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Pulling Back the Curtain: Thomas R. Chauncey, MD, PhD

August 30, 2022

September 2022

In this edition, Thomas R. Chauncey, MD, PhD, discusses his winding road to medicine and the joys and challenges of clinical care and trial work.

Thomas R. Chauncey, MD, PhDThomas R. Chauncey, MD, PhD, is a physician at Seattle Cancer Care Alliance, associate professor of medical oncology at the University of Washington School of Medicine, associate professor at Fred Hutchinson Cancer Center, and director of the Marrow Transplant Unit at the VA Puget Sound Health Care System

Tell us a little bit about your upbringing.

I’m from the Hyde Park neighborhood of Chicago and had extended family in the area. It was a great place to grow up in the 1960s and 1970s, with many parks and Lake Michigan for recreation. We shared the neighborhood with the University of Chicago, so there were the advantages of living in a big city but also having a sense of being in a university town. This meant there were a lot of events that influenced the whole community.

There was no one in my immediate family who was involved in medicine, health care, or science, and my parents and close relatives were all more humanities- and business-oriented. There was an emphasis on education, being well read, and being well informed.

What was your path to becoming a physician?

In college I majored in math and biochemistry and was interested in history. I wasn’t really thinking about being a physician, though a number of friends were planning on medicine. In fact, I had a math professor who spoke to me about becoming an actuary, and I thought that sounded like a real possibility.

Over time, I became more interested in biochemistry and decided on a career in laboratory research, so I went to graduate school with that as the goal. As I was settling into the rhythm of the lab and thinking about different projects, I found that a lot of the more interesting ideas were geared toward clinical questions. I thought I would be in a better position to address those ideas if I understood the clinical background, so I started thinking about medical school but wasn’t sure it would be a good fit. I had started with some trepidation, wondering if this was going to be the right thing to do. I liked the science but wasn’t sure that I could be a clinician. As I went through medical school, I began to appreciate the clinical aspects of practicing medicine.

Tom and his wife Mary Wikel-Chauncey
Tom and his wife Mary Wikel-Chauncey

How did you become interested in hematology?

Hematology was a great rotation in medical school and probably closest to some of my scientific interests, though I tried to keep an open mind about clinical medicine and the specialty where I’d want to practice and get involved with research. There were other specialties that interested me from a research perspective but not necessarily from a clinical perspective. The hematopoietic organs are impressive in both health and disease, and while in medical school, I was more interested in the non-malignant side of hematology, that shifted when I started residency.

In the 1980s, outcomes for most patients with hematologic malignancies were not very good, and while that didn’t necessarily dissuade me, it seemed like there were more ways to make a clinical impact in classical (non-malignant) hematology. Then I came to Seattle, where hematopoietic transplantation had a strong presence. I did a rotation at the Hutch during my second year of residency and thought it was fascinating. There was hope for many of those with heme malignancies, and the biology was no less interesting. That’s when my focus started to shift toward malignant hematology.

How do you balance your roles in research and patient care?

It’s a challenge and a continuing evolution. By necessity, I now spend a lot of time on administrative issues and clinical care and relatively less on clinical research. I don’t have a great answer on how to achieve the right balance, other than to say that it’s a continuous process based on opportunity and preference, and something that requires regular attention, especially with changes in personal priorities.

What do you find most fulfilling and most challenging about clinical care and clinical trial work?

Clinical care is gratifying when outcomes meet or exceed expectations. While it is satisfying to be part of trials with favorable results, many trials don’t achieve their goals, and it is frustrating and disappointing when we are unable to make the impact we would have liked. While enrollment on trials offers a chance to improve outcomes, for some there may not be another opportunity at effective intervention if the trial is unsuccessful. It can also be a challenge to ensure that the risks of the trial intervention are proportionate to the risk and prognosis for those enrolled.

Working at a VA facility in the Northwest involves a range of geographic challenges with many patients having to travel long distances, though a critical advantage of VA care is accessing current therapies with minimal adverse financial effects. This is especially true for hematopoietic cell transplantation.

How would you characterize the field of hematopoietic cell transplantation and the progress that’s been made over the years?  

When I was training in the 1980s, allogeneic transplantation was well established but was typically a difficult process with expectations of significant toxicity and mortality. This limited eligibility for many, especially those who were older and less fit. While the impact of extending survival for younger age groups is an important goal, most with hematologic malignancies are older, and they had been excluded from allogeneic transplantation.

Strategies to decrease the severity of graft-versus-host disease and treatment-related toxicities with less intensive regimens have been successful and continue to be refined, with expectations of better efficacy and safety in a broader range of patient ages and comorbidities. Other studies have helped to increase the number and better define selection of available donors.

The addition of cellular and small-molecule targeted therapies as adjunct to transplantation has potential to further improve outcomes, along with better techniques to monitor disease status when combined with adaptive interventions for evidence of progression. Moving beyond using these strategies only in advanced stages of disease has the potential for seeing even greater improvements in outcomes.

Dr. Chauncey and his daughters, Anna (left) and Irene, circa 1998
Dr. Chauncey and his daughters, Anna (left) and Irene, circa 1998

What do you like to do for fun when you’re not at work?

It’s always hard to find the right balance, and I can’t say that I’ve consistently achieved that equilibrium. It’s a process that requires continuous refinement according to the opportunities in your life. I used to fly fish and tie flies, but the tying got too far ahead of the fishing, so I had to leave both behind. Living in the Northwest requires some attention to gardening, and we grow fruit trees as well as a fairly extensive herb garden. My wife, Mary, and our daughters, Irene and Anna, are really a continuous source of support and inspiration.

Who are some of your mentors and how have they influenced your career?

There have been many influential mentors, so it is hard to name just a few. I was already pretty set on hematology or oncology when I started residency. Robert Livingston, MD, was one of my first medicine attendings as an intern and was a compassionate clinician and an accomplished clinical researcher. Even though our interests were different, since he was division chief, we met regularly from fellowship through my early faculty years, and he always had insightful and constructive advice. Frederick Appelbaum, MD, provided me with my first opportunities in clinical trials in acute myeloid leukemia (AML) through the SWOG Cancer Research Network and offered regular counsel on trial strategies. There have also been a lot of important mentors in transplant, starting with Rainer Storb, MD, whom I met early in fellowship and who always offered supportive advice and has been a tremendous resource in allogeneic transplantation. George McDonald, MD, has been an informative resource for clinical projects as well as transplant physiology and the management of transplant toxicities. H. Joachim Deeg, MD, is a source for expert perspectives as well as more patient-focused opinions. William Schubach, MD, PhD, has been a colleague and was section chief at VA Puget Sound. He was committed to our administrative and research agendas, with a valued opinion on most any issue and a continual source of support.

What advice do you have for early-career physicians in hematology?

Find something that interests you and that motivates you from different perspectives. Try to imagine your goals for balancing clinical care, research, and/or administration. Ultimately, be prepared to go where your plans take you, as well as unexpected opportunities and challenges that come up. That is, of course, true for most any pursuit.

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