Oncology Fellow Advisor presents our Day in the Life series. In each segment, we interview a prominent thought leader about how he or she got into the field of oncology and his or her typical workday.

In this issue, we interview Sandra Swain, MD, medical director of the Washington Cancer Institute, in Washington, DC. We are honored to include such a prominent clinical researcher in this series. 

Earlier this year, Sandra Swain, MD, wrote and published a paper that in some ways defines her career. The study was a drug trial of patients diagnosed with early breast cancer, an area in which Dr. Swain is recognized as an international authority. More tellingly, the study—which included more than 5,000 patients from 185 medical centers—is the culmination of 14 years of work.1

“Clinical research is very hard and takes a strong commitment,” she says. “Fourteen years working on a clinical trial is a long time without results and a publication. So it’s a long-term process; it’s not overnight.”

Dr. Swain currently sits on the board of directors of the American Society of Clinical Oncology (ASCO). However, when she first began planning her career, she actually felt that becoming a full-fledged physician might have been beyond her.

“I grew up in an age when there weren’t that many women in medicine and it wasn’t that common for women to have the professional careers that they have now,” she said. With her interest in anatomy and physiology, Dr. Swain had planned to become a physical therapist, but the guidance of an advisor helped her realize that she had the capability to go farther in medicine.

During her fellowship at the National Cancer Institute (NCI), Dr. Swain carved out the research niche for which she’s now internationally recognized—inflammatory breast cancer. The disease accounts for less than 5% of all breast cancers diagnosed in the United States; however, survival rates for those with this highly aggressive type are far below those of more common breast cancer types.

“In those years, we were doing clinical trials on very selected rare diseases,” Dr. Swain says of her time at NCI. A mentor was researching locally advanced breast cancers and Dr. Swain became “very interested in working on a disease in which we could make more progress than the other earlier-stage diseases, which weren’t as aggressive,” she said. “I really felt that it was important to be doing research in that area.”

Since then, Dr. Swain has designed and implemented more than 20 clinical trials and is currently the principal investigator of 3 Phase III adjuvant breast cancer trials through the NCI-funded National Surgical Adjuvant Breast and Bowel Project (NSABP). She also has published more than 180 articles in leading medical and cancer research journals.

As the director of the cancer institute at the Washington Hospital Center, much of her time is now devoted to administrative tasks; however, she still maintains a robust research program and makes time to see patients 1 day per week.

“I’ve never wanted to be primarily in private practice, that’s not my goal. For me, I’m very passionate about clinical research,” she said. “[But] I think it’s very important for people doing research, especially if they’re doing clinical research, to be seeing patients. You need to be seeing patients to understand what the issues and questions are,” she added.

As a teacher, Dr. Swain has received awards for mentoring from both the NCI and the National Institutes of Health. Her most important advice for fellows choosing a mentor: “Make sure that the mentor has enough time to spend with them and actually sit down with them and come up with a plan.”

The plan should involve both short- and long-term goals, she says. Short-term goals should involve joining Phase II, investigator-initiated trials at a fellow’s home institution, or other research projects that will allow a fellow to get published fairly quickly and establish research credentials.

Expectations between the mentor and the fellow should be made clear up front, she emphasized, with the goal of being first author on research the fellow has done. “You need to make sure that as a fellow, you will get the publication and the credit for the work that you do,” she said. One way to ensure this is to write a review, which also strengthens a whole constellation of research and writing skills.

Over the longer term, fellows should focus on getting involved in major clinical trials or other national-scale projects by connecting with key opinion leaders in their chosen area of focus.

A great way to do this, Dr. Swain said, is to make a point of joining professional organizations and attending national meetings, like ASCO. Fellows benefit by networking with mature investigators who can guide them as fellows and junior faculty. The society benefits, Dr. Swain said, by getting fresh ideas from younger members with a better grasp of technology and social networking.

Dr. Swain added that the annual Methods in Clinical Cancer Research workshop in Vail, Colorado is perhaps the best way for young academics to get ahead. “It’s very competitive for them now, but it’s an outstanding learning experience,” she said. Accepted clinical fellows and junior faculty essentially bring a research project idea and write a protocol over the 1-week conference.

In competitive fields like breast cancer research, fellows can establish themselves through their passion, Dr. Swain said. “What it takes is passion and commitment. There is always room for people who have these qualities,” she said.

“It doesn’t matter that there are vast people in your area of interest; there are many more questions to ask and progress to be made,” she said.

However, even in fields like breast cancer where physicians can specialize in specific disease types or on highly specialized preclinical research topics, ultimately one of the most rewarding aspects of oncology is the holistic nature of cancer care, Dr. Swain added.

“One of the reasons that oncology is so great is that we take care of the whole person,” she said. “We’re not just doing a specific procedure, because the disease affects the whole body and mind. So that’s a very positive thing—you really have to have compassion for the patient and be thinking all the time as [to] how it affects the person as a whole.”

If you would like to nominate someone to be interviewed for our “Day in the Life” series, please send an e-mail to oncologyfellowadvisor@mcmahonmed.com.

Reference

1. Swain SM, Jeong JH, Geyer CE, et al. Longer therapy, iatrogenic amenorrhea, and survival in early breast cancer. N Engl J Med. 2010;362(22):2053-2065.


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