
20:39 --> 20:40up deciding it's not quite
20:40 --> 20:41right for them.
20:42 --> 20:43Although I think
20:44 --> 20:45some of that,
20:46 --> 20:48may relate to the people
20:48 --> 20:49they're around.
20:49 --> 20:50And I think we all
20:50 --> 20:52need to think about having
20:52 --> 20:52supportive
20:53 --> 20:53environments
20:54 --> 20:56for one another so that
20:56 --> 20:57we can best take care
20:57 --> 20:59of patients, which brings me
21:00 --> 21:01to my next question.
21:03 --> 21:04Could you
21:04 --> 21:05talk about
21:08 --> 21:09some clinical
21:10 --> 21:11experience you've had
21:12 --> 21:13that has really had a
21:13 --> 21:14profound
21:15 --> 21:16effect on you,
21:17 --> 21:18in oncology.
21:19 --> 21:21And whether it's
21:21 --> 21:22how someone
21:24 --> 21:26responded to a treatment or
21:26 --> 21:27whether it's
21:27 --> 21:30more of a story about
21:31 --> 21:34the challenges of dealing with
21:34 --> 21:35advanced cancer and all of
21:35 --> 21:37the complex emotions.
21:37 --> 21:39And and and as part
21:39 --> 21:40of that, maybe you can
21:40 --> 21:42also just reflect a little
21:42 --> 21:44bit on how you deal
21:44 --> 21:45with all the complexity
21:46 --> 21:46of of
21:48 --> 21:50the emotions surrounding cancer medicine.
21:51 --> 21:52Nicole, do you wanna start?
21:54 --> 21:55Yeah.
21:56 --> 21:57I think,
21:57 --> 21:58I did And I'm sorry
21:58 --> 21:59if this is a hard
21:59 --> 22:00question.
22:01 --> 22:04That's alright. I think that,
22:04 --> 22:05you know, I can think
22:05 --> 22:06of a particular
22:06 --> 22:09patient experience early in fellowship.
22:09 --> 22:10I I saw a young
22:10 --> 22:12woman in her forties who
22:12 --> 22:14had a history of hormone
22:14 --> 22:16receptor positive, HER two positive
22:16 --> 22:17breast cancer, and she had
22:17 --> 22:19completed all of her curative
22:19 --> 22:20intent treatment. She had done
22:20 --> 22:22everything, you know, that we
22:22 --> 22:22had, you
22:23 --> 22:24know, recommended that she do.
22:24 --> 22:25And
22:25 --> 22:26I saw her,
22:27 --> 22:28you know, with one of
22:28 --> 22:31our supervising physicians, and she
22:31 --> 22:31was
22:31 --> 22:33complaining of, you know, back
22:33 --> 22:35pain, neck pain, pretty severe,
22:35 --> 22:36wouldn't go away.
22:37 --> 22:38And
22:38 --> 22:40we, you know,
22:40 --> 22:41decided that we would go
22:41 --> 22:42ahead and do a workup
22:42 --> 22:44to see, unfortunately, if her
22:44 --> 22:45cancer had come back.
22:46 --> 22:48And, unfortunately, the workup showed
22:48 --> 22:49that it did. And, you
22:49 --> 22:51know, as the fellow, I
22:51 --> 22:52was able to really take
22:52 --> 22:54the lead on breaking the
22:54 --> 22:56news to her, discussing it
22:56 --> 22:58with her family, guiding her
22:58 --> 22:59through the next steps, and
22:59 --> 23:00really starting her on a
23:00 --> 23:01new treatment,
23:02 --> 23:03and starting her on a
23:03 --> 23:04new treatment that ultimately made
23:04 --> 23:06her feel so much better
23:06 --> 23:07and get back to doing
23:07 --> 23:08the things she loved to
23:08 --> 23:09do in her life and
23:09 --> 23:11spending more meaningful time with
23:11 --> 23:12her family.
23:13 --> 23:14And we see patients like
23:14 --> 23:15this every day.
23:17 --> 23:18I think that,
23:19 --> 23:21you know, this particular patient,
23:21 --> 23:22you know, really
23:22 --> 23:23valued,
23:23 --> 23:25you know, our health care,
23:25 --> 23:26our our time that we
23:26 --> 23:27spent with her, and,
23:28 --> 23:30and how we sat and
23:30 --> 23:31explained everything with her and
23:31 --> 23:33her family and really helped
23:33 --> 23:34her her get through this.
23:36 --> 23:38And how old was she?
23:38 --> 23:39She was in her forties.
23:40 --> 23:42Okay. So now I know
23:42 --> 23:43you've also taken care of
23:43 --> 23:44people
23:44 --> 23:46who are that much closer
23:46 --> 23:47to your age, which is,
23:47 --> 23:49I will tell our audience,
23:49 --> 23:51is certainly younger than forties.
23:53 --> 23:53And
23:54 --> 23:56how do you how do
23:56 --> 23:57you deal with that without
23:58 --> 23:59either getting
24:02 --> 24:04getting so involved you can't
24:04 --> 24:06think about other things? And
24:06 --> 24:07how do you deal with
24:07 --> 24:09it without getting worried about
24:09 --> 24:10yourself?
24:12 --> 24:13It's a really hard thing
24:13 --> 24:15to do seeing younger patients
24:15 --> 24:17with with cancer that are
24:17 --> 24:18so close to us as
24:18 --> 24:19you as you mentioned.
24:20 --> 24:22I I think that
24:22 --> 24:23it is,
24:23 --> 24:25I think, a very meaningful
24:25 --> 24:26experience to see the younger
24:26 --> 24:27patients because I do think
24:27 --> 24:29we can relate to them
24:29 --> 24:30very well and understand, you
24:30 --> 24:31know, where they are in
24:31 --> 24:33their life, what their goals
24:33 --> 24:34are, what experiences
24:34 --> 24:36are important to them. And
24:36 --> 24:37I I think that ultimately
24:37 --> 24:40helps us better personalize our
24:40 --> 24:41approach and our treatment
24:42 --> 24:42for them.
24:43 --> 24:44In terms of, you know,
24:44 --> 24:46thinking about yourself, I I
24:46 --> 24:47think that
24:49 --> 24:50focusing on the medicine, but
24:50 --> 24:52also thinking about the the
24:52 --> 24:54individual patient's goals in front
24:54 --> 24:55of you is helpful and
24:55 --> 24:57not in putting it on
24:57 --> 24:58on taking care of the
24:58 --> 25:01patient rather than thinking about
25:01 --> 25:02yourself or their age. And
25:02 --> 25:04I I think what's amazing
25:04 --> 25:06about medicine is we have
25:06 --> 25:07so many amazing colleagues that
25:07 --> 25:08we work with every day,
25:08 --> 25:10and it's really a multidisciplinary
25:10 --> 25:12team effort to take care
25:12 --> 25:14of patients. And so when
25:14 --> 25:15we're having a tough time
25:15 --> 25:16or we have a question,
25:16 --> 25:17we can always go to
25:17 --> 25:19our colleagues and mentors to
25:19 --> 25:21to discuss the case and
25:21 --> 25:22and hear their thoughts, which
25:22 --> 25:24is exceedingly helpful.
25:25 --> 25:25Echan?
25:26 --> 25:26You wanna
25:27 --> 25:28Yeah.
25:28 --> 25:30Those were great points. And
25:30 --> 25:31to to that point,
25:32 --> 25:33I had a mentor who
25:33 --> 25:34was saying that
25:34 --> 25:35illness,
25:35 --> 25:37including cancer, is really affecting
25:37 --> 25:39you the most when it
25:39 --> 25:41it's making you lose sense
25:41 --> 25:42of who you are.
25:42 --> 25:43And what I mean by
25:43 --> 25:46that is that you
25:46 --> 25:48people are defined by why
25:48 --> 25:49they love do what they
25:49 --> 25:51love doing, what they enjoy
25:51 --> 25:52doing, and what drives them.
25:52 --> 25:53So if you lose that,
25:53 --> 25:55it becomes very difficult,
25:56 --> 25:57to to
25:57 --> 25:58keep going. And and
25:59 --> 26:01that that's really when I
26:01 --> 26:02I I connect the most
26:02 --> 26:03with patients,
26:04 --> 26:06including young young patients. I
26:06 --> 26:07had someone who was a
26:07 --> 26:08younger individual
26:09 --> 26:10who who was diagnosed,
26:11 --> 26:11with a lymphoma
26:12 --> 26:13after weeks of
26:14 --> 26:14vague,
26:15 --> 26:17but concerning symptoms that no
26:17 --> 26:18one had put the finger
26:18 --> 26:19on. And, eventually,
26:20 --> 26:21on one hand, he was
26:21 --> 26:23relieved to have a diagnosis
26:23 --> 26:24of a of
26:25 --> 26:27a severe but treatable illness,
26:28 --> 26:29but also it was it's
26:29 --> 26:31always it's always comes back
26:33 --> 26:34to what you what you
26:34 --> 26:36need to do to to
26:36 --> 26:37feel fulfilled as a person
26:37 --> 26:38and, you know, that that
26:38 --> 26:39person
26:39 --> 26:41were they were studying and
26:41 --> 26:42they had to. We
26:42 --> 26:44are together almost we had
26:44 --> 26:44to negotiate.
26:45 --> 26:46How do we approach that?
26:46 --> 26:48I want you need to
26:48 --> 26:49be treated, obviously, but I
26:49 --> 26:50want to make sure that
26:50 --> 26:51you keep your sense of
26:51 --> 26:52identity and what makes you
26:52 --> 26:53wake up in the morning
26:53 --> 26:55and what you're passionate about.
26:55 --> 26:56So it's always difficult
26:57 --> 26:59to to talk about these
26:59 --> 27:00things, but it makes it
27:00 --> 27:02rewarding when you're able to
27:02 --> 27:04match those two
27:04 --> 27:06needs together, the treatment, but
27:06 --> 27:08also the individual's life.
27:09 --> 27:10I think those are
27:11 --> 27:13two really great
27:14 --> 27:16comments or series of of
27:16 --> 27:18comments, and I I have
27:18 --> 27:19to say I often think
27:19 --> 27:20and it's not something that
27:20 --> 27:22happens at one point in
27:22 --> 27:22time.
27:23 --> 27:24It's a process. But I
27:24 --> 27:26think as an oncologist,
27:26 --> 27:27if you haven't
27:29 --> 27:30come to terms with your
27:30 --> 27:31own mortality,
27:31 --> 27:32it becomes hard
27:33 --> 27:33to
27:35 --> 27:37function in as effectively as
27:37 --> 27:38you might otherwise in a
27:38 --> 27:39clinical setting.
27:39 --> 27:41Well, we only have
27:41 --> 27:42a little less than a
27:42 --> 27:43minute.
27:44 --> 27:45Of course,
27:45 --> 27:47some doctors
27:48 --> 27:49are in community settings, other
27:49 --> 27:51at academic settings.
27:51 --> 27:52I know that you've both
27:52 --> 27:55chosen to pursue careers in
27:55 --> 27:56academic medicine.
27:56 --> 27:58And if you can, in
27:59 --> 28:01fifteen seconds or less, each
28:01 --> 28:01just
28:02 --> 28:03comment about why it is
28:03 --> 28:04that you chose
28:05 --> 28:07to pursue a career in
28:08 --> 28:08at a university.
28:09 --> 28:11Well, I think practicing in
28:11 --> 28:13academics is incredibly exciting. We're
28:13 --> 28:14really on the forefront of
28:14 --> 28:16cutting edge research, and you're
28:16 --> 28:18working with mentors and colleagues
28:18 --> 28:19that are so inspirational,
28:20 --> 28:21in addition to our amazing
28:21 --> 28:23patients, Etienne.
28:23 --> 28:24Same thing for me. My
28:24 --> 28:25goal is to be a
28:25 --> 28:28pioneer in cancer research to
28:29 --> 28:30develop new treatments so that
28:30 --> 28:31no one has to
28:32 --> 28:33have a cancer diagnosis that
28:33 --> 28:34we cannot treat appropriately.
28:35 --> 28:37Doctors Etienne Leveille and Nicole
28:37 --> 28:37Casasanta 00:28:38.275 --> 00:28:39.635 are clinical fellows at the
28:39 --> 28:40Yale School of Medicine.
28:41 --> 28:42If you have questions, the
28:42 --> 28:44address is cancer answers at
28:44 --> 28:45yale dot e d u,
28:45 --> 28:46and past editions of the
28:46 --> 28:48program are available in audio
28:48 --> 28:49and written form at yale 00:28:49.840 --> 00:28:51.600 cancer center dot org. We
28:51 --> 28:52hope you'll join us next
28:52 --> 28:53time to learn more about
28:53 --> 28:54the fight against cancer.
28:55 --> 28:56Funding for Yale Cancer Answers
28:56 --> 28:58is provided by Smilow Cancer
28:58 --> 28:59Hospital.

Information

The Future of Cancer Care: The Next Generation of Oncologists with guests Drs. Etienne Leveille and Nicole Casansanta September 14, 2025.