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Mar 10, 2020

Guest host Dr. Miriam Knoll, radiation oncologist at the John Theurer Cancer Center at Hackensack Meridian Health, interviews a wide range of oncologists who reflect on their diverse experience, greatest challenges, and the unforgettable moments that have shaped their careers in this special podcast series exploring early-career oncology and more.  In this episode, Dr. Knoll speaks with Dr. Howard Burris, ASCO President (2019-2020). 

TRANSCRIPT

ASCO Daily News: Welcome to the ASCO Daily News Podcast. I'm Dr. Miriam Knoll. I'm delighted to be the Daily News guest host for a special podcast series that will explore the full spectrum of oncology careers. I am a radiation oncologist in New Jersey at the John Theurer Cancer Center. In this series, you'll hear from a wide range of guests about their diverse experiences, greatest challenges, and unforgettable moments that shaped their careers.

In our first episode today, it's an honor to welcome Dr. Skip Burris, President of ASCO during the 2019 to 2020 term. Dr. Burris is President of Clinical Operations and Chief Medical Officer for Sarah Cannon, a cancer institute of HCA health care. He is also an associate of Tennessee Oncology PLLC, where he practices medical oncology. Dr. Burris reports no conflicts of interest relevant to this podcast. And I also report no conflicts of interest relevant to this podcast. Full disclosures related to all Daily News podcasts can be found on the Episode page.

Dr. Burris, welcome to the podcast.

Dr. Skip Burris: Thank you very much, Dr. Knoll. I appreciate you having me as your guest.

ASCO Daily News: So, Dr. Burris, I'm going to jump right into it. You've almost completed your 1-year term as ASCO president, and this undoubtedly has been a major highlight of your career. So, I really want to ask you something that I think a lot of ASCO members, when they see the ASCO president such as yourself, they're wondering. How does one become the ASCO president? And was this something that you always wanted to do? And did you think about it and plan for it?

Dr. Skip Burris: Great question, and you're exactly right. It's been an exciting year. It is such an honor to work with not only the membership, but the superb staff, the full-time staff that runs ASCO that's headquartered in Washington. I have always—had always hoped to have the opportunity to run for ASCO president, and it is something that—it was always on the list of things that I would like to have had the opportunity to do. And the fact that it came to fruition has been a joy and been exciting.

Hard to plan for it because, each year, there's two candidates that run. The pool is actually fairly small of potential candidates, because one of the requirements is that you have to have been on the ASCO board previously. So, serving on the ASCO board is the first step in the process. And then, obviously, having been on the nominating committee, it sort of narrows down to those people that are placed in their career or have the sort of perspective where it might be appropriate for them to run for ASCO president.

But it absolutely is an honor. And the past presidents that you work with and the incoming presidents really make the office of the president a team sport. And I've been fortunate to have Dr. Bertagnolli and Dr. Johnson before me and Dr. Pierce and Dr. Vose coming afterwards. And there is a nice team spirit to how we've all approached—the year goes by fast, and it's important to have some overlap and synergies as we think about objectives that we're trying to achieve.

ASCO Daily News: Wow, so that's really interesting. I actually did not know that, that in order to be nominated to run for ASCO president, one first has to have sat on the ASCO board.

Dr. Skip Burris: Yes, that is true. And ASCO board nominations come from a lot of different places. But in general, the ASCO board for the majority of the seats is really loose. Folks were nominated for the elections from their experience serving on ASCO committees. So, for our listeners, participating in the various committees and task force and opportunities to engage with ASCO both locally and nationally is certainly something to pursue.

My journey with ASCO began in 1990. I was fortunate to have our cancer center director, Chuck Coleman, Dr. Coleman elected as president of ASCO back then. Through the years, [I] served on a number of committees in the '90s and then served on the board in the 2006 to 2009 timeframe. So, it's been a lifelong journey to become the ASCO president, serving on a number of committees and such. But it really—it put me in a good place to actually know the staff and know the system, so it's been a productive year and looking forward to the Annual Meeting that's approaching quickly.

ASCO Daily News: Yeah, we're all really excited about that. So, it sounds like you're saying that it's a long process. It's a lot of time spent volunteering and getting to know people. And you actually had a 10-year lapse from when you sat on the board to when you were nominated and became president?

Dr. Skip Burris: Yes. And during that time, stayed engaged and participated in government advocacy projects and served on committees and participated in some of the task force. So, it is something where I urge folks to be members of ASCO. We're continuing to look at how we expand and enhance and serve our membership. But it doesn't need to be something where folks enjoy coming to serve the society. It isn't about that 1 year. It really is the culmination of many, many years invested in the society.

ASCO Daily News: Yeah, and that makes sense. So, I wanted to shift gears just for a moment and ask you more about your practice as an oncologist. And some questions that we've gotten when thinking about this podcast was people wanted to know if they're interested in being involved in clinical trials and running clinical trials and they're currently not, what would you recommend for that? How would someone get involved in clinical trials?

Dr. Skip Burris: So, I always encourage physicians to participate in clinical trials. I firmly believe that we're still in a place in the development of new oncology therapies that we need clinical trials to decide what our best course of action and treatment plan should be. It's not a cliche to say that the best management of a cancer patient is usually participation in the clinical trial. Not everybody has to participate in clinical trials at the earliest investigational drug level.

We still have important questions to answer in the arena of Phase II and Phase III trials. Actually, important question as we sort through all the new drugs that are available to us, which ones should be given in the neoadjuvant or adjuvant setting? And which might be best saved for the metastatic setting? I do caution folks that the most important element of the clinical trial process after the physician leader is the infrastructure. And Sarah Cannon, we have a fabulous administrative staff. I think our key to success at Sarah Cannon has really been the investment that we have made in the data managers and the regulators and the financial staff and the like.

And so, one should not take that with any sort of casualness that that's something that can be done as a hobby, but I don't mean that to scare someone away. I think that if you're in a smaller practice or you're new to research, my best advice would be to look at who your partner should be. Is there a network for you to join? Is that affiliating with the network or is that affiliating with an NCore site, part of the NIH NCI program? Is there an alliance that can be formed with a university in your region or some other practice setting?

But having that partner to help with the early stages of getting some trials up and running is something that every oncologist should take advantage of that opportunity. And I know most networks and alliances and universities are, in fact, welcoming getting community colleges involved. I mean, that is where the vast majority, 80% plus of patients are seen.

So, one, positive on folks doing it. Two, really think about how you're going to have your infrastructure, maybe at your local hospital, that's willing to help you with that infrastructure. And then third, think about who your partner is, and that's so you're not going alone.

ASCO Daily News: Wow, so that's great advice. And I appreciate that you mentioned private practice doctors. I'm technically private practice myself, and I think that's really important for us to be thinking about. Because sometimes it seems like that hurdle is really just too large. And it sounds like what you're saying is think about what opportunities that do exist and how we can foster that connection, that, really, every community hospital should want to have or be thinking about with that cancer center that increasingly are being part of these network, really large conglomerates. So what you're saying is you can use that to your advantage and get involved that way, instead of thinking about building everything yourself in your own center.

Dr. Skip Burris: Absolutely. And you know your situation there, and you have a premier practice with a very academic, community-based practice at Hackensack University Medical Center and akin to but different than what we have at Sarah Cannon where we've got several of those types of locations. But both the institutions proving that someone can be in what is basically community oncology practice—not employed by a medical school or academic medical Center—and yet really participate in high level care with clinical trials. And that's what we've got to do to better serve the country and actually serve the world.

We cannot expect that every patient is going to be able to make that trek into a tertiary medical center. And as we walk this out, we have got to bring the trials to the patients, and we've got to bring the therapies to the patients. And that's where an effort at embracing these community oncologists is something that we always hold dear to our heart.

Yeah, so I can tell you from my own experience, when I first started off at Hackensack, I was actually medical director of one of the network sites, which even though-- you know New Jersey. There's a hospital in every corner. So, this hospital was in my clear. It was called Hackensack Mountainside. And even though it was only 20 minutes from the cancer center that it was affiliated with, patients really wanted to stay in their hospital.

ASCO Daily News: And it's important to bring that perspective because it's not always the case that you can just tell a patient, no, you should go here. They really want to be treated in their community hospital. So being able to offer them what they need is really important. Or even sometimes what I would do is I would bring them over to the cancer center, give them something unique and special that we couldn't do such as a gamma knife radiosurgery, and then bring them back to the main hospital and continuing their care there with their regular oncologist and primary care doctor—everything else that they wanted to continue at their main hospital.

Dr. Skip Burris: Yes, well said. I couldn't agree more. And being that liaison and making that connection is going to be a key next step as we try to get more patients and volunteers, physicians involved in research.

ASCO Daily News: Yeah. So, I want to ask you another question, which is what is the worst career advice you've gotten?

Dr. Skip Burris: So the worst career advice that I received, and it was early in my career—and I want to make sure I call out that I have some great mentors and my career has been focused on early drug development, Phase I clinical trials, and I'm fortunate to have had Dr. Daniel Von Hoff as my first mentor in that regard.

But along the way, various other professors and various other leaders there in San Antonio would offer up the advice, which wasn't helpful, which was if you don't do this, you'll never be successful. And on the list of "If you don't do this, you'll never be successful" were if I didn't pick a tumor type—I mean, just—early in my career, make a decision. You're 30 plus years old, new to oncology. And great if a tumor resonates with you, but I wasn't ready to make that commitment. I really liked patients, and I really liked working with oncologists.

Second thing was you'll never have credibility if you don't have lab experience. I mean, you've got to have a lab, even if it's a small lab, if it's a one-day-a-week lab, but you'll never have credibility if you don't have a lab. And I did the minimal amount of laboratory work. And, again, I liked being with people. I liked the oncologists I practiced with, and I liked the patients, and so the lab career wasn't for me.

And then thirdly and maybe more that era was if you don't take a tenure track at a university, you'll never be a respected thought leader. And so those have to, have to, have to’s we're actually bad advice. And, luckily, I ignored those as I pursued my passion. And my passion was really, during the '90s, the exciting new drugs that were coming along, just how grateful cancer patients were, and what an honor it was to take care of cancer patients.

And then actually, as you and I both know the optimistic spirit of most of our colleagues, I actually liked coming to work and being with oncologists. So, setting up and having a community-based practice that did clinical research and ignoring those early have-to’s turned out to be a great selection for me.

ASCO Daily News: Wow. I love how you have three worst career advice examples and that you remember them so vividly. I think that's amazing. And like you said, you can think that someone's wrong without having bad feelings towards them, right? But the fact is, they were clearly wrong.

Dr. Skip Burris: Correct. And that—you get that perspective. I mean, there are—if I had loved a lab, it probably would've worked out. If I had decided I liked this particular cancer and I threw my heart and soul into it, that probably would've worked out. But the fact is I think you've just got to take a few minutes and know what gets you out of bed and what gets you excited every day and then try to stay true to that.

ASCO Daily News: Yeah, that's amazing. So, what would you say is the best career advice you've ever gotten?

Dr. Skip Burris: I've had several folks give me really excellent career advice along the way. And my background's a little bit unique because I went to the United States Military Academy at West Point for my undergraduate. So along the way and in my training and through connections, many, many great military leaders of the country I had the opportunity to interact with. And there were little things that were said to me along the way.

One of my first connections in the military was with General Maxwell Thurman, who was a be-all-you-can-be person. And that was his motto with the Army at those times. And then I had the good fortune to interact with General Norman Schwarzkopf, whose very simple advice was always when placed in charge, take charge.

And those sort of things always stuck with me through the years, but I received some great advice from a mentor and colleague, Dr. Stan Winokur, who, early on in my career, he told me, "While you're busy trying to be famous and you're trying to be a thought leader, when you go into a patient's room, that's their time. And do three things. We sit down for every visit. Always ask them an open-ended question and listen until they answer. And third, make sure that you examine every patient. Have that personal touch. Put your stethoscope on them, feel their belly, do that examination, and create that human connection."

And I have kept that in mind. And to this day, when I go in an exam room, I do those three things. And I think just making sure that that patient, whether it's 5 minutes or 15 minutes or whatever, you're in the room with them. Between the nurse practitioners and the hustling for treatment and all the paperwork that has to be done, that has enabled me to have that connection with my patients. And I just think back. That's very simple advice, and it really was something that I've kept near and dear to my heart. And it's worked out for me through the years.

ASCO Daily News: Well, thanks for sharing that with us. That's really amazing advice. So, my last question is, what advice would you give to trainees and early career oncologists?

Dr. Skip Burris: Today, in the field of cancer, boy, just all the opportunities and the excitement with the many new therapies and just the flood of information. It can be overwhelming. I think that can contribute to our concerns about burnout and our concern about doctors being overwhelmed. So, a couple thoughts that I would say to somebody early in their career.

One is that you can do absolutely anything, but you also absolutely cannot do everything. And so hard to say no and hard to pick and choose, but really, really eyes open, listen to your heart, take a broad perspective, but resist the temptation to try to be all things to all people all the time. And then secondly, I think it's important as you're deciding where to spend your time and your career, I looked at two elements of that.

You've got to love what you're doing, be that patient care, clinical research, laboratory, or some combination of those or lecturing or the others. But also, you're going to spend a lot of time at work. And so, make sure that you're choosing an area where you like being with those people. That's something that I got that advice early on not only loving what you do, but love being with the people that you're doing it with. And I think that's something that folks early in their career will really need to think about as they choose what particular path they're going to take.

ASCO Daily News: Thanks so much for the candid advice and spending this time with us today. And I wanted to thank all of our listeners for joining us for this episode of the ASCO Daily News Podcast. We absolutely love, love to have your feedback, so please drop us a note at DailyNews@ASCO.org. And rate and review us on Apple Podcasts. Have a great day.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.