Though famous for walking his dog in his Tennessee neighborhood, in professional circles Howard "Skip" Burris III, MD, FACP, FASCO, is President and Chief Medical Officer for Sarah Cannon, the Cancer Institute of HCA Healthcare, in Nashville, and current President of the American Society of Clinical Oncology (ASCO).
While eager to discuss ASCO and his goals as president, Burris first explained that he has been happily married to his "beautiful wife, Karen, for 38 years," mother to his two sons, Stephen and Marc, and now daughter-in-law, Caroline, and 1-year-old grandson, Liam, are in the family mix. Not to be forgotten is "Olivia, my dog, a Wheaten terrier," he said with obvious delight. "Every night when I come home from work, she greets me as if I'd just returned from 3 years at war." A 10-handicap golfer and movie buff, Burris said time "hanging out with the family" gives balance to the intense world of cancer, to which he has chosen to devote his life's work.
He recently took time out from his diverse and pressing endeavors to introduce himself to Oncology Times readers via a lively and instructive Q&A.
How did cancer become your professional focus? What influenced you most?
"First and foremost, it was the patients. During my medical training [at University of South Alabama], residency, and fellowship [at Brooke Army Medical Center, San Antonio], surgical subspecialties were fascinating to me. However, they entailed episodic relationships with patients, as opposed to some areas in internal medicine where doctors developed real relationships with patients.
"As I did oncology rotations, I was attracted by the patients and their courage, how grateful they were for whatever you could do for them. Such an appreciative group of patients was unique. In the late 80s and early 90s, outcomes weren't what they are today. I connected with the doctors in terms of their passion for helping patients and their optimistic view in trying to make their lives better. I became involved in the science of cancer later; it was the patients and the doctors that first attracted me to it and have influenced me most."
Do you have a specialty area in oncology?
"I didn't begin with a disease specialty. Instead, my greatest satisfaction and interest came through working with a drug development phase I program. I was a phase I investigator. My mentor, Daniel Von Hoff, MD, who has won numerous awards for his work in cancer, worked with brand-new drugs. The idea of treating patients who had largely exhausted standard options and had not been able to eradicate their cancer was the beginning of my practice and clinical research.
"Patients were coming to us for another idea, another option, and another alternative. While they presented a diverse group of cancers, they comprised a very similar patient population; they all had to do something different to survive. While hoping to find some benefit for themselves, they also wanted to help other people and shape the future of cancer treatment by participating in studies.
"It was an exciting time. Some of the first modern drugs were beginning to work, so we actually had patients who benefitted-lived longer, felt better, and experienced positive outcomes. That was thrilling."
Are there any drugs of note with which you've been associated?
"I was fortunate to participate in the phase I trials of some of the first drugs which matured to become real drugs and commercial successes, such as docetaxel and gemcitabine. Then in the late '90s and early 2000s, I worked with the drug T-DM1, a breast cancer drug that has had remarkable success through the years.
"I was lucky to have been involved in a number of phase I trials with drugs that ended up being winners. Helping not just dozens of patients on the studies, but thousands of patients around the world, is something of which I'm very proud.
"At Sarah Cannon, we've done more than 300 first-in-human trials. I try to emphasize that the important thing to remember is there have been more than 300 patients who stood up and volunteered in the setting of fighting their own cancer and agreed to be enrolled in these clinical trials. They have done great things for the world of cancer with their participation. It is a unique group of patients with whom we work and share our journey."
Have you reflected about this period of medical history during which you've grown your medical career?
"Yes, indeed I have. It has been extraordinarily dynamic, revolutionary. In the '90s and the first part of the last decade, we lumped patients into groups, and there was a one-size-fits-all approach to many of our treatments and our regimes. Now, we have a better understanding of biology, how the immune system works, and the fact that every patient is unique and every tumor is different. With molecular profiling and all the advances right in front of us, we have a more individualized approach. Some patients may need a boost to their immune systems, others may need a pill that targets a mutation. There were eight drugs approved by the FDA in 1998; in contrast, there were 49 approved last year in just cancer alone. It's amazing to see it come that far."
Why do you feel drawn to serving ASCO as opposed to another organization?
"I think of ASCO as the overarching organization of oncology professionals that really serves as the voice of oncology. We're often asked to weigh in on local, national, and international levels about important topics such as access to care, reimbursement, and new drug approvals, among many other things.
"ASCO's scope and scale absolutely make us the leaders in cancer education. We've accepted the responsibility to provide that educational avenue through meetings and other venues, connect people to share their work, and continue to get the word out about new advances, opportunities, and issues going on in oncology.
"These reasons highlight the imperative to help ASCO membership continue to grow, both nationally and internationally. In fact, ASCO had its first global meeting in Thailand this fall. Sarah Cannon presented one of the clinical trials there, submitting some data, and offering information on some of the new therapies we're working with. It will be an exciting time. I believe ASCO is the organization to pull the world together, help us to learn from each other, and advance the cause of cancer care."
Now that you're in this leadership role at ASCO, are there issues that come to the top of your list to tackle?
"We often think to 'divide and conquer' as a means to solve problems. I think cancer actually demands the opposite paradigm. We need to unite and conquer. The nursing aspect of cancer care is so critical. Scientists, administrators, regulators, pharmacists-all are such integral parts of the care team. Patients know that the receptionist at the front desk, the technician drawing their blood, and the person doing their vital signs are often the people who can do little things to make their day go better. Those are the people who will remind us of problems the patients might be having.
"Patient advocates are a special group as well. My educational program chair lead is Tatiana Prowell, MD, who divides her time between Johns Hopkins and the FDA. One of her primary responsibilities at the FDA is as a liaison with patient advocacy groups, making sure their voices are heard in the drug approval process.
"There are so many more eyes and hands and minds involved in this grand 'team sport' of providing the best care for patients. My drive to help grow ASCO's membership involves being inclusive of all the important members of the care team. We must utilize them as speakers at meetings, and on committees and tasks forces to work through problems such as access to care, participation in research, and really thinking about the various unseen needs that patients have."
What other issues are top-of-mind for you?
"There's been a lot of interest in how we can increase the number of patients participating in clinical trials and, at the same time, learn from the care of all cancer patients. We have a focused initiative to increase access to and availability of clinical trials.
"This can be done in a number of ways, including broadening the eligibility criteria to be closer to that of the real population. We still operate within the mindset that if you've ever had a prior cancer, you're ineligible for a clinical trial. But many patients, due to better treatments and age, have had a stage I cancer successfully removed; that shouldn't prohibit them from going on another clinical trial later.
"Additionally, we used to believe that when somebody developed a brain metastasis, there was going to be such a poor outcome that the patient must be excluded from a trial. Now we know that many patients live so much longer and end up both getting a brain metastasis and having a successful treatment. Those patients should not be excluded from clinical trials either.
"We must also give consideration to older patients. There are some laboratory issues that work against older patients (such as kidney function, etc.) that probably shouldn't exclude them. We should recognize that kidney function as a factor that might require different dosing, but we still need to include those patients in clinical trials.
"Finally, clinical trials offer an opportunity to learn from real-world data. ASCO has made great investments in CancerLink, our data integration platform in which a number of practices participate. Eleven abstracts were submitted to ASCO this past year all based on real-world data that came out of this system.
"As an interesting example, an approval of a breast cancer drug for men was not achieved by doing a study of men with breast cancer, but rather by looking at real-world data from oncology practices, seeing how men did with that breast cancer drug, how well they did staying on the therapy, and how much they benefited. I believe such real-world data can help us look at less common tumors and allow patients, who might not be able to travel for a clinical trial, have their data utilized to improve the lives of others. ASCO will continue a big initiative there."
Can you discuss ASCO's commitment to the Conquer Cancer Foundation?
"Conquer Cancer Foundation is ASCO's philanthropic arm that funds more than 70 young investigators every year with grants that jumpstart their clinical research or academic careers. We will continue to emphasize our commitment to these emerging investigators, the future leaders of ASCO and of many clinical research programs and centers. We need those who are excited about improving the lives of cancer patients and going into oncology research, both clinically and in the laboratory.
"Honestly, with all the data available today, we should be able to improve outcomes even more than we already have. Encouraging colleagues to give back to the field by donating to the Conquer Cancer Foundation will be a front-and-center initiative."
Is there a way oncologists can be the more proactive in furthering the goal of conquering cancer?
"I firmly believe that every oncology professional should join ASCO. Saying that we've got the voices over 40,000 members right now is certainly powerful, but why not have 100,000 members who are really weighing in with participation in meetings, speaking up, and serving on task forces and in committees?
"Secondly, it is very easy in this busy world to let others do the clinical research and let others do the clinical trials. However, I believe the best care for patients is often provided in the context of clinical trials. I would like every oncologist out there to be thinking about how they can contribute better in that arena within their practice and with patients for whom they provide care.
"Lastly, I do think we as medical professionals should pay back for the successes we've enjoyed. We have chosen this profession, and it's rewarding. I certainly feel blessed. Investing in the future by supporting young investigators is a moral obligation. We must take on that attitude. If not us, who?"
Valerie Neff Newitt is a contributing writer.