In an interview with Targeted Oncology, Maen Hussein, MD, a Q3 2023 Oncology Icons honoree, discusses his path to the community oncology setting and highlights upcoming trends in oncology he feels will improve patient outcomes.
The journey into the field of oncology for Maen Hussein, MD, stemmed from an unexpected encounter during his medical school electives. Though initially uninterested in the field, coming to the United States and seeing the number of developments had him captivated as he saw the potential to make a significant impact on cancer treatment.
Hussein, medical oncologist and hematologist, Florida Cancer Specialists & Research Institute (FCS), strived to be part of something groundbreaking, solidifying his decision to pursue a career in oncology. He began working in the community oncology setting based on his passion for continued learning.
In community oncology, Hussein can manage a wide range of cancer types and work in clinical trials, all while maintaining a close connection with his patients. His dedication to his patients extends beyond clinical care as he actively participates in community initiatives where he has advocated for policies to reduce the incidence of cancer, is involved with the American Cancer Society, as well as other philanthropic activities, all of which show his commitment to serving the community.
Throughout his career, Hussein has witnessed a lot of progress and developments, and he remains optimistic about the future of cancer treatment. Hussein remains driven by his desire to improve the quality-of-life of his patients.
“With every improvement we make, we are making a better place and people will want to come back... Be a good community member, not just someone who takes. Be more of a giver than a taker,” said Hussein in an interview with Targeted OncologyTM.
In the interview, Hussein, a Q3 2023 Oncology Icons honoree, discusses his path to the community oncology setting and highlights upcoming trends in the field of oncology he feels will improve patient outcomes in the future.
Targeted Oncology: What inspired you to pursue a career in oncology?
I went to medical school at the University of Jordan, Amman, Jordan. When I was 14, I went to high school there, and then I scored high, and my mother, she had a chance to go to medical school, but she thought it was too long, so she went to pharmacy school, and then she regretted it. Since then, she kept subconsciously feeding me that I needed to be a doctor someday. She says she didn’t push me but in a smart way, she would tell me how doctors are wonderful, people like doctors, and that glorified that decision. So, I became a doctor.
Now why oncology? Funny story, because I did not like oncology when I was doing my rotations in medical school, but then I had a chance to do 2 months of electives in the United States in any hospital I wanted, if they had a teaching program. I picked oncology for 1 month. I was really impressed by how advanced technology in oncology treatment was at that time compared to what it was back home [in Jordan] where it used to be like a death sentence to have cancer. I would attend tumor boards, some lectures, and grand rounds, and saw that there's a lot to be done in the field of oncology.
In my mind, I predicted that the next century was going to be the century of oncology. The 20th century was kind of the century of infectious disease as we didn't have antibiotics. Alexander Fleming discovered penicillin then and we started giving antibiotics, and people stopped dying from infections. That was a revolution in medicine. I felt like that would be next in oncology where we can help prevent cancer, and I really wanted to be part of it.
There's a lot you can do because not much has been done, so it's nice to be 1 of the pioneers that hopefully one day we can reach to a level where it can be very easy to treat cancer and at least manage the disease. Oncologists strive to get the patient to remission, maintain quality-of-life, prolong survival, and I wanted to be part of this. You can see the advances that we have had in the last 20 years. It's amazing how good we're getting. Though we're not there yet, it's way better. I feel like we're doing a good job, and it just motivates us. Every success motivates us to do even better, and I'm happy I picked this field.
What motivated your choice to work in the community oncology setting?
I was in a fellowship program that was at a university hospital and was academic, but they did have community outreach clinics, and they cater to a lot of the patients in a community way. I give credit to our program director, Paul Petruska, MD, who taught us not just the science of oncology, but also part of the business of oncology and how to be aware of the cost of drugs, how to help the patient get the drugs, and how to interact with the pharmaceutical representatives and how to be confident, learn from, and teach them how to interact. I felt that I did not want to just be in just 1 field, and I liked the diversity and the fact that there are different diseases. I felt like I needed and wanted to know it all. I know it's very hard these days, but it's nice to be able to manage different types. I felt that being in a community oncology setting would help that and I felt I could still do research. Though it can be hard to do research in community oncology, once one achieves that goal, it's fulfilling, because it's not just given. You had to work hard for it, you made a name for yourself. It's always more gratifying when you worked hard for something that was tough to get.
I felt like the good thing about community oncology was that I could still do teaching, and I could still do research. I have been a principal investigator for a lot of clinical trials and have been a part of a lot of trials, almost 40 to 50 trials in the last 10 years. These were trials where drugs were approved for different types of cancers or even supportive care. We can get that in a community setting. I like how [in community oncology] we can control how we want our lives to be, rather than being employed in an academic environment where there can be some restrictions, and one may not have the liberty to do whatever they want.
How do you approach building relationships with your patients? Are there any stories that you could share?
When I moved to Florida in 2006, the Iraq war was still ongoing, so my name wasn't associated with very pleasant people. Imagine I go into a patient's room and say, ‘Hi, I’m Dr. Hussein.’ One could see the look in their eyes. People are very nice, but when they don't know something and they hear only bad things about a certain culture, there can be a scary fear and worry about how they're going to treat you, or how they're going to provide the best care. What saved me is sports because I love sports. I became a big Boston fan, I started watching baseball, football, basketball, hockey, and of course, soccer, my first sport. I followed the news and I get those notifications on my phone whenever something happens. A lot of patients also love sports, and they would have a New York Yankees hat or jersey, or one with the name of a college or something, so I started talking to them about this. That really got me closer to the patient. Suddenly, they would forget my last name, and some of them would go out of their way to tease me about games.
I had a patient who was a Jets fan. I'm a Patriots fan. On a Sunday night, if they just beat the Patriots, he would call the office at 8 in the morning and make sure on my computer, they put like a paper saying ‘go Jets’ so I could see it. That relationship was great and how [my patients] felt so close to me that I'm not just a doctor, that I'm also a friend and we discuss different things. Patients are smart. They can tell who cares and who doesn't care. It's amazing that within 6 months of me being in this area, I would ask my patients primary care questions, like, do you have a doctor? [They would say] I trust your opinion, and that made me feel that I'm doing something right and made me feel good. It makes me want to do more. [As a doctor] it feels like they gave this trust, and we want to make sure that we don't let them down. We want to work harder, we want to study harder, we want to do more, like improve care.
Within the first year, I was a board member with the American Cancer Society. I remember we went lobbying to increase cigarette taxes in Florida so we could minimize [the number of] people buying cigarettes, especially younger ones, if we made them a little bit more expensive. Those politicians promised not to raise taxes, but it's not a tax, it's a choice. It took us a lot of work, but it happened, and I felt like I did something for the whole community here and did something to reduce the incidence of cancer. [It made me feel] part of the community now. We must give back to the community and do more to help. We're fortunate with FCS that we have a foundation, and we encourage philanthropy, so we participate a lot in philanthropic activities in our community to make them feel that we're part of them.
What recent advancements in oncology have you been most excited about recently?
I'm excited about the personalized care we're doing. I'm excited about how fast genomic, molecular oncology is evolving where I feel like at some times, we can take a blood sample and we can tell what cancer the patient has, how to treat it, what [adverse] effects the patient may get from the treatment, and even what is the best treatment to give to the patient. We have to follow-up with the patient later on and do surveillance or survivorship, but I feel like we are getting closer. I'm hoping it can be in my time, I'm optimistic, and that's exciting where quality-of-life will improve the patient's because we're just targeting the cancer with their therapies, minimizing [adverse] effects, and even the long-term economic cost will be better, because we're minimizing a lot of comorbidities that patients may get from cancer therapy.
That's becoming accessible. [Patients] do not have to go to academics, that's how fast science is evolving. They don't have to go to an academic, they can get this done in a community setting. At our practice, FCS, we have a next-generation sequencing lab now. We're not at university so I'm sure in the future that will be accessible and will be something one can do in any lab, any clinic, or office. I feel that's exciting. The other thing is the immunotherapy part and how we are deciphering how to manage the immune system to also fight cancer.
What are some challenges that still exist?
I think that we still have issues with enrolling patients in clinical trials. I think there's still a big challenge, not just with patients, but even encouraging doctors to participate in trials. We see that in our practice that few are the active ones that refer patients to trials. A lot of doctors don't want to do the extra steps, and we need to change that culture and that behavior. We need to encourage the patients to challenge their doctors and to ask for clinical trials because I feel if we can enroll faster, we can get our answers faster.
Of course, there is an economic challenge. Everything is expensive, and they are very expensive. I don't know how we can sustain this, with all the new drugs being very expensive, and the combinations. [Patients] are living longer because we're helping them live longer. I think those are our big challenges: Trying to find the answers fast by enrolling [patients] in trials and having to keep in mind the economic impact of new treatments and testing.
Are there any upcoming trends or developments in oncology that you think are going to significantly impact patient outcomes moving forward?
I think the early detection of cancer and the modes of surveillance, after even treating cancer to try to detect recurrences at the earliest stages have a good impact, and even an economic impact. One might feel like they do the test and know that the treatment may be not working and not give unnecessary treatment for those patients. I think that hopefully the trend of using more genomic testing in either diagnosis or trying to decide treatment or surveillance is an optimistic trend for the future.
What advice do you have for aspiring oncologists, especially those in the community oncology setting?
Very simple: Work for quality. You will do great, and money will come. If you work for money, you lose quality, and don't do well, so work for quality. That should be the aim. You can never think you're perfect, because once you think you're perfect, you're not going to get better. Aim for perfection, but always know that you're only 1 step closer to perfection, but you're never going to get there. This way you keep improving on yourself. And be nice, even if people are not nice to you. You will change a lot of minds and hearts by being a kind person. Patients don't want a grumpy doctor.
Try to volunteer in your community to help improve it. The way I look at it, if we improve the community, this is where we live, and it will be a better place. We can always make changes. Every improvement we make, we are making a better place and people will want to come back. Be nice to the nurses, to the students, and don't spare teaching them because those people may take care of you sometime and you may end up needing their help. Be a good community member, not just someone who takes. Be more of a giver than a taker.
Do you have anything you would like to say to your co-honoree, Daniel Efiom-Ekaha, MD, FACP?
Congratulations, man. It's nice to see more people getting that honor because that means other people are doing the same thing and caring for their patients, and it makes my heart happy. Some people just want to make money, but I can tell you, most doctors can make money in other ways other than medicine, so I hate when people accuse us of doing it for the money. It is heartwarming to see that there are other people who go out of their way to provide that care enough to be nominated by their peers and get that honor.