Dr. Eleni M. Rettig, MD Brigham and Women’s Hospital, Harvard Medical School, Harvard University

 

Dr. Eleni M. Rettig, MD

Assistant Professor, Department of Otolaryngology - Head and Neck Surgery,

Brigham and Women’s Hospital, Harvard Medical School,

Harvard University

Dr. Rettig is leading figure in head and neck cancer. She received  her medical degree from Baylor College of Medicine. She trained in Otolaryngology-Head and Neck Surgery at the Johns Hopkins University and did her fellowship in Head and Neck Surgical Oncology  at the Mayo Clinic. Dr Rettig has numerous contributions in head and neck squamous cell carcinoma and adenoid cystic carcinoma. She has authored >50 publications and approximately 2,600 citations.

 

 

 

The first question for you is, why did you choose to specialize in head and neck surgery? What attracted you in the field back then and what attracts you right now?

In head and neck cancer surgery specifically, I really enjoy the surgeries and I really enjoy the patients. And I think it's important when you think about your future as a physician or as a surgeon, to think about not only the surgeries that you do -because I enjoyed a lot of different types of surgery within ENT-  but also think about the time you're going to spend in clinic with these patients, and the time you're going to spend rounding on the floor, or your research interests, and think about how all those align. I really enjoy spending time with my head and neck cancer patients and meeting their families and talking to them through their diagnoses as well as the surgeries. Also, the research is just fascinating to me! There's so much that we're learning about these types of cancers. How we manage them changes year to year based on what we're learning on the research side of things. The surgeries are long and can be difficult, but I always found that time flies when I'm in the OR doing these types of surgeries. I think that says a lot about how you want to spend your time during the day. You know, when you look up and are surprised that six hours have passed, when you are in the OR.

 

I see. And is there anything that you don't like about the specialty? I'm talking about the sub-specialty: head and neck surgery.

It can be challenging and it's definitely not for everyone. The hours can be long, and you have to have the support from your family to facilitate that career. It can also be emotionally exhausting, I think. To take care of sick patients and talk about death and dying on a daily basis can be difficult. So you really have to take care of yourself, too, in order to make it a sustainable job.

 

 

Yes. And is there something in particular that you do in this regard? Like what helps you cope with it on a day-to-day basis?

I think I have very strong family support. I have two children, and my husband takes care of them during the day. That allows me the flexibility to stay later if I really need to. But also, he's just very supportive about my career and how I can help people with my training. I also think having some sort of activity that refreshes you mentally and physically is very important. For me, spending time with my family and exercising are very important.

 

 

I see- it’s refreshing! You have been a successful professional athlete in the past, and I'm wondering how that helped you in your professional career, if you feel that it did, and how it affected your career trajectory.

Yeah, it has absolutely helped me. Much of surgery and much of taking care of patients, especially being part of a multidisciplinary team in the care of cancer patients, involves being on a team with many different parts. There's no way you can do it all by yourself. Having played on a team before and understanding the way that teams succeed has been very helpful for me, I think. People ask why I like to do surgery, and part of it is just that you're working with a team, and everybody has to be on their game. But it's also social, and you're creating something and you're helping someone.

 

So, it sounds like you feel that there are lots of similarities between the two.

There are. And I think that's why you see a lot of athletes going into surgery because we enjoy being, you know, part of a team.

 

 

Yeah, absolutely. I'm a former water polo athlete myself, so I can totally relate to the team feeling. Now, in your first response, you talked about how treatment options, treatment patterns in head and neck change on a yearly basis almost at this point. Honestly, there has been a lot of innovation in the field in the past decades. Where do you see the field going in the next decade?

That's a huge question! I think I'll focus on the biomarker aspect of our fields because that's what I'm interested in and working on right now. I think that a lot of what we do will be impacted by what we're learning about biomarkers, in particular, liquid biopsy for HPV-positive disease, which is what I'm working on. But also, I think we're going to start to use it more and more for HPV-negative disease, too. We're just starting to look into that. But for HPV-positive disease, what we're seeing is very exciting. There are different uses for liquid biopsy, potentially in screening, although there's a lot of work to be done there, diagnosis, monitoring response to treatment, potentially risk stratifying, for treatment intensification or de-intensification, and then surveillance. There are just so many different facets of this disease where I think we're going to see biomarkers having a role. That said, I think we need to be very careful in how we approach it because it's definitely not a one-size-fits-all solution to all of our problems. We need to learn a lot about who it may work for and how to use it.

In addition, immunotherapy is completely changing the face of our field in head and neck cancer, in particular right now in cutaneous squamous cell carcinoma. We're seeing a lot of changes day-to-day in how we practice based on the use of cemiplimab.

 

 

Now you mentioned de-escalation, and I was wondering if you can share a few thoughts about that and meaning that we've seen that HPV-positive patients do significantly better than HPV-negative ones. And there has been a significant number of negative trials in the escalation. I don't know if you have any thoughts about that and what do you think is a good way or a good approach to stratify those patients and identify the ones that can go with de-escalation?

 

Yeah, that's the million-dollar question, right? How do we stratify and select the patients? Because, frankly, most patients do well, but the ones who don't do poorly. HPV-positive disease can be devastating for a small percentage of these patients. I really applaud a lot of the work that's going on right now to figure this out. The initial excitement about de-escalation is definitely tempered by several big trials that essentially show that de-escalation is not for everyone. In addition to clinical factors, for example, the Mayo trials found that extra-nodal extension is incredibly important; those patients should not be deescalated. I think there will also be some molecular factors that we look at, and I don't think we know yet which ones those are going to be, but there's a lot of exciting work going on in that area. For the time being, it probably makes sense to continue overtreating some patients just to prevent some of the failures that we do see in HPV-positive disease. I think that a lot of that will change in the next ten years.

 

I understand. Now, you have obviously published extensively in HPV+ head and neck squamous cell carcinoma and adenoid cystic carcinoma, and it sounds like your research is an important component of your career. So, I was wondering how have you been able to balance it with your clinical practice, your administrative duties, and everything? How does research factor in there, and how do you manage it all?

It's a great question. It's challenging, right? It's very challenging. I decided very early on that because I wanted to do microvascular reconstruction and ablation, I would not pursue the NIH-funding track because, for me personally, I don't think I could do both of those things well, like having my own lab, spending a lot of time writing grants, being a reconstructive surgeon, and also having a home life where I'm present with and supportive of my family.

So the research that I do is mostly born out of my clinical practice and out of questions that come from seeing patients. The clinical trials that I have are mostly just based on the patients I see and the questions that I think would be helpful to answer for them. They naturally go together. Also, it's been very helpful for me to work with colleagues; most of my research is very collaborative, and I have wonderful colleagues here at Dana-Farber that I can work with. There's also a research infrastructure here. Without those things, supportive colleagues that are brilliant, interested, and good to work with, and the research infrastructure of a place like Dana-Farber, I'm not sure I'd be able to do it. So it's very much a team sport for me, and that's the only reason that I can make it work.

 

 

You've worked with and mentored a lot med students and residents. What, in your opinion, makes a successful resident and a future successful academic surgeon? Do you have any advice for more junior colleagues.

The medical students and the residents that I've worked with are all brilliant and all work very hard, and I rarely have to tell anyone to work harder. I would say the advice that I would give is to work smart. Identify projects and mentors that will help you to focus your interests. I think early on, it's good to talk to a lot of different people and see what the different opportunities might be. But at some point, you do want to narrow your focus, and that will allow you to be more efficient. You don't want to have your hands in a million different projects; you want to have a clear path forward, setting limits on what you're doing. The same goes for your career in general. Setting limits on the time you spend at work is incredibly important because it's not sustainable to just keep working. You have to have something outside of work that reinvigorates you, that energizes you, and allows you to be your best self and do your best work while you are at work.

The best advice I ever got was as an early attending. I heard this talk- it was about looking at your work as a garden with a fence. You have your space and your amount of time, and whatever is inside those limits, do a really good job on your garden. But there's also a fence and a boundary, and you need to decide what's in your garden and what's outside your garden. Work hard on the things that are within your boundaries. That was really helpful for me because just because you can do something doesn't necessarily mean you should. To make this career sustainable, you need to set limits on what you're doing. So that's been really helpful for me.

The other piece of advice is if you have a research interest, it's helpful if it aligns with your clinical interests and with who you're working with. See what your resources are and try not to force it. If you are interested in research, a lot of times, it will organically happen. But if you try to force it, it may not work out as well.

 

 

Thank you so much, Dr Rettig!