Week 6 (Justin) - Final reflections

It's hard to believe that the clinical immersion has come to an end! This has definitely been an incredible experience that I will carry with me for a long time. When I first arrived in NYC, I was excited to learn about the technical aspects of radiation oncology--the complex biology of solid tumors, the physics underlying the design of radiation treatment fields, and the engineering of the machines built to deliver these treatments. By shadowing Dr. Marciscano and the other clinicians in the department, I succeeded in learning about all of these things. Beyond the technical side of medicine, however, I was pleasantly surprised to find that a significant amount of my learning was also focused on the human side of medicine. How do you convince a patient with curable disease to undergo cancer treatment when they are clinically depressed and seemingly ready to give up? How do you make a patient feel confident about the team of surgeons, medical oncologists, and radiation oncologists working on their case? How do you break the news to a patient for which all treatment options have failed, and the only course of action left is palliative care to ease the patient's pain? Physicians must possess the technical know-how to make the best clinical decision for their patients, but must also display an immense capacity for empathy and compassion to guide their patients along their treatment journeys. 

Importantly, this shadowing experience has also shown me how doctors approach problem-solving in the clinic. After spending many years working in a lab, it was refreshing to be exposed to a different type of complex problem that requires equally complex solutions. I found that a clinician's day is never boring; though there may be some patients that have textbook diagnoses with known cookie-cutter solutions, there are always several patients that come in with a unique set of circumstances that have never been seen before. I've come to realize that physicians, scientists, and engineers are all trained to think in different ways to solve a different type of problem. It is this diversity in thought and training that makes collaborations between these three groups of people so powerful and necessary in order to solve medicine's greatest challenges.

On the research front, I was unfortunately unable to carry out any actual experiments due to certain logistical delays in the lab and some unforeseen circumstances on my part. Nonetheless, spending a part of the past 6 weeks in the Marciscano Lab exposed me to the many fascinating research initiatives in radiobiology and anti-tumor immunity. In particular, I found that radiation oncology research has a lot more overlap with my research interests than I expected. Despite how commonly radiation is used in the clinic, there is surprisingly little known about the specific mechanisms by which radiation modulates cell-cell interactions. Many researchers at Weill Cornell are starting to tease apart tumor-immune reactions through an immunology approach, which typically involves multi-omics analyses to identify specific immune cell subsets that change the levels of specific cytokines, chemokines, or immune receptors in response to radiation. Though we are learning quite a lot from these studies, I think it would also be very interesting to investigate how radiation affects cell-cell interactions through the lens of a biophysicist and bioengineer. Are there observable patterns to how radiation damage impacts the surfaces of tumor and resident immune cells, including expression and transport of surface receptors and glycoproteins? How does radiation impact the physical and chemical composition of the tumor microenvironment to affect immune cell penetration in solid tumors? Are there ways to manipulate cell-cell interactions to make tumors more sensitive to radiation damage? 

I am immensely grateful to everyone who played a role in organizing this program and for being able to take part in such a unique experience. I am also extremely thankful to Dr. Marciscano for hosting me and being a fantastic mentor, along with the other radiation oncologists that I shadowed, including Dr. Ng, Dr. Knisely, Dr. Sanfilippo, Dr. Golden, and Dr. Cardenes. Until next time!