For This Giant of Cancer Care, a Holistic Approach Was Always in the Treatment Plan

OncologyLive, Vol. 20/No. 6, Volume 20, Issue 6

A 2018 Giants of Cancer Care® award winner for Supportive, Palliative Geriatric Care, Patricia A. Ganz, MD has spent much of her life working to improve the quality of care for patients with cancer.

Patricia A. Ganz, MD

Patricia A. Ganz, MD—Patti to her friends and colleagues—sees herself as positive minded. “As an oncologist, you have to be very optimistic,” she said. Her mother used to say that everything turns out for the best, and this same philosophy has served Ganz well during a career spanning 4 decades.

A pioneer in cancer survivorship and the late effects of cancer treatment, with heavy clinical and research involvement in breast cancer and its prevention, Ganz has spent much of her life working to improve the quality of care for patients with cancer. Treating the whole patient and delivering high-quality cancer care are concepts she has embraced throughout her career.

An Exciting New Field

She has been a faculty member of the David Geffen School of Medicine at UCLA since 1978 and the UCLA Fielding School of Public Health since 1992. Currently she is director of the Center for Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center (JCCC) at UCLA.Although she worked in a pediatric cardiology laboratory at UCLA during summer breaks in college, Ganz correctly anticipated that her career focus would be on adults, largely as a result of exposure to her father’s practice in occupational medicine for workers in the industrial area of Los Angeles. She briefly considered becoming a cardiologist. However, when she became a first-year resident in the 1970s, a dynamic new chief of hematology and oncology served as her attending physician and sparked her interest in this exciting field.

Engaging with patients with cancer was easier, Ganz said. “Even the patients I saw who had advanced disease, you could talk to them about what was happening. You couldn’t do that with patients with advanced cardiac disease, who were very depressed but wouldn’t open up and talk.”

It didn’t hurt that chemotherapy drugs were being introduced that revolutionized the treatment landscape. “Some of the new drugs that were becoming available, like cisplatin and doxorubicin, were really exciting, and I thought, ‘Oh my gosh, it looks like we’re going to be able to cure cancer,’” Ganz said.

A Bright Start

“It was that experience that made me think, ‘This is a whole new field. Maybe I’ll do a fellowship in this.’”Growing up in Los Angeles, Ganz had a broad range of service-oriented interests and no shortage of role models.

She also had diverse academic interests in high school. Ganz credits her parents for encouraging her to explore every possibility.

In addition to doing clerical work for her father’s medical practice in the summers, Ganz drew inspiration from her mother’s search for professional fulfillment outside the home.

“You have to imagine, this was in the 1960s. Where I grew up, nobody’s mother worked,” said Ganz.

“My father was always saying I should consider medicine, and I didn’t know if I wanted to go to school for that long.”

Whole-Patient Care

Nevertheless, after high school, Ganz attended Radcliffe College and was a member of a class of 300 women who, in 1969, were the last to graduate separately from Harvard University. In the all-female class, Ganz was “surrounded by bright women.” Ganz said that she never would have thought of going to medical school were it not for the women in classes ahead of her who inspired her.Ganz completed her training in internal medicine and hematology and oncology at UCLA Medical Center from 1973-1978, also serving as chief resident in medicine. In her first faculty appointment, Ganz was given the opportunity to start a hospice at a UCLA-affiliated Veterans Affairs (VA) hospital. We created a ward that wasn’t just for people in the last few months of life. We were taking care of a spectrum of patients.”

This experience profoundly altered her thinking. “I realized that all the things that hospice was proposing in terms of psychosocial support, symptom management, and so forth, we should be doing for everyone from the time of diagnosis.”

Ganz had a wonderful medical support team and said that running that unit pointed her toward the concept of whole-patient care.

The Right Place at the Right Time

She took her work a step further in collaboration with Anne Coscarelli, PhD, and Richard Heinrich, MD, who in a clinical trial were investigating the value of a support group for veterans and their families. They needed a way of measuring the outcome, and to gain a better understanding of what patients were coping with, the researchers visited Ganz’s clinic. Thanks to them, Ganz was introduced to tools of psychological science.Ganz has been a member of JCCC for her entire career. Her emphasis on the field of breast cancer outcomes research came about by chance after she and her colleagues had difficulty recruiting patients with colorectal cancer for a National Cancer Institute (NCI)-funded research project on colon and breast cancer. As a result, the study focused solely on breast cancer.

Fate also played a role in Ganz’s career during a relocation effort in 1992. “I’d been chief of hematology and oncology at the VA hospital [since 1984], and I don’t know if you could call it a midlife crisis or what, but my office got moved and I thought about what I wanted to do for the next 20 years.”

In thinking about her future, Ganz reflected on what she enjoyed most. “I had not been formally trained as a research methodologist but had learned by doing. And this was what really brought me pleasure and was something I wished I could do full time.”

As it turned out, JCCC had been looking for someone who could serve in the School of Public Health and co-lead research within JCCC in its Population Science Group. Ganz learned about the position from Ellen Gritz, PhD, the director of the Division of Cancer Control at the time. She had never considered undertaking a role like this, but after learning that the position had dual involvement with JCCC and the UCLA Fielding School of Public Health, she went on to compete successfully for the position and joined the faculty alongside Gritz in 1992 as the associate director of the Division of Cancer Control.

A Full Schedule

Within a year, Gritz was recruited by The University of Texas MD Anderson Cancer Center in Houston, Texas, leaving Ganz to step in as director, a role she has held to this day.Ganz also teaches 1 class a year in the Department of Health Policy and Management at the Fielding School of Public Health. She is a distinguished professor of medicine and health policy and management at UCLA, chairs the University Committee on Appointments and Promotions, and serves as editor-in-chief of the Journal of the National Cancer Institute.

Day to day, her cancer center role is primarily in research administration, where she serves as an informal mentor and collaborates with colleagues from Johns Hopkins University and Dana-Farber Cancer Institute on an NCI-funded study on the benefits of mindfulness and meditation in the treatment of breast cancer in young women.

Ganz also spends a half-day each week in consultative practice, seeing patients who are at high risk for breast cancer, as well as survivors who are experiencing cognitive problems and sexual difficulties or who need help with treatment-related symptoms. “Often this is the first time the patients have had anyone address their psychosocial needs,” Ganz said. “It’s a very rewarding practice.”

High-Quality Care Starts With the Patient

Ganz has found time in her career to edit journals and publish 14 books, 76 book chapters, consensus statements, technical reports, and more than 420 research papers.At JCCC, Ganz supervises 2 postdoctoral fellows who are researching cancer-related cognitive changes, survivorship, and quality of care, areas that she’s very passionate about.

Ganz believes that doctors should not just give a patient a drug but make the experience effective, efficient, and personalized. She chaired the expert committee that produced the 2013 Institute of Medicine report Delivering High-Quality Cancer Care: Charting a Course for a System in Crisis. This report has had a major influence on healthcare policy for cancer care delivery.

A career-long advocate for whole-patient care, Ganz is pleased with the growing emphasis on patient involvement in the care process. “Right now, what’s been so exciting for me is the move to include patient-reported outcomes in regular practice,” she said. “The patient voice is so critical to delivering high-quality care.” She explained that a clinical trial report on pain or insomnia or neuropathy would be incomplete and unreliable without input from the patient. “You have to get it from the patient.”

Looking to the Future

Ganz hopes that her current research on host factors, which affect susceptibility to disease, leads to fresh insight in managing cancer. “We give cancer treatment, and some people get through without any problems and they don’t seem to have any residual effects. Then you have people who have a little bit of treatment and have a terrible time,” Ganz explained. With host factors, researchers are examining what patients bring to their cancer that oncologists don’t currently know about.Asked what she’s passionate about outside of work and career, Ganz lists family and hobbies. She and her husband, Tom, love to cook and travel. “I’m very fortunate that even though I could retire, I love what I do and will be in the game for a bit longer. There’s still a lot of opportunity, and I’m working with people I believe in and can trust with the research that I’ve done thus far. I want to make sure they are fully launched and have successful careers.”