Head & Neck Cancer

Spring break in Florida is a ritual for many college students, full of crazy activities. My spring break trip to Fort Lauderdale in 1982 was wild in a different way. It was during that break that I discovered what I wanted to do with the rest of my life.

I escaped from the cold weather of Chicago, where I was in medical school at Northwestern, to South Florida to visit my family. Rather than head to the beach on a Saturday morning, I attended a symposium on breast cancer that my father, also a radiation oncologist, recommended. After the conference, I met Dr. Jay Harris of the Harvard Joint Center for Radiation Therapy, one of the speakers. Harris, a renowned radiation oncologist, convinced me to go to Boston to take a senior elective course in radiation oncology. I spent a month there and absolutely loved the experience.

I subsequently did my residency at the Joint Center. Even after deciding to pursue a career in radiation oncology, I was not sure on which area I would focus. As a resident, I rotated among the different services and especially enjoyed my work with head and neck cancer. It was intellectually stimulating and very challenging in terms of day-to-day management of the patients. The things that most of us take for granted—eating, drinking, and breathing—can be seriously impaired both by the cancer itself and the treatment thatis necessary.

I came to Duke in 1987 and have concentrated in the field of head and neck cancer. Head and neck cancer includes all types of cancer from the collarbone to the top of the scalp except for tumors originating in the brain. Some examples include cancers of the larynx,tongue, tonsils, sinuses, and saliva glands. While tobacco use and heavy alcohol use are considered factors in developing head and neck cancers, nearly a third of my patients rarely drink and have never used tobacco.

About 60 percent of my job is patient oriented and the rest is research. My job would be impossible without the expertise and assistance of a dedicated team that includes a physician assistant, nurses, residents, physicists, dieticians, and administrative support. While each day may be somewhat different, there are similarities each week. On days in the clinic, I take part in an 8:00 a.m. meeting with residents and then see 20–35 patients over the course of the day. We see initial consultations, patients undergoing treatment, and former patients coming back for a check up.

Continuity of care is crucial because problems can arise even after the completion of treatment. I love seeing patients who I have treated in the past. It’s very uplifting to see them continue with life.

Other days, I plan the treatments I’ll give my patients. Technique matters in radiation oncology. Our job would be simple if we only had to focus on aiming the radiation beams at the tumor. We must exert equal effort in attempting not to do long-term harm to healthy tissues that are adjacent to the tumor. As the technology that allows us to accomplish both of theses goals has improved over the years,the process has become more complex and time consuming. Before the patient even starts treatment, I spend about three to four hours of planning per patient compared to an hour previously, to make sure that the best care possible is delivered.

I am gratified to know that since I joined Duke we have been at the forefront in the development of innovative, new, and better treatments that are allowing more patients with head and neck cancer to survive and lead normal, productive lives. A major reason that I love working at Duke is that I can actively collaborate with great researchers on projects that will hopefully lead to even more improvements in the future.

At Duke, we offer many clinical trials in which patients can receive cutting-edge treatments. Some of these treatments may change the face of cancer and are currently not available to patients anywhere else in the country. It’s intellectually satisfying to see a new treatment successfully go from idea to implementation.

As much as I love my job, there are things in life besides work. I enjoy spending time with my wife and two daughters. I also try to ride my bicycle five to six days a week, weather permitting. Riding makes me feel good mentally and physically—it increases my tolerance for stress and lets me relax. It also gives me uninterrupted time to think.

Some people may think that being an oncologist is sad and depressing. While there are definitely sad moments in my job, it is not at all depressing. In fact, I find it quite uplifting. Head and neck cancer overall is more curable than many other types of cancers. Even for those patients we cannot cure, I know that I can often alleviate some of their symptoms and suffering, and that too is both important and satisfying.