Cheryl Martin (Host): Holy Cross Health is a leader in cancer care, recognized nationally for its excellence. We learn more about its comprehensive cancer services with Dr. Mark Steves, a Surgical Oncologist at Holy Cross Health. This is Your Best Life Podcast from Holy Cross Health. I'm Cheryl Martin. Dr. Steves, thanks for coming on.

Mark Steves, MD: Thank you for having me.

Host: First, please tell us what brought you to the D. C. region from Atlanta and now to Holy Cross Hospital?

Mark Steves, MD: Yeah, it's, a good story. Basically I was born and raised in Atlanta. My mother and father were both physicians, one from Peru and one from Mexico and after I finished college and then medical school in Atlanta I went on and did my Surgical training at Emory University. And certainly I thought I would stay in Atlanta however, things happened. There was a turnover in leadership and both myself and my cancer center director at that time Dr. Paul Sugarbaker, thought it was best to move on to greener pastures and so we came to the Washington Hospital Center in downtown DC to start that cancer center back in the early 90s. And we continued to be there up until the great disruptor happened, which was COVID. COVID happened four years ago. It certainly changed everything that we were doing as cancer surgeons though COVID was not as deadly as it was in new York City where everything ground to a halt. Here in most of the hospitals, we were allowed to continue with cancer surgical services because it was thought to be essential and needed. Trauma services of course continued on but all other elective surgery was stopped for several months. So fortunately we continued. On the back end of COVID though, we saw a lot of changes, a lot of senior surgeons that were with us at the time and even Dr. Sugarbaker himself retired. My surgical oncology regional director moved to Omaha and assumed a new job and so I started looking around last year. I left in September of 2023, the Washington Hospital Center and was looking around to stay in the area. My wife had just gotten a job on the nursing school faculty at Georgetown University so we were anxious to stay. I actually knew about the cancer center at Holy Cross opening up earlier in 2023. So i just sent a letter of introduction to Dr. Van Coots, and then shortly thereafter, I got a call and then here I am several months later.

You know my goal is to help our community and bring high quality surgical care which we already have in place but we wanted to add to it to our community and to help the rest of the surgical staff and medical staff at Holy Cross Health.

Host: Thank you so much Doctor for just giving us a thumbnail of coming to Holy Cross Hospital Talk about what are several key principles that guide your practice of medicine and surgery.

Mark Steves, MD: Well one of the things that strikes me in the practice of medicine and surgery is you can view it as a job only but this is more than a job. This is service to others and to your community. That's how I practice medicine and surgery. We want to be of assistance to our community and sometimes it can be a very humbling experience especially when you're dealing with complex issues such as cancer care. The other thing I want to mention is that we want and we do use a holistic approach to cancer care. We try to share with our patients, try to understand their experiences, try to understand who they are as individuals and all their interests. Basically by knowing who they are, we can help guide them through the myriad of decisions that need to be made for their cancer care. The whole is greater than the sum of its parts, so the more that we know the better we are able to understand the patients, but also help guide them through their surgical journey.

Host: And I am sure that they appreciate the holistic approach and it comes across as being very individualized as well. Talk about your scope of practice and what types of cancers you treat.

Mark Steves, MD: Currently my scope of practice is basically centered around liver and pancreatic cancer cases, gastric cancer cases, small bowel cancer cases, colorectal cancer cases but most of the colorectal cases are what we think of as being locally advanced, meaning a high burden of tumor. And I also deal specifically with a lot of cancers that have recurred from a variety of primary cancers. One of my other specialties is treatment of patients with sarcomas. Sarcoma is a fancy Greek word, comes from a Greek word which means fleshy. It's kind of a fleshy tumor. Most of these occur in the extremities, in the muscles, the arms, legs, shoulder and back but several of them do occur in the abdomen in the peritoneal cavity, and I do a lot of surgery for that and then there's a very specialized sarcoma of the GI system, the bowels, called gastrointestinal stromal tumor. I have been dealing with that disease before we even knew what actually it was. A lot of this is outlined in a book chapter that I wrote in one of the sarcoma books several years ago but I do a lot of gastrointestinal stromal tumor surgery in the area.

Host: How is the delivery of cancer care unique compared to other acute and chronic conditions, let's say, such as heart disease.

Mark Steves, MD: What's unique about cancer care is not only do we have medical oncologists, which are cancer doctors that give chemotherapy but there are also radiation oncology doctors who give radiation therapy to tumors, to cancers. And also we have people like myself who are surgical oncologists, that have had specialized training in the surgical care of the cancer patient. A lot of cancers these days are best treated with multimodality, meaning chemotherapy, surgery, radiation, not necessarily in that order but in some kind of order. Let's say you have a rectal cancer. It is not unusual to get chemotherapy and or radiation therapy up front before any surgical approach is undertaken. The same for pancreas cancer surgery and certainly for gastric cancer surgery, we like to treat patients up front with chemotherapy and then proceed on with a surgical event. So basically it involves multiple modalities, chemotherapy, radiation therapy and surgery and we have to take the patient through that path and have to have them understand what we're doing, what our ultimate goals are and we need to have a shared decision making about that. This can be very difficult for patients because once they hear the word cancer;

it is such a powerful word that they tend not to listen or not effectively listen to what you have to say after you mention the word cancer so sometimes it takes several visits to help them understand what this all entails. Basically we try to help them manage the uncertainty because you cannot predict the future.

 Let's say you have a cancer that has a 90 to 95 percent excellent response. The problem is statistics are statistics. For any one individual either you're going to respond or you're not. And it's hard to understand that and we try to help them understand the future which can sometimes be very difficult dealing with uncertainty while maintaining the hope is our goal.

Host: And I can only imagine that this requires a lot of sensitivity and you kind of touched on this before that the patient provider relationship is integral to providing high quality care. Anything else you want to add on what you do to build a strong relationship with your patients?

Mark Steves, MD: Well it's interesting to know, there was a University of Chicago memorandum or manuscript that went out in 2015,outlining the multiple complaints that patients had about their cancer care. This is from from, polled throughout the Chicago area. But it's the same whether you're in New York City, Washington D. C., Wheaton, Maryland, Atlanta and everywhere basically the biggest complaints from patients was there was never enough time with the physician. The next one would be they don't know me as a person, they just know me as a patient. Let me address the first one. Healthcare is becoming increasingly complex and right now the patient care providers are so overwhelmed that they can only spend 15 to 20 minutes with the patients. When you come with a diagnosis of cancer and have an appointment with any of our practitioners that specialize in cancer care at Holy Cross Health; you're going to get more than 15 minutes. Because it's almost impossible to help you understand your diagnosis, the treatment options, come to a shared decision making process in 15 to 20 minutes. So our initial meetings can last well over an hour easily to an hour and that helps us build a relationship with the patient. Time is needed to build that relationship and that rapport, to help the patient understand the complex information that is being given to them.

The other thing as I mentioned is in that University of Chicago manuscript is the patients complain that the physicians don't know them as, as a person they know them as a patient as a disease process. Well, we try not to talk to patients. We try not to talk at patients we try to listen and talk with them. It's that back and forth that helps a patient understand that you have their best interests at heart and you are trying to convey the information that you have to have them have an understanding and make a good decision. You know you don't wanna be too paternalistic.

But it does make you realize that the patients don't know as much as you know but your job is to help them understand as much as they possibly can understand no matter who they are, no matter what walk of life. It's like navigating the system in a foreign country. To them, cancer care is a foreign country and we try to make that

not be the case.

Host: Very well said. Is there anything else in closing that you'd like to add just regarding cancer care at Holy Cross Health?

Mark Steves, MD: Well, I am very fortunate that I've joined an excellent facility that has a lot of healthcare providers that are already performing high quality medical, surgical and radiological care to our community and I just came just to add my expertise to this system.

Host: Dr. Mark Steves, thanks so much for exposing us to the great cancer care at Holy Cross Health. Thank you.

Mark Steves, MD: Thank you.

Host: To learn more, visit Holycrosshealth.org. If you found this podcast helpful, please share it on your social media and for other topics of interest to you, check out our full podcast library. This is Your Best Life podcast from Holy Cross Health. Thanks for listening.