What does a typical working week look like for you?
Varied and interesting, and that is why I love my job! I spend half my time looking after patients with lymphoma (with a special interest in Waldenstrom’s macroglobulinaemia of course!), and the other half of my time looking after patients with myeloma and associated disorders.
I look after inpatients on the wards for 3 months of the year, and this is done in 1 month blocks. This involves taking patients through autologous stem cell transplantation, and other types of chemotherapy, and complications from chemotherapy. We often see new patients that have been admitted as emergencies in this setting, and typically with WM this could involve a patient with a very high IgM level and potential viscosity problems.
We see most of our patients in outpatient clinics and on our day unit, where we review how they are getting on with chemotherapy, and for those patients not on treatment, ensure that they are remaining well, and assess the status of their disease.
Quite a significant part of my working week involves clinical research: I am the clinical lead for late phase research for haematology in Oxford, and this role involves managing a large clinical trial portfolio, looking after the finances and ensuring that appropriate studies are done, and can recruit safely. Running clinical trials is one of most important parts of my job – these often give patients the opportunity to obtain therapies earlier than they might do on the NHS, and this can potentially have significant benefits.
As I work in a teaching hospital, education is also very much on the weekly agenda, with regular teaching given to medical students, and also junior doctors.
What made you take such an interest in Waldenstrom’s macroglobulinaemia?
My interest in all lymphoma started when I spent 2 years working on the development of antibody therapies for non-Hodgkin lymphoma (including rituximab). This was extremely interesting, and gave me the opportunity to meet with and discuss the development of lymphoma therapies with national and international experts. I found this very inspiring, and since then I have had an interest in lymphoma.
I became specifically more interested in Waldenstrom’s macroglobulinaemia during the latter part of my registrar training, which was focused at University College Hospital London. Whilst there, I spent a lot of time working under the tutelage of Dr Shirley D’Sa who has the biggest WM practice in the country. Whilst there, I was lucky enough to see and learn about many different aspects of the management of patients with WM, and realised that it is often complex, challenging , but also very rewarding, as we have so many effective therapies.
What do you enjoy about your work, and why?
First and foremost, I enjoy seeing and looking after patients. The very nature of WM means that you build up relationships with people over a number of years, and this can be extremely rewarding. It is a privilege to be able to look after people and take them through their therapeutic journey, with all its attendant highs, and unfortunately sometimes lows.
I also very much enjoy working in Oxford, with some wonderful, inspiring colleagues who very much help you develop personally and professionally. In Oxford we are blessed with a very strong lymphoma Department where we are all aligned trying to provide the best care that we possibly can.
The third aspect that I particularly enjoy about my work is clinical research. I am currently the chief investigator of the National trial in relapse Waldenstrom’s macroglobulinaemia (the only trial for this running in the UK at the moment), where we are investigating the combination of rituximab and a drug called pembrolizumab, to see what effect this can have in patients who progress or are intolerant to drugs such as ibrutinib. Being involved in assessing new drugs and new combinations to try and take the field forward and improve outcomes for people is extremely interesting, and certainly one of the best parts of my job.
What is the most challenging part of your role, and why?
The hardest part of my job is related to time pressures. We have increasing number of therapies in all the conditions that I look after (which of course is excellent news), but with this comes added layers of complexity, and sometimes it really feels like you cannot give every single patient all the time they need every single time, whether it be an outpatient appointment, or other specific types of patient interaction. And that is very frustrating.
How has the COVID-19 pandemic affected your work? What changes have you had to make?
There have been some very significant ways in which our work has adapted during the pandemic. Where possible we have limited face-to-face contact, and we have tried to prioritise telephone contact or remote video consultation where it is deemed to be safely possible. This often can work for a condition like WM especially when people are not on treatment.
We have also had to think carefully about what therapies to use and why, and how potential therapies could increase the risk of not only catching COVID–19 but also potentially getting more complicated COVID –19. Moving forwards into 2021 and beyond, we are increasingly thinking about how well COVID-19 vaccinations are going to work in our WM patient cohort, and getting data on antibody responses to vaccines and trying to understand what is the best way of protecting our patients moving forwards.
Face-to-face meetings between doctors have also essentially been stopped since the start of the pandemic, and we now have Microsoft teams for our MDT meetings and virtually all other Dr-to-Dr interaction where possible. This has meant that I have occasionally been working at home, which has been required to maintain social distancing in the medical offices at work. Conferences I have attended have also been virtual, not in person
What advice would you have for a newly diagnosed patient?
There is no one size fits all, and what I try and do when I am meeting a patient for the first time is to make sure that they have all the time they need, so I can really paint a clear and accurate picture of their condition, and ensure that I can integrate the most up-to-date data from their initial investigations to try and give them a sense of what the natural history of their condition may be.
Some patients do not need treatment at diagnosis, and it is really important to explain why that is the case, and what that potentially means for their life moving forwards. If they do need treatment, there is often more than one option, so what I would certainly do is to sketch out the pros and cons of different options, and making sure that by the time we have been through everything, they have a clear understanding of the best way to take things forward.
What I would say to any newly diagnosed patient is that pleasingly, medical science is moving forwards very quickly in WM and associated disorders, and new therapeutics are becoming available often, continuing to increase the options that we have for all of our patients.
What do you enjoy doing outside of work?
In my spare time, I am a keen runner, and last year (partly aided by lockdown and lack of other leisure activities!) I was able to run my first 1,000 mile year. After running, I will often be found in the kitchen, trying to concoct a new recipe or two – the more unusual the ingredients are, the better! Apart from running and cooking, the main focus of my spare time is my two young daughters, who certainly keep me on my toes!