Focus on Geriatric HemOnc with Mazie Tsang, MD, MAS, MS

Mazie Tsang, MD, MAS, MS, an Assistant Professor at the Mayo Clinic in Phoenix, Arizona, spoke with Blood Cancers Today about her new role with the Mayo Clinic Comprehensive Cancer Center’s lymphoma group and the importance of communicating with patients empathetically.

When did you develop an interest in medicine? I became interested in medicine when I was in elementary school. My father had epilepsy, and I initially wanted to be a neurologist to better understand his medical condition and how to help him. I remember doing a report for school on epilepsy to try to understand epilepsy and what neurologists do. It was at that time I really thought, “I want to be a doctor.”

What led to your work as a lymphoma specialist? Did you have a specific mentor or experience that guided you to focus on older adults with hematologic malignancies? I became interested in lymphoma through a series of different events. One of the biggest motivators was working with extremely wonderful people who specialized in lymphoma and chronic lymphocytic leukemia (CLL).

The very first oncologist I shadowed was Dr. Matt Matasar in 2011 through the Memorial Sloan Kettering Cancer Center Summer Fellowship. I absolutely loved how he interacted with his patients. I thought, “I would like to have this kind of relationship with my patients and team!” Then, I went to residency at Mayo Clinic in Rochester, Minnesota, where I worked with Drs. Curt Hanson and Sameer Parikh, who were doing CLL research. After these early experiences, I wanted to become a CLL and/or lymphoma specialist. My interests in incorporating palliative medicine and geriatric oncology evolved through life and patient care experiences.

Can you tell us about your clinical research and your teaching plans for your new role as a faculty member with the Mayo Clinic Comprehensive Cancer Center’s lymphoma group? Mayo Clinic has three different sites that are part of one cancer center. I’ll be based primarily in Phoenix, Arizona, where I will specialize in lymphoma and conduct geriatric hematology research. I am developing my research port­folio based on my prior work with older adults. I look forward to developing new mentorship relationships and research ideas inspired by my clinical work.

I plan to weave in geriatric and supportive care components, such as incorporating a muong>You published an article titled “The Importance of Empathy as I Have Studied and Experienced It,” which outlined the techniques used at the John A. Burns School of Medicine to promote empathy in physicians and how these practices impacted you and your patients. How have these techniques continued to shape your practice? What would you say to today’s medical students about how to continue building and promoting empathy throughout their careers? Professors at my medical school, the University of Hawaii John A. Burns School of Medicine, made it a priority to teach us about how to honor patients’ values, perspectives, and cultures. I am so incredibly grateful for these lessons and for everyone I met through medical school.

I realized after years of training and having family members who had different medical illnesses that we can become desensitized in medicine. What we deal with in a 15- to 30-minute visit is something that is completely rocking our patients’ lives and has completely changed their life’s course.

As medical students, we might closely identify with patients because we might have had a medical experience with our loved ones or maybe we had a personal illness. Throughout our training, we are taught to medicalize different illnesses, so that we can be objective and focus on treating diseases. I think being empathetic is recognizing that our patients may be going through an extremely challenging time. Some patients rely on our clinic visits—even waiting two to three weeks to see us can be excruciatingly long and painful. For some of my patients whose entire life revolves around their cancer, sometimes that time together in the clinic is something they’ve been holding onto for weeks or months. I think it can be easy to forget since we see cancer every day and this is our career. Sometimes we can forget the nuances in the day-to-day lives of our patients.

One of the reasons I really enjoy communication ​​and decision-making research is that a lot of it involves listening to patients and eliciting what’s important to them. I learned so much from my patients. They educate me about how to better support them and share about what they’re going through. My patients guide me so that whatever research I do could address their needs.

Your research has indicated that older adults tend to under-enroll in early-phase oncology clinical trials and that many rely on their oncologists to help them successfully navigate this complex process. What are a few specific things oncologists can do to help older adults in this regard? Older adults are under-enrolled in clinical trials. What my team and I found is that it’s not due to a lack of interest, at least that is the case in tertiary cancer centers. The patients we interviewed come to these cancer centers because they want different options, and clinical trials have become part of the treatment armamentarium.

What we have found, though, is that oncologists have a primary role in navigating their patients to enroll in trials. It falls upon the oncologists and their medical team to be able to identify which patients would be great candidates for clinical trials and then start that conversation. It’s important to make sure that older adults recognize what options are available to them. Oncologists can have a continued conversation about whether their patients are interested in clinical trials or whether it’s something that they could derive any benefit from.

The other problem with many clinical trials is the cap on the age of enrollment. It would be helpful to remove the age cap and focus on other parameters instead, such as function. Using geriatric assessments could help identify which older adults could feasibly enroll in and benefit from trials.

What do you see as the biggest challenge regarding the treatment of older adults who have lymphoma, and are there specific tools or research avenues that might combat this challenge? Right now, the treatment options are moving more toward cellular therapies for older adults with lymphoma, especially in patients who have relapsed/refractory disease. Some of the biggest challenges that result are trying to identify which patients would do well.

For example, in the early chimeric antigen receptor (CAR) T-cell clinical trials, people with cognitive impairment were excluded because of the neurotoxicity associated with CAR-T. One of the questions with patients who are older, who have cognitive impairment or dementia, would be at what threshold would they not be a candidate for CAR-T?

It is also crucial to assess quality of life and try to have conversations with older adults about how the treatment could either benefit or hurt them. The third piece is that a lot of these cellular therapies require that patients have a caregiver. Sometimes as older adults age, they may not have a caregiver; maybe their loved one has passed on, or they might be in an institution. Being able to come up with a management plan that factors in caregivers would be helpful as well, especially because caregivers are so heavily involved in the care of many older adults.

What do you like to do outside of work? I really enjoy spending time with my family. I have two kids, so I love taking them to the museum and going outdoors. We enjoy having different adventures. That’s something that I really look forward to with the move to Arizona.

What is one thing most people would be surprised to learn about you? I really love music and learning different musical instruments. It’s something that I don’t share because I have been out of practice since I started medical school.

Mazie Tsang, MD, MAS, MS, is an Assistant Professor at the Mayo Clinic in Phoenix, Arizona, where she conducts research in geriatric hematology and specializes in lymphoma.