An MUSC Hollings Cancer Center colorectal cancer doctor is one of only 12 physicians across the nation to have been selected to participate in the National Cancer Institute’s Early-stage Surgeon Scientist Program (ESSP).National
Thomas Curran, M.D., was chosen for the three-year program, which ensures that surgeons have protected time, or time during which they aren’t expected to care for patients or perform administrative duties, so they can conduct research.
He’ll investigate why too few patients go home with anticoagulants, commonly called blood thinners, to prevent blood clots after gastrointestinal, gynecologic or urologic cancer surgery.
“One of the more exasperating aspects of medicine is that we have many things that we know work really well that aren’t being used as frequently or on the patients who would benefit the most,” Curran said. “That’s one of the areas that has resonated with me as a faculty member. For health services research, it’s an important area of investigation to understand the health care delivery process and how we can improve it.”
Hollings director Ray DuBois, M.D., Ph.D., a physician-scientist, praised Curran’s work.
“Dr. Curran is an exemplary surgeon who is focused not only on improving care for the patient in front of him but for all patients by investigating underlying causes of lack of guideline adherence and disparities in cancer outcomes,” DuBois said. “His study has the potential to uncover new information that will influence care across South Carolina and the U.S.”
Blood clots are a known complication of these surgeries. Although relatively rare, they can be devastating when they happen, Curran said. They’re a leading cause of death for these cancer patients within the first month after surgery. For this reason, multiple medical societies recommend prescribing blood thinners when patients are discharged as a precaution against blood clots.
However, only 10% to 40% of surgeons prescribe these medications to cancer patients after surgery.
For those patients who get a prescription, there’s very little data on how well they follow directions for how to take the medication.
Curran’s goal is to improve compliance with the guidelines on both the surgeon’s side and the patient’s side.
To do this, he’ll hold informational interviews to find out why people don’t follow the guidance; his application noted that there are perceived barriers that aren’t obvious simply by looking at the data.
There have been a variety of possibilities suggested as reasons why the guidance isn’t followed, including cost, concerns about bleeding complications, lack of awareness and concerns that patients will not take an injectable drug. Anticoagulants in pill form have recently come on the market and may make a difference. However, Curran said their safety and effectiveness are still being compared with the injectable form.
He’ll then conduct a randomized trial at the MUSC Health locations in Charleston, Florence and the Midlands to see if surgeon-focused education efforts and a decision support tool within the electronic medical record result in an increase in the number of patients who are prescribed anticoagulants to prevent blood clots after surgery. He’ll also evaluate whether patient education focused on the importance of these anticoagulants improves the number of patients taking the medications.
Curran noted that this research also has the potential to address disparities in outcomes between Black and White patients. Black patients with cancer in the abdomen or pelvis are 40% to 70% more likely to suffer from blood clots than White patients. At the same time, although the specifics of anticoagulant prescription haven’t been studied, studies have shown that, overall, Black patients get cancer care that complies with the latest guidelines 15% less frequently than White patients.
Putting these statistics together, Curran believes that improving how often surgeons prescribe anticoagulants after gynecologic, urologic or gastrointestinal cancer surgery could in turn decrease the disparities in outcomes.
Because the research will be conducted across three MUSC Health locations, meaning it will pull from different patient populations and will include community hospitals and an academic medical center, Curran believes that the results could apply to communities across the U.S.
DuBois said this research could contribute to standardizing care even further and ensuring that patients, no matter where they are treated, get the care that follows the latest guidelines.
“As an NCI-designated cancer center, this is part of our mission,” he said. “Conducting research across the spectrum, from the basic science lab to health care delivery studies, adds to the body of knowledge about cancer care and improves care for all.”
According to the NCI, the number of physician-scientists in the U.S. has decreased from 4.7% of doctors to only 1.5% since the 1980s. And yet physician-scientists have been invaluable in contributing to advances in medicine, according to a piece in the New England Journal of Medicine, accounting for more than a third of the Nobel Prizes in physiology or medicine.
The dwindling numbers are likely caused by a combination of less grant funding, more administrative duties and pressures to concentrate on tasks that hospitals can bill for, according to the NCI. For surgeons, there’s an extra hurdle. Because they spend so much additional time in training, they’re much further along in their careers before they can consider submitting grant applications to conduct research.
The ESSP program builds a class of early-career surgeons who will train together over the course of the program while each conducting their own research, with the expectation that they will continue to conduct cancer research throughout their careers.