Latest / Becker’s Healthcare Podcast / Himalee Sabnis, MD, MSc, Pediatric Hematologist and Oncologist at the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta

Transcript

Himalee Sabnis, MD, MSc, Pediatric Hematologist and Oncologist at the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
• 0:04
  - understand what it takes to lead a health
• 0:05
  - system right now. The decisions are enormous.
• 0:08
  - The variables are constantly shifting, and the stakes
• 0:11
  - of getting a call wrong don't stay contained.
• 0:14
  - That's not a complaint. It's a structural reality.
• 0:17
  - And it's why the most effective c suite
• 0:19
  - leaders are deliberate about where do they go
• 0:21
  - to pressure test their thinking.
• 0:22
  - Becker's fourteenth annual CEO and CFO roundtable
• 0:26
  - brings together more than 1,500
• 0:28
  - executive level attendees
• 0:30
  - and nearly 400 speakers for four days built
• 0:32
  - around growth, financial sustainability,
• 0:35
  - workforce strategy, and the leadership questions that don't
• 0:38
  - have easy answers.
• 0:39
  - Join us November second through the fifth in
• 0:41
  - Chicago.
• 0:42
  - For the agenda and event details,
• 0:45
  - visit beckershospitalreview.com
• 0:47
  - and click on the events tab in the
• 0:49
  - upper right.
• 0:51
  - Welcome to the Becker's Healthcare podcast. I'm Chris
• 0:54
  - Sosa, your host. And I'm thrilled to be
• 0:55
  - joined today by doctor Hamali Sabnish, associate professor
• 0:59
  - as well as a pediatric hematologist and oncologist
• 1:02
  - at the Aflac Cancer and Blood Disorder Center
• 1:04
  - of Children's Healthcare of Atlanta. Doctor Sadness, thank
• 1:07
  - you for joining us today.
• 1:09
  - Thank you for having me. I'm very happy
• 1:12
  - to be here.
• 1:13
  - Wonderful. So, doctor Sadness, for those in our
• 1:15
  - listening audience who may not be
• 1:18
  - so familiar with yourself, would you please introduce
• 1:20
  - yourself and let us know a bit about
• 1:22
  - your background?
• 1:23
  - For sure.
• 1:24
  - So my name is Emali Sadness, and I
• 1:26
  - am a pediatric hematologist
• 1:28
  - and oncologist.
• 1:29
  - And actually my journey to this field has
• 1:31
  - been a bit of a journey across the
• 1:33
  - world.
• 1:34
  - I first grew up in Mumbai, India in
• 1:37
  - a family of doctors and scientists.
• 1:39
  - And it was really the curiosity to learn
• 1:42
  - more about research,
• 1:44
  - that brought me here to The US.
• 1:46
  - And I first completed a master's in biomedical
• 1:49
  - sciences at SUNY Albany
• 1:51
  - in Upstate New York And then followed up
• 1:53
  - with a residency in pediatrics at Children's Michigan
• 1:56
  - in Detroit.
• 1:58
  - And that's really where I discovered that there
• 2:01
  - was one field that really brought two of
• 2:03
  - my favorite interests together.
• 2:05
  - And that was pediatric oncology because it brought
• 2:08
  - pediatrics,
• 2:09
  - which is something that I've truly loved.
• 2:11
  - And,
• 2:12
  - the understanding for scientific research in one's
• 2:16
  - one field.
• 2:17
  - And so that led me to my fellowship
• 2:19
  - at Children's Atlanta and at Emory University where
• 2:22
  - I completed it the fellowship in pediatric hematology
• 2:25
  - and oncology.
• 2:27
  - And I now serve as the clinical director
• 2:29
  - of one of the largest pediatric
• 2:31
  - leukemia and lymphoma programs in the country.
• 2:34
  - Leukemia, as many people are aware, is a
• 2:36
  - common cancer in children. And though we cure
• 2:38
  - many, we still have a long way to
• 2:40
  - go before we say 100% cure is available.
• 2:45
  - Thank you, doctor Souda. So, yes, on today's
• 2:47
  - podcast, you're here to discuss,
• 2:50
  - all the work that Children's Healthcare Atlanta has
• 2:52
  - been doing with leukemia and lymphoma.
• 2:55
  - So along those lines, could you let us
• 2:57
  - know what does it take exactly to build
• 2:59
  - and sustain collaboration and program like this that
• 3:02
  - assembles such a varied expertise?
• 3:04
  - And what would you say is the hardest
• 3:05
  - part? I know it's a lot. So so
• 3:07
  - take that. You know?
• 3:09
  - Yeah.
• 3:09
  - For sure. So the high risk leukemia program,
• 3:12
  - high risk leukemia and lymphoma program actually at
• 3:15
  - Children's Atlanta
• 3:17
  - was started in
• 3:18
  - February 2020.
• 3:20
  - And as you can imagine, we were not
• 3:22
  - prepared for what was to follow after because
• 3:24
  - that was right the timing could not have
• 3:26
  - been worse right before the global pandemic.
• 3:29
  - But I think,
• 3:31
  - when we started it, we had a very
• 3:33
  - simple vision
• 3:34
  - and that was to really improve the quality
• 3:36
  - of care we provided to patients
• 3:39
  - and families of what we call high risk
• 3:42
  - leukemia and lymphoma. So let me define that
• 3:44
  - term a little bit because viewers may not
• 3:46
  - know that. So patients typically with leukemia and
• 3:49
  - lymphoma, especially in pediatrics,
• 3:52
  - get treated with chemotherapy.
• 3:54
  - And chemotherapy
• 3:55
  - is typically the
• 3:57
  - is, early or the first, avenue for treatment.
• 4:00
  - However, there are some patients where that is
• 4:03
  - not enough.
• 4:04
  - And the treatment
• 4:05
  - gets a lot harder and that often involves
• 4:08
  - what we call a stem cell transplant,
• 4:11
  - commonly sometimes referred to as a bone marrow
• 4:13
  - transplant,
• 4:15
  - or what we see more recently immunotherapy
• 4:18
  - or immunotherapy
• 4:20
  - approaches to treat this cancer.
• 4:22
  - So high risk patients are basically patients that
• 4:25
  - need more than chemotherapy alone to get their
• 4:28
  - cure.
• 4:30
  - So at the time of the inception of
• 4:32
  - this program,
• 4:33
  - we decided that the best way to actually
• 4:36
  - coordinate and collaborate on care was to get
• 4:38
  - the experts
• 4:39
  - of,
• 4:40
  - who specialized in leukemia lymphoma along with the
• 4:44
  - stem cell transplant experts and to start a
• 4:47
  - conversation
• 4:48
  - to help,
• 4:49
  - bridge any gaps that we see in care.
• 4:51
  - And so this began as a weekly discussion,
• 4:54
  - that we would meet
• 4:56
  - once a week for an hour and go
• 4:58
  - over any patients that required this coordination.
• 5:02
  - So now it's important to remember that when
• 5:04
  - we started this, we are really the first
• 5:06
  - of its kind in the Southeast. There was
• 5:09
  - no other program that did this in the
• 5:11
  - Southeast, and we were the only the second
• 5:13
  - program in the country
• 5:15
  - doing this at that time. So there wasn't
• 5:17
  - a lot of precedence.
• 5:19
  - So as we started building the program, we
• 5:22
  - started learning a few things. And one of
• 5:24
  - our early lessons was that, one, this program
• 5:27
  - was definitely needed,
• 5:29
  - and two, that administrative
• 5:31
  - support was key.
• 5:32
  - So initially, in the first two years, once
• 5:35
  - we established the need of the program, we
• 5:37
  - reached out to other experts
• 5:39
  - beyond leukemia and lymphoma and beyond stem cell
• 5:42
  - transplant,
• 5:43
  - and this included
• 5:45
  - experts in the field of cancer predisposition.
• 5:49
  - Those, that understand why certain kids get cancer
• 5:52
  - and whether there's any genetic causes for them.
• 5:55
  - We reached out to genetic counselors,
• 5:58
  - infectious disease experts who specialize in infectious disease
• 6:02
  - management in patients with leukemia lymphoma
• 6:05
  - and also immune oncology experts which was also
• 6:08
  - a very developing
• 6:10
  - field at that time. And everyone we reached
• 6:12
  - out to was really excited to be part
• 6:14
  - of the effort so that really helped our
• 6:16
  - cause.
• 6:17
  - And then
• 6:18
  - finally, two years into this, we were able
• 6:20
  - to
• 6:21
  - show enough data and show enough,
• 6:24
  - output
• 6:25
  - that we were able to speak to children's
• 6:27
  - leadership, and we were very thankful for them
• 6:29
  - to
• 6:30
  - join our efforts and let us hire a
• 6:32
  - program coordinator for the high risk programs. So
• 6:35
  - that person is key because they manage the
• 6:38
  - operations of this program, but also
• 6:41
  - take care of outreach, education, and research opportunities.
• 6:46
  - So you're asking what was the hardest part
• 6:48
  - of this all. So it's, now that it's
• 6:50
  - been almost six years of doing this, I
• 6:52
  - look back and I think I I really
• 6:54
  - think it's the time and the effort
• 6:57
  - because it's
• 6:58
  - it you do require time and understanding of
• 7:01
  - the field to be able to get in
• 7:02
  - the right people and the right minds,
• 7:05
  - but also you need to think about what
• 7:07
  - comes next because the field is constantly evolving
• 7:09
  - and it's changing.
• 7:11
  - So if you put your mind in to
• 7:14
  - figure out what comes next, it helps you
• 7:16
  - kind of plan for it in the best
• 7:18
  - frame of, mind.
• 7:21
  - For sure. So, doctor, you mentioned the
• 7:24
  - supportive
• 7:25
  - administration certainly being key elements of all this.
• 7:27
  - So
• 7:28
  - in addition to that, what would you say
• 7:30
  - are the mechanisms that Children's has in place
• 7:34
  - to make removing barriers to access a real
• 7:36
  - operational commitment? Because it it takes a lot
• 7:38
  - as you mentioned.
• 7:40
  - Yes. And we are very thankful for,
• 7:43
  - all the support that children's,
• 7:45
  - health care of Atlanta has provided to this
• 7:47
  - program because like I said, it's unique.
• 7:50
  - And initially, we really focused on bringing state
• 7:53
  - of the art leukemia therapies
• 7:56
  - and care to all children, adolescents, and even
• 7:58
  - young adults. We actually take care of a
• 8:00
  - fair bit of young adults, and this was
• 8:03
  - mainly within Georgia.
• 8:04
  - So in terms of support from the leadership
• 8:08
  - at Children's,
• 8:09
  - we still continue to have our weekly conferences,
• 8:12
  - but now we've expanded to allowing
• 8:15
  - physicians
• 8:16
  - to call in from other facilities within Georgia
• 8:19
  - with questions.
• 8:20
  - And they are able to get consults and
• 8:22
  - information
• 8:24
  - regarding treatment decisions for their patients quickly and
• 8:27
  - efficiently.
• 8:28
  - We've also expanded now via telehealth so that
• 8:32
  - our experts are able to provide resources such
• 8:35
  - as genetic testing,
• 8:37
  - counseling,
• 8:38
  - and we within the Aflac Cancer Center have
• 8:41
  - a comprehensive
• 8:42
  - precision medicine program that we are now able
• 8:45
  - to offer to these patients that are being
• 8:48
  - treated outside of children's.
• 8:51
  - This in all has actually facilitated conversations
• 8:55
  - between us
• 8:56
  - and patients and families
• 8:58
  - because they are able to reach out to
• 8:59
  - us and actually get what we call a
• 9:01
  - second opinion or a consult
• 9:03
  - with one of our experts,
• 9:05
  - and they're able to get all their questions
• 9:07
  - answered without actually having to travel to children's.
• 9:11
  - This year, we are planning
• 9:13
  - a big outreach visit program. So we're actually
• 9:16
  - going out to meet several regional pediatric centers
• 9:20
  - who refer their patients to us, and our
• 9:22
  - aim is to really enhance our collaboration,
• 9:25
  - but more importantly,
• 9:26
  - gather feedback on how children's can further strengthen
• 9:30
  - access
• 9:31
  - to all the children in the state.
• 9:33
  - I will mention that we at Children's have
• 9:36
  - the unique,
• 9:38
  - position because
• 9:39
  - while chemotherapy is given to pediatric
• 9:42
  - cancer, and
• 9:44
  - blood disorder children across the state,
• 9:46
  - we are the only place that offers stem
• 9:49
  - cell transplant,
• 9:50
  - which means a child who's diagnosed in Savannah
• 9:52
  - or Macon or Augusta
• 9:54
  - still comes to our center for that extra
• 9:57
  - level of care.
• 9:58
  - And so while we may not be initially
• 10:01
  - involved in their chemotherapy
• 10:03
  - decisions, we get very intricately involved in their
• 10:06
  - stem cell transplant and post transplant therapies.
• 10:10
  - And I always say this, but it sounds
• 10:12
  - like a cliche now, but we always remember
• 10:15
  - with great power comes great responsibility.
• 10:18
  - And I think we are fortunate at children's
• 10:20
  - to have the access
• 10:22
  - to these cutting edge technologies and diagnostics
• 10:25
  - and therapies,
• 10:26
  - but then we carry the responsibility of sharing
• 10:28
  - that with all.
• 10:30
  - That that's a great message, certainly, doctor. And,
• 10:32
  - I will always appreciate a superhero slash Spider
• 10:35
  - Man reference
• 10:36
  - in our podcast.
• 10:39
  - In all serious, you mentioned, how
• 10:41
  - the program is
• 10:43
  - expanding. So how many states right now are
• 10:46
  - represented in in those who you're able to
• 10:48
  - consult with?
• 10:49
  - So we do have some limitations
• 10:52
  - in terms of who we can consult directly
• 10:54
  - based on the state health laws.
• 10:57
  - So we have three other programs within the
• 11:00
  - state. One, pediatric oncology programs that those are
• 11:04
  - the ones in Savannah, Augusta, and Macon. So
• 11:06
  - they form our big referral center. But outside
• 11:09
  - the state, we actually get consults from, patients
• 11:14
  - who live in Georgia but actually receive their
• 11:16
  - care at Chattanooga,
• 11:18
  - because it's physically just closer than driving all
• 11:21
  - the way down to Atlanta. So we have
• 11:23
  - a fair bit of patients from there. And
• 11:25
  - as this program has grown, we've actually gotten
• 11:28
  - consults from,
• 11:29
  - physicians and patients outside the state. And so
• 11:33
  - while we have to limit ourselves in terms
• 11:36
  - of,
• 11:37
  - direct consults with patients out of state, we
• 11:39
  - are able to provide some degree of guidance
• 11:42
  - that can help the physician who's calling in
• 11:45
  - to make treatment decisions. And this extends to
• 11:47
  - South Carolina, Florida,
• 11:49
  - Mississippi, and Louisiana.
• 11:52
  - That's fantastic. I'm glad the expertise is making
• 11:54
  - its way radiating outside of Atlanta to to
• 11:57
  - other patients and families who need it.
• 11:59
  - So, doctor, when
• 12:01
  - once you have the team together, which it's
• 12:04
  - taken a long time, I'm sure. You said
• 12:05
  - you're six inches into this program right now.
• 12:08
  - So once you have the team together, how
• 12:10
  - do you go about communicating
• 12:13
  - complex high risk diagnosis to the families,
• 12:16
  - and how has your approach to all this
• 12:17
  - evolved?
• 12:19
  - So,
• 12:19
  - leukemia is unique in terms of,
• 12:22
  - pediatric oncology, and I say that because
• 12:25
  - it is the most common cancer
• 12:27
  - in children.
• 12:28
  - However, we it's also a place where we've
• 12:31
  - seen tremendous progress.
• 12:33
  - So it is incredibly
• 12:34
  - rewarding to be a part of a field
• 12:36
  - that's constantly evolving and is giving higher and
• 12:39
  - higher cure rates.
• 12:40
  - But at the same time, one of the
• 12:42
  - things that I always remember and teach my
• 12:44
  - team is that when you sit across and
• 12:47
  - talk to a family with
• 12:49
  - telling them that their child has either a
• 12:51
  - leukemia or a lymphoma,
• 12:53
  - all the knowledge that you have, the cancer
• 12:55
  - and the medical knowledge and the research, really
• 12:58
  - becomes very personal.
• 13:00
  - Because at that point, you're helping a family
• 13:03
  - understand something that they'd really never imagined having
• 13:05
  - to face.
• 13:07
  - And so every family is different. Every family
• 13:10
  - comes from a different background. So I think
• 13:12
  - the biggest lesson that we learn from that
• 13:15
  - is to be able to explain things to
• 13:18
  - families where they are able to understand it.
• 13:21
  - Because one of the biggest,
• 13:23
  - fallbacks or
• 13:25
  - problems I see in medicine
• 13:27
  - is we have really smart people doing really
• 13:30
  - great jobs.
• 13:31
  - But unless you're able to explain or under
• 13:34
  - make the family understand,
• 13:36
  - it's kind of pointless because they have to
• 13:39
  - be equal partners in this journey.
• 13:41
  - The other thing that I really love
• 13:44
  - about pediatric oncology, it's not just the medicine.
• 13:47
  - The science is fascinating, and I love the
• 13:49
  - research and all the advances,
• 13:51
  - but it's also the human side. So one
• 13:53
  - of the things we always talk within our
• 13:56
  - team is that it's very important that we
• 13:58
  - own a family's trust, and we don't take
• 14:00
  - that lightly.
• 14:02
  - We support them through a lot of
• 14:04
  - uncertainty. There's certainly good days and there's certainly
• 14:07
  - terrible days,
• 14:08
  - but then just being there on those difficult
• 14:11
  - days matters most to them. And I have
• 14:13
  - had several families who come back later and
• 14:16
  - thank us, and everyone is very grateful because
• 14:20
  - they are entrusting us with the most precious
• 14:22
  - thing they have.
• 14:23
  - But remembering that no matter how long you
• 14:26
  - do this, I've been doing this for fifteen
• 14:27
  - years. But every single day, I go with
• 14:30
  - the fact and the thought that what I
• 14:32
  - say is new to someone hearing it for
• 14:34
  - the first time.
• 14:37
  - That's certainly very important to bridge that gap
• 14:40
  - between knowledge
• 14:42
  - on the end of the physicians and the
• 14:44
  - care team and the patients, and that that's
• 14:46
  - always evolving too. So I'm glad that all
• 14:48
  - of you are thinking about this in, you
• 14:50
  - know, great detail.
• 14:52
  - So speaking of communication,
• 14:54
  - so if you were
• 14:56
  - now that you have the program built over
• 14:58
  - six years, obviously, you're not done. You still
• 15:00
  - have a lot a long ways to go.
• 15:01
  - It's I would I would imagine. But now
• 15:04
  - that you do have this program established, so
• 15:06
  - if you were to advise
• 15:08
  - other programs, other health system leaders, say they're
• 15:10
  - building some sort of high acuity, multidisciplinary
• 15:13
  - program, can be oncology, can be any other
• 15:16
  - specialty, what are two or three things that
• 15:18
  - you want them to consider that are essential?
• 15:22
  - So I think a few lessons we've learned
• 15:25
  - along the way. The first one is having
• 15:27
  - a shared vision. When we started this in
• 15:30
  - 2020,
• 15:31
  - it was, like I told you, a very
• 15:32
  - simple vision. Just we need to do better.
• 15:35
  - Something is not being done quite right,
• 15:38
  - and we need to have that shared vision
• 15:40
  - between leaders who can then see that this
• 15:42
  - is the right thing to do for, for
• 15:44
  - patients at that time.
• 15:46
  - I think the second thing that you have
• 15:48
  - to remember is that as a leader, you
• 15:50
  - have to be willing to put the hard
• 15:52
  - work in yourself first.
• 15:55
  - We flew solo for, like, really two years
• 15:58
  - without any administrative support partly because
• 16:01
  - for us to be able to go to
• 16:03
  - children's leadership and tell them, hey. This is
• 16:05
  - what we need. We needed to get that
• 16:07
  - information first.
• 16:08
  - And especially for programs that don't have a
• 16:11
  - lot of precedence,
• 16:13
  - that's a hard thing to do because you
• 16:15
  - need to really believe in it to then
• 16:17
  - put the hard work, to then show the
• 16:19
  - merit to be able to get the support
• 16:21
  - you need.
• 16:23
  - And at the end of the day, in
• 16:25
  - pediatric oncology
• 16:27
  - specifically,
• 16:28
  - but also for any field in medicine,
• 16:31
  - one of my mentors always taught me that
• 16:33
  - it's always remember you have to do what's
• 16:35
  - right for the patient. And in our case,
• 16:37
  - we have to do what's right for the
• 16:38
  - kids.
• 16:39
  - And so the kids
• 16:41
  - remain our biggest inspiration.
• 16:43
  - They have a tremendous resilient spirit and the
• 16:46
  - ability to find joy in the worst circumstances,
• 16:49
  - and that helps us do our job because
• 16:52
  - it is not easy on a day to
• 16:53
  - day basis.
• 16:54
  - But remembering to do what's right for them
• 16:57
  - keeps us going the long distance.
• 17:01
  - We can certainly learn a lot from the
• 17:03
  - smallest patients among us, doctor Sandis.
• 17:05
  - Thank you so much for being on the
• 17:06
  - podcast today and sharing
• 17:08
  - all the the progress that has been made
• 17:10
  - at the high risk leukemia and lymphoma program
• 17:13
  - down at Children's Healthcare of Atlanta. It's been
• 17:15
  - a pleasure having you on, doctor.
• 17:17
  - Thank you so much. I'm happy that I
• 17:19
  - was here.