Prof. Timothy M. Pawlik1, Jin Ye Yeo2
1Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center at The Ohio State University, Columbus, USA; 2CCO Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. CCO Editorial Office, AME Publishing Company. Email: editor@thecco.net
Expert introduction
Prof. Timothy M. Pawlik (Figure 1) received his undergraduate degree from Georgetown University and his medical degree from Tufts University School of Medicine. Prof. Pawlik completed surgical training at the University of Michigan Hospital and spent two years at the Massachusetts General Hospital as a surgical oncology research fellow. He then went on for advanced training in surgical oncology at The University of Texas M. D. Anderson Cancer Center in Houston. Prof. Pawlik’s main clinical interests include alimentary tract surgery, with a special interest in hepatic, pancreatic and biliary diseases. Prof. Pawlik also has an interest in medical ethics and completed a fellowship in medical ethics at the Harvard School of Public Health. Prof. Pawlik’s research focuses on determinations of factors associated with prognosis and staging of gastrointestinal cancers, as well as the economics of cancer care. He also studies patient/physician communication and patient engagement, as well as patient perception of cancer-care goals. Prof. Pawlik has consistently been recognized by Castle Connolly as one of America’s “Top Docs.”
Prof. Pawlik has published over 1,700 articles and over 100 book chapters, in addition to editing 14 surgical textbooks. His research has been cited over 92,000 times with an H-index of 148 and an iCite weighted RCR of over 3,000. Prof. Pawlik serves on multiple editorial boards and is Editor-in-Chief of Journal of Gastrointestinal Surgery, Deputy Editor of JAMA Surgery, as well as an Associate Editor for Annals of Surgical Oncology. Prof. Pawlik has served on the executive council of several of the premier surgical associations in the United States. Prof. Pawlik is a member of multiple surgical societies including the American Surgical Association, Society of Surgical Oncology, Society of Surgery of the Alimentary Tract, Halsted Society, and Society of Clinical Surgery.
Figure 1 Prof. Timothy M. Pawlik
Interview
CCO: Your clinical interests include hepatic, pancreatic, and gastrointestinal diseases. What drove you to focus on these areas?
Prof. Pawlik: My interest in hepato-pancreato-biliary (HPB) surgery stems back to residency and fellowship. For me personally, having mentors in this field propelled me to look more closely at HPB surgery as a specialty. When I was at University of Michigan as a resident, there was a young attending Dr. Alan Yahanda, who trained in Hopkins and was someone I really looked up to, and then when I was at MD Anderson, Dr. Nicolas Vauthey was my mentor. I had people in the field who I really respected as a young learner, I liked what they were doing and found them interesting, and I wanted to be like them. For liver and pancreatic surgery, I like the tactical aspect of it. It is a challenging and tactical endeavor, especially in liver surgery, where no two cases are the same. There is a lot of variety when operating on these patients and the combination of needing excellent clinical judgement as well as excellent technical skills to treat patient with complex HPB diseases appeals to me. Finally, I would say that it is a tough disease. Many of these patients do not have a favorable prognosis and I am interested in being part of the patients’ journeys as they struggle with serious diagnoses. I find it very rewarding to talk with patients and their families as we are going through their cancer journeys and grappling with their diseases. Hence for these reasons both in and outside the operating room, HPB surgery has appealed to me.
CCO: Could you provide a brief overview of the current publications on the prognosis and staging of HPB cancers? Are there any findings that you find most promising?
Prof. Pawlik: Traditionally, most of the staging for cancers and HPB cancers have been based on pathology, morphology, and histology, where we look at the size and number of tumors, tumor grade, and lymph node metastasis, but I think what we are getting to understand more is the molecular prognostic factors to better understand the underlying pathogenesis, molecular genesis, and carcinogenesis of these tumors. This is probably one of the areas that is a couple years behind us, with a prominent example being the KRAS mutant influencing colorectal liver metastasis and clearly demonstrating that patients who have KRAS mutations have worse prognoses than those with wild type status. This is a perfect example that shows that it is not enough to look at the Fong score or the Clinical Risk Score, and that we need to have molecular markers of a prognosis. We also see this emerging in intrahepatic cholangiocarcinoma that the better understanding of the molecular underpinning of that disease not only allows us to prognostically stratify them better, but also helps us to treat patients better and target their cancer with more personalized approaches, whether it be targeting IDH1 or FGFR2. Hence, I think that we are headed to focus more on the individual personalized profile of these tumors rather than simply looking at traditional pathologic features.
CCO: You completed a fellowship in medical ethics at the Harvard School of Public Health. How has this background influenced your approach to patient care and research?
Prof. Pawlik: As I alluded to, I deal with cancers that have grave prognoses. I completed both a Masters in Theology at Harvard Divinity School and then a fellowship in medical ethics at the Harvard School of Public Health because I think that as a surgeon, I provide technical expertise, but as a healthcare provider and a provider of care, I also want to ensure that I have a holistic approach to my patients. With a background in theology, philosophy, and ethics, it helps me to understand some of the other challenging issues that may be part of a cancer diagnosis and how a patient and their family are grappling with the diagnosis. I think that any experience that one has in their life has an influence on their perspective on life and situations so I think my background in theology, philosophy, and medical ethics definitely informed my approach to how I engage with patients around shared decision-making and decisional analysis, and also how to be present for them as they go through their cancer journey. It has definitely changed who I am as a person and I think it has also informed who I am as a healthcare provider.
CCO: Your research includes the economics of cancer care and patient engagement. Can you discuss some of your key findings in these areas and their implications for improving cancer treatment?
Prof. Pawlik: One big area of research that our group is trying to look at is social determinants of health, which are the non-medical factors that can impact your health. One of them is the economics of healthcare. Our work and others have clearly demonstrated that factors like social vulnerability, for example where you live, your access to transportation, jobs, food security, and education, can have a very dramatic impact on your access to surgery as well as your postoperative outcomes. In fact, the social determinants of health can have as much as or more of an impact on your outcomes, than some of our traditional medical factors like whether you have diabetes or hypertension. A lot of our work is focused on trying to delineate these social determinants of health in the preoperative setting, so not only can we identify these factors but we can bring to bear resources to fill these gaps, whether it be assistance with transportation, assistance with food pantries, and securing safe food for individuals. What we have been studying recently is how we can incorporate these determinants into the electronic medical record, and perhaps even use artificial intelligence to identify patients at most risk for the social determinants of health, so we can intervene earlier to optimize their perioperative and post-surgical outcomes.
CCO: With over 1600 published articles and numerous editorial roles, what drives your prolific output in academic writing and publishing? How do you manage your time and stay motivated?
Prof. Pawlik: I like to write. When I was in Harvard Divinity School, there was a lot of writing so I spend about an hour a day writing or revising papers and I think that has something to do with my output in clinical production, but ultimately, it is a team effort. I am lucky and blessed to work with great research fellows and a great faculty. I derive immense enjoyment working with my research fellows, helping them to identify interesting clinically relevant research ideas and formulate research plans, do the analyses, revise their papers, and see them bloom during their time in our lab. Those experiences bring me immense enjoyment, and working with them has provided me the opportunity to not only impact care through our research, but many of these fellows have graduated from our lab for 5-10 years now, with some still in the United States, and some back in their countries, and they are doing wonderful things. It is like a coaching tree. If you want to run fast, you run alone, but if you want to run far, you run as a team. I think that has been a big reason for our collective success. I think the other thing is to do what you are passionate about. If you are passionate, it is not really work. I love doing research, I love writing, and I love thinking about these things, so to me it is about following my passion and it is not really considered work. But I do think that you need balance and make sure you take time for your family, yourself, and your clinical work, and over time, make sure that you are delegating responsibilities. If you build a successful team around you and everyone is practicing at the top of their license, you can achieve a lot as a collective.
CCO: You have been recognized as one of America’s “Top Docs” by Castle Connolly. What does this recognition mean to you, and how do you strive to maintain excellence in your clinical practice?
Prof. Pawlik: It is nice to be recognized as a top doctor, but I think it is nicer to see that in our Department of Surgery here at Ohio state that so many of my colleagues have been recognized as top doctors. I am proud to say that in our department of surgery, we have well over half of our faculty recognized as top doctors. I am lucky and blessed to be surrounded by clinical excellence and I think that being part of such a robust group, my HPB group with Dr. Dillhoff, Dr. Cloyd, Dr. Tsai, Dr. Blair and others, has helped to perpetuate my own clinical excellence. I think being part of an excellent multidisciplinary team allows us to deliver the best care to our patients and give them the best shot at being cured of their cancer.
CCO: How has your experience been as an Editorial Board Member of CCO?
Prof. Pawlik: It has been a great experience. It has been fun to see CCO come so far and continue to progress and attract high-quality articles from around the world and continues to emerge as an important journal for people to find information about cancer, oncology, and the most up-to-date treatment for cancer patients.
CCO: As an Editorial Board Member, what are your expectations for CCO?
Prof. Pawlik: I hope the journal will continue to emerge as a go-to journal for providers in cancer and hopefully be able to publish more guidelines, seminar reviews, and provide state-of-the-art information that is clinically relevant for cancer surgeons, and be a journal that can provide clinicians and those who are taking care of patients with the latest and best data to inform their clinical practice. To me, that is ultimately what is most important when it comes to research – that the research is actually read and applied to the care of patients so we can improve the surgical techniques and approaches that we apply to our patients with cancer.