When beginning a mentor/mentee relationship, Linda Hasunuma, PhD, has several tips in mind for both parties to get the most rewarding experience.

“Even though there are different kinds of mentoring for research or teaching, establishing a relationship in which the mentee can feel that they can share what their goals are is important. Sometimes the goals might diverge from what the faculty member wants or has been trained to draw out from the mentee,” Hasunuma, an assistant director at the Center of Advancement of Teaching at Temple University in Philadelphia, Pennsylvania, said. “People may have different paths and good personal reasons for those different paths. It’s just about mutual respect and cultural respect as well.”

Hasunuma and Emtinan Alqurashi, EdD, assistant director of online and digital learning, Center for the Advancement of Teaching at Temple University, led a workshop during the 5th Annual Synergistic Partnership for Enhancing Equity in Cancer Health (SPEECH) conference about mentorship, which was intended to address the lack of formal training and preparation for faculty mentors. The conference was held May 18, 2023, in partnership with Temple University, Fox Chase Cancer Center, and Hunter College.

During the workshop, attendees reflected on the essence of good mentoring, which was agreed to be centered around care, trust, and respect. Hasunuma mentioned that consistent and regular communication is essential to tailoring a mentoring approach that meets the unique needs and goals of each mentee, emphasizing that successful mentorship in the medical field or any other field requires personalization and understanding each individual identity and lived experiences.

™, Hasunuma highlighted the importance of empathy and support as it relates to mentorship, as well as advice for establishing a successful fellowship program and communication strategies.

: What was the rationale behind developing a mentorship workshop?

Hasunuma: Mentoring is something that faculty do as part of their jobs, but there isn’t any formal training, preparation, or guidance about mentoring. We’re expected to do it through our teaching and advising in our role, but we don’t reflect on the experience. When [we were discussing] the workshop, it was about being intentional, thoughtful, and thinking about what it means to be an effective mentor, and to also consider our different identities.

A lot of the ideas about mentoring, like other things in academia, are based on certain hierarchical relationships. It’s thinking intentionally about how we build trust and community and more authentic relationships, and keeping in mind our intersecting identities of the faculty member and the students.

How do you tailor your mentoring approach to meet the unique needs and goals of your mentees?

One needs to have consistent regular communication and build that relationship over time. It’s not just about your professional goals, but getting to know each other as people. It’s an investment and a commitment. That’s why there should be more incentives and recognition for the faculty who do take the time to take this very seriously. You’re not just helping them professionally, you’re coaching them about life, work-life balance, and navigating difficult situations that may come up because maybe they are a first-generation student, from an underrepresented group, or a woman.

Just having regular communication is important so that through those checkins, those issues can come up naturally. It may be helpful for both the mentor and mentee to also reflect on what they want to get out of the relationship. What are their hopes and goals?

As a mentoring physician, are there certain dimensions of mentorship that should be given more attention in the medical field than in others?

There is no one right or one easy formula or approach; personalizing it is key. Understand that some people, because of their past and lived experiences, may need more resources. Understand that that’s not a deficit. Understand and be sensitive to the fact that you may have different responsibilities, such as being a caregiver; you have children or other folks that you’re taking care of. Just get a better sense of the individual’s full self and life. Help them develop the skills needed to successfully navigate and become a professional or practitioner.

Give them opportunities to practice and develop the skills needed to publish and do research. A lot of research-based faculty tend to go for the superstar students who can help them with their research. Be mindful [and consider], “Who do I tend to recommend for fellowships and internships?” Reflect on yourself. “Am I missing or excluding anyone; are there other people I could give more practice, opportunities, and support to?”

One example you mentioned is women who become mothers and have to juggle taking care of their children while managing their career. It’s a challenge, so when you can learn from each other’s experiences, that can be important for them.

Especially for women. That is so important to our retention in the field, to be able to talk about work-life balance and parenthood. I changed my dissertation chair from a man to a woman who was a mother to children because I also became a mom in graduate school, and I needed someone to tell me that I can still do it. You will have hard days when your children are sick, and it’s OK. [It’s important to] have a role model as well as someone who was able to do it in a unique way—maybe not the traditional way—but still extremely successful and did it with a family.

What strategies do you use to supply constructive feedback for your mentees?

Good mentors are coaches; you do it in a way that the feedback is constructive and productive, and will help your mentee develop or strengthen an area. For some first-generation students like me, there are things I didn’t know. I needed someone to cue me in about networking. I knew how to be a good student, but I didn’t necessarily know how to publish. I needed more opportunities and a lot more mentoring about that. How do I submit an article or even create an abstract or proposal? How do I apply for grants? [These were] things beyond book learning and classroom learning.

Sometimes I felt like I was burdening people. There is also that fear, especially for women, women of color, or first-generation students, who think, “Maybe by asking this question, it will confirm that I don’t belong here.”

You hesitate. I’ve had some first-generation students say that they don’t want people to know they’re first generation. There are these little things, the social and cultural things, and having the confidence to know, “It’s my right to be able to go and ask these questions and go to office hours and ask for opportunities.” It’s OK to do that, and that’s what’s expected, in a way.

Articles

Linda Hasunuma, PhD, highlights the importance of empathy and support as it relates to mentorship, as well as advice for establishing a successful fellowship program and communication strategies.

Personalization Is Key to Successful Mentorship

My research in population genetics integrates genetics and large-scale electronic health record data to identify meaningful biomarkers of treatment consequences and develop algorithmic models to support clinical decision-making. Additionally, it emphasizes that genomic inequities aggravate existing health disparities and bias genetic discoveries toward more represented populations. As such, I focus on the identification of genomic biomarkers across ancestral populations with cancer. This has culminated in several high-impact publications, which include but are not limited to as follows: 

The identification of the distribution of 

 across cancer types and by sex and race. As 

 G12C mutations are important targetable drivers, this was the first comprehensive description of the prevalence of this mutation across different populations. 

Germline variant contamination has varying impacts on tumor mutational burden (TMB). 

Pembrolizumab (Keytruda) is an FDA-approved immune checkpoint inhibitor (ICI) for patients with high TMB (≥ 10 variants/megabase) based on the tumor-only sequencing panel from FoundationOne. In work published in 

 we hypothesized that because of germline variant contamination, tumor-only sequencing panels likely lead to more pronounced TMB inflation in non-European patients relative to European patients. We leveraged 3 different cohorts: The Cancer Genome Atlas, DanaFarber Cancer Institute, and Memorial Sloan Kettering Cancer Center, all of patients diagnosed with solid tumors. Results showed that tumor mutational biomarker calculation can be inflated if based on tumor-only sequencing, especially in non-European patients. They further showed that this impacts clinical outcomes among patients treated with ICIs. Similar to patients with low TMB, patients with falsely high TMB estimates have significantly worse outcomes compared with patients with true TMB-high tumors when treated with ICIs. We then went on to develop and validate a methodology to calibrate TMB derived from tumor-only sequencing platforms. This work has gained widespread recognition globally, led to invited talks at American Association for Cancer Research, Korean Society of Medical Oncology, and Tempus grand rounds, and has been highlighted in more than 10 media outlets, with several editorials published in Cancer Cell, Nature, and Nature Reviews Genetics. 

Different ancestries lead to varying dispositions. 

 interrogating germline mutations in patients with kidney cancer across different ancestries and highlighting that European and Black patients have different germline mutations that predispose them to kidney cancer. From an epigenetic standpoint, I have pioneered work that maps the epigenetic landscape of 3 subtypes of renal cell carcinoma (RCC): clear cell, chromophobe, and papillary; using different sequencing techniques to map the chromatin and transcriptional landscapes. Our team showed that the epigenome of chromophobe RCC differs from that of clear cell and papillary. Along with the team, we developed an integrated approach that identified 50 candidate histology-specific master transcription factors, which can be further leveraged to better understand RCC pathogenesis. We also leveraged a methodology based on preferential transcription of certain gene alleles, termed allelic imbalance, that can nominate and prioritize causal risk single-nucleotide polymorphisms that are likely to alter transcription factor binding sites.

Finally, I have spent many of my research efforts on underserved populations, which also spans people living with HIV (PWH). PWH are more likely to develop and/or die from cancer vs people living without HIV (PWOH). 

ICIs changed the cancer treatment paradigm, but PWH have either been excluded from clinical trials or included with stringent inclusion criteria. As such, addressing the safety and efficacy of ICIs and other systemic treatments in PWH remains of utmost importance as oncologists expand treatment options for PWH. Where trials fall short or lag behind, real-world studies present an opportunity to address knowledge gaps and guide clinical decision-making for PWH. 

Cancer Therapy using Checkpoint inhibitors in PWH-International (CATCH-IT) is an international consortium focused on the outcomes of PWH receiving ICIs. The consortium consists of 33 national and international cancer centers focused on improving the care for PWH.

In the first study from CATCH-IT, the team investigated the safety and efficacy of ICIs in 451 PWH. They showed that ICIs were safe with no unexpected adverse effects. Moreover, they showed that clinical outcomes, including overall survival and progression-free survival, were similar among PWH and PWOH. This work, now published in the

supports inclusion of PWH in ICI-based trials and motivates clinicians to offer ICIs to patients.

Nassar AH, Adib E, Kwiatkowski DJ. Distribution of KRASG12C somatic mutations across race, sex, and cancer type. N Engl J Med. 2021;384(2):185-187. doi:10.1056/NEJMc2030638 

Nassar AH, Adib E, Abou Alaiwi S, et al. Ancestry-driven recalibration of tumor mutational burden and disparate clinical outcomes in response to immune checkpoint inhibitors. Cancer Cell. 2022;40(10):1161-1172.e5. doi:10.1016/j.ccell.2022.08.022 

Abou Alaiwi S, Nassar AH, Adib E, et al. Trans-ethnic variation in germline variants of patients with renal cell carcinoma. Cell Rep. 2021;34(13):108926. doi:10.1016/j.celrep.2021.108926 

Nassar AH, Abou Alaiwi S, Baca SC, et al. Epigenomic charting and functional annotation of risk loci in renal cell carcinoma. Nat Commun. 2023;14(1):346. doi:10.1038/s41467-023-35833-5 

El Zarif T, Nassar AH, Adib E, et al. Safety and activity of immune checkpoint inhibitors in people living with HIV and cancer: a real-world report from the cancer therapy using checkpoint inhibitors in people living with HIV-International (CATCH-IT) Consortium. J Clin Oncol. Published online May 16, 2023. doi:10.1200/ JCO.22.02459

Population genetics integrates genetics and large-scale electronic health record data to identify meaningful biomarkers of treatment consequences and develop algorithmic models to support clinical decision-making. 

Understanding the Impact of Population Genetics on Cancer Treatment

As I faced my final year of fellowship for medical training, stressed was the best word to describe how I felt. I was not stressed by lack of training, inexperience, or confidence. It was the decision that loomed ahead. Where would I work? How would I choose between academics or private practice? What type of career and life did I want to build? Until this time, my decisions were largely dictated for me through matching processes. Now I would be responsible for my own decision, for better or worse. 

I scoured the internet, interviewed attendings, and made pros and cons lists. I still felt uneasy as I narrowed my field of choices. Nothing seemed to fit. 

Then a unique opportunity presented itself in the form of a hybrid role. Interested, I decided to learn more about a position that I did not even know existed. I learned that I could marry an academic interest with a private practice style of clinic. I could teach both residents and fellows, while also having my own panel of patients. Not only would I not need to secure grant funding, but I could pursue it if desired. The compensation would be competitive with room to grow. When the position was offered to me, I jumped at the chance. 

Now, 12 years later, I am still working in my first attending role and loving the hybrid nature. But why? Most hybrid roles combine aspects of private practice with academics, but individual programs vary in how they allot responsibilities. In my role, I am given an expected level of clinical productivity. With planning, this has allowed me to decide how many patients per day I would like to see. In my model, I never have a day of more than 20 outpatients, and most days I see fewer than that. 

My clinic days are limited during the handful of weeks per year I serve on our inpatient service, and my partners assist with juggling schedules on those weeks. The time I have away from the office falls within a generous allowance for vacation and continuing medical education. 

Now on the academics front, I am able to teach residents and fellows via outpatient clinic, inpatient service, and didactics. Our section keeps a roster of clinical trials—including phase 1—available for patients, and I have been fortunate to open clinical trials quickly at our center. I am encouraged to publish papers and write clinical trials and I have a team of colleagues who work on these projects alongside me. We hold section meetings to review clinical trials that we would like to open and/or close, and to update our treatment guidelines for our cancer center accordingly to ensure we are providing optimal and appropriate cancer care. 

As I considered the hybrid model, I also wanted to be able to fit in leadership roles at my cancer center and volunteer involvement with the American Society of Clinical Oncology. I have been able to fulfill all of these passions as well as participate in leadership development opportunities. As I progress through my career, I may choose to increase leadership activities and decrease academic activities. This is the only career model where you can have freedom to make those adjustments, maintain a clinical presence, and seek balance. 

As time passes, more hybrid cancer centers are forming. This creates more opportunities for fellows and early-career oncologists. As you seek career opportunities, be sure to look for these roles. Professional and personal satisfaction are both possible with this option that optimizes work-life balance.

Professional and personal satisfaction are both possible with a hybrid option that optimizes work-life balance.

Marrying Career Interests

For Priya U. Kumthekar, MD, her role as a fellowship program director is part of a journey that has come full circle. She was the very first fellow within the Neuro-Oncology Fellowship at Northwestern Medicine Feinberg School of Medicine in Chicago, Illinois.

“I got to see the program that I grew up in and add to it, so it feels like a service that I can give back to the program that has given me so much,” said Kumthekar, who also serves as associate professor of neurology and internal medicine in the Ken and Ruth Davee Department of Neurology. “I’ve gotten to see a lot of positive evolution over the past decade.”

She also was able to see the fruits of her labor. As a fellow, she started research for a phase 2 trial (NCT01898130), which is evaluating bevacizumab (Avastin) in patients with recurrent solid tumor brain metastases who have progressed on whole-brain radiation treatment.

“Some of the research that I started as a fellow, I got to see through completion my first handful of years as an attending—which is such a gift, because I see a lot of fellows who do a great job doing research and fellowship, and then must abandon or hand off some of their work to others as they move on to a different institution,” she added.

The experience is all part of the boutique-type of experience within the Northwestern’s NeuroOncology Fellowship Program, which typically takes just 1 new fellow annually.

™, Kumthekar details the specialized program for fellows while reflecting on her own experiences, highlights her research in brain metastases, and offers advice to both fellowship directors and current fellows in oncology.

: What does the fellowship program at Northwestern encompass? How would you describe the components of it?

: Our fellowship is the neuro-oncology fellowship, which is [certified by] the United Council of Neurologic Subspecialities [UCNS]. We are a relatively new fellowship, since the 2000s, in terms of officially being a fellowship. Our fellows do 1- or 2-year fellowships, and they are focused on primary brain tumors, metastatic brain tumors, and neurologic complications of systemic cancers and anticancer therapies.

You have been with this program from the very beginning—as a fellow! What has that experience been like? Is it a challenge for enrollment when there are other more established programs?

I was the first fellow to complete the program here, and now I’m the program director. When I was selecting my fellowship in 2010, I was looking for programs around the country and at the time, there was only a handful of UCNS accredited neuro-oncology programs—we were among the first.

I decided to stay at [Northwestern], but I was only selecting between about a half dozen [fellowship programs] nationally; fortunately, that happened to be a place that was one of those.

There are a few pieces of that. Building the program and having the program itself be strong in this landscape of new programs requires a lot of crosstalk with other program directors across the country. We meet at least once or twice a year. There have been some great national leaders in the fellowship who have really pioneered things, such as journal clubs. Because we’re such a [small] program, we need to come together in numbers, especially in an era like today where we can do everything remotely over Zoom—why not have those fellows feel like their co-fellows are folks across the country as opposed to just being alone at an institution or having very few fellows? That’s one way of growth.

Then there’s growth that you may have been alluding to, which is: How do we attract more applicants to the field? That takes time. There are more now than there were 10 years ago, which is great; we’re moving in the right direction.

By nature, neuro-oncology is a smaller field than, say, epilepsy or stroke or other more prevalent neurologic diseases that we see trainees go into. However, we can take fellows from internal medicine, who then have done an oncology fellowship, and we can take neurosurgical residents. It’s a unique fellowship in that we can take a multitude of different resident specialties, as opposed to other fellowships, which typically only [accept applicants] from 1 residency type.

This sounds like it provides a more personalized and/or intimate setting for a fellowship.

We usually have, on average, 1 new fellow per year. We are a big neurology center; we have just chosen to keep it as a more boutique program. There are other programs across the country that have a half dozen or more neuro-oncologists, and other programs with zero, that have great neuro-oncology specialty representation, so it varies. We [participate in the electronic San Francisco Match program].

We pride ourselves on having a more personalized experience by adding only 1 fellow annually. If there is a review, book chapter, or research project to be done, then that 1 fellow will get [the task]. That competition doesn’t exist.

By the time they’re halfway through their first year, or perhaps after their first year, they are basically acting autonomously—almost as one of our colleagues more than a fellow because the way that we have structured our program allows for that. I’m proud of our program in terms of being able to produce physicians who are very capable, ready to run their own practice, able to run busy clinics, and, at the same time, juggle and inpatient service and research—which are real-life scenarios.

Speaking to the uniqueness of this fellowship program, what else is important to highlight?

Our brain tumor program is a unique one, and we’re tied to a strong medical school. We have a brain tumor–specific SPORE [Specialized Program of Research Excellence] grant at Northwestern, which allows us to expose our fellows to more research, and potentially more research opportunities. It allows for them to see how it works, the interplay between basic science, translational medicine, and building clinical trials off that. It gives this unique viewpoint to our fellows on science and beyond.

How would you define the role of a fellowship director?

Everybody has a different way of fellowship directing. I see myself as a facilitator; I don’t necessarily have to be the best at all roles myself. This means I don’t need to be their research mentor, their personal mentor, their educational mentor, or the best educational lecturer. What I need to do is facilitate their experience. I need to facilitate them having the right research opportunities, the right education, and the right clinical exposures. Those needs are different [depending] on the fellow that comes in.

It’s not practical as a fellowship director to see yourself being all roles to your fellows. One should know the strengths and downfalls of their program so that one can facilitate the strongest experience possible for each fellow.

You have been working on clinical research that you started as a fellow, and staying at Northwestern allowed you to see it through its completion. Can you expand on this?

I wrote my first proposal with my mentor, when I was a fellow for an investigator-initiated study; it was a clinical trial for treatment [of patients with] brain metastases. A lot of fellows get this experience, where they’re learning how to write clinical trials as a fellow. Then, they typically hand that [research] off, as they leave their fellowship.

For me, when it was time to open the study, I was a new attending. I was able to open that study that I worked on as the principal investigator, see it through to completion and, a decade later, I’m writing that manuscript now. It takes time, but it’s nice to be at the same spot to be able to complete it.

What advice do you have for fellows looking to specialize in brain cancer? What do you wish that you knew then that you know now?

As a fellow, I wish I knew that you can tailor what your career looks like and what your job looks like as you’re feeling your way through it. It’s very different once you’re on your own as an attending, and it looks very different than as a trainee. You don’t have to put together that perfect job in 1 or 2 years as an attending, but over the years, you can gradually mold your career like a sculpture. It’s not just going to appear overnight, but you can gradually feel your way into what works for you.

Think about the] foci that you want to have centrally in your career and in your job, then build it to match over the years. Then 10 years later, you can hopefully say, “I liked this job that I built up, and this is suiting me.” Sometimes we have this vision of steps to get through. Often, our thought process is first: medical school, then residency, fellowship, and then a job. However, that’s not the reality of this. One should shape it and mold it as they go along.

Priya U. Kumthekar, MD, details the specialized program for fellows while reflecting on her own experiences, highlights her research in brain metastases, and offers advice to both fellowship directors and current fellows in oncology.

A Neurology-Oncology Fellowship That Provides a More “Boutique” Feel

Many of you are just beginning your training journey in hematology and oncology. Welcome!

This will be a tough year. Most fellows are incredibly busy and face emotional challenges as they navigate the path of cancer diagnosis to death with patients. As I face these scenarios myself, I try to remember what drew me to the field of oncology. Each fellow has their own list, but this list—search terms for which I extracted from ChatGPT—resonates with me and is a great opportunity to reflect:

As a hematology and oncology specialist, you have the opportunity to make a significant impact on the lives of your patients. You will be helping them fight cancer and other blood-related diseases, which can be life threatening.

Hematology and oncology are consistently changing, with new therapies being developed around the clock. As a result, you will have the opportunity to stay at the forefront of medical research and innovation.

Hematology and oncology treatment involves a multidisciplinary approach, which means that you will work closely with other health care professionals, such as surgical oncologists, radiation oncologists, and pathologists. This will allow you to gain a broader perspective on patient care and collaborate with other specialists to provide the best possible care for your patients.

A focus in oncology means you will be working in a growing field with a high demand for specialists. This also means that there are plenty of job opportunities available and a good potential for career growth.

Helping patients and their families through the difficult journey of cancer and blood-related diseases can be incredibly fulfilling. Knowing that you have made a positive impact on someone’s life can be one of the most rewarding aspects of working in hematology and oncology.

However, I have also learned along the way that emotional investment is real, and if I allow myself to lose some boundaries, I experience a hemorrhage of my own emotional stories. As a result, I lose my ability to fully engage with those who need me, both at work and beyond.

Taking care of yourself is essential when treating patients with cancer. Here are some tips, also using from search terms for which I extracted from ChatGPT, that may help:

It is normal to feel a range of emotions when dealing with dying patients, including sadness, frustration, and helplessness. Acknowledge these emotions and allow yourself to feel them. It is important not to suppress your emotions because this can lead to burnout.

Reach out to colleagues, friends, or family members for support. It can be helpful to discuss your feelings and experiences with someone who understands what you are going through.

It is essential to take breaks when caring for patients who are dying. Schedule time for self-care activities, such as exercise, meditation, or spending time with loved ones.

Be kind to yourself and practice self-compassion. Recognize that you are doing the best you can in a difficult situation.

It is important to set boundaries with your patients and their families. Although it is important to be empathetic and supportive, it is also essential to protect your own emotional well-being.

If you are struggling to cope with the emotional toll of working with patients who are receiving end-of-life care, consider seeking professional help. A therapist or counselor can provide support and guidance to help you manage your emotions and prevent burnout.

You are embarking on an amazing phase of your career. Embrace that which is novel and take care of yourself along the way. 

Jill Gilbert, MD, is a professor of medicine and the director of the Hematology/Oncology Fellowship Program at Vanderbilt University Medical Center in Nashville, Tennessee. 

Most fellows are incredibly busy and face emotional challenges as they navigate the path of cancer diagnosis to death with patients. 

Vol. 15/No. 3 | Oncology Fellows

Personalization Is Key to Successful Mentorship

Understanding the Impact of Population Genetics on Cancer Treatment

Marrying Career Interests

A Neurology-Oncology Fellowship That Provides a More “Boutique” Feel

Tips to Get Through Your Oncology Fellowship