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Operating from Every Angle

Jennifer Tseng, M.D., M.P.H.

Jennifer Tseng, M.D., M.P.H.

During the surgical rotation of her third year in medical school at the University of California, San Francisco(UCSF), Jennifer Tseng, M.D., M.P.H., met a doctor who would change her life. This physician, however, was not a faculty member or a peer student, but a patient lying in the hospital bed riddled with metastatic pancreatic cancer. A pathologist, he had flown up to UCSF to undergo a complex surgery called a Whipple to remove the tumor, only to wake up from the anesthesia to find that they got  as far as an exploratory procedure to discover the cancer had spread. As a doctor, he knew this was a death sentence. “So they talked about where he would have dinner that night,” Tseng recalls of the moment the lead surgeon met with him post-operatively, “because the unspoken context was there was nothing else they could talk about. And I found that incredibly frustrating. As a student, you’re all geared up to see this great case but then you realize, it’s not really about the case, it’s about the patient, that individual patient and the problem. And something about that clicked in my brain.”

That click led Tseng, now chief of surgical oncology at Beth Israel Deaconess Medical Center, to dedicate her career to the improved treatment of pancreatic and other upper gastrointestinal (GI) cancers despite—or perhaps because of—the fact that they can be some of the most difficult cancers to treat. Often striking in the prime of life, pancreatic cancer has the lowest five-year relative survival rate of all major cancers at just 6 percent, with 73 percent of patients dying within the first year of diagnosis. “I’ve always liked hard problems,” says Tseng. “I’ve always liked to spend time with people who are undergoing crises or turmoil in their lives and trying to make a difference at times when it seems like the intervention actually can help. And even if you don’t save every person, I think if you’ve tried and they know that you’ve tried, that’s something that resonates with me.”

A surgeon by trade, Tseng knows that her field remains an integral component of treating most cancers and has been an advocate for ensuring that surgeons are at the decision-making table in her role as clinical co-director for surgery at BIDMC’s Cancer Center. But, when it comes to a disease as complex as pancreatic cancer, Tseng is also humbly cognizant of surgery’s limitations, noting that she considers herself a surgeon only after being a person first and a doctor second in her personal clinical hierarchy. “I like surgery. Surgery is fun. Surgery
is dramatic,” she says. “But it’s just a tool. If you’re a hammer and the whole world looks like a nail, then you’re not going to realize when the hammer’s not going to work. I would be delighted for surgery to become completely unnecessary for pancreatic cancer.”

Jennifer Tseng, M.D., M.P.H.Tseng knows that making cancer surgery obsolete will require not only embracing the importance of all the areas in cancer care that exist today but also ensuring that there are a lot more alternatives in the toolbox in the future. “Surgeons have been taking excellent care of cancer patients for a long time, but now in the 21st century, we realize that we must have a respect for all the other disciplines,” she says. “Of course, you don’t want to be diffuse either. But you need to learn that you subspecialize in certain things to have an understanding, an empathy, for these other fields, enough not to be dangerous but to be respectful—that’s what is helpful to patients.” Tseng says that this inclusive approach to care, which has been an integral component of BIDMC’s cancer practice for decades, is something she and her colleagues are trying to build on across the board at the Cancer Center. In her own specialty, she has been working with A. James Moser, M.D., director of the Institute for Hepatobiliary and Pancreatic Surgery, in his effort to establish a multidisciplinary conference in pancreatic cancer as well as multidisciplinary clinic for the disease. In bringing this collaborative approach to pancreatic cancer to fruition, Tseng especially credits Mark Callery, M.D., chief of general surgery, as well as other leaders in gastroenterology, GI medical oncology, radiology, radiation oncology, palliative care, pathology, genetics, nursing, and nutrition. “These are thrilling times, because that way we can have all the specialists in one place,” she says. “It’s so important to have everyone in the same room and from completely different subspecialties with the ability to cross talk, sharing both their clinical expertise and scientific experience.”

When it comes to her own scientific expertise, Tseng also takes the multidisciplinary strategy to heart, working on subjects that range from the cellular to the individual to the population level. “In terms of research, it doesn’t matter to me whether it’s a molecule or a piece of clinical data,” she says, “because if it can tell me what the best treatment is going to be for a patient or improve the treatment for a patient down the line then I want it all.” At the cellular end of the spectrum, there’s her search for biomarkers for pancreatic cancer, molecules in the blood or other bodily fluids that indicate the presence or absence of the disease. At the patient level, she is building data-driven models to determine for each individual pancreatic cancer patient the optimal sequence of treatments, which now may include surgery, chemotherapy, radiation, and more. And through the societal lens, she is looking at what might cause disparities in cancer care and outcomes, a longtime personal interest that she is now expanding in partnership with the Massachusetts Department of Public Health. A surgeon with a public health background may seem an anomaly, but Tseng says her training in the subject has made her a more effective clinician and researcher, not only by providing her with productive collaborations and biostatistical proficiencies, but also by literally broadening her horizons. “In the old days, surgeons tried to change the world one patient at a time,” says Tseng. “And I think that will always have to be done. If you don’t have that individual relationship with a patient, you will never have that personal perspective to really affect policy. But on another level, for me at least, is the ability to understand on a macro level how these things occur. The most holistic way that a public health degree has helped me, and continues to help me, is just an understanding that every individual, whether it’s an individual person or an individual disease, does not exist in a vacuum.”

Jennifer Tseng, M.D., M.P.H.Although it might seem that she can do just about anything herself, Tseng is quick to point out that she doesn’t exist in a vacuum either, surrounding herself with people who have similar passions but differing skills to cover every angle of a clinical or scientific challenge. “I think what I’m really good at is identifying other people that are really good,” she laughs. “I think my strength is being able to see that certain something in other people, whether it’s a secretary or a student or a trainee, and then trying to help them, as best I can, be their best selves.” In that vein, Tseng gets most excited talking about her mentoring relationships with young physician–scientists, stressing that it would be in this pool that she would pour the majority of philanthropic support that came her way. She sees investment in early-career talent—from small fellowships all the way up to creating an educational institute—as a fruitful and forward-thinking way to advance all that she is trying to accomplish. “I will try my whole life to beat cancer, on an individual level, on a division level, on an institutional level,” says Tseng. “But I’m one person. That being said, if I can multiply that through the course of my career through trainees and mentees, then I will have achieved 100 times more than what I could do as an individual. So it’s from them that I will have that legacy.”

Tseng hopes that her legacy will be that the medical students in the future won’t need to encounter, as she did, patients who have to accept their pancreatic cancer as a death sentence. She wants them to experience, more and more, the grace and inspiration that she has been privileged to witness in her patients who have survived. Tseng stresses that with increasing donor support of efforts to gain understanding of the effect of disparities in health care delivery and to augment the technological advances in minimally invasive surgery and cellular-based, targeted therapies, she sees a glimmer of hope that things are moving in that direction. While she has been highly successful in obtaining funding from comparatively conservative sources such as the National Institutes of Health, the Howard Hughes Medical Institute, and the American Cancer Society, Tseng says that partnering with more adventurous individual philanthropists is not only more personally inspiring but will be essential to making the high-risk, high-yield proposition of “curing the incurable” a reality. “We haven’t won the war yet, but we’re poised on that brink of being able to truly make big changes in cancer,” she says. “The next decade is going to be the time when we actually make these bad cancers into submissive, beatable diseases. I really feel it.”

Contact Information

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Beth Israel Deaconess Medical Center
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