Graff Highlights the Importance of Perseverance and Self-Advocacy as a Woman in Oncology

Although Stephanie L. Graff, MD, encountered several setbacks along her journey to becoming a breast medical oncologist, she has now found her place as a leader in the field through a combination of determination, optimism, and a willingness to hold both an open mind and an open door for the deserving women following in her footsteps.

“If you widen your thinking and challenge yourself to be uncomfortable, which is where our biggest growth can come from as humans, amazing things can happen,” Graff said in an interview with OncLive® during the 41st Annual Miami Breast Cancer Conference. To kick off the meeting, OncLive hosted its inaugural Women in Oncology event, which brought women across oncology specialties together to discuss their career and life experiences. As a panelist at the event, Graff discussed her own career path and led a discussion about the challenges and joys of balancing work and personal life.

In the interview, Graff shared moments in her early career that prompted her desire to become an oncologist, advice for honoring commitments and simultaneously practicing self-forgiveness in the professional and personal spheres, and ways that all institutions and individuals can confront gender bias to create a more equitable field for all.

Graff is the director of Breast Oncology at Lifespan Cancer Institute, as well as an associate professor of medicine at Brown University, in Providence, Rhode Island.

OncLive: What did your personal journey to becoming an oncologist look like?

Graff: My path to becoming a woman in oncology has been a bit winding at times. I grew up in a small town in rural Missouri. Both of my parents are not doctors; my dad has an eighth-grade education, and my mom worked in a factory for a big part of my childhood. When I decided I wanted to be a doctor, they didn’t have any guidance or support for me. I went to a 6-year combined BA/MD program because I thought: ‘Well, if I’m going to be a doctor, I should just go to medical school.’ Luckily, that worked out because I didn’t have a backup plan.

When I got into medical school, I loved the science of oncology. I loved the pharmacology, the pathology, every part of it. One of my mentors had told me: ‘Your job is to read about your job, so you have to love what you read about.’ I connected with oncology.

Then, as I started going through fellowship and looking for jobs, I did not think I wanted to do academic [medicine]. My first job was in community oncology. However, I had loved research, and I thought it was important to have trial options for patients to expand the knowledge base [in oncology] and help move our field forward. The site I joined was [part of the] National Cancer Institute [NCI] Community Oncology Research Program. I ended up loving working on community trials and accruing patients to trials. I had some success with that, which ultimately led to partnership and leadership opportunities within the Sarah Cannon network. I ended up being with Sarah Cannon Cancer Institute for 10 years, which, although not a traditional academic center, clearly does a ton of research; they are pioneers in research themselves.

At this mid-career point, I was ready for a new challenge and transitioned to the team at Brown University. I had the opportunity to help them grow as they moved toward their road to becoming an NCI-designated cancer center. There have been ups and downs on that journey. That’s what a lot of people’s path looks like; it’s hard at times, surprising at times, and easy at times, and where you end up is not always where you thought you would. Keeping that open, flexible mind just keeps opening doors for you.

Throughout your education and career, what challenges did you face, and how did you find ways to turn those obstacles into opportunities?

My brother died when I was in medical school, right as I was going into my residency match. Although I had originally planned to look more broadly for internal medicine residencies, the death of my brother at that time meant it was important to me to stay close to home and support my family. That significantly changed what residency match looked like for me.

When I was in fellowship, I had started out as a thoracic oncology researcher. I had been doing lung cancer research but my mentor changed institutions, so I started looking for new opportunities to connect with a mentor. I accidentally found my way into the breast oncology department and asked them to become my new mentors. Here I am now as a breast oncologist, so clearly that was a happy accident.

Similarly, at the time that I started my community oncology career, I did not think I wanted to be an academic medical oncologist. I had specifically chosen a nonacademic career, and then had tremendous success and enjoyment doing clinical trials with the Sarah Cannon team. Fortunately, I had lots of opportunities and was able to stay engaged in the clinical research community, both through Sarah Cannon and opportunities through ASCO, so when I decided I was ready for that change, the door was still open. Now, here I am at an academic medical center in a leadership role. There have been setbacks and big changes, and I’ve had a little bit of luck and a little bit of perseverance to turn those moments on their heads.

What advice would you give to other women in your field about navigating career transitions?

During our Women in Oncology summit at the 41st Annual Miami Breast Cancer Conference, I made the comment that it’s always easier to think the grass is greener on the other side, but it’s important to take a step back and figure out what opportunities you have to fix things in your own grass. Often, we can approach our institutions, bosses, and colleagues, and say: ‘I’m looking to make a change.’ Maybe you’re interested in changing disease types, maybe you’re interested in narrowing your focus, maybe you’re interested in more research and leadership. If you don’t tell someone and maybe tell them more than once so they really hear you, you might need more support. Maybe you need to say: ‘If I don’t have this, I think I’m going to need to be thinking about new career opportunities.’

You don’t know for sure that you need the big transition. First, consider the opportunities you have at home. Then, anytime you’re transitioning, you want to go in with the clearest set of perfect situations and negotiable situations. What does your dream job look like? What’s your perfect vision? What are the things that, if you had to negotiate and give up on, you’d be willing to let go of?

Think about those things in context. If geography is the most important to you, if your entire family or support system is in Minnesota, for instance, you probably aren’t going to interview for jobs in Florida. If the most important thing to you is being a breast oncologist, and a place only has positions open for melanoma experts, it’s probably not the right place for you. You need certain fits, but there [can be] flexibility in some of those features.

How do you navigate work-life balance, and what would you tell colleagues who feel they are struggling in this area?

When I think about work-life balance, I always say it’s not the work-life balance. It’s the work-life pendulum. I recently heard someone call it the ‘work-life wrecking ball,’ which is hilarious. It’s not a scale that’s in balance; it’s a scale that’s swinging back and forth wildly. There are moments, days, weeks, and months when I am an amazing researcher, physician, mom, and wife, and there are days, moments, weeks, months, and years when I am terrible. Those things swing back and forth.

If you look at them in movement, it looks great, but we tend to be our own worst critics. When we’re reflecting on that pendulum swinging, we only see the swings to the widest ends of the spectrum, to the bad places on both the career side and the life side, which probably isn’t fair. It’s important to take stock of where you really are. Some beautiful research shows that there’s something empowering about having a word that describes how you’re feeling, and that just by having the language for what you’re feeling, you feel less alone in that feeling, because you can name it.

Events like the Women in Oncology brunch are powerful, because women and men in oncology sit and talk about [how hard it is] to have preschool and early elementary school kids, because they go to bed so early, and you’re rushing home, and they’re tired and cranky, and they’re crawling all over you, and you’re physically exhausted, and you feel like you barely get to see them. And [many other people] can say: ‘I know that feeling.’ Being seen and knowing your experience is normal is so validating. To sit with women saying that their parents are sick, have Alzheimer’s, cancer, [or another] end-stage [disease], and they’re trying to manage that illness 2 cities or 2 states away while their kids are in high school, is validating because that distress and weight [are feelings] everybody’s familiar with.

Sometimes being able to have the words to share [one’s] experience can help us all come together, even if nobody has the perfect solution for it. Trust me, there’s no perfect solution for it. We’re all making it up as we go along, but that’s also the beautiful messiness of life.

How have you experienced gender bias in academic medicine, and how can people challenge these issues at the personal and institutional levels?

Gender bias can look like a million different things. There are tiny micro biases, and there are great, big, terrible events. I’ve experienced the full spectrum.

[At the Women in Oncology event], we were talking about maternity leave. I said that as a fellow, I used part of my research time as maternity leave. That’s an example of gender bias because that’s where that maternal pay gap or maternal experience gap starts. I had less real research experience than my male colleagues because none of them had to use maternity leave for research. You can guess that I got less research done at home on maternity leave.

There are examples of women being introduced as ‘Stephanie’ rather than ‘Dr Graff,’ when their male colleagues at the same podium or microphone are then introduced as Dr X and Dr Y. [That] is the smallest example, but [is emphasized] when it’s in contrast like that. If everybody [were introduced by their first name], it would not be as uncomfortable as when you’re othered. Those things catch your attention and feel uncomfortable.

Then, there are moments where it’s more [about] missed opportunities. [For example,] there’s an opportunity to travel to a meeting or take on a new leadership role, and you aren’t asked, not because you’re not capable or not thought of, but because the assumption is that as a woman, mother, caregiver, and all the other roles that are a part of our pendulum swinging, we wouldn’t want it. I should have the power to decide what’s right for me and my family. Those are the examples of gender bias that you don’t even know you’ve missed out on because nobody even gave you the opportunity to choose.

What’s important is that we keep raising the conversation around these moments [to support women] in leadership. I’m going to put myself in that [category], because I’m a senior oncologist in many leadership positions. When I’m thinking about who to invite for a talk, or who to offer a leadership position to, it’s important that I don’t think: ‘Oh, well, she just had a baby or her kids are still young, maybe it’s hard to travel,’ and [instead] offer [those opportunities] broadly. Or more importantly, post them publicly, and let people apply so they can be considered without those moments. Also, ask people what their preferred address is so you get Dr Graff right the first time and learn to pronounce that last name correctly. All of those are ways we can do better globally.

What were you most excited to see come out of the Miami Breast Cancer Conference this year?

One of the big highlights of [the conference] is that it’s a much smaller meeting that still attracts all the internationally recognized leaders in oncology. You have the opportunity to walk up to some of your heroes in oncology and ask them questions in the hallway, which I love. On the first day, [we saw] all the multidisciplinary tumor board cases. As a medical oncologist, I often miss out on the radiation oncology and surgical oncology debates, and yet, in the clinic, my patients ask me [about those topics]. It’s helpful to get to be a part of those conversations. Sometimes, meetings that are a bit smaller than ASCO, for example, which is so huge and daunting that you can’t take it all in, are empowering because of both their [accessibility] and depth.