Maie St. John, MD, PhD, a renowned surgeon, scientist and educator, is the Samuel and Della Pearlman Chair in Head and Neck Surgery and co-director of the UCLA Head and Neck Cancer Program.
You joined the UCLA faculty after completing your residency in otolaryngology here in 2005, and you were named chair of the Department of Head and Neck Surgery in January 2018. You have had many years to observe this department. How do you assess its strengths?
In many ways, UCLA was the birthplace of this field, and it is my privilege to be a part of this great legacy. Dr. Paul Ward, who was the chair from 1968 to 1991, built a legacy of head and neck surgery beyond otolaryngology. Then, Dr. Gerald Berke stewarded the ship to where it is now — a top program of excellence in research, patient care and education, and a Mecca for people coming to be trained. I am humbled and thrilled to be in this position, and if I have learned anything, it’s been by standing on the shoulders of giants. I often liken this department to Michelangelo’s David. When Michelangelo was asked how he created David, he said it was all in the marble. Here it’s the same — it’s UCLA and the individuals in our department with their creativity and commitment to patients that allow us to create an outstanding team.
What is your vision for the future?
We want this to be the top head and neck surgery department in the world, and to work with international partners to shape the future of otolaryngology. I think the two main pillars for the future will be innovation and collaboration. We want to establish an innovation ecosystem. This will provide a space for the best and brightest who come to UCLA — students, residents, fellows and faculty — to think creatively about how we are going to change practice or change therapies to ensure a better future for all of our patients and our community. We are seeing that same vision throughout our health system, where people are being encouraged to think about and pursue trans-disciplinary approaches to real-life problems.
What would be an example of this?
One of my patients was a 32-year-old female who developed a tongue cancer. When she and her husband came into my office, they asked me two very salient and poignant questions. The first was how much of her tongue I was going to need to resect, and the second was how would I know that we have removed the entire cancer. With our current care approaches and knowledge, we can answer those questions, but the truth is we could still do a better job. The morning I was coming to the hospital to operate on her, I was backing my car out of my driveway and it started beeping as I approached the front hedges. That started me thinking. When we are operating, we use our clinical judgment, our vision and our tactile senses to ensure complete and adequate resection of tumors. But if my car can tell me when I’m near something more dense — and we know that biologically a cancer cell is different from a normal cell — why can’t we harness technology to come up with a tool that can query how far we are from the cancer in real time in the operating room? And so, after I operated on that patient, I went over to the engineering school and signed up to give a lunchtime seminar where I presented our clinical needs. That was the beginning of the development of a camera that can see cancer cells intraoperatively so that we can resect all of the cancer tissues and preserve all of the surrounding normal tissues. I wanted to get better answers for patients by working with our team in my research laboratory. This is the kind of environment we have at UCLA — a wide range of experts, all working in close proximity in an atmosphere where there is that “eureka” spirit, with the sense that anything is possible if we innovate together to make it happen for the sake of the patient.
How does that collaborative spirit translate to the clinical arena?
I have a dear friend who traveled around the country seeking opinions for the care of his cancer, and he told me that one surgeon would give an opinion and three weeks later he would get another opinion from an oncologist and a week after that he would get a different opinion from the radiation doctors. It made him wonder if they were working together to come up with what’s best for him. At UCLA, we started our multidisciplinary Head and Neck Cancer Program with patients in mind. Many of them travel here from far away, and so one afternoon we set up a high-level discussion designed to reach a consensus on the care the patient should receive. The patient is then seen in the clinic by all of our specialists together. That discussion includes not just surgery, but also clinical trials and other approaches, and it includes the voice of the patient.
Patient-centered care is obviously a top priority for you and the department.
Absolutely. I believe that if we take care of the patients, everything else takes care of itself. So many of us were motivated to go into medicine by our desire to care for the person in front of us, and as long as we remind ourselves of that, whether it’s thinking about innovation, compassion or personalized medicine, we will do our best. I want UCLA to be a place where patients know that we care at every level, and that we offer only the treatment we would offer to members of our own families.
There are more than a half-million people in the U.S. who have survived head and neck cancers, and that number is sure to grow as long-term survival continues to become more common. To better address the needs of these patients, UCLA has established the Head and Neck Cancer Survivorship Program.
Dinesh Chhetri, MD, a professor in UCLA’s Department of Head and Neck Surgery and director of the survivorship program, notes that many complications and side effects can arise after completion of treatment for a head and neck cancer. “Our systems have been focused on cancer treatment and surveillance, but not as much on management of complications and side effects, as well as patients’ psychological adjustment, after their initial cancer treatment,” Dr. Chhetri says.
Patients in the Head and Neck Cancer Survivorship Program receive a comprehensive evaluation of their needs, and then are directed to appropriate resources for symptom management and psychosocial support, including treatment for swallowing problems, pain management, nutrition counseling, physical therapy and counseling services, Dr. Chhetri explains. In addition to individual clinical encounters, survivors are invited to attend support groups and educational seminars.
“When patients are being treated for a head and neck cancer, their focus is on their survival; they’re not typically thinking about what happens after the cancer has been successfully treated,” Dr. Chhetri says. “We need to pay more attention to how these patients can have the best possible quality of life as cancer survivors. Our goal is to assist and empower patients to maintain a robust life long after their cancer treatment.”