In an interview with Targeted Oncology, Q2 2023 Oncology Icons honoree, Tara Graff, DO, MS, discusses her path to community oncology from academia, and hopes to continue to advance community-based research in the future.
Just 15 years ago, Tara Graff, DO, MS, set out conduct research at the Medical College of Wisconsin (MCW). MCW’s Froedtert Memorial Lutheran Hospital is where Graff began her fellowship and where admittedly, she had planned to retire one day. Life had other plans, according to Graff, a hematologist/oncologist and physician champion and lead, Mission Cancer Trials Program, at Mission Cancer + Blood.
Family led Graff to relocate to Des Moines, Iowa, and where she took on a role in the community practice.
“If you would have told me 15 years ago that I would be in Iowa, I wouldn’t have believed it. I think that everything that I've done up until this point, from graduate school to medical school to my fellowship training, has provided me with the tools and resources to do what I’m doing today,” said Graff, in an interview with Targeted Oncology™.
Although the patients, region, and cancer types were different from what Graff was used to, her goal to make a mark on cancer research did not die. Graff said, “it evolved.” Today, Graff leads a community-based clinical trial program at Mission Cancer + Blood. The program is a collaborative effort between Mission Cancer + Blood, Iowa-Wide Oncology Research Association, Des Moines Oncology Research Association, and Mercy Cancer Research. Together, the organizations have more than 100 research studies and clinical trials that are being conducted on a national and international scale.
Graff explained that the program gives access to the newest therapies to underserved patients. This is one reason that community-based research is so important, she said.
“The patients usual start in the community. Seventy to 80% of them are in the community and then are referred to academic centers. We need to be able to offer those patients not what's been used over the last 15 plus years, but what's new and relevant today. Those patients are here, they're in our backyard, they're not 2 hours away. We need to be able to truly help our patients in the here and now. If we don’t, we'll lose our patients.”
In the interview, Graff, a Q2 2023 Oncology Icons honoree, discusses her path to community oncology from academia, and hopes to continue to advance community-based research in the future.
TARGETED ONCOLOGY: Are the start of your career, what were your main goals?
Graff: When I first became an oncologist, what I intended to do for the rest of my life was lymphoma and transplant. I was at a large academic institution, Medical College of Wisconsin, where I started my career and I planned to end my career. I was very happy and heavily involved in research. But, as life has it, there are curveballs and paths change. My change was my husband. I tried commuting back and forth from Des Moines to Milwaukee, but that didn't work out very well. It only worked for about a year. Then, I ultimately decided to join my husband in Des Moines, Iowa, where I joined, at that time, Medical Oncology/Hematology Associates, which is now Mission Cancer and Blood. It was a little bit different. I wasn't a homegrown Iowan, and I didn't intend to do community oncology. I was an academic, so I was a fish out of water.
It's amazing how quickly one has to adapt to their environment. Suddenly, I was seeing different cancers and things I didn't really think about a lot, and that was interesting.
What were your goals once you started working at Mission Cancer + Blood? What were your key challenges treating patients in Des Moines?
Over the next several years, I wanted to merge my 2 worlds. I started my career as a basic scientist, I have a master's degree in T-cell immunology, and I did cancer research at the bench for years before I went to medical school. My heart has always been in research. Research is basically scientific advancement for patient care, but I was always on the other side of it, and then becoming an oncologist, I got to kind of go from A to B, and then B to C, which I found very fulfilling. I needed to figure out how to build that niche in a community oncology world, which is not something you see every day, because community is community, and academia is where the research is done. But that isn’t true because there's a lot of community groups that do research. So, I decided to sort of make that my goal.
Over the next several years, I helped build up the clinical trials program. Just in the last few years, it has exploded. I've been able to bring the best of both worlds together. It also brought the best patient care we can offer because patients don't want to necessarily have to travel. They don't want to drive 2 and a half hours, or 4 hours for clinical trials and new therapies. They want to stay home. This is especially for people in the Midwest because they're busy farming and doing all sorts of other things that limits their ability to travel far distances. What I wanted to do was bring the latest and greatest therapies, right to their own backyard, and we've been able to do that.
What should oncologists know about your community-based clinical trials program?
We've had several clinical trials that keep patients here. They don't have to travel, and they get to stay with their families. That's really what it's all about. The treatment landscapes for all cancers, not just lymphoma, but also solid tumors, are developing and becoming more targeted every day. If we don't keep finger on the pulse and adapt to that with new medicines and new trials, we're not doing right by our patients. I've tried to make the goal of really getting more partners involved and getting community clinicians involved in research more. We haven't just opened several lymphoma trials, we've are opening several breast cancer trials, lung cancer trials, we're starting our phase 1 research program, and a theragnostic program. We are going to be a central hub for all these patients so they can get the latest and the greatest, which is really what it's all about.
How have your goals changed over the past 15 years?
When you're in academics, it's all about research and funding and trials, whereas now my focus and goal is to be able to give my patients the best access to care. But I couldn't do that without the tools from my past. I don't think my goals have changed, but they have evolved.
I have 16 partners, I have multiple colleagues, nurse practitioners. There are all these different people who don't necessarily all think alike, or have the same passions, or maybe aren't involved in research. One of my newer goals to get others to be as excited about research and advancements as I am, I don't expect everyone to be a scientist, but it’s good to have a research-oriented mind. But I've been able to get several of my partners involved in research and the opening of clinical trials.
If you would have told me 15 years ago that I would in Iowa, I wouldn’t have believed it. I think that everything that I've done up until this point, from graduate school to medical school to my fellowship training, has provided me with the tools and resources to do what I’m doing today. I’m grateful for the support our staff at Mission Cancer and Blood, and our administration. I have a wonderful team of nurses and nurse practitioners that I always say if they didn't do what they do, I couldn't do what I do. That support has allowed me to go out and to speak and educate. I want to be involved. I want us to have the latest and greatest right here, and I want our patients to have everything, including access to clinical trials. That's where my focus is, that's my goal is to keep is to keep making Mission Cancer and Blood is as great and as strong, world renowned as we possibly can be.
Can you explain the importance of community-based clinical trials?
The patients usual start in the community. Seventy to 80% of them are in the community and then are referred to academic centers. We need to be able to offer those patients not what's been used over the last 15 plus years, but what's new and relevant today. Those patients are here, they're in our backyard, they're not 2 hours away. We need to be able to truly help our patients in the here and now. If we don’t, we'll lose our patients.
What do you hope to do next in your position?
It’s not a new thing. I plan to keep growing this program. My wish is that we bring more partners on board, so that we can do big trials that are not typically available in the community setting. My second goal is to play a part in bringing limiting the lack of diversity, which is a big theme in research. In the Midwest, we have disparity based on geographic location. Our group has 22 outreach clinics. We service people who don’t have cars and don’t have the funds for transportation. It’s a different type of disparity that we have here, but it’s still a disparity. I hope to do everything I can to help provide access for those patients.
As you aim to expand the clinical trial program, what are the key challenges you expect?
Again, I think access to care will be an important challenge. Also, finding for clinical trials, drug cost, drug reimbursement and drug availability are expected challenges.
In terms of all research for all tumor types, I think it will be important to design trials that are going to allow patients to have potential cure. I'm kind of speaking broadly across all oncology but I think we're in a day and age where we're figuring out mutations and targeted therapies for those mutations, so that our patients aren't having to rely on multiple lines of chemotherapy. I think that's important to keep designing trials that are giving our patients chemotherapy-free treatment plans, and potentially a cure. That's what we're trying to strive for, and there are challenges to that. But I think bringing together those brilliant minds will allow us to prolong the life and quality of life of our patients through community-based clinical trials.
I would just say congratulations and thank you for doing what you're doing and your regions. I think it takes those of us who are in community and who are research oriented to provide our patients with access to best care possible. My co-honorees and several colleagues of mine throughout the country are driven, so, I commend them, and I thank them. I am glad that there are several of us on this journey to doing just that for our patients.
Nominations for the Oncology Icons award program are accepted on a rolling basis throughout the year. To be eligible for the Q3 award that will September 15, 2023. To submit, please click here.