Mary K. Gospodarowicz, MD, FRCPC, is determined to help reduce the worldwide burden of cancer, a problem of epic proportions. Her approach is simple: adopt what works and reject what doesn’t. Much progress in the fight against cancer can be made without waiting for the next paradigm-changing breakthrough, she asserts. Only someone with her “just do it” attitude could tackle the challenges of global cancer and maintain such a demanding schedule at the same time.
Dr. Gospodarowicz, a radiation oncologist, is the Medical Director of Princess Margaret Cancer Centre in Toronto and President of the Union for International Cancer Control (UICC). Commenting on the importance of the UICC, she noted, “It is the only organization that aims to bring together the wide variety of players needed to achieve improvements.”
Medical Training
Born in Gdansk, Poland, Dr. Gospodarowicz began medical studies in her native country before immigrating to Canada, where she graduated from the University of Toronto Medical School. She then joined Princess Margaret Hospital. “I did my training in internal medicine there. I also trained in medical oncology and radiation oncology, so I have triple boards,” explained Dr. Gospodarowicz. Like many academic oncologists, Dr. Gospodarowicz was drawn to the field by the opportunity to make advances in a disease with so much need; she also found the evolving research opportunities exciting.
Dr. Gospodarowicz began her radiation oncology career at Princess Margaret Hospital and has never left. “In Canada we tend to stay put if it’s a good institution. There are some institutions in the United States that often hold their doctors for the duration of their careers, such as MD Anderson, Memorial Sloan-Kettering, and Dana-Farber, but doctors in the States tend to move about more than we do,” commented Dr. Gospodarowicz.
Focus on Radiation Oncology
At the onset of her academic career, Dr. Gospodarowicz immersed herself in clinical trial research. “My strength was in developing clinical trials, and early on I was involved in cooperative group studies. In fact, in the mid 1990s, I chaired the genitourinary trial committee for the National Cancer Institute of Canada trial group, which is similar in its structure to the U.S. cooperative groups,” said Dr. Gospodarowicz.
She continued, “In the late 1990s, I became very interested in precision radiotherapy, mainly because of the tremendous advances in the field. Because of funding issues, we were lagging behind where we should have been, so I took a leadership role as Chair of Princess Margaret Hospital’s Department of Radiation Oncology. And for about 10 years, my main focus was increasing our image-guided precision radiotherapy capabilities.” In 2012, she finished her 11-year term as Chair of the Department of Radiation Oncology and Chief of the Radiation Medicine Program.
Thanks largely to Dr. Gospodarowicz’s work, Princess Margaret Cancer Centre has one of the world’s largest radiation oncology programs with more than 40 radiation oncologists, 50 medical oncologists, 60 surgeons, and 18,000 new patients each year, mainly from the Toronto area. “Princess Margaret has a good record in redefining treatment standards, having for example persevered with work on stopping radiotherapy [following orchiectomy] for stage I testicular cancer and opting instead for active surveillance, which is now widely accepted as standard of care,” said Dr. Gospodarowicz.
As the Medical Director of Princess Margaret Cancer Centre, Dr. Gospodarowicz distills the institution’s cancer care philosophy into a simple but comprehensive message. “We need to work on three fronts: (1) Prevent cancer so fewer patients get cancer, (2) cure more cancers with better treatments, and (3) prevent side effects, or treat side effects to repair the damage. And throughout all this, support the person you are treating. After all, we are all people.”
The World Stage
By nature, Dr. Gospodarowicz is a hard-driving visionary, but she’s also a pragmatist who realizes that the best way to get things accomplished in the complex world of oncology is by implementing guidelines. Dr. Gospodarowicz understands that health care—especially when operating on the macro level, as she does—is a business, and the principles that make businesses successful, such as standardizing operational functions, improve quality and efficiency. “If people in health care would understand that, they would treat guidelines differently and not as something that infringes on their medical autonomy,” said Dr. Gospodarowicz.
This organizational philosophy is the underpinning of her work in the fundamental issue of tumor classification. It was her work in TNM staging that first brought her into contact with the UICC, which develops and maintains the system. “I’m currently co-chairing UICC TNM Project. It was this work in staging that helped me get into more leadership roles, which eventually led to the presidency,” said Dr. Gospodarowicz.
Redefining the UICC
In fact, she is the UICC’s first president from Canada. “We recently had a strategic retreat in which we redefined the purpose of the UICC. The central question we posed was: Why does the UICC really exist? And we decided that the UICC’s basic function is to unite the very diverse global cancer community. We have about 750 different members, so it’s no easy task. The scope ranges from the huge American Cancer Society to a community organization in Turkey of mothers whose children have leukemia,” said Dr. Gospodarowicz.
She continued, “The purpose of UICC is to unite the cancer community to reduce the global cancer burden, to promote greater equity, and to integrate cancer control into the global health and development agenda.”
Dr. Gospodarowicz explained that because of its strong international membership, the UICC has great potential to align and unite the voices necessary to bring about substantive changes, especially in underserved nations. To that end, Dr. Gospodarowicz contends that there clearly is a need for more health-care investment in low- and middle-income nations. “We do have industry financing for some of our programs, but we need to do much more with other organizations. Targeting philanthropists is difficult—you need a skilled execution body to create the tight proposals that agencies such as the Gates Foundation will act on. We need to capitalize more on our partnerships with WHO and IARC [International Agency for Research on Cancer], and others such as GAVI, the global vaccines agency,” said Dr. Gospodarowicz, adding, “Naturally, fundraising is important, but you also need to make the most of the resources you have.”
Health Care in Canada
The contentious debate over health care in the United States centers largely on spending and access. Asked if Canada faced similar issues in health care Dr. Gospodarowicz responded, “The ongoing challenges in both systems are the same: paying for high-quality cancer care in a cost-effective manner. While my colleagues in the United States have to negotiate with multiple insurance companies, I have to negotiate with the government, which entails providing evidence that treatments are effective,” said Dr. Gospodarowicz, “Cancer care in Canada is supported by jurisdiction-wide, population-based cancer-control strategies, but it does have its challenges regarding resources and timeliness of access to care,” she noted. “All in all, I think that both of our countries do a good job caring for our cancer patients.”
Despite her overwhelming responsibilities as Medical Director of Princess Margaret Cancer Centre and her presidency of the UICC, Dr. Gospodarowicz said that first and foremost she is a physician. “I’m very proud of being able to look after patients because that’s the one thing that keeps you real. Coming back to the clinic and being inspired by your patient’s courage and commitment is what keeps me going,” said Dr. Gospodarowicz. ■
