Some medical professionals spend their careers in a lab, bettering the world through their research, while others focus on being caring physicians towards their patients. Dr Tina Cascone, MD, PhD, does both. Dr Cascone is a cancer researcher whose nascent career already shows great promise. She's currently studying how immunotherapy can be used to treat lung cancer — or rather, why cancer cells can become resistant to such treatments. Her work drifted towards research after someone close to her developed cancer while she was in medical school. She still works directly with her patients, though, and considers her clinical responsibilities part of the foundation of her career. We spoke with Dr Cascone to learn about her day to day work and how she got to where she is today.
First of all, tell us a bit about your current work and how long you've been at it.
I am a medical oncology fellow beginning my third and final year of training at the University of Texas MD Anderson Cancer Center. Much of my work this year will focus on my research, however, I will still have an opportunity to interact with my patients once a week. Since early 2015, I have been working on a research project designed to better understand how lung cancers become resistant to one particular type of treatment, immunotherapy. Immunotherapies work by allowing the patient's immune system to better recognise cancer cells and destroy them. Unfortunately, less than a quarter of patients with lung cancer benefit from immunotherapy so resistance to these types of treatments is a major problem. My research is supported by Lung Cancer Alliance through a Young Investigator Award and the T32 National Institutes of Health training grant.
What drove you to choose your career path? Why oncology and what drove you to focus on research?
Almost everyone knows or has known a person whose life has been adversely affected by cancer; I am no exception. When I was in medical school, someone very close to me developed cancer. This became the catalyst that drove me to learn as much as possible about the disease. I remember the fascination that came from learning about the genetic changes that take place during cancer development. Soon, I knew that I wanted to pursue medical oncology as my profession. During my last year of medical school, I became actively involved in research studies designed to identify the factors that determine how patients with some types of cancers in the chest respond to chemotherapies. It was at this time that I began to see that results from research have the potential to guide therapy and possibly impact patient lives.
What kind of education and experience did you need to get where you are today?
After graduating from medical school in Naples, Italy, I entered the school's oncology fellowship program. In 2007, I had a unique opportunity to fully immerse myself in studying non-small cell lung cancer at MD Anderson. At the same time I was able to earn my doctoral degree and by 2012, I had gained a strong research background. As my research experience was coming into focus, I sought opportunities to directly help patients as well. It was important for me to see my research in action by working with the people I set out to help. I entered the Internal Medicine Residency Program at Washington University School of Medicine in St Louis, MO, and after completing that training, returned to MD Anderson for my Hematology-Oncology Fellowship in July 2014.
What kinds of things do you do beyond what most people see? What do you actually spend the majority of your time doing?
Honestly, it's possible that most of the patients that I see are unaware of the time I spend in the laboratory and some of my colleagues in the laboratory may not be aware of how much time I spend taking care of patients. Both roles are very important to me and are the foundation of what I do each week. During this third year of my fellowship, the majority of my time will be spent in research to complete my project, but I will continue weekly check-ins with my lung cancer patients as well.
What misconceptions do people often have about your work and job?
Some people may believe that you cannot be both a caring physician and a good scientist because medicine and science require rigorous training and commitment. Pure scientists may not consider you a true researcher due to clinical responsibilities while master clinicians may think your bedside skills are not sharp because you are in the lab doing experiments. I think cancer research and patient care are very complementary and feed each other. The results of research that I do can have a direct impact on the patients that I see every day. That's a wonderful feeling.
Another potential misconception is that science is a solitary pursuit that is conducted by individuals isolated in their laboratories. This couldn't be further from the truth. I collaborate with a number of people every day and most of our laboratories have an open concept where you can interact with your coworkers, exchange ideas and work as a team, which are all critical aspects in pushing the field forward.
What are your average work hours? Typical nine to five schedule or not?
I don't know any physicians that work a nine to five schedule. My day typically starts very early in the morning by answering emails or preparing for a meeting or presentation and planning my work day. I am in my office by 8:00AM and on the go all day before heading home later in the evening. I tend to follow up on the results of tests I may have ordered for my patients or work on my research a bit later at night, before bed. I try to spend time with my family and my dog every day to balance my work hours. Weekends are a time for hobbies, family and some research and clinic work.
What's the worst part of the job and how do you deal with it?
The worst part of my job is watching a patient, friend or family member fight, then lose their battle to a disease. I am not sure that you ever get over it completely. Despite the professional maturity that you acquire during the course of your training, it's hard not to get emotional about what cancer does to patients, to their families and to their lives. My patients are always on my mind and provide inspiration for my work.
What's the most enjoyable part of the job?
If your inspiration is to become a doctor, no matter what type of doctor you want to be, you must love the feeling of helping others and I feel this every single day. Helping a patient beat a disease or being able to provide a new treatment that helps improve their quality of life is without question the most rewarding aspect of my job.
What do people under/over value about what you do?
People may undervalue the amount of effort that this profession requires to provide excellent patient care and to more generally advance the field of cancer science. Changes in this field happen rapidly so in order to stay current you need to remain curious and devoted to ongoing study while not losing sight of the heart you need to stay connected with patients you meet with day after day on their cancer journey.
What kind of money can one expect to make at your job?
During postgraduate training, salaries definitely aren't commensurate with the amount of hours and effort put into work, but that's OK. I knew what I was signing up for when I decided to follow this path. I didn't consider money as a determining factor in the decision to dedicate my career to helping those who are sick and to advance the field of study.
Is there a way to "move up" in your field?
Every road for a researcher is different depending on your personal goals. My goal is to become an independent investigator at an academic medical centre. Being an outstanding clinician, being productive by meeting your clinical responsibilities, mentoring young trainees and securing grant money for your research are just a few of the ways that you are evaluated. I think it's also important to fulfil institutional duties and responsibilities, for example teaching, mentoring students, serving on committees and to publish your research in respected medical journals to move up in your career.
What advice would you give to those aspiring to join your profession?
I think medicine is a very noble profession and there is no greater satisfaction that you can receive than helping others. The physician-patient relationships you develop in your practice are highly rewarding and, as a cancer doctor, you accompany your patients in a long journey that requires compassion. Medicine and science are always changing so this field also offers an opportunity for lifelong learning. I would encourage anyone that is thinking of entering medical school to make arrangements to shadow a physician and get familiar with research to have a better understanding of what their future career would be. This approach will help them to make an informed decision. If you like it, go for it.
Career Spotlight is an interview series on Lifehacker that focuses on regular people and the jobs you might not hear much about — from doctors to plumbers to aerospace engineers and everything in between.