Sarcoma

From the Physician's Desk

An Interview with Raphael Pollock, MD

As the Director of The Ohio State University Comprehensive Cancer Center, Raphael Pollock, MD, is a surgical oncologist treating patients with soft tissue sarcomas. A leader in his field, he is optimistic about the future of sarcoma treatment.

What is the most important advice for someone who is newly diagnosed with sarcoma?

Given the rarity and the complexity of sarcoma, I highly recommend seeking care at a dedicated sarcoma center. In a typical hospital, a doctor may see one to three sarcoma patients a year. Although that physician may be highly skilled, the experience that comes from someone who sees 300-400 sarcoma patients a year is invaluable. Additionally, a sarcoma specialist understands how a patient’s treatment from the very beginning really sets the path. For example, decisions made early on, such as choosing how much tissue to take during a biopsy, how and where to make an incision or the type of treatment to administer, will affect the patient’s future treatment options. Getting to a sarcoma center is not always possible. In those cases, I encourage people and their caregivers to reach out to a sarcoma center for advice and planning purposes. Most are more than happy to offer help.

How do you approach each new patient’s case?

Two types of patients usually contact me. When I see people who have an undiagnosed or biopsied mass, I talk with them first about sarcoma in general. I go over staging, and I explain that every case we have is presented at our multidisciplinary planning board meeting. The board is made up of sarcoma-certified physicians who analyze every patient’s pathology and other test results to recommend the best possible treatment. What happens next is something I’m particularly proud of, and I know our patients appreciate it, too. We schedule doctors for the patients, not the other way around, and we have entry-level radiation and medical oncologists on site. It’s a patient-centric system that enables the patient to see many doctors and ancillary personnel in a couple of hours instead of over a couple of weeks. It is more effective, and it builds relationships, something I feel is essential. In fact, my cell number is on my business card. Patients don’t hesitate to use it, and I deeply enjoy helping them when they do.

The majority of my patients, however, come to me when their sarcoma has recurred. They typically find me on the Internet or through my activities as a medical advisory board member for several organizations. They often feel that since previous treatment wasn’t successful, I’m a bit of a last ditch effort. I find it more encouraging to share the basic philosophy that we are taking a disease process that is potentially lethal and trying to convert it to a chronic disease, one they can live with. Sometimes their previous recommendation was a surgical procedure that would leave them with a significant life-affecting outcome. Surgery is the mainstay of sarcoma treatment, but we can often craft a solution that doesn’t have a life-defining result. We’re able to do so because we use a team approach to surgery. It’s common for us to have five surgeons with five different specialties working on a case, which gives us the opportunity to do things together that we wouldn’t be able to do alone.

If patients choose to be seen elsewhere, I am always open to giving referrals or being involved in meetings to discuss inconsistencies in test results or treatment plans. The goal is always for the patient to be comfortable.

Do you often recommend clinical trials?

When we discuss treatment options, we discuss the clinical trials that are available depending on the patient’s treatment history. Currently, many clinical trials for recurrent sarcomas focus on systemic therapies. We also make sure people understand that they will always get the equivalent of standard of care if they participate in a trial.

Each oncology discipline has a distinct contribution to make, yet they are all interdependent. It’s interesting to note that although sarcoma is a rare disease, there are a number of areas where sarcoma clinical trials have led the oncology field. Neoadjuvant chemotherapy was first used successfully in 1976 on sarcoma tumors, and the first molecularly-targeted treatment was deemed successful in a sarcoma clinical trial. A clinical trial is also responsible for determining that limb salvage surgery was just as effective as amputation with far more manageable side effects.

To further the progress in trials, we have the Sarcoma Alliance for Research through Collaboration (SARC), an organization made up of about 45 sarcoma programs across the country that focuses on finding and conducting clinical trials. We coordinate with the European Organization for Research and Treatment of Cancer (EORTC), a similar organization in Europe that actually allows U.S. participants to take advantage of clinical trials happening in Europe. That isn’t common, but the intent is to make these observations and advances available to benefit patients everywhere, regardless of location. There is a lot of altruism in those groups, and in the industry overall.

What is on the horizon for sarcoma treatment?

Personalized medicine is just beginning in sarcoma treatment. Because it is such a rare disease, it isn’t easy to build research programs for it. However, with the AJCC staging updates introduced recently, we are getting closer to defining molecular staging criteria. We are also doing exciting work on nomograms (prediction tools), which allow us to share very accurate information about prognosis with patients based on clinical and pathological findings.

What drives you, professionally and personally?

I have numerous facets to my career that give me a wonderfully broad perspective. I operate two full days a week, see patients in clinic and am Director of the Sarcoma Research Laboratory at Ohio State. Our surgical fellows work alongside me in the clinic, and I supervise and actively mentor 16 surgeons in a collaborative environment. My most important accomplishments, however, are my three children. All three attend Ohio State University, two as undergrads and one in medical school. It gives me so much pleasure to see my kids reaching out and fulfilling themselves.

 

 

 

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