Zlotnick Reflection - Calvin Lau

My experience this year has reaffirmed my passion for global health oncology research. I have been able to narrow my field of interest within global health pediatric oncology to delayed diagnosis and treatment abandonment, which unfortunately is an all-too-common reality in the landscape of Peruvian pediatric oncology care.  

In Peru, pediatric oncology is not a required rotation in the pediatrics residency. This difference in training can lead to delayed diagnosis in the community, especially in the case of soft tissue cancers and solid tumors, which often grow indolently over the course of weeks to months. These cancers often have overall worse outcomes than the more common liquid tumors such as lymphoma and leukemia, which present more abruptly and acutely. An additional factor is low awareness among parents about the urgency of referral for growing masses. Some parents believed, erroneously, that their child’s bone growth would regress spontaneously, others thought that their child’s retinoblastoma was not necessary to remove. In many cases, these parents had already seen doctors or medical providers who reinforced these ideas.

This knowledge gap at both the provider and parent and patient levels can lead to delayed, aggressive diagnoses that are incredibly difficult to treat, availability of resources notwithstanding. By the time these cases arrive at Instituto Nacional de Enfermedades Neoplásicas (INEN), they are advanced and often require salvage therapies or modified chemotherapy regimens that are suboptimal for survival. From my experience, much of the additional challenge of pediatric oncologists at INEN was the management of these cases, which are so much rarer in the US. I believe that finding different ways to target this knowledge gap may lead to a significant improvement in healthcare and hospital outcomes in Peru. The qualitative research study I contributed to while at INEN sought to do just this, by interviewing parents about managing febrile neutropenia, a complication of cancer treatment.

However, I continued to grapple with understanding my role as a resident physician from the United States. While I was able to communicate with my team overall, there were still instances in which my Spanish skills prevented me from contributing my full potential. There is just so much nuance to language and communication, especially in the realm of collaborative research in which one has to make suggestions and opine on the suggestions and ideas of other group members. Therefore, at times I felt I was holding the group back. And while I did provide a useful resource in using qualitative research software, and was able to help teach that to my group, I didn’t always feel particularly useful outside of that. I attempted to address this by making sure to tread lightly, to speak as politely as possible and also clarify others’ questions/commentary before I responded. I found that in this way, I had much more success in being an appropriate and respectful contributor to our research project.

Although there are many cases that stand out over my time in Peru, the common theme I keep coming back to are about the universal experience of childhood. Children, in sickness and in health, have a brightness and a hope in them that spans languages, classes, and IV poles. In Peru, I found that they play the same video games as our patients at Packard; they enjoy doing arts and crafts and are fearlessly protective of their parents. There are some who are incredibly precocious, and some who are chronically cranky and upset. The teenagers like to associate with themselves, while the young kids often collaborate for arts and crafts. The teenage boys love to play computer games, and everyone likes watching videos on their phones. And while that universal experience brings me a smile, it also forces me to confront that in many other ways, these Peruvian patients face a different reality. One in which their family income greatly dictates of their prognosis, one in which their skilled physicians do not have all the tools that they need to provide the care that everyone knows they deserve. It is for this reason that I will continue contributing to the febrile neutropenia study. It is exciting that my colleagues in this research will be presenting their work at the 2024 International Society of Paediatric Oncology conference. 

While my personal career plans will be taking a hiatus from the acute care/hospital setting, I still plan to stay involved with oncology as a stem cell hospitalist at Packard, and will continue developing my skills in global health research to eventually apply to fellowship in the coming years. 

Dr. Calvin Lau received a David A. Zlotnick Memorial scholarship to support his rotations in Peru and completed his Stanford/Packard pediatric residency in June 2024.