Some people struggle with what they want to be when they grow up. For Dr. Ishwaria Subbiah, the decision to be a doctor was so easy that she calls it a “no-brainer.”
“Medicine was a way of life for me. I’m a third generation of doctors and second generation of oncologists,” she says. “When it came time to pick a field of work, I don’t think I spent too much time questioning whether medicine was right for me or not. I loved the work and I love taking care of communities in that way.” Dr. Subbiah is the executive director for Cancer Care Equity and Professional Wellness at the Sarah Cannon Research Institute (SCRI.) She is also the medical director of Supportive Care Oncology, Health Equity, and Professional Well-Being for the US Oncology Network.
Even for those who know they want to pursue medicine, choosing a specialty can be a challenging decision. Again, Dr. Subbiah knew exactly what she wanted to do when she graduated from medical school.
“I grew up around oncology. My mom was a medical oncologist in rural Pennsylvania,” she says. “So that comfort with a very difficult illness was there from the beginning. It was part of my day-to-day life.” She describes doing homework in her mother’s infusion center because the chairs were comfortable and there were popsicles to be had; she was a child raised to feel at home in the spaces where people received cancer treatment.
But even though it was such a natural fit for her, “The decision to go into oncology was still very much a deliberate one,” she says. “It hit all the boxes. You’re taking care of people during some of the most difficult and unplanned times in their life … What you bring to the table is that foundation of data and expertise, woven together with hope and optimism.”
That foundation of data and expertise is what drives Dr. Subbiah every day. As an executive director at SCRI, she works to develop new and more effective cancer treatments for patients across all walks of life. As she puts it, cancer treatment is a rapidly evolving field, and she has to stay at the front lines of the battle.
“There are new treatments by the day in cancer care,” she says. “A textbook from even four years ago could be obsolete because there have been so many advances.”
Staying ahead of a disease like cancer sounds like a daunting task, but Dr. Subbiah is well equipped. She has devoted her life not just to researching cancer treatments, but also to treating patients directly and using her position as an administrator to advocate for the adoption of newer and better treatments. She considers administration, academics, and clinical patient care to be the three “buckets” of expertise that she can combine to effect the most change in the world of oncology.
“These [buckets] are all complementary, and there’s a synergy in there that I can only tap if I have a chance to do focused work in all three,” she explains.
Photograph: Diana King
In addition to being a clinician, Dr. Subbiah is an editorial leader for the journal Cancer (produced by the American Cancer Society), the Journal of the National Cancer Institute (JNCI), JNCI Cancer Spectrum, and the Journal of Geriatric Oncology. She has received the ASCO-Conquer Cancer Foundation Merit Award twice, as well as the AACR-GlaxoSmithKline Outstanding Clinical Scholar Award.
So how do Dr. Subbiah and her team stay ahead of cancer and work toward better outcomes in cancer care? The solution starts with the patients who participate in clinical trials. Dr. Subbiah recognized right away that there were entire populations of patients who were not represented in the trials used to test new cancer treatments, and that was unacceptable.
“When you look closely at those who participate, you see key people, part of our families, being excluded from the studies. Older adults; people in rural areas; people in racial and ethnic minority communities; those with disabilities; veterans; those with other medical problems, like diabetes and heart failure. You start to see that these are the folks who are being excluded either outright or unconsciously from these clinical trials. And these are people who are all in our families and our friend circles. That disconnect between who participates in the study and the ‘real world’ is what drove me to this work.”
She says her mission, her “north star,” is clear. “We want to be sure every person has access to cancer clinical trials, and as close to their home as possible. That they can access these cutting-edge treatments without having to uproot their life.”
Closing the “access gap,” as Dr. Subbiah puts it, represents a bit of a paradigm shift in the world of oncology, and change isn’t always welcome. One of the challenges of her work is convincing stakeholders, especially those who don’t interact with patients, to see the value in expanding access to clinical trials. She says that her role as an administrator gives her the chance to engage with those stakeholders and convince them that equitable representation of populations in clinical trials isn’t just a smart thing to do, it’s the right thing to do.
“When we get that buy-in from someone who’s an important part of cancer care delivery but may not have seen the work in access and equity space in that way before, when I see that light bulb go off, that’s something that recharges the batteries for a while,” she says. “Each of those conversations, those interactions, are ones that I could only do if I was in the position that I am now.”
Once the stakeholders understand the importance of the work, they can help to create an environment in which those who administer patient care can feel more comfortable tweaking their methods. Change can be scary, but as fast as cancer moves, the best way to fight it is to ensure that clinical trials include as many of those affected by cancer as possible so that treatments can be updated to be as effective as possible.
“When you put the rubber to the road and you propose some tweaks to how a study is designed, that’s when people who are part of the trial design have to start rethinking their own approach and processes,” Dr. Subbiah says. “This is where having that initial buy-in, the lightbulb moment with them, is crucial.”
Thinking of her own legacy, Dr. Subbiah talks about how she hopes others will pursue what matters to them in the same way that she has. She believes everyone should have a north star (or a few) representing the work they want to do and the change they want to make in the world, and she says staying focused on those goals can ensure that we don’t lose sight of what’s important.
“Have clarity for what your north stars are,” she says. “Be sure that how you work and spend your time reflects how calibrated you are to those north stars. The easier path may be continuing in the comfort zone the way things are, but if that means you have to change what your north stars are or put aside some of those hopes, you have to make sure that you’re making a conscious decision and that you’re OK with that.”
Beyond that, she wants her legacy to be one in which the consideration of equity in medical spaces is another “no-brainer.” She wants the culture to shift to a point where ensuring that all populations are represented in clinical trials and patient care is just normal, day-to-day behavior, not something that someone like her has to advocate for.
“We really just want some of these elements of culture changes to be part of people’s mindsets so you don’t need an equity person at the table reminding you [to consider underserved populations],” says Dr. Subbiah.
Of course, she plans to keep fighting for that equity. As she says with a smile, “I would very much like to put myself out of a job.”
