Medical Oncologist (Clinical Trials) – Dr Ross Jennens

NAME: Dr Ross Jennens
PROFESSIONAL TITLE: Medical Oncologist
HOW LONG HAVE YOU BEEN IN YOUR ROLE FOR? 13 years

WHERE DO YOU WORK: Epworth Richmond, Victorian Comprehensive Cancer Centre (Peter MacCallum Cancer Centre)

WHAT DOES YOUR ROLE AS A MEDICAL ONCOLOGIST INVOLVE?
I meet patients after they have been diagnosed with cancer to discuss medical treatment options. They may also meet surgeons to discuss surgical treatments, and radiation oncologists to discuss radiotherapy treatments. Medical treatments used to predominantly involve chemotherapy medications, but there are an increasing number of non-chemotherapy medications, such as hormonal treatments, targeted agents, antibody treatments and new immune therapies. As a trained specialist physician, I am often also the doctor looking after day-to-day medical problems which may arise during cancer treatment. Some of my patients are given treatments to help improve the chance of cure. Other patients have cancers which cannot be cured, where the goal of therapy is to improve symptoms and extend life expectancy.

WHAT ARE CLINICAL TRIALS?
The only reason we know our current treatments are effective is because of people enrolled in clinical trials in the past. Clinical trials involve trying new medications that are hoped to be more effective than our current treatments. For some trials, everyone on the trial gets the new therapy. For other trials, there may be a randomisation process where some people get the standard therapy and others get the new therapy. I don’t get to choose which treatment they get, and often don’t even know which treatment they are having. That way, we can objectively assess whether the new treatment is better than the old one. Often patients will say they want to have the new therapy, but sometimes we find the new treatment isn’t any better or has more side effects. Sometimes the old stuff is better than the new stuff!

CAN ALL PATIENTS ENROL/PARTICIPATE IN CLINICAL TRIALS?
Clinical trials have very strict eligibility criteria. This is to ensure that the types of patients enrolled on the trial will be the ones most likely to benefit and least likely to have serious side effects. For most trials, people have to be reasonably well to enrol. It is always worth asking your doctor if there is a trial suitable for you, either at the hospital you are having treatment, or other nearby hospitals. I generally advise against travelling long distances for trials, as it is usually not a one-off treatment, but ongoing appointments and visits that can stretch out over many months or even years.
ARE THERE ANY COSTS ASSOCIATED WITH CLINICAL TRIALS? Most centres ensure that patients participating in clinical trials do not incur out-of-pocket costs. Sometimes even travel and parking expenses will be covered. You are always best to talk with your doctor or trial nurse regarding any potential costs.

ARE THERE ANY COMMON MISCONCEPTIONS ABOUT CLINICAL TRIALS?
Plenty! It is surprising how few people have a good understanding about clinical trials. Clinical trials are very tightly regulated and take a long time from an initial idea to completing a trial. A trial protocol is written which details exactly all of the features of the trial; this document is usually 100 pages or so. There is also a patient consent form that provides all of the required information for a patient to be able to provide informed consent. This is often around 20 pages in length. These documents are reviewed by the ethics committee of each trial centre, which is a group of 10-12 doctors, lawyers and laypeople who ensure the trial is reasonable, safe and ethical. Each trial usually runs for a year or two recruiting patients. Some trials are just run at one or two hospitals, but some of the large trials may be at 150-200 hospitals worldwide. It then usually takes a few years for results to be available, analysed and reported.

WHY DO YOU THINK CLINICAL TRIALS ARE IMPORTANT FOR CANCER PATIENTS?
Clinical trials are the only way of proving a new treatment is better than an old treatment. All of the major advances in cancer treatment over the last 50 years and due to well constructed, rigorous clinical trials. Each trial takes a huge amount of resources and are understandably very expensive to undertake. Some trials are sponsored by government research funds, some by collaborative groups, and others by the pharmaceutical industry. However it requires a large randomised trial with usually 500-1000 patients to be able to prove a new treatment is effective. Studies based on only small numbers of patients are frequently unreliable.

WHAT DO YOU LOVE ABOUT YOUR ROLE?
I have the unique opportunity to help people at the time in their life when they are often the most frightened, vulnerable and scared. A diagnosis of cancer is almost always terrifying. To be able to provide information and treatment options, and reassure patients that there is not only myself, but a whole team of dedicated people here to look after them is very beneficial.

ARE THERE ANY CHALLENGES TO YOUR ROLE?
Always. Understandably, some patients or their family members can be upset, sad, frustrated or angry when facing a diagnosis of cancer. Some days, I get to give good news all day, and come home with a warm glow that my treatments are effective and I am a good doctor. However, other days, every patient I see has relapsed or progressed, and it is never easy to give bad news, especially to patients whom I have been looking after for years and are like friends. Also, I have to keep up with all of the results of clinical trials worldwide as new treatments become available, so I never stop learning.

WHAT IS THE BIGGEST LESSON YOU HAVE LEARNT IN YOUR CAREER?
Avoid being rushed. It doesn’t help me and it doesn’t help my patients. Only bite off as much as you can chew!

IF YOU COULD GIVE ONE PIECE OF ADVICE TO CANCER PATIENTS, WHAT WOULD IT BE?
Don’t Google! Although the internet is a fabulous resource, it is also filled with unhelpful advice – even less helpful than Great Aunty Doris. There are some reputable websites and it is worth speaking with your oncologist or nurse about places to start looking. My Cancer Pal has handy links.

HOW DOES A PATIENT FIND OUT MORE ABOUT CLINICAL TRIALS?
Cancer Council Victoria’s website- www.cancervic.org.au has information about clinical trials and up-to-date information about all of the trials available in Victoria. www.australiancancertrials.gov.au has an Australian-wide cancer trial database