Supporting Medical Programs
Interdisciplinary Medical Fellowship in Thyroid Cancer
Memorial Sloan-Kettering Cancer Center (MSKCC)
In this proposal, we outline a unique clinical fellowship training program focusing on thyroid cancer. The overall goal is to develop a cohort of academic thyroid cancer specialists, trained in research methodology to expand our knowledge of thyroid cancer. There are no fellowship programs in the United States which focus solely on thyroid cancer.
The training environment, Memorial Sloan-Kettering Cancer Center, is a large international referral center with over 4000 thyroid cancer patients under active surveillance or treatment. The program faculty is comprised of national experts in endocrinology, nuclear medicine, thyroid surgery, radiology, pathology, and radiation therapy. All faculty hold full-time appointments at the Weill Medical College of Cornell University and all participate in ongoing residency training programs.
Fellows who are selected will complete a diverse curriculum that exposes them to all aspects of the care of thyroid cancer patients. In addition, they will receive formal instruction on basic and clinical research methods, including grant writing, to enable them to achieve independence in an academic environment. Opportunities exist at MSKCC for fellows who initiate successful research programs to continue working at the medical center for up to two additional years under the direction of a research mentor.
This program was designed to provide high level training in both clinical and research aspects of thyroid cancer care with the specific intention of returning the trainees to their home institutions where they can develop and lead multidisciplinary thyroid cancer programs.
Primary Goal (Educational Objectives)
To develop a group of academic endocrinologists equipped with advanced training in the clinical management of thyroid cancer and in clinical research methodology in order to continue a national and international effort to prevent, control, and cure thyroid cancer.
Thyroid Cancer is increasing in the United States. The American Cancer Society estimates that there were more than 35,000 new cases diagnosed and treated in 2008. The most recent SEER/NCI analysis of cancer trends in the USA over the past 50 years found that thyroid cancer had the highest annual percentage increase of any cancer between 1992-2001.
Although we are learning more about potential etiologic agents (eg. radiation) and the genetic abnormalities associated with certain types of thyroid cancer, the cause(s) of this upward trend is still poorly defined. The American Cancer Society estimates that approximately 1600 Americans died of thyroid cancer in 2007. More Americans die of thyroid cancer each year than die of Hodgkin’s disease, cervix cancer, or testicular cancer. Millions of dollars of federal funding support vigorous research efforts to control diseases such as Hodgkin’s Disease, cervix, and testicular cancers, but almost no federal funding exists for clinical research into thyroid cancer.
The clinical realities of managing thyroid cancer patients are rapidly changing. New agents such as recombinant human TSH and new technologies such as Power Doppler ultrasonography and positron emission tomography are reshaping our approach to monitoring for recurrent disease and to determining prognosis. New pharmacological and radiotherapeutic approaches to controlling and treating metastatic disease are also rapidly evolving. For the first time ever, we are seeing an explosion in potential novel treatment agents for advanced, RAI refractory thyroid cancer.
In this climate, we feel that clinicians and clinical scientists who choose to supervise the care of thyroid cancer patients need to have direct exposure to a wide variety of educational experiences which span surgical, nuclear medicine, endocrine, radiologic, and pathologic disciplines.
The Memorial Hospital for Cancer and Allied Diseases is a unique center with a Thyroid Cancer Working Group consisting of twenty-four full-time attending physicians with a major interest in thyroid cancer. These individuals have expertise in diverse medical disciplines, and they all hold full-time faculty appointments at the Weill Medical College of Cornell University. All members of the Working Group, furthermore, have a strong commitment to the education and training of young physicians.
We have developed a formal training program in which highly qualified physicians-in-training would be schooled in the complex and interdisciplinary issues of diagnosis and management of patients with thyroid carcinoma. In addition to obtaining clinical skills these physicians would be immersed in a variety of clinical and/or basic research programs to prepare them as independent investigators. Through this mechanism, we hope to develop a nucleus of talented clinical investigators who will lead the next wave of discoveries leading to the progressive control and cure of thyroid cancer
This program is open to individuals who are board-certified in Internal Medicine and who have completed two years of endocrinology fellowship or two years of nuclear medicine training in an ABIM accredited program. At the start of the MSKCC fellowship, all individuals must be eligible for board certification in either Endocrinology and Metabolism or in Nuclear Medicine.
Venue and Curriculum
Individuals accepted into the program will be involved in an intensive immersion into all aspects of the diagnosis and treatment of thyroid cancer. By the end of the program they will develop the experience and skills to direct a thyroid cancer program at their host institutions. The course of study will be carried out at the Memorial Sloan-Kettering Cancer Center in New York, NY.
The addition of Dr James Fagin and his thyroid cancer molecular research laboratory to MSKCC in the fall of 2006 has greatly expanded our thyroid cancer translational research program. The Fagin laboratory provides an unparalleled opportunity for thyroid cancer fellows to participate actively in translational research in thyroid cancer as we strive to develop novel therapies for thyroid cancer patients.
This center has a large referral base and a large population of thyroid cancer patients under active management. Importantly, approximately 50% of the active outpatients have metastatic disease and are at high risk for mortality from the disease. Candidates will have direct exposure to the following educational modules:
- Fellows will attend three full-day outpatient clinics throughout the year in adult Thyroid Cancer Clinic in which they will have a primary management role in patients with thyroid cancer. They will be exposed each week to at least 40-50 thyroid cancer patients during these rotations. They will follow the same patients longitudinally during their entire stay.
- Fellows will admit patients to MSKCC for radioactive iodine therapy (usually 2-3 patients a week) in addition to the 5-8 outpatient RAI therapies performed each week.
- Fellows will participate in weekly Nuclear Medicine Tumor Board, weekly Thyroid Surgery Conference, and weekly Endocrine Grand Rounds and journal clubs. They will supervise and coordinate a city-wide monthly thyroid cancer conference held at MSKCC.
- Fellows will be expected to be involved with either bench or clinical research projects relating to thyroid cancer. Candidates will be selected at least six-months prior to beginning the program and will develop research plans prior to beginning the fellowship year with one of the attending faculty members.
- Observation of surgical removal of thyroid nodules, total thyroidectomy, and neck dissection techniques
- Nuclear Medicine instruction on the performance and interpretation of radioiodine scans, radioactive iodine therapy, and positron emission tomography and Instruction on formal dosimetric analysis to determine safety limits for 131I
- A rotation in the radiation oncology service will provide direct experience on the methods of intensity modulated radiotherapy and state-of-the-art high intensity confocal radiation therapy.
- A rotation in the chemotherapy of advanced thyroid cancer with a medical oncology team will be available. This will also include exposure to Phase I and Phase II protocols, testing new anti-cancer agents.
- A rotation in the Department of Pathology to read both surgical specimens and cytology specimens. A large teaching file of slides will also be available as part of the Pathology curriculum for the fellow.
Fellows will be allowed to participate in all of the activities of the Cornell Affiliated Fellowship in Endocrinology, which is an ABIM-accredited program that has been in continuous operation for fifty years. The faculty of this program are attending physicians at Memorial Sloan-Kettering Cancer Center, the New York Presbyterian Hospital, the Weill Medical College of Cornell University, The Hospital for Special Surgery, and The Rockefeller University. All institutions are located on a single 10-block campus on the upper east side of Manhattan. Many weekly conferences and seminars focusing on all aspects of endocrinology are offered as part of this program. In addition the thyroid cancer fellows have access to all of the basic and clinical research seminars, formal research conferences, and weekly clinical conferences in general medicine and general oncology that are available at this large medical center complex.
R Michael Tuttle, MD. Professor of Medicine, Endocrinology Service,
MSKCC. Co-director, Endocrine and Metabolism Fellowship, MSKCC.
Steve M. Larson, Professor of Nuclear Medicine, Associate Program Director
H. William Strauss, Professor of Radiology
Head and Neck Surgery:
Ashok Shaha, Professor of Surgery
Jatin Shah, Professor of Surgery
Dennis Kraus, Associate Professor of Surgery
Bhuvanesh Singh, Assistant Professor of Surgery
Jay Boyle, Assistant Professor of Surgery
Richard Wong, Assistant Professor of Surgery
R. Michael Tuttle, Professor of Medicine
James Fagin, Chief, Endocrinology, Professor of Medicine
Richard Kolesnick, Professor of Medicine and Pharmacology
David Pfister, Associate Professor of Medicine
Richard J. Robbins, Professor of Medicine, Program Director
Rebecca Leboeuf, Assistant Professor of Medicine
Matthew Fury, Clinical Assistant Physician
Eric Sherman, Associate Professor of Medicine
Ronald Ghossein, Assistant Professor of Pathology
Oscar Lin, Assistant Professor of Pathology
Charles Sklar, Professor of Pediatrics
Nancy Lee, Assistant Professor of Radiation Oncology
Lucy Hann, Associate Professor of Radiology
Fagin Molecular Thyroid Laboratory
James Fagin, Professor of Medicine, Chief Endocrinology Service
Jeff Knauff, PhD