Season 3 - Episode 4: The Future of Clinical Trials: Decentralized and Patient-Centric

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Episode Guest:

 

Shaalan Beg MD MBA FASCO is Senior Advisor for Clinical Research at the National Cancer Institute. He is a medical oncologist and clinical investigator with interest in novel clinical trial delivery methods. He is leading initiatives to use technology-enabled, trial services to increase access for oncology trials. Dr. Beg has been a member of the Bloomberg New Economy International Cancer Coalition and  White House Cancer Moonshot committee on innovation in trial delivery. Previously, he oversaw clinical trial operations at UT Southwestern’s Simmons Comprehensive Cancer Center, where he also developed the pancreatic cancer program and served as the Principal Investigator of the Experimental Therapeutics Clinical Trial Network (ETCTN) grant.

 

 

Show Notes:

• Shaalan Beg, MD, MBA
• Science 37
• Virtual Clinical Trials Office
• NCI Division of Cancer Treatment and Diagnosis (DCTD)

Ad: Worta McCaskill-Stevens Career Development Award for Community Oncology and Prevention Research (K12)

• Pancreatic Cancer Action Network (PanCan)
• ASCO Leadership Development Program
• American Society for Clinical Oncology

Your Turn Recommendations:

• Empire (podcast)
• 300 Arguments by Sarah Manguso

Transcripts:

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 the challenging issues surrounding clinical trials, particularly how they can keep up with the very encouraging increase in new potential clinical interventions being developed.

Listen through to the end to hear our guest make an interesting recommendation and where we invite you to take your turn. And of course, we're always glad to get your feedback on what you hear and suggestions on what you might like us to cover. The show's email is NCICC@nih.gov.

Our guest today is Dr. Shaalan Beg, Senior Advisor for Clinical Research at the NCI and a Principal Investigator at Science 37. Welcome, Dr. Beg.

Shaalan Beg:

Thank you for having me. This is amazing.

Oliver Bogler:

So the increase in potential interventions for cancer, while itself is good news, has led to a bottleneck at the clinical trial stage. Sounds like a good problem to have, but still a problem, right?

Shaalan Beg:

Yeah, we are in a situation where the scientific discoveries from the lab are piling up and the clinical trial infrastructure is just not ready to test those discoveries into the clinic in an efficient manner, which means that there's a backlog, which means that innovative scientific approaches to help treat cancer are not making their way into the clinic for clinical trials. And in oncology, where clinical trials are largely considered part of standard of care, that means that in frequent situations, that bottleneck is preventing access for standard of care for a lot of people with cancer.

Oliver Bogler:

So what are the main challenges in the infrastructure that you see? How can they be overcome?

Shaalan Beg:

I think about them in three different buckets. One is what are the different hypotheses or observations from the lab or our non-clinical observations that we want to study more formally in a prospective manner.

The second is the infrastructure to operationalize clinical trials in a manner which is compliant, in a manner which is ensuring patient safety and high integrity data.

And the third is having the ability to have a workforce that can support this clinical infrastructure. And when I think about workforce, I think about not just the postdocs and the students and the fellows and residents, I also think about the development of our clinical research coordinators and data specialists and administrators for the clinical trial infrastructure.

And then of course, principle investigators who are largely responsible for coming up with innovative ideas, defining the strategy to translate those discoveries into the clinic and then leading the entire initiative. And all of this comes before we even have the data that's required to submit for regulatory purposes. You know, I don't think that that's something that we can even talk about because the bottleneck is really much earlier.

Oliver Bogler:

So I'm a cancer survivor and I've had the privilege of participating in a couple of clinical trials. So from a patient point of view, I sort of understand it, right? You read a protocol, you read all the guidance and the cautions and then you sign it. And then in my case, I had an immunotherapy to prevent the recurrence of my breast cancer. It was a HER2 peptide immunization. But looking at it from the other side, from your side, there's a lot to clinical trials. Can you sort of unpack for us a little bit, like, okay, you are a clinician investigator, you have a great idea, and you're like, I need to do a trial. What does the road ahead look like for you?

Shaalan Beg:

As an investigator, the first thing that I think about when I see that there's a new discovery that has potential applications at clinic is ‘does this match the patients that I see in my clinic?’ Am I able to translate this discovery in a way that it can make a short-term immediate-ish impact on the patients who come through my clinic?

The clinic that I largely participated in was focused on GI cancers and over the years gravitated more to pancreas and biliary cancers. And so I would think about those opportunities in a disease specific way and that allowed me to go deep into understanding the various mechanisms that rule the disease of my interest and take it from there.

So there has to be a match between the hypothesis and the access for patients. I say that and it seems like it's pretty obvious, but sometimes it isn't. And one of the most common reasons that clinical trials are unsuccessful is that the clinical trial was not able to accrue patients in a specified timeline to the extent that the science has moved on and the trial may not have even completed enrollment.

So that's first is ‘do I have the patients that who can benefit from this clinical study?’ Second is really the, I guess that's also number one is the science behind the proposal and is the rationale sound? Is there a clear logic in terms of what allows me as a not a basic scientist to understand the potential mechanism on how this intervention can modify the treatment?

And is there a path to move that forward? Something as simple as how is the drug going to be delivered? How is the treatment, what medications can it be combined with? Do those fit in a clinical development paradigm, which can be accepted into the clinic? And as a clinical investigator, we think a lot about how to dovetail those new innovations into standard of care.

In diseases such as HER2 positive breast cancer, there are many existing treatments that are out there that are effective for that disease. So a new discovery in that space needs to be able to be a step above what is already available, or it needs to position itself in a situation where the existing treatments have already been unsuccessful.

In a disease such as pancreatic cancer where there are not a lot of effective treatments, even the approved treatments are modestly effective, the bar for our ability to be innovative and ask more provocative questions in the clinic and expose our patients to such a hypothesis is sometimes lower because both the people with cancer are looking for more innovative treatments. The standard treatment is not something they're really excited and receiving either. And on the investigator perspective, it's the same way. We want to be able to move those opportunities forward.

Oliver Bogler:

So you mentioned one critical element, and you mentioned several, but one was having enough patients to accrue sufficient numbers to complete the trial. Obviously, the rarer the tumor, the bigger that challenge is. So NCI and other groups have built these networks, these cooperative groups, right, that allow clinical trials to be simultaneously opened across multiple centers to sort of address that problem. But it's not always effective. Even if you have a cooperative group, I know from what I've heard from you and others that some trials just don't accrue. So is that because they are not offering something that people want or what else is going on there?

Shaalan Beg:  

So we're a victim of our own success. As we start to understand cancer biology and what drives cancers in people and how cancers are becoming resistant to approved treatments, we have started to classify cancers into smaller and smaller subgroup. So people don't just have breast cancer anymore. They now have ER positive or negative, PR positive or negative, HER2 positive or negative breast cancer. You don't just have colon cancer, you now have BRAF mutated or wild type, KRAS mutated or wild type, and then every type of KRAS varies as well. So as we understand cancer and cancer biology better, we have started to split the diseases into more restrictive buckets, which means that most cancers that we're doing studies on are rare tumors.

And there are not a lot of practices that see a critical mass of every one of those diseases where they could significantly accrue a critical number of patients. That again leads into another aspect which you and I have talked a lot about, which is the centers, let's say there's a center that focuses on triple negative breast cancer or an investigator who focuses on triple negative breast cancer, that investigator probably resides in an academic medical center in an urban environment. So if you have a drug which is looking for triple negative breast cancer, you keep going to such investigators who have built a reputation around triple negative breast cancer. They may fill up your study, but then you may end up with a lot of urban patients who don't represent the typical patient who has triple negative breast cancer because by large, most of those patients are going to be seen in the community.

So now when as a sponsor or when you're someone who's running that clinical trial or thinking about accruing a clinical trial, you want the patients who are going on that clinical trial to be representative of the patients who have that disease. And you can't just accrue a large study which has regulatory intent with a handful of sites. So then you start taking bets as an investigator. I don't know that's the correct term to say take or not, but you open more sites that will be able to enroll more patients on clinical trials and some of them will deliver, but a lot won't. And I think as a general rule, I think the 80-20 rule that applies to a lot of things in the world and in our daily lives also applies here and 80 % of the enrollment takes place from 20 % of the sites. So you still end up with a lot of sites that end up underperforming. When you're overseeing a network or you're an investigator or you have a strict timeline and a strict budget, that can sometimes feel very unsustainable.

Oliver Bogler:

So the promise both of personalized medicine, right? We've heard of that buzzword now for more than a decade. But what you're saying is that while it's a wonderful idea and concept, it actually makes it very challenging to develop clinical trials that can test it effectively. Plus, the unevenness in how the health care delivery system is built overall means that not everybody can participate. Those sound like really significant challenges.  

So you joined the NCI to take a look at some of these big challenges and tackle them. And I know that you're also working with a group in the NCI's Division of Cancer Treatment and Diagnosis, the Virtual Clinical Trials Office. Can you tell us about the work that you're doing to try and take on some of these issues?

Shaalan Beg:

Yeah, the Virtual Clinical Trials Office is the brainchild of Dr. Jim Doroshow at DCTD and the NCI, who is looking to see how we can apply services centrally to help improve clinical trial patient identification and screening at various sites. Related to the question that you had before, all clinical trials have fairly restrictive inclusion and exclusion criteria. Some trials are looking for left-handed unicorns is what one of my collaborators once mentioned. And finding patients for those studies becomes challenging. And we know that patients and people who have cancer are very likely to enroll on a clinical trial if they're only asked.

And if we can come up with ways to help increase that rate that that can then lead to higher enrollments onto clinical trials. And sometimes the physicians who are caring for those patients are not aware of the study, or they're not aware that the patient who they have is eligible for that study. may not be front of mind, and they may not know about the study at the right time of the patient's care.

So, what the virtual trials office is accomplishing is to use resources at NCI to identify people and screen them for eligibility across various clinical sites to help support NCI-funded clinical trials activity. And it's been successful in terms of understanding what the nuances are for offering these services to the sites, contractual agreements, communication with sites, making sure that there is sufficient on-site resources to then take over once a patient has been enrolled. And that's one mechanism with which we can improve enrollment on cancer clinical trials so that our trials don't last longer and that the sites are also looking for additional resources so they can focus their staff's effort on people who are highly probable to enroll in clinical trials and not end up not enrolling on the study.

These teams of nurses and coordinators are also supporting sites on activities such as adverse event reporting and data cleanup. And this is a tremendous resource which we are learning to,  responding to what feedback we're getting from sites to help curate the services that are available.

There are other examples beyond this experience as well of centers developing hub and spoke models to provide support to less resourced clinical satellite or community clinical research centers. And it's important for every site to be able to understand exactly what their needs are, what their PIs needs are, what their site staff's needs are, and to be able to curate those services in a way that takes the load off of the site themselves.

And you can already imagine that as we learn more about providing these services for patient identification and eligibility screening, that can then be translated into other additional steps such as medication shipment to a patient's home, adverse event collection at the patient's home using telemedicine for those resources. And the NIH has had a few successful experiences in leading and supporting these studies during COVID. And as we are thinking about factors such as interstate medical licensure, shipping medications across state lines and how that varies between oral and IV medications, we're able to set up the framework for us to use these novel mechanisms to make clinical trials more accessible so that patients, people who have cancer, doctors who are caring for those folks who otherwise may not have a supportive team to run clinical trials can have some additional support so that they can make those trials available for their participants.

The NCI benefits by being able to increase access of their trials in the community, the sites and the doctors and patients who get their care there benefit by being able to access those resources closer to home as well.

Oliver Bogler:

So you've mentioned telemedicine as one facilitator of this idea of the Virtual Clinical Trials Office that also allows more people to participate. I wonder if you also see opportunities, for example, I could imagine an AI sort of looking metaphorically over the shoulder of the physician as they are treating a patient and saying something like, this patient might have the characteristics that match this trial that's currently on offer. And at the right time, as you said, sort of to give that that critical piece of information. Is that the kind of future that we can look forward to?

Shaalan Beg:

Yeah. The NCI is supporting the USCDI+ cancer initiative, which is looking to structure EMR data elements within the electronic medical records and to optimize that list to enable clinical trial matching. And that's precisely the vision that that initiative has is how can we automate a lot of the patient characteristics for identifying people for a clinical trial. When we go down the list of inclusion and exclusion criteria, I'll give you an example. When it comes to age, demographics, or kidney function, or even past medical history, those are probably easily, quote unquote, I'm air quoting here, extractable from medical records. But when it comes to lines of therapy, that's one of the very tricky inclusion criteria to automate because it requires the machine to be able to interpret from the physician's note, what are the prior lines of therapy, recalibrate that into the language which is present in the protocol and see if that matches or not. And even if you put five oncologists in the room together and ask them to document a structured patient's prior treatments, they're going to structure it 10 different ways.

There is no standard and I don't think there necessarily needs to be a standard, but there is no standard on documenting factors such as lines of therapy. So there are elements around data residing in the electronic medical records that is a barrier to us being able to create this trial matching AI bot in the background.

The second component for being able to match patients onto a clinical trial is actually the way the data resides in the clinical trial protocols themselves. Surprise, surprise, there are many different ways that the protocols are structured and there is very little agreement in how inclusion exclusion criteria are even structured, which makes it hard to digitize those criteria and be able to apply them.

And there are initiatives, some supported by the FDA even, that is encouraging the deployment of digital or structured protocols, I should say, where the schedule of assessments and inclusion exclusion criteria, dose modifications are all built in a harmonized way so that these tools can then start to read the protocols in a way that they can then find the matched participant as well.

So there's a lot of work that's happening on both ends of this matching equation both in being able to identify patients in a timely way using structured and unstructured data in electronic medical records, and then on the other end, to be able to interpret clinical trial protocols.

And there are a lot of challenges, and the biggest challenge for both of these is really is the way we've been doing it all the time leading up to here, because it does require us to change behaviors which we have been very used to for decades and serve very good purposes for a very long period of time. And then there is a process that needs to go in terms of uptake and acceptance and optimization. And we are seeing stakeholders taking that on.

Oliver Bogler:

Sounds like an exciting time to be in this field. But I hear what you're saying. You've got to change the culture alongside the technology and to really accomplish the goal.

I wanted to ask you about your role at Science 37. You served there as VP of oncology, and you're still a principal investigator there, if I'm correct. And you oversaw the decentralized clinical trial program there for oncology. What was your experience in that group, and how has that helped you in your current role?

Shaalan Beg:

Yeah. So decentralized clinical trials is a term that gained a lot of popularity around the COVID pandemic. when a lot of clinical trial centers and offices were shut down, frankly, or patients were not coming into the offices at the same rate. We then realized that a lot of the components that are required to oversee someone's participation on a clinical trial have already existed. Like there was FDA guidance in terms of decentralized trials. There's some language out there even before COVID came about around the interpretation of Form 1572, which is a regulatory document that the FDA uses.

But we saw the demand for decentralized clinical trial services surge during COVID. And when I use the phrase decentralized trials, I want to focus on a couple of elements. We're talking about any clinical trial related procedure that takes place at a location that is not the investigator's location. So it could be the patient's home, it could be another doctor's office, it could be my colleague's office, just not my own office. And when we talk about decentralized clinical trials, we don't necessarily need to think of an entire clinical trial as being decentralized versus not. There are different elements within the clinical trial. The physical exam is one element. The history is one element. Collecting the vitals is an element. Getting imaging lab collections are all specific elements. And each one of those could be done centrally at the PI's own office, which is the way we've been doing clinical trials throughout, or they could be decentralized to where we can perform those activities at site other than the investigator.

What I just described to you right now is the synthesis of lot of learnings that we went through over the last many years. And what's been very, I've been very happy to see is that when we started to talk about decentralized clinical trials, and this is a concept that's been around for a very long time, but when we started to talk about this in the space of oncology, the initial reactions were, that's never gonna work because in oncology, the drugs are too toxic and the patients are too sick and how are we going to enable these studies?

And what we found through varying experiences is that for the right drug, with the right study question for the right patient population, it does have a role. And when we surveyed large comprehensive cancer centers and asked them about their use on decentralized trial elements, 100 % of their sites now say that they have had experiences with some component of decentralized trials. That could be e-consent, it could be telemedicine, it could be getting scans close to where the patients are. But it's making its way into oncology, surely and steadily.

During COVID, when study-related activity was halted at lot of centers, there was a clinical trial which was structured in a way to administer subcutaneous treatment for HER2-positive breast cancer at the participants' homes. So patients were screened and identified at 12 large academic medical centers. After those patients were enrolled, the entire care was done using a telemedicine platform with nurses going to the patient's home, administering the medication, collecting blood samples, even doing a bedside ejection fraction assessment for the heart.

And this was a study with an intent to expand regulatory labeling of the drug that was being studied. And the study ended up enrolling about 140 patients and 26 % of patients who enrolled on that study were Black, Hispanic or Asian. Before the study, I would have said, you know, I don't know what the cultural acceptance even of receiving cancer therapy at home is going to be. And what we've realized is again, you know, we need to ask our patients on what their preferences are. These decentralized methods have a significant advantage of reducing participant burden for a clinical trial. The participant's child doesn't have to take off of work in order to drive their parent to the office for study-related visits. And granted, we're not going to do liver biopsies on the dining table or administer RT therapy in the living room. But especially when you look at the new treatments that are coming in through the pipeline. We're looking at lot of sub-Q medications. We're looking at oral medications, IM medications that have side effect profiles which are conducive to administration at home. There are more trials that we can impact using these tools.

And why it's important for us to think about this in the clinical trial space is that we're seeing standard of care administration evolving as well. The University of Pennsylvania and the Huntsman Cancer Center in Salt Lake City have at-home programs for delivering their normal standard of care cancer treatments at home. There's a list, the last time I checked, of 15 anti-cancer treatments, infusions, that they have deemed safe to be given at home. That includes platinum drugs, includes some new therapy medications. So essentially, medications that don't have a high risk of infusion reactions can be done at home. So we need to keep an eye on how that is evolving and make sure our trials are able to accommodate.

So there are a lot of challenges in that space. And I would say one of the major challenges is to provide sites and investigators the right SOPs to be able to execute these clinical trials in a safe and compliant way.

At the end of the day, we want to make sure that our participants' safety was not compromised in any way and the integrity of the data that we collected was not compromised in any way. And depending on what element we're looking to decentralize for what type of study, those two can line up very nicely, in which case we're seeing it move forward or not, in which case we keep doing work the way we've had in the past.

And the FDA came up with guidance which helped address many of the concerns that sponsors and investigators have for being able to operationalize these clinical trials. And now we're seeing those guidances percolate through the societies and through the communities and sites are looking at it to see what their roles may be. So I think the next few years are going to be very exciting as we see centers, again, learn from NCI's virtual trial office experience and what's happening outside as well to operationalize studies even within their own network.

And I hope that cancer centers can completely redefine what they consider is their catchment area. Because oftentimes, cancer centers will feel that patients who walk through their doors are their patients. But now with these tools and services that we have available, we are able to provide access for discoveries in our hospitals and clinics and cancer centers into areas which otherwise would not have been accessible.

Oliver Bogler:

That sounds like phenomenally important work. Thank you. Thank you for doing it. We're going to take a short break. And when we come back, we'll talk about careers.

[music]

Calling all senior oncologists committed to community oncology and reducing health disparities! Are you passionate about shaping the next generation of researchers?  Apply to The Worta McCaskill-Stevens Career Development Award for Community Oncology and Prevention Research (K12) program and mentor promising clinical scientists.

This unique NCI program supports the training of clinical scientists in community cancer prevention, screening, intervention, control, and treatment research.  The program welcomes proposals for innovative research and career development programs with an equity lens and a focus on increasing diversity in clinical trials.  

As a program leader, you would guide clinical scientists from various oncology specialties as they conduct research, potentially even leading their own independent clinical trials.  This is a chance to leverage your expertise and make a lasting impact on cancer research and care in underserved communities. 

For more information about the McCaskill-Stevens K12, including how to apply and our staff contact details, visit our webpage – link is in the shownotes.

[music ends]

Oliver Bogler:

All right. We are back. I'm always curious on what got people started in their path to medicine and science. What was that for you?

Shaalan Beg:

You know, if you were to go back and read my personal statement for medical school, it probably looked like a lot of others, right? In terms of wanting to go into medicine with the desire to enter a profession where you get to help people day in and day out. And as I started to go through my journey for medical school and residency and fellowship, I was looking for a field which was in evolution, was evolving quickly, new discoveries moving into the clinic that was exciting and growing and oncology checked a lot of those boxes.

I think my pursuit into the space of oncology, there are probably some overrepresented influence by a few mentors and some patients who I've cared for over the years that shaped my thinking, that made it clear for me on how I want to spend my time and go through the process. The last many years have been absolutely amazing in terms of being able to have the privilege to care for people who have cancer and work with scientists who have exciting discoveries and want to move that into the clinic. And then from an operational perspective, building programs where we can create change and do things in a way that helps people's lives.

Oliver Bogler:

I'm also curious about how you decided to take on this sort of big challenge of overall of clinical trial. I don't know what the right word is delivery clinical trial performance. It seems like everything right. You already mentioned your specialty is in GI cancer and pancreatic cancer specifically, I guess. But in addition to this very challenging clinical practice what made you think OK I also want to work on this bigger problem of structural issues around clinical trials.

Shaalan Beg:

I was the medical director for our clinical trials office at an NCI designated cancer center at UT Southwestern in Dallas. And I started to appreciate the impact of operational efficiencies, the importance of developing team members, helping them map out their careers, the role of stakeholder engagement in being able to successfully pull off a clinical trial or a clinical trial ecosystem.

Then I think I got bit by the informatics bug and really started to see the impact of electronic medical records and data that's emanating from electronic medical records. Our ability to change how we generate evidence using these tools. And for me, it's being able to be in a position where I can help take advantage of the developments that are taking place around me. Like 10 years ago, it was electronic medical records and it was harmonizing the data. And now we're seeing impacts on AI. And for me being part of that change and maybe having a small part in defining the narrative and how people talk about applying these tools in the oncology space was something which was important.

I also got annoyed when I would meet my friends and colleagues and we would talk about our programs that we all were doing a reasonably good job about offering these services for patients who walk through our doors. And I mentioned this earlier, but that we weren't doing enough for people who couldn't walk through our doors. And that was really the driver for me to be able to think differently because there was an opportunity to really grab these opportunities, these developments, grab the bull by its horns and kind see what we can make with it.

And we're still very early in writing that chapter and there's a lot of work that needs to be done, but I think the direction is clearly changing. And I can tell you that the direction is changing because when I started to talk about decentralized clinical trials in oncology, people said that's never going to happen. Oncology is too difficult. And now people are saying, well, we've always been doing that anyway.

I think there's a difference in how it's being perceived, but there's still a long way to go. I don't think that that's just one tool that we have. And I think you mentioned AI, what those applications are going to look like. We have no idea how evidence generation is going to be in 10 years.

Oliver Bogler:

So you've also been involved in the Pancreatic Cancer Action Network, and I wonder if you could tell us a little bit about that experience and how that has influenced your approach to patient-centric research.

Shaalan Beg:

So when I was a junior investigator trying to find my way in the scary world of GI oncology, I had the privilege of working with a scientific basic science collaborator, Dr. David Boothman, on work that he was doing around KRAS mutated cancers.

And that relationship led to a series of successful grant applications and clinical trials that were funded and studies that we ran in Dallas as well. And those were initially supported by the Pancreatic Cancer Action Network.

I credit them tremendously for supporting my early work and credit them for me being in the field and having an interest in continuing to give back to the community. Every year, PanCan has a 5K where we've had a team. And the first time we had a team, it was me and we didn't have a team, we showed up to -  Purple Stride is the name of the 5K - David Boothman and I showed up, we grabbed a couple of lawn chairs and we had a poster that we grabbed from one of the booths when nobody was looking and we wrote UT Southwestern and we tied them to those chairs and we just stood there and started to see patients. And that evolved into us having a booth. It grew to our team to now, know, the UT Southwestern has three teams and raised a lot of money and, you know, is a force over there.

And again, it's not just the folks at PanCAN, but also the community that PanCAN had built around pancreatic cancer was my tribe or is my tribe. That's where I found my mentors. That's where I found my colleagues where peer mentorship is a thing. Talking to folks who are grappling with similar challenges that I may be at that phase of my career and PanCAN provided that community, they provided those resources and that mission and they'll always have that space in my heart. So still have my Pan Can pin on my blazer if you see me at oncology conferences.

Oliver Bogler:

Shalaan, you're also a graduate of ASCO's Leadership Development Program and you've held committee positions at ASCO and at ECOG at ACRIN. Can you describe how these leadership experiences have helped you shape your goals and your pathway?

Shaalan Beg:

I got bit by the leadership development bug through a leadership program that UT Southwestern had. And you have to realize for a lot of doctors, we kind of stumble through our training because we're good test takers. And we're book smart.  Sometimes that could come at the expense of other aspects of our battery of skills. For me it was really important to realize that leadership development, being able to lead a team and grow professionally is actually, there's a science to that as well.

I always used to think that great leaders are born and not developed. And once I realized there's a method to it, I've been very, very hungry to learn more and more in that space and to apply those in real time, the positions that I've held. And it's a process. I don't think that any leader will ever say that they have learned everything there is and we all learn from experiences more than we do in courses.

But, again, the realization there, if I link it to the clinical research activities, is how can you build a program where research coordinators and research staff want to join your team and not your colleagues' team? How do you build a program where fellows and trainees come to you as opposed to other folks and you're able to pick folks to work on your team? And there are aspects around developing the team, communicating your leadership, communicating your ideas and then making sure that those folks are being developed and their goals are met, which for me was very important in order to be able to be successful in completing my pancreatic cancer clinical trials.

And it was that connection which a lot of us will learn through the process of time by getting knocked around a little bit by mistakes that we make. And I'm sure you have stories to tell. I certainly have stories to tell. But you know, if these leadership courses and leadership experiences can help us have more self-awareness and make us more efficient and better stewards of our resources, then why not?

And the ASCO Leadership Development Program was a fabulous experience, which not only was an introduction to the skills which the leader should have, but also was a way to be introduced to the ASCO community in a way that you understand how ASCO functions, what are the levers that they have that they can pull and that they can influence and where we can see ourselves. And that has led to a series of relationships within ASCO and responsibilities within ASCO, which has been the highlight of a lot of the work that I do and definitely amongst the months that I've enjoyed the most.

Oliver Bogler:

I forgot to expand the acronym ASCO, the American Society for Clinical Oncology. So clearly a very important group to you.

My last question, what advice would you give to someone who might be listening, who is fascinated by your path and your work and is interested in following in your footsteps? What would you say to them?

Shaalan Beg:

I would lean on one of my favorite TV shows, Ted Lasso, and say, be curious. I think the exact phrase is be curious, not judgmental. And ask questions. People will appreciate you asking questions. You'll be surprised by what other people are thinking about when you express some curiosity, when you show interest in what folks are doing. And for me, it really is about the journey. Yes, the destination is important. We all want to change the way cancer is treated and cancer care delivery is administered. But it is about the journey and how we make that change and how the community comes along in that journey as well.

Oliver Bogler:

You know, I hear they're making a new season. So.

Shaalan Beg:

I can't wait.

[music]

Oliver Bogler:

All right. 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 or anything you found inspirational or amusing or interesting. You can send these to us at NCIICC@nih.gov. Record a voice memo and send it along. We'll play it on an upcoming episode. But now I'd like to invite our guest to take his turn.

Shaalan Beg:

So I've become really interested in history. I don't know if that's something that guys my age typically start getting interested in generally or not, but in particular, there is a podcast called the Empire podcast. Oliver, are you English?

Oliver Bogler:

No, I'm German by background, but I grew up in England. Did a lot of my growing up there, yeah.

Shaalan Beg:  

So you would appreciate the specific … they start off talking about the East India Company and the British Empire and the influence of the East India Company and the British in India. But there is a specific episode around the Koh-i-Noor diamond, which was the largest diamond, and where it came from, how it exchanged hands, and they walk through many different empires and different kingdoms that it goes through until it makes its way to London. And even after it gets to London, how the Queen was viewing this and built relationships around it. So if you have time, I would highly recommend the Empire podcast. And if you're going to pick one, I think that you'll find the Koh-i-Noor diamond episode very interesting, but then they do go on and talk about other empires as well. And the hosts are fairly engaging as well.

Oliver Bogler:

That sounds great. Yeah, I'm going to give that a listen and we'll drop a link in the show notes. Thanks for that.

I'm also going to make a very brief recommendation for a very brief book. It's called 300 Arguments. It's by Sarah Manguso. And it's one of those books that you sometimes see at the counter there at the bookstore and you sort of pick it up. So I picked this up on a odd chance a few months back. And it's basically, as she says, “think of this as a short book composed entirely of what I hoped would be a long books quotable passages”. So it's just little statements that are little, you know, they're food for thought or they're stimulus for thought. I keep it here on my desk and between, you know, meetings and calls, I sometimes pick it up and look at one of the ideas in here, one of the arguments, and I enjoy that. So that's my recommendation.

Dr. Beg, thank you so much for joining us today and for sharing all your experience and your advice.

Shaalan Beg:  

Thank you very much for having me.

Oliver:

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.

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