Creating Confidence While Climbing the Ranks in the Lymphoma Field

“Sometimes you have to be a little more assertive and a little louder, and you have to step up to the front,” Julie M. Vose, MD, MBA, said.

Finding a mentor who will guide and support you through your career can make the entire experience worthwhile. This point was emphasized by Julie M. Vose, MD, MBA, and Avyakta Kallam, MD, who both believe they have come to excel in the field of lymphoma thanks to the help of their mentors.

In the latest Breaking Barriers: Women in Oncology, CancerNetwork® spoke to both clinicians about their personal and professional journeys. Vose is the division chief and Neumann M. and Mildred E. Harris Professor in the division of Hematology and Oncology at the University of Nebraska Medical Center (UNMC), as well as co-editor-in-chief of ONCOLOGY®. Kallam is an assistant professor in the Division of Lymphoma in the Department of Hematology and Hematopoietic Cell Transplantation at City of Hope in Duarte, California.

Prior to Kallam’s position at City of Hope, she worked at UNMC under Vose’s mentorship. Through each of their journeys, the women have faced various challenges, such as learning to be assertive, or adjusting to the way medicine is practiced in the United States.

Although dedicating yourself to research is important, Vose and Kallam each spoke about they have learned how to stand out, underscoring the confidence it takes to be a woman in medicine. Both acknowledged that while it has gotten better to be a woman in lymphoma, there are still significant inequalities in the field today.

Back to the Basics

James O. Armitage, MD, is a mentor to both Vose and Kallam. Specifically, he introduced Vose to lymphoma. As he nurtured her research interests, he introduced her to other colleagues and taught her how to network. Through this guidance, she was able to begin working on clinical trials early in her career.

Armitage is the Joe Shapiro Professor of Medicine in the Division of Oncology and Hematology at UNMC. He is a leading expert in the field of lymphoma. In 2018, he received the Giants of Cancer Care award from CancerNetwork’s sister brand OncLive®.

Kallam’s interest in lymphoma stemmed from all the developments that were consistently occurring in hematology. She specifically wanted to focus on redefining new standards of care for those with lymphoma.

At the beginning of Vose’s career, she was involved in autologous stem cell transplantation and looking at new cancer therapies. She focused on CAR T cells and radio-labelled antibodies. Vose noted there has “been tremendous improvement over the years and a lot of research,” stating that “it’s exciting to be involved in it”.

At UNMC, Kallam was able to work with Vose, Armitage, and other colleagues on CAR T-cell therapy. Since she began her career, she has had the opportunity to see these CAR T-cell therapies get approved and gradually become standard-of-care options.

When Vose first began her career, patients who underwent a stem cell transplant were often in the hospital for 6 to 8 weeks. Now, the treatment can be done as an outpatient procedure.

A big theme when looking towards the future is creating personalized therapy for patients.Kallam hopes to be able to tailor therapies for a patient based on pathology, genomics, and individual preference.

“That would be the ideal treatment,” Kallam said.

Navigating the Field of Lymphoma

Breaking into a mostly male-dominated field can be difficult. Kallam had originally trained in India. One of her biggest challenges upon arriving to the United States to complete her training was trying to understand the differences in clinical practice and cultures between countries. She credits the mentorship of Vose for helping her to navigate these times.

When Vose began her career, she described herself as a rarity in the field given that there were far fewer women in oncology. She received mentorship from both men and women and felt that it helped her gain perspective on her career trajectory.

“[As women], we had to do everything. [We] worked twice as hard and did everything 2 or 3 times better than anybody else to prove that we were equal. We’ve come a long way since then, and things are much more equitable [today],” Vose said.

When looking at the day-to-day work, Vose said there are still some hurdles that need to be overcome. She said a lot of people do not necessarily see women as physicians; some patients still call her a nurse. However, she works hard to make sure her presence is known and accepted.

Asserting yourself is something that Kallam is still working on. For example, speaking louder to command attention is sometimes needed to let the patient know that a woman is leading the team.

Vose remarked that asserting yourself this way may make women appear more aggressive or paint them in a bad light. However, these steps are necessary to make others view you as an equal or as a leader.

“[Right now, this is] probably one of the biggest challenges I’m facing as junior faculty. I have discussed this with Dr. Vose before as she has mentored me, and she has helped me become a little bit more assertive. I still have a long way to go in terms of building confidence in myself to be able to speak up,” Kallam said.

The Impact of Mentorship

While training at UNMC, Kallam was inspired to go into the field of lymphoma because of her time working with Vose. Seeing a woman in a successful position helped her believe that this career was achievable. Vose was also able to open different doors for Kallam to help her advance her research.

“[Vose allowed me] to grow. If there were certain grants or certain applications that I wanted to be a part of, she gave me those opportunities and pushed me along the way. I’m very grateful to have a mentor like her so early in my career,” Kallam said.

Getting a mentor early in one’s career is essential, according to Vose. She equates it to having a roadmap, with the mentor telling you which roads you need to travel and sharing tips along the way on how to get there.

Having been given that roadmap from Vose, Kallam knows there is a lot of energy and enthusiasm in someone just starting their career. A mentor is needed for proper direction and guidance among newer clinicians as empathy is shared by someone who has been in the same position before.

Words of Wisdom

One of the most important pieces of advice Kallam gave to those starting out in the field is to always remember the bigger picture. It’s crucial to remember why they are working to advance the field of lymphoma and to find a cure for their patients.

Vose advises to listen, network, and do your own research. These actions will help one become an independent clinician. She also emphasized seeing the patient as a person; getting to know them and their families to truly relate to them.

As Armitage mentored Vose and Kallam, he reminded both that life is too short to avoid things you find enjoyable.

“What we do is important, and we do impact a lot of lives. At the end of the day, we also need to have a good life. It’s important to interact with your family, take vacations, and to take your personal time. Whatever helps you to make sure that you’re clear and able to help all the patients is important,” Vose concluded.