For Alison Loren, MD, thinking broadly and inclusively is key to her new leadership of the Hematology/Oncology division at Penn.
The division of Hematology and Oncology is one of several in the Perelman School of Medicine’s department of Medicine with a name that joins two or more distinct specialties together with an “and.” But as indicated in its name, more commonly expressed with only a slash, as Hematology/Oncology, this division has a culture of bringing people and ideas closer together. Many top-tier academic institutions separate these specialties, or they focus on oncology within the context of a stand-alone cancer center, with hematology at arm’s length. But at Penn, those who study and care for blood diseases like hemophilia work shoulder-to-shoulder with physicians caring for patients with colon, lung, or other so-called “solid” tumors, as well as with sub-specialists who care for blood cancers and perform cellular therapy and bone marrow transplants.
Alison Loren, MD, who became chief of Hematology/Oncology in September 2022, refers to it as a “liberal-arts division” partly for that reason — but she’s quick to note that, while she embraces the term, it isn’t one of her invention. She credits a former division chief, Stephen G. Emerson, MD, PhD, and an emeritus professor and fellowship program director, DuPont Guerry, MD, for the term, and also for helping to shape the division to embody a classic “liberal arts” approach to problem-solving across multiple dimensions with grounding in literature and culture, as well as science.
Loren stepped into this role in the 50th anniversary year of the division, as only its fifth chief, after founding chief Richard “Buz” Cooper, MD, Sanford Shattil, MD, Emerson, and most recently Lynn M. Schuchter, MD, the Madlyn and Leonard Abramson Professor of Clinical Oncology, who served to great acclaim for 15 years. The division, together with the Abramson Cancer Center, which celebrates its own 50th birthday this year, has a storied past.
David Vaughn, MD, a professor and vice chief for clinical affairs in the division, has chronicled its history and growth from a small cadre of hematologists and, initially, one medical oncologist, to a powerhouse division changing the face of medicine. For a book published last year, Discovery and Healing: Reflections on Five Decades of Hematology/Oncology at the Perelman School of Medicine at the University of Pennsylvania, Vaughn interviewed all of the living past division chiefs, as well as dozens more faculty who, together with important philanthropic contributions, drove the division forward.
Recently, he sat down to interview Loren, his longtime colleague and new chief, to discuss her plans for the next chapter of that history.
David Vaughn: What have you learned from the division’s past chiefs that you now bring into your role?
Alison Loren: The nature of academic medicine has really changed over that 50-year timeframe. There are lessons that you can draw from each of those people but adapt them to today's culture. I didn't know Dr. Cooper, although I know he was a giant. Dr. Shattil showed a great passion for intellectual achievement.
Steve [Emerson] is a Renaissance man and he knows something about everything. He impressed on me how important it is to be broad in your thinking and appreciate the nature of our “liberal arts” hematology/oncology program. You should think about arts and humanities and not just about the science, and you should think about the whole patient and what you can bring in from other disciplines to enhance what we're doing.
Following in Lynn’s footsteps now is humbling. Not only is Lynn a strong leader, an accomplished scientist, and a wonderful doctor, but she also radiated a feeling of warmth, that this was her family. What I learned the most from her is her inclusivity and belief in a big tent. She includes staff and the teams from our satellite sites. And she treats everyone equally. I hope to continue in that tradition.
Why did you want to take on this role of chief of the division?
I view this role as an opportunity to help remove challenges and barriers for other people. Sometimes people need help clarifying their goals or understanding paths forward. I like to think that I’m somebody who can engage in those kinds of conversations to help people figure out what their wishes and dreams are.
I came to this explicitly because of the faculty and our fellows, building on my experiences as director of the Hem/Onc fellowship program for many years, and most recently as vice chair of faculty development in the Department of Medicine. We have so many phenomenal clinicians and researchers and education experts, and my job is to let them do their best work by removing as many barriers as I possibly can.
What are the benefits of having a division of Hematology/Oncology, as we have at Penn, compared to other institutions where medical oncology and hematologic malignancy, and classical hematology, are separate divisions?
It keeps us all very humble and appreciative of what we don’t know and how many wonderful experts we can tap as colleagues. And it's a good way to think more globally about how to advance the whole mission.
A lot of our peer institutions are cancer centers. They’re very focused on cancer care only, which can be great, but sometimes means that you’re not thinking about all the other things that might happen to a patient or other areas of expertise they need.
A great example is gene therapy for the hemoglobin-related disorders thalassemia and sickle cell. We are experts in gene therapy and cell therapy at Penn Medicine. We do it all the time for our cancer patients now. One of our colleagues, Dr. Farzana Sayani, established the first adult thalassemia program in the country, and it is still one of only two. She also directs the Penn Comprehensive Sickle Cell Program. Kids who are born with these serious blood disorders are largely cared for at pediatric centers, like Children’s Hospital of Philadelphia (CHOP). We now have a fairly large population of thalassemia patients who are adults, who are aging out of CHOP. Now there are newly approved cellular gene therapies for these blood disorders. As a leader in creating and treating cancer patients with cellular and gene therapies, we are ready for that. We’re going to be the first adult thalassemia gene therapy program to open in the country because we know how to do this.
Let's talk about the Pavilion, our new inpatient hospital which opened in October 2021. How has it impacted inpatient care?
The physical environment has improved. The rooms are absolutely stunning. And I really think that that enhances patients’ well-being — they don't mind being in the hospital quite as much. It’s a very patient-friendly environment. Patients can see the names, photos, and job roles of the care team on their giant flat-screen TVs and are always oriented to who's in the room and what the plans are for the day. I also appreciate that we have a dedicated cancer ICU that is right next to our blood cancer and bone marrow transplant / cellular therapy unit, where patients sometimes become very ill. The fact that we can have them go right down the hall to the ICU and right back gives us a lot of opportunity to interact with our critical care colleagues and makes their care more seamless.
How do you plan to promote the values of diversity, equity, and inclusion within the division?
The most important thing is having fellows and physicians and staff and nurses and advanced practice providers (APPs) who represent the diversity of our community. And I'll be honest, we are a ways from that, particularly for physicians from backgrounds underrepresented in medicine (UIM). Nationally, the percentage of UIM racial and ethnic minorities in hematology/oncology is lower even than other specialties. Our division’s efforts to improve diversity are led by our vice chief for DEI, Dr. Yehoda Martei. Under her leadership, we have implemented several programs to introduce high school, college, and medical students from under-represented backgrounds to our specialty. We hope that by enriching the pipeline of trainees with diverse backgrounds, we will ultimately see better representation among our faculty ranks.
Focusing on our care for marginalized patients in need is really important, too. Within classical hematology, especially, sickle cell anemia is a devastating health issue that is especially common among Black patients. We know that patients with sickle cell disease do better when they are cared for in a comprehensive sickle cell center. There are several FDA-approved drugs to reduce complications in sickle cell, and we know statistically that there are more patients with sickle cell disease in Philadelphia than are being cared for in a comprehensive sickle cell center. And so we are working on our community outreach, trying to build trust in that community
In medicine, there's a lot of talk about physician burnout. The COVID-19 pandemic in particular was really such a stressful period. What do you want to do to help faculty maintain their sense of enthusiasm, interest, and growth?
I think about that every day. We’re really lucky we take care of amazing patients with wonderful colleagues. We're able to offer incredible therapies and when they do well, that's incredibly rewarding. But even when they don't, most of us derive satisfaction in helping patients as fully as we can, including a transition to hospice care. We're lucky that the work is really engaging, but it also can be exhausting.
A couple of things are key to keeping people engaged, resilient, and refreshed. One is trying to be more in-person. Hybrid and virtual options are great for inclusivity; people who have commitments at home or other challenges can still participate in a conference. I like that there is that flexibility. But there's no replacement for in-person interaction. The more that we can encourage people to come to work and engage with each other in person, that's going to help.
The other important thing is teams. When you're by yourself, work can so easily feel lonely, sad, and hard. And the work that we do is difficult. But having a colleague that you can share the experiences with is huge. Having a partner with you in the clinic, regardless of their training or professional role, makes it so much more pleasant. The patients feel better cared for because they see that there is a team. Team building is a big mission for me, making sure that we have nurses and APPs so that everybody is in this “nest of care” — the patients, the doctors, the nurses. We're all in this together.
What's your vision for the future of the division? Where do you see us 10 years from now?
I believe we'll be even awesomer than we are now — we're us, but better. I envision a place where everyone is excited to come to work. We can offer the very best patient care — we are continuing to pioneer the newest advances in genetic, targeted, immune, or cellular therapy. We are actually giving these cutting-edge therapies to patients in our clinics and hospitals every day. We have all the right supports in place to provide care to every aspect of our patients and their lives — supporting them in all the right ways. We have the right staff and the right resources to provide the right care at the right time in the right place, in the best possible way. We are already doing so much of this, but we will do it even better ten years from now. We will keep recruiting the best trainees, supporting the outstanding research that's already flowing on a smooth path, being willing to take risks and make investments to move the field — and our division — forward. When I'm ready to step down, that’s how I'd like to leave things.