Fighting Cancer & Bridging Divides with Dr. Nancy Davidson

This episode of The Space In Between centers on cancer—a topic that touches nearly everyone and, crucially, reminds us of our shared humanity. When a loved one receives a diagnosis, compassion cuts through ideology: neighbors cook meals, coworkers donate PTO, communities fundraise. Fighting cancer becomes a common cause that unites us in hope. Host Leigh Morgan is joined by Dr. Nancy Davidson—renowned breast cancer oncologist, translational researcher, and executive vice president/chief academic officer at Fred Hutch Cancer Center—to offer a clear-eyed, optimistic update on where oncology stands and where it’s headed. And along the way, they share tips for how bridging divides across cancer benefits us all.

Transcript

0:01

Hello and welcome to the. Space in between podcast. I'm your host Lee Morgan. Again, this podcast is for listeners who are fed up. Up with the hyperpolarized nature of the world today. And who crave. Craves spaces where current events can be discussed in construct. enlightening and delightful ways. Let's get.

Leigh Morgan: 0:28

Hi everyone. Welcome to the Space In Between podcast. We have a special episode today as we will talk about a topic that touches all of us, whether through a friend, a family member, or our own journey. That topic is cancer. I've been wanting to do an episode on this topic for a while and for two reasons. The first is because there is an an incredible amount of innovation, both scientifically and in the clinic in oncology. are seeing this in prevention and treatment, and also we're finding some cures, which is really exciting I get to hear about this due to my role on the board at the F Fred Hutch Cancer Center in Seattle. And frankly, I want more people to feel the sense of hope and optimism that I do. The second reason relates to the focus of this podcast itself. We live in a world that too often feels polarized and fraught with division, yet fighting cancer is a cause that unites all of us. about it, when you are a loved one is diagnosed with cancer, well, compassion and shared humanity. Take the lead. These moments provide powerful anecdotes to a time of great uncertainty. So we are going to anchor together and ground ourselves and get a state of cancer update from one of the world's preeminent physician scientists, Dr. Nancy Davidson. Dr. Davidson is a world renowned breast cancer oncologist and translational researcher serving as executive vice president and chief academic officer Fred Hutch Cancer Center. also a professor at the University of Washington Medicine What I want you to know about Nancy and her work is that her research and her work in the clinic has helped save tens of thousands of lives, if not more, those diagnosed with breast cancer, that's not by accident. She has worked with some amazing people on her team, and she is always the first to give credit to others, which is one of the reasons I respect her so much. leadership roles include the past president of the American Society of Clinical Oncology the American Association for Cancer Research. If you're elected president by your peers for these two, membership organizations, that means you are a, preeminent leader in the field. And she is widely respected for bridging science patient care, and bringing institutional vision to organizations she's been a part of. I am really excited that, Dr. Davidson, we'll call her Nancy here on the show agreed to join us. Nancy, welcome to the Space In Between podcast.

Nancy Davidson: 3:27

Thank you so much, Lee. It's a great opportunity for me to be able to talk with you.

Leigh Morgan: 3:31

Well, excited about our conversation today. And Nancy, I gave listeners a little background on you. There's so much more to say. are a giant in the field of breast cancer and oncology, and as we've gotten to know each other over the last few years, one of the things that strikes me is your ability to relate to people in a authentic, confident, and approachable way. Where does this mix of leadership capabilities come from?

Nancy Davidson: 4:02

I think that it partly reflects passion. I'm really passionate about what I do. I think it also reflects the fact that the people that we have the chance to work with are so amazing. It reflects the opportunity to interact with patients. I learn so much from the patients that I've been able to care for over the years. And so all those constituencies are so important now we need to keep them connected. So that's what I wanna be able to accomplish. I feel like I really feed off of those who are around me. As you already mentioned,

Leigh Morgan: 4:31

I've seen that in so many different settings. that something that was a part of your family culture growing up or would you say it's just something that's part of your personality or maybe a mix?

Nancy Davidson: 4:43

a mix. You, you know Lee, I am the daughter of two geologists. Both my parents were geologists and, and you know, when I grew up for my mom to be a geologist, you know, a rock scientist, that was pretty unusual. So I came from a scientific family, but I have to say that I think my parents were a little disappointed because they feel like geology is real science. Medicine and biology, you know, that sort of softer. but I suspect that background, you know, certainly helped to propel me forward in my field.

Leigh Morgan: 5:12

Well, that's funny that, science and the research you do being sock. I guess if you study rocks, everything else might be literally soft.

Nancy Davidson: 5:22

Yep. Geology, mathematics, physics, chemistry, that would be real science in their view.

Leigh Morgan: 5:28

Well, I have been trained as a behavioral scientist and so there, it's definitely a hierarchy here because those of us in the behavioral science field are often, seen as the folks doing the soft science, so, well, I'm grateful for your parents and your mother. What a trailblazer. And you as well, we do see more, women, breast cancer docs. But when you were coming up through medical school, there fewer women than men. Was that, is that the case?

Nancy Davidson: 5:54

I came to medical school just about the time that women were, were being, um, admitted for. So my class, it was about a third women. But I agree with you as I went through my training and got to the point where I started my training in medical oncology, specialty of drug administration to cancer patients in my training class, I was the only woman out of nine people. Things are slowly but surely changing. You know, these days in breast cancer where when I went to Johns Hopkins, I was the only female doctor in our breast cancer group. Now here at Fred Hutch and University of Washington, we have only a couple men. Um, so things are really changed dramatically and it field like breast cancer where many of the physicians are now women,

Leigh Morgan: 6:35

that's remarkable. And I've heard that over half of our school students are women as well. So that's a, a big dramatic shift. One that's, I think very positive opening up for. People from all different backgrounds.

Nancy Davidson: 6:49

absolutely.

Leigh Morgan: 6:50

I'd love to talk a little bit about your sense of what's happening in research and in clinical settings in cancer. You obviously have a bird's eye view, your breast cancer doc, but you've hospitals and you know, big roles at Fred Hutch and at Pittsburgh and Johns Hopkins. What do you want listeners to know about innovations or advancements in the field of oncology?

Nancy Davidson: 7:17

Oh, Lee, it's too bad we have only an hour. But, I think what I want people to know is that we really are seeing the fruits of decades of research, both in the laboratory and in the clinic, that are bringing. Far better results in the setting of clinical cancer. I think because of a lot of fundamental research that's been done in the laboratory, much of it actually taxpayer funded. We, we are funding this through the National Institutes of Health. We've been able to really dissect the pathways that lead to cancer, all types of cancers, many types of cancers, and, and what you understand those kinds of mechanisms and those pathways. Then you could be able to think about how you can intervene, you know, how can you have some sort of, um, intervention that's going to target a pathway that's Dr., Driving a particular cancer. So I think that right now we're seeing that, opportunity to bring science into the practice of medicine, from a drug perspective, both in terms of targeted therapies for particular molecules, but also immunotherapy, you know, using the body's own immune system, something that we had not been able to do for a long period of time. although I'm focusing on that, I wanna also have us recall that cancer treatment also involves surgery and radiation therapy.

Leigh Morgan: 8:27

Okay.

Nancy Davidson: 8:28

As we've been making a lot of inroads with the systemic therapies of cancer, so much work has been done in those areas so that the kinds of surgeries, the large potentially mutilating surgeries that we used to do in the past, we've gone to be able to really, pair those down, to the minimal required surgery, which obviously leads to much better results. Same thing is true for radiotherapy. You know, in the breast cancer world, Lee, it used to be that women with early breast cancer would get six weeks of radiotherapy to her breasts. These six weeks, these days, based on clinical trials that have been done, some women can accomplish that radiotherapy with the same results in five days. And that's'cause of our better understanding of, um, the mechanisms of cancer, why cancer grows, how you can treat it effectively. And also because of our investment as a society in our field, in clinical trials that have systematically allowed us to try to establish. The best possible therapies. The most effective with the least toxic.

Leigh Morgan: 9:29

you've talked about pathways to cancer. Can you give one two examples of what two different pathways would be and what has changed over time?

Nancy Davidson: 9:40

I'm gonna take the example of breast cancer'cause you gave me that license. So, breast cancer, 300,000 diagnoses in this country every year. But, you know, breast cancer is not 1D disease. It turns out that there are a lot of different molecular types of breast cancer. For example, many women or men with breast cancer will have a breast cancer that makes the estrogen receptor protein and the progesterone receptor protein. And those tumors are driven by hormones, often the body's own hormones. And so if we know that and we understand the growth pathways that are triggered by that hormone exposure, then we can think about how to intervene, how can we block the impact of that hormone on those tumor cells, and do it in a way where as best as possible, it's specific for the cancer and hopefully minimizes effects on normal tissues. So that's one pathway. That's a really common one in breast cancer. Another one that's gotten a lot of attention, over the last 20 plus years because of the development of targeted therapies is a pathway that's driven by a protein called HER two, that's HER2. And so we know again about a lot about what this protein does and why it drives cancer, and it turns out that understanding that, that we've been able to develop either antibodies against that protein for small molecules, drugs that can be given or. They can block that pathway and that can have anti breast cancer effects. So this is an example of how by virtue of, looking at the molecular characteristics of the breast cancer, we can get some sense of what seems to drive it, what makes it tick, and then we can try to tailor our therapies to the pathways that are important. And equally importantly, we know that there are other kinds of therapies that we have where we can say, nope, you don't need this. You know, if you have a, her two negative breast cancer, anti her two therapy is probably not gonna be useful, then we shouldn't try it and we should spare you the side effects.

Leigh Morgan: 11:35

That's really helpful. And I think, you know, this listeners may or may not know, I, I worked at Genentech,

Nancy Davidson: 11:42

Hmm.

Leigh Morgan: 11:43

great, biotech company based in the San Francisco Bay Area. And of course Herceptin, is named after the her two, receptor that you just mentioned, that was one of the first treatments that was targeted of like, if we can tell that that's, but through a diagnostic test, we can give you this one specific drug which quote unquote targets just that, setting. I'm really, uh, proud and this is a great example of how industry, that a number of companies have done some really novel research, to help. Develop therapies. Now that research builds on the great research that's done in our research institutes, and centers of which you've been a part of. Again, Johns Hopkins, Pittsburgh, and now Fred Hutch and the University of Washington. I'm grateful for the collaboration and the public and private sector.

Nancy Davidson: 12:35

Leah, I always say that a lot, a lot of work is done in the academic medic medical centers, but at the end of the day, it doesn't matter how great a treatment is in the academic medical center, if it can't be in a position where it is, able to move into a commercial sphere and then ultimately be able to disseminate, we're not gonna get anywhere. And I agree with you completely. Companies like Genentech. I think we're revolutionary in the way that they thought about this and the way that they made it possible to bring it to people.

Leigh Morgan: 13:02

Yeah, great, great company. And there's lots of other great companies out there doing really, excellent work to translate the research into And you mentioned one thing that I think is really important that cancer is not one disease. Now that might. Surprise a lot of listeners. Can you say more about that? Because we often say, oh, this person has cancer, and then there's, well, what kind? But we think cancer's one thing and it's not.

Nancy Davidson: 13:32

so I, I agree with you completely that cancer is of course, basically defined by a number of biological characteristics. It has to do with, unchecked growth, with ability to avoid the immune system. With the ability to make blood vessels, right? Land a new place and set up a housekeeping with new blood vessels, things like that. But cancer can be derived from a variety of organs in the body. So our first characterization is often the, the organ of origin start in the lung, start in the colon, and start in the breast to start in the prostate. and so that gives it biological characteristics that, you know, they might be a little different in the colon than they are in the lung, for example. Some things might be in common, but some things might be completely different. The molecular pathways that trigger that malignancy, that the challenge is that we've come to realize that not all colon cancers are created equal. Now all lung cancers are the same. So for example, in lung cancer, an area where there was very little therapy for a number of years, you know, we now understand that there are several different subtypes of lung cancer. And knowing the biological subtype is extraordinarily important in terms of selecting therapies. For example, in lung cancer, there's another molecule called the EGF receptor epidermal growth factor receptor. It's actually a cousin of that, HER two gene that we were talking about. But this EGF receptor is really important in driving some lung cancers and especially if it's mutated, if there's a change in the DNA sequence that makes it misbehave. So knowing that has made it possible to, first of all identify those specific lung cancers, but also develop so many targeted therapies against those so individuals who have that kind of lung cancer might be able to take pill therapies, other kinds of therapies, and have effective disease control now for a number of years. Having said that, there are other kinds of lung cancers, different molecular pathways where those EGF receptor targeted drugs are not gonna be useful. And so you need to be thinking about other types of approaches.

Leigh Morgan: 15:36

we've talked about targeted a lot. Is that the same as saying precision

Nancy Davidson: 15:42

Yeah.

Leigh Morgan: 15:43

or precision oncology?

Nancy Davidson: 15:45

Yeah. I think that, um, when I think you're right that, precision oncology or precision medicine would be hopefully being able to understand the biological characteristics, ideally of the tumor as we're talking about cancer and the host, right? Because cancer is well within people. so we'd like to understand that specific relationship, and use that then to try to select for therapies that are the most likely to be successful, most likely to target the cancer and not the normal tissues. And by the same token, exclude those therapies where we think that there's a very low likelihood of success. But because I don't have any treatments that are without side effects, there's a possibility of no success for toxicity.

Leigh Morgan: 16:26

One of the areas that I've become more aware of is this area of immunotherapy, can you paint a picture of. Immunotherapy, what is it? And maybe in a historical context, right? Thinking about the last 15 years, we had some novel therapies like Herceptin, Avastin was another, breakthrough, treatment. Not the only ones that were breakthrough, but then we moved into this exciting area of immunotherapy. And I'm curious is happening now and where you see immunotherapy going, set the table for us first.

Nancy Davidson: 17:04

Ah, another place where we could talk for forever. But, but I think you're right that, um, the historical perspective and actually immunotherapy of some kinds goes back a century. the historical perspective is that we're. We've been troubled by the fact that our bodies have great immune systems and they are supposed to be out there targeting things that are foreign to your body, viruses, bacteria, all those kinds of things. But also, ideally, your body ought to recognize a cancer cell when it goes awry and say, Hey, you shouldn't be here and get rid of it. So there is something wrong in the cancer situation where the body's own immune system no longer recognizes these abberant cells, these rogue cells as foreign and destroys them. So that's led to a huge amount of interest in, first of all, what's wrong with the immune system, why doesn't it act right? And second, what can we do to rectify the situation? So I agree with you, Lee, that I think of several different ways of trying to do this. Some of them involve antibodies, as you talked about, and the receptive molecule, the, Avastin molecule. These are antibodies that are injected into the vein and that target those particular pathways. So that's one form of immunotherapy. Another form actually is something that's really come up over the last decade or so, and these are what are called checkpoint inhibitors. And that the one that probably gets the most attention is something called pembrolizumab or Keytruda. If you catch late ITV, you'll see ads for Keytruda and it's,

Leigh Morgan: 18:29

Many ads,

Nancy Davidson: 18:30

yeah. What's interesting about these is they, are not targeted towards a particular protein. They're targeted in a way that they're trying to basically reset the immune system so that it recognizes these foreign tumor cells in a way that it didn't before. And what's interesting about them is that these, agents can be used across a variety of cancer types. They seem to be the most useful in those cancer types that have a lot of damage to their DNA. So melanoma lung cancer. They're not quite as, useful in some of the other cancers that are, a little bit less related to damaged DNA, but a, um, major, major set of inroads over the last 15 years. And then the whole second area is cellular therapy, which is, remember your body's immune system is not only the antibodies, but it makes, but we have a lot of immune cells that are fighting, um, white blood cells of various kinds. And so we now have available to us, um, ways of trying to take these cells from a patient that aren't working the way they should and engineer them in a way that we hope they, we rev up their response against tumor cells in their own body. Um, and this is in area called CAR T cells. Um,

Leigh Morgan: 19:37

a lot about CAR T cells.

Nancy Davidson: 19:39

yeah, Ibar, antigen receptor, um, Tcell, very, very big area. I'm really fortunate. I'm here at Fred Hutch where we were one of the leaders in this field. Um, my colleague Stan Riddell and some of his graders. Amongst the people who really brought this forward in the laboratory and then commercialized, it actually took it into a small biotech firm. And through a series of events, you know, these CAR T cells are now available for a variety of tumor types, largely blood cancer related tumor types. And we are working very hard to try to figure out how we can take the insights and the advances that have been made there and bring them into certain kinds of solid tumors. So I see that as a big, an area where there's a lot of opportunity. because these CAR T cells and related cells, at least so far, have not as been successful in common solid tumors, the lung cancers, the breast cancers, as we have seen in certain leukemias or lymphomas or multiple myeloma.

Leigh Morgan: 20:35

Which are considered liquid.

Nancy Davidson: 20:37

Yes,

Leigh Morgan: 20:38

you know, you have your solid tumors and your liquid tumors, which are blood-based.

Nancy Davidson: 20:42

yes.

Leigh Morgan: 20:43

yeah. So just so folks, really

Nancy Davidson: 20:45

Yeah,

Leigh Morgan: 20:45

very different settings, very different types of cancer. And can this be used in new settings of solid tumors? Is what the, that's what the future holds. Maybe

Nancy Davidson: 21:00

I think that that's a really active area of, um, research right now. I agree with you completely that where these have been most successful so far as in these blood cancers mostly because they have a special target. You know, they have one protein that's driving them, and so these CAR T cells can be engineered to really hone in on that protein in many solid tumors. The breast cancers, the prostate cancers, the lung cancers, they don't have a single achi Achilles heels, and so it's a little bit more difficult to figure out how to target those CAR T cells.

Leigh Morgan: 21:30

got.

Nancy Davidson: 21:31

talking about though, is that in some cases, you know, this approach can be potentially curative. It's a rigorous therapy. uh, not trivial, but, those who receive this therapy can sometimes have very, very long-term regression of their cancer. exciting times.

Leigh Morgan: 21:54

Speaking of cures, where have we seen advancements in the last five years around curing certain types of cancer?

Nancy Davidson: 22:04

I'm gonna share you with you my definition of cure with the one that I share with the patients that I care for, um, which is that my idea of cure for breast cancer patient would be that you would die at the age of 90 from a heart attack without any evidence of, recurrence of your breast cancer or any substantial toxicities from the treatment that you received. So that doesn't mean that you might not have some microscopic lingering breast cancer cells somewhere. But if they're not troubling you, then I'm not gonna be too worried about that. And I will call that a cure. So, you know, many of our cancers are potentially curable, if you use that definition. Early stage breast cancer often cured people die of something else. Early stage colon cancers, a lot of work that's gone on in there. certainly many prostate cancers, we now realize that individuals can be, um, treated effectively and, you know, move on and other ailments will, come into play. I think some of the newer areas where we're excited are that melanoma, skin cancer, something that, you know, when I started you had surgery and if the, uh, melanoma came back, the number of drugs that we had was extremely few. But things like this checkpoint inhibitor did, I talked to you about. These agents are now able to potentially cure. So far as we can tell, some people who have advanced melanoma now cure right now means that they've received treatment and they seem to be free of their advanced melanoma 10 years later. so that's not 30 or 40, but for a disease which was rapidly fatal before, you know, that's a really, really impressive outcome. Certain of blood cancers, chloric, mys leukemia. Not a very common kind of leukemia, but one with a targeted therapy. And that's another one where we think that many people who have this kind of illness, can be treated effectively. They may have to take treatment for a while. It may be a chronic part of their care, but they, um, are found to actually die of other causes at the same rate as people who've never had that leukemia. So I think that those are things where we feel like there's been an enormous amount of success. And you know, that's one of the reasons why we have seen that cancer mortality death from cancer in this country has been dropping by one to one and a half percent per year. So that means that over the last several decades, we've seen about a 30% decrease in mortality in death from cancers writ large in the United States. As a consequence, I think of a lot of these, things that you and I have just been talking about. Mm-hmm.

Leigh Morgan: 24:45

Thank you for those examples. And it, it's heartening to think that we'll see more examples of cancer being cured using the, standards that, that you mentioned. And I do wanna touch on prevention.

Nancy Davidson: 25:00

Hmm.

Leigh Morgan: 25:00

that 30 to 40% of all cancers are preventable to environmental or lifestyle factors. And and if you think about it, really an incredible statistic. So that if we as a society, individuals, families, communities can make some shifts. Let's just say 40% of all cancers, they don't, happen. And a part of this, of course, is ensuring that there's affordable easy access for primary care. Where we do see, cancers often diagnosed and then we get referred to specialists. what do you see in terms of trends in cancer prevention?

Nancy Davidson: 25:43

Well, I agree with you completely. I, I'm a therapist, right? I was trained to. Treat cancer. But I think many years ago it became very clear to me that we're not gonna treat ourselves out of cancer. That we really do need to think about the upstream, as you just talked about, and that that is the whole field of prevention. And then also related early detection. But I, think you're right that the current thinking is that a third, maybe 30 to 40% of cancers are potentially preventable. Nice piece that just came out actually from the A A CR that you and I were just talking about. Every year at this time, they put out their progress report, an annual progress report about what's going on in cancer. Beautiful section on prevention in there for your listeners, aac.org, is where, find that the Cancer Prevention Progress report for 2025. but what are those causes? Well, the first one, of course, I hope is pretty obvious. Tobacco,

Leigh Morgan: 26:35

the

Nancy Davidson: 26:36

tobacco exposure contributes to, um, the development of a dozen different cancers. It's not just lung cancer. Um, and so decreasing or eliminating tobacco consumption is the single most important thing that we could do from an environmental perspective to decrease the, morbidity and mortality from cancer. You know, you and I live in the state of Washington where our tobacco, our smoking rate right now is 10%. Now that's a lot better than it used to be, but that's 10% too many, right? I mean, that is totally preventable. Cause so many kinds of cancers. That's the first one. I think the second thing I wanna put out is, you know, there's a lot of interest right now in obesity. there's the sense that, um, our obesity epidemic might be contributing to a variety of cancers, especially in older people. Um, breast cancer, prostate cancer, colorectal cancer. Again, there are a variety of cancers that, whose incidents, whose diagnoses are increased in those who are obese. And so all of the work that we're trying to do to fight the obesity epidemic, and there's a lot of work going on right now. It may have wonderful effects on, one's body and on diabetes risk and cardiac risk, but we're hoping maybe it's gonna have some anti-cancer risk as well.

Leigh Morgan: 27:46

Okay.

Nancy Davidson: 27:47

Um, anti-cancer, um, effects. Uh, the third thing I I wanna put out is that, somewhere around 20% of cancers around the globe are related to infectious agents, viruses, or bacteria.

Leigh Morgan: 27:59

Okay

Nancy Davidson: 28:00

so we now have what I call cancer prevention vaccines, right?

Leigh Morgan: 28:05

prevention vaccines. Yes. Tell us more.

Nancy Davidson: 28:08

The Hepatitis B vaccine,

Leigh Morgan: 28:10

Okay.

Nancy Davidson: 28:10

because hepatitis B virus contributes to the development of liver cancer and enormous killer around the world. And of course, the HPV vaccine, um, which targets the human papilloma virus. And that virus is very important in the development of cervical cancer, but also head and neck cancer. It probably isn't known that in our country, many, many head and neck cancers are actually related to HPV exposure. Those, of course, are diagnosed in men and in women. And so HPV vaccination can help to decrease the development of both of those kinds of cancers. And it ought to be used, in both boys and girls to greatly reduce that risk. So I, I look at this as, you know, areas that are incredibly important in our country, but also globally, because these are things that we ought to be able to eliminate over time with the use of vaccination. last thing I'm gonna put out is that there's obviously a lot of interest in, um, things that we're exposed to in life. I think that's a real area, an active area, very active research, trying to understand some of the environmental, external environmental, um, things that might. lead to cancer. Um, and, and obviously in the past, I think our government has been quite assiduous in trying to reduce one's exposure to those kinds of agents. Asbestos for gene.

Leigh Morgan: 29:28

Those are helpful examples and one of the things that I've learned as well is that we can learn a lot about prevention and treatment of cancer by understanding the backgrounds of patients, race, ethnicity, their gender. And you mentioned about the prevalence of breast cancer for women. That's in a way that's a bit of a no-brainer and easy for us to get our head around. I'm aware that rates for colon cancer, for Alaskan native folks the highest in the world. And there's a lot of interest of why is that happening? Because if you understand why it happens, then you have a better opportunity to develop prevention and treatment strategies. We also see African American, populations, for men and women in colon cancer, et cetera, et cetera. So the dimensions of race and ethnicity and gender play an important role in prevention and diagnoses and treatment. you talk about why it's important to understand these things and how information about one's background has a prominent and important role in public health?

Nancy Davidson: 30:45

Well, actually that sounds like a topic that you're better suited to discuss than me, Lee. But, um, I, I agree with you that, we think about an individual, but we always think about the individual in the context of their environment and also in the context of their family, right? So we didn't discuss, for example, but a really common risk factor for cancer is a family history of cancer, right? Of a particular cancer. And that probably has to do with both genes and maybe environment, right? Your family may have a genetic predisposition to a cancer, for example, in, uh, colon cancer, something called the LID syndrome, or in breast cancer, people who have abnormalities in these BRCA genes, BRCA one and two. so understanding that is really important for the individual and also for their family. but you are also a product of what goes on around you. and so I agree with you completely that your environment in which you live, the exposures to which, you are approximate, your socioeconomic status. I think all of those things are extremely important and it, it's pretty complicated to think about those interactions, Lee. And so sometimes it's difficult to parse them out in a way where you can think about concrete interventions that can be made. But I also agree with you that studying hotspot areas, for example, Alaska Natives, as you just talked about in colorectal cancer, we're gonna figure that out. It's gonna be complex. There's not gonna be like a single smoking gun, I don't think. But I suspect when it's, um, sorted out that we'll be able to take those learnings and we'll be able to figure out how they can apply to other individuals in other environments where they're relevant and where they're not. And so that whole area of research is so important. So complicated but I think is fueled by a lot of the progress that we've made in some of the biology of cancer, which now allows us to use that as a foundation to do these larger societal, social, settings that need to be done.

Leigh Morgan: 32:49

what headwinds, if any, do you see in the fight against cancer?

Nancy Davidson: 32:54

Well, I think, uh, as excited as I am about the progress that we've made, I can see several things that might, Lead to us making more of a pause than I would like to see. the first would be that, you know, all of the research that you and I talked about that has gone into clinical practice, virtually all of that was funded through the federal government in the United States and in related organizations around the room where world. But you know, that's an enormous source of, support for us to undertake this kind of study from the laboratory all the way through to the clinical trials. I, I hope that your listeners are aware that, um, that president's proposed budget, is for a massive decrease in NIH funding. and that includes the National Cancer Institute. And so that would have a chilling effect on our opportunity to do lifesaving research going forward. We wouldn't see the effect tomorrow, but I think that 10 years from now, we may well see that, you know, some of these developments, these things that are moving along that you and I have just talked about. They'll be dead in the water because we haven't been able to do the fundamental research down. The second thing that I see as a real challenge is that, care is only as good as getting it to people. and you know, and I know that in the United States, many of us are dependent on federal funding for our healthcare. Probably, uh, close to half of Americans are covered by either Medicare or Medicaid or some combination thereof. and I think that, uh, there are major proposals that I suspect your listeners are aware of to alter Medicaid coverage in a way that I think will be very damaging and very injurious for a number of people who are, in my opinion, excellent Medicaid recipients. I worry of course, that whatever transpires in that area may ultimately come over into Medicare. Recall that most people who get cancer are older. And so the Medicare population is especially affected by anything that changes their healthcare and therefore their opportunity for appropriate cancer treatment. And then the last thing I'm worried about, and you already touched on it, is that I'm a believer, obviously I'm a zealot about the impact of science and how, um, scientific work and the evidence that it generates has been so important in our steps forward. But, but I don't know that everybody, um, in our society shares that, enthusiasm, about the impact of science and how it has changed our lives for the better. and so I think that this is an area where we're going to have to be really, really, attentive to trying to make sure that we bring everybody along. I hope to understand what we have been able to accomplish, and what we still need to accomplish and how it has an impact on them and theirs. You know, them as an individual, the family around them and the people that are around them. The treatment for the cancer of their aunt is because of all these investments that we have talked about. Um, and so I hope they can share the same enthusiasm I have for that. And so I think that we really need to be thinking about this in the context of all biomedical research and all healthcare delivery.

Leigh Morgan: 35:50

So important what you, you've said, and of the things that's challenging talking about this or that I think is challenging. It's those of us who are and really can see and anticipate the knock on effects to funding, cuts in biomedical research to massive cuts in health insurance,, there's estimates of plus or minus 10 million, beginning 2024 that won't have coverage, they're gonna get sick. The other knock on effect is health insurance rates for the rest of us are gonna go up, so these are really important things that haven't actually happened right now. And so if things don't impact us right now, it's understandable that it may feel like just talking heads saying the sky is going to fall in the future. What have you learned about crossing that bridge of things that we know are gonna be detrimental in the future, but right now we might not feel it.

Nancy Davidson: 36:53

Well, I think we have to play the long game. You know, I've been in the field for several decades and I think we've also, been at works in the road in the past. You know, when I started as a young investigator, it was a very difficult time with the NIH budget and so it was very demoralizing for investigators because they couldn't get the funding to do the really exciting work that they felt might have an impact. I became a cancer center director at Pittsburgh, as you mentioned, just at the time of the great recession, when. The economy fell apart, 2000 8, 7, 8, remember that. We had a couple year pause almost. I mean, we were able to maintain the status quo, but we were certainly not able to advance in the may way that we would've wanted. And I would say we also all of space, a watershed at the time of the COVID Pandemic, another difficult time for us economically. A time where at least briefly, I think there was a slow down in some of our cancer related research, although obviously there was a wealth of, research that went on in developing and then implementing and disseminating the COVID vaccine and appropriate treatments for COVID. So I feel like we've had these ups and downs before. I'm hopeful that we're gonna continue to weather this one. Um, in the same way that, you know, we're gonna continue to make our progress. I think one of the things that sometimes affects people, Lee also is that. You remember the person who died of pancreatic cancer after a very short period of time and say, you know, cancer, nothing's been accomplished. Not making any progress. That person who's in your sphere, right, but you may not be even aware of the other people wrapped around you, who were treated for cancer a while ago, are now survivors that are just moving on in their lives. So you remember the difficult situations and sometimes the ones that are the successes are not quite so much in the forefront of your thinking. I think the other thing I meant to mention is that I'm also really worried about the pipeline of investigators. We've done a lot of good work, but there's more to be done. Of course we need to be in a position where our successors are gonna be able to come into the field, and bring the, those new ideas and bring that innovation, and continue to accelerate actually, over what we've already accomplished. I people are pretty demoralized right now because they're saying what you said, which is, wait a minute, what's the future here? If the bottom is gonna drop out of research funding, for example,

Leigh Morgan: 39:12

Yeah.'cause it's a research like your perspective, looking back over these time periods where we've weathered other periods that researchers look out, you know, 20, 30 years and they know that it's not often in the lab, all of a sudden you just dis discover something. It takes

Nancy Davidson: 39:31

um.

Leigh Morgan: 39:32

years and years sometimes to make breakthroughs and then to see those scientific innovations translated into drugs or treatments or prevention strategies. I share that concern, Nancy. And, what I take heart from your comments is that you've weathered. A few periods of upheaval where it also felt like, oh my goodness, funding's going down. Or, you know, some, other headwinds. And I, I wanna make sure that we really hone in on that. think we will get through this. Um, and it is a, a tough time right now. There's a friend of mine, Francis Henderson, And she once said to me, she said, yeah, sometimes it's like being in a fog, and I won't say the full F word, but it's like being in a freaking opportunity for growth you're in the middle of it and you know, you need to get out of it. And, I'm not sure I wish for this, time of growth, but you're, we're in a little bit of a fog here. We're not sure where and when we're gonna get out of it. I am certain however, that, that we will. It's just the human spirit, I think we, will persevere somehow, even amidst a little too much suffering.

Nancy Davidson: 40:50

I couldn't agree with you more. I, I think for, for me, when I, sometimes I'm thinking about throwing up my hands, I think to myself, you know, I, I still have the honor of taking care of patients and, you know, our cancer patients face uncertainty every single day, right? They're never, certainly at the time they're in active treatment, they're not quite sure which, where things are going. They're also in a fog of sorts, right. As we try to navigate. by golly, if they can do it, so could we.

Leigh Morgan: 41:18

That's a, a powerful testament and you, witness that on a daily basis in, in your work in clinical care. two last questions. have held a lot of. Big consequential roles in your career leading thousands at leading cancer centers, uh, around the US being chair of, asco, the preeminent oncology organization, and you've shared a bit of perspective of having weathered some up and down times. What are some leadership lessons that you've learned that has helped you build the high trust cultures and high performing teams, of external realities that may strike us as polarizing or divisive?

Nancy Davidson: 42:18

In the cancer world, I think we're very fortunately that it's the mission. That's the first thing, right? That I think that everybody that I work with shares a vision about our mission. It's a pretty easy one. It's one that everybody can embrace, right? Which is, who wouldn't want a world without cancer? Let's face it. That's something we can all agree on that that would be a really good thing. In fact, it would be more than a really good thing. It would be awesome. so I think that mission is really important in terms of building teams that Second is realizing that cancer is such a complicated series of diseases that we're gonna need a lot of people with a lot of different skills who are gonna come to the table. And they're all equally valuable. They're all equally important, and all of their contributions need to be recognized that we need to think about how to come together as a team, which also means that, uh, you know, we all have a lot of ego, but, but sometimes in this world, um, we need to think about how we're going to, harness those egos in a very, harmonious way to get to that mission. But at the same time, also making sure that everybody gets credit and they feel like, yeah, I really did accomplish something here. I was part of a team that did this, made a difference in that. and we see that across our board, right? I see this every day when I go to see patients. I work with the team, I work with the medical assistants, the nurses, the nurse practitioners, the pharmacists, the dietician. We all have a role to play here. and all of us are valuable and all of us are needed, and all of us need to feel good about what we've done and how we're gonna get credit for it, and that we have a contribution, that we may have a way of making things even better. Same thing on our research side, we have so many folks who contribute to our research and in order to make it the best possible, to make sure it's incredibly valuable because resources are scarce and we only wanna use them on the best possible ideas. So I think it's that sense of, um, mission of inclusivity, of making sure that everybody feels great, pride in what we've accomplished. Understands how they contributed to that all exceed important and also that I think that we all are, um, people who are resilient to know that we're in it for the, in the long game because in patients cancer and research, it doesn't go exactly the way we want every time. And so we have to learn from some of those things and pivot and try to build on it.

Leigh Morgan: 44:34

Powerful what you said, focusing on mission, being inclusive, everyone contributes and acknowledging that everyone brings something to the table and then this long game, the resiliency. Those are lessons that I think we can apply whether we're at a cancer center or leading a small team or general manager of a retail store. These are actually in the ground, if you will, that all of us. Whether lot of the, polarization and division that we see in the world, we can just root in these four things. I think those are powerful lessons. So my last question for you, you had a magic wand and you could make one wish for listeners so that they can really internalize and feel that hopefulness, in cancer and also mitigate some of the headwinds that you mentioned, what would that one wish be?

Nancy Davidson: 45:32

Well, of course I would wish for a road without cancer, but I think where, where I'm going to go is I, I I, I am wishing that we, can embrace the research that we're doing, and to understand, first of all what's accomplished for us in the past, how much positive change has taken place in the field like cancer, but also recommit ourselves to continuing it as we try to think about the next inroads that we need to make. And then lastly, I, this is a lot of wishes, isn't it, Lee? Um,

Leigh Morgan: 46:01

as you want.

Nancy Davidson: 46:02

yeah. I, I think that, uh, cancer still strikes such terror in so many people's hearts, and I get it. I really get it. But, I would hope that pe, if people hear that word, they would understand that this is not a death sentence. Right? That so much. Can be done in the field of cancer treatment and management. And that, let's remember that in this country, the majority of people survive their cancer for at least five years. And, and we need to build on that. We need to make it even longer and even more.

Leigh Morgan: 46:33

Those are two great wishes. I love it. Really centering the research and supporting that and then understanding that when that fear arises, balance that with, a sense that there is hope We are getting better at treatments and we are better we rally around each other and see the humanity each other and caring for each other and ourselves. Cancer into our lives. I think that's a powerful anecdote to the times that we're in, which for many of us, can feel a, a little uncertain at times. I am grateful for our time because I feel bolstered. I've learned a lot. Nancy, I wanna thank you for your incredible career and continued service Fred Hatch Cancer Center and in the many places and spaces that you walk globally in oncology. Thank you for joining me on the Space in Between podcast.

Nancy Davidson: 47:30

Lee, thanks for the opportunity to speak with you and your listeners.

Leigh Morgan: 47:33

Okay. Bye for now.

47:37

I hope you. Enjoyed this episode of the space in between podcast. If. If you did, please hit the like button and leave a review. Wherever you listen to the show. And check out the space. Space in between.com website, where you can also leave me a message.