What happens when devastating cancer diagnoses transform into manageable chronic conditions? Dr. Terry Peabody, Chair of Orthopaedic Surgery at Northwestern University and past AOA president, takes us on a compelling journey through the evolving landscape of musculoskeletal oncology.
Dr. Peabody shares profound leadership wisdom gained from mentors who taught him that true leadership means "bringing people along with you, not pulling up the ladder." This philosophy has shaped his approach to both patient care and professional development throughout his distinguished career.
Whether you're a healthcare professional or someone whose life has been touched by cancer, this episode offers valuable insights into how leadership, technology, and compassion are shaping the future of orthopaedic oncology.
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Transcript
Episode Transcript
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Speaker 2 (00:23):
Welcome to the AOA Future in Orthopedic Surgery
podcast series.
This AOA podcast series willfocus on the future in
orthopedic surgery and theimpact on leaders in our
profession.
These podcasts will focus onthe vast spectrum of change that
will occur as the futurereveals itself.
We will consider changes asthey occur in the domains of
(00:43):
culture, employment, technology,scope of practice, compensation
and other areas.
My name is Doug Lundy, host forthis podcast series.
Joining us today is Dr TerryPeabody.
(01:05):
Dr Peabody is the Edwin WarnerRyerson Professor of Orthopedic
Surgery and Chair of theDepartment of Orthopedic Surgery
at Northwestern UniversityFeinberg School of Medicine.
He also provides care forpatients at Lurie Children's
Hospital and is a member of RHLurie Cancer Center.
He's a native of SouthernCalifornia.
He earned his Doctor ofMedicine degree and his
residency at the University ofCalifornia, irvine, and did his
fellowship on oncology at theUniversity of Chicago.
(01:26):
Dr Peabody is past president ofthe American Orthopedic
Association, former chair of theAOA Academic Leadership
Committee and vice president ofthe Orthopedic Residency
Committee of the ACGME.
He was a director of theAmerican Board of Orthopedic
Surgery.
He was a director of theAmerican Board of Orthopedic
Surgery and he has significantresearch and clinical expertise
(01:49):
on benign and malignant bone andsoft tissue tumors, including
limb salvage surgery andfunctional restoration for adult
and pediatric patients.
And also it's important to notethat Dr Peabody is an AOA
pillar of the orthopedicprofession.
So, terry, dr Peabody, welcometo the podcast, sir.
Speaker 3 (02:10):
Thank you, Doug.
Appreciate the invitation.
Hope you're doing okay.
Speaker 2 (02:19):
Yeah, man, it's good to see you.
All right, my friend.
So, as you know, we've beentalking about the future in
orthopedic surgery and you are avery well-known oncologist.
You and I served together justone year apart for 10 years on
the American Board of OrthopedicSurgery.
I've got to know you and yourlovely bride, jane, for quite a
while and you are certainly anexpert on this, but you're also
an expert on leadership, beingan AOA pillar and a former
(02:41):
president of the AOA.
So, dr Peabody, can you give usa pearl, some wisdom as you see
it in terms of leadership andhow it can affect us, especially
as we look forward into thefuture?
Speaker 3 (02:57):
Well, I think.
Thank you, Doug.
I think the number one thingwas we were all inspired by
people in our careers who welooked up to, who seemed to
always want to do the rightthing.
We're fairly selfless in howthey did things and really were
more interested in their legacyin many ways than what they were
(03:17):
actually accomplishing on a dayto day basis.
They wanted to bring peoplealong with them.
To bring people along with them.
They're not pulling up theladder, they're facilitating
them to get on the ladder andlooking back for the people
behind them, trying to bringthem forward.
And I appreciate that so muchfrom people like Mark Hoffer and
Mike Simon that that's the kindof leader I wanted to become
(03:40):
and hopefully I have.
I think the AOA is a big partof that.
I learned how to work withother people and like minded
people, you know, who wanted agreat residency, who wanted
great departments, who wanted tofacilitate the profession and
sort of fulfilling what it wasmeant to be, and so it's been an
honor to be part of the AOA.
(04:01):
It was an honor to lead themfor a year.
Part of the AOA.
It was an honor to lead themfor a year, but for me it was
all about the mentoring Ireceived when I was younger and
the sense that it was aboutsomething bigger than I was.
So that's the pearl.
That's the only pearl I have.
Honestly.
It was a tremendous experienceto be part of that and the board
as you said, it was a highlightof my professional career being
(04:22):
a member of the board.
So those two things it's been.
It's been a terrific, it's beenan honor.
Speaker 2 (04:29):
Thank you.
Yeah, and you, we had a goodtime together doing that.
It's a lot of work but it'sworthwhile.
Also, got to know you throughthe AOA as well.
All right, my friends.
So, as you know, we are talkingabout the future in orthopedic
surgery and going to you aboutyour chosen profession of
oncology.
You know, it seems like all thetime we're hearing about these
(04:55):
really devastating cancers whichare now being treated
extraordinarily successfullywith biologics and other things
that have really turned the tideon a lot of these illnesses.
Tell us if you could be so boldwhere do you think the future
is going in terms ofmusculoskeletal oncology?
Speaker 3 (05:14):
So, I think you know we think about diseases burdens.
Perhaps you know burden ofdisease if you will, but it's
not that kind of burden anymore.
The initial, when I startedsomeone with metastatic disease
had a dismal outcome within amatter of months to maybe a
couple of years, and so youwould treat people in that
(05:34):
manner.
But these targeted therapiesand it's really remarkable have
had a tremendous impact, affectnot only longevity but also
quality of life for thoseindividuals.
Even with advanced metastaticdisease breast cancer, kidney
cancer, lung cancer Patientsoftentimes can live years with
those diseases and livereasonable quality of life and
(05:57):
want to continue with the sameactivities they did before.
And so orthopedic oncology isgoing to continue to grow, not
just because of the numbers youhave more patients with more
disease living longer but alsothere's more to do because you
want to treat not only theimpending fracture per se or a
(06:18):
lesion that requires some sortof treatment.
But we're being a little bitmore aggressive, I would say,
about things that we used to wecouldn't really help, like
pelvic fixation for patientswith fractures, percutaneous
fixation, interesting sorts oftechniques to improve the
quality of a patient's life,doing more elective total joint
(06:38):
replacements on patients, evenin the face of metastatic cancer
, because again, they're goingto live a long time, many of
them, and with these therapiesit's really extended the amount
of function that these peoplehave and our ability to improve
that function.
So we're doing a lot moresurgery, I would say, on
patients with metastatic disease, and not so much just for
(06:59):
fractures but for other reasons.
The other thing that's going togrow is reasons.
The other thing that's going togrow is, you know, our
prostheses for primary tumorssarcomas have gotten pretty good
and have expanded beyond thetumor world.
But within the tumor world, theways to fix things, you know,
as opposed to cemented stems,some of this compressed
(07:21):
technology is very interesting,seems to have good results A lot
of 3D printed materials, a lotof cutting guides, custom
processes for pelvicreconstructions.
I think they really improve thesituation, more so than when we
gave up on them early, whenthey would fail earlier, get
infected.
We understand what else has tohappen plastic surgery, things
(07:43):
like that but you know my workextends sometimes into the bad
fractures or the horrible totaljoints.
You know the worst tumor youcan get right, the revisionoma,
where you have to use thesetumor prostheses to try to
salvage a limb that doesn't havecancer but it looks like it
(08:03):
does.
Sometimes it's just beendestroyed.
So those are probably the twofastest growing areas, I would
say.
Another area of interest isosteointegration, which I think
is going to see a little bit ofresurgence in this country,
especially for above-kneeamputees who are otherwise
healthy.
The sense of an osteointegratedstem with a prosthesis that's
going to continue, I think, toimprove and be associated with
(08:26):
better outcomes for patients.
So I'm hopeful in those threegeneral areas.
I think it's a good thing we'reeducating more people in
orthopedic oncology because Ithink they'll be needed going
forward.
Speaker 2 (08:39):
You know a couple of insights that I had on y'all.
You know I just hired anorthopedic oncologist here a
year and a half ago and you know, in terms of expense, I mean
you guys do some incrediblyexpensive surgery as compared to
you know some of the more breadand butter kind of things that
come through.
(08:59):
But you guys are kind of themarquee of completeness or
quality or sophistication of thedepartment.
It's like, well, we've got anorthopedic oncologist, therefore
we rock and all this otherstuff.
I mean you guys kind of bringthat.
I hate to blow your ego up alittle bit, but it seems like
you kind of bring y'all, bringthat to the table.
Speaker 3 (09:20):
Yeah, nobody's really accused me of being
sophisticated Doug.
Well, that would be true, Ithink.
You see what I'm saying.
Excuse me being sophisticatedDoug.
Well, that would be true, Ithink.
Speaker 2 (09:29):
You see what I'm saying.
Speaker 3 (09:30):
I do you know.
I think orthopedics has ninesubspecialties, right, we all
have our strengths and thethings that we bring to a
department.
I think the oncologist ingeneral feels reasonably
comfortable with a whole lot ofdifferent things and is capable
of doing a fair number of thingsbeyond oncology.
I think it's somewhat inorthopedics.
(09:51):
I don't want to say it'sdividing, but, you see, a move
towards the outpatient surgeonand the inpatient surgeon, the
trauma, the spine, the tumorperson.
They probably have more incommon with their colleagues in,
say, sports, shoulder, elbow,some of these other specialties
which are largely outpatient anddon't really require a hospital
(10:12):
at all.
But certainly forhospital-based systems or for
academic medical centers, anorthopedic oncologist is pretty
important, I would say.
You're right, though, when itcomes to cost of prostheses and
the expense associated with it.
If it truly was a high volumebusiness, we would be losing a
lot of money.
But I have seen some of thosecosts decrease over time as
(10:36):
things have become more modularand, like everything, there's
more competition in the market.
So I think it is balanced, butI think an orthopedic oncologist
does bring something to adepartment.
Obviously, I'm biased.
Speaker 2 (10:50):
Right.
One thing I've noticedspecifically in terms of trauma
surgery what we saw as traumasystems got better as people
started using more advancedtrauma resuscitative techniques
and patients started surviving.
And in addition to this, youlook at all the safety features
in cars now with airbags and allthe safety features that people
(11:13):
were surviving we would see nowconstellations of injuries that
people survive and we have todeal with where they used to be
attached to people who are inhyperboleic shock and died at
the scene or died in the traumabay.
Now they're surviving and we'rebeing presented with these
disastrous injuries.
We're like, wow, we've neverseen this.
Where were these injuries?
Well, they were people whopassed away before they got to
(11:36):
us.
Let me make the analogy, so,with the advance in the stuff
that y'all are doing and themedical oncologist and radiation
oncologist.
How is that changing thepresentation of the orthopedic
oncology patient to y'all as themusculoskeletal surgeons?
Speaker 3 (11:56):
I think we see it more as a chronic type of issue.
I don't want to say chronicdisease, but a lot of patients I
will follow for years withmetastatic disease, as opposed
to similar to trauma where itwas an acute intervention and
then never see them again.
I have a long-term relationshipwith most of these metastatic
patients Because rarely is it so.
(12:19):
I mean occasionally it's bad atthe time of presentation when
the patient first shows up.
I mean occasionally it's bad atthe time of presentation when
the patient first shows up.
But once things are sort ofmanaged in that acute phase,
over time it's just thingsbubble up.
I don't mean to indicate peoplelive forever, because they don't
, but they live a long time andthey live long enough to develop
(12:40):
other problems.
So it's become a broader fieldas opposed to this is problem A.
We're going to do this Now.
It's manage A and thenanticipate what's going to
follow and keep your eye out forother things.
Imaging is so much better thanused to be.
(13:04):
Pet scanning.
We know more detail about morepeople than we ever have.
How do you follow that?
How do you monitor it?
How do you intervene earlybefore there's another issue?
So I'd say it's a much closerrelationship with my patients I
ever had and a much longer termrelationship.
Speaker 2 (13:16):
What would you tell a young like one of your fellows?
What would you tell one of yourfellows if they said what do
you think my career is going tolook like relative to yours?
How would you tell them thatwould be the same and or
different?
Speaker 3 (13:28):
I think the patient interaction will be largely the
same.
I don't think that's going tochange, but get used to the
intensity of it, because you'restill breaking bad news on
occasion.
You have to tell patients andbe honest with them about what
you can do and what you can't dofor them.
That's not going to change.
(13:49):
All that stuff is good, butyou're going to have more tools
than I had to make things better.
For example, horrible S tabulardisease.
In my day we had one optionwhich was a Harrington
reconstruction cement pins.
Put it in hope it works.
If it worked great.
A lot of times it never worked.
(14:10):
It fell apart.
You ended up taking everythingout.
Now there's options.
Now there are actually thingsyou can do earlier to head it
off or, if it's gotten bad, tomake it better.
They'll have a lot more options.
They'll also have a lot ofnon-operative options.
You know we do a fair amount ofcryotherapy now, radiofrequency
, ablations, things that arepercutaneous therapies.
(14:32):
They have to get used to doingthat Image-guided surgery, which
I did not do.
They need to be good atNavigated surgery.
They need to be good atNavigated surgery.
They need to be good at, theyhave to get used to this idea of
3D printing and developingcutting models that they will
(14:54):
use in surgery.
It's going to be, I think, ahigher tech field than the one
I'm leaving.
I didn't learn all that stuff.
My hope is that my successorcertainly will.
Speaker 2 (15:02):
That's very interesting.
So the big metastatic diseasesthat y'all I imagine you see are
breast and prostate right.
Speaker 3 (15:09):
They're common, but they don't tend to fracture as
often as they used to.
Why is that the bad one now isactually kidney cancer.
Why is that?
I think they're caught early.
For breast and prostate theytend to be, at least on occasion
, sclerotic disease, so theytend not to fracture, but the
treatments are so numerous forboth those diseases.
(15:30):
There's been a lot of researchand money into breast cancer for
the last 30 years, so there's alot of options for women and
men that have breast cancer.
Prostate cancer the same.
The struggles we still have arekidney cancer.
That's a hard one to manageoperatively and a hard one to
get control of.
There's immunotherapy for it,but it tends not to work well in
(15:54):
bone.
So those are the challengesthat are repetitive over time
and the hardest things to get.
Stability in Thyroid cancer isstill around and that's a hard
one to manage because it tendsto progress in bone regardless
of what kind of treatmentpatients get.
Colon cancer, you know,increased so much in numbers
(16:15):
that we're seeing more coloncancer in bone now.
It's just so common.
But you know those are sorts.
It's changed a little bit andthen I'm not sure, but it seems
like myeloma is more common thanever.
Anyone in their 50s and 60swith lucid lesion it seems like
there's a lot of myeloma outthere and there's a lot of
(16:40):
effective treatments stem celltransplants, car T therapy but
they still get a fair number ofbone issues.
So the diseases are kind of thesame, but the ones that are
more challenging for us areactually the kidney cancer,
thyroid cancer, some of themyelomas.
Speaker 2 (16:53):
Do you feel that there's a general increase
overall or in what y'all, asmusculoskeletal oncologists, are
seeing, or is it staying thesame?
Speaker 3 (17:02):
I think, it's.
Speaker 2 (17:03):
I'm trying to figure out where the future is.
Speaker 3 (17:04):
It's staying the same , but I think kidney cancer may
be on the rise a little bit.
What I see, a little bit too,is my colleagues in town don't
really want to do any tumor work, and that's fine.
I don't blame them.
But very few people feelcomfortable even rotting
metastasis, which wasn't true, Iwould say, 20, 30 years ago.
(17:27):
I did not do nearly the amountof metastatic work then that I
do now.
I think we get a fair amounttransferred in.
I just think again there's thisa little bit of a divide between
inpatient, outpatientorthopedics and as I deal with a
lot of private groups that arelargely outpatient, that aren't
attached to a hospital, if theysee something that just doesn't
(17:49):
make sense it won't be easy forthem to care for, they'll send
it to the academic medicalcenter.
So I'm not complaining, that'sthe way it is and I think
that'll continue to happen goingforward.
They shouldn't.
You know.
If they don't feel comfortablethey shouldn't be caring for the
patient.
Feel free to ship it.
But I do see that transitional,but I'm sure you feel the same
(18:09):
thing and that's true, I think,for trauma, infection and tumor.
Speaker 2 (18:16):
Yeah, I've built my career basically on saying yes.
What was the question you?
know trying to keep sayingbecause doctors are like water,
right, they take the path ofleast resistance.
So if you're the one thataccepts everything and you don't
keep score of insured versusuninsured, versus whatever,
before long you're their go-tofor everything and they call you
(18:36):
for their family members whenthey get hurt.
So, as you know, I was on theboard with you when I had
prostate cancer.
I've been very open about it.
I had a lot of men along theorthopedic surgeons along the
way reach out to me and talk tome about it.
Where I was going was I wastreated at MD Anderson, because
that's where one of my bestfriends who's a urological
(18:58):
oncologist is, and I was stunnedat how well the system worked
and I compared it to thehospital system I was in at the
time.
I was like we should be doingwhat these folks are doing.
I felt as big as MD Andersonwas, and my wife and I kept
talking about it.
It seemed like they had builtthe building and the whole
system for me, which of course Iknew was not the case and I
kept talking about it.
(19:18):
It seemed like they had builtthe building and the whole
system for me, which of course Iknew was not the case, but I
was like this seems so muchfocused on me and what I need
that I was.
We're not doing this at mypractice and my hospital, where
we don't provide that level ofindividual care.
So where I'm going is do youfeel that as we progress as
(19:40):
cancer or as musculoskeletalcancer, going to become more and
more focused in these megacenters like yours MSK, md,
anderson, fill in the blank,mayo, whichever or is it going
to now diversify out into the aswe make more and more
musculoskeletal oncologists?
Is it going to go out more intothe community and where are we
(20:00):
going with this?
Speaker 3 (20:02):
I think it's actually going to get more centralized
over time.
As you pointed out, it's anexpensive undertaking for the
institution.
Sometimes there's imagingprofits or some other things
that come downstream, but as faras the surgeries go they're
expensive and costly compared todoing routine total joints,
(20:22):
primary joints.
It's a tough, tough business ifyou're doing those sorts of
volumes, so, but I sense, eventhough we're educating a fair
number of people, that thosepeople are congregating at the
major centers.
I don't see a lot of thismoving into the community.
I don't think communityorthopedic surgeons really A
feel comfortable or B want to dothis type of work, and so I
(20:45):
don't see that really occurring.
Again, I hate to keep using thetrauma analogy but I think big
poly trauma will always be atbig centers and it should be
right.
You're made for it.
You can manage those issues.
It's hard to do in a communityhospital.
What I have seen and what,frankly, I see works a bit, is
(21:08):
for maintenance therapy,radiation oncology, imaging
medical oncology for your dailytreatments.
That does seem to get exportedinto the community hospitals,
but they tend to be affiliatedwith the major centers and MD
Anderson does that a bit, Ibelieve, so that you may go for
your event, a surgery orsomething significant, you know,
(21:32):
some intervention, bone marrowtransplant, whatever, but for
your surveillance, may beexported to a less intense
environment.
I think that's probably thefuture right.
Speaker 2 (21:45):
Yeah, like I said, I went down there because that was
where my friend was.
I didn't know anything about it, but uh great play yeah, I
guess our good friend valeriewas down there all right however
, once again I mean, there's atremendous.
I remember when I was in atlantathere was a tremendous amount
of competition between ctca andemory, and then you know, all
(22:08):
the outside ones are alwaystelling you that there there's
so much competition for thecancer patient out there from
the systems.
How is that affecting the careof the cancer patient out there
from the systems?
How is that affecting the careof the cancer patient?
Is that making them better orworse?
Speaker 3 (22:23):
I think the number one challenge of patient with
cancer encounters and you maycorrect me is there's a lot of
confusion at the start.
Speaker 2 (22:31):
Oh yeah, no question.
Speaker 3 (22:33):
You.
You get this horrible sort ofnews and somebody is presenting
it to you who's trying to help,but everybody else is trying to
help too, and so you have a lotof input and there's no clear
path.
You know, and I think patientsstruggle with that, and I
understand that.
(22:53):
I think, though, everybodywants to have a cancer center,
everybody wants to care forpatients that have cancer A lot
of volume issues there, but Ithink, particularly in
musculoskeletal work, there'sonly a few places that have a
track record and really do itwell.
There are three locations inChicago.
(23:16):
You would probably go, I'm oneof them, there's two others.
There are three locations inChicago.
You would probably go, I'm oneof them, there's two others and
we all sort of know each otherand we know what you're doing,
and I know any city in thecountry.
I can pretty much tell youwhere you would go for our level
of musculoskeletal oncologycare or breast cancer, prostate
(23:37):
cancer, the more common diseaseswhere all the faith-based
hospitals and health networkshave cancer centers and will
keep those sort ofself-contained.
But I think, when you talkabout orthopedic oncology,
there's really only a fewrecognized places to be and
people that take care of theseproblems and my job is to sort
(23:59):
of clarify that they don't haveto be with me but they should
only be at these other coupleplaces if they're considering
this type of care and trying toprovide that clarity I think is
really important.
It's just so you know, sooverwhelming the inputs they're
getting and they have friendsand colleagues who are telling
them oh, you got to go here yougot to go, there you got to go
(24:20):
to the best place wherever, andwhat I have found is there's
probably no best place.
Every place has pluses andminuses.
Patients will never know thatand if it makes them feel better
to get opinions at some of thebig cancer centers in the
country, god bless them, but thetreatment will be the same
likely at any major centers yougo and you know the cancer group
(24:45):
has really tried to have thesecenters of cancer excellence.
It's like everything theranking systems and things.
But there are some criteria forthese cancer centers and you
probably want to find one that'sactually got the designation as
a cancer center.
So I you know it's.
It's confusing.
It's not perfect.
You were fortunate.
There's a lot of good placesyou can go, but having that kind
(25:09):
of, you need people whoactually manage those problems
on a regular basis.
Speaker 2 (25:14):
And when I started looking into it myself, I
realized that I think that a lotof those rankings you may
correct me, but those rankingswere based on things that really
were not important to me, andthe important thing to me was
that's where my friend was, so Itrusted him and that was the
end of that, you know, okay,terry?
So when we look at the futurein orthopedic oncology, just
(25:37):
moving forward, is this going tobe sunshiny and good?
Is it going to be cloudy?
Is it going to be rainy and bad?
When you talk about, I mean, weall see these horrible cancers
which devastated families, whichyou know destroyed the lives of
young children and I mean brokeeverybody's heart that was
anywhere around it.
(25:57):
And now some of these tumorsand some of these cancers are
now being cured and these kidsare going on and living with
cures or near cures andsignificant remissions where
they're able to get on withtheir lives.
Where do you see the future inorthopedic oncology in reference
(26:18):
to the overall spectrum?
Speaker 3 (26:21):
Well, I'm not one to certainly not in my lifetime
will there be a cure for cancer.
I don't think that's coming.
I think they're all differentdiseases and but there are
better treatments and we willmake continued headway, not so
much on the surgical side but onthe medical side.
And you know, there's a newdrug, it seems like, every week,
(26:42):
that they're finding iseffective against certain types
of cancer, and I think thatthey'll continue to hone that
down and get combinations ofdrugs that don't wipe people out
, you know that, allow them tolive their lives and have some
quality of life and at the sametime keep the tumor under
control.
And so my goal is to make againthis sort of a chronic disease,
(27:05):
Not like hypertension ordiabetes, but sort of like
hypertension or diabetes.
You check it, you monitor it.
When it gets a little out ofcontrol, you change your
medications a bit and just moveon from one drug to another.
You'll always be on some sortof treatment always, but you
know you'll have a high qualityof life and hopefully some
length, Cause I think that'swhat people really care.
(27:28):
They want, they want to live agood life.
They'd like a long life, butit's more important to have a
good life, I think, time withyour family and be able to work
and do the things you like doing.
If you can give them that gift,that's a wonderful thing.
Speaker 2 (27:45):
Absolutely.
Thank you All right.
Well, it's been my distinctpleasure to discuss the future
in orthopedic surgery as itrelates to musculoskeletal
oncology with our past AOApresident and pillar of the AOA,
Dr Terry Peabody.
Terry, thanks for being on thepodcast.
Speaker 3 (28:03):
Doug, thanks very much, great seeing you.
Best of luck.
Speaker 2 (28:06):
Yes, sir, y'all stay tuned for future episodes of
this podcast and this series onthe AOA future in Orthopedic
Surgery.
Thank you.
Welcome to the AOA Future in Orthopedic Surgery
podcast series.
This AOA podcast series willfocus on the future in
orthopedic surgery and theimpact on leaders in our
profession.
These podcasts will focus onthe vast spectrum of change that
will occur as the futurereveals itself.
We will consider changes asthey occur in the domains of
(00:43):
culture, employment, technology,scope of practice, compensation
and other areas.
My name is Doug Lundy, host forthis podcast series.
Joining us today is Dr TerryPeabody.
(01:05):
Dr Peabody is the Edwin WarnerRyerson Professor of Orthopedic
Surgery and Chair of theDepartment of Orthopedic Surgery
at Northwestern UniversityFeinberg School of Medicine.
He also provides care forpatients at Lurie Children's
Hospital and is a member of RHLurie Cancer Center.
He's a native of SouthernCalifornia.
He earned his Doctor ofMedicine degree and his
residency at the University ofCalifornia, irvine, and did his
fellowship on oncology at theUniversity of Chicago.
(01:26):
Dr Peabody is past president ofthe American Orthopedic
Association, former chair of theAOA Academic Leadership
Committee and vice president ofthe Orthopedic Residency
Committee of the ACGME.
He was a director of theAmerican Board of Orthopedic
Surgery.
He was a director of theAmerican Board of Orthopedic
Surgery and he has significantresearch and clinical expertise
(01:49):
on benign and malignant bone andsoft tissue tumors, including
limb salvage surgery andfunctional restoration for adult
and pediatric patients.
And also it's important to notethat Dr Peabody is an AOA
pillar of the orthopedicprofession.
So, terry, dr Peabody, welcometo the podcast, sir.
Speaker 3 (02:10):
Thank you, Doug.
Appreciate the invitation.
Hope you're doing okay.
Speaker 2 (02:19):
Yeah, man, it's good to see you.
All right, my friend.
So, as you know, we've beentalking about the future in
orthopedic surgery and you are avery well-known oncologist.
You and I served together justone year apart for 10 years on
the American Board of OrthopedicSurgery.
I've got to know you and yourlovely bride, jane, for quite a
while and you are certainly anexpert on this, but you're also
an expert on leadership, beingan AOA pillar and a former
(02:41):
president of the AOA.
So, dr Peabody, can you give usa pearl, some wisdom as you see
it in terms of leadership andhow it can affect us, especially
as we look forward into thefuture?
Speaker 3 (02:57):
Well, I think.
Thank you, Doug.
I think the number one thingwas we were all inspired by
people in our careers who welooked up to, who seemed to
always want to do the rightthing.
We're fairly selfless in howthey did things and really were
more interested in their legacyin many ways than what they were
(03:17):
actually accomplishing on a dayto day basis.
They wanted to bring peoplealong with them.
To bring people along with them.
They're not pulling up theladder, they're facilitating
them to get on the ladder andlooking back for the people
behind them, trying to bringthem forward.
And I appreciate that so muchfrom people like Mark Hoffer and
Mike Simon that that's the kindof leader I wanted to become
(03:40):
and hopefully I have.
I think the AOA is a big partof that.
I learned how to work withother people and like minded
people, you know, who wanted agreat residency, who wanted
great departments, who wanted tofacilitate the profession and
sort of fulfilling what it wasmeant to be, and so it's been an
honor to be part of the AOA.
(04:01):
It was an honor to lead themfor a year.
Part of the AOA.
It was an honor to lead themfor a year, but for me it was
all about the mentoring Ireceived when I was younger and
the sense that it was aboutsomething bigger than I was.
So that's the pearl.
That's the only pearl I have.
Honestly.
It was a tremendous experienceto be part of that and the board
as you said, it was a highlightof my professional career being
(04:22):
a member of the board.
So those two things it's been.
It's been a terrific, it's beenan honor.
Speaker 2 (04:29):
Thank you.
Yeah, and you, we had a goodtime together doing that.
It's a lot of work but it'sworthwhile.
Also, got to know you throughthe AOA as well.
All right, my friends.
So, as you know, we are talkingabout the future in orthopedic
surgery and going to you aboutyour chosen profession of
oncology.
You know, it seems like all thetime we're hearing about these
(04:55):
really devastating cancers whichare now being treated
extraordinarily successfullywith biologics and other things
that have really turned the tideon a lot of these illnesses.
Tell us if you could be so boldwhere do you think the future
is going in terms ofmusculoskeletal oncology?
Speaker 3 (05:14):
So, I think you know we think about diseases burdens.
Perhaps you know burden ofdisease if you will, but it's
not that kind of burden anymore.
The initial, when I startedsomeone with metastatic disease
had a dismal outcome within amatter of months to maybe a
couple of years, and so youwould treat people in that
(05:34):
manner.
But these targeted therapiesand it's really remarkable have
had a tremendous impact, affectnot only longevity but also
quality of life for thoseindividuals.
Even with advanced metastaticdisease breast cancer, kidney
cancer, lung cancer Patientsoftentimes can live years with
those diseases and livereasonable quality of life and
(05:57):
want to continue with the sameactivities they did before.
And so orthopedic oncology isgoing to continue to grow, not
just because of the numbers youhave more patients with more
disease living longer but alsothere's more to do because you
want to treat not only theimpending fracture per se or a
(06:18):
lesion that requires some sortof treatment.
But we're being a little bitmore aggressive, I would say,
about things that we used to wecouldn't really help, like
pelvic fixation for patientswith fractures, percutaneous
fixation, interesting sorts oftechniques to improve the
quality of a patient's life,doing more elective total joint
(06:38):
replacements on patients, evenin the face of metastatic cancer
, because again, they're goingto live a long time, many of
them, and with these therapiesit's really extended the amount
of function that these peoplehave and our ability to improve
that function.
So we're doing a lot moresurgery, I would say, on
patients with metastatic disease, and not so much just for
(06:59):
fractures but for other reasons.
The other thing that's going togrow is reasons.
The other thing that's going togrow is, you know, our
prostheses for primary tumorssarcomas have gotten pretty good
and have expanded beyond thetumor world.
But within the tumor world, theways to fix things, you know,
as opposed to cemented stems,some of this compressed
(07:21):
technology is very interesting,seems to have good results A lot
of 3D printed materials, a lotof cutting guides, custom
processes for pelvicreconstructions.
I think they really improve thesituation, more so than when we
gave up on them early, whenthey would fail earlier, get
infected.
We understand what else has tohappen plastic surgery, things
(07:43):
like that but you know my workextends sometimes into the bad
fractures or the horrible totaljoints.
You know the worst tumor youcan get right, the revisionoma,
where you have to use thesetumor prostheses to try to
salvage a limb that doesn't havecancer but it looks like it
(08:03):
does.
Sometimes it's just beendestroyed.
So those are probably the twofastest growing areas, I would
say.
Another area of interest isosteointegration, which I think
is going to see a little bit ofresurgence in this country,
especially for above-kneeamputees who are otherwise
healthy.
The sense of an osteointegratedstem with a prosthesis that's
going to continue, I think, toimprove and be associated with
(08:26):
better outcomes for patients.
So I'm hopeful in those threegeneral areas.
I think it's a good thing we'reeducating more people in
orthopedic oncology because Ithink they'll be needed going
forward.
Speaker 2 (08:39):
You know a couple of insights that I had on y'all.
You know I just hired anorthopedic oncologist here a
year and a half ago and you know, in terms of expense, I mean
you guys do some incrediblyexpensive surgery as compared to
you know some of the more breadand butter kind of things that
come through.
(08:59):
But you guys are kind of themarquee of completeness or
quality or sophistication of thedepartment.
It's like, well, we've got anorthopedic oncologist, therefore
we rock and all this otherstuff.
I mean you guys kind of bringthat.
I hate to blow your ego up alittle bit, but it seems like
you kind of bring y'all, bringthat to the table.
Speaker 3 (09:20):
Yeah, nobody's really accused me of being
sophisticated Doug.
Well, that would be true, Ithink.
You see what I'm saying.
Excuse me being sophisticatedDoug.
Well, that would be true, Ithink.
Speaker 2 (09:29):
You see what I'm saying.
Speaker 3 (09:30):
I do you know.
I think orthopedics has ninesubspecialties, right, we all
have our strengths and thethings that we bring to a
department.
I think the oncologist ingeneral feels reasonably
comfortable with a whole lot ofdifferent things and is capable
of doing a fair number of thingsbeyond oncology.
I think it's somewhat inorthopedics.
(09:51):
I don't want to say it'sdividing, but, you see, a move
towards the outpatient surgeonand the inpatient surgeon, the
trauma, the spine, the tumorperson.
They probably have more incommon with their colleagues in,
say, sports, shoulder, elbow,some of these other specialties
which are largely outpatient anddon't really require a hospital
(10:12):
at all.
But certainly forhospital-based systems or for
academic medical centers, anorthopedic oncologist is pretty
important, I would say.
You're right, though, when itcomes to cost of prostheses and
the expense associated with it.
If it truly was a high volumebusiness, we would be losing a
lot of money.
But I have seen some of thosecosts decrease over time as
(10:36):
things have become more modularand, like everything, there's
more competition in the market.
So I think it is balanced, butI think an orthopedic oncologist
does bring something to adepartment.
Obviously, I'm biased.
Speaker 2 (10:50):
Right.
One thing I've noticedspecifically in terms of trauma
surgery what we saw as traumasystems got better as people
started using more advancedtrauma resuscitative techniques
and patients started surviving.
And in addition to this, youlook at all the safety features
in cars now with airbags and allthe safety features that people
(11:13):
were surviving we would see nowconstellations of injuries that
people survive and we have todeal with where they used to be
attached to people who are inhyperboleic shock and died at
the scene or died in the traumabay.
Now they're surviving and we'rebeing presented with these
disastrous injuries.
We're like, wow, we've neverseen this.
Where were these injuries?
Well, they were people whopassed away before they got to
(11:36):
us.
Let me make the analogy, so,with the advance in the stuff
that y'all are doing and themedical oncologist and radiation
oncologist.
How is that changing thepresentation of the orthopedic
oncology patient to y'all as themusculoskeletal surgeons?
Speaker 3 (11:56):
I think we see it more as a chronic type of issue.
I don't want to say chronicdisease, but a lot of patients I
will follow for years withmetastatic disease, as opposed
to similar to trauma where itwas an acute intervention and
then never see them again.
I have a long-term relationshipwith most of these metastatic
patients Because rarely is it so.
(12:19):
I mean occasionally it's bad atthe time of presentation when
the patient first shows up.
I mean occasionally it's bad atthe time of presentation when
the patient first shows up.
But once things are sort ofmanaged in that acute phase,
over time it's just thingsbubble up.
I don't mean to indicate peoplelive forever, because they don't
, but they live a long time andthey live long enough to develop
(12:40):
other problems.
So it's become a broader fieldas opposed to this is problem A.
We're going to do this Now.
It's manage A and thenanticipate what's going to
follow and keep your eye out forother things.
Imaging is so much better thanused to be.
(13:04):
Pet scanning.
We know more detail about morepeople than we ever have.
How do you follow that?
How do you monitor it?
How do you intervene earlybefore there's another issue?
So I'd say it's a much closerrelationship with my patients I
ever had and a much longer termrelationship.
Speaker 2 (13:16):
What would you tell a young like one of your fellows?
What would you tell one of yourfellows if they said what do
you think my career is going tolook like relative to yours?
How would you tell them thatwould be the same and or
different?
Speaker 3 (13:28):
I think the patient interaction will be largely the
same.
I don't think that's going tochange, but get used to the
intensity of it, because you'restill breaking bad news on
occasion.
You have to tell patients andbe honest with them about what
you can do and what you can't dofor them.
That's not going to change.
(13:49):
All that stuff is good, butyou're going to have more tools
than I had to make things better.
For example, horrible S tabulardisease.
In my day we had one optionwhich was a Harrington
reconstruction cement pins.
Put it in hope it works.
If it worked great.
A lot of times it never worked.
(14:10):
It fell apart.
You ended up taking everythingout.
Now there's options.
Now there are actually thingsyou can do earlier to head it
off or, if it's gotten bad, tomake it better.
They'll have a lot more options.
They'll also have a lot ofnon-operative options.
You know we do a fair amount ofcryotherapy now, radiofrequency
, ablations, things that arepercutaneous therapies.
(14:32):
They have to get used to doingthat Image-guided surgery, which
I did not do.
They need to be good atNavigated surgery.
They need to be good atNavigated surgery.
They need to be good at, theyhave to get used to this idea of
3D printing and developingcutting models that they will
(14:54):
use in surgery.
It's going to be, I think, ahigher tech field than the one
I'm leaving.
I didn't learn all that stuff.
My hope is that my successorcertainly will.
Speaker 2 (15:02):
That's very interesting.
So the big metastatic diseasesthat y'all I imagine you see are
breast and prostate right.
Speaker 3 (15:09):
They're common, but they don't tend to fracture as
often as they used to.
Why is that the bad one now isactually kidney cancer.
Why is that?
I think they're caught early.
For breast and prostate theytend to be, at least on occasion
, sclerotic disease, so theytend not to fracture, but the
treatments are so numerous forboth those diseases.
(15:30):
There's been a lot of researchand money into breast cancer for
the last 30 years, so there's alot of options for women and
men that have breast cancer.
Prostate cancer the same.
The struggles we still have arekidney cancer.
That's a hard one to manageoperatively and a hard one to
get control of.
There's immunotherapy for it,but it tends not to work well in
(15:54):
bone.
So those are the challengesthat are repetitive over time
and the hardest things to get.
Stability in Thyroid cancer isstill around and that's a hard
one to manage because it tendsto progress in bone regardless
of what kind of treatmentpatients get.
Colon cancer, you know,increased so much in numbers
(16:15):
that we're seeing more coloncancer in bone now.
It's just so common.
But you know those are sorts.
It's changed a little bit andthen I'm not sure, but it seems
like myeloma is more common thanever.
Anyone in their 50s and 60swith lucid lesion it seems like
there's a lot of myeloma outthere and there's a lot of
(16:40):
effective treatments stem celltransplants, car T therapy but
they still get a fair number ofbone issues.
So the diseases are kind of thesame, but the ones that are
more challenging for us areactually the kidney cancer,
thyroid cancer, some of themyelomas.
Speaker 2 (16:53):
Do you feel that there's a general increase
overall or in what y'all, asmusculoskeletal oncologists, are
seeing, or is it staying thesame?
Speaker 3 (17:02):
I think, it's.
Speaker 2 (17:03):
I'm trying to figure out where the future is.
Speaker 3 (17:04):
It's staying the same , but I think kidney cancer may
be on the rise a little bit.
What I see, a little bit too,is my colleagues in town don't
really want to do any tumor work, and that's fine.
I don't blame them.
But very few people feelcomfortable even rotting
metastasis, which wasn't true, Iwould say, 20, 30 years ago.
(17:27):
I did not do nearly the amountof metastatic work then that I
do now.
I think we get a fair amounttransferred in.
I just think again there's thisa little bit of a divide between
inpatient, outpatientorthopedics and as I deal with a
lot of private groups that arelargely outpatient, that aren't
attached to a hospital, if theysee something that just doesn't
(17:49):
make sense it won't be easy forthem to care for, they'll send
it to the academic medicalcenter.
So I'm not complaining, that'sthe way it is and I think
that'll continue to happen goingforward.
They shouldn't.
You know.
If they don't feel comfortablethey shouldn't be caring for the
patient.
Feel free to ship it.
But I do see that transitional,but I'm sure you feel the same
(18:09):
thing and that's true, I think,for trauma, infection and tumor.
Speaker 2 (18:16):
Yeah, I've built my career basically on saying yes.
What was the question you?
know trying to keep sayingbecause doctors are like water,
right, they take the path ofleast resistance.
So if you're the one thataccepts everything and you don't
keep score of insured versusuninsured, versus whatever,
before long you're their go-tofor everything and they call you
(18:36):
for their family members whenthey get hurt.
So, as you know, I was on theboard with you when I had
prostate cancer.
I've been very open about it.
I had a lot of men along theorthopedic surgeons along the
way reach out to me and talk tome about it.
Where I was going was I wastreated at MD Anderson, because
that's where one of my bestfriends who's a urological
(18:58):
oncologist is, and I was stunnedat how well the system worked
and I compared it to thehospital system I was in at the
time.
I was like we should be doingwhat these folks are doing.
I felt as big as MD Andersonwas, and my wife and I kept
talking about it.
It seemed like they had builtthe building and the whole
system for me, which of course Iknew was not the case and I
kept talking about it.
(19:18):
It seemed like they had builtthe building and the whole
system for me, which of course Iknew was not the case, but I
was like this seems so muchfocused on me and what I need
that I was.
We're not doing this at mypractice and my hospital, where
we don't provide that level ofindividual care.
So where I'm going is do youfeel that as we progress as
(19:40):
cancer or as musculoskeletalcancer, going to become more and
more focused in these megacenters like yours MSK, md,
anderson, fill in the blank,mayo, whichever or is it going
to now diversify out into the aswe make more and more
musculoskeletal oncologists?
Is it going to go out more intothe community and where are we
(20:00):
going with this?
Speaker 3 (20:02):
I think it's actually going to get more centralized
over time.
As you pointed out, it's anexpensive undertaking for the
institution.
Sometimes there's imagingprofits or some other things
that come downstream, but as faras the surgeries go they're
expensive and costly compared todoing routine total joints,
(20:22):
primary joints.
It's a tough, tough business ifyou're doing those sorts of
volumes, so, but I sense, eventhough we're educating a fair
number of people, that thosepeople are congregating at the
major centers.
I don't see a lot of thismoving into the community.
I don't think communityorthopedic surgeons really A
feel comfortable or B want to dothis type of work, and so I
(20:45):
don't see that really occurring.
Again, I hate to keep using thetrauma analogy but I think big
poly trauma will always be atbig centers and it should be
right.
You're made for it.
You can manage those issues.
It's hard to do in a communityhospital.
What I have seen and what,frankly, I see works a bit, is
(21:08):
for maintenance therapy,radiation oncology, imaging
medical oncology for your dailytreatments.
That does seem to get exportedinto the community hospitals,
but they tend to be affiliatedwith the major centers and MD
Anderson does that a bit, Ibelieve, so that you may go for
your event, a surgery orsomething significant, you know,
(21:32):
some intervention, bone marrowtransplant, whatever, but for
your surveillance, may beexported to a less intense
environment.
I think that's probably thefuture right.
Speaker 2 (21:45):
Yeah, like I said, I went down there because that was
where my friend was.
I didn't know anything about it, but uh great play yeah, I
guess our good friend valeriewas down there all right however
, once again I mean, there's atremendous.
I remember when I was in atlantathere was a tremendous amount
of competition between ctca andemory, and then you know, all
(22:08):
the outside ones are alwaystelling you that there there's
so much competition for thecancer patient out there from
the systems.
How is that affecting the careof the cancer patient out there
from the systems?
How is that affecting the careof the cancer patient?
Is that making them better orworse?
Speaker 3 (22:23):
I think the number one challenge of patient with
cancer encounters and you maycorrect me is there's a lot of
confusion at the start.
Speaker 2 (22:31):
Oh yeah, no question.
Speaker 3 (22:33):
You.
You get this horrible sort ofnews and somebody is presenting
it to you who's trying to help,but everybody else is trying to
help too, and so you have a lotof input and there's no clear
path.
You know, and I think patientsstruggle with that, and I
understand that.
(22:53):
I think, though, everybodywants to have a cancer center,
everybody wants to care forpatients that have cancer A lot
of volume issues there, but Ithink, particularly in
musculoskeletal work, there'sonly a few places that have a
track record and really do itwell.
There are three locations inChicago.
(23:16):
You would probably go, I'm oneof them, there's two others.
There are three locations inChicago.
You would probably go, I'm oneof them, there's two others and
we all sort of know each otherand we know what you're doing,
and I know any city in thecountry.
I can pretty much tell youwhere you would go for our level
of musculoskeletal oncologycare or breast cancer, prostate
(23:37):
cancer, the more common diseaseswhere all the faith-based
hospitals and health networkshave cancer centers and will
keep those sort ofself-contained.
But I think, when you talkabout orthopedic oncology,
there's really only a fewrecognized places to be and
people that take care of theseproblems and my job is to sort
(23:59):
of clarify that they don't haveto be with me but they should
only be at these other coupleplaces if they're considering
this type of care and trying toprovide that clarity I think is
really important.
It's just so you know, sooverwhelming the inputs they're
getting and they have friendsand colleagues who are telling
them oh, you got to go here yougot to go, there you got to go
(24:20):
to the best place wherever, andwhat I have found is there's
probably no best place.
Every place has pluses andminuses.
Patients will never know thatand if it makes them feel better
to get opinions at some of thebig cancer centers in the
country, god bless them, but thetreatment will be the same
likely at any major centers yougo and you know the cancer group
(24:45):
has really tried to have thesecenters of cancer excellence.
It's like everything theranking systems and things.
But there are some criteria forthese cancer centers and you
probably want to find one that'sactually got the designation as
a cancer center.
So I you know it's.
It's confusing.
It's not perfect.
You were fortunate.
There's a lot of good placesyou can go, but having that kind
(25:09):
of, you need people whoactually manage those problems
on a regular basis.
Speaker 2 (25:14):
And when I started looking into it myself, I
realized that I think that a lotof those rankings you may
correct me, but those rankingswere based on things that really
were not important to me, andthe important thing to me was
that's where my friend was, so Itrusted him and that was the
end of that, you know, okay,terry?
So when we look at the futurein orthopedic oncology, just
(25:37):
moving forward, is this going tobe sunshiny and good?
Is it going to be cloudy?
Is it going to be rainy and bad?
When you talk about, I mean, weall see these horrible cancers
which devastated families, whichyou know destroyed the lives of
young children and I mean brokeeverybody's heart that was
anywhere around it.
(25:57):
And now some of these tumorsand some of these cancers are
now being cured and these kidsare going on and living with
cures or near cures andsignificant remissions where
they're able to get on withtheir lives.
Where do you see the future inorthopedic oncology in reference
(26:18):
to the overall spectrum?
Speaker 3 (26:21):
Well, I'm not one to certainly not in my lifetime
will there be a cure for cancer.
I don't think that's coming.
I think they're all differentdiseases and but there are
better treatments and we willmake continued headway, not so
much on the surgical side but onthe medical side.
And you know, there's a newdrug, it seems like, every week,
(26:42):
that they're finding iseffective against certain types
of cancer, and I think thatthey'll continue to hone that
down and get combinations ofdrugs that don't wipe people out
, you know that, allow them tolive their lives and have some
quality of life and at the sametime keep the tumor under
control.
And so my goal is to make againthis sort of a chronic disease,
(27:05):
Not like hypertension ordiabetes, but sort of like
hypertension or diabetes.
You check it, you monitor it.
When it gets a little out ofcontrol, you change your
medications a bit and just moveon from one drug to another.
You'll always be on some sortof treatment always, but you
know you'll have a high qualityof life and hopefully some
length, Cause I think that'swhat people really care.
(27:28):
They want, they want to live agood life.
They'd like a long life, butit's more important to have a
good life, I think, time withyour family and be able to work
and do the things you like doing.
If you can give them that gift,that's a wonderful thing.
Speaker 2 (27:45):
Absolutely.
Thank you All right.
Well, it's been my distinctpleasure to discuss the future
in orthopedic surgery as itrelates to musculoskeletal
oncology with our past AOApresident and pillar of the AOA,
Dr Terry Peabody.
Terry, thanks for being on thepodcast.
Speaker 3 (28:03):
Doug, thanks very much, great seeing you.
Best of luck.
Speaker 2 (28:06):
Yes, sir, y'all stay tuned for future episodes of
this podcast and this series onthe AOA future in Orthopedic
Surgery.
Thank you.
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