Defeating Cancer with Outcomes Based Precision Medicine with Anna Berry, Scientific Director of Personalized Medicine and Medical Director of Molecular Diagnostics
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: All right welcome back to the Outcomes Rocket Podcast where we chat with today's most successful and inspiring health leaders. Today have a very special guest for you. Her name is Anna Berry. She's a highly talented physician in medicine. Very, very much specializing in personalized medicine. She's a scientific director of Personalized Medicine and Medical Director of Molecular Diagnostics over at the Swedish Cancer Institute. A very, very big pleasure to have you on the podcast. Dr. Barry and really excited to dive into the things that you guys are up to there.
: Thank you. Thank you for inviting me.
: It's a pleasure. So what got you into the medical sector to begin with?
: Well, you know actually I think the way I got to be involved with medicine was just basically by my philosophy and life is just pay attention to the opportunities that present themselves and follow what interests you. I was interested in science growing up and the opportunity arose to go to medical school due to my science background. And once I got into medical school I found out that I really loved it. I actually started out as a general surgery resident and through that became exposed to pathology and through that became exposed to molecular diagnostics and through that came into cancer care. So kind of a little bit of a winding path.
: Very cool. And I really love your guiding principle and I think it's something that listeners we can all learn from, right? You've got to make sure you stay focused and what you find interesting and what you're great at and by that you can never go wrong in your approach. So as your career has taken you to all these very interesting and exciting areas of medicine what do you believe Anna is a hot topic that needs to be on every medical leaders agenda today. And how is your organization approaching?
: Well I think I work in genomics so what to Nomex means is studying large parts of the genome which you know we couldn't really do in the past we can only study a little bit at a time. So we've had a technological advancement where we can explore large parts of the genome and we call this genomics and this is the area I work in. But I think it's relevant to every area of medical care. We can look at the genomics that you're born with the genes that you see in all of your cells in their body. Or we can do what I'm doing which is looking at genes only in the abnormal tissue like in tumors. And by understanding the genetic makeup of your body and your cancer then we can find better treatment. So I think that's always been a goal in research but now it really has come more into standard clinical care, understanding what are your risks and how does your disease actually work through studying genomics and even proteomics all of the OMEX you know we've come up with a lot of very innovative treatments for cancer and for other diseases. And looking forward, genomics also can help us look at risk, disease risk and wellness and ultimately you know we'll be able to prevent cancer and other genetic diseases.
: Yeah it's a pretty exciting work and I think the contributions that you and the organization that that you're part of is exciting for health leaders in general. What would you say is the best way that healthy eaters need to be thinking about this. Let's say providers for example. How should they be thinking about this and operationalizing it?
: I think to think about it is actually bolster a little bit different. I was going to say thinking about it is easier than operationalizing but I'm not I'm not so sure about that. The fact is that many physicians and nurses and really everyone in medical care were not trained in genomics even looking at like five or ten years ago it was all kind of theoretical was like looking at biochemistry or molecular biology in school and it was kind of an abstract concept. So now that it's really fully integrated in medical care a lot of people are playing catch up looking to see you know how they can bring their basic knowledge up to speed. So I would say engagement is really the main thing. Looking at each other looking to conferences, just really engaging and trying to figure out how you can understand it. And I think the one thing you don't want to do is just avoidance which I think comes into play particularly for physicians who are maybe in smaller medical centers. They're not involved in academics. It's easier to just say well maybe I don't have to pay attention to that you know that sounds like kind of a fancy thing. I think everyone really needs to pay attention to it. This field is moving so quickly that you really can't afford to ignore it. So I would say engagement is really the most important aspect to everything. And on an administrative level I think you really you need a plan and you need a plan for engagement. Because like I said this is not going away it's relevant and these days patients have so much more access to information that the patients are coming in asking for this. The patients are coming in saying I've already had this genetic test there in the case of direct to consumer genetics. They've gone out and had 23 and here's something else. They're bringing their results into the doctor even in the case of cancer care. There's a company called Color genomics where you can get your cancer genetics test done. So patients may actually be bringing this to the doctor so that even if the doctor isn't you know planning on doing this you know they might not have any choice. You know people are engaged and this is happening and it's happening very quickly. So I think institutions need a plan and doctors need education and awareness. And more than that engagement. There's so many people in this field there are so many different conferences online resources. I just think people really need to engage.
: That's such a great call. Dr. Berry and the listeners the head in the sand strategy is not going to work here. So let's definitely take a note from Dr. Berry's advice and start planning for incorporating this engagement as it relates to this. Now, would love to hear a little bit more about how your organization has has created results or some some outcomes based off of the work that you're doing.
: So the work that we're doing is related to cancer. I work in the Cancer institute at Swedish in Seattle. And the program that we've designed here is designed to basically track outcomes for patients who get genomic testing on their tumors and are then treated with targeted agents. So the type of testing we're talking about would look at genetic abnormality in your tumor that can be targeted with a specific drug. The idea being that that therapy would be more specific pure tumor and should only affect the tumor and not affect your body. In reality things aren't exactly that simple you know these genes have functions that are normal in your body and it's not quite that clean yet but it still is a really attractive therapy and people that respond to these abnormalities. A good example is an alpha inhibitor for lung cancer that has an abnormality in the Elk protein. They have very dramatic responses and it can extend their lives by you know five or ten years. So we want to capture all of this information. The thing is that it's not going to be everyone it's going to be a very small subset of patients that may have these mutations. So you know we need to find that patient and match them to the right drug. So some of the drugs will only be approved for a certain type of tumor. You know like that alt drug may only be approved for lung cancer. So if you have a bladder cancer that has that mutation you also want to get that drug. So what's happening in reality is you know patients are getting the drugs they're getting them that what we call off-label it's not the approved indication, but if everyone just gets those drugs kind of you know here and there and we don't track the outcomes then we don't capture that information then we don't move the field forward quickly. So what we're trying to do at the Swedish Cancer Institute is do this in a responsible fashion so that when the patients have the abnormality and they get the drug, we track their outcomes. So that's really the number one goal of our program is to track the outcomes and capture that information. Other goals would be to get the patient into these programs so either to get them the off-label drug or or ideally to get them enrolled in a clinical trial using that drug. So at Swedish we have a large number of clinical trials. We have a Phase 1 trial unit that we just opened. Phase 1 being the first time that drug is used in a human being. And these are targeted towards these targeted therapies and immune therapies. And we have a translational research database where we bring in the patients genomic data and other lab data and we combine that with their clinical data from the electronic medical record. Also our clinical trials management system so we can link them to trials. Our tumor registries and we put this all together to improve both our clinical efforts and our research efforts.
: I think that's so interesting. And I guess I just didn't imagine Dr. Barry that in general the outcomes of particular drugs weren't being followed and I think it's a great focus area that you guys are spending time on because if we're going to improve, like you said and help the field move forward. We've got to start measuring these things.
: Absolutely and using drugs off label isn't really new. You know it would just be like you know any drug what's available in the physician decides that oh you know it turns out you know address the pews for depression is also good for anxiety in people to start using it. But you're absolutely right. You know, if we don't actually track those outcomes then it's not as useful, it doesn't become useful for every other patient and particularly in genomics there can be a lot of confounding factors. If that out dread doesn't work for bladder cancer there could be reasons why that are particular to a bladder cancer. There could be issues you know that individual patient has other mutations or they have a genetic predisposition that makes them not able to respond to that. There's another field in genomics called pharmacogenomics which deals with how you respond to drugs. So it's just gotten so complex that it's very important that we capture that data. The other reason why it's great to capture that data and another project that we're working on with an outside company is that the it is complex. So we're testing hundreds of genes at a time and we're also bringing in all of the other information you know like as far as your age, the type of tumor you have, your radiology and all of those things the stage all of those things can come in and be analyzed. It used to be in the old days we could do that but it was hard you know it involved a lot of math and it involved epidemiologists and you know a lot of time and effort. And these days with machine learning we can analyze it much easier and quicker and to greater benefit. So that's another reason to capture all of this complex data electronically and in a format where we can use it and analyze it.
: So what would you say. That's such a great point the use of these advanced technologies like machine learning the algorithms really is pairing nicely with the new capabilities and the genomics and the OMEX to date. What would you say one of your proudest medical leadership experiences is?
: I think the launch of this program. I know when I describe it it sounds pretty simple but you know it's really innovative when we launched it now almost four years ago there wasn't anyone really really actually doing this. You know we were I would say one of the first to actually bring the outcomes into that and combine them with genomics and this type of program. Like I said we opened the Phase 1 unit. We also started in molecular tumor board that was very active. So I think that I'm really proud of this program actually and we've designed our own Assaye, our version 1 Assaye now is now what we're using but again at the time four years ago it was really innovative and we were able to design and implement that in my lab.
: Yeah that's super exciting and that's how fast this move four years ago. And what you had was innovative and now you're on to something new. That's how fast this is moving listeners. So back to Dr. Barry's point is that you really have to stay plugged in and there's a lot of meetings that you can attend. There's there's webinars there's conferences to be able to stay abreast of what's happening in the field. Congratulations, see you and your team on on what you've done there, the innovation and and the collaboration and the high level of achievement that you guys are doing is just pretty impressive. So congrats to what you guys are up to.
: Thank you.
: So we're getting close to the end here. I always wish we have more time with our guests but the nice thing is that the Outcomes Rocket, we just have little conversations here that help move health care forward but was curious what's an exciting project that you're working on today that you want to share with the listeners.
: So as I mentioned the the machine learning but another thing that we're dealing. The swedish as part of the Providence Network in Providence also includes the Institute for Systems Biology so big collaborators for us and one of the project we're working on with them is a type of wellness project where we're looking at early stage breast cancer survivors who have had chemotherapy and we're looking in kind of a multi-OMEX analysis where we're looking at their gene, their RNA expression, proteomics even the microbiome you know looking at the organisms in their body and we're also looking at their functional analysis you know like if they've had any any cognitive deficits or side effects from their chemotherapy to see who is going to have those side effects and how we can treat them and who will ultimately have better outcomes. And this is a big issue because we have so many cancer survivors these days. And breast cancer is super common. So we're hoping that the data will mean from this project will help a large group of people who luckily are growing group of breast cancer survivors.
: Some great efforts there and I think it's it's a very good focus for that particular group. We definitely need more more resources and support for them as they do get better. This section of the podcast Anna where you and I are going to build a medical leadership course on what it takes to be successful in medicine. It's the 101 of Dr. Anna Berry. And so we're going to write out a syllabus for questions lightning round style. So some quick responses followed by your all time favorite book. You ready?
: Yeah. All right.
: What's the best way to improve health care outcomes?
: The best way to improve healthcare outcomes is to have a data driven program that accommodates big data.
: What's the biggest mistake or pitfall to avoid?
: The biggest pitfall to avoid is to remain static and not be open to change.
: how do you stay relevant despite constant change?
: You have to be flexible. The days where you could say your program and leave it there for you know 10 or 20 years are over. You have to be constantly willing to change and adjust.
: And finally what's one area of focus should drive everything in a health organization?
: A patient driven system. Every organization should be aware of what's important to individual patients and what's going to improve individual patient outcomes.
: And finally what's your favorite book?
I would say you know my favorite book in this field is the Emperor of All Maladies which has a history of cancer. It's kind of a book that describes cancer as if it were a living thing written by Siddhartha Mukherjee. And then Dr. Mukherjee also has a new book called Gene which has a similar thing for genomics that I've just started. But the Emperor of All Maladies is a wonderful book for understanding cancer's history both in America and in the world.
: Awesome recommendation Dr. Berry. Listeners, don't worry about writing that down. Just go to outcomesrocket.health/swedish and you're going to be able to find all of the show notes, a transcript and links to all the things that we discussed. Dr. Berry before we conclude I'd love if you could just share a closing thought with the listeners and then the best place where they could follow your work and get in touch with you.
: So a closing thought would be that the field of cancer research is moving quickly and that there's a lot of hope for treating this disease and I think we'll have big advances in the next five or 10 years. So I think it's really a message of hope and I can be contacted through the Swedish Cancer Institute website and my direct e-mail would be firstname.lastname@example.org and anyone is welcome to email me.
: Outstanding. So listeners, there you have it. The insights from Dr. Berry. I definitely think that you'll find this episode insightful and go ahead and hit the rewind button and listen to it again because there's definitely a lot of really great points that Dr. Berry left us with. Dr. Berry just want to say big thanks for spending time with us.
: Thank you for inviting me.
Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.
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