October Physician of the Month: Clara Lee
Precision and innovation have defined the career of Clara Lee, whose impact on breast cancer care and research stretches from operating rooms to smartphones. Get to know the October Physician of the Month at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James).
Lee started college with a very clear picture of her career path.
“I wanted to be a primary care physician and influence public healthcare policy— I thought I would be a doctor and treat one person at a time,” she says. “My role models were physicians who were staff members for members of Congress, worked in the White House or were politicians.”
Before that plan came to fruition, though, a massive health crisis changed her thinking.
“With the AIDS epidemic, I realized there were other aspects to healthcare, such as discrimination and lack of access to healthcare, and that’s where I wanted to make an impact.”
Lee earned a Master of Public Policy degree at Harvard University’s Kennedy School of Government, and then started medical school at Yale University School of Medicine, where she discovered surgery during her third year.
“It was like a whole new realm of living opened up to me and it changed my life forever,” says Lee, whose newfound path led to the fields of plastic surgery, microsurgery, oncology and breast cancer.
“Microsurgery is a general term to describe operating on things you can’t see with the naked eye and that you have to look at through a microscope,” she explains.
In breast reconstruction, this type of very precise surgery involves transferring tissue from one part of the body to the reconstruction site and then “reconnecting the blood vessels so the tissue will live.”
Reconstruction research leads to tech-based solutions
Breast reconstruction is a purely elective surgery and federal laws require health insurers to pay for the surgery, according to Lee.
“It’s a major surgery—generally bigger than the mastectomy—and there can sometimes be complications such as infections, problems with healing and the death of some tissue,” she says. “So, there should be a reason for the surgery.”
Lee’s first research study focused on how women decide on whether or not to have breast reconstruction surgery after mastectomies. She found that 57 percent of women did not make “high-quality” decisions that match patients’ goals and are made with accurate information about risks, benefits and possible complications.
“It’s important for women to be fully informed about their options, the pros and cons of each option and their personal preferences related to their appearance, recovery and risk of complications before they decide,” Lee says.
New tech-tools for patient-tailored treatment
Factors such as these contributed to the development of BREASTChoice, a digital decision aid developed at Washington University in consultation with Lee.
“It’s a website that asks patients questions about their medical history, what factors they care about, and then walks them through educational modules and advises them, based on their answers, what they should consider,” Lee says. “It’s very interactive and will be embedded in their medical records so they can discuss it with their physician.”
WORDS (Women and Oncologists Reaching Decisions Without Surgery) is another of Lee’s major research projects. Funded by Pelotonia, WORDS utilizes an app called RECORDR that breast cancer patients can download to their smartphones in order to record conversations with their doctors. Those recordings allow patients to better understand what their doctors say, and to come up with follow-up questions for future appointments. Researchers can compile the results of this data and analyze how women decide whether or not to have mastectomies or bi-lateral mastectomies.
“This is the first step—a study to gather information about how women make these decisions, so we can then help them make better decisions,” Lee says.
Next step: emphasis on emotions
Even as she’s immersed in all of this research—and performing breast reconstruction surgery—Lee is working on her next public policy idea.
“It’s the role of emotions in a patient’s decision about their cancer treatment, focusing on breast cancer patients,” she says. “[Emotions] can affect decision making. They can have a constructive role or a destructive role and make us less rational and make decisions we don’t really value.”
This emphasis on emotions widens Lee’s comprehensive approach to improving outcomes through informed decision-making.
“Good research should be based on finding out what patients really care about and helping them make the best-possible decisions for their lives—for their long-term quality of life.”