Chapter 08: A Study of Thrombosis Opens New Research Niche in Side Effects
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Description
Dr. Elting explains how her study of thrombosis in cancer patients enabled her to establish a new research niche.
She explains how her study of thrombocytopenia led to her interest in thrombosis and helped shape her approach: looking at individual patients at MD Anderson and carefully describing symptoms in this large population in a way that had relevance to current practice. This was the beginning of her focus on side effects, she notes.
Next, Dr. Elting compares her approach to the typical retrospective study often conducted by fellows. She notes that the most frequent question she received from reviewers was, Are these symptoms as bad outside of MD Anderson, in ordinary practice? She explains why MD Anderson has a different patient population, but notes that it was possible to generalize this information to the general population and she began to look at expanding studies accordingly.
Identifier
EltingL_02_20150305_C08
Publication Date
3-5-2015
City
Houston, Texas
Interview Session
Linda S. Elting, DrPh, Oral History Interview, March 05, 2015
Topics Covered
The Interview Subject's Story - The Researcher; The Researcher; Professional Path; Discovery and Success; Discovery, Creativity and Innovation; On Research and Researchers; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; MD Anderson Culture; Patients; Patients, Treatments, Survivors
Transcript
Tacey A. Rosolowski, PhD:
Stay tuned. [laughter] That's good. And we decided today to spend time talking about your research. And last time we ended up talking about the studythe first study that you did independently, really, of Dr. Gerald Bodey, which was your study of thrombocytopenia. And so, I wanted you to continue the story of the evolution of your research, because it certainly moved into a whole variety of different areas of policy and population.
Linda S. Elting, DrPh:
Okay. The thrombocytopenia study led to another similar study on thrombosis. So, in one case, we were worried about people not having enough platelets. And in the other, we were worried about them having too many platelets, and developing clots. They were similar studies to what I had done in the past, and that is, they were about individual patients at MD Anderson. And itthe contribution wasto the literature and to the field was to describe the side effects in a really, really large population. Because MD Anderson is so large in terms of the people it cares for, we're able to put together a large population of people treated in a short period of time. And so, it provides information about the outcomes of these side effects, and the serious nature of these side effects, in a relatively small time period, so it's relevant to current practice when it gets published. And that wasthe thrombocytopenia and the thrombosis studies were sort of my beginning to look at other side-effect problems. I had moved to general internal medicine from infectious diseases, and so I was seeing a wider range of problems there.
Tacey A. Rosolowski, PhD:
Could I ask a question?
Linda S. Elting, DrPh:
Mm-hmm.
Tacey A. Rosolowski, PhD:
Now, it sounds like, from our conversation last time, too, that you were really involved in putting together these very large studieskind of landmark studies
Linda S. Elting, DrPh:
Mm-hmm.
Tacey A. Rosolowski, PhD:
investigatingputting together data from populations in ways that had never been done before. Why hadn't it been done before?
Linda S. Elting, DrPh:
Well, some people had done it. It was not uncommon at all for new fellows to come to MD Anderson to do their clinical year as fellows, and then to do a year of research, and as one of their projects, to do a retrospective chart review of some clinical problem. And it was also extremely common for those fellows to see an interesting case of something, and then to publish that. Because part of their research experience is to publish and to aggregate data and those sorts of things. I think what I did was take what had been done by many fellows and ramp up the methods. I worked really hard to be able to put denominators on things.
Tacey A. Rosolowski, PhD:
What does that mean?
Linda S. Elting, DrPh:
Instead of just saying, "We had fifty-seven cases of this,"I added into that, "and there were 123 people at risk, and so, this is a common problem." When you don't have that denominator, you don't really know how big the problem is, particularly if you're reporting from MD Anderson, which is different from everyplace else on earth. So I think that that attention to the methodologic issuesthe focus on the epidemiology of the problem as opposed to the clinical aspects of the problemtook that kind of research to a new level. And it allowed me to do some very good descriptions of toxicities and side effects. At that point, virtually all the information we had about toxicity and side effects of treatment of cancer came from randomized clinical trials of treatments. And the problem with those studies it that those are highly selective patients. They're very compliant. They start out pretty healthy compared to other cancer patients. They're the cream of the crop in terms of cancer patients. And so, we didn't have a very good feel for how serious or severe these toxicities were in all comers who needed our treatments. And so, looking at thatlookingcomparing trends over time with different drugs outside of clinical trials, getting large experience with the elderly, who are almost never on clinical trials, and those kinds of things really expanded our knowledge about what thesome of the patient burden associated with our treatments is. So, as I did that, I think two things happened kind of, in my mind, around the same time. The first was that the biggest question I got from reviewers, from colleagues all over the world and everything, wellwas, "Well, but you're from MD Anderson. MD Anderson is not like anyplace else. Do you have any idea if these things are as a bad or as frequent or worse in just everyday clinical practice everyplace else, where all the rest of us work?" So there was this question about the generalizability of MD Anderson's patients information.
Tacey A. Rosolowski, PhD:
Can Ican I ask you whyI mean, when these colleagues and reviewers said MD Anderson is unique, I mean, what kinds of factors were they referring to? What was the gap between MD Anderson and sort of the more ordinary practice environment?
Linda S. Elting, DrPh:
Well, MD Anderson is a referral institution. So, we get thethe largest part of our population has always been people that no one else would treat because they had something that was quite rare, or they had something that was quite advanced. It's also a place with some profile in the community, so it's a place where some people want to be treated. That means the people who manage to get themselves here were very motivated; they're educated; those sorts of things. So there are all kinds of things. They'rethey tend to be younger than the population with cancer, in general. They're a little bit healthier. They don't have as much diabetes and hypertension and those sorts of problems, because you have to have a certain amount of good health to enable you to travel here and to have the stamina to keep up with treatments that are away from your home. So, we understand that. We know that's true. We recognize we see a biased sample that is worse off for their cancer, but better off for everything else. So, the ability to take our patient information and apply it in everyday practice in the community has been questioned, and we understand that. That's a perfectly reasonable andquestion to ask. And so, because of that, I started trying to explore opportunities to examine similar problems, but in the general population. And so, that's when I began to expand to looking at these toxicities, using large databases.
Tacey A. Rosolowski, PhD:
And whatabout what year was that? Kind of what time period?
Linda S. Elting, DrPh:
Maybe late "˜90s, early 2000s.
Recommended Citation
Elting, Linda E. DPh and Rosolowski, Tacey A. PhD, "Chapter 08: A Study of Thrombosis Opens New Research Niche in Side Effects" (2015). Interview Chapters. 712.
https://openworks.mdanderson.org/mchv_interviewchapters/712
Conditions Governing Access
Open
