Editor Spotlight: Dr. Arjun Gupta
Dr. Arjun Gupta is a Medical Oncology Fellow at Johns Hopkins; he has an interest in GI cancers, palliative/supportive care, and care delivery. He is an Associate Editor for Medical Oncology at theMednet!
Dr. Arjun Gupta grew up in New Delhi, India, and he had one thing on his mind as a kid: cricket. His father was a pediatrician and his mother a pathologist, so Arjun would practice his cricket skills in the driveway while his father saw young patients out of their home that doubled as a clinic. Most often the children went in for routine checkups and immunizations, and there was one reaction Dr. Gupta never tired of seeing: "I remember the kids left our house smiling, often peeling away the wrapper from a candy Dad would give them," he recalls. That was his first experience with medicine, though he didn't give it a second thought until early high school.
"I realized in middle school that, although I loved cricket, I didn't have what it takes to play for the national team," Dr. Gupta remembers. His friends responded to his concerns with a joke that he could join the team as a physiotherapist and follow Sachin Tendulkar, widely regarded as the greatest cricketer, across the world. "That was the first time I seriously considered a career in medicine." As is the case in many countries, medical school starts directly after high school in India. So, Dr. Gupta studied hard during his senior year and went on to receive his MBBS from the All India Institute of Medical Science, New Delhi, in 2013.
His interest in cancer, however, sprung from earlier, familial experiences. "In 1999, my grandmother passed away. And from then until 2007, through most of middle and high school, I roomed with my grandfather. He's one of my biggest inspirations. Just before I entered medical school, he unfortunately died of lymphoma. Seeing him suffer was heartbreaking; and that was my first experience with cancer." There were two books that Dr. Gupta took with him to America to continue his education in medicine. The first was The Emperor of All Maladies by Siddhartha Mukherjee (2010): "my mother introduced me to that book, and it changed how I saw and thought about cancer indefinitely." The second book came from his studies in pathology, a seminal textbook of Robbins and Cotrans: Basic Pathology. "It's the only medical textbook I've read cover to cover, and this was back in 2008-9. Hopefully I still remember some of it!"
Dr. Gupta now concerns himself with ongoing research on symptom management, supportive care, and care delivery: "there are aspects of cancer that patients and caregivers suffer from, which we often overlook. There is avoidable suffering. There is waste in medicine. There are adjustments we can make that improve patient and caregiver outcomes, their experience, their time, and their resources." Optimizing this care is his primary research interest. By way of example, Dr. Gupta and colleagues recently published a study in JCO Oncology Practice which demonstrated the overuse of certain extended radiation treatment courses for patients that may have been suitably treated with less intensive treatments. Despite clear guidelines from the American Society for Radiation Oncology, certain physicians had individually high rates of prescribing the extended fraction regimen. "This takes time away from home, and is draining to patients who may have a limited life expectancy!" Dr. Gupta explains. His work focuses on identifying, and fixing, these outlier practices.
Sometimes finding disparities and burdens requires examining realms beyond what we consider conventional conceptions of physical, emotional, and financial suffering. For instance, a recent editorial, co-written by Dr. Gupta and his colleagues, reviewed studies concerning the financial burden of parking costs on cancer patients: "one analysis of > 1,000 GoFundMe campaigns for financial obligations in cancer care revealed that > 25% were for transportation costs...[and] in a study of > 2,000 individuals with cancer, an inability to pay for travel was associated with a delay in seeking cancer care." Perhaps most striking was a study that said, "In a 2019 survey of nearly 800 individuals with breast cancer, 48% reported that the cost of transportation was a barrier to receiving treatment."
Dr. Gupta made the ethical argument that parking costs should be abolished for patients with cancer, who are already undergoing so much. He also conducts clinical trials focused on symptom control, and is currently working on a protocol to better characterize pancreatic-cancer associated pain and to develop novel treatments for it.
Along with this research, Dr. Gupta commits himself to alleviating the burdens on his patients as best he can. "What I prize most about oncology is being good friends with my patients and their families. It is especially gratifying to remain in touch with families even after a patient has passed. It is inspiring being around colleagues and mentors who put the patient first—sometimes calling their patient after stepping off the podium after a big presentation. Patients, and patient care refreshes me." Those sentiments ring true for his advice to prospective doctors about to enter oncology: "it's a fabulous branch. I can't imagine doing anything else," Dr. Gupta says. He also advises young trainees, "explore as many options as you can in the field; it’s okay to have diverse interests."
Those diverse interests led Dr. Gupta to theMednet: "one of the challenges facing oncology trainees is the sheer pace and volume of information coming out, and how to process, integrate, and apply this knowledge. Since I’ve started as a fellow, the first-line treatment paradigm for advanced liver cancer has changed twice already. A third change may be coming soon. theMednet caught my eye as a resource where brilliant people post real life questions, and brilliant people answer; it's an amazing tool to keep up and learn, and hopefully soon for myself, even answer."
Outside of work, Dr. Gupta still has time for his old passion. In fact, a year-long friendship with one of his first patients as an oncologist inspired him to attend the cricket World Cup in the UK and witness a famous India-Pakistan game, an experience that Dr. Gupta published an essay about in JAMA Oncology. On and off the field, Dr. Gupta is still learning and applying valued life lessons as a medical oncology fellow at Johns Hopkins.