At age 19, Ronald Chen had no idea he would one day become a doctor. A college student uncertain about his future, Chen took a year off. The decision changed everything and set him on a course toward his current position as an assistant professor in the Department of Radiation Oncology and a researcher dedicated to bettering cancer care for North Carolinians. For his work, he earned the School of Medicine’s 2013-14 James W. Woods Junior Faculty Award.
We sat down with Dr. Chen to discuss his motivation and his research, which has shed light on the differences between three main types of radiation therapy for prostate cancer. He’s also conducted research on why there are disparities in the care of black and white prostate cancer patients.
I went to the University of Kansas, and I was very involved in promoting volunteerism during college. At one of the national conferences, I heard about a hospice program, and I talked with the people who ran it. At that time, I was a chemical engineering major. But partway through college I realized that chemical engineering wasn’t what I wanted to do. I actually left school for a year and volunteered full-time at the hospice, which was run completely by volunteers. All of us lived in the hospice, and we served as the primary caretakers for dying patients.
That was a life-changing experience. I decided I wanted to be a doctor. I went back to school and changed my major to pre-med.
I went to medical school at Harvard knowing I wanted to be a cancer doctor. During my training as a radiation oncologist, I realized that I wanted to not only take care of cancer patients but also to advance the care of patients. So during my residency at the Harvard Radiation Oncology Program, I had the opportunity to get a master’s degree in public health at Harvard – a one-year program. I did that to learn how to become a good researcher.
Now, I specialize in prostate cancer in the clinic, and my research is also focused on prostate cancer. I feel, as an academic physician, that having my clinic patients and experiences drive my research and then having that research feed back into improving patient care is a very nice synergistic way to do things.
Radiation technologies have developed over time to help improve the cure rates for prostate cancer patients and also to help reduce side effects of radiation.
But there’s a phenomenon in this country where we tend to adopt the latest treatment – usually the most expensive treatment – before research proves that the latest technology is better than the prior one.
In this particular study, we first looked at an older radiation technology. We found that that 3-D conformal radiation, which had been used for many years to treat prostate cancer, led to more side effects compared to intensity-modulated radiation therapy, or IMRT. Currently, across the country, almost everyone uses IMRT for prostate cancer. We found indeed that IMRT led to fewer side effects. It’s a newer technology than 3-D conformal radiation.
Then we studied another radiation therapy technology – proton therapy. It’s in the media a lot because of how expensive it is – about $150 million dollars to build one machine. There’s a debate about whether it’s better than IMRT, but very few studies have looked at that. Our study was one of the first. We weren’t able to find any reduction in patient side effects with the use of proton therapy compared with IMRT.
Since our study, a couple of other studies have found that proton therapy might slightly reduce short-term side effects compared to IMRT, which disappear over time. Those studies found no benefits with regard to long-term side effects. And there’s been no evidence that protons are more effective in treating the cancer.
There are about 10 proton radiation centers across the country currently, and about 20 more are being built right now.
A lot of my research looks at how we can improve care and benefit our own patients in North Carolina. Many researchers here at UNC, including my mentor Dr. Paul Godley, have done research on racial disparities in prostate cancer care. We know from prior studies that African American men tend to be diagnosed later, they tend to receive less aggressive treatment, and they tend to more commonly die from prostate cancer than do Caucasian men.
We studied why. We looked at whether there’s a longer delay between diagnosis and treatment in African American patients -- you could imagine that a longer delay could lead to a higher chance of reoccurrence of cancer. In this study, we looked at Medicare patients, and we found that – on average – African American men took a week longer between diagnosis and starting treatment compared to Caucasian men. And the delay was even longer for patients who were diagnosed with aggressive, high-risk prostate cancer.
Why that is we don’t really know. But, our study urges the research community to conduct more studies – so we can potentially make that better.
Essentially CyberKnife is a small radiation machine attached to a robot. The patient lies on a table and the robot moves to where the tumor is to deliver radiation to the tumor. The benefit is that it’s an extremely accurate way to deliver radiation targeted to a tumor. It helps us minimize radiating normal tissue so that we reduce side effects as much as possible.
The other thing that’s really important about CyberKnife is that the machine and the radiation it delivers can follow a moving target. For prostate cancer treatment, this is important because the prostate is a moving target. So are lung tumors -- CyberKnife can move to follow the lung tumor as the patient breathes.
To be clear, CyberKnife is not appropriate for every tumor. But it is commonly used for prostate, lung and brain tumors. There’s good evidence that it’s effective and safe in certain types of tumors – especially small tumors – and has allowed us to be very accurate.
Another advantage of CyberKnife is that we’ve been able to dramatically reduce treatment time. For example, standard prostate cancer radiation generally is every day for eight weeks. That’s a long time for patients. But with CyberKnife, we’re able to reduce treatment to four or five days total. Our research has shown that this is an effective treatment for early prostate cancer and patients have good quality of life outcomes afterwards.
A lot of research is currently being done to use Cyberknife radiation in additional situations. There’s currently a clinical trial being conducted here at UNC for patients with liver tumors and spine tumors – and continued research will help us learn more about the effectiveness of CyberKnife radiation in these settings.
I would say my job involves three different parts. I think of myself as physician first, because I want to help cancer patients live better lives. I think my research compliments that and allows me to be a better doctor and potentially advance treatments that help us get better outcomes for patients. Also, I teach medical students and residents. I think of that as complementary to my patient-centered mission, as well.
I think the most important and rewarding part of my job is interacting with patients and following them after treatment to make sure they’re doing well.
Ronald Chen, MD, MPH, is an assistant professor in the department of radiation oncology at the UNC School of Medicine and a member of the Lineberger Comprehensive Cancer Center. The James W. Wood Junior Faculty Award, which comes with a $3,000 stipend, supports promising young members of the School of Medicine’s clinical faculty. Chen has also been awarded the school’s 2012 Medical Student Research Mentor Award.