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 Christine Canning,
MHP, PA-C
The author is a PA at the Dana Farber Cancer Institute and a Principal Associate in Medicine at the Harvard Medical School, Boston, Mass. She is also a part-time lecturer in the Physician Assistant Studies Programs at Northeastern University and Massachusetts College of Pharmacy, Boston. She has indicated no relationships to disclose relating to the content of this article.
Photos by Rick Friedman
My work as a PA allows me to combine
a variety of activities. My clinical practice is in the outpatient setting, and I also have supervisory
and administrative duties related to both our hematopoietic stem cell transplantation (HSCT)
program and our PA service. Plus, I have teaching responsibilities at the nearby Northeastern
University Physician Assistant Program. In my 16 years as a PA, I have found that there are virtually
endless opportunities to grow, learn, and contribute to the many layered aspects of patient care.
8:00 AM—Teaching at Northeastern University
Two sessions a year, I have the opportunity to teach immunology and oncology.
This session will cover hematologic malignancies. While most of our time is spent on the clinical
aspects of care, the students often want to discuss the specific ways in which PAs can contribute
to the care of such a highly complex patient population. While cancer care is not for everyone, my
experience has been that PAs are very well suited to this field. With our medically modeled training,
when placed in the right setting, we partner well with our supervising physicians to provide the
highly detailed and compassionate care that our patients require. I frequently remind my students
that patient care is a privilege that we earn every day and that they must be prepared to pay attention
to how much the patients have to teach us.
10:30 AM—Outpatient clinic
The Dana Farber Cancer Institute (DFCI) HSCT program is located at one of
the largest transplant centers in the country. Each year, approximately 300 autologous and allogeneic
stem cell transplants are performed for the treatment of hematologic malignancies. I have worked
in the outpatient clinic with the division chief, Dr. Rob Soiffer, for more than 16 years. Much of
our work involves the development and administration of clinical trials. As a coinvestigator,
I have had the opportunity to assist in the development of and improvements in transplantation
and, in particular, posttransplant immunotherapy. This work has been a fascinating and challenging
blend of science and patient care.
Again, I have found this to be a perfect niche for a PA. In the past year,
we have added four more PAs to various outpatient programs where the focus is clinical trials and
experimental therapeutics. Our trials involve pharmaceutical interventions with new drugs
for the treatment of leukemias as well as cellular and vaccine trials aimed at manipulating the
immune system. I am so encouraged by the progress that we have made, and yet I still see the challenges
that we face in the treatment of such disease as leukemia, lymphoma, and multiple myeloma.
12:00 noon—Inpatient BMT PA meeting
In the past year, we have opened our new attending/PA bone marrow transplant
inpatient service. As Director of PA Services for DFCI, I assisted with the design and development
of this program. This service is a fairly new model within our hospital, and it has been an exciting
challenge for all involved. We have been fortunate in recruiting several very talented and dedicated
PAs. The care of BMT patients is difficult and complex, and the PAs have all extended themselves
to build this program and expand their clinical skills. Our goal is to build a team of expert clinicians
who provide the highest level of care to our patients and also provide the continuity of care that
is not always possible on more traditional teaching services. Over time, we foresee a PA service
composed of PAs at all stages, from those on school rotations, to oncology “fellows,”
to a series of graduate PAs at all levels of experience. We hope that our PA service will support the
teaching, learning, and professional development of our PAs, so that in turn, our patients will
benefit from the skills and teamwork of this highly motivated team. Toward that end, each Tuesday
we meet as a group to address and solve problems of the new service, share interesting cases or diagnostic
dilemmas, and generally to support one another through this tremendously challenging time.
1:00 PM—JCAHO
This week our institution is undergoing our Joint Commission on Accreditation
of Healthcare Organizations reaccreditation review. I have been called by the committee, along
with the Chief Medical Officer and Chair of the Credentialing Committee, to describe our institution’s
process for credentialing PAs and conducting competency reviews. These are all issues that we
have addressed aggressively over the past year, as our PA service grew from two PAs to eleven, with
five new positions just approved.
2:00 PM—Inpatient rounds
I accompany Dr. Soiffer on rounds of patients who are currently admitted
for stem cell transplant or with posttransplant complications. The transplant service has two
teams: BMT A, treating mostly patients who have had allogeneic stem cell transplants, and BMT B,
treating mostly patients who have had autologous stem cell transplants. We admit 5 to 10 patients
per week for transplant. The acuity of patients undergoing transplant can be quite high. While
each team does have an inpatient attending physician assigned, as well as either house officers
or PAs, most of the outpatient attending physicians remain very involved in the care of their patients
even while they are hospitalized. Visiting all the inpatients each day can be quite challenging—yet
it provides great continuity of care for the patients and the psychological support that they and
their families require during such potentially difficult therapy. This is again where I see a unique
role for PAs, as we help to facilitate the link between the physician and the patient.
PA Christine Canning examines a patient being
treated at
the Dana Farber Cancer Institute.
4:00 PM—Protocol review meeting
Once every other week, we have a departmental protocol review meeting. At
this meeting, various investigators on the staff present upcoming clinical trials, as well as
summaries and updates of ongoing research within the group. It is an excellent informal opportunity
to pose questions and reflect upon trends within our patient population, as well as within transplantation
as a whole. My background in laboratory research gave me the perfect foundation to segue into clinical
trials work as a PA. I have always been fascinated by the immune system, and both of my supervising
physicians, Dr. Rob Soiffer and Dr. Jerry Ritz, have given me every opportunity to pursue this work.
5:00 PM—Program technical review meeting
As Program Technical Director for HSCT, I am also responsible for identifying
areas where we have systems issues that need change or improvement. I meet with the program leadership
to review any programmatic changes that we are implementing, hiring issues, and policy updates
that we are making in our ongoing effort to provide excellent, safe, and effective care to our patients.
The area of stem cell transplantation requires the orchestration of any number of specialists
and disciplines. During this meeting, we work to coordinate the efforts and improve the communication
among such groups as medicine, nursing, care coordination, social work, the bone marrow transplant
coordinators, the unrelated marrow donor program, the clinical trials group, and inpatient services.
With such a busy and complicated program, there is always room for growth and improvement; and while
my clinical training as a PA did not prepare me specifically for this role, it has been indispensable
in allowing me to understand the interactions with so many other disciplines.
6:00 PM—Home again . . .
I head home for dinner with the two people who make it all worth it: Paul, my
husband of 19 years, and our 9-year-old son, Aidan. Then it’s homework and (hopefully) playtime
before bed.
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