The Future of Oncology Education and AI I Interview with Alberto Costa

Usually, when I try to explain our mission, I prefer to tell the story on how we were born in the early 80s. I was working in Milan. I was lucky to be at the right place at the right time.

My mentor was Professor Veronese, who is the breast cancer surgeon who started conservative surgery. He was, at that time, very well known in my country, in Italy. We were called.

I was accompanying him to do a visit to a very important and wealthy man in Milan who was complaining for bone pain for years. His doctors were treating him for arthritis, and nobody thought that could have been metastatic prostate cancer. The man was nearly 90, so it should have come.

This is the beginning of the story. When everything was clear, we clarified the treatment, we did help him, and he said, I want to leave my wealth. I have no children, no heirs, so I’m very happy to leave my wealth to a project.

My problem was not the lack of research. My problem was the lack of education. The fact that my doctors, my nurses, didn’t think of the option of a prostate cancer.

We went to explore, and we realized, at the time, more than 10% of cancer patients were dying for late diagnosis and or wrong treatment. Not for the lack of research, but for the lack of education. This is it.

That’s our story. He left us the money, which is why we are independent. We have no sponsors, and we can every year develop a plan of courses, fellowship, certificate of advanced studies, and everything you can find on our website, which is to improve the knowledge and the skills of doctors and nurses, and other professionals, including psychologists, and including other specialties, to improve the performance with cancer patients.

I would like to ask you, it is a debate within oncological professionals that cancer is an epidemic versus curable disease. What is your opinion, personal opinion, as a specialist about this statement?

So that’s normal. The second is that the general statistics are influenced by those parts of the world who have, unfortunately, less prevention measure and less tools to treat the cancer. So, as always, the rich West has learned not to smoke, to eat better, to change the diet.

And at the same time, we are those who have the good hospitals, the good drugs and the good treatment. So, cancer is a reflection of the inequalities of the world and the big injustice where a good part of the poor smoke, as we were smoking. I started to smoke when I was in the army.

My father started to smoke because during the war, they didn’t have to eat. So, they were smoking. So, I think, at the same time, the development of research has made cancer more chronic.

We see now people with bone metastasis for 10 years, for example, which was unthinkable. When I was an active clinician, the diagnosis of metastasis was the end for the patient. Now, it’s the norm to have breast cancer patients, prostate cancer patients, even lung cancer.

A lung cancer patient with an ALK mutation can live. One is not a secret. The chair of our advisory board, Professor Pavlidis, says openly he has ALK-mutated lung cancer and is now five years and he is on treatment and he keeps working.

All these things were unthinkable for us until 10 years ago.

If you don’t have it, you don’t. I don’t know. Actually, this is one of the problems because so many patients say, but why?

I didn’t smoke, I didn’t drink, I did physical exercise and now I have, I don’t know, leukemia, for example, or as you say, pancreatic cancer. So, still, the serendipity and the random chance in life exists a lot.

If you don’t, you don’t have. What do you think about this?

And health is the same. That’s why it’s a general problem on the inequalities of the world. And particularly in Europe.

Don’t forget, we are very fond of the fact we are European School of Oncology. Nothing against the rest of the world, but we do not do any activities in Australia, in Africa, in China. We are focused on Europe.

This was the will of the donor, of our endowment giver. And that’s why also we have focused since the beginning, our activity on the inequalities between West and Eastern Europe. We have been the first investing a lot because…

Yeah.

And as a motto, it’s learning to care. Yeah. Therefore, how important is lifelong learning principles for oncologists, for doctors, for nurses, to learn all the time?

And this was the difference. I wanted to put the accent on learning rather than teaching, because all schools at the time were focusing on teaching. They are focusing, like the hospital, were focusing on doctor rather than the patient.

The school were focusing on the professor rather than the students. But for us, the most important part was the process of learning. Teaching, we can change.

We invite constantly. We check our teacher. And we have also a question on the quality of their English, the quality of their empathy in accepting the questions, the quality of their slides.

And constantly, we do not re-invite those who have the lowest score. So in some way, the learners decide who is the good teacher. Yeah.

And the learner says, I’ve learned this guy was right. And this one may be a great scientist, may be a great clinician, but he’s not capable to teach, to transfer. So the accent is on learning.

And the accent is on care instead of treat, because treating is a protocol, is a dose of a drug, is a procedure for surgery. But caring is different. Caring is remembering and being fully aware that the part of the body that you are treating belongs to a body.

And this body has a soul, and has a life, and has a family, and has a history. So learning to care is really our motto.

And this is care.

As you know, by definition, the cancer patient asks, why me? That’s the first and foremost question. And you can’t be a good oncologist if you don’t know how to handle the why me question.

You mentioned that ESO is mainly focused on Europe and European institutions. I would like to ask you if ESO has partnerships outside Europe, for example, with the International Psycho-Oncology Society, or World Health Organizations, or other NGOs outside Europe, if you have partnerships or collaborations on specific subjects.

We prepare a plan, we tell them what we would like to do, and we do. And this has been working very well for years. So by definition, we can’t do much.

And in the past, we were a bit, oh, we can do this, we can do that. We have done, for example, a special program. We supported the first breast cancer and colorectal cancer screening in Georgia, for example.

And we are very proud of that. And we have beautiful links with that country. Or we have done similar things.

We’ve done a specific plan in Kyrgyzstan, because they didn’t even have the knowledge to those, the receptors, the hormone receptors of breast cancer. So we started from scratch and fun. But more and more, we think that this is not our mission.

We are not the WHO. We are not, of course, with international societies, we have a link, but mostly with the European offices, for example, CEOP Pediatric. We do a masterclass every two years with them, but with CEOP E, CEOP Europe, because we can’t.

Now I would like to talk a little bit about, also about educations and the COVID period. Education, as I was a student and I do my education, I’m still doing it. It’s better when it’s face to face, like going to see, have this empathy with the professor and the professor with the students.

What about the period of COVID? How hard was it for ESO to move all the courses in online in terms of message that should be received?

So we had this weekly appointment called the E-Grand Round, every Thursday, every week on Thursday. And in some way, this was a kind of anticipation on what then happened with COVID. So we had the experience, we had the knowledge, we have the calendar and we had to expand that way for two years.

For the same reason now, we are reducing the activity online a lot and going back to the activity in presence because now many other people are now doing with the experience of COVID. They are doing online education. So it’s not a necessity for us anymore.

We go back to our core activity, which we try to offer. We offer a course for medical students who want to understand whether they could become oncologists. And then we have the master class and then we have the certificate of advanced studies and then the clinical training centers.

We give the fellowship to go practically in a cancer center, including the center.

In education or in oncology in general? Both of them. Which one do you want to take it first?

Everybody has to express himself or herself in his own language, be capable. And now, as you see, the artificial intelligence is making very fast and beautiful progress in this. I was shocked.

For the first time, I went to a meeting in Athens and with my cell phone, putting the camera, I was looking at the slides in Greek and reading them in Italian. Not even in English, in Italian, in my language. So, we are promoting this so much, and we dream of doing courses where everybody can follow the course in his own language.

And this story of the so-called bad English as official language, I hope it will finish, because it’s not true. It has always given an advantage to the mother tongue English speakers who look more intelligent, more competent, but they just knew the language better. It was a matter of language.

So, to me, artificial intelligence is very welcome for the communication in language. And in oncology, as you know, the experiments are very nice. The application to screening, for example, breast cancer screening.

The computer is probably more capable than a single radiologist to find a suspicious lump, a suspicious image. Or in dermatology, I remember the famous paper where five German dermatologists were put against the computer and seeing a number of images and saying, is this a melanoma or not? And the computer did better because the computer had 100,000 images stored in the memory and the human being cannot do it.

This is not replacing, of course, but these are welcome. Should be treated as a tool. Absolutely.

We are now approaching the final of our interview and I would like to ask you one last question. As, let’s say, one of the founders of ESO, now the CEO of ESO, how do you think is going to look ESO in the next decades? Let’s say in the next 10 years, with all this artificial intelligence, going back to face-to-face learning, inequalities in societies, conflicts, a lot of challenges for people, for doctors, for patients.

How do you think ESO will look like as an entity, as an institution?

And people know that when they come to ESO, they can say what they really think because there is no influence whatsoever. And the second, I’m happy observing the translation, the transformation, because the first students are now becoming our teachers. And I remember them as students.

And I see them, it’s like with the children, you say, what do you mean you are a professor of oncology in Skopje? Really? You were my student.

And I am. And the link with the institutes, the key institutes, you know, Europe has made a big effort with the Europe Beating Cancer Plan and Stella Chiriakidis as Commissioner. And we see the results.

I mentioned Skopje because I was in Skopje recently and they showed me that they have a network with the phone and they tell each other, I say, I have a patient with a sarcoma, what would you do? And they got the answer from Ljubljana, from Rome, from… So technology, well used, will help a lot.

Dr. Costa, thank you very much for having you. Thank you. It was a very, very nice interview and a very, very nice talk about, let’s say, life in general, life for caring for people with cancer.

Thank you. Thank you very much.

Previous editions of “Beyond The Cancer Diagnosis”

Edition 1: Beyond The Cancer Diagnosis: Psycho-Oncological Aspects Of Kate Middleton’s Diagnosis

Edition 2: Beyond The Cancer Diagnosis with Sonia Amin Thomas – Survivorship

Edition 3: Beyond The Cancer Diagnosis: Dialogue with Wendy Lam, Hosted By Adrian Pogacian

Edition 4: Beyond The Cancer Diagnosis: Dialogue with Camille Moses, Hosted By Adrian Pogacian

Edition 5: Beyond The Cancer Diagnosis: Dialogue with Tihana Gašpert, Hosted By Adrian Pogacian

Edition 6: Beyond The Cancer Diagnosis: Dialogue with Amanda Balakirsky, Hosted By Adrian Pogacian

Edition 7: Beyond The Cancer Diagnosis: Dialogue with William Breitbart, Hosted By Adrian Pogacian