Chapter 12: Research on Hypertension, A Side Effect of Inhibitors
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Description
Dr. Escalante describes her studies of hypertension control, work begun when inhibitors were prescribed to cancer patients. She talks about the severity of the hypertension and the research questions that she posed. Dr. Escalante explains that her team began to do data-mining to design prospective studies and also collaborated with clinical trials to study side effects. She describes the process of acquiring data from data pools and patient charts. She also compares the electronic medical records systems, EPIC and ClinicStation. Dr. Escalante notes that she will be presenting this work at a conference this June. She also explains that this information will help community physicians treating patients and survivors as well as providing opportunities to inform the public and health professionals about drug toxicities.
Identifier
EscalanteCP_02_20140514_C12
Publication Date
5-14-2014
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The Researcher; The Researcher; Devices, Drugs, Procedures; Professional Practice; The Professional at Work
Transcript
Tacey Ann Rosolowski, PhD:
Okay. I guess one final question I wanted to ask you from the research perspective was I know we talked last time about how when you came to MD Anderson in 1988, I mean, there was a sense that, yes, we need to have general medicine people in house, but it was rather slow to evolve into a research-based field. And I’m wondering what is the evolution that you have seen in the past almost two decades, three decades, yes, in acceptance of that, or an understanding on the part of basic scientists and physician scientists that, yes, this allied area of research is really essential to their function as oncology people.
Carmen Escalante, MD:
Well, we’ve made a lot of strides, I mean, and it took a while, and I guess it wasn’t until I was selected as the permanent chair of General Internal Medicine that I was given some resources to make that happen. I was at-interim for five years before, and really during that at-interim period we had no funding to be able to do that. So in about 2005, we were given funding in a few positions, and I was fortunate to be able to recruit Dr. Maria Suarez-Almazor, recognizing that I do some research, but that’s not my strongest—that’s not my biggest strength. And Dr. Suarez is an internationally renowned health services researcher. She’s mentored numerous faculty. And I was able to recruit her, and she is the deputy chair of research in the department. And we were able to recruit another senior scientist, Dr. Bob Volk, whose focus is decision science, and we’ve been able to, with the help of Dr. Suarez, we’ve successfully had two tenure-track faculty tenured, and now with independent funding, and we have a third on tenure track right now. And so we’ve gone from minimal research funding to two to three million a year of funding. A few years ago—I think it was about two years ago—we led the division for a couple of years in funding—
Tacey Ann Rosolowski, PhD:
]Wow.
Carmen Escalante, MD:
—in a department that was not considered even within the Division of Internal Medicine a main research component, and we led. I think now we may be second or third in line over the last one year or so. But with the help of Dr. Suarez, we’ve been able to develop a very focused group. Our research varies by faculty, but it’s really focused on toxicities and symptoms, with the exception of Dr. Volk, who has done some work on decision-making in the preventive area.So I’ve been very pleased with how much we’ve been able to do, and for a relatively young department in the last, really, nine years, because it didn’t really start happening until 2005. I think Dr. Suarez was recruited in 2006, and it just has taken off. We even have a general internal medicine fellow that is 25 percent clinical and 75 percent research so that we could grow our own faculty with research backgrounds, and that has worked very well. We’ve actually hired a recent graduate in the fellowship program who is in—now Dr. Suarez has developed for the division a program to train faculty, young faculty members, in research methods. And our fellow, who is now faculty, is one of our first enrollees in that program, and is spending approximately—I think she’s spending 80 percent of her time learning clinical research methodology and getting a master’s and then 20 to 25 percent clinical work.
Tacey Ann Rosolowski, PhD:
Wow. Let’s back up a little bit, because I imagine that the process of formalizing general internal medicine as a department was kind of a milestone at MD Anderson. So tell me how that happened. I have in my notes that in ’97 you had the opportunity to be chief of section.
Carmen Escalante, MD:
Mm-hmm.
Tacey Ann Rosolowski, PhD:
And then in 2000, I mean, there’s a division and a department. How does all that work? So if you could tell me that story and kind of tell me what was the significance of those moments of creation and the changes, that would be great.
Carmen Escalante, MD:
So we transitioned. Previously we were all sections, so we have the Section of General Internal Medicine, just like the Section of Infectious Disease and Cardiology and all the other subspecialties, except oncology. That was included in the Department of Medical Specialties. And when I was hired in ’88, that’s how it was until, I think, about 2000. I became the section chief in ’97. I think it’s ’97. We were all in the Division of Medicine, it was called back then. It included all the cancer or oncology departments, and then the Department of Medical Specialty, which included all the other internal medicine specialties except cancer. In 2000, Dr. Mendelsohn decided that we would be a separate division and the sections would become equal departments to oncology.
Tacey Ann Rosolowski, PhD:
Why did he decide that, do you think? What was the reason that he was given?
Carmen Escalante, MD:
Well, I believe, and what I’ve heard, is that we were not being treated on the same level as the oncology departments, that positions, faculty positions, and other resources were often diverted to the oncology areas, which were considered higher priority than the other internal medicines. And, you know, we are not a division that’s going to cure cancer per se, but we contribute in helping get this patient so that they can get their cancer treatments, and in a way—
Tacey Ann Rosolowski, PhD:
Well, arguably. (laughs)
Carmen Escalante, MD:
Yeah.
Tacey Ann Rosolowski, PhD:
Arguably, I mean, if a patient dies because of hypertension, they’re never going to be cured of cancer—they might be cured of cancer. (laughs)
Carmen Escalante, MD:
Right. So, you know, I mean, it depends on which side of the—you know, your view of it.
Tacey Ann Rosolowski, PhD:
Yeah. Yeah.
Carmen Escalante, MD:
But, I mean, we were not considered as high a priority, and I think that created a lot of issues for the faculty in Internal Medicine as well as for the others that we treat that are outside of Medical Oncology, the surgery groups and radiotherapy and stuff, because we may or may not have gotten the faculty positions needed to take care of those patients adequately. And it presented an issue for others in the higher levels of the institution, and I think Dr. Mendelsohn decided that this how he was going to resolve the issue. So they pulled us out of Division of Medicine, renamed the Division of Medicine the Division of Cancer Medicine, that included the oncology departments, and separated the other internal medicine subspecials and created a Division of Internal Medicine. And all the sections became equal in being separate departments, similar to how Cancer Medicine was. And I think, from the internal medicine side point, we felt validated. We felt that this was good for us. I’m speaking, I guess, for a lot of others in my sense, but I think it was, looking back, it was a very good thing. And the Division of Internal Medicine grew a lot over those nine years throughout all the departments. We were resourced better. We had a lot of growth in General Internal Medicine. At around 2000, we may have had probably less than ten faculty—
Tacey Ann Rosolowski, PhD:
]Wow.
Carmen Escalante, MD:
—maybe seven, eight at that time. Now we have thirty-two; thirty-one, thirty-two. So you can see the growth rate.And we’ve developed a lot of new programs. I think it’s been good for everyone, not only internal medicine, but I think if cancer medicine groups look back, they’ll see that it helped us to better care for the oncology patients, whether they were being treated by a medical oncologist, a surgeon, a radiotherapist. I mean, we need a team approach to take care of these patients, because they don’t come in with just cancer. They come in with other co-morbidities and they develop other internal medicine issues during their treatment, from toxicities of cancer we talked about from the treatment, to toxicities or side effects related to the cancer itself that our various other medical subspecialties can adequately care for. And I think the patient benefits, and it allows the oncologist to continue their treatments and hopefully get the best outcome for the patient not only from cancer treatment, but from the entire global prospect of their care.
Tacey Ann Rosolowski, PhD:
How does MD Anderson compare in resourcing general internal medicine? I mean when you compare MD Anderson with other institutions, that’s what I meant.
Carmen Escalante, MD:
I think we’re far ahead. I mean, Memorial [Hermann] does now have a—I’m not sure if they call it division, section, what the title is, but they have a general internal medicine. They don’t have as many of them, as many faculty. They’re a little behind us, I think, in development, but they now do have a General Internal Medicine Group that is similar. But we’ve been ahead of the game from the beginning, and I think we’re much larger than they are at this time.
Tacey Ann Rosolowski, PhD:
Do you have a sense of what the longer-term impact has been on patient care? I mean, has anybody tried to look at that? I mean, I can imagine that would be an extremely thorny issue to look at, but, I mean, what’s your sense of—
Carmen Escalante, MD:
I mean, I’m not sure if there’s evidence, I mean as far as a study that has shown because we have such a big group of internal medicine, not only in General Internal Medicine but ID and all those, that our patients are better cared for and have better outcomes. I personally think they do. I think it would be very complex. I mean, we do have patients have a lot of good results here. I certainly think that part of it is because we’re here to contribute. How do you prove that? I don’t know, other than taking that away. But, you know, I feel very good that our group is necessary and appreciated by the other members of the care team and by our patients. You know, we see a lot of patients throughout, both inpatient and outpatient throughout the hospital, and have picked up a lot of niches that nobody was really kind of overseeing. For example, we have an Anti-Coagulation Clinic to help manage anti-coagulation. We have IMPAC, our Periop Clinic that works well with the surgeons in trying to improve the care of patients before and after surgery.
Tacey Ann Rosolowski, PhD:
What does IMPAC stand for?
Carmen Escalante, MD:
]Internal Medicine Perioperative Assessment Clinic.And there are numerous other examples, our Cancer-Related Fatigue Clinic, trying to improve fatigue. So, you know, for patients, I think, they may not get this in a community center. They may not get this even in other comprehensive cancer centers. But these are pieces of the puzzle that, you know, the better we care for those pieces, the better the whole outcome is for the patient, including their cancer care.
Recommended Citation
Escalante, Carmen MD and Rosolowski, Tacey A. PhD, "Chapter 12: Research on Hypertension, A Side Effect of Inhibitors" (2014). Interview Chapters. 770.
https://openworks.mdanderson.org/mchv_interviewchapters/770
Conditions Governing Access
Open
