← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Dr. Frederick L. Greene, Emeritus Chair of Surgery at Carolinas Medical Center and Medical Director of Cancer Data Services at Atrium Health-Levine Cancer Institute
00:16:19
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- [00:02]
A
The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit and more. The conversations get real. Leaders will share how their scenario planning for policy shifts brief, breaking through value based care barriers and building clinical teams that translate new ideas into real world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
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B
This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to be joined by a brilliant physician surgeon leader. We're joined today by a surgical oncologist that also serves as a medical director as part of the Advocate Health System, which is now the second or third largest not for profit systems in the country. He's based in Charlotte. We're here today with Dr. Rick Green. Dr. Green, could you take a moment and tell us a little bit about your career and where you focus today?
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C
Well, thanks, Scott. It's a real pleasure to be with you today. I've been in Charlotte for 28 years and I came as chairman of surgery and director of the surgical Residency program here at our academic medical center. And over the years I've been interested in surgical oncology, mostly breast cancer, pancreatic cancer, GI tract cancer. And currently I serve as medical director of cancer data services, which means I work with a wonderful group of cancer registrars which are now called oncology data specialists, and they collect all of the data on cancer patients. So all of the data that we use is used for research, it's used for advocacy, it's used for a number of issues. And it's just a pleasure to work with a wonderful group of professionals here.
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B
In that area and talk for a moment. You're a surgical oncologist by background. I know UVA and Yale and tremendous career. Talk about the evolving world of cancer and cancer treatments and how challenging it is for oncologists to keep up today with all the changes in what's going on and try not to stay burnt out with the amount of just the amount of cancer that's out there and oncology needs that aren't needed. Talk a bit about the changes and the ability to keep up and the challenges.
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C
Well, it's been an amazing evolution, of course, in the many years since I finished my residency in 1976 and again I was going into cardiac Surgery when I was at Yale. But I really had sort of a feeling and a calling for what was going on in the cancer world, and so got involved in that. One of the areas that I've been working on is the staging of cancer. And I've had the pleasure over the last 35 years of heading up the staging system that we use. I know you're familiar with people when they talk about stage one, stage two, stage three. Well, I head up that system worldwide, and it's called the TNM system, the tumor node and metastasis system. And so we come out periodically with all of the new data. And so my work here in Charlotte is really to make sure that every patient who comes into our cancer center, which is the Levine cancer institute, is categorized with the proper stage of cancer. I also had the opportunity of being the president of the commission on cancer for the United States, and I'm very much interested in accreditation, making sure that every institution in the country has all of the things it needs to take care of cancer patients. So those are the big areas. Since I finished my training and of course, in my own work in the operating room in GI tract and breast, I've seen such great advances, and I'm very happy to say now, of course, there are first few areas, like pancreatic cancer. We have a little. A little while to go, but we're making some. Some headway. And again, as a surgeon who's involved in cancer, I think that, of course, the surgical removal of cancer is very important. But we work very closely with our radiation oncologist, our medical oncologist. We're very lucky here in Charlotte to have a proton therapy unit, which is really state of the art. So I think we've made a lot of good progress.
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B
Thank you. And take a moment on staging, because this is so scary when somebody gets a cancer diagnosis. You know, I'm obviously familiar with stage 1, 2, 3, 4, and depending on what the cancer is, it could be curable and treatable at certain stages, not at other stages. Other cancers seem so difficult. You know, still, a lot of the brain cancers, the tumors, the pancreatic cancer, still seems so difficult to treat. But when somebody gets this diagnosis of stage three, stage four. Talk to us a little bit about that, because that seems to be, depending on the cancer, incredibly scary, or sometimes not quite as scary. But talk about. I guess it's always scary. But talk to us a little bit about that staging.
- [05:36]
C
Well, you're absolutely correct, Scott. And you know, when you talk, when you sit down with a cancer Patient and their loved ones, what's the first thing they do when they leave the office? They go to the Internet. They go to the Internet to try to figure out what's going on, how long they're going to live. And of course, there are so many things in the Internet that are incorrect. You can't legislate the Internet. And so they use certain staging systems and plug them into these data calculators to figure out if you're going to last five years or 10 years. So one of the things we try to do is, in the group that I've been working with, is create calculators that put the proper stage in patients. And so if they do go to the Internet, we work with many institutions, and of course, my own institution is involved in this to make sure that patients have the right data, especially in what you're talking about advanced cancer, stage three, metastatic cancer, stage four. And so these are the things that we try to do so people don't get the wrong information. And that's really the problem. And so we try to proliferate this all through journals and papers and everything that cancer patients go to. And so stage is the bedrock, the absolute bedrock. And that's what we call the most important part of what goes on in a cancer diagnosis. And that's why we want all clinicians to be well aware of. Of the stages of the cancer they work with. And that's why I do a lot of lecturing around the country trying to talk to physician groups as well as patient groups and registry groups to try to make sure they're using the right data.
- [07:17]
B
Thank you. No, that is fascinating. How did the stage system develop? When did that develop? Because now it's. Anytime somebody gets a cancer diagnosis, from breast cancer to prostate cancer to. To other cancers, the first thing you start to hear is the staging of it. How long has that been part of cancer diagnosis?
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C
That's a great question. Actually, the TNM system, the system that we use today, started in the 1940s, and it started by a surgeon named Pierre Denois. He was working in Paris, and he first developed a staging system for breast cancer. So I'm very happy to tell you that it was a surgeon who started this entire staging system. Now, of course, what happened, this morphed into many different sites for especially adult cancers that we use. And I got involved in the late 1980s, early 1990s. So now we're into the ninth version. I took over in the sixth edition. Now we're into the ninth version, or ninth edition of our cancer staging system, but it started with a surgeon back in the 1940s and 50s.
- [08:31]
B
And cancers are so different. But when you think about the staging system, even though treating cancers is so different, depending on the types of cancers, some much more susceptible to treatment, some much more difficult to treatment, does the uniformity of the staging system work across all cancers?
- [08:53]
C
Well, again, a great question. When we started, or when the TNM system started, it started as an anatomical system only the tumor, the node, the metastasis. And what we've done over the years is add biological markers and molecular markers to the system, because, again, personalized medicine, of course, as you know, is the key. So every patient has a little different marker to their cancer, a little different biology. So we've added these markers, for instance, in testicular cancer and breast cancer over the years, because it's not just an anatomical staging system. But I will tell you the reason that we've had to keep the anatomical system. If you're a surgeon working in sub saharan Africa, where all you have is a surgeon and a pathologist, you don't have an academic center that can do all of the testing that you need. So you still need the anatomical system as well as the molecular system that we've developed. So this is. This is really the key, and that's why we have to keep adding genetics to all of this. The key to all of this is the genetic markers in cancer, and they will be added to many of these different sites in the future.
- [10:04]
B
Fascinating. Could you also talk about sort of the biggest trend you're watching currently and what you're most focused on and excited about this year and heading into 2026 that we're now into 2026.
- [10:20]
C
Well, I think, again, as I've stated, the collection of data is so important and making sure it's accurate. One of my jobs at our Levine cancer institute is do the quality review as well. And I think it's so important for every institution to make sure that the data that's put into our registries locally is correct. Because what do we use the data for? We put it into our state registries every time we have a patient in Charlotte that's entered into the North Carolina state registry, and then it's added into our large database developed by the american college of surgeons, which is called the national cancer database. So my point is that I think today accuracy is the key. You have to have accurate data put in, because if you don't, you won't know how these prognostic factors will work. Using the tnm system. The other point I think I want to make to you is the trend of accreditation. Accreditation is so important that again, I was very proud to head up the Commission on Cancer, which is in charge of all accreditation of institutions in the United States for their cancer work. So what we try to do is make sure that accreditation cuts down on the variance. In other words, when a patient goes to a small community hospital that's accredited, we want to make sure that they get the same care and as going to an academic center that I serve in Charlotte. And this is so important. So accreditation is important and registry information is important. And that's why I think we're making head roads in cancer, because again, ultimately research is based on all of the data we collect.
- [12:05]
B
You've had this remarkable career, surgical oncologist leader, cancer leader, really remarkable career, headed up the Commission on staging of Cancer. An amazing career. Now, I know that you've got at least one brilliant child and probably more. What advice would you give to young emerging leaders regardless of what field they're in? Any advice that you would give to young emerging leaders and do they listen to advice from their father?
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C
Well, that's a great question. And I do a lot of mentoring. I think one of the things is that you have to open doors for people and networking is so important. And so what I try to do to young people who I talk to from in high schools and colleges and even later in residency is make sure they do something they enjoy. And that's so important. You have to learn something every day. I tell my children and grandchildren, make sure you learn something every day. And for me in my career, we always want to be relevant. And that's why I love what I do. And medicine, of course, I've spent almost 50 years in medicine, but to me, relevancy is important. Learning something every day is important because you can contribute in so many different ways. And again, talking to you, I find is a wonderful contribution. And certainly I'm aware of the work that you're doing in your work to make sure that all healthcare is achieving its goals. So I think those are the kinds of things that I like to tell the up and coming individual today, whether it's a surgeon or non surgeon.
- [13:58]
B
I think that's just as fantastic, you know, and I love this concept of one, I'm a huge fan as you are of lifelong learning. And you know, if you're not learning, you're not growing and you're not even staying fresh, you're not even staying static. If you're not learning and constantly trying to learn in this concept and doing it in this. This wonderfully professional way that you do it, of staying relevant as we end up in the middle of our careers and so forth, and staying in the game and staying relevant, it resonates so well. I can't even tell you, Dr. Green, before I let you go, anything else you'd like to share today with the audience about what you do or any advice you'd like to give?
- [14:42]
C
Well, I think again, what I try to tell people is we want to think not only about therapeutic measures, but we certainly want to think about prevention. And I think prevention and screening are so important in my work and the cancer work that I do and I've done over the years. So we don't want to wait, of course, until somebody has an issue with cancer. And I think the role of a physician, and especially somebody in surgery is to make sure that they're giving good advice to people on how to live healthy lives. And, and that's what we try to do. And I think that's the important thing. And I'm so glad that there's so many issues coming out. I have the opportunity, Scott, of hosting three podcasts on cancer related activities. And many of the things that I talk about are prevention and screening in these. And I try to make sure that my audience hears the message that I'm trying to give to them.
- [15:45]
B
Just fantastic. Amazing what you do in the career that you've had, people that you've helped to mentor. Dr. Green, what a pleasure to visit with you on the Beckers Healthcare podcast. We're a huge fan of the Levine Cancer Institute, the Levine Cancer center, and what you've done with it, what they've done with it with Atrium advocate and so forth. Remarkable. Thank you so much for joining us today.
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C
Well, I look forward to seeing you in April in Chicago.
- [16:13]
B
God bless you. Thank you so much.
- [16:15]
C
Thank you.