On Dec. 3, the Division of Internal Medicine, Division of Cancer Medicine hosted the IOTOX Clinical Education Symposium.

More than 250 people attended the hybrid event, held live at Hickey Auditorium. The hybrid event brought the oncologic community together to better understand the treatment and care of patients with toxicities due to an IO treatment plan. 

Health professionals from MD Anderson and invited guest speakers/panelists provided clinical presentations and case discussions to guide the diagnosis, potential treatment options, implement standard care and also highlight potential future research directions.

Keynote speakers were:

• Douglas Johnson, M.D., Associate Professor, Clinical Director of Melanoma, Vanderbilt University Medical Center
• Julie Brahmer, M.D., Director of Thoracic Oncology, Johns Hopkins Kimmel Cancer Center

External panelists were:

• John A. Thompson, M.D., Professor, Chair of NCCN Guidelines of Management of Immunotherapy-related toxicities
• Bryan James Schneider, M.D., Clinical Professor, Co-chair, ASCO guidelines on the management of adverse events in patients treated with ICIs
• Michel Obeid, M.D., Ph.D., Deputy Physician, responsible of LCIT Lausanne Center of Immuno-oncology Toxicities, ESMO guideline panel

On Sept. 1, General Internal Medicine created the new Geriatric Medicine section, which is dedicated to the cancer care for patients 65 and older.  

“I am very excited for the creation of the Geriatric Medicine section,” says Carmelita Escalante, M.D., chair, General Internal Medicine. “The team deserves this formal designation following their championing of superb efforts in their care for this population."

Geriatric Medicine is led by Section Chief Tacara Soones, M.D., associate professor. The section’s goal is to ensure that older adults receive age-friendly cancer care that aligns with their specific health outcome goals and care preferences.

“We hope to ensure that all older adults receive age-friendly care that is consistent with what matters most to older adults, their families and care partners,” says Soones.

Geriatric population faces unique vulnerabilities

Between 2012 and 2050, the number of Americans ages 65 and older is expected to double from 43.1 million to 83.7 million, according to the U.S. Census Bureau. And thanks to modern medicine, more people are not only surviving cancer, but are living longer, too.

But, as adults get older, they face increased risk of developing cancer, as well as increased risks of memory loss, falling, poor nutrition, and difficulty speaking. These are important details for providers to know when caring for them.

“While all older adults do not need to see a geriatrician, frail patients can really benefit from seeing a geriatrician to address conditions that affect their cancer treatment and overall quality of life,” says Soones.

The American Society of Clinical Oncology recommends that all adults over 65 undergo a geriatrics assessment prior to starting chemotherapy. MD Anderson uses this assessment when creating a tailored treatment plan.

“The goals of the assessment are to capture vulnerabilities and to help clinicians and patients make treatment decisions,” says Soones. “Geriatric Medicine will allow MD Anderson to meet these guidelines as we see growing numbers of older adults.”

Partnering with providers

Geriatric Medicine will partner with providers across the institution with guidance in caring for this population. The geriatrics team has identified champions throughout the institution to share this knowledge.

“With the large number of older adults seen at MD Anderson, all oncologists are geriatric oncologists,” says Soones. “Through partnerships in research and education, we hope to ensure that all cancer care providers ‑‑ including clinicians, nurses, patient services coordinators, and patient escorts ‑‑ have the skills and expertise to incorporate geriatric knowledge into their patient care and research.”

For example, clinical trials that include diseases that primarily affect older adults should tell providers not only how long patients will live and if they're likely to experience symptoms like nausea and vomiting, but also if they're likely to be able to live independently.

Geriatric Medicine will also partner with clinical researchers to identify additional outcomes that are meaningful to our older patients.

In the 2022-2023 U.S. News and World Report, MD Anderson ranked No. 1 in the nation for cancer care. Of the six adult specialties at the institution that were ranked, the Internal Medicine division contributed to four of them, either as the sole or joint contributor.

One of these specialties was Geriatrics, ranked No. 47 (tie), which became its own section on Sept. 1. In this article, Carmelita Escalante, M.D., chair, General Internal Medicine, reflects on the section's accomplishments that contributed to this national recognition. 

1. Geriatrics has continuously been ranked among the nation’s best. Why would you say that is?  
   
   Although our Geriatrics team is relatively small, they have sought to educate other care providers within the institution in regard to appropriate knowledge and care practices. Their efforts are demonstrated in the superb ranking.
   
   
2. How does the ranking relate to the level of patient care?
   
   The ranking is reflected in the sum efforts of our geriatricians to help our patients and to aid other clinicians in providing the most appropriate and up-to-date care for our older cancer patients. 
   
   
3. In general, what do you attribute the success of the General Internal Medicine/Geriatrics team to?
   
   I attribute this success to the passion, motivation, and utmost desire to provide the “best care” possible to older cancer patients and to share their knowledge and successes with others. They are truly “multipliers."
   
   
4. ​​​Besides being nationally recognized by U.S. News and World Report, what is an accomplishment achieved in FY22 in Geriatrics and/or General Internal Medicine that you are most proud of?
   
   I am proud of the geriatric team’s persistence in growing the program. We started with one geriatrician several years ago, and now we will have a team of three physicians, an advanced practice provider, a program coordinator and geriatric champions throughout the institution.
   
   The team is motivated and truly optimistic despite past challenges as we grew.
   
   
5. ​​​​​​​What are you looking forward to in FY23 for your department?
   
   I am looking forward to the joining of our third geriatric faculty member, Lara Magnabosco, M.D., and the implementation of our inpatient geriatric medicine consultation/co-management service.
   
   I'm also excited about the the initiation of the clinical trial work for the hospital at home program Tacara Soones, M.D., has been championing, and the application and designation of “Age Friendly Care” for our geriatric clinic.

In the 2022-2023 U.S. News and World Report, MD Anderson ranked No. 1 in the nation for cancer care. Of the six adult specialties at the institution that were ranked, the Internal Medicine division contributed to four of them, either as the sole or joint contributor.

One of these specialties was Gastroenterology and GI Surgery, ranked No. 32. In this article, Mehnaz A. Shafi, M.D., chair ad interim, reflects on Gastroenterology, Hepatology & Nutrition's accomplishments that contributed to this national recognition.

We are very pleased to be recognized by U.S. News and World Report. Our department has consistently worked to improve the patient care experience, prioritizing safety and innovation.

We established effective PPE protocols in the endoscopy unit, and multiple safety checks prior to procedures.  

Our team developed “Fast Track” protocols to prioritize patient care.

We have incorporated the use of new technologies such as artificial intelligence in colon polyp detection, and novel endoscopic full thickness resection techniques for the removal of large and complex lesions that traditionally required surgery .

We have an expanding clinical program in the management of colitis resulting from immunotherapy toxicities. This also involves several prospective clinical trials.

The liver consult service, a recently established team, has expanded rapidly over the past two years now involve now a third of the inpatient consults we see.

The department has expanded in the Houston Area Locations, where patients appreciate short wait times to clinic and endoscopy procedures. We have also expanded collaborations with medical oncology and surgery in pancreatic and esophageal disease management.

We a have an active research program with National Institutes of Health-funded grants in colon cancer detection markers and chronic pancreatic disorders.

Our success is overwhelmingly due to the people who make our Gastroenterology, Hepatology & Nutrition team, the technicians, doctors, nurses, administration, schedulers all collectively contribute to our success.

A proud achievement for us is getting accredited by the Accreditation Council for Graduate Medical Education for an MD Anderson Gastroenterology fellowship program, which started in July 2022.

In the 2022-2023 U.S. News and World Report, MD Anderson ranked No. 1 in the nation for cancer care.

Of the six adult specialties at the institution that were ranked, the Internal Medicine division contributed to four of them, either as the sole or joint contributor.

One of these specialties was Diabetes and Endocrinology, ranked No. 13. In this article, Steven Sherman, M.D., chair, reflects on Endocrine Neoplasia & Hormonal Disorder's accomplishments that contributed to this national recognition. 

1. Last year, Diabetes and Endocrinology was ranked No. 17. This year, it’s No. 13. What would you say contributed to this jump in ranking?
   
   I’m not sure that there is any significant difference between this year’s and last year’s rankings.
   
   However, over the past five years, we have experienced a steady upward climb in rankings, which is really quite remarkable given that we provide a highly specialized and narrowly focused “brand” of endocrinology.
   
   The major contributing factors probably include some measures of institutional excellence, such as the focus on safety and our high-quality nursing care. But there are two key differences between our scores and those of other dedicated cancer centers:
   
   1) our greater volume of inpatients treated for diabetes and other endocrine conditions, reflecting our consistent focus on providing superb inpatient consultative care, and
   
   2) the reputation of our research-driven program in advanced endocrine cancers, contributing to our higher “reputation score."
   
   
2. How does the ranking relate to the level of patient care?
   
   The rankings include weightings for better patient outcomes, such as 30-day survival after admission and the likelihood of patients being able to be discharged to their homes.
   
   Our patient volumes are unparalleled, and as stated on U.S. News' website, “higher volume is associated with better outcomes.”
   
   Also, an important contributor to all the MD Anderson specialty rankings is our repeated Magnet designation for quality of nursing care.
   
   
3. In general, what do you attribute the success of the Endocrine Neoplasia & HD team to?
   
   There is a commitment to excellence in patient care to make a difference
   in the outcomes of the people who seek our help that permeates the entire department.
   
   All of the institution’s core values are reflected in that commitment, driven by caring and discovery. 
   
   
4. Besides being nationally recognized by U.S. News and World Report, what is an accomplishment achieved in FY22 in your department that you are most proud of?
   
   The establishment of an institution-wide glycemic management program, dedicated to safe, effective care of diabetic inpatients with cancer, and the continued growth of innovative clinical trials for patients with advanced and aggressive thyroid and adrenal malignancies, are both tremendous collaborative efforts led by members of this department.
   
   
5. What are you looking forward to in FY23 for your department?
   
   ​​​​​​​​​​​​​​First, I look forward to continued growth of all of our important programs, with new faculty focused on advanced endocrine malignancies, bone health and diabetes management.
   
   I also eagerly await more opportunities for our group to interact in person, to share and celebrate successes and accomplishments both big and small.

In the 2022-2023 U.S. News and World Report, MD Anderson ranked No. 1 in the nation for cancer care.

Of the six adult specialties at the institution that were ranked, the Internal Medicine division contributed to four of them, either as the sole or joint contributor.

One of these specialties was Pulmonology & Lung Surgery, ranked No. 38.

In this article, Scott Evans, M.D., chair ad interim, reflects on Pulmonary Medicine's accomplishments that contributed to this national recognition.

1. Last year in the Pulmonology & Lung Surgery category, MD Anderson received a High Performing rating. This year, it’s No. 38. What contributed to the jump in ranking?
   
    We are very honored to be ranked No. 38 this year, as this reflects the superb care that is provided by our care teams.
   
   As these ratings are reputational, in many ways one can consider an increase in the rankings as indicative of consistent excellence. In other words, our reputation has grown year after year because we have provided great care time and time again.
   
   However, there are also important practice changes that have also likely contributed to our assessment, such as our expansion of very cutting-edge imaging and robotic technology that is not available in many centers.
   
   
2. How does the ranking relate to the level of patient care?
   
   I am confident that we are the best in the world at providing pulmonary care to patients with cancer and cancer complications. I’d like to think that this ranking acknowledges that excellence.
   
   
3. In general, what do you attribute the success of the pulmonary team to?
   
   In broad strokes, I believe the success of our care teams derives from technical excellence, recognizing the patients’ needs and having the knowledge and skill to appropriately intervene; collaboration, working effectively as a team with integration of different but essential components; and selflessness, putting the needs of the patient first.
   
   It’s an honor to work in an environment where our faculty, advanced practice providers, nurses, technical staff and administrative teams can all pull together to benefit our patients.   
   
   
4. How has the pulmonary team supported each other and patients through the COVID-19 pandemic?
   
   COVID-19 has been a challenge, particularly considering that so many of our interventions generate respiratory aerosols that can spread viruses.
   
   However, it has been inspiring to witness our teams just keep showing up to care for our patients, even early in the pandemic when we really didn’t know what level of risk we were facing.
   
   I think this shared commitment to our patients really helped bond our teams, knowing that we were all in this together.
   
   When you’re all pulling in the same direction, it becomes natural to lift each other up.
   
   
5. Our new fiscal year starts Sept. 1. What are you looking forward to for Pulmonary Medicine?
   
   I’m excited to see the continued expansion of our services at our Houston Area Locations in the Texas Medical Center, The Woodlands and West Houston.
   
   We are expecting to continue to increase the number of advanced interventions across these campuses, thanks in part to delivery of additional technologies.
   
   I also expect FY23 to bring new insights into the management of patients with cancer therapy-related toxicities, including checkpoint inhibitor-related pneumonitis, as our group has amassed tremendous depth of knowledge in this space.

On June 1, Symptom Research officially launched its Section of Patient-Centered Analytics.  

The section, led by Section Chief and Associate Professor Christopher Gibbons, Ph.D., supports the department by analyzing patient-reported outcomes using modern statistical and artificial intelligence methods.

These outcomes can help researchers gain deeper insights on how a patient’s treatment affects their quality of life and help clinicians provide more timely care and better symptom management. 

“We wanted to better represent the full extent of work undertaken by Symptom Research, which has a rich history of developing patient-reported outcomes to assess cancer symptoms,” says Gibbons.   

Better understanding patient-reported outcomes 

In Symptom Research’s role in patient care, the department sends validated questionnaires to measure important domains related to their health.

Examples include how they’re responding to treatment, the symptoms they’re experiencing, their satisfaction of care, and how their treatment is impacting their social and emotional well-being.  

Taking it a step further, the section takes a deeper dive into these patient-centered outcomes.  

“The section’s goal is to build on that history and expand Symptom Research’s goal to include a wider range of patient-centered outcomes, including financial toxicity, function, mental health, and quality of life,” says Peter Grace, Ph.D., Symptom Research chair ad interim.  

These outcomes help researchers be more aware of how patients are feeling and how they should proceed moving forward in caring for them and other patients in the future.  

“Patient-reported outcomes are remarkably versatile,” says Grace. “As a clinical intervention, they can improve patient quality of life, reduce symptoms, and even increase survival. The data collected from PROs can then be re-used to conduct comparative research and quality improvement.”  

Using artificial intelligence and data science for deeper insight  

Symptom Research and Patient-Centered Analytics believes that newer technology resources, such as data science and artificial intelligence (AI), can improve the value of care to help predict and achieve outcomes most important to patients.  

“Our focus is to develop strategies to help ensure every patient receives care, which prioritizes their values,” Gibbons says. “We envisage a future where cancer care is informed by individual patient priorities and every patient will achieve the outcomes they most desire.”  

Symptom Research has utilized AI-based decision aids, such as tools to help women with breast cancer understand what their likely outcomes following mastectomy and reconstruction will be, as well as to help guide difficult decisions around the end of life for women with ovarian cancer.  

Gibbons says data science is essential for the department to bring together a wide range of data sources to inform their algorithms.  

“To me, data science means thinking differently about data and how it can be used to gain new insights into cancer care," Gibbons says. "Data that comes directly from the patient is invaluable when building systems to guide collaborative decision making.”

The Internal Medicine division is proud to present our 2020 Annual Report. 

This issue exemplifies the outstanding accomplishments achieve in FY19 and FY20 by our compassionate and dedicated faculty and staff, who worked tirelessly in caring for our cancer patients. 

Featured stories

• 20th anniversary of the Internal Medicine division
• Internal Medicine's vital role in providing COVID-19 care
• Efforts of the Immuno-oncologic Working Group to address and treat patients with toxicities resulting from immunotherapy
• Goals and outcomes of our departments and sections
• Feature stories on patients and trainees

Internal Medicine stands proudly alongside faculty and staff across MD Anderson Cancer Center in supporting our mission of Making Cancer History®.