Professor Bogda Koczwara is Professor of Medical Oncology at Flinders University, Adelaide, and Head of the Department of Medical Oncology at the Flinders Centre for Innovation in Cancer at Flinders Medical Centre. She is also President of the Clinical Oncological Society of Australia.
I became interested in oncology almost by accident. I was working at Flinders Medical Centre as a basic trainee in internal medicine and was asked to do a rotation in oncology to replace another doctor. I liked oncology because I could do much more for patients than I had expected and the experience got me thinking about what makes a fulfilling and meaningful life. My patients were facing that question and I also re-examined my own values. I left my rotation not just skilled but enriched. At that time, Flinders didn’t have an accredited training position in oncology so I did a year of haematology and then three years advanced training at Roswell Park Cancer Institute, in Buffalo, New York. Roswell Park is one of the oldest designated cancer centres in the world. It was amazing to be able to learn the hands-on craft and to see the history around me.
I have always loved Flinders Medical Centre. It is progressive and open-minded. When I came back to Australia from the United States in 1997, I knew I wanted to work at Flinders. It didn’t have a department of medical oncology, so I had to develop one myself. At first, I had a part-time job, which grew into full-time. We recruited more oncologists and developed a clinical trials unit. I am proud of how far we’ve come. It’s been a team effort. The hospital has gone from not even having a department of medical oncology to just having opened Flinders Centre for Innovation in Cancer. We have a busy trainee program, which attracts good-quality trainees. We’re doing a lot of new things in cancer but most importantly we provide a comprehensive cancer service. Creating and growing the department has been a meaningful and exciting part of my career.
I am also proud of my work to establish the Australia and Asia Pacific Clinical Oncology Research Development Workshop (ACORD). The idea for ACORD came after I attended a course for junior researchers in cancer in Colorado, US, in 1998. Cancer visionary Dr Daniel Von Hoff developed the annual course, which continues to this day. It’s where junior cancer researchers work day and night to develop good research ideas. It’s exhausting and inspiring. I came back from that course and felt we needed to have that in Australia. With the help of many people around Australia and the world, I convened the first workshop in 2004. It runs every two years, with participants from all over Australia, New Zealand and Asia. It is inspiring when you see a trainee from Australia sitting next to a doctor from Bangladesh who explains the cancer challenges in their country.
My current main area of interest is survivorship. We are victims of our own success in oncology. More people are surviving cancer, and want to stay cancer-free and live a healthy life. As oncologists, we need to deal with the long-term effects of cancer treatment in survivors — such as heart disease, osteoporosis and premature menopause — and that really stretches our boundaries. I’m hoping we can start to collaborate more on survivorship research around Australia. We will host the first survivorship conference in Australia in February 2013.
Survivorship issues reflect the evolution of oncology. In the 22 years since I graduated from medical school, I have seen an evolution in cancer care — in science, practice and patient outcomes. If this can happen in my career, imagine what will happen 20 years down the track.
I’ve been lucky to find many mentors from many walks of life. Dr Trevor Malden, an oncologist at Flinders, has been a great mentor and friend. He has this wonderful balance of being meticulous and careful and being really connected with patients. The CEO of Cancer Council Australia, Professor Ian Olver, has also been a great support and guide, and was an enormous support in establishing ACORD.
Oncology is an exciting area, because you can really make difference. That difference is based on science, but also on the art of human connection. I take my work personally. I can feel physically ill when I worry about a patient with a suspected recurrence. I need to manage the number of patients I have so that I can maintain personal contact without being overburdened.
One of the hidden gifts of oncology is that you learn about the fragility of life. Oncologists learn to value their life because they know that life can change in an instant. Every success is a miracle. Every sunrise and sunset is a joy. Every joke that a patient cracks with you is a source of celebration. You learn how to face some of the demons of life — death and dying and saying goodbye. You learn that saying goodbye matters. These are important life skills that oncologists are forced to acquire as part of their job. Oncology is not for everybody, but if you can deal with those issues, it enriches both your personal and professional life.
- Interview by Marge