Dr. Joseph Connors is an author on more than 400 peer-reviewed scientific articles and for, the past three years, has been named one of the World's Most Influential Scientific Minds; his publications have been cited by other researchers more than 60,000 times.
Following graduation from Stanford in 1981, he started his career with BC Cancer and never left. In 1986, he became Head of BC Cancer's Lymphoma Tumour Group and then Clinical Director of the Centre for Lymphoid Cancer in 2000.
Most recently, he published in New England Journal of Medicine the results of an international clinical trial he led that revealed a promising new combination treatment for patients with advanced Hodgkin lymphoma — the biggest advance for these patients in almost 30 years.
He is now retiring from clinical practice. Here are a few of his thoughts on his time with BC Cancer and on the future of oncology.
What's been the focus of your work at BC Cancer?
I've chose to have a fairly clear focus over the time that I've been here: lymphoid cancers – cancers that develop in lymphocytes, which are the cells that make up our immune system. They're a unique set of diseases that already had reasonably good treatments when I started my career, though we have considerably better treatments today. I've seen outcomes get better for patients, and our understanding of their biology has improved substantially. I think we're poised now to make even bigger strides over the next few years. I'm excited for the next generation of cancer scientists and clinicians.
How has oncology changed during the course of your time with BC Cancer?
By the 1980s considerable progress had been made in defining individual types of cancer and developing some types of treatments, including chemotherapy and radiation therapy, to maximize benefits and minimize toxicity. But, in retrospect, I think we were rather naïve at the time in terms of what we thought was going to result from continued application of what had worked in the past. There was still only a rudimentary understanding of cancer and how cells change to become malignant. The tools of genomic sequencing and detailed characterization of the molecular biology of lymphoma only became available in the 1990s and 2000s. In the 1980s we had 20 or 30 drugs, most of which had non-specific off-target effects with some good effects on cancer. Today we have in excess of 200 different drugs and many of those, especially those developed in the last five to 10 years, are much more targeted. They have bumped up effectiveness and they have reduced off-target toxicity.
What's your perspective of oncology going forward: do you see cancer becoming a manageable disease?
I think that having once grossly underestimated the difficulty of treating cancer, we should be cautious about how overly optimistic we might become. I don't think we will ever have a single or simple solution to cancer. What we will have are better ways to detect it earlier, at times when interventions can be more meaningful, and we will have better interventions that are more selective and less toxic. We will slowly increase the number of cancers that can be cured outright, even when widely metastatic. I think we will continue to see incremental steps. Oncology is very different today than it was 20 years ago and it will be even more different 20 years from now than what it is today.
What do you see as the most pressing problem for oncology today?
Almost all of the diseases I treated regularly 30 years ago or more, I did so at the cost of several thousand dollars. Those exact same diseases treated at today's best standards can easily consume hundreds of thousands of dollars. That has occurred because we have quite sensibly built a machine that rewards invention and discovery. The reward is patent protection and exclusive ownership of novel interventions. We gave that tool to corporations and they have behaved rationally and realistically as entities with one single job: maximize profits. The problem, of course, is that this can lead to an outcome that is antithetical to what society needs. Now we need to figure out a way to put the genie back in the bottle. We should not change things so drastically that we discourage invention and discovery, because there's a lot left to be discovered and invented, but we need to bring this back under control. We cannot spend a million dollars on every cancer patient, but we are currently on that trajectory. We are on a collision between what society needs and what patients need. We have to fix that.
Is there something from your time with BC Cancer that you are most proud of?
Every oncologist remembers those special cases where the grimmest of prognoses appeared to be present and we were able to save a patient from inevitable illness and death. That's always gratifying.
It's also been gratifying to work here in B.C. and Canada, because there is a firm commitment to delivering equivalently good health care to everybody. That poses economic challenges to the country and the province: we live in a very big place with an asymmetrically distributed population — we have large rural areas with very few people and a few urban centres with most of the people. We would be neglectful of our responsibility to the whole population if we didn't figure out a way to reach out to the whole population and provide them with excellent care. We would also be remiss in constructing a system for the participation in cancer research for individual patients not also being distributed across the province. So, one of the projects that I worked hard on for years, that I'm quite pleased with the outcome of, is that we figured out a way to do that for B.C. We now offer the opportunity to contribute to and participate in ongoing translational research to patients in the very northern most and very eastern most reaches of the province. We haven't got it perfect, but we've done a pretty good job.
I think we've also done a good job of keeping track of what we've done so that we are constantly learning from our experience. We've done that by building a comprehensive database that allows us to look at experiences and translate actual outcomes in ways that allow us to modify treatment policies and to try to optimize them in the future. Building that kind of a system has been a real learning experience and it's built a wonderful platform for conducting research.
Can you offer any advice to young oncologists: what do you wish you would have known when you were first starting your career?
Do not underestimate the challenges inherent to the task. There is no more complicated biological phenomenon than the evolution of malignant behaviour in multicellular organisms.
And remember, clinicians, that although you work in a world of bad news, you're not the cause of that bad news. You're part of making available to people the best mechanisms for coping with that bad news. You are going to take care of people that do not do well. You are going to see people in whom the best approaches fail. You have to help people through that crisis by staying in touch with them and understanding their experience. But you have to leave it at work. Go home and have your own separate life. You have to learn to compartmentalize effectively. You cannot do this job well if you lose your capacity to be empathetic with your patients. You cannot do it well in the long run if that distorts what happens in your personal life. You have to figure out a way to accomplish that.
What will you miss the most about BC Cancer?
I already miss taking care of patients. I will miss being invited into the lives of all different kinds of people. I've looked after criminals. I've looked after CEOs. I've looked after the folks struggling at the lowest echelons of society and I've looked after very rich people. Very few of those people would have ever invited me into their life if they weren't forced to come and see me because of cancer. And meeting those varieties of people has been a wonderful privilege.
BC Cancer has been a good place to work. The people who work at a cancer centre are a special set and it's been a real privilege to work with them. I very much appreciate the opportunity that B.C. and BC Cancer has provided me personally and professionally. I'm quite grateful for that. I wish everybody well.