Partners in Hope: Dr. Gardner

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Our profiles cover everyone from those facing sarcoma to caregivers, family members and more. Today we are proud to feature Sarcoma Specialist Jerad M. Gardner, MD. Thank you Dr. Gardner for this informative profile piece.

Eric D. Davis Sarcoma Foundation (EDDF): Tell us about yourself professionally (education, employment, etc)

Jerad M. Gardner, MD (JG): I attended medical school at Tulane University in New Orleans, which was a wonderful experience aside from Hurricane Katrina happening my senior year. I completed residency in Anatomic and Clinical Pathology at the Houston Methodist Hospital, and I then pursued two sub-specialty fellowship training years in both dermatopathology and bone/soft tissue sarcoma pathology at Emory University in Atlanta. My sarcoma pathology training was completed under the direction of Dr. Sharon Weiss, one of the most respected authorities on the diagnosis of sarcoma and other soft tissue tumors in the world. She wrote the first (and still most widely used) comprehensive medical textbook focusing on sarcoma and soft tissue tumor pathology, and she has also published numerous sarcoma research articles over her career. During my year with Dr. Weiss, I saw over 4000 sarcoma and other soft tissue pathology cases, most of which were difficult cases sent to her for expert second opinion; most pathologists will not see as many soft tissue tumor cases in their entire career as I was able to see in just one year working with Dr. Weiss. It was a truly amazing experience working with her one on one every day, conducting sarcoma research under her guidance, and learning from her the art and science of making accurate diagnoses on challenging sarcoma cases.

After completing my training, I moved to Little Rock, Arkansas, to become an Assistant Professor of Pathology and Dermatology at the University of Arkansas for Medical Sciences (UAMS). In my practice here, I review skin pathology and bone/soft tissue sarcoma pathology cases including cases sent for expert consultation and second opinion. UAMS has the only comprehensive sarcoma treatment center in Arkansas affording me excellent opportunity to work closely with orthopedic oncologists (sarcoma surgeons), medical oncologists, radiation oncologists, and radiologists who all have expertise in working with sarcoma patients. All of our sarcoma specialists at UAMS meet together twice per month for sarcoma tumor board where we discuss new or unusual sarcoma cases and then decide as a group the best strategy for personalized treatment of each individual patient.

EDDF: Why did you decide to focus on sarcoma?

JG: I saw multiple sarcoma cases early in my pathology residency training which made a huge impact on me. I was intrigued by their histologic patterns (appearance of the tumor under the microscope), their unusual presentation and behavior compared to most other types of cancer, the wide variety of different subtypes of sarcoma, and their rarity compared to other cancers. Something about rare and esoteric tumors appeals to my sense of intellectual curiosity, and I feel that fascination with a subject helps make one work harder to become better at it. I also had two wonderful teachers and mentors in residency, Dr. Alberto Ayala and Dr. Jae Ro, both of whom had gained extensive experience with sarcomas during their years spent working at M.D. Anderson in Houston and both of whom took the time to try to pass some of that knowledge on to me. I’m forever indebted to them. The combination of an interesting subject and excellent mentors led me to my fellowship with Sharon Weiss and my career in sarcoma pathology.

Only later did I realize the most important reason of all to focus on sarcoma pathology: the patients. Ensuring accurate diagnosis of these rare tumors is the first step to proper treatment.  As I’ve gotten to know many sarcoma patients recently through my involvement with sarcoma support groups on Facebook, I’ve realized that the real reason I spend every day thinking about and reading about and diagnosing sarcomas is so that I can do my part to improve treatment and quality of life for the people afflicted by sarcoma.

EDDF: What would you like to see in the future for sarcoma patients?

JG: Better therapies. Honestly, I think this is what all cancer patients and physicians want to see for all types of cancer, not just sarcoma. We’ve come a long way with some types of sarcoma, but for others we have made frustratingly little progress in developing more effective therapies to improve survival. Targeted therapies that inhibit specific molecules in cancer cells have been very effective for some types of cancer, and I hope to see more of these drugs become available for sarcomas in the future.

The other thing I would like to see for sarcoma patients is more awareness and better online resources. I think sarcoma societies and foundations like the Eric D. Davis Sarcoma Foundation have come a long way in making that a reality. Social media has also allowed for more rapid and complete dissemination of sarcoma awareness messages to other physicians, to medical organizations, to medical policymakers, and to patients than ever before. If you use social media, you can help further this mission by getting plugged in with the many sarcoma focused groups and individuals on Facebook and Twitter and sharing or re-tweeting their content with your followers and friends.

EDDF: After an adult receives a sarcoma diagnosis, what are some of the first things you suggest that they do?

JG: Google is a wonderful thing, and it is one of the first tools that I use when confronting anything that I’m unfamiliar with, but running straight to Google the day you receive your sarcoma diagnosis and spending hours looking up everything you can about sarcoma may not be the best thing to do. There is a time for that, but it’s not the moment you get your diagnosis. If I were a patient, I know I would be disregarding this advice as I expect many of you will (otherwise, you would likely not be reading this page!). But let me caution you that as useful as it can be, Google can also bring medical information overload and even conflicting medical information that can be very hard to process if you are not a medical professional (and even if you are one, sometimes). All of that information can increase rather than decrease your anxiety, and more stress is the last thing you need now. You need time to process things emotionally and to formulate the first steps of a clinical plan with your doctors. So maybe consider taking a break from researching sarcoma online, at least at first. After you have had some time to breathe and digest your diagnosis and have a clinical “next step” in place, then you can consider adding new info to your plate and doing some research.

Here are some other things to do once you receive a sarcoma diagnosis:

  1. Have your pathology materials reviewed by a sarcoma pathology expert. This is crucial. Many sarcomas can be relatively easy to diagnose for the majority of general surgical pathologists; on the other hand, some of them are very challenging and often require expert review.  As a patient, it’s difficult to know which types of sarcomas are the challenging ones.  I think it is a great idea to be as certain as possible of the diagnosis up front before initiating treatment or diving into Google to learn everything about your tumor. Accurate diagnosis is the key to proper treatment. You can initiate an expert consultation on your pathology materials in most cases by asking your surgeon who did the biopsy to request the pathology department to send out your case for a second opinion. Or, if you plan to visit a sarcoma treatment center for treatment or a clinical consultation, there is a high likelihood that your pathology will automatically be reviewed by an experienced sarcoma pathologist at their center. Of course, if your initial biopsy was performed at a center that specializes in sarcoma treatment, there is most likely a competent sarcoma pathologist on staff who already reviewed your biopsy and thus a second opinion may not be necessary in that case.
  2. Make sure your treating physician has experience treating sarcomas. If your surgeon/oncologist/other treating physicians plan to treat your sarcoma, ask them how many sarcoma cases they have treated before. If they seem unfamiliar with sarcoma or say they rarely deal with it (sarcomas are, after all, a very rare group of tumors), you may wish to seek an opinion elsewhere from sarcoma treatment experts. This isn’t about picking good doctors versus bad doctors. It’s about selecting doctors who have experience with your specific rare disease.
  3. Remember that your exact subtype of sarcoma is very important. See my comment below about “common misconceptions about sarcoma”. Different sarcomas often behave and are treated very differently. Embryonal rhabdomyosarcoma is completely different from dermatofibrosarcoma protuberans which is nothing at all like alveolar soft part sarcoma etc, etc, etc. Sarcoma pathology is a world of alien terminology that seems to all sound the same and is foreign to most lay people (and many doctors, too). The exact type of sarcoma you have is something you should memorize. When you are researching sarcomas on Google, when your physicians are discussing sarcoma treatment, when anything comes up regarding your care, make sure that you question if the information applies to your precise type of sarcoma. Sometimes the answer is legitimately “we don’t know” because some types of sarcoma are very rare and don’t have good data in the literature. But you need to be able to advocate for yourself by knowing exactly which sarcoma you have and making sure that your treating medical team knows it, too.
  4. Remember that statistics are just numbers. You are an individual patient. It is impossible to know which percentage you will fall into when looking at statistics regarding survival or metastasis or recurrence or anything regarding sarcoma behavior or treatment. Statistics are a great way of helping medical professionals gain a general idea of how a certain type of sarcoma will behave or act overall. But they do not often help us in figuring out which individual sarcoma patient will do well or not. So don’t get too bogged down or depressed by the numbers.

EDDF: Do you think it is important for a sarcoma patient to be treated by a sarcoma specialist? 

JG: Absolutely! Sarcomas are so rare that many doctors will never see a single case in their entire career. Even physicians who specialize in cancer such as medical oncologists, ontological surgeons, and surgical pathologists may see relatively few examples of sarcoma unless they have a specific sub-specialty focus on sarcoma diagnosis or treatment. I think it is ideal for sarcoma patients to at least seek an opinion from a sarcoma treatment center where they can be sure that their pathology slides are reviewed by a bone/soft tissue sarcoma pathologist to confirm the diagnosis and that their treatment plan is formulated by surgeons and oncologists who have abundant experience in the details of treating sarcoma.

EDDF: What is a common misconception about sarcoma?

JG: That sarcoma is just one disease. This is false. Just as cancer overall is a group of many diseases and is not just one single disease, so it is with sarcoma. There are numerous types of sarcoma and many types of sarcoma are vastly different from one another in behavior. Some occur almost exclusively in infants or young children while others are common in older adults. Some arise only in the skin while others grow from the deep soft tissues and almost never involve the skin. Some are fairly indolent and only rarely metastasize or cause death, whereas others are highly aggressive and cause mortality in the majority of cases. Knowing the exact type of sarcoma (e.g. – dermatofibrosarcoma protuberans, angiosarcoma, dedifferentiated liposarcoma, leiomyosarcoma, etc) that a patient has is CRUCIAL to understanding its potential behavior and to formulating an appropriate treatment plan.

EDDF: From your perspective as a professional, what are some of the best ways friends and family can support sarcoma patients and caregivers?

JG: Don’t imagine that you can understand exactly what someone with sarcoma is feeling or experiencing. Don’t feel that you have the ability or right to give them advice unless they ask for it. Even if you have had cancer or know someone close to you with cancer, sarcoma patients are different in many ways. They often face unique challenges and frustrations on top of those experienced by patients with more common types of cancer (e.g. – breast, colon, or lung cancer). Sarcoma patients often have dealt with the frustration of initial misdiagnosis or delayed diagnosis. They may have been sent to more than one specialist because their local physicians are not familiar with how to treat their rare type of cancer. Friends and family may not understand the seriousness of their disease because they have never heard of it or have never seen a commercial or colored wrist band about it. The sarcoma patients that I know express a lot of frustration with these things. From what they have told me, the lack of understanding and support from friends, families, and even physicians can sometimes cause more stress and pain than the actual tumor itself does.

So what can you do? Admit that you might not know about their cancer but express an interest in learning about it with them. Tell them that you are there to just listen if they ever need to vent. Offer to help cook meals, help give rides to and from clinic, help with any other errands that you can…even little things can go a long way in reducing stress in what must surely be one of the most stressful things a person can ever experience in life. If they are interested in sharing their story or promoting the message of sarcoma awareness, help them start a social media campaign or support their existent campaign by re-tweeting or sharing their posts on Twitter and Facebook. Join and donate to the sarcoma society of their choice. And above all, just ask them what you can do to be there for them.

This LA Times article provides a wonderful strategy on how to avoid saying the wrong thing to people in crisis (including, but not limited to, sarcoma patients):

EDDF: Is there anything else you would like to add?

JG: I am happy to provide a second opinion on sarcoma pathology cases. Should you wish to have me review your case, please contact me at jgardner@uams.edu to arrange for a consultation.

 

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