Being Part of the Contagious Enthusiasm

In a full-circle scenario, Cedars-Sinai Cancer, based in Los Angeles, California, welcomed back Margaret Liang, MD, MSHPM, in July 2023 to the institution where she completed her fellowship. Liang joined the Division of Gynecologic Oncology within the Department of Obstetrics and Gynecology, and she is also serving as director of the Gynecologic Oncology Fellowship Program.¹

“The opportunity to come back and continue building and expanding it was exciting. I feel very privileged to have that chance,” Liang said.

Her research focuses on the financial burden of patients with cancer, particularly gynecologic cancers. The latest paper she coauthored, published in Frontiers in Psychology in July 2023, outlined steps being taken by the Emotional Well-Being and Economic Burden Research Network, a National Institutes of Health–funded organization focused on addressing economic hardship due to disease and reducing the financial burden among patients with cancer and other diseases.²

In an interview with Oncology Fellows, Liang discussed her decision to assume the fellowship director position at Cedars-Sinai and what she finds most rewarding about her new role. She also offered advice for fellows as she reflected back on her earlier academic oncology years.

Oncology Fellows: Congratulations on your new role! What inspired you to want to return Cedars-Sinai as the fellowship program director in gynecologic oncology?

Liang: I graduated from the Cedars-Sinai Gynecologic Oncology Fellowship Program in 2017, so I was excited about the opportunity to come back to where I trained. It’s nice because the fellowship goes to different types of health care systems and that’s how I became interested in health services research [and] learning how to optimize how patients navigate the complicated health systems and all the things that are needed for them to go through their cancer diagnosis and treatment.

What are you most looking forward to in your new role?

Gynecologic oncology is unique because we often will treat patients throughout the care continuum and do both surgery and medical management of their disease, which is a little unique in oncology. The specialty itself has been having [a bit of] an existential crisis about where we want this subspecialty to go in the future. It can be a confusing and overwhelming time for new trainees and early graduates.

Thinking of novel strategies to help our trainees navigate all these different hats or roles that we play in the care of women with gynecologic oncology is challenging but also an exciting part of my role.

You will be mentoring residents and trainees as part of your new role. What is your outlook on this component?

Their enthusiasm is very contagious. That gives a lot of motivation to me [in terms of] my day-to-day work, which is rewarding but can also be very challenging given the difficult clinical scenarios that we have to help patients and their families with. However, it is really rewarding for me to see trainees progress, from the early times of their training until later on, how much they grow, both as surgeons and as physicians who just become more confident. The whole circle of giving back within academic medicine [is what I am passionate about].

Please discuss your research focus.

I’m very interested in a term called financial toxicity, meaning the financial burden that patients and their families go through both due to the monetary out- of-pocket costs they face as well as the time costs. An example is a patient being unable to work for income or [who] enjoy[s] working [but cannot]. I’ve done a lot of descriptive work, specifically in gynecologic oncology, but what I’m most excited about now is [that] we’re starting to shift into the intervention space where we’re trying to develop interventions at the patient level, the caregiver level, the health system level, and maybe even the policy level to try to improve things for the future. It’s a difficult problem because it’s multipronged, but it’s exciting to be able to move to...trying to find solutions, rather than just describing the problem.

What is one thing you wish you had done differently during your fellowship? Or is there something about your fellowship experiences that you did not expect?

Reflecting on what I gained during fellowship, besides the obvious clinical training, [I didn’t] take the time to recognize all the interpersonal communication skills that I ended up building. That’s both [in terms of] understanding [how] your own patient [who’s] sitting in front of you...want[s] to receive information and how to navigate difficult conversations, as well as navigating expectations of family members and other loved ones of patients.

At the same time, trainees are often navigating the personalities and the demands of faculty and mentors. That is a valuable skill that I didn’t recognize I was gaining while I was in fellowship, and now looking back I use those skills all the time.

What’s the biggest piece of advice you would share with new oncology fellows?

The other big thing is really utilizing the community around you. Oncology can be difficult because we are helping patients during a sensitive time in their lives. There has been a lot published about physician burnout in medicine, but particularly in oncology. Really leaning into your colleagues at your own institution, fellows at other institutions [who] maybe you met during interview season, as well as senior and junior mentors...you might have met [can be very helpful].

Also, I found that becoming involved in professional societies was a good way to offset some of the stressors that I have in my oncology work. It’s helpful in imagining how I’m going to sustain this throughout my entire career

References

1. Cedars-Sinai Cancer welcomes gynecologic oncologist Margaret Liang, MD. Cedars-Sinai. July 12, 2023. Accessed October 4, 2023. https://www.cedars-sinai.org/newsroom/cedars-sinai-cancer-wel- comes-gynecologic-oncologist-margaret-liang-md
2. Pisu M, Liang MI, Pressman SD, et al. Expanding research on the impact of financial hardship on emotional well-being: guidance of diverse stake- holders to the Emotional Well-Being and Economic Burden of Disease (EMOT-ECON) Research Network. Front Psychol. 2023;14:1196525. doi:10.3389/fpsyg.2023.1196525