Dr. Jean Connors Of Harvard Medical School On The 5 Things Everyone Needs To Know About Cancer

An Interview With Savio P. Clemente

… Everyone handles the stress of the cancer diagnosis and treatment differently. Support structures with family and friends can be very helpful. Some people don’t like 100 people coming to the door with tuna noodle casserole and some people love that. Patients often need to limit their engagement to close personal support, as well as complementary therapies.

Cancer is a horrible and terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?

In this interview series called, “5 Things Everyone Needs to Know About Cancer” we are talking to experts about cancer such as oncologists, researchers, and medical directors to address these questions. As a part of this interview series, I had the pleasure of interviewing Jean Connors, M.D..

Jean M. Connors is a hematology attending physician, the Medical Director of the Anticoagulation Management Services, and the Hemostatic Antithrombotic Stewardship Program at Dana-Farber Brigham Cancer Institute, and an Associate Professor of Medicine at Harvard Medical School. She received a medical degree from The Johns Hopkins University in Baltimore, USA, and completed her residency in internal medicine at Beth Israel Deaconess Medical Center in Boston, USA, as well as fellowships in transfusion medicine and hematology and oncology from Brigham and Women’s Hospital. Dr. Connors is an Associate Editor for the Journal of Thrombosis and Haemostasis (JTH) and is a member of many professional societies, including the American Society of Hematology (ASH), the International Society on Thrombosis and Haemostasis (ISTH), and the World Thrombosis Day Scientific Steering Committee.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

I originally moved from Queens, New York, to Southern Maine when I was five years old. My family was very athletic, so we did a lot of activities together like swimming, boating, skiing, and long-distance sports, like triathlons. This active-focused lifestyle continued all the way through my completion of medical school.

In third grade, my teacher got me interested in science. I remember doing modules on magnets and light bulbs and looking at snails and fish in the small classroom aquarium. This really sparked my interest in the subject which helped shape the path I would follow for the rest of my career. I went to a public high school in Cape Elizabeth, Maine, followed by Wellesley College for undergrad, and Johns Hopkins University Medical School. My husband ended up going back to Boston, so I followed suit for residency at Beth Israel Medical Center. I always had an interest in coagulation and decided to focus my medical school research projects on the subject of platelets and platelet function. I eventually applied to a hematology fellowship at Brigham and Women’s Hospital focused on coagulation research in which I tried to clone the P2Y12 receptor on platelets. It didn’t work, but it did push me to my next challenge of a transfusion medicine fellowship.

Now, I see patients and am the medical director of the anticoagulation management services and hemostatic antithrombotic stewardship at Dana Farber Cancer Institute and Brigham and Women’s Hospital. We provide services for nearly 3,700 patients on different anticoagulants, especially those with cancer who often have unique and specialized needs.

What or who inspired you to pursue your career? We’d love to hear the story.

It started with my third-grade teacher, Mrs. Dutton. I paid attention to science all throughout my schooling. In high school, I had an honors biology teacher who was very rigorous, and I loved his class. In college, I was already interested in pursuing science. I had the opportunity to be mentored by Dr. Marsha Rosner from MIT. I had a hard time deciding whether to pursue a PhD in Science or do medicine. I ultimately chose medicine, because of my love for the physician-patient interaction and caring for people.

This is not easy work. What is your primary motivation and drive behind the work that you do?

For a long time, the data for how to manage patients with coagulation problems was fairly unknown. Unlike other diseases such as high blood pressure, coagulation was sometimes viewed as a ‘black box’. It was hard to get people into trials, and there weren’t many advances in drugs to treat thrombosis, also known as blood clots. About 12 years ago, a colleague of mine said, “I’ll do almost anything you do in benign hematology, but I won’t treat coagulation patients, because there’s no data and you guys make it up.”

What this meant was that we needed to carefully craft individual patient plans and do our best with clinical expertise without a lot of data to guide how to manage these patients. Data eventually started to come out on how to manage cancer patients with thrombosis. Now, as new drugs have become available, we have much more opportunity and newer anticoagulant medications that are easier to take. Patients with cancer have unique challenges. Many thrombosis patients are not taking a lot of medications or need frequent treatments or procedures. You can check in on them once a year. Patients with active cancer can have a lot of medical issues that require significant clinical expertise and judgement. There are unique challenges that these patients face, so it’s gratifying and rewarding to be able to help them through the difficult medical situations they so often face.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

One project I just completed was a large national trial on antithrombotic agents in COVID-19, the ACTIV-4B Outpatient Thrombosis Prevention trial funded by the NIH/NHLBI. This took a lot of time and effort during the pandemic to get this randomized trial up and running, to get sites to participate, and to get the patients in, all with the goal of trying to mitigate serious complications related to COVID-19. We were able to successfully finish and publish that trial and are now working on secondary components. From this trial we learned that most outpatients that have COVID-19 do not need anticoagulation treatments. This has allowed many COVID-19 patients to avoid potentially fatal complications that earlier COVID patients were exposed to.

Others include the Caravaggio trial where I was the national lead investigator for the U.S. involvement. We released the results at the end of March 2020 and, given the state of the world at that time, there was obvious anxiety about how the results would be viewed. One of the lead authors, Giancarlo Agnelli, was based in Italy. It wasn’t clear whether he’d be able to make it to the conference for the presentation of our findings due to the sudden outbreak of COVID-19 around the world. This was a hugely important study, because the medication we studied showed less bleeding in the cancer patients than other similar anticoagulants, and effectively made an impact in thrombosis and cancer healthcare across the world.

There was also a PCORI, Patient Centered Outcomes Research Institute, funded clinical study that I co-chaired. The study was a pragmatic clinical effectiveness trial of any one of the direct oral anticoagulants versus traditional low molecular weight heparin in patients with cancer and thrombosis. Working with my co-chair Deb Schrag created great synergy as she is a population scientist focused on colorectal cancers and I am a thrombosis expert. We’ve just completed writing up the results of this trial that should be published in the coming weeks. All this data helps the medical community shape clinical practices for patients with cancer and thrombosis.

For the benefit of our readers, can you briefly let us know why you are an authority about the topic of Cancer?

My professional life since attending Johns Hopkins Medical School has shaped me into the cancer and thrombosis expert that I am today. As a hematology attending physician at Brigham and Women’s Hospital and the Dana Farber Cancer Institute, I support the research and treatment of thousands of cancer patients each year. Other facets of my role include acting as the medical director of the Anticoagulation Management Services and the Hemostatic Antithrombotic Stewardship Program, as well as an associate professor of medicine at Harvard Medical School. I have also participated in fellowships in hematology and oncology at Brigham and Women’s.

Ok, thank you for all of that. Let’s now shift to the main focus of our interview. Let’s start with some basic definitions so that we are all on the same page. What is cancer exactly?

Cancer is the uncontrolled growth of an abnormal cell type. These abnormal cells arise from normal cells due to mutations in the DNA and genes that are usually responsible for normal growth and development. Some cells revert to less mature cells, and some remain mature, but grow rapidly and can be destructive to normal tissue.

Cancer therapies essentially are aimed at eradicating the growth of these cells. Over the last decade, we’ve found treatments that actually target the mutations or effects of these mutations.

What causes cancer?

As we know more about the genetics of cancer, there are a few different causes of cancer. People can inherit a specific genetic disorder that predisposes them to certain types of cancer, or, as people age and cells continue to multiply, DNA can be replicated incorrectly resulting in a mutation that gives the cell an advantage to grow into a cancerous cell cluster. The immune system is always trying to fight this off, but sometimes a cell can escape detection. That’s where trying a tumor vaccine can be successful with ongoing investigations in this area.

What is the difference between the different forms of cancer?

In some ways, this is still a puzzle to be answered. Some mutations are very specific to certain cancer types, while some inherited mutations make it easier for you to acquire another mutation. When you acquire these somatic mutations, there are random events that happen within the cell to cause it to mutate, making it easier to develop into a potentially cancerous cell. Why one person gets kidney cancer, and another gets colon cancer is actively being investigated.

I know that the next few questions are huge topics, but we’d love to hear your thoughts regardless. How can cancer be prevented?

We definitely know some environmental risk factors like smoking, excessive alcohol use, prolonged sun exposure, and exposure to a large amount of certain chemicals such as benzene are linked to increased risks of cancer. There’s been a lot of recent press articles on younger people getting colorectal cancer and there’s a question about whether it’s linked to a diet high in red meat, alcohol, or other associated factors. There’s still a lot we need to learn.

Even with very few environmental factors, there’s still a lot that people can’t control. If you have a strong family history of cancer, you may need to eat a low fat, low-red meat diet, not smoke, and not drink excessive alcohol to prevent cancer. Otherwise, there are a lot of factors that trigger cancer that we haven’t uncovered yet and really can’t control.

How can one detect the main forms of cancer?

There are guidelines developed by many different societies, like the United States Preventive Services Task Force, on age and sex appropriate screening for cancer. Mammograms, colonoscopies, and prostate exams are all important to detect the most common forms of cancer. The ages are shifting now — screening colonoscopies have just been altered to be recommended starting at age 45, compared to 50 where it was previously.

Cancer used to almost be a death sentence, but it seems that it has changed today. What are the odds of surviving cancer today?

The significant advances in understanding the genetics behind cancer and the cell biology of cancer has really changed how we treat difference cancers. We used to treat cancer with nonspecific drugs that prevented cell growth or division, which is where a lot of the toxicities from chemotherapy came from, such as nausea or hair loss. With the advent of improved specific agents that affect a specific cell type, targeted therapies for the enzymes defects that cause some cancers, and immune checkpoint inhibitors, as well as improved supportive care therapies, we are much more equipped to directly tackle and target the specific cell problem with some cancers and to harness the immune system to control other cancers. Patients now are living much longer no matter what type of cancer they have.

I often say that cancer is now a chronic disease for some people even if they cannot be cured, because they can still live many more years than they would have in the past. When people are newly diagnosed with cancer, they should not feel that all is lost. There are many new treatment options available now

That said, when you look at patients living longer with cancer, their risk of getting a blood clot also increases. These factors that increase the risk of a blood clot include the type of cancer, treatments, therapies, and surgeries, so patients should be aware that as they live longer, they may develop other complications like thrombosis.

Can you share some of the new cutting-edge treatments for cancer that have recently emerged? What new cancer treatment innovations are you most excited to see come to fruition in the near future?

The approaches coming to fruition now, like immunotherapies and check-point inhibitors, have been in development for years. One of the first immune checkpoint inhibitors, ipilimumab, was approved in the U.S. in 2011 for melanoma. We now know that they are being used in many different types of cancers to effectively counteract the disease. There is continued incremental improvement on new treatments across the spectrum.

The Car-T Cell Therapies for lymphomas take the patients’ own T-Cells to a lab and use lab techniques to modify the antigens on the receptor of the cell so that they engage in an enhanced immune activity against cancers. This is just one example of relatively new treatments shaping the future of cancer care.

Healing usually takes place between doctor visits. What have you found to be most beneficial to assist a patient to heal?

Everyone handles the stress of the cancer diagnosis and treatment differently. Support structures with family and friends can be very helpful. Some people don’t like 100 people coming to the door with tuna noodle casserole and some people love that. Patients often need to limit their engagement to close personal support, as well as complementary therapies.

The Zakim Center at Dana Farber offers these complimentary therapies, like massage, reiki therapy, acupuncture, and others to support the conventional cancer treatments being offered. Light exercise, like even a walk to the mailbox can be helpful, as well as yoga and meditation.

From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?

Don’t be afraid to talk to them about their diagnosis and experience. By ignoring the elephant in the room, it can make them feel isolated. It’s important to respect the patient and what makes them feel comfortable. By providing meals or taking on tasks for them like walking their dog, doing their laundry, or just visiting them to offer companionship, you can take a huge burden off these patients. It’s important to offer, because patients may not feel comfortable asking for the help.

What are a few of the biggest misconceptions and myths out there about fighting cancer that you would like to dispel?

Often, people want to try to find what caused the cancer or what they did or didn’t do that resulted in the cancer developing. With very few exceptions as listed above, such as smoking, we don’t know what caused the cancer to develop in most patients and will not be able to figure it out. As we discussed earlier, there have been significant advances in the treatments for cancer that enable people to live with cancer for much longer time today than even 10–15 years ago.

Thank you so much for all of that. Here is the main question of our interview. Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Cancer? Please share a story or example for each.

1. Stay on top of routine cancer screening tests.
2. Don’t hesitate to get new symptoms checked out.
3. Remember that there have been significant advances in cancer treatments in the last few years.
4. Blood clots can occur in patients with cancer.
5. Develop your support network of friends and family members, big or small, and don’t hesitate to ask them for help.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

World Thrombosis Day has already launched an awareness campaign about the signs and symptoms of blood clots and has information for patients with cancer and thrombosis. I would have people start by spreading the word that these resources exist, and as with friends and family members, don’t hesitate to reach out to these resources.

How can our readers further follow your work online?

Readers can go to Twitter @connors_md or publications of my work at jean m connors — Search Results — PubMed (nih.gov).

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work. Thank you!