In this episode of "On the Edge of Breakthrough: Voices of Cancer Research," Stacy W. Gray, M.D., A.M., Director of Clinical and Scientific Strategy and Vice President of System Strategy at City of Hope, joins Monty Pal, M.D., F.A.S.C.O., for an engaging discussion on how precision medicine and AI are transforming cancer care — and why elevating the patient voice is key to driving progress.
Dr. Gray highlights City of Hope’s leadership in precision medicine, from expanded germline testing and the INSPIRE program to emerging early‑detection studies using whole‑body MRI and liquid biopsy. The episode dissects how system‑wide integration and new technologies can expand access to expert opinions, match patients to clinical trials and ensure high‑quality cancer care, regardless of a patient’s geographic location.
Oncologists sometimes worry that sharing genomic results without concrete recommendations may increase patients’ anxiety. But as Dr. Gray notes, research shows that what patients want most is actionable information that helps them understand what comes next. Her work has helped catalyze innovations such as molecular tumor boards and large‑scale genomic programs that make testing more accessible and clinically meaningful.
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Full Transcript
Dr. Monty Pal:
I'm Dr. Monty Pal from City of Hope, and this is on the edge of Breakthrough Voices of Cancer research. Each episode, we bring you the minds behind the science, the stories behind the data, and the breakthroughs that could change everything. Let's dive in. Welcome everyone to On the Edge of Breakthrough Voices of Cancer Research. I'm so delighted today be sitting down with one of my dear friends here at City of Hope, Dr. Staacy Gray, she's a professor and vice president of Systems Strategy here at City of Hope. Welcome, Staacy.
Dr. Stacy Gray:
Thank you so much. Excited to be here.
Dr. Monty Pal:
Well, I have been looking forward to this interview for a long, long time. Me too. You're one of my favorite faculty members here, and you've done so much in the way of research. But before we get into the nitty gritty of that, I wanted to just kind of talk about your start in the field. What sort of inspired them to get into oncology? Take us back to your early days of training.
Dr. Stacy Gray:
Yeah. Um, so I think, uh, for, for as long as I can remember, um, one of the things that has been most meaningful to me is really connecting with people, right? So, um, sitting down, talking, listening in particular, and trying to understand what it is that people need the most, right? And I thought, well, I really love to do that, and I love biology. And I kind of think that maybe that would be a really good combination, right? To, to be able to take the thing that I love to do with people and try to figure out in the context of medicine how I can listen to their story and help them to make the best decisions they can for their healthcare and help them to have the best outcomes. My mom got sick when I was in high school, and, um, she developed breast cancer, and I saw the kind of care that she received, and it was care that would probably be really good for some people, but it wasn't care that was particularly good for her. And I think that one of the things I took away from that is that there were some really important things, um, in terms of communication between her and her doctor that just did not go well. One of the take homes from that was to think about how I could study health communication and try to really understand the field and really understand the way to improve it as a way to try to improve care. Y
Dr. Monty Pal:
You know, that anecdote explains so much about the direction of your research. You know, it's interesting as we had Tanya Dorf on this program mm-hmm <affirmative>. Who's one of my, you know, another one of my favorite colleagues here at City of Hope, and, and she was walking us through a scenario that she had with her mother who's diagnosed with A PML when she was in high school mm-hmm <affirmative>. And she described that interaction with the oncologist as being so different from what you and I would expect from a patient experience nowadays. I don't wanna rip off a bandaid here, but Yeah. Do you mind telling us a little bit more about that experience that you had with your mom?
Dr. Stacy Gray:
No, I would be very happy to. Um, I think that, uh, you know, my mom felt a lump in her breast when she was 39, and she was, she was diagnosed just right after her 40th birthday. And for someone who's that young right, to think about what it means to have a breast cancer diagnosis and to go through treatment, and there are a lot of things that I think that she would've been excited to do and willing to do, like participate in clinical trials and think about doing everything she could to get the most cutting edge care that just never really materialized. Right? She was, she was treated at, at a small hospital, um, and didn't have the kind of access to the care that we provided City of Hope, for example. And I think that, um, for her, it was kind of treating her the way that you would treat any garden variety breast cancer patient who was, you know, 39 or 78. Right. And, and for my mom, that approach just wasn't kind of the approach that she needed, and I think was something that she couldn't talk about because she didn't have the language to talk about, and her doctor didn't have the time to talk about it. And, um, I witnessed that and thought, you know, gosh, there really has to be a way to do that better.
Dr. Monty Pal:
Yeah. That, that's so fascinating. It seems like it was sort of a mix of different things, right? It was the treatment setting. Yeah. Maybe not having access to clinical trials, the, you know, sort of, uh, the, the nature of the relationship with communication being hurried and so forth. But I, I do see that translating to so much of what we're gonna talk about on this program. So, so that was your high school years. Take us through college medical school training and how this sort of winding path brought you to where you are today.
Dr. Stacy Gray:
Yeah. Yeah. So, um, so I decided I wanted to go to medical school and, um, I, at that point in time thought I would be, um, more of like a, a kind of a country doctor. I, I was born in col. No kidding. Yeah. Yeah.
Dr. Monty Pal:
Okay.
Dr. Stacy Gray:
I was, um, I was born in Colorado, and I thought I would end up going back to the mountains and, and that was kind of the paradigm that I knew, right? I didn't grow up in an academic family. I, I was not exposed to academic medicine. And, um, and then I went to the University of Chicago and, um, the, you know, it's a, it's a place that's very oriented toward research and very much about trying to think about how we can, um, improve, you know, on everything we do. Right. And, um, I just loved it. I really, really loved it. And I thought for the first time, well, maybe I wanna do something that can, um, help not just like my patients one-on-one, but maybe let's think about how I can do research to impact much larger groups of patients. Right. And maybe I can think about, I actually, um, while I was a fellow in, in an oncology, I did a master's degree at the Harris School of Public Policy
To try to think about the ways in which we, um, make as a society decisions about how to allocate healthcare resources and how, how to form policies around how we're gonna take care of patients. So, um, it was a whole new world to me, and, and I think that, um, it was very eye-opening, but also really exciting, um, to, to think about doing medicine in a way that was very different than I had ever seen or seen modeled, um, or I had ever imagined. And when it comes to oncology specifically, you know, um, you remember what it's like to be, uh, you know, a resident <laugh>, you know? Indeed. Yeah, indeed. Uh, and, um, and a resident who, you know, Q3 call, Q4 call, like very, very tired. It was, it was an amazing, amazing experience. And I think, you know, doing something fairly unconventional, like sitting at Annenberg helped me to see research questions in a different way that I think added a lot of value.
Dr. Monty Pal:
Oh, that's interesting. I, I was looking through some of your early papers, and I think there's a sort of resonating theme around communication, right? You know, one pertains to surgery in the context of thoracic oncology and, and maybe that physician perception of how to approach older patients. I mean, you wanna walk us through some of that early work that you did?
Dr. Stacy Gray:
That was a study that we did that looked at, um, outcomes in patients who had early stage lung cancer and thinking about, um, is care consistent across the country or is it not? And the hypothesis, the hypothesis was that, um, potentially that at places where you do more surgery, um, that you might have better outcomes than at patients places where you don't do a lot of surgery. Um, because a lot of thoracic surgeries can be very complicated, a high risk. And one of the things that we found was that not only at high volume centers were people more likely to offer surgery to older and sicker patients, um, than at low volume centers, but we also found that their outcomes were better, even though they were operating on generally sicker patients. So it's one of those things that's kind of, um, like how is it that, how is it that providers are thinking about the risk and benefits? How are they talking to patients about the risk benefits? And then how does that then translate into ultimately patient outcomes?
Dr. Monty Pal:
Yeah, yeah. No, absolutely. It makes a lot of sense. And I think the other field that was sort of emerging, correct me if I'm wrong, because I think we trained around the same time Yeah. Was, was genomics and medicine, I, I still remember, right? Being in residency and hearing about, you know, for instance, gefitinib and erlotinib and these EGFR directed therapies for lung cancer, and lo and behold, it brings up this need to, you know, start doing gene-based profiling. Right, right. Which was, which was I think, very new for us at the time. Time very new. Yes.
Dr. Stacy Gray:
Yes.
Dr. Monty Pal:
Um, but I think that you were one of the first people to really start thinking about how the patient actually sort of conceives of that very, very sort of complicated bit of data, right. You know, you see that patient in clinic, you tell them that they cancer, that's hard enough mm-hmm <affirmative>. But then to sort of dive into the science behind it and say, well, there's these gene mutations that are driving it, we're gonna try to treat these mutations, et cetera, et cetera. It's overwhelming, isn't it? So, so tell us about your approach and your thoughts around, you know, how we sort of take and process all this complex genetic data.
Dr. Stacy Gray:
Exactly. Monty, I think that you, um, really outlined a lot of the thinking really nicely, which is in, in the era of, of a genomic revolution, right? We went from testing patients where we would do one gene at a time, so maybe EGFR, maybe KRAS, maybe something else. And that information is manageable, right? Um, and you really can understand exactly what it means and what to do with it, right? Then you get to panel based testing, right? Where you might have, you know, at that time, like 30 genes on the panel. And then something is, is, is really, it's kind of like for providers, how do you decide if you have two findings, which one to use, right? And for patients, like, what does it all mean? And then you throw in the, the addition of germline testing or testing of inherited DNA to look for risk of developing cancer in the first place. And you're starting to see that, like, then you have two different genomes that you're testing that may have different results
Dr. Monty Pal:
Mm-hmm <affirmative>.
Dr. Stacy Gray:
And, um, we were very curious at that very early stage, right? How patients were gonna perceive it, as you said, and how providers were going to incorporate this testing into their practice, and what kinds of things that they were, um, worried about and what they needed support around, and what they felt very comfortable with. So we did a series of studies, um, when I was in Boston, um, the first of which was before the launch of our internal tumor profiling platform called Profile, I did a survey of oncologists and, and asked them basically, how confident were you in using this information, um, and how likely would you be to offer this testing to your patients? Um, and this is, you know, kind of shocking to think it was, you know, not that long ago. Um, but at a, at a, at a, at a comprehensive cancer center, about a quarter of the providers said that they weren't at all confident in their ability to use this information, and that they really needed additional support and education and, um, uh, and infrastructure to help them understand and interpret it. We also found in that study that, uh, those people who were more confident in understanding, um, the genomic information were more likely to offer it to their patients.
Dr. Monty Pal:
Okay?
Dr. Stacy Gray:
So this was a gap that we had to really fix in order to make sure the patients got the testing that they needed. That actually, um, was right before we did a, a, a larger study to, um, that was guided, um, through an N-I-H-N-I-H consortium where, um, the NIH said, okay, we can now do very large scale testing, whole exome testing, or whole genome testing where you're getting, you know, thousands and thousands of bits of information coming back. We can do this technically, but we don't know what that's gonna look like in the clinic. So they selected seven sites around the country to do pilot programs where we were using whole exome and whole genome sequencing, um, immediately, and then kind of iterating to try to figure out, are we doing it right, are we not doing it right? Where are the pain points? And then coming up with best practices then to disseminate across the country.
So we did a study where we, um, enrolled, um, patients with advanced colorectal cancer and advanced lung cancer. Um, we offered tumor normal whole exome and transcriptum sequencing, um, as well as return of results for all of the information. And there were some things that were quite interesting. You know, one thing is that people felt like the patients wouldn't want the germline information, because at this point in time, it's before PARP inhibitors, it's, it's, I see before a lot of the immunotherapies that you can, um, actually, uh, use germline information to guide therapy. And, and they were like, these patients are at the end of life. It's not gonna be relevant for them. They're not gonna wanna know. And what we found in fact, was that actually patients wanted all of the information. It was, um, you know, over 95% of most information, all that was actionable.
Fewer patients wanted things that wouldn't be actionable. For example, the patients realized that this would be incredibly beneficial for their families, even if it couldn't change their care. We also found out that, um, providers at, at this point, now this is several years later, were much more comfortable with tumor testing, but they were still very uncomfortable with germline testing. So we, um, created, uh, molecular tumor boards, which now are very commonplace, but were not at the time, um, to think about, um, what the information meant, what we would return, what we wouldn't return, um, and really to help with that wraparound support that the oncologists were asking for.
Dr. Monty Pal:
So you've, you've investigated the physician's perception Yeah. Of genomic tests with some really interesting findings on my mind. I, I'll tell you that I was actually in that camp of individuals who really had a lack of confidence, right? In approaching genetic testing upfront in the sense that, you know, you, you worry about missing that needle in a haystack, right? You know, you get this broad panel test, you get tons and tons of information that could theoretically guide therapy, but how do you use it all? I, I wonder if this was a common experience. What, what did you find were perhaps the top reasons for physician apprehension around getting this massive amount of data?
Dr. Stacy Gray:
Yeah. So, um, people were worried, just as you said, that they would not interpret it correctly, and they wouldn't know how to make decisions. Uh, people were concerned that actually patients, um, might have, um, strong emotional responses, right? So particularly around the germline information that it might just something that was very difficult for them to handle. And when you put that in context of already having a cancer diagnosis and being kind of at the end of life, that it was just, um, unnecessary. Um, and I think that they were also, um, concerned about managing people's expectations, right? So there's so much hope around precision medicine. There's so much hope about what tumor testing can do. And particularly in that era, there were tons of media stories and things on the internet, and, and, and people were worried, right? Like, if we do this testing and we're saying we're testing every gene that we possibly can, and we don't find something that it would be devastating for patients.
Dr. Monty Pal:
I see that, that sense that, you know, you get that genetic testing back and you have to walk into that room and just say, well, gosh, this really doesn't mean anything for your case. Right? I can see that being disheartening. That's really interesting. You know, I, I actually had a chance to dive a little deeper into some of these studies that you've done in the past. And now from the patient perspective, it seems as though by and large patients seem to want to get that information. You've done some really nice work around understanding the psychological impact of this information. Sounds as though for the most part, patient's psychological impact is, is relatively minimal from the genetic data. Having said that, you do allude to some subsets of individuals who do derive more impact than others. I mean, can you give us a clue as to which patients maybe we should be mindful of on the provider side as being more sensitive to genetic information?
Dr. Stacy Gray:
Yeah, yeah. Um, and I, I'll just, I'll preface that by saying this was a really important goal that, um, actually the NIH had, right? Okay. In these, in these pilot implementation projects, what they wanted to do is they're like, we're throwing so much information at people. We're doing this technology that, um, we don't really yet know how to harness entirely, and we wanna make sure we're not harming people. So we did, um, uh, a meta-analysis across the entire consortium where we pooled all of our data together. And this, this consortium had, we had several sites that had cancer patients. We had some that were only cancer risk, there were pediatric populations, there were patients of healthy adults, cardiovascular populations. So it was a very broad mix
Dr. Monty Pal:
Mm-hmm <affirmative>.
Dr. Stacy Gray:
Of participants that were in, um, uh, in our studies. And, um, what we found, as you said, is by and large, very low levels of distress, very low levels of anxiety. Some of the, um, smaller populations, we did see a hint, like in pediatric populations, for example.
Dr. Monty Pal:
Okay.
Dr. Stacy Gray:
Where, um, a lot of them are on like a diagnostic odyssey. Maybe they have, uh, an unknown disorder or, or early, um, very, very cancer at a very, very young age. And there, particularly for the parents who are answering the surveys, for the most part, there was kind of more apprehension and, and, um, more anxiety around testing.
Dr. Monty Pal:
I was trying to put myself in, you know, the shoes of a patient in that situation and thinking maybe it was exactly as you alluded to those younger patients where they're worried about the downstream implications of particularly germline testing, perhaps. Right. I, I can imagine that causing a bit of distress. But, you know, nonetheless, I, I think that the cumulative body of work that you've done really points towards the fact that, you know, patients perhaps aren't as, you know, affected as we might perceive them to be, right. By really sort of disclosing the genetic testing. Is that a fair sort of takeaway?
Dr. Stacy Gray:
I think that's very fair. And, and it's our work and work, um, across the field that has very consistently shown that, um, not only do patients want the information, um, it is very helpful and, um, is often actionable, but there are minimal, um, signs that it is, um, distressing. It produces anxiety, uh, or there's tests related to stress.
Dr. Monty Pal:
So, Staacy, take me from the Farber to City of Hope. First of all, I've gotta ask you. Yeah. I mean, I, I remember everybody being so excited about your arrival here, uh, myself included. Um, it tell us what it took for us to draw you over from, uh, the esteemed Dana Farber.
Dr. Stacy Gray:
This is just a really exceptional place. I mean, I think that the thing there, there are a couple things. Like, one is the group of population scientists here is phenomenal. Um, and as a cancer care delivery and health communication researcher, like that was a very important community for me. Um, I, I think the other thing is that as a freestanding cancer center, right, that is focused on the care of, um, cancer and DBE diabetes patients, um, this place is mission driven in a way that is unparalleled. Uh, in terms of any other place I've been, it is, it is incredibly remarkable. I felt that, I also felt as a freestanding cancer center, that there is, um, an agility. There's an ability to kind of dream about what, what, what you wanna do, and then be able to execute quickly. 'cause there are not a lot of competing demands from the football team or from the history department or those sorts of things, right. <laugh>. Um, and so those things kind of together along with amazing faculty, um, and mentors here, um, it just seemed like the right place.
Dr. Monty Pal:
I, I love the way you put that because I will say, I was just doing fellowship interviews yesterday and, and counseling some of the fellows who are thinking about a position in City of Hope said to several of them, the beauty of this place is we focus on cancer all the time. Yeah. Right? Cancer, diabetes, research. These are the two sort of, you know, pillars of the institution. And, you know, we're not distracted from that mission as you suggested. Uh, you know, walk us through some of the work that you did. You, you led our precision medicine efforts here, uh, when you joined, and I think did a fantastic job of it. Walk us through some of your areas of focus once you made the transition over to City of Hope.
Dr. Stacy Gray:
Yeah. So I think it was a really, um, natural evolution. So I said at the beginning it was kind of around doctor patient communication and thinking about how do we optimize care by listening to people. The next is like, how do we think about understanding unique biology and kind of doing that real time to personalize care? And here it really has been about dissemination and implementation, right? So once we know something is effective, right? Once we know that these are valuable, how do we get them to as many people as possible in a way that is going to be, um, most likely to positively impact their care and their health? Right? So, um, we had a, a, an amazing opportunity at City of Hope, as you mentioned, in the precision medicine program, to try to really get these genetic and genomic technologies out to as many people as possible.
So we had, um, uh, the precision medicine study called Inspire. And there we were consenting people to have, um, tumor profiling. And it's actually the same kind of profiling tumor, normal whole exome and transcriptome that we did in that very small study at Dana-Farber, which we, um, you know, were able to test over 7,000 people. And the germline testing for inherited cancer risk was very important. 'cause we know that, um, you know, the guidelines that we use to determine who should have testing to see if they have an elevated risk of cancer, miss about half of the people.
Dr. Monty Pal:
Half of people, yes. Really. No kidding. Wow.
Dr. Stacy Gray:
Okay. And, um, the guidelines ha were very, very, very important. Um, in the beginning when genetic testing was $4,000, $5,000 for a test. Now genetic testing, the, the cost for something like a germline panel test has fallen dramatically, right? So the need to have very tight guardrails over who gets it and who doesn't get it, I think, um, at least from an economic perspective, have, have, have dramatically lessened, right? So one of the things that we wanted to do is help to, to contribute to the evidence base showing that liberalization of, of testing across patient populations was actually going to find more mutation carriers and have a positive, um, impact on their care. Um, and that we could do it at scale, right? So we've also changed the model of how we deliver genetic testing, um, eliminating the pre-test counseling, which is usually like an hour visit before somebody has genetic testing and really doing it in a much more scalable model.
So there are a couple important things about that. One, similar to the other studies we found that people really do want this testing. It was an opt-in and over 98% of people said, yes, I want, I want the testing. Um, two, we found, um, that, uh, there are high rates of mutations, um, among our cancer patients and the people who are coming to see us for cancer risk evaluation. And the third thing, um, which we presented at ASCO in 2024, this is work that, um, was led by, uh, Alana Solomon on my team, who is one of our genetic counselors and is also now the deputy director of the Center for Precision Medicine, was to look at the psychological assessment to say, with this without pretest counseling, are people doing okay? The data that we presented ASCO and that we're now, um, uh, in revision right now, um, in terms of a paper, um, looks very reassuring.
Dr. Monty Pal:
Good. Good. So it was consistent with your previous findings,
Dr. Stacy Gray:
Consistent,
Dr. Monty Pal:
Right. Suggesting that patients are, are comfortable knowing
Dr. Stacy Gray:
Yeah.
Dr. Monty Pal:
Right.
Dr. Stacy Gray:
Comfortable knowing and comfortable knowing in a model of care that is not standard, right. With this whole idea of, of really not going into the pros and cons of genetic testing and talking about all of kind of the, the likelihood that somebody will be positive or not, that like it's safe to do genetic testing without that and then counsel people on the ad.
Dr. Monty Pal:
Yeah. Yeah.
Dr. Stacy Gray:
The precision medicine program was led by Steve Gruber, um, uh, he was the, the director of the program, and I was the deputy director and, and Heather Hampel. And that we're now working together as a group to really get a lot of the data, like I was talking about out, um, and get it published as a way to try to help, um, influence kind of policy and guidelines around, around genetic testing.
Dr. Monty Pal:
Oh, that, that's really important to know. That's really important to know. And, and I believe your efforts have really sort of gone, you know, in other directions within the precision medicine realm as well. One of the things that we always think about as an institution is early detection. Yeah. Right? And, and I was really intrigued to hear about some of the work that you've done with Dan Raz, one of our thoracic surgeons. You mind telling us a little bit about that?
Dr. Stacy Gray:
Yeah. So, um, one of the things I'm doing is I am, I'm constantly thinking about what's next, right? Like, we do an amazing job and we can take really good care of patients, but our tools aren't perfect, right? And so in, when it comes to cancer screening and when it comes to early detection, um, we, we need to do better, honestly, right? We need to detect cancer when it is curable. Um, and so, uh, Dan Ra, who's one of the thoracic surgeons, as you mentioned, and I did a a, a small study looking at the use of, um, whole body MRI combined with, uh, a liquid biopsy test, um, looking for, uh, markers that people might have cancer. So it's a multi cancer early detection test. The main goal of the study was to try to see what the impact was on, um, people's cancer worry, right?
How much they're concerned about it. And we, we, we did the first study that, that you're referencing in a population of people who were at higher risk, either 'cause they had a do genetic mutation Okay. Or because they had a strong family history, right? Because we thought those would be the people who would be most likely to be worried, and those would be the people that we'd really want to make sure, um, are, are having a good experience through this, through this program. Um, and so we did a pilot with a hundred, a hundred patients and, um, remarkably we found, uh, we found four cancers that were asymptomatic and had not been detected by routine screening. We found a couple of, um, precancerous, uh, pancreatic lesions that are now monitored. And we found one, um, hematologic disorder that, um, needs to be monitored for progression as well because of the ejective mutation, pretty high rates of cancer in these asymptomatic individuals. And we found that 85% of them had a decrease in their cancer worry after going the pro through the program. So, um, people really appreciated it. Um, and, uh, they definitely are interested in moving things like that forward to try to be more and more proactive about their care.
Dr. Monty Pal:
I mean, four out of a hundred is, is actually, it's an alarming rate, isn't it? I mean, yeah. You know, I, I treat kidney cancer, as you well know, and it's really largely an incidental diagnosis. Somebody goes in for kidney stones or goes in for abdominal pain, gets a scan, and boom, that's how the diagnosis typically comes about. But I, I love the concept of perhaps a more systematic look, right? To see whether or not one has these, uh, early signs of malignancy or, or malignancy already, as you mentioned. Where do you see this field going? Uh, do you see a point in time when everyone's gonna get routine imaging and a blood test to achieve an early
Dr. Stacy Gray:
Diagnosis? Yeah, I think, um, that's one of the, the, the things I'm most excited about, right? So, um, one of the principles in cancer genetics is really trying to use data to risk stratify people, right? So, um, what we do is we understand as much as you can about an individual person's biology and how it's unique to come up with a risk that helps us to understand what the right level of screening is. 'cause we wouldn't wanna do whole body MRI in every person that's unnecessary, right? But we wanna know who might need that intensive screening and who might need less intensive screening, right? So I think the future is actually, um, using large data to, um, discover associations and, and risk factors that we are currently unaware of, um, taking that with novel imaging and novel, um, blood-based assays to try to then in the highest people who are at highest risk use, um, more intensive screening, both imaging as well as blood-based testing to try to find the people who have cancer, um, when it, when it's, again, very, very early and very curable. Um, and I think our ability to do that rest stratification is only gonna get better as we have more data. So,
Dr. Monty Pal:
So pardon my naivete here, but does this sort of tie into your role within system strategy as well? Is this sort of implementation science a part of it?
Dr. Stacy Gray:
Yeah. Yeah. So I think, um, we've talked a lot about, about kind of what it is to, to do implementation of things that we know now are, are, um, beneficial, right? But I spent a lot of time thinking, as I said before, about like what's, what's, what's on the horizon, right? And, and given all of the heads headwinds we face in medicine, right? How can we think about those constraints, take what we know about what's happening now, and anticipate what technologies are coming soon so that we are in the best position to be able to, um, use the new tools as quickly as we can for as many people as we possibly can once we know they're effective. And so that's a lot of what we do in strategy is we try to think about, you know, where are we going two years from now, three years from now, five years, 10 years from now? And how do we make sure City of Hope is prepared?
Dr. Monty Pal:
Brilliant, really, you know, we've talked a lot in this program about this rapid expansion that we've had across Chicago and Atlanta and Phoenix, uh, and it seems like an excellent opportunity for us to reach sort of a broader population, right? To implement these types of screening modalities that we've discussed today. And any thoughts on how we might optimally harness, you know, this new growth that we've had?
Dr. Stacy Gray:
Yeah, absolutely. I think that one of the things that, um, that is really important about what we do is making sure that people have access to the level of care they need, right? So, um, we as a system, right? We need to think about, um, somebody comes in for a diagnosis, is that diagnosis going to be best treated with phase one trial? In which case they, you know, may need to travel, or is that going to be best taken care of? You know, at our clinical network sites where we're expanding things like access to bone marrow transplant and, um, you know, cellular therapy and, um, a lot of the new technologies that are coming in a way that they're, um, supported with the expertise that we have, um, at, you know, from the experts we have across the, across the system. So I think that, um, what we need to do is to really fully integrate in a way that we can make those decisions kind of in real time as to understanding what the biology is, understanding where people are in their disease, what they want back to the, the connection with people, and then making sure that they are getting that as quickly as possible and as close to home as possible.
Dr. Monty Pal:
So, so if you don't mind, I'm gonna actually take this back to Yeah. This very touching scenario you described with your mom. Yeah. You know, and, uh, again, I was really sort of struggling to, you know, fathom how we could sort of better approach a situation like this. So imagine a patient, let's say a young patient with breast cancer who comes to perhaps one of our sites in the outskirts of Los Angeles or Chicago, you know, how do we make sure that that patient walks away with the optimal experience, access to clinical trials, access to the best diagnostic, uh, test, for instance, how, how can we make that a reality at all of our centers throughout the network?
Dr. Stacy Gray:
Yeah, that's exactly what I think about every day.
Dr. Monty Pal:
Okay. Okay.
Dr. Stacy Gray:
<laugh>, I think that we do it through two main ways, right? Is actually by building our community. And I think things like, like, like this podcast are helping to do that, right? Really connecting, um, the people from across our system with the, um, with the people who are leading in their field, right? Um, I also think that there are a lot of things that we're doing at City of Hope, like the City Forum and others where people are getting exposure to other people across the organization that are incredibly helpful. And I think if you feel that you have a community, it's much easier to, you know, pick up the phone. It's much easier to write somebody an email or send them an epic, um, an epic message, right? So I, I think that, um, creating that sense of belonging and togetherness is incredibly important in terms of making sure that we're comfortable and we know what we need to do when people need maybe different care. The second answer, I think, is about using technology.
Dr. Monty Pal:
Okay?
Dr. Stacy Gray:
Right. So it's, it's leveraging technology to make sure that if somebody has a need for genetic testing, they get genetic testing. If somebody has a genomic alteration and there's a clinical trial that we immediately identify that, that that patient is potentially eligible for the trial. And we can do that. I think using, um, a, a lot of the things like we have our hope LLM and trying to evolve that into clinical trial matching, um, platform where we can, um, take some of the burden off the providers for like, remembering all of this and have it be more automatic as a system. So I think, and that's just one example of how I think we can use, um, technology and AI to improve the experience of the patients expr, improve the experience of providers and, um, improve outcomes.
Dr. Monty Pal:
Y you know, one example that I'll cite, which I've had firsthand experience with, and I think this is a creation from your group, is this sort of ongoing running tumor board. So now we, we principally use Epic to communicate about our patients and, and we have this setup now within the GU group. I don't know if this is still in beta or if it's across other teams as well, where, you know, any physician at any site has sort of access to my kidney cancer trials and, you know, my perspective on patient cases and so forth, they can reach out to Tanya DOR for prostate, they can reach out to Alex Razzi for testicular cancer. Uh, I think it's a brilliant way to sort of bridge the, the gap both in terms of geography, time zone, et cetera, right? Mm-hmm <affirmative>. So we can get these instantaneous second opinions.
Dr. Stacy Gray:
Yeah, I think it's, I think it's incredible and our, our group cannot take credit for it, but I think it is, um, an example, you know, we all remember the curbside, right? Mm-hmm. Walking down the hall and seeing somebody and saying, Hey, can you help me with this? And I think it's, it's a way to, to scale that through technology so that it, it, it does both build community and it ensures that the expertise is there at the point of care when people need it. So, um, and I think it's just an early example of the ways in which we can kind of take every point along the patient journey and try to use technology to make sure that they're getting the right care at the right location as close to home, um, and as quickly as possible.
Dr. Monty Pal:
Uh, I'm gonna ask you a tough question and, uh, you know, I'm curious as to how you're gonna answer this. There's so many cancer centers out there that are undergoing massive degrees of expansion. Yeah. I'm just curious about how the City of Hope approach has been different, in your opinion.
Dr. Stacy Gray:
Mm-hmm <affirmative>. Mm-hmm <affirmative>. Probably one of the most important differences is that we are expanding in a way that, as we call it one city of hope, where we are ensuring that no matter where you are, that the culture is the same. That the mission is the same, that the values are the same, that people know what the expectation is and are inspired to, to work in the same way. So it's not like some centers are, are kind of hanging up a shingle. We're gonna hang up a shingle, you know, in San Diego, we're gonna hang up a shingle right out in, um, any area right. Around a major metropolitan area. And it's kind of about brand, but not about quality.
Dr. Monty Pal:
Yeah. Yeah.
Dr. Stacy Gray:
And I think what we're doing is we are, we've put the experts in place and we're doing all of those things at the system level. We're not doing them, you know, at the big cancer center and kind of leaving everybody else to fend for themselves,
Dr. Monty Pal:
You know, without having the lens into the system strategy as you do. I, I think I would've given a very similar answer. I'm just so thrilled with how the level of quality that we've always tried to maintain at our main hub here in Duarte has really been maintained across Chicago and Atlanta and Phoenix. And, and exactly as you said, Stacy, we've, I think, put all the right players in place, right? Mm-hmm <affirmative>. People with, you know, decades of experience Yeah, right. To lead these enterprises in these different cities. So I'm, I'm very, very optimistic about our future.
Dr. Stacy Gray:
Me too. Me too. You asked me, you know, what would be different, right? Um, if, if a young breast cancer patient came in to City of Hope, and, and I can say that even though, um, you know, thankfully I have no young breast cancer patients in my family right now, but, um, but I did have a family member. My father actually came to City of Hope recently, and I have to say at every single point, his experience was different than the kind of experience that I think that my mother had many years ago. I mean, from our amazing crossing guards who just embrace cancer patients and make them feel at home to the people who check us in, to the people who call us on the phone to the doctors who, you know, go to their tumor boards to really get the expert opinion from everyone before making a decision. It's just the kind of, you know, personalized, connected, and, um, superior care that I think is really unrivaled.
Dr. Monty Pal:
Brilliant. No, I, I couldn't agree with you more. Couldn't agree with you more. You know, the other thing that I wanted to chat with you about, Stacy, is I've gotten to know you in the capacity as, as a leader who's just so vociferous in terms of advocating for her junior faculty. Right. I've seen this in several different capacities. You know, we interviewed Tanya Dorf recently, as I'd mentioned. She's my, uh, boss in the GU group, and a wonderful boss at that. Um, she mentioned all the hardships that she's had to endure, you know, and academic medicine. She was told at one point, which I just found appalling that women shouldn't be in academic medicine.
Dr. Stacy Gray:
Oh, that's horrible.
Dr. Monty Pal:
Yeah, indeed. Tell us about your approach. Tell us about, you know, your perspective on, you know, young people getting into the field and, and just give us a lens into how you support your junior faculty faculty.
Dr. Stacy Gray:
You know, I think one of the most important things for me is to understand what people like, what their goals are, right? And, and what their hopes are. And sometimes people don't know, right? And so then the, the, the interesting part is figuring, helping them to figure that out with them. But I think that once I know what it is that people want to do, I do everything in my power to empower them to have the tools and the skills and the, um, and the courage to do what they need to do to advocate for themselves. And then I do everything I can to be an advocate, um, on my side. I think that, you know, our future is our, is our junior faculty, right? That is the future of medicine. And, and so nothing more important other than patient care, than investing in the young people who are gonna bring our field forward into the future. And, um, and there are a lot of hurdles, right? It's not an easy place to work all the time. So, um, thinking about making sure that they're getting promoted at the right time, thinking about making sure that they have the resources they need to sponsoring people that you don't even know well, because you can see that they're gonna have an amazing career. Like, I look for those opportunities as, as much as I can.
Dr. Monty Pal:
Yeah. And I can assure our audience, this isn't just lip service. You have been such a wonderful and passionate advocate for our junior faculty. I, I truly feel that many of 'em remain with us because of your advocacy. In fact, I mean, really well done. Um, we always wrap up by asking our guests a, a tough question. Again, I've consulted you with a bunch of tough questions, but the title of this podcast is on the Edge of Breakthrough Voices of Cancer Research. What does on the edge of breakthrough mean to you?
Dr. Stacy Gray:
I think that we are literally at the edge of one of the most disruptive transformations in medicine that has happened, probably ever, which is the introduction of large language models in ai, um, into medical practice. And, um, I think there are so many things to be excited about that, I mean, I don't know if you use the Dax Co-pilot, um mm-hmm <affirmative>. To do your, to do your, um, notes. But I mean, thinking about the fact that we have technology now that we can use on our phone to be able to get away from the computer and not type while we're talking to our patients, we can actually just sit and look at them. I mean, I think change is everything about the visit, right? And, and, and when we about the ways in which we can understand biology, that we can, um, discover, like I was talking about before, you know, new elements of risk that we've never understood when we can have AI help us to understand what somebody's genomic profile is, not from a genomic test, but from their h and e slide, right?
I, I think it will change everything that we do. And I think one of our challenges as a system is to understand how we can use those tools as quickly as we can to improve care and to identify where maybe, hmm, they're not ready for prime time and we have to slow down a little bit, right? Because I feel like there are gonna be so many models and algorithms and companies and, and things that are rushing into this space. And it's, it's the careful but quick execution of the things that we know that are gonna be helpful, that's gonna be the most exciting.
Dr. Monty Pal:
I, I am so grateful that we have somebody like you at the helm navigating us through this sea change in medicine. Agree with everything that you said.
Dr. Stacy Gray:
Thank you,
Dr. Monty Pal:
Staacy, thank you so much for joining us today. This has been such an insightful, enlightening podcast. We're gonna have to have you back to dive a little bit deeper next time.
Dr. Stacy Gray:
Thank you, mon. My pleasure.
Dr. Monty Pal:
Thanks for tuning in to On the Edge of Breakthrough. See you next time for more insights from the front lines of cancer research and care.