Season 2 – Episode 7: Together for Tomorrow: Tackling Childhood Cancer

Listen and Subscribe to Inside Cancer Careers

• Apple Podcasts
• Spotify Podcasts

Episode Guest

Brigitte C. Widemann, M.D.

As chief of NCI’s POB Dr. Widemann oversees and active basic, translational and clinical research program for children and young adults with hematologic and solid malignancies.

Dr. Widemann joined the NCI in 1992 as a pediatric hematology oncology fellow after having obtained her MD and completed pediatric residency at the University of Cologne in Germany. Her research has been focused on drug development and early clinical trials for children with refractory solid tumors, rare tumors and genetic tumor predisposition syndromes, in particular neurofibromatosis type 1 (NF1). She received tenure at the NIH in 2009 and became the Chief of the POB in 2016. The work of her research team on NF1 resulted in the first U.S. Food and Drug Administration approved medical therapy, the MEK inhibitor selumetinib, for children with NF1 and inoperable, symptomatic plexiform neurofibroma. Dr. Widemann is also a co-leader of the Cancer Moonshot funded My Pediatric and Adult Rare Tumor (MyPART) network, which aims to advance the understanding of rare tumors and the development of more effective therapies.

Dr. Widemann is a member of the Association of American Physicians and recipient of the AACR-Joseph H. Burchenal Award for Outstanding Achievement in Clinical Cancer Research. She also serves as special advisor to the NCI Director for childhood cancer. She has authored more than 200 original scientific papers, and has conducted many clinical trials.

 

Andrea M. Gross, M.D.

Dr. Gross is a pediatric oncologist who focuses on clinical trials research and tumor predisposition syndromes, such as neurofibromatosis type 1 (NF1).  Her areas of interest include developing and utilizing functional outcome measures for tumor predisposition syndromes, working with rare disease patient advocates to increase patient engagement in clinical trial design and dealing with the challenge of medication adherence in the NF1 population.

 

 

Sneh Patel 

Mr. Patel research is focused on investigating Neurofibromatosis Type 1 (NF1) disease. His clinical research is geared toward understanding the spectrum of tumors that form from NF1 and learning the clinical indications that informs when to intervene at certain stages to prevent the disease from progressing into a malignant form.

 

 

 

Show Notes

Brigitte C. Widemann, M.D.
Andrea M. Gross, M.D.
Sneh Patel
NCI Pediatric Oncology Branch (POB)
NIH Clinical Center
My Pediatric and Adult Rare Tumor (MyPART) Network
Cancer Moonshot
Childhood Cancer Data Initiative (CCDI)

Ad: NCI Rising Scholars: Cancer Research Seminar Series

 Your Turn Recommendations: 

Ologies: Ask Smart People Stupid Questions
The Anatomy of Hope: How People Prevail in the Face of Illness by Dr. Jerome Groopman
OncoDaily.com

Episode Transcript

Oliver Bogler
Hello and welcome to Inside Cancer Careers, a podcast from the National Cancer Institute, where we explore all the different ways people fight cancer and hear their stories. I'm your host, Oliver Bogler   from NCI's Center for Cancer Training. Today, we're talking about research on pediatric cancers and about combining medicine and research to make advances against these devastating diseases. Listen through to the end of the show to hear our guests make some interesting recommendations and where we invite you to take your turn.

So it's my pleasure to welcome Dr. Brigitte Widemann, Chief of the Pediatric Oncology Branch in the Center for Cancer Research at the National Cancer Institute. She's also the head of the Pharmacology and Experimental Therapeutics Section and serves as special advisor to the NCI Director for Childhood Cancer. Welcome.

Brigitte Widemann
Thank you. It's great to be here.

Oliver Bogler
I'm also very excited to welcome two members of Dr. Wiedemann's research team, Dr. Andrea Gross, former heme/onc fellow, now assistant research physician in the Pediatric Oncology Branch. Welcome.

Andrea Gross 
Thank you.

Oliver Bogler
And Sneh Patel, who is currently doing a post-bac and is also on the research team in pediatric oncology. Welcome.

Sneh Patel
Thank you for having me.

Oliver Bogler
Dr. Widemann. Brigitte, what are some of the unique challenges in treating pediatric cancers compared to adult cancers and how does your team address these challenges?

Brigitte Widemann 
Thank you. I think the challenges are multiple -fold, but we also have made a lot of progress. One of the challenges is it's a very small patient population. It's about 1% of adult cancers. There are only around 15,000 or so cancers that occur in children and adolescents per year. Biologically, cancers in children are very different from adult cancers, but pharmaceutical companies focus on the common cancers and that makes drug development and new clinical trial sometimes very, very difficult. There are many different types of pediatric cancers, some where the progress has been tremendous and we have very high cure rates, but others where unfortunately the progress has been really lagging for the last two or three decades even, and in particular for pediatric and young adult cancer patients that have metastatic disease that has spread or that have disease that has come back after frontline treatment. 
At the NIH, we work in a space where we focus on areas that may not be done by the big cooperative groups. We want to complement and synergize, and we very much build on developing intramural - extramural collaborations. And the last point I want to make, we have the wonderful NIH Clinical Center where we can bring patients from anywhere in the world. And that has been a very unique resource to study some of the very rare cancers that would be difficult to study elsewhere.

Oliver Bogler
Yeah, and you mentioned the Clinical Center. So there's quite a lot of history there, right? In fact, some of the earliest breakthroughs in chemotherapy and combination chemotherapy at the clinical center in the middle of last century was made in pediatric diseases, right? 

Brigitte Widemann
Absolutely, absolutely. And including leukemias. And for me, one of the big learning lessons was the researchers that then treated young kids with leukemia, they were destined to die. They used combinatorial approaches and people said, you are killing these patients with the treatment. But this was what led to combinatorial therapy, which is a lesson I always try to think of because I'm more an incrementalist. Sometimes we have to think big and be brave.

Oliver Bogler
So that work is still influencing the way the Pediatric Oncology Branch does its research today?

Brigitte Widemann
Yeah.

Oliver Bogler
Dr. Gross, do you want to elaborate on that? Andrea, please.

Andrea Gross
Just to add exactly what Brigitte said, that pediatric oncology is its own unique universe and absolutely the types of advances we've seen in the, especially in the leukemia world are the ones that we're hoping to see now in the solid tumor worlds, because, you know, as Brigitte mentioned a little bit, the survival rate for pediatric leukemia when they first started doing those studies that you mentioned was very, very low, almost zero. And now the overall survival rate for all comers of pediatric leukemias over 80%, which obviously isn't perfect and we want to do better, but it's amazing compared to what it was. 
Unfortunately, some of that same progress hasn't been seen in the solid tumor space where for patients with the metastatic or relapsed refractory solid tumors and sarcomas, the outcomes are much poorer in general. And so, you know, I think we're hoping with some of the exciting advances in the last decade or so with immunotherapies, cellular therapies.

many of which have been driven by work here at the Clinical Center and elsewhere to try to make progress in some of those more difficult tumors.

Oliver Bogler 
So why do you think that is? Why were leukemias more initially tractable to these sort of combinatorial approaches? And was that just lucky that people started with those diseases? If they'd started with the solid tumors, the successes would not have been the same, right?

Brigitte Widemann
No, I don't think the successes would have been the same. And we actually tried to adapt what was done in leukemia with high doses and multi-agent chemotherapy. We've made progress in solid tumors, but the one tumor that one could highlight, neuroblastoma, where we give multi-agent chemotherapy to stem cell transplants and radiation and surgery, it is a boatload of very toxic treatment and still the rates of survival are’nt nearly as good. And I think it's the biology of the disease that is different, but also getting access to the sites of disease is a very important question. One of the reasons, maybe brain tumors in particular, we haven't made much progress. So I think understanding the basic science and the biology and then using this to develop innovative treatments, it's a key component. But yes, you're right, Oliver.

Andrea Gross
You're talking to a couple of people who are focused on the solid tumor space, you know I think from the leukemia side, one of the big advantages they have is they can look at their tumor all throughout the course of treatment. It's much easier to access a piece of the tumor. You can get it from blood, from bone marrow, to really see what's happening at every stage of treatment. And they've been able to use that knowledge and learn about the biology of what happens in response to treatment, what's happening in resistance.

With solid tumors, that becomes much trickier because you have to do a biopsy, which is often an invasive procedure. And until recent years, honestly, unless it was for clinical diagnostic purposes, we often didn't do research biopsies for children because it was considered not necessary. But I think there's been a real shift in the understanding of how important getting an understanding of that basic biology is. And so even when there might not be a direct clinical indication having, for patients who are on research protocols, regular biopsies at the time of progression or on treatment so we can really get a better sense of the biology of what's happening is something that I think is going to be more and more important and maybe one of the reasons the leukemia side has been able to make more progress than the solid tumor side.

Oliver Bogler
You can close the loop between what you're doing clinically and the response in the biology more quickly. So, Sneh, let me turn to you. You are doing more foundational research and investigation on these tumors, and I think you're focusing on NF1. Can you tell us what is NF1 and what's the focus of your work?

Sneh Patel 
Yes. So NF1, which is neurofibromatosis type 1, is a cancer predisposition syndrome that affects about one in 3,000 to one in 5,000 children in the U.S. And it is a disease that is caused due to a dysfunction of this gene called NF1 that leads to the overactivation of this specific pathway that causes these solid tumors to grow.
NF1 has been characterized by a spectrum of benign tumors to the really aggressive malignant peripheral nerve chief tumors, MPNST, which are the highly aggressive sarcomas, which have really low survival rates. Dr. Gross and Dr. Widemann are experts in NF1 along with the team that we have here at the NIH, but it's a disease that we've been working on and I've been doing some clinical research to understand the spectrum of these tumors and understand the clinical indications of malignant transformation and how we can risk assess and intervene at certain stages to prevent the disease to progress into the malignant form.

Oliver Bogler
So when a patient presents with NF1 or when you have, maybe they have knowledge about their genetic inheritance, right? And so maybe they know their risk. I guess what you're saying is one of the questions is how will this individual patient progress or what will be their fate, so to speak? And that's what you're trying to understand to how you can more accurately predict it. Did I understand that correctly?

Sneh Patel
Yes, I think the main question, the fundamental question in the NF space is to risk assess and determine which lesions are going to turn malignant. And that's a very difficult thing to do because of a multitude of reasons. But correct, that is something that we're trying to understand more from the biology to the clinical phenotypes that we see.

Oliver Bogler
So how does that NF1 work fit into the bigger mission of the branch? I think there's a general emphasis, right, Brigitte, on predisposition syndromes and similar things.

Brigitte Widemann
Yeah, so we try to, at least that's how I look at it, we would not want to do things that are done at the outside. We would not want to reduplicate and we couldn't, you know, trials for newly diagnosed leukemia patients where there's standard therapy. We try to focus, I think, very much in line with the mission of the CCR to solve problems that are neglected, they have an unmet need, where we can make a difference. So that would include genetic tumor predisposition. And in particular, I think because these patients need follow up over time. And that's one thing we can do so well at the NIH with natural history studies, where we indeed, like we have followed patients, I've been here so long for 20 plus years. I've seen them when they were three years old and when they've become young adults. And I've seen a number of patients where the benign tumor very quickly turned to malignant tumor. And that's devastating to see. So for us being able to follow, like with longitudinal volumetric MRI and things that would be very expensive at the outside, there would be no clinical indication. And there's no grant that gives you 20 years to study something. I think we have to really look at how can we use the resources that we have to advance and so genetic tumor predisposition is one example.

Oliver Bogler
So I know that you're also a founding member of the NCI's Rare Tumor Initiative and co -leader on the Cancer Moonshot that was funded for pediatric and adult tumor, the My Pediatric and Adult Rare Tumor Network, MyPART. Can you tell us about that initiative and how that fits into the bigger picture?

Brigitte Widemann
Yeah, it kind of a lot of what we learned with NF1 getting after really hard work to the success learning that yes, we can understand the natural history, this helps in drug approval. In finding the first medical treatment for these tumors, we thought we have to expand this to other rare tumors. And so we developed the natural history study for other rare tumors and have built some impressive cohorts with Dr. Wedekind in chordoma and Dr. Del Rivero in adrenocortal carcinoma.
I firmly believe you need champions. Like it takes a lot of work to do NF1 alone. So the more champions we can have, the better. And a new effort that we're currently working on with the Childhood Cancer Data Initiative is to develop a national study where hopefully there are multiple national champions that take on the more than 200 rare cancers that we have so that we can make more progress.

Oliver Bogler
Right, you mentioned the Childhood Cancer Data Initiative, which is another big initiative. 

Brigitte Widemann
Yes, yeah, it's to provide like the foundational infrastructure needed so that this can actually be meaningfully studied and we don't redevelop natural history studies for every, every single tumor. Yeah.

Oliver Bogler
So, Andrea, I know that part of the MyPART is also patients and advocacy groups. I wonder if you could comment on their role in the work that you're doing.

Andrea Gross
Patients and advocacy groups are just an essential part of everything that we do in POB and in MyPART and in all of our work. I work particularly with the NF community and the patient advocates are an integral part of every step of the way. We work closely with them when we're in the design phase of trials. I'm part of a group where we work with patient representatives who help us design endpoints and determine what is meaningful for them, right? Because if you're going to design a clinical trial and you want to measure something, you want to make sure that the thing you're measuring is meaningful to the patient, right? Obviously, tumor shrinkage is an easy one, but what if you're trying to measure and see if the pain improves or if overall quality of life improves? Well, what measures are you going to use and are they asking the right questions?
And so getting the patients involved in the process early on in research has been hugely important in our rare disease community because these patients and their families are really the experts about these rare diseases, right? They are the ones who are living it and experiencing it and we are learning from them constantly.

Oliver Bogler
Yeah, and I imagine that in the realm of pediatric cancers, there is a very strong advocacy community. I mean, nobody wants to see anybody with cancer, but seeing a kid with cancer is many, many times worse. And of course, their parents, I'm sure, and their families are engaged, right?

Andrea Gross
Absolutely, absolutely. And I will say, pediatric cancer in general, because all pediatric cancers are rare, but especially in some of these rare disease communities, I think there's just a tight network of patients and families, because again, they end up having to be the experts in many cases. If you have a physician in the community who sees one case of something in their entire career, those patients and those families really end up having to advocate and learn about their condition and are such a valuable resource for us as we're trying to learn about how we can help them.

Oliver Bogler
So Sneh, as I'm going to say, the newest member of the pediatric oncology field in this conversation today, I wonder what your perspective is on the biggest needs and areas of investigation?

Sneh Patel
Yes, as you mentioned, so I recently joined the pediatric oncology branch and I've been very fortunate to work under the mentorship of Dr. Widemann and Dr. Gross. And I think I've been very fortunate to be exposed to the research and the clinical side of things and how they're combined here at the Clinical Center. 

And so I think to answer the question, one of the biggest needs that I've seen, I guess would be the CCDI initiative that you mentioned about the data pulling and working and collaborating with other institutions to increase the number of samples that we have and the data that we have on these patients. We've already mentioned the point about these being really rare diseases. And I think for a lot of the analyses and experiments that we try to do, we sometimes don't have the statistical power  or just enough numbers to draw meaningful conclusions and inferences. And I think these different data initiatives and different institutions coming together has been a huge need that I've seen. And the collaboration in the pediatric oncology space in general has been very inspiring.

Oliver Bogler
Brigitte, the same question to you, given the unique sort of perspective that you've described for intramural research at NCI. Where do you think that the Pediatric Oncology Branch should be, let's say in five years, where are you focusing your energies?

Brigitte Widemann
I want to see progress in some of the tumors that I have not had progress in before I retire, ideally, but like MPNST, I think we're getting close. 

Oliver Bogler
Sorry, can you expand that acronym for us?

Brigitte Widemann

Malignant peripheral nerve sheat tumor, these are these very aggressive sarcomas. We've done multiple clinical trials and patients typically do not respond. It's extremely, extremely rare. But I do think we're learning more about the biology and I believe we're getting closer. We're also getting closer at potential prevention strategies. I think one thing that I would like to mention is the cell-free DNA efforts. Like Andrea mentioned, we can't do biopsies easily. It's just, and in kids, it's really hard. But, you know, Dr. Shern in our group with Dr. Sundby they have pioneered for NF1 cell -free DNA. So from a regular blood sample, they can now distinguish benign pre-malignant, malignant tumors. And we currently do in patients at risk, we do MRIs every six months, but it may still escape us. So this is a technology that I think will revolutionize how we can monitor not only NF1, but other tumors. And I hope this will inform our solid tumor clinical trials. 
And then the other area, you know, that I think we will hopefully make a lot of progress is by not only targeting the tumor cell, but the tumor microenvironment. And we have researchers here in the POB, Dr. Kaplan, Dr. McEachron, who look at the microenvironment that is immune-suppressive. How can we make the microenvironment more active that tumors can be, you know, treated effectively?
There's a lot more work, but I really do think within the next five to 10 years, we will make breakthroughs in solid tumors. It may not be cures directly, but I think getting deep remissions for some time at least, that's what I want to see.

Oliver Bogler
That's fantastic. Sounds like a really exciting time to join this field. And we're going to take a quick break. When we come back, we'll talk to our guests about their career paths. 

[music]

Nas Zahir 

The NCI’s  Rising Scholars Seminar Series is a monthly seminar series we started about one year ago. 

We cover topics of all areas of cancer research, including data science and molecular mechanisms of tumor biology, as well as behavioral science.

We invite the speakers to discuss their career path as well as talk about their research highlights.

The goal of the NCI Rising Scholars Seminar Series is to highlight the research and the contributions that are being made by postdoctoral scholars who are funded by NCI through career development awards or fellowships, and also those who are conducting research at the NCI in the Center for Cancer Research, for example.

Talks are the third Thursdays of every month from two to three p.m. Eastern Time. 

The presenters for the NCI Rising Scholars Seminar Series are selected by a variety of means. The first set of measures is looking to see whether there's a first author publication in the prior year. So for 2024, we examined for all of 2023. And then we ranked papers based on their number of citations as well as the field citation rate. And we also looked at  balance of demographics of the speakers, geographical location, as well as gender, race, and ethnicity to the extent possible.
  
We'll put a link in the show notes to the events page for the NCI Rising Scholars Seminar Series so you can register as well as look up recordings for past webinars.

[music]

All right, we're back. Sneh, let's start with you. What first got you interested in science?

Sneh Patel
I would say, so I grew up in India. So I grew up in India until I was 14. My dad used to own a pharmaceutical business. And when I was really little, between the ages of eight and 10, I would kind of tag along with him and go to different hospitals and and emergency rooms where he would go and pitch his products and sell. That was my initial exposure to medicine, but obviously I was too young to really understand the intricacies and what it really meant for me. So for me, I think what really got me into medicine and to pursuing a career in academic medicine specifically was first my hospice experience in college when I was a nursing assistant. Just being able to work with terminally ill patients and seeing then how the research that I was doing at my institution and then the research that I'm doing now, how it can truly impact the patients and really being able to provide care in the most challenging moments. And I think so those were some of the key moments in me becoming interested in a career in medicine.

Oliver Bogler 
Now, I know that you did some research with a good friend of mine, Krishna Bhat at MD Anderson. So was that your first experience of sort of cancer research at a cancer center?

Sneh Patel
Yes, so prior to that, I was doing genetics research at Emory. So doing glioblastoma research at Dr. Bhat’s lab was my first experience in cancer research space. And it was such a positive experience that I decided to do that for my gap year. And now due to the tremendous mentorship and what I've been able to see and learn, I really do foresee this in my future and in my career as I go into medical school.

Oliver Bogler
Yeah, Krishna is a great mentor. So currently you're a post-bac at NCI. So on your way, I think, to medical school, right? 

Sneh Patel
Yes, correct.

Oliver Bogler
Why the post -bac? What drew you to doing a post -bac?

Sneh Patel
The reason was twofold, I wanted to take some time off before going to med school to gain more experience, whether it was clinical or research or a combination of two. And so for that reason, I when I applied for a position in Dr. Widemann’s and Dr. Gross's lab, it was the perfect thing for me to to experience in my gap year, because I just needed to, I just wanted to gain some more exposure and experience and kind of, you know, pediatric oncology spaces of unique experience that I was able to get from this gap year. So all of that combined was the reason for me to take this post-bac year.

Oliver Bogler
Is your plan to stay in pediatrics and are you going to be combining research and medicine? Is that your goal?

Sneh Patel
Yeah, so I'm still deciding between the pediatrics and the different, the medicine space, but I definitely do know that I want to do research and want to integrate research into my clinical practice. So something in academic medicine is the goal at this time.

Oliver Bogler
Fantastic. Andrea, the same question for you. What first got you interested in science and what led you to medicine?

Andrea Gross
Yeah, gosh, so I come from a family of medical professionals. So my father's a physician. My mother's an occupational therapist. So from a young age I'm one of the very few very odd people who knew from a very, very young age that I wanted to be doctor I think in kindergarten when I was asked what I want to be when I grew up. I said pediatrician.

Oliver Bogler
That's impressive.

Andrea Gross (24:47.278)
It's a little strange but…  And then, you know, actually subsequent to that, I had some personal experience in the medical field and really saw what a difference an amazing physician could make in one's experience. Also what a difference a less amazing physician could make, you know, a little bit of what not to do. But, you know, it was really eye -opening to me the way that a good physician could just take whatever situation one was in and help you through it and frame things and make even really difficult situations less so. And I really always wanted to be that person to be able to help people get through those difficult times and be able to help people even though we know there are going to be difficult times knowing that there's someone with them going through it. 
So I actually applied for medical school as a combined program. So out of high school, I combined, I went to the University of Connecticut combined program in medicine, which was an eight year program. So it was four years of college, four years of med school. But essentially, I like to describe it as you were you were already in unless they kicked you out of the medical school. So you still had to take the MCATs, but we had to maintain a certain GPA and score. And the really nice thing about that was that it allowed us some flexibility. I didn't have to be focused on just taking the classic pre-med classes and worrying about that. I was able to really explore other interests and also get to have some experiences shadowing and doing things during college that I wouldn't have otherwise. 
Then I went to residency at Cincinnati Children's Medical Center, which is an amazing, amazing institution for my pediatric residency. Totally biased opinions Sneh, but pediatrics is the best. We've been trying to convince him. And spent a year there as a chief year and then came out to Children's National Medical Center to do my pediatric hematology oncology fellowship. And there the fellowship director, Holly Meany, as well as one of my clinical mentors, Shana Jacobs, had actually both done research with Dr. Widemann. And when I told them I was interested in doing clinical research, they pointed me in Dr. Wi demann's direction. And so that was back in 2015. And she's been stuck with me ever since.

Brigitte Widemann
I'm very fortunate about that.

Oliver Bogler
That's a fantastic path. Brigitte, the same question for you. When did you know you wanted to be a physician, a scientist?

Brigitte Widemann
You know, I don't actually truthfully remember. When I was little, I would always play a nurse because that seemed to appeal to me a lot. But I don't have anybody in the medical field in my family. But I do think this interest in helping people and learning how to do that was a big drive for me. I studied medicine in Cologne in Germany. I also was very fortunate to spend a year with a scholarship at the University of Glasgow, where there was a lot more hands-on. And I could see that I was not a good medical student clinically. I was very humbled. I really learned a number of lessons. It was an amazing, amazing year. And then during my residency at Cologne, really enjoyed pediatric oncology a lot. There are relationships you establish, and dealing with a family, not only one patient, but you have a whole family and how the relationships develop and establish and become very close. And then the next step was that I knew there was this fellowship in the United States at the NIH where you do both clinical work and research. And that seemed like a dream. So that's what got me here. 

Oliver Bogler
So you came over and you're still here....

Brigitte Widemann
Because it's the best place. I haven't really worked anywhere else, so I can say it, but the freedom to pursue research questions, there's so many wonderful aspects of being here.

Oliver Bogler
 Sneh is on his way. Andrea and Brigitte, you already are physician scientists, right? You are people who combine clinical care with foundational research, clinical research as well. What is that like? What are the biggest challenges? What are the joys? And what are the difficulties of such a career? It seems like a lot. 
Brigitte Widemann
So I would say I appreciate the physician scientist because I think even when you do clinical research is still science, but I don't run a basic science lab. We have some people who do both and I think it's quite challenging and you can, I believe only do it, be an 80% bench scientist and 20% effective clinical researcher if you have help in the clinical translation.
I very much admire these physician scientists, but I can say from my observation, it is challenging because as a clinician, you always want to be committed to your patients. And that typically takes more time. So you can get really pulled into different directions. I would say being in the pediatric oncology field, if I was just a clinician… the clinical research is what inspires me to continue. So having this aspect is really important and the balance that we have with that. Andrea, I don't know what your thoughts are.

Andrea Gross
Yeah, I, you know, obviously to echo Brigitte, so I'm her staff clinician. So one of my main roles is to help enable and move forward the research that we do together in the clinical space. So just as Brigitte, I don't have a bench space or a free clinical aspect to my work. But it is an amazing, amazing privilege to be able to work with these patients and families who volunteer to participate in clinical trials. Again, they are the experts in these conditions. And so we are just constantly learning from them. And I think that aspect of it, it's very humbling. You know, every time we start to feel like we know what we're doing, you know, a new patient comes along with something we've never seen before. And it's really, it's never boring. It's always an exciting, and again, very humbling sometimes experience. 
But again, overall, I think that's one of the great things about pediatric oncology is that early on people recognize that because it's a rare disease, we had to collaborate to do research and everything is based around research, both here at the NCI, but also really out in the general academia. And so it's really part of who we are as a profession to pursue research in the pediatric oncology space, and so I just feel very privileged to be part of that. 
Oliver Bogler
So to close, what advice would you give to our listeners who are thinking about their own futures, their own careers, or maybe are inspired by what they've heard? Sneh, let's start with you. Someone who's perhaps following you a few years behind, what would you say to them about your own experience?

Sneh Patel
Yeah, I've since I just graduated college, I think something that I would tell someone who is following my footsteps is to, to take their time and try to get as much exposure and experiences as possible. I think oftentimes nowadays it's very common for people to take gap years, multiple gap years between college and med school. And I've reaped the benefits of it getting exposed to these different experiences doesn't just help you decide if medicine is for you, but also just grounds you in the sense that you really do understand the profession that you're getting into and it kind of motivates you and inspires you to continue this for the rest of your life. 

So I think for me, the greatest advice would be to take time and invest in experiences where you get these diverse opportunities and mentorship, I think, is another thing. Dr. Gross and Dr. Widemann have been great mentors, and I've been very fortunate to have amazing mentors even in college. And I think I'm forever in debt to everything that they've done. And I think they've really carved my path into medicine. So just reaching out and having these people who support you in life is also really essential. So those would be my two points.

Oliver Bogler
Thank you very much. Andrea, what advice would you give?

Andrea Gross
So I would echo what Sneh said, and it's been such a pleasure getting to work with you, Sneh, over this past year. 
I think one thing is it's not a race for sure. I think there's often this feeling of, oh, you've got to get to the next thing. You've got to speed up, combine things, move things more quickly. And I totally agree. Taking your time to find what you're passionate about, what excites you, what makes you want to get up and go to work in the morning is absolutely essential. 

And I think just as a secondary, to that once you get into the medical field and when you're trying to figure out what it is you want to do in medicine and how you want to get there, keeping your mind open. I joked that I said I knew I wanted to be a pediatrician since I was six, which is absolutely true. But I had no idea about pediatric oncology. I went, I looked at all sorts of different aspects of subspecialties and other things and really enjoyed many of them, but I've ultimately found my way to the place where this felt like home. And, where I felt like this is where I could make the most difference. And so just keep your mind open as you're going through every part of the experience, you can learn something. I was never going to be a surgeon. I learned a ton from my surgery, rotation and medicine that I still use and think about. So just absorbing everything you can, even if you know that's not going to ultimately be your path.

Oliver Bogler
Great advice. Brigitte, what do you say to the generations coming up behind you?

Brigitte Widemann
Yeah, maybe from a lesson that I learned not to let fear be the decision maker. Don't think, oh, this is difficult. This is complex. I can't do this. I don't know if I can handle mice or whatever. Really be OK to pursue something that sounds really difficult or challenging, because maybe you end up actually liking it. And I definitely remember thinking, OK, pharmacology and running assays, that's something I'm surely can learn but all the basic stuff, I wasn't so sure. And I think, well, yeah, maybe I would have done it and would have enjoyed it. So give it a try and don't be afraid. That would be my recommendation.

Oliver Bogler 
Thank you. Thank you so much. Thank you all of you for sharing your work and your stories with us. Thank you.

Brigitte Widemann
Thank you, Oliver.

Andrea Gross
Thank you.

Sneh Patel
Thank you.

[music]

Oliver Bogler
Now it's time for a segment we call Your Turn because it's a chance for our listeners to send in a recommendation that they would like to share. If you're listening, then you're invited to take your turn. Send us a tip for a book, a video, a podcast, or a talk that you found inspirational or amusing or interesting. You can send those to us at nciicc@nih.gov. Record a voice memo and send it along, and we may just play it in an upcoming episode. Now I'd like to invite our guests to take their turn. Let's start with you, Brigitte.

Brigitte Widemann
Okay, so when I grew up in Germany, my spices that I knew were salt and pepper. And that was about it. And coming to the United States, and of course this is different in Germany nowadays too, there's so many spices and diverse dishes that I so much enjoy. And while you can get them in a restaurant, you can actually cook them by yourself. Pick a new spice, look at a recipe, and enjoy the many different types of food that are there and share them with your friends.

Oliver Bogler
That's great advice. I love to cook myself and yeah, trying something new is just so fun. Andrea, please..

Andrea Gross
Yeah, well, so during the pandemic, I, or right before the pandemic, I actually got a dog and while walking my dog, I listen to a lot of podcasts. And one podcast that I have really enjoyed in the last year or so is called Ologies. It's a podcast that the host is Alie Ward and the slogan of it is ask smart people, stupid questions. And it's really fantastic. Each week she kind of dives in with an person who's an expert in some very esoteric fields. Last week, or recently, there was one about black holes. And just ask anything you could possibly want to know. And it's just a really approachable, really fun, really interesting podcast that I highly recommend.

Oliver Bogler
I'm gonna go look that up. We'll drop a link in the show notes as well. Sneh, please.

Sneh Patel
Yeah, I would like to share a book that I read recently when I was going through this application cycle. It's a classic in the medical space. It's called The Anatomy of Hope by Dr. Jerome Groopman. He's a hematologist oncologist who talks a lot about the role of hope in a physician's role in taking care of patients and the balancing of presenting this realistic possibility of overcoming the disease but being honest about the prognosis and the risks involved. And I think he does a tremendous job using case studies to explain the role of hope and the science of it in medicine. So I would recommend that.

Oliver Bogler
That sounds like a great read for someone who is planning on going into medicine. Great. I'd like to make a recommendation as well. Mine is for a website OncoDaily.com. It brings daily cancer related news items that are curated from all across the web, as well as some inspiring stories. And it celebrates a broad range of cancer professionals highlighting their work and fosters a community. The person behind this great work is Dr. Gevorg Tamamyan, a professor and chairman of the Department of Pediatric Oncology and Hematology at the Yerevan State Medical University in Armenia. I had the pleasure of meeting Gevorg and visiting him when I participated in global cancer work in a prior job. And I was inspired by his vision and leadership and love to read OncoDaily. So you can find it at their website, on LinkedIn and other social platforms. Take a look.

That’s all we have time for on today’s episode of Inside Cancer Careers! Thank you for joining us and thank you to our guests.

We want to hear from you – your stories, your ideas and your feedback are welcome. And you are invited to take your turn and make a recommendation to share with our listeners. You can reach us at NCIICC@nih.gov.

Inside Cancer Careers is a collaboration between NCI’s Office of Communications and Public Liaison and the Center for Cancer Training. It is produced by Angela Jones and Astrid Masfar.
Join us every first and third Thursday of the month wherever you listen – subscribe so you won’t miss an episode.

If you have questions about cancer or comments about this podcast, you can email us at NCIinfo@nih.gov or call us at 800-422-6237. And please be sure to mention Inside Cancer Careers in your query.

We are a production of the U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Thanks for listening.