IMPACT OF
MULTIDISCIPLINARY TEAMS AND CANCER RESEARCH.
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Cancer researcher used to work exclusively in Zylos. Now
sometimes they worked at multidisciplinary teams. Does then health treatments
get the patient faster? Welcome to" The Clinicians Roundtable" on
ReachMD XM 157. I am your host, Dr. Bruce Bloom and joining us to discuss the
impact of multidisciplinary teams in cancer research, is Dr. Jordan Berlin,
Associate Professor and Clinical Director of Gastrointestinal Oncology at the
Vanderbilt University Medical Center in Nashville, Tennessee.
DR. BRUCE BROOM:
Dr. Berlin, welcome to ReachMD.
DR. JORDAN BERLIN:
Thank you.
DR. BRUCE BROOM:
Tell us about our own medical oncology specialty, what you
do at Vanderbilt?
DR. JORDAN BERLIN:
I am considered a gastrointestinal oncologist. I, along
with my team, treat the patients with tumors of the GI tract. So anything that
once the food passes the mouth and gets into the esophagus, anywhere the food
goes or its involved in digestion, we take care of that, includes the liver,
the pancreas, as well as the entire intestinal tract, the stomach, and we have
by virtue of the fact that the GI tract is the most common site for, a disease
called carcinoid, included.
DR. BRUCE BROOM:
You say you treat the patient, do you also do research?
DR. JORDAN BERLIN:
I also do clinical research or translational research
helping to bring the laboratory research from our GI program or elsewhere into
the clinic to try and learn more as we do in clinical trials.
DR. BRUCE BROOM:
So, how would you say you are week or your month is split
up?
DR. JORDAN BERLIN:
Well, I also run a clinical trials office, so my week is
split up between administrative, working on the clinical trials office that is
supposed to be 50% of my time, then 50% of my time is spent in the clinic and
then I have got about 20% of my time going to research trying to develop
programs and then I have got time mentoring and of course meetings, special
multidisciplinary meeting. So, I actually am considered more than 100%
committed.
DR. BRUCE BROOM:
Is there a common theme to either the treatments that are
used in these gastrointestinal cancers or the way they develop and the kinds of
things that they cause?
DR. JORDAN BERLIN:
There are many commonalities between the cancers, but not a
true common theme like there used to be. There used to be really have one
drugs for these diseases, 5FU. So everything got 5FU. So, a GI oncologist was
known for just using 5FU. But nowadays, we have got a lot more options and the
diseases are becoming more and more differentiated. The mention of carcinoid
earlier, is the one that is most significantly different, though primary liver
cancers are very different; however, the intestinal cancers seemed to have some
commonality and the gastric and esophageal cancers seemed to have some
commonality. So, we can somehow lump them together, having said that as we are
learning more and more about molecular basis of cancer, were splitting them up
more.
DR. BRUCE BROOM:
Have you seen as you do these kind of researching get to know
these cancers more than either within a single patient; there is a wide variety
of cancers within that person?
DR. JORDAN BERLIN:
Not so much within an individual person, though there are
family syndromes where the patients are particularly prone to having cancer.
They will have one or two or three different cancers during the course of their
time working with us.
DR. BRUCE BROOM:
And when you do a biopsy on a particular cancer in a
patient, do you find different areas of the body that the cancer actually looks
different even within one patient?
DR. JORDAN BERLIN:
Yes, in fact at our multidisciplinary team report this
morning, we have two cancers where one was the sarcoma which is a cancer that
is not the part of the GI tract per say, but can grow anywhere and in this
case, it has grown inside the abdomen and in the course of the sarcoma, there
appeared to 4 different sarcomas in one pathology specimen and then we had
colon cancer specimen removed from the liver where part of it was poorly
differentiated or looked very unlikely primary colon cells and then the other
part was actually fairly well-differentiated and mucin-producing and you cannot
see that where there was variability. If we looked at them by microbiology, we
will probably find even more differences across the cancer.
DR. BRUCE BROOM:
And is that one of the reason why it is so difficult for us
to eradicate cancer because even within a single patient, it seems to be
multiple diseases?
DR. JORDAN BERLIN:
We believe that that is the case. That as the cancers are
being studied more and more we are learning the complexity of cancer. So, for
example pancreas cancer where over 90% of the patient will have the K-ras
mutation and a Codon 12, the fact is that there are cells within the tumor that
have that mutation and the cells within it that do not have the mutation, but
again it seems to be a fairly uniform mutation in pancreas cancer; however, it
is still not a 100%. So, we are finding more and more variability and that may
be playing a role because when you kill off percentage of the cancer cells that
are sensitive to the chemotherapy or other therapy that we are using, there may
be a small percentage that have inherent resistance and those are going to
survive and there are going repopulate your cancer over time.
DR. BRUCE BROOM:
So, cancer itself seems to be a little multidisciplinary? I
know that you are sort of attacking at the Vanderbilt with a multidisciplinary
approach. Can you talk to us a little bit about that?
DR. JORDAN BERLIN:
Both in the laboratory, the laboratory to clinical approach
and the clinical approach, we are really approaching cancer with a variety of
people. The most common thing is in the clinic where we have multidisciplinary
clinics that involves surgeon, radiation oncologist, and medical oncologist all
working together. Most of the collaboration is accomplished through the
conferences or tumor boards where we have radiologist and pathologist helping
us to evaluate the data that we have and we can come together to develop a plan
rather than treating it in a silo and doing as you please all by yourself to
work together to come up with a plan one that the radiation oncologists, the
surgeons, the medical oncologists all agree upon, even if all are not involved
in the treatment of that individual patient. So, we work together as teams of
physicians. In addition, frankly that allows multiple medical oncologist to
give their opinions, multiple surgeons, etc. to place the size of Vanderbilt
that has a number of people that do the same things.
DR. BRUCE BROOM:
So, are not these multidisciplinary teams, besides their
physicians, are there support personnel and other people that are involved?
DR. JORDAN BERLIN:
So, I will use the best example for me as the tumor boards that
I am involved with, we have tumor boards other diseases other than GI and the
tumor board this morning was attended by radiologist, pathologist, to help use
to review the pathology and the x-rays. We also had, as always, one of the
nurses involved in genetic counseling in case we find the patients with the
family syndrome and we had a couple of the other nurses who come in addition to
the usual physicians, residents, surgeons, medical oncologist,
gastroenterologist will attend at times, and so a variety of different
specialties come in and of all whom provide some support one way or another.
Dr. Bruce Broom:
Tell us about the signal transduction and self proliferation
research program that you are involved in?
Dr. Jordan Berlin:
I am actually in the GI program here at Vanderbilt, but we
collaborate with the signal transduction and the other program here at
Vanderbilt in terms of doing clinical trials and I think that that example is
very good because when I got my last grants, he was to do a clinical trial and
liver cancer based on some data that we had obtained in the laboratories by
couple of our surgeons as well as little bit of data conducted one of our
signal transduction laboratories and the person who actually ended out
conducting the laboratory portion of our clinical trial primarily he has been
doing research in melanoma, but really focusses on signaling transduction. So,
we have really worked together as a group to develop the grounds, the clinical
trial, and actually we collaborate with other institutions on that clinical
trial to get it done.
DR. BRUCE BROOM:
So, how was this program team formed, were people chosen or
did they sort of select down to be part of the team?
DR. JORDAN BERLIN:
So, the people usually choose to be the part of the team.
In the cancer center, we have three clinical programs and three basic science
programs and within those programs, people are selected to be in their program
based on what their research primarily involve, but when it comes to developing
an individual protocol especially at our institution, we try to work between
programs, so that signal transduction may work with GI one week and they may
work with the breast group the next week, it is developing as a group, but your
researchers what drives where you go in terms of which program within the
cancer center that you are part of.
DR. BRUCE BROOM:
So, this signal transduction program has two broad ends, so let's
talk about the first one, which is increasing the awareness of the research
that is going on within each member's laboratory to encourage collaboration.
Tell us how that works for you and the kinds of breakthroughs that you might
have seen because of this kind of interdisciplinary work?
DR. JORDAN BERLIN:
There are few ways we collaborate to learn a little bit more
about each other. The most obvious is just through ordinary lectures. We will
have the members of the laboratory give a talk about what they are doing and
what there work is and of course anybody at the cancer center wise it is
invited or actually at institution wise you do not have to be a cancer center
member these are posted, but in addition we actually tend to have a research
retreats. These research retreats have been very helpful in that we will not
have just one program present, but multiple programs present at the same time,
so that the people who attend from all the program, they will see what other
research is going on and that will hopefully increase the collaboration between
the groups and it really works well. In addition, the leadership actually
often discusses what their program is up to in separate meetings, but the
larger way of doing it is through the research retreats and the common regular
multiple times a week lectures that go on.
DR. BRUCE BROOM:
So, do you think this kind of open this on all medical center
campuses or do you think this is kind of unique to what goes on at Vanderbilt?
DR. JORDAN BERLIN:
We like to believe that we have achieved it through a
greater degree than most other campuses to some degree this probably exist at
every campus, but I think it is to a greater or lesser degree, at each
institution. Depending on the leadership, I think the leadership at Vanderbilt
has been one that has fostered collaboration and that is an important of what
happens in science. If the leadership does not foster collaboration, the
people who are following, would not be encourage to do so, and therefore would
not do it on their own.
DR. BRUCE BROOM:
Do you believe in enrolling patients where possible clinical
trials to learn more about what the best and safest way is to treat
gastrointestinal cancers?
DR. JORDAN BERLIN:
Yes, I think clinical trials are the future for every
disease still. We have very few diseases where it really succeeded to a great
extent such as testicular cancer or where we cure the majority of patients and
we have no disease where we cure everybody. So, until we are curing everybody
or nearly everybody with the disease, clinical trials are the way to go to
improve upon what we are doing. Most of the time, clinical trails went unsuccessful
just do not improve upon care. It is very rare that the clinical trail will
have an experimental arm that will actually be worse than the original
treatments, but that does rarely happen; however, most of the time, either it
is going to improve the care or will be the same. Again, if our care was so
great, we would not need to do the clinical trials.
DR. BRUCE BROOM:
When you are working with the patient, how do you help them
decide which clinical trail to participate in?
DR. JORDAN BERLIN:
We generally have a limited number of clinical trails per
setting. In other words, if a person has stage III colon cancer, we usually
have only one stage III cancer trail. If we have multiple trails as we do with
stage IV colon cancer, there are usually some parameters or some requirements
that may make it different, but we often have for our some prioritization. We
needed a group as multidisciplinary team and decide what the priority is. So
that we have a trail that for example that is an MCI sponsored grant fund trail
that will often be the priority trail over almost anything else here at our
institution.
DR. BRUCE BROOM:
I would like to thank our guest, Dr. Jordan Berlin,
Associate Professor and Clinical Director of GI Oncology at the Vanderbilt
University Medical Center in Nashville Tennessee. We have been discussing the
impact of multidisciplinary teams and cancer research.
You have been listening to The Clinicians' Roundtable on
ReachMD XM 157, the channel for medical professional. For complete program
guide and broadcast, visit www.reachmd.com. For comments or questions, call us
toll free at 888-MD XM 157 and thank you for listening.
You have been listening to Public Health Policy in America,
a special ReachMD XM 157 interview series with our nation's top health leaders
in public health. This month ReachMD XM 157 will be discussing the many issues
challenging public health policy in America. For our complete schedule of
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