Blase Polite talks to colleague and friend, Toni Cipriano-Steffens, about his unique path into the oncology world and how his background helped him ask questions that had been previously overlooked.
CIPRIANO-STEFFENS: Can you tell us a bit about who you are and what you do at the University of Chicago?
POLITE: Sure. So the first thing is that I was never going to be a doctor. That was very clear. I was the youngest of four, my father was an obstetrician gynecologist and he was very clear that I was never going to be a doctor.
I was very much policy focused. I started in urban poverty and health equity and spent many years in Washington D.C., working on health care policy. Only after, did I go back to medical school and eventually became an oncologist. I then found my way back into policy and health equity, which remained a passion of mine. That’s when the worlds just sort of collided.
CIPRIANO-STEFFENS: So you never really intended to go to medical school?
POLITE: No that was probably one of the bottom things on my list of things I was going to do. I did not take science classes in college. I was a public policy and economics person at the University of Chicago. So no, healthcare was not a field that I thought I would go into.
CIPRIANO-STEFFENS: So when you did decide to go that way, why cancer? Why oncology?
POLITE: I've always joked that the thousand-page pathology text books you read in medical school, that have everything you need to know about disease, always ended their chapters with cancer. So I always knew when I got to the cancer section, I was almost done with a chapter. I think that was probably when cancer first took a positive association in my brain.
However, cancer just hits me intellectually. Both from a science standpoint and from a larger philosophy on life. You get to watch humanity at its best, in the cruelest circumstances. I always say that I'm fortunate in that for the most part I get to see the good sides of humanity while doing this work. I get to watch friends, family, mentors, and acquaintances come out of the woodwork with really no clear personal gain. So it's a fulfilling place for me, as crazy as that sounds to people, it's a very fulfilling place for me.
CIPRIANO-STEFFENS: Let’s talk about how you got into health disparities on the south side of Chicago and what you have seen.
POLITE: We started looking at our neighborhood and realized that if you look at the breast cancer rates in Chicago they are absolutely through the roof. Higher than any city in the United States. If you look at where the concentration is, it is essentially in the University of Chicago area. So we began to start probing why this was the case. We realized there were some genetic influences and there were some environmental influences, but there was clearly a social justice aspect of it.
That's what I've really been dedicating my life to for the last 12, 13, 14 years. To better understand how we make improvements that reach everywhere from concrete policy to the work that you and I have been doing, which is trying to understand how individuals from different cultural backgrounds interact with the healthcare system and how that impacts their decision making.
CIPRIANO-STEFFENS: I know that there has been a lot of work done in health disparities and looking at social economic status but you want to go a bit more deeply than that, right? What are the measures that have been done and where does social justice really play into it?
POLITE: People recognize that low income patients are more likely to get and die from cancer, but then they just move on. They say it's a poverty problem. My question is what is it about poverty? Is it income? Is it neighborhood? Is it because you don't have access to parks, not giving you a chance to walk? Is it because you're in a food desert and therefore you're being exposed to the worst of all processed foods? Is it about poverty or social isolation? Is there more exposure to pollution? Those are the driving questions that I want to get at. People's cultural upbringing, what they learn, what they hear in church, what they hear from their relatives, and how do these things play into your decision making.
CIPRIANO-STEFFENS: So where has this taken you? I know that you've been studying health disparities for a long time now.
POLITE: I started looking into the literature that was out there on what affects the way people make decisions. Do you delay getting care because you put faith in God? These things play into institutional racism and issues with the health system because people may not see much benefit in entering the healthcare system where they will not be treated well or they look at family members who've gotten cancer that went to the hospital and died quickly.
It remains a question of do people become spiritual because they have cancer or does the spirituality precede and lead to more advanced cancer? That's been a lot of our work. What people bring into the room especially when they’re facing a potentially terminal illness is their faith and what role God plays in their life. How do the treatments and chemotherapy and surgery play in with God's will? These are the kind of things that patients are telling us.
These are the things that are absolutely on their mind and most important to them when dealing with their cancer diagnosis. And we are trained to not even discuss it. So why is that? Because we're uncomfortable. We feel like we're entering an area that's forbidden. You don't discuss religion and politics, we're sort of taught that. Yet the patients are asking for it. They want to know that at least somebody is acknowledging the importance of their spirituality in their decision making even if we don't believe it. They want to know that we understand it and that we respect it.
CIPRIANO-STEFFENS: How did you see these ideas relating to treatments?
POLITE: There's some data out there that people were delaying care and not getting care because of religious views. We saw very clearly that minority patients were less likely to get looked at for cancers. Then as we looked into some of our own data, we saw higher refusal rates for treatment.
There’s a lack of spiritual synergy. When you don't have this connection, people feel like there's a fight between their faith and the medical decision they’re making. When the health care team acknowledges the importance of the spirituality, all of a sudden you're no longer in a fight. Now you have a therapeutic working relationship where you can work through these things together.
CIPRIANO-STEFFENS: I just want to end with a quote from one of the nurses from the IV therapy unit. One day she turned to me and said, “Thank you. Thank you for bringing spirituality back into clinical care because we've been waiting for it for as long as I've been here, 15 years. It is so helpful. For the patients and for us.” So that's a way of me thanking you for letting me participate in this life changing research because it's more than research, it’s almost a calling.
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