Karen Gelmon, MD, was born and reared in Saskatoon, the largest city in the Canadian province of Saskatchewan. It is surrounded by vast prairie and situated along the Trans-Canada Yellowhead Highway and is home to the University of Saskatchewan. “We lived close to the University,” she shared. “My father originally dreamed of becoming a doctor but was denied entrance to medical school because of the quotas on Jewish people. He ultimately went to dentistry school in Minneapolis. In Saskatoon, at the university hospital, he did a lot of specialty work with children who had disabilities, such as mental developmental problems, or kids with cleft palates.”
Karen Gelmon, MD
Dr. Gelmon continued: “I was one of four children, and my father involved us in his work, which gave me insight into health care. I also had an uncle who was a hematologist. We were a close family, and I grew up hearing interesting conversations about medicine. They even let me accompany them to the hospital. I remember distinctly going with my father to see a man who had come out of the prairie with a huge tumor on his face. So, I had a lot of early exposure to medicine.”
Dr. Gelmon noted that her mother was a home-care social worker. When Dr. Gelmon was in high school, her mother enlisted her to tutor one of her patients, a young aboriginal woman with children who experienced paraplegia after a serious car accident. “I was conscripted to teach her,” she explained. “There was a sense from my childhood experiences that sickness and injuries were part of life, and you did your best to help people in need. In the end, my father was right: I was destined to become a doctor.”
Early Indecision
Dr. Gelmon’s father had always thought that she and her brother should become physicians, which they did. “I tried to buck the established path to a career in medicine,” she admitted, “so I majored in philosophy when I entered University.” However, after graduating with a BA in philosophy, she realized it wasn’t her calling; the passion simply wasn’t there. The early calling of medicine eventually prevailed, and Dr. Gelmon went to the University of Saskatchewan School of Medicine, where she attained her medical degree.
“It was a good school, but small, so you got a lot of personal attention,” she commented. “Part of our curriculum was a 4-month elective. I ended up working in Kenya; it was a wonderful learning experience and an opportunity to gain confidence.”
A Mentor’s Advice
After medical school, Dr. Gelmon went to BC Cancer Agency in Vancouver (BC Cancer) for her internal medicine residency. “In the first year, one of my rotations was oncology, and my mentor, Dr. Jim Goldie, got me excited about theories of how cytotoxics worked. He was also interested in both oncology and history, and I became fascinated by his rich stories about the field. I first thought about hematology, but Dr. Goldie said liquid tumors were ‘too easy’ and solid tumors were the real challenge,” said Dr. Gelmon.
“There was a sense from my childhood experiences that sickness and injuries were part of life, and you did your best to help people in need.”— Karen Gelmon, MD
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After her residency, Dr. Gelmon did a several-month stint at Roswell Park, still trying to feel her way between hematology and oncology. “I returned to Vancouver, where I planned to do bone marrow transplant work in solid tumors. However, my plans changed when I got asked to work at a teaching hospital, as the hematologist had suddenly died. This was during the AIDS epidemic, and the hospital I was at was at the forefront; I followed an opportunity to London to work on AIDS epidemiology and clinical research. My husband, who is British, my young daughter, and I lived in London for 2 years before we returned to Vancouver, and I have been at BC Cancer ever since,” Dr. Gelmon shared.
Research and Clinical Care
Asked about her current work and research, Dr. Gelmon noted that her research activities have centered on the development of new therapeutics for patients with breast cancer and other cancers. Despite a demanding research schedule, Dr. Gelmon is still very active in the clinic.
“After so many years of practice, I find it rewarding that I still consider clinical medicine interesting,” she continued. “For example, I recently saw a woman who had a recurrence of her breast cancer after an initial diagnosis 25 years ago. How could this cancer stay latent after more than 2 decades? This is a fascinating question that drills to the characteristics of this disease, and finding answers to these perplexing questions helps lead to the development of better therapeutic options,” according to Dr. Gelmon.
Dr. Gelmon was Co-Chair of the Breast Site Committee for Canadian Cancer Trials Group (CCTG, formerly the NCIC-CTG), Chair of the Investigational Drug Committee for that group, and a member of the NCI Breast Steering Committee as well as on the executive board of the Breast International Group (BIG). She was a Komen Scholar and on the scientific advisory board of the Susan G. Komen Foundation. She was also Co-Chair of the scientific advisory board of the Ontario Institute of Cancer Research. She continues to do clinical research and is now Chair of the University of British Columbia/BC Cancer Research Ethics Board.
“I’m involved in several clinical trials, both large and small,” she revealed. “I’m on the steering committee for the OlympiA trial of olaparib in breast cancer and the PALLAS trial, both of which are international randomized phase III trials. I’m also involved in two Stand Up To Cancer programs studying new drugs—one is in triple-negative breast cancer and another is investigating a new mechanism of action for several different cancers. Then there’s some exciting translational research I’m doing here at BC Cancer with a couple of colleagues. And I am involved in the POSITIVE study for young women wanting to get pregnant after a diagnosis. So, it makes for a full day,” commented Dr. Gelmon. She firmly believes that younger oncologists need to be given opportunities for clinical trial and other leadership roles, and so she is stepping back.
Education Is Vital
Dr. Gelmon stressed the need to reach out to various groups, whether it be young medical professionals or the lay public. “It’s important to educate people on how oncologists think. For example, people need to better understand clinical trial design and drug development to appreciate the eligibility criteria used in trials. Oncology is such a rapidly evolving field that it is vital to disseminate as much information as possible.”
Asked about the challenges faced by today’s oncologists, Dr. Gelmon said, “Many of the studies looking at therapeutic efficacy have shown that a significant percentage of anticancer drugs produce only minimal clinical outcomes. There are other studies trying to identify drugs that do produce meaningful results. Our problem is determining the best ways to use the drugs we have in the most value-based way. This process is complicated by the fact that there are so many different and complex treatments and regimens. So, we have our work cut out for us, but I’m optimistic that as a community, we’re recognizing the need to identify value in care, which will help to prevent overtreatment of our patients.”
Difference Between Healer and Companion
Dr. Gelmon stressed that physician burnout in today’s ultra-demanding clinical environment is an increasing threat to the workforce. “Oncologists face huge levels of disappointment, in that many of our patients will eventually succumb to cancer, no matter how hard we work to save them. Not being able to meet our patients’ expectations can wear us down mentally after time. A philosophy that helps me deal with this clinical reality is embracing the difference between healer and companion.”
Dr. Gelmon said the central role of an oncologist is that of companion during the patient’s clinical journey. “We can be there for our patients, giving them our knowledge and best recommendations. We can advocate for their psychosocial needs and help their families during difficult times. This approach will take some of our ego out of the process, so we don’t view it in terms of success or failure. Success is helping our patients to feel safe, even if they face a devastating prognosis,” stressed Dr. Gelmon.
Conclusion
In closing, Dr. Gelmon stressed the importance of cancer prevention. “We know that lifestyle issues contribute to obesity and changes in our metabolic equipose, which in turn is related to the development of many cancers. We need to address obesity in the same way we addressed smoking.” ■
DISCLOSURE: Dr. Gelmon has served on advisory boards for Pfizer, AstraZeneca, Novartis, Lilly, Genomic Health, NanoString, Merck, Mylan, Roche, BMS, and Genentech. She has received research funding from Pfizer, AstraZeneca, BMS, and Roche. She has provided expert testimony for Genentech.
