Options Improving Odds
Rabia Cattie, M.D., is practicing in an undeniably innovative era of oncology.
When she began her fellowship in 2009, there were very few targeted therapies, almost no immunotherapy options and the standard of care for most cancers was limited to chemotherapy. Fast forward eight years and the rate of advances in state-of-the-art medicine — along with the extension of life expectancies — is head-spinning.
To outsiders looking in, the changes in cancer care are ground-breaking, exciting and life-changing. To Dr. Cattie, they are all that, and yet, in many ways, more challenging than ever.
“It’s a mixed bag because the more medicine we have, the more options we have; the more difficult it becomes to pick the precise treatment for your patient,” she says. Now physicians have bigger decisions to make: which therapy option to start with and what other side effects to watch for, like changes in the thyroid or other endocrine damages causing diabetes.
“There are so many new medications and the way we sequence our treatment choices is challenging,” she says. “It takes a lot of dedication, and time and knowing your patient, to do it correctly. It’s a different way of doing things. ‘Easier’ might not be the right way to say it. But it surely is better. Patients are living longer.”
For example, she says, metastatic lung cancer patients given only a year to live a decade ago are now living four or five years — and often with a better quality of life. Many stage-4 lung cancers and melanomas are immediately prescribed immunotherapy, a drug regimen that teaches the body’s immune system to fight the cancer and frequently allows the patient to avoid the nausea and weakness caused by chemotherapy. Other cancers are also benefitting from targeted therapies that act to block the genetic mutation, allowing the cancer to run rampant.
These newer treatments have been the result of clinical trials, something Dr. Cattie and her oncology partners at the East Jefferson Regional Cancer Center at the Yenni Pavilion feel strongly about. “A lot of our patients are literally helping us get these new drugs approved,” she says. In particular, they are involved in the MATCH trial for new targeted therapies after multiple lines of care don’t work. There are also active trials for kidney and prostate cancer, and an immune therapy trial for triple-negative breast cancer, which currently offers few options.
East Jefferson’s clinical research department works with LSU on the trials and also has an affiliation with physicians at MD Anderson in Houston. “Our ability to discuss the cases with collaborators is very helpful to our patients,” Dr. Cattie says. “For my most challenging cases, I sometimes encourage them to go to MD Anderson … we leave no stone unturned in the fight against cancer.”
She shares multiple success stories and especially likes the story of one of their patients who began immunotherapy recently and the cancer “just went away.”
“Cancer is more of a chronic disease at this point,” she says. “Of course, our goal is curing cancer completely, but, while we’re getting there, one of the goals is that it becomes a chronic disease. The patient gets treatment, lives a functional life … a good quality of life. It restores my faith.”
The emotional side of practicing oncology: “It’s a fine balance,” she says. “You have to train yourself. You have to be empathetic, you have to be kind, you have to compassionate … but you can’t let it overwhelm you so you are unable to help the patient. But I have to say, there have been times I have cried with my patients. Especially if I’ve known them for years … it makes us human. Treating patients is a bonding experience.”
On sharing difficult news: “I find that being honest is the best policy,” Dr. Cattie says. “That’s what helps me handle the emotional aspect of it. I’m not hiding anything from my patients. If you start this journey with the cancer patient, and go through it with them step by step, when it doesn’t work, you’re honestly telling them that and sharing new options.
You’re working as a team. The more involved the patient gets with their own care, the more they have a say in it.”
The patients are the most important part: After several years practicing in general medicine as a hospitalist, Dr. Cattie decided to pursue an oncology/hematology fellowship. She was fascinated by the science and study of the blood but, “I really liked the patient-centered aspect of it,” she says. “Your patient is your patient forever … and when your patients do well, you can’t compare it to any other specialty. You can accomplish so much, and all the work you do with your patient is truly gratifying in the end.”
Medical School: Allama Iqbal Medical College, University of Punjab, Lahore, Pakistan
Residency: SUNY Downstate Medical Center, New York City, Internal Medicine, chief resident
Fellowship: SUNY, Hematology-Oncology, chief fellow
East Jefferson General Hospital Regional Cancer Center at the Yenni Pavilion
4200 Houma Blvd., Floor 3