OncoInfluencers: Dialogue with Rob Pieters, hosted by Shushan Hovsepyan

Join us for an exciting new episode of “OncoInfluencers”, hosted by Dr. Shushan Hovsepyan. In this episode, we have the honor of featuring Rob Pieters, who is the chief medical officer at the Princess Maxima Center for pediatric oncology and Professor of pediatric oncology at the University of Utrecht in the Netherlands, he’s the editor in chief of the European Journal of Cancer for Pediatric Oncology.

In this interview, Rob Pieters discusses his personal journey and his vision for the future of oncology, highlighting potential advancements in cancer treatment. He also shares his thoughts on leadership and the importance of maintaining a work-life balance, among other interesting topics.

Rob Pieters is the president-elect of the International Society of Paediatric Oncology (SIOP). He holds the position of Chief Medical Officer at the Princess Máxima Center for Pediatric Oncology and serves as a Professor of Pediatric Oncology at the University of Utrecht in The Netherlands. Pieters is a key figure in the establishment of the Princess Máxima Center for Pediatric Oncology, having initiated and co-founded the center.

His research primarily focuses on developing personalized therapies for childhood acute lymphoblastic leukemia (ALL). Pieters plays a significant role in numerous international childhood cancer study groups and serves on advisory boards of various global cancer institutes and organizations. In recognition of his contributions to pediatric cancer care, he was honored with a Royal knighthood as an Officer in the Order of Oranje Nassau in 2018. Pieters has authored over 600 book chapters and peer-reviewed journal articles, supervised more than 50 PhD students, and is a regular speaker at international conferences.

The host, Shushan Hovsepyan is a pediatric oncologist and adjunct assistant professor at the Yerevan State Medical University. Currently, she is the Editor-in-Chief of OncoDaily Medical Journal.

She completed her clinical at the National Institute of Cancer in Milan, Italy and at the St. Anna Children’s Research Hospital in Austria. Furthermore, she held a research fellowship position at the European Organisation for Research and Treatment of Cancer in Brussels, Belgium.

Dr. Hovsepyan also completed the Postgraduate Harvard Medical School’s Effective Writing for Healthcare program. She is a former co-chair of the SIOP Global Health Network Education and Training Working Group.

OncoInfluencers: Dialogue with Rob Pieters, hosted by Shushan Hovsepyan

00:00 Introduction
1:41 Personal journey in pediatric oncology
3:31 Definition of mentorship and their role in Prof. Pieters’s career
5:36 Stories about patients
9:35 The inspiration behind the establishment of Princess Maxima
15:11 Future of pediatric oncology
19:45 What is the leadership?
22:30 Motivation for running SIOP presidency
24:15 Work-life balance
26:23 Infulential books during Prof.Pieters career
29:06 About hobbies
29:51 Advice for young pediatric oncologists

The transcript of OncoInfluencers: Dialogue with Rob Pieters, hosted by Shushan Hovsepyan

Shushan Hovsepyan: Good morning everyone. I’m your host, Shushan Hovsepyan, a pediatric oncologist from Armenia. And today on OncoDaily, we have a very special guest joining us, a true luminary, expert in the field of pediatric oncology, Professor Rob Pieters. Welcome, Professor Pieters. It’s an absolute pleasure to welcome you here on Onco Daily.

Rob Pieters: My pleasure.

Shushan Hovsepyan: So I know that there is no need for introduction because everyone knows you, but still, Professor Pieters is the chief medical officer at the Princess Maxima Center for Pediatric Oncology and professor of pediatric oncology at the University of Utrecht in the Netherlands.

He is the editor in chief of the European Journal of Cancer for Pediatric Oncology. His research primarily focuses on personalized therapies for childhood acute lymphoblastic leukemia, and he holds a lot of leadership positions and advisory boards. He is a member of advisory boards of cancer-related institutes and organizations globally.

And finally, he’s the new president-elect of the International Society of Pediatric Oncology, for which I would like to congratulate you. And I know that you will make a wonderful leader, also on this platform.

So, all right, so then let’s start. So, let’s begin our conversation by exploring the origin of your journey in pediatric oncology. How did you decide to start working in pediatric oncology? And what initially sparked your interest in this field?

Rob Pieters: Yeah, this is a little strange to start, perhaps, but I started to study human movement science because I wanted to do research in the field of rehabilitation, physical therapy and those kinds of things. And after a year of doing that, I learned, in my idea very well, how to do research. But I didn’t learn too much about the field where I wanted to do my research in the future.

So I decided to start in addition to that, medicine. So, to have one study focused on more doing research and the other more on practical things so in the medical field. And during my study in medicine, I saw two children dying from cancer. And then I thought, oh, this is a much more important field of doing research to help children with cancer to develop better therapies. And so I thought, well, I’m going to direct on that.

So this is the way how I got involved in the pediatric oncology world. And so at the end, I finished both studies. So I had, I thought, a very good profile to do both research and care for children with cancer.

Shushan Hovsepyan: Oh, that’s very interesting. You started in a completely different field, and now you are in pediatric oncology. And it’s also truly inspiring how the patient experience can shape our careers. And I’m sure that during your training, you had a lot of mentors. And I would like to hear your opinion, how you would define mentorship. And could you also explain to us the role of mentors throughout your journey?

Rob Pieters: Yes. And that’s perhaps even difficult to answer because there are so many people that you learn something from. But what I think is, the person that I learned most of in my, let’s say, my career was in my first year when I studied human movement science. We had a teacher in the field of philosophy of science, and he inspired me a lot about how to do research, but mainly about our own limitations, that many things we think are true, that they all are based upon the concepts of how we think and how to do research, and that also these principles can change during history and will change in the future.

So we are quite limited in what we think we can do or how to make the world better. And so everything is very limited in what we as human beings can do. That was, I think, the most inspiring teacher I ever had.

And that changed my view on the world and changed my view of studying something, how limited we are.

Shushan Hovsepyan: Thank you for sharing that. And also being a young oncologist, I feel the importance of mentors day by day. Especially if you are working in a low resource setting, mentors are crucial, that can help you and guide you. People you have a lot of experience that can completely change your mindset.

And also throughout my short career in pediatric oncology I’ve encountered some patients, whose stories have left a lasting impact on me, and I’m sure that you have same. Could you discuss any memorable story that has had a profound impact on your career?

Rob Pieters: I’m relatively old already, so there are many many many patients that I still remember, and each patient has its own story. But, yeah, there are a few more memorable patients.

I don’t know how much time you have, but will try to give you a ew examples or one example perhaps.

It’s always difficult if you have to talk to a child that will die, because there are no curative treatments available anymore. And I remember one story that I talked first to the parents, this was a girl of six years old, with a certain tumor, and I talked first to the parents, of course  that we could not cure her anymore and that she was going to die, and nobody knew when.

But it would probably take a couple of months before she would die. And of course, the parents were extremely sad and crying and they asked me how shall I tell this to our daughter? And so I said, well, let me do it, because then it’s so difficult to find the words. Let me speak to your daughter, and then you can notice which words she will use. And you can start from there. So in the next talk, I talked with this patient, with this young girl, and with her parents together. And so I said to this girl, I don’t have any pills anymore that I can completely cure you.

And as some young children do, she simply straightforwardly said, am I going to die? And I said, yes, you are going to die, but not tomorrow. It’s not that after one night’s sleep you will die. It will take hundreds of nights, so that she realizes that it’s not tomorrow, but it’s far away.

And then she asked me, am I going to heaven? So I said, yes, of course you’re going to heaven. Why do you think you will not go to heaven? And she said, well, I want to go to heaven because my grandmother and grandfather are there. I said, okay, yeah, of course. So you go to your grandfather and grandmother, so of course you will go to heaven to meet them there. And then she turned to her parents and she said, I hope you will come soon also.

And this was funny and very sad at the same time. But this is how children think of that age. They think very practically. And for the parents, this was a way for their daughter to make the way free for them to talk with her about death and what is behind death or after death. I must say after death. And whatever religion you have or you don’t have, I’m not religious, but it helps parents to choose the words with their child to speak about death. And so this was a story that I will never forget. But there are so many stories like this. So many stories.

Shushan Hovsepyan: Yeah, I imagine. And that is the wonderful thing of working with children. And you never expect what they are going to say. And that is actually the most wonderful thing I find in pediatric oncology. And speaking of collaboration, you are currently serving as the chief medical officer of Princess Maxima. Could you share with us the inspiration behind the establishment and how it has revolutionized pediatric cancer care in the Netherlands?

Rob Pieters: Yeah, well, before the Princess Maxima Center came, we had seven childhood cancer centers in the Netherlands. And of course, every center was a good center. And I was chairing one of these seven centers. And on a certain day, my colleagues, my six colleagues and myself, we sat together to discuss how to divide the research money. We obtained research funds from a foundation, and we talked about how to divide this money. And of course, everybody wanted to have slightly more than one-seventh of this amount of money.

And so we asked ourselves the question, if your grandmother saves €1,000, would you be happy if we divide it by seven? Or should we give it to the best research of all?

My grandmother would be happy if we would give it to the best research. But who’s the best researcher among us? Who is the best researcher? And six of them, by definition, cannot be the best because there can only be one best. But how can we solve this? Because then one will get the money and the other six will not get anything. And so if the best research does not work in your own center, how do you deal with it? And why are you doing this?

And the second even more important question was if your own child got cancer, to whom would you go in the Netherlands? Would you go to your own center with a child with a brain tumor, or with a child with leukemia, or a child with a sarcoma or a lymphoma? Who’s the best? Who has the best team of us for each type of cancer?

You cannot be the best in all these things. And would you go with your own child to a second-best center, or would you go to the best center? Well, I would know what I would do, and everybody knows what you would do. So how to solve this? And if you would go with your own child to another center, why are you doing this? Probably for your own ego, and probably for your own institution, but not for this chid.

So we said if we work together, we would all merge everything into one new National Childhood Cancer. And then my grandmother will be happy. The money will go to our best researcher instead of just defining it a little by everybody. And every child will get the best team that we have, the best team available, not only your own child but every child.

And this was basically the principle of the Princess Maxima Center. We decided to merge everything to start not only the professional, but also with the parents’ organization, was very much in favor of this initiative. So this initiative was taken by and parents’ organization and the Dutch Childhood Oncology Group, and they together started the Maxima and they are still the owner of Princess Maxima Center, and by this we created the largest Childhood Cancer Center in Europe, which was never the goal itself, but it was the side effect of the merge of all research all care we have.

So now we have a very large Childhood Cancer Center. So we work with about 600 researchers, about 900 people in the care and about 150 to 200 people in the supportive departments, the HR and those kinds of things.

So we now exist for more than five years, almost six years actually already. And we don’t only want to make the difference for Dutch children with cancer, because they’re luckily only 600 children with cancer in the Netherlands. But there are 25000 children with cancer in Europe, and 3 to 400.000 children with cancer worldwide.

So we hope we can use our expertise also to help other centers in the world. Mainly East and South Europe, but also in some countries in Africa and Indonesia to help these countries building up better childhood cancer centers so that we can really well, we have a mission, like many other institutions, have a mission to cure every child with cancer. But then you can not limit yourself to the Netherlands. That would be quite stupid.

Shushan Hovsepyan: No, that’s, truly inspirational. And also, the model of Princess Maxima was something that our center, Pediatric Cancer Blood disorders, center in Armenia took inspiration from. And, we implemented the same approach. We unified all the centers in one and, in 2019. And I think especially if the country is small, it’s very important to have only one center centralized. And also, I participated in the master course of, uh, Princess Maxima. And, when you enter the center, you feel that science is going there and, it’s, of course, one of the largest centers in Europe. And it’s something that you would like to have, also in your center.

And, now going back to pediatric oncology research, how do you envision the future of pediatric oncology, particularly in terms of advancements in research and treatment? I know that this is a very broad question, but I just wanted to hear your opinion. What, you think that has an immense promise now?

Rob Pieters: Well, the classic three options for therapy, surgery, radiotherapy and chemotherapy. We know them for 50, 60 years. They are used in pediatric oncology. But of course, the new immunotherapeutic approaches are extremely promising and very important to incorporate these into our therapies and also in our first line therapy.

So there’s a lot to do. There is a lot to win there. It took us 50, 60 years to come to the current standards of chemotherapy and radiotherapy and surgery. And even after 50, 60 years, we are still improving these three modalities of treatment. But to incorporate this fourth, modality of treatment, immunotherapy, therapeutic approaches, that’s extremely important. And that’s not done in 5 or 10 years. That will take much more time than that.

So the antibodies, the bispecific antibodies, the antibody drug conjugates, the cellular therapies, the Car-T cells, especially. But they may also be other cellular therapies that are coming up. So that is an incredibly important development. And that’s probably the most important development from the last 5 to 10 years. And I’ve never seen such a change in the concept of treatment during my life.

On the other hand, still also working on precision medicine and precision medicine. I mean, not only targeted therapies for specific genetic abnormalities, which is an important thing, but also, based upon the molecular genetic abnormalities and the response to therapy. So the response to the first courses of chemotherapy we adapt the intensity of treatment. And there’s a lot of development also there in the different fields of cancer.

So, like the mission of the Princess Maxima Center is also the mission of SIOP, it’s the mission of everybody, increasing the cure rate and increasing the quality of survival, so decreasing the side effects. And those are two things that should go well together. And if we think of that already in the 70s, we could cure about one third of children with cancer, with relatively mild therapies. And we increased therapies for everybody.

So it’s important to decrease the therapy for those for whom it can be reduced while maintaining the highest survival. And at the same time, look very carefully to how to improve the therapy and cure more children, for those who cannot be cured at the moment with more, let’s say, specific therapies and both things can go very well together, that’s the major challenge and worldwide, of course.

There’s a much more important challenge to make these therapies available for everybody, because most of our children have no access to these treatments. And that’s where I see a lot of opportunities. So sometimes people think you cannot do, let’s say highbrowse research and also take care of, working together with countries or sites outside our privileged countries, to help children there. But you can do both. We should do both.

So that’s also very important with training programs and international collaborations to make their therapies available for everybody and not only children, in countries that can afford everything.

Shushan Hovsepyan: Yeah. That’s very true. And, I see every day in our daily practice that the accessibility of drugs, especially for the new drugs, is a huge challenge for developing countries. And hopefully, in future we will have some solutions for that.

And, for the next question, you hold a lot of leadership positions, and, I would like to know, what is leadership for you and, what qualities make an effective leader especially in the field of pediatric oncology and also what strategies you use for effectively managing and motivating a team, especially for Princess Maxima. I know that it’s a huge team. And, yeah. What are your strategies?

Rob Pieters: Well, I don’t have that many strategies, to be honest. I follow my intuition. And, sometimes I say to people, forget all these management courses and leadership courses. It’s, it’s nice to look at, but follow your intuition and probably then you do the good thing and always as well try also as a leader to be a leader with the goal, with the simple goal of curing more children.

So the golden rule is always, what would you do for your own child? Would you do, for instance, if you open a phase one two study in children with cancer, which you expose your own child to such a treatment, if the answer is yes, then you’re doing the good study, If the answer is no, you don’t do the good study. So leadership is I think the most important is to be an inspiration for other people. And always to keep close to your mission and not let yourself distracted by other things that may be that may seem very attractive. So always keep course. Follow your mission, follow your heart, and don’t make things complicated.

The world is not complicated. The world is extremely easy. But people may make it complicated. And I think part of good leadership is also in walking around not by having many meetings, but walk around, in your center where you work and also at international meetings, but walk around in your center and just, talks in the corridors. Those are more helpful than any type of scheduled meeting. So just walk around and have your ears open and stay close to yourself and. Yeah. And smile. That helps. That helps. Be optimistic. Be optimistic.

Shushan Hovsepyan: Thank you for sharing that. it’s actually a strategy and it can be used for, for every leader. And continuing on that, what motivated you to run for the presidency of the SIOP? What specific goals do you want to achieve during your presidency?

Rob Pieters: Yeah, well, it’s part of the phase of life where I’m in that I spend a lot of time with others, of course, to establish the Princess Maxima Center. I spend a lot of my working life into research and care for patients, a lot of research in the field of leukemia. And I realized that with all these things, if you do research, if you do care, you should also organize things better. That’s very important.

And therefore I probably run into different positions in all kinds of groups and advisory boards for, in the field of childhood cancer for the presidency of SIOP, well, several people approached me, and this sounds arrogant, but I don’t mean it arrogant or Rob, you should do this. And this is something that fits with you in your phase of life and with your experience. So I thought, yeah, why not?

And it fits also in what I said in the beginning of this interview that, perhaps I can use what, you know, my experience in bringing people together not only in the Netherlands but also internationally, that is, and thereby at the end, making the future for children with cancer better than it’s now, and not only in the Netherlands but worldwide.

Shushan Hovsepyan: Yeah, I know that you will succeed in that. And I’m really happy that you are going to work also on that field and continuing again on that, so you have a lot of leadership positions, clinical research and how you maintain the work life balance?

Rob Pieters: It’s, you know, childhood cancer is part of my life. It became part of my life. And many journalists or many journalists very directly journalists ask me, how can you separate these? I can’t, I can’t, and this does not sound like that I’m holy or that I’m the Pope or whatever. 

But it would be strange if you can completely separate these things. Which doesn’t mean that I don’t like to do other things than being busy with the children with cancer. But, it is such an impressive field where we work in. It’s so demanding, seeing children with cancer and seeing children dying and trying to improve this, that I cannot separate it. There’s not a day in my life that I’m not involved in something with children, with cancer, also nowadays.

But it doesn’t matter, because I can combine it. But you need to invest a lot of energy in it. But, you know, I think that work is an essential part of our life. If nobody would work, nothing would improve. And it makes me also feel good that when I will die in the future, you never know when. But, that’s how it will take a long time. But I have the feeling that I did something useful in my life. I hope, I hope I did. It’s for others to judge on that. But that’s also why I cannot separate these things.

Shushan Hovsepyan: Yeah. That’s so nice to hear. And, could you recommend any books or resources that have been particularly influential for you during your career?

Rob Pieters: Well, there is one book that I always recommend to people. Unfortunately, it’s only written in Dutch, but it’s in English, the translation of the title is The Unconscious Brain. And we think we are very rational people. We think we are very organized, and if we have to make a decision, you think, ah, these are the positive things, these are the negative things.

But this book, The Unconscious Brain, shows us a very painful conclusion, which is and this is all the scientific research that is done in the field of the unconscious mind shows that we take all important decisions from our unconscious mind. It goes so quickly that after that, after we’ve taken the decision, we try to find the arguments that fit with the conclusion.

If you buy a house, for instance, and if it’s very old and actually it’s a ruin, you say, oh, this is a very romantic house, it has character. And then you’re going to find the arguments that fit because you like the house. So all and all these important decisions you make are not rational. And this book influenced me. I think it did it. It shows how limited we are. I already said this also in the beginning of the interview. We are not that smart. Absolutely not, absolutely not.

And another book that is more or less in the same direction is that major inventions of human beings are not, are almost always, invented at the same time at different places, which in the world which means that the, the major inventions are not because people are so smart, but because the time is right, the time is there that some things have to be discovered, not because a people thought of it, but because the time is right, that the mind is ready for it. So that’s also to make us more modest about how we think we can shape the world.

Shushan Hovsepyan: Yeah, I will definitely check those two books out. And, about, beyond your professional pursuits, what do you enjoy doing for fun?

Rob Pieters: We live on a lake, so we go, sailing or by motorboat on the lake. And what I like most is playing padel, which is a very famous sport in Argentina and in Spain and which is extremely growing in the Netherlands at the moment. And I like to play. I used to play tennis and I used to play soccer but playing padel also is very nice. Yeah. So I like to do that. I do it as often as I can. Yeah.

Shushan Hovsepyan: That’s interesting. And, before we wrap up, what advice would you give to young pediatric oncologists?

Rob Pieters: Well, how should I say this? Never let somebody stop you. So just follow what you think is good. And of course, you should have a good vision or mission. I must say good mission. And follow your mission. And don’t let anybody stop you from that. That’s important, for whatever.

Shushan Hovsepyan: Yeah, that’s wonderful advice. Because, well I had some experiences during my fellowship, that I wanted to do something. And, a lot of people were forcing me not to do that. But at the end when I did that, I succeeded. And, that is something that reminds you that, even if people think that, you cannot do that, but you should be confident, you should be self-confident so that you can succeed in life.

Rob Pieters: Yeah. And let nobody say that self-confidence is the same as being arrogant.

Shushan Hovsepyan: Yeah. Correct. Yeah, that’s very correct.

Rob Pieters: Those are two different things.

Shushan Hovsepyan: Yeah Excellent. So, Professor Pieters, thank you very much for your time. And thank you for accepting our invitation. It was an absolute pleasure for me. And I hope to see you, during pediatric meetings, in future.

Rob Pieters: Okay. Well, I hope to see you. Also you’re young enough to attend a lot of meetings, so I hope I can do it also. Yeah. Okay. Thank you. My pleasure.

Shushan Hovsepyan: Thank you.

Previous episodes of OncoInfluencers

Episode 1: OncoInfluencers: Dialogue with Françoise Meunier

Episode 2: OncoInfluencers: Dialogue with Dean Crowe

Episode 3: OncoInfluencers: Dialogue with Nagashree Seetharamu

Episode 4: OncoInfluencers: Dialogue with Julie Gralow

Episode 5: OncoInfluencers: Dialogue with Lillian L. Siu

Episode 6: OncoInfluencers: Dialogue with Douglas Flora

Episode 7: OncoInfluencers: Dialogue with Pasi Jänne

Episode 8: OncoInfluencers: Dialogue with Tony Mok

Episode 9: OncoInfluencers: Dialogue with Fadlo R. Khuri