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Alicia Morgans: Hi, my name is Alicia Morgans and I'm a GU Medical Oncologist at Dana-Farber Cancer Institute in Boston. I'm so excited to have here with me today, Dr. David Quinn, who is an Associate Professor of Medicine and a Medical Director of the USC Norris Cancer Hospital in Los Angeles. Thank you so much for being here with me today, Dr. Quinn.

David Quinn: It's great to be here, Alicia. Welcome to Los Angeles.

Alicia Morgans: Well, thank you. It's been a long time since I've been anywhere and it is wonderful to be here with you. I wanted to talk with you today about something that is really important to the Prostate Cancer Foundation, and of course in general in medicine, which is really the promotion of women through the ranks of GU Medical Oncology, and ensuring that they have opportunities within the prostate cancer research and clinical arena.

And I know that this has been a topic that has been very near and dear to your heart, and you've promoted the rise of multiple women throughout our ranks in research and in clinical practice. I'd love to hear your thoughts on how we can do that better, what you have done that has been successful, and why this is so important.

David Quinn: Well, it's a big topic. It's a really important one. I think my history in mentoring goes back to when I ran the internship program at my hospital, and all of a sudden kind of overnight, we have 50% more women. Which is where we are. In fact, it's higher than that in medicine, so we have had a big change. It was very clear that the needs of those women in their careers were different. Then as time went on, we had a training program for physicians, a specialist program, and during my time there as the senior person running that, we were over 50% women.

That was good because I think we were, I guess, being permissive of achievement for those women, and it was something they felt comfortable doing. It wasn't easy. From that perspective, when we come to oncology and GU Medical Oncology, it's paying it forward. Who did I first meet in America as formative people outside of my own group? Tia Higano, Maha Hussain, and then there were a host of others, Nancy Dawson.

They were all extremely good to me, and they were part of what made something very collegiate, but also not overly driven by testosterone, masculinity, whatever you want to call it. People will say, "Well, most of the people that get GU cancers are men. Why would a female oncologist want to get into that when they can do breast cancer or something else where there is a kind of 50/50 split?"

I think that was a key kind of realization and we would have some insane discussions. Then afterward one of those people or others would come and say, "That was relatively insane. Once we've settled down, we can have a chat about what we think." The balance really helped rationalize that. I think having what were relatively few women involved at that time, we are talking 20 years ago, but where they were not scared and wherein the group we really wanted to hear what they had to say because they look at things completely differently.

The great strength in training and academic achievement comes through a heterogeneity of thought. We need people that are going to think differently about things. It's not just differences between men and women, it's people of different backgrounds and different perspectives. I think we were talking about the Prostate Cancer Foundation. For as long as I can remember, they've been looking to get people with different aspects on the problem and bring them together. It's important and I've enjoyed it. The other thing is that I have had great people to work with and that's the thing that I'd reflect on.

Alicia Morgans: Well, you certainly have worked with some of the leaders and do medical oncology, you are one of them yourself playing key roles in SWOG, in the DOD, and in other leadership arenas. The women that you mentioned are some of the women that have shaped what we currently do in prostate cancer care.  But there are two women in particular that I want to hear a little bit more about that you mentored and helped develop. These women, like the other women you mentioned, have been funded by the Prostate Cancer Foundation and do phenomenal work. Can you tell me a little bit about Ana Aparicio? I just learned today that you and Ana worked together many years ago, and still collaborate I'm sure on many levels.

David Quinn: Oh yeah, so, well, Ana came from a different place. She was educated in Spain, she worked at the VA, and then she came into our fellowship program. Which was great, because she'd have opinions on all sorts of things that were not the standard, which was good. We'd talk about general things, but then as things developed, it was clear that we needed more faculty. She started at USC, she was interested in epigenetics. She worked with Peter Jones who's very eminent in that area, he was our cancer center director at the time.

She worked mainly on lung cancer actually for about a year, and then we had a position come up. We'd interviewed and we had some good people come, but it just didn't seem to fit. There were always issues about moving people around. I talked to her and I can remember, I kind of was being a bit hedged about how this position might come about and whether she would consider being part of the GU team. She said, "Well, okay, I need to think about it." She said, "Okay, let me think about it." So she said, "Well, GU is what this place at USC is all about. So, what's the problem?" I said, "Okay, well, I just didn't want to push you into it." She said, "I wouldn't let you push me into it." I thought, "Yeah, that's true."

I think we did very well, and what impressed me about Ana was if we had toxic therapies, dose-dense MVAC, she was not scared. She would get in there and kind of manage that. Also, her interaction with our urologist was key. Then, unfortunately for family reasons, she had to move to Houston. I introduced her to Christopher Logothetis, I think that has seen her lifetime learning extended. I think that has been a great personal interaction also with the rest of the team at MD Anderson. What I think is fantastic is she can translate ideas that are a little bit off-beam, they are not the mainstream. If we look at what aggressive variant prostate cancer is, the rest of us were realizing we were seeing this. She and others, Chris and [inaudible 00:08:20], and the team Paul [inaudible 00:08:24] worked on this.

Now I'm hoping we are going to see a phase three trial that will test that premise. And I think it's a very important concept to take the elements clinically and test them. Also, looking at those patients in trials, very important, distilling it down. She wrote one of the most difficult papers to write in history. It was in clinical cancer research and it was about this entity defining it. I always try to get my fellows to read that. It is long, and there's a lot of data in there, but it's still relevant.

Alicia Morgans: She has accomplished so much and I'm happy to hear how that started and how you supported her career within your group, and then also helped her transition when she needed to do that. We will circle back in a minute because I'd love to hear how you generally think about supporting women in their academic development. There is one other person I wanted to hear a little more about, a great friend of yours and a great friend of mine as well, Dr. Tanya Dorff, can you tell me a little bit about your interactions with her?

David Quinn: Well, I first met Tanya when she was a fellow at USC and I got off on the wrong foot because we had interviewed at least three candidates named Tanya, and I gave her the wrong last name. I said, "look, I'm really sorry" and she said, "yes, the person you're talking about went to City of Hope and she's subsequently done well, as well." But I hadn't met any of these people. I just didn't happen to interview them. That was okay and I thought, "Wow, this could be a long month." It wasn't a long month.

She dealt with a couple of really difficult patients and she spoke better Spanish at that time than anyone I knew, of course, she spent a significant time growing up in Columbia. Her life journey was interesting to that point. Coming out of fellowship, we really wanted her to come to USC and for a variety of reasons, we did not have a position for her. I can remember several of the urologists being very upset that we did not. For example, the late John Stein was almost in tears when I had to tell him, so anyway, she was beyond well regarded at that time.

She went off to work in a very, very good private practice and then, ended up the opportunity, came about, we had a position and she came back to us and she was with us for about a decade. During which time she worked extremely hard. She would come and ask me what her strengths and weaknesses were, and I'm thinking, wow, that's a difficult question. We would go through things and she would also talk about making her weaknesses better, which such an immense depth of personality, almost entirely devoid of ego, not entirely, but almost.

The thing is over time, she grew to be much better than me and she needed to grow. We then had the difficult conversations that all mentors have when she needed to move to another institution to take up a leadership role. That was good because it caused me to reflect and I wasn't ever, there was never a question about her succeeding. It was only an issue of whether the other place was good enough to make sure that she was able to do that. She's gone on to better and greater things. We still interact at least weekly. We have some common projects. And I think from that perspective, it's great to see her move forward, to get PCF grants, to do different things where I may have talked her out of doing something, she's charged forward now at City of Hope. And then she'll often ask whether I want to partner with her on things. I'm thinking, "Wow, am I now good enough?" And she still seems to think that I am, but I have to work at it. So that's a great transition to have as a mentor. And I think also I've seen her grow as a person, and that may be more important for women than it is for men, growing as a person. You never, or very rarely, hear a male junior faculty or fellow say, "I need to become a better person," when in actual fact, we do. So I think from that perspective, that's my lesson from her. And I strive to be a better person because of her.

Alicia Morgans: Well, that is beautiful. And I love to hear the learning and the mentorship actually going both ways in that situation. And you've clearly both benefited from each other. And if you had to say, what is your, I guess, the number one goal that you have as a mentor for women, for anyone, what would that be?

David Quinn: That's a good question. So as a person, you need to be on some sort of road to happiness. And if you're not on that road, you need to rethink and not be scared to recalibrate, do something different. And there are some people in their career, and I talk to residents and fellows about this, I don't care what they want to do just as long as it's the right thing and they're comfortable with it. And then the other issue is trying to have that balance. You can call it work-life balance, which is fine. But I also think that the balance is more complicated than that. What's happiness? Will you be happy in your achievements in your career if you get to a point in your career where your family and children don't know you? And the answer is usually no. But some people will close themselves off and do that. But my view is that they don't achieve as well. So if we talk about where people are going in their lives, it's actually important to have that discussion.

And I think some people that are early in their careers, they don't confront the questions about what they want their life and relationships to be. It can be simple or complicated. And also whether they want to have a family or not. And these are decisions now that I think we discuss more openly. What is the right career choice for them? Will it be stimulating and provide a balance? Some of our trainees are happy to go off and work in a clinical environment for all of their life and then retire with benefits. And hopefully along the way, they will hit that happiness goal. Others are more ambitious and need to achieve things. We've talked about a couple of them. But I think developing the character to deal with problems and solve problems that are clinical and translational and basic, is very important. So, that happiness goal, it's got to be in there. You don't have to be miserable to succeed. You will have to make some sacrifices and work, but most people in our field are very happy to do that.

Alicia Morgans: They are. It's not the easy road to be a GU medical oncologist. That's for sure.

David Quinn: Now, on the other side, I don't know whether you're going to interview the people we've talked about, so they may tell you about deep regrets and other things. And so I think that we all have where we missed an opportunity. We weren't quite quick enough. We didn't realize that this was where the field was going to go. And so I think that the environment at PCF in the meetings is very positive towards women. And another colleague that I have not mentored formally at Dana-Farber was pregnant. I don't know how many months, but it was obvious, Rana McKay. And she came into I think one of the last PCF meetings we had. It was at UCLA. And she sat in the front row for the whole thing and needed to get herself organized in the advanced stages of pregnancy. But I think it was interesting the way people just kind of accommodated that and didn't bat an eyelid.

And what was really interesting was that there were some fellows there from all disciplines. And I usually stand at the back because I can't sit for very long. So they would say, "Who was the lady at the front? And I said, "Well, that is Rana McKay, and it's not her first baby. I don't know what number. But that's what it's all about." And some of them were thinking... The cogs were ticking over, to say, "Okay, I can do this as a career and have a family." So that's an important example. And that's understating Rana's contribution to that and many other meetings where I think the contributions academically and intellectually are kind of key.

Alicia Morgans: Absolutely. And Rana is a great example of that balance, whatever you want to call it, the happiness balance I think is a good way to think about it. So any final thoughts on how people like you, who are in your position of leadership in so many different ways, can support women within your institution or more broadly to continue to succeed?

David Quinn: I think that we have lip service and guidelines that says we need to be developing women, people from different backgrounds, etc., etc. That's fine. But there also needs to be some sort of personal touch. So the people we've talked about are easy to like, not difficult to work with, are a blessing on any program. As we work with, most of us work with residents and fellows, we need to connect with them, whether they're male or female, or whether they don't assign. I think it's just kind of important. And their life journey will be a little different no matter what. So for the residents and the fellows at the moment, we've had two years of very, very different situation related to COVID-19. And we've had less contact. We were doing our clinics at the county hospital via telemedicine. So in other words, we were talking to the resident or fellow and we were sitting at home or in our office. And you miss stuff. You also miss stuff because we're all wearing masks. And just how the people are, what their body language is like and how they're traveling.

And I got a big shock this year, because I normally do July on the Norris inpatient unit, which is where my wife says, "Well, I won't be seeing you much this month." So I'll say, "Okay, I'm sorry. I'll do my best." But where we do have contact with the residents as they come out of internship. And I realized very quickly that having had a break from that for a year, I'd done other service jobs, that this was kind of different. You know, they'd had a year of COVID, and really, they were pretty flat. And educationally, we were doing well. In fact, they said we were doing better than well. But in terms of just their lives doing COVID, it was relatively miserable. And we had to have a kind of debrief on that one.

And just at that time, it became, I guess, in the media apparent that there were some self harm issues at other places amongst the residents, also more senior doctors. And I felt bad. I hadn't connected for a year. Now, I'd seen the people, but it wasn't like I'd sat there and said, "Hey, what's going on for you? Where are you headed in your life now? What have you decided?" So a number of us realized that we needed to communicate with each other to address that issue.

Now, I don't know how the GU medical oncologists are traveling because I haven't talked to any of them face to face for quite some time. Actually, that's not true. We had a dinner in July where I think six of us got together in Los Angeles and we got to have a little bit of discussion about how we were doing, but that personal can action is important. There'll be people that will go through difficult times, and you want people that can deal with those things so that they can get strong and deal with other things. And I have two female trainees at the moment in GU medical oncology and I'm watching them be much better than I ever was with difficult situations. But having the challenge of socializing them in the GU medical oncology situation, so can I introduce them to Tia Higano and Maha Hussain, who are still with us, but are on Zoom.

And there is a realization that stretching right to the early stages as we develop as medical people, that one person's not going to be enough, but also that critical loss of mentors. And we've had a few for the residents, not the past, thank goodness, but went to other places. And when their prime mentor is somewhere else, that's a big adjustment for that person where they've got to work out whether they really wanted to do that or whether they were in "Just in love with a mentor." And these are difficult discussions to have, but they're important.

So I think we need to spend our time supporting people. I feel guilty that I don't have more time and that I don't use it better. But this is something that PCF has helped encourage. I think it's very collegiate. And I can't remember when we started having the Women's Day. But I remember the first time after we'd had the Women's Day, I said to Howard Soule, we were at a DOD meeting, and I said, "How did it go?" And he said, "Oh, it went very well. And you'll be pleased to know that next year you'll be able to go if you want it." And I thought, "Okay." I said, "Howard, I'm not sure whether there's something you need to tell me." And he said, "Well, yes, there is. We feel like we need to have a comfortable environment where men are not dominating, but you'll be able to sit in a session or tune in. And if you behave real well, they might even ask you what you think."

So I think that's been good. And the discussion will occur in a very different way to a mixed group, maybe an all male group. Most urologists in various parts of the world are male. And so that discussion is very different for them, plus the culture of where they are. And so we need to keep working on that. And I think that's been a big success initially, because they said, "Okay, we've had our discussion, but we don't have to close the doors." And I think that that's interesting. We're thinking, "Okay, the group is far more self assured." And also the reason for initially maybe not having the male gender there was that women can discuss their challenges, insecurities and will get beyond a lot of that stuff because they realize that there's some common things happening here, and that if they're working with male mentors or male colleagues, they need to be not shy in making that point. And I'm always interested in my section to try and sure that we don't have all men. Now, if I'm outnumbered and it's all women and I retire, I might be okay with that. But I would say, "Look, if a good man applies, you should consider him because I think that he might have contributions and perspectives that are different to yours."

Alicia Morgans: Well, that's a wonderful perspective. Thank you. And it is just a delight to hear how you think about inclusiveness and different perspectives and all that you do and all that you touch and support and how that leads to of course, supporting phenomenal women in medicine and in prostate cancer specifically. So, thank you so much for taking the time to go through all of it. I sincerely appreciate it.

David Quinn: All right. It's great to see you, Alicia, and I hope you have a good time here in Los Angeles.

Alicia Morgans: Thank you.