Ines Vaz-Luis won the Women Who Conquer Cancer award at the latest Congress of the American Society of Clinical Oncology in Chicago, last June.
This title rewards Ms Vaz-Luis for her pioneering role in the post-treatment care of breast cancer-free patients, an overlooked research field called Survivorship.
Born in Portugal, Ms Vaz-Luis graduated from the Harvard Medical School and practised at the Dana-Farber Cancer Institute (both in Boston, Massachusetts) for five years before moving to Gustave Roussy, a cancer-research hospital in Villejuif (Val-de-Marne).
She is the director of the Cancer Survivorship program at Gustave Roussy, where she manages a team of oncologists and researchers dedicated to survivorship treatments.
“Survivorship is often linked to follow-up and rehabilitation treatments. The term has widened over the years,” she told The Connexion. “To me, survivorship is about offering a post-treatment, post-diagnosis, post-remission course adapted to a single patient,” she added.
Read more: Why are more young people in France getting cancer?
The role of AI in cancer
Ms Vaz Luis’ research team has worked on projects involving artificial intelligence to assess the fatigue of women treated for breast cancer and to develop strategies to prevent it. The team has also studied the barriers for women to stick to their treatment.
Survivorship is not as widespread in France as in the United States, but it is growing, Ms Vaz Luis said.
She spoke about the award, her work, her desire to dismantle paternalism in the field, and why the population should be more open about health issues to help research advance faster.
“Cancer affects us all. Not speaking about it and not getting tested means nothing will change,” she said.
Congratulations for the award! Did you expect it?
No. This award was not on my radar and I did not apply for it.
The decision was made by several people that I mentored and tutored over the years; they were the ones who put my name forward. It is touching to know you’ve inspired people to the point that they nominate you for an award.
What have you achieved in the fight against cancer?
I would say I am still fighting this disease. I believe our team has been quite pioneering in building personalised care pathways, moving towards a world with fewer after-effects from cancer.
I hope we are laying the foundations for a more personalised healthcare system, centred on the patient, moving away from a paternalistic structure towards one where the patient has a real role in their care.
Where did your interest in post-operation, treatment medicine come from? I read your mother died from breast cancer. Did it start from there?
My mother was diagnosed with breast cancer during my first year of studies. But I wanted to be an oncologist from the start.
Of course it influenced me on a personal level, all the more because I also lost several friends of the same age to this disease.
These experiences mean that I approach oncology in a very personal way. I treat my patients with this experience in mind, while also advancing oncology, particularly breast pathology and care pathways.
How would you define ‘survivorship’? How should we understand it?
Traditionally, survivorship refers to 'follow-up care', what comes after treatment. It encompasses everything that transitions from active treatment to what follows.
I think the term has evolved today into a broader concept. It now begins at diagnosis.
Survivorship includes the concept of supporting the patient, transforming the cancer experience into something better, completely tailored to the patient.
Today, survivorship is almost a journey, a journey of post-treatment, remission, diagnosis, progression, recurrence, or end of life.
The term is much broader now. It involves continuous and personalised care for each patient.
A part of your work is to find the best pathway for each patient?
We work on three axes. One is stratification, with a large number of patients and data on a scale to help us isolate, understand, predict, and quantify the number of after-effects to develop the patient's pathway.
The second axis aims to enrich the care pathway. We rely on digital tools to create, for example, digital companions for patients.
We are currently developing self-management programmes for patients, including physical education programmes, cognitive or behavioural therapies, etc.
The last one looks at the social impact of breast cancer, the social disparities between individuals. Ideally, we would be able to mix all three together.
How do you explain that only 47.7% of French women regularly get screened for breast cancer? How do you account for such a low percentage?
I think, overall, there is not a lot of engagement from the population on this issue. We need to engage the population in health behaviours.
The healthcare system cannot survive with this reactive way of treating diseases. We, as individuals, do very little in terms of prevention and detection.
We lack engagement in health behaviours.If you ask women their reasons for not getting screened, they probably won't say it's unimportant or that they don't feel concerned.
We need to change something at a behavioural level to make people more engaged, and that includes screening.
Read more: Mobile health bus targets cancer prevention in France
Is there a stigma about breast cancer? I watched a French show where one woman admitted she did not tell anybody about it when she was diagnosed.
I think there is a stigma with cancer in general. It is seen as a life-threatening disease. It remains true but not like in previous years. A few years ago, it meant almost certain death. It’s intrinsic to our society. It poses many problems. For example, it is complicated to return to work...
One of your studies shows that one in five women does not return to work a year after the end of treatment.
It is a lot. Can you imagine? And the study was about young women only. It is a figure that shows a strong societal impact.
We all need to destigmatise the disease. We are an ageing society. Cancer is a reality for all women. Not screening or communicating about it will not change this reality.
Fortunately, many patients recover from a large number of cancers or live a long time with their cancer. If a patient does not wish to communicate, it is their right. It should not, however, hinder their ability to be helped.
We also need to take care and communicate about the after-effects of cancer, such as dealing with mutilation, but also the cessation of sexual activity.
We have a majority of women who have sexual dysfunction after breast cancer and who are not taken care of. They don’t even dare to talk about it. If we do not demystify this, the journey will always be more difficult.
Is this an aspect of medicine too often overlooked?
Yes, it is. This aspect of medicine is not the core focus of oncology, but it is becoming an increasing priority. I am being contacted more and more, including internationally. This is bound to grow and be something that healthcare systems will now offer.
You did your research master's at Harvard Medical School and worked at the Dana-Farber Cancer Institute, affiliated with Harvard University. What did you learn there?
A lot. It was a life-changing experience because my entire approach to research was shaped there, from thinking about it, designing it, and implementing it.
It was incredible to have such professors and mentors. These are people who, even today, are with me. It structured my thinking for research. I feel immense gratitude for having had them as role models.
Do they practise medicine differently in the United States?
It is a completely different system. Dana-Farber, for example, is a private clinic with absolutely incredible resources.
The patient gets everything they need because the resources are 10 times bigger.
Here in France, we provide a lot of quality care but our systems suffer from a significant shortage of healthcare staff. We do the best we can with limited resources.
You focus on the economic aspect, but do they treat patients the same way? The term 'survivorship' seems very American, very individual-centred.
That’s true. The concept originated there and we are importing it. The American patient is different from the French or Portuguese patient.
The American is very 'empowered', they come with their list of questions about themselves. It is a more proactive and participatory form of medicine.
In France, we are beginning to see patients asking more questions, wanting a collective decision with the doctor.
Here, I sometimes find there is a lack of trust in the pharmaceutical system, for example. We need more overall education so that patients have access to the right resources to avoid having a poor perception of their illness.
