Chapter 01: The Path to Radiation Oncology

Chapter 01: The Path to Radiation Oncology

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Description

In this chapter, Dr. Cox talks about his educational background, his training in radiation oncology, and his interest in cancer. He also discusses his further training in several European hospitals and the development of the field that used to be called “radiotherapy.”

Identifier

CoxJD_01_20040319_C01

Publication Date

3-19-2004

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Educational Path; Personal Background; Educational Path; Character, Values, Beliefs, Talents; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; The History of Health Care, Patient Care; Understanding Cancer, the History of Science, Cancer Research; Portraits; Mentoring; On Mentoring

Transcript

Lesley W. Brunet, CA

You’re originally from Ohio. I was interested to see that.

James D. Cox, MD

Yes.

Lesley W. Brunet, CA

Where in Ohio?

James D. Cox, MD

I was born in Steubenville, Ohio, but I didn’t live there for very long. My family moved to Charleston, West Virginia, and so I spent the first eight years of my life in Charleston. Then we moved back to Dayton, Ohio, and then lived there through my teenage years.

Lesley W. Brunet, CA

Then you went to school at Kenyon College?

James D. Cox, MD

I went to Kenyon College in Gambier, Ohio, about which I am very proud. I graduated with high honors. Then in 1997, I actually got an honorary Doctorate of Science degree from Kenyon, and they asked me to become a trustee, so I’ve sort of recommitted myself to Kenyon after thirty-five years of not going back.

Lesley W. Brunet, CA

There’s something about that thirty-year rule.

James D. Cox, MD

Yes. Then I went to the University of Rochester Medical School in Rochester, New York, and spent three years there. The summer between my second and third year, I became interested in a program that had been popular at the University of Rochester, which is where medical students took a year out to do something else. Now, these days, everybody wants to compress it. This was the opposite. It was started by a pathologist. The original idea was that the students would spend a year doing autopsies and learning the pathology of disease from autopsies, but then it became working in a laboratory. For me, I became interested in cancer, and I wanted to go to a cancer hospital. At the recommendation of a surgeon who was the cancer coordinator at the University of Rochester, Charlie Sherman, I wrote to several places and got a variety of responses, but the most encouraging response came from Juan del Regato, who was the head of a small cancer hospital in Colorado Springs, Colorado, which, as it turned out, was the major training ground for radiation oncologists at that time. But I went there not because of radiation oncology; I went there because I was interested in cancer, and I spent a year at that small cancer hospital in Colorado Springs. Then through the influence of Dr. del Regato and that experience, I decided to go into radiation oncology, went back to the University of Rochester, got my degree, again with honors, and then did an internship that I sort of tailor-made at the University of Chicago, again geared toward cancer—six months in medicine, six months in surgery—which I have now replicated for our residents here.

Lesley W. Brunet, CA

So that’s your interest in surgery here?

James D. Cox, MD

Yes. So I spent that one year in Chicago and then went back to Colorado Springs and did my residency training there in radiation oncology, which at that time was called therapeutic radiology.

Lesley W. Brunet, CA

The name changes quite often.

James D. Cox, MD

The name changed really just from therapeutic radiology to radiation oncology.

Lesley W. Brunet, CA

Of course in the old days they called it radiotherapy.

James D. Cox, MD

That’s right. They called it radiotherapy here. That’s right. That’s right. But the board certification was in therapeutic radiology. You see the second one up there? That was at that time what one became board certified in. That was a time when you could still become board certified in radiology, where you could practice radio diagnosis or radiotherapy. But that disappeared in 1972 or 1973. You had to do one or the other.

Lesley W. Brunet, CA

Was that a bad—?

James D. Cox, MD

It was old. When you figure the origins of or the beginnings of radiology, it was not without reason that you were using an instrument, and you could use it for diagnosis. Very few people used it for therapy, but over the years that became more prominent, especially as high-energy therapy became available in the forties and fifties. So the field really took off in the fifties and the sixties, and I was part of a program that was funded by the National Cancer Institute to train people in radiation oncology, because there was a recognized shortage and a need nationwide for people who were so trained. So there were, initially, three centers that were funded by NCI for training: Yale, Stanford, and this Penrose Cancer Hospital in Colorado Springs.

Lesley W. Brunet, CA

That’s surprising, isn’t it?

James D. Cox, MD

The first people that were trained at Yale and Stanford, I believe, were training beginning around 1965 or so, and that was a time, actually, when I began my training. Actually, my internship was in 1965, and then my formal training was in 1966 through ’69. (Telephone rings. Interruption.)

James D. Cox, MD

We were talking about Penrose and the whole field of training and so on.

Lesley W. Brunet, CA

I did want to ask you, before you get too far, what triggered your interest in cancer?

James D. Cox, MD

Actually, doing autopsies as a second-year medical student. Don’t ask me why. There was no personal connection. It was purely intellectual. I was fascinated by the disease and how it behaved. I found that when I was a second-year student and then in my third and fourth year, as I learned more about cancer and took care of cancer patients, it was just a constant source of interest to me. I was intrigued. Some people get into cardiology and some people get into rheumatology and, in fact, I got into oncology before I knew what I was going to do as a specialist. So I became a cancer student long before I became radiation oriented.

Lesley W. Brunet, CA

So you had a different viewpoint, then, than other people.

James D. Cox, MD

Yes.

Lesley W. Brunet, CA

So then you did your residency, and then you went to France.

James D. Cox, MD

Spent at year at France’s largest cancer hospital, the Gustave Roussy Institute—which was in a suburb right outside of Paris—and had a great experience. The Gustave Roussy is sort of France’s version of this; although, well, of course, Anderson was much smaller at the time. But it was a very, very busy place with a lot of breadth and depth, and I learned a great deal. I had been in a very small hospital with a cancer program, so my training was sort of intensive but not broad. Then I went to Gustave Roussy, and it just broadened it enormously. During the time I was in France, I did go to a couple other of the major cancer centers in Europe, especially The Royal Marsden Hospital in London and The Christie Hospital in Manchester and then also in Sweden.

Lesley W. Brunet, CA

Historically, Europe was so much ahead of us in terms of radiology. Was that still the case when you went?

James D. Cox, MD

No, but it was very much the case where my mentor, Dr. del Regato, came from. He trained at the University of Paris and then the Radium Institute of the University of Paris. He was a Cuban sort of expatriate who had to go to France. He was given the opportunity to go to France for training because they closed the University of Havana Medical School because of a political crisis in the early twenties. That was in the early twenties. So there was an organization—actually a cancer organization—that helped some of the Cuban medical students go on and get training in Europe. He went to the University of Paris, learned French, became a French scholar, and did his medical school and then his specialty training. But unlike the vast majority of people who trained at that time, he too was cancer oriented, so he only did the therapeutic part of radiology, even from the thirties.

Lesley W. Brunet, CA

That was very early.

James D. Cox, MD

Which was very early. So when he came and established training in the United States, it was training in radiation oncology. The first people he trained were people at the Ellis Fischel Cancer Hospital in Columbia, Missouri, and then in 1949 he went to the Penrose Hospital in Colorado Springs and started a cancer program and was there for twenty-four years until he retired in 1973.

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Chapter 01: The Path to Radiation Oncology

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