From India to the Forefront of American Medicine: Anju Nohria's Journey as a Cardio-Oncology Pioneer

Welcome to India Today News. Our guest today is Dr. Anju Nahoria. She is widely regarded as a top tier international leader and pioneer in the field of cardio-oncology. On November 14th, she will be honored as a healthcare trailblazer at New England Choice Awards Gala at Burlington Marriott Hotel in Burlington. Today we are going to talk to her about her journey and especially this new emerging field of cardio-oncology. Anju, welcome to our show, and we are really looking forward to honoring you on November 14th. Thank you so much, Upendra. I'm so grateful to be here. You are one of the very few specialists around the world about this new field of cardio-oncology. So let us start there. What is cardio-oncology, for those of us who are not familiar with that? So cardio-oncology is a relatively new field that has emerged in the last 10 to 15 years. It really focuses on the intersection of Cardiology and cancer. So a lot of cancer therapies can lead to cardiovascular complications that can either limit cancer treatment or limit the patient's quality of life or even their survival after they have completed cancer treatment. In fact, heart disease is the single largest cause of non-cancer related death in cancer survivors. So really the goal of this field is to one, identify people who are at risk for developing cardiovascular complications from cancer therapy, to try and prevent these complications to the best of our ability so that they can complete their cancer therapy without interruption. And lastly, for those people who do develop complications that cannot be prevented, to try and optimize their cardiovascular health so that in the survivorship phase, once they have completed cancer treatment, they can live long and healthy lives. This field has emerged in the last 15 years or so. So how many specialists are in this area around the world? So I would say that currently we are really limited to major cancer centers and major academic centers, but slowly the word is spreading and it is becoming something that more and more people know about. Unfortunately, in smaller places and in community practices, this is still not a subspecialty that is available. So it's really an exciting moment to be part of this field because you can make a significant impact both in terms of education, both in terms of helping people to establish new programs in their centers, and really to create an awareness amongst both oncologists and cardiologists about this intersection between the two diseases. What about this field in countries like India or even in Europe? Is it widely known there or not yet? So Europe, yes, it's quite widely known. In fact, the European Society of Cardiology has a chapter on cardio-oncology, as does the European Society of Medical Oncology. In India, there are new burgeoning areas of cardio-oncology. So there is a center, obviously, Tata Cancer Institute in Mumbai has a big cardio-oncology presence. They also have places in South India that are doing this. And in Calcutta, they recently had a big conference on cardio-oncology where they invited a lot of speakers from the US, etc. Southeast Asia, there's also beginning to be a presence. In fact, the next Global Cardio-Oncology Society meeting is going to be in Japan. So that is an effort to bring Asian countries into the fold and to educate Asian oncologists and cardiologists about cardio-oncology. So we're working hard to try and spread the word, and it's definitely growing worldwide. How did you get interested in this field? So, like many things it was serendipity. I was a heart failure and transplant doctor by training and I worked at the Brigham. When trastuzumab or Herceptin came out, this was a drug that was used to treat a high-risk breast cancer, they found that about 10 to 15 percent of the women who were getting this drug developed weakening of the heart muscle or cardiomyopathy. And I was asked by one of the physicians at Dana-Farber if I would be interested in seeing these patients because it intersected well with my cardiovascular specialty. So I started out by seeing these patients and then slowly as cancer therapies progressed, more and more of them were attacking pathways that were common to the heart and cancer. And so the evidence of cardiotoxicity started to grow from these targeted therapies. And I sort of grew with the field, to be perfectly honest, because as one of the first cardio-oncology programs in the nation, the other ones being MSK or Memorial Sloan Kettering and MD Anderson, you know, we were one of the big three that had this cardio-oncology program, we kind of grew with the field. Is there any symptom for this type of issue or no? It had to be really checked and treated? Yeah, I think the symptom is the same that you would feel if you had those problems from any other cause. You just have to be aware that these cancer therapies can cause this problem. And if you're aware of that, then you can do appropriate surveillance. And when you see the person, you can appropriately manage and treat them. What makes it a special field is that you do have to be a little bit facile in cancer treatment in addition to being a cardiologist, because you have to know what cancer drugs are being used for what disease, what their potential side effects are from a cardiovascular standpoint. And then you have to educate your oncologist as well about who they should think about referring, you know, to you if the patient develops a particular problem. How did you get interested in the first place in medicine? So, you know, like all people in India, first of all, I was good in biology. So that was that helped. And second of all, I think when I looked around and I said, you know, where can I do something that would actually make a difference in people's lives? Medicine seemed to be an obvious place. My mother had always wanted to be a doctor, but got married at a very young age. So she obviously encouraged me my whole life to, you know, become a doctor and flourish in that field and allowed me to come to America on my own when I was 16. So, you know, she really was a big person who pushed me to fulfill my dreams of becoming a physician. Coming to America at 16, for what study did you come and what happened? So I won a scholarship to a school called the United World College. At that time, there were six of these schools. They were international schools that were started by Kurt Hahn and Mountbatten after World War II as a way of promoting world peace and understanding amongst young people. And India sent a few kids every year and I happened to get into one of them in the US. And it was a scholarship, and then I came here, and then one thing led to another. I ended up getting into college, so I ended up going to college here, and then med school and so on. And then, unfortunately, I never went back to India to live, even though my parents continued to live there till today. You come here at the age of 16, you know, leaving everything in India. This is the first time you might have left your home there too, right? Yeah. So now, when you come here, so where did you go for college and the medical school here? So I went to Harvard University for college and I went to Harvard Medical School, specifically the health science and technology program, which is a combined program between Harvard and MIT. And I think that program was instrumental for me because they really encouraged you to work in a lab at the same time that you did your clinical medicine. And it really gave me that foundation for understanding the importance of research in your clinical career. So, now I have to ask you this question, since you mentioned your mother. So, when you told her that, look, you are going to go to medical college here in America, what was her reaction? Did you tell her on phone or you met her personally? No, she was excited. She was thrilled, you know, that I could get into med school here. And at that time, it was hard to get into med school, primarily because if you were a foreigner, you weren't eligible for any grants. and Health Science and Technology Program. actually paid for your tuition. It was the only program in America where if you got in, they paid for your tuition. So if I hadn't gotten to that program, I probably wouldn't have gone to medical school in this country. So I really was very lucky. Hello. So now, did you tell this story? I want to feel how she reacted. Did you meet her in person? Or did you tell her on the phone? No, probably on the phone. You know, in those days, you called your parents once a month on the phone, right? So I probably told her on the phone and she was excited for me. My mother never said, why aren't you back in India? I miss you, you know, etc. She was one of these mothers who just wanted you to. Do what was best for you and never gave any guilt or any other kind of feeling. You know, she just wanted you to achieve what you could. So now let us come back to medicine part. Of course, the science and medical institutions and all, they have made tremendous progress as far as the health of human beings are concerned. Too many advancements have been made. Now, of course, the AI has been added. So if I ask you to look into your crystal ball and just give some sort of an overview that where the healthcare and the human body is really heading. In the future, in the next 5-10 years. It's a tough question, but let's see what you say. So I think things are moving more and more towards personalized medicine, right? So I think the future doctor is going to have the tools to integrate. Clinical presentation, your physical imaging, biomarkers, your genetics, your laboratory values, all of these things are going to be integrated to come up with sort of a personalized medical plan for you going forward. And I think. We're not all going to be treated as like, you know, you have high cholesterol, so you all deserve cholesterol medication. Like it's going to be individualized to what kind of cholesterol problem you have. What is your genetic propensity? What is the degree of blockages you already have? You know, what is your lifestyle? So I think it's going to move to more and more of a personalized approach. And that AI is going to help with that because it's going to be important for the integration of that. I think for the future doctor. The important thing is going to be one how quickly you adopt all these technologies. I think the people who are able to adopt them and adapt them into their practice are going to be more successful and I think increasingly the doctor who is really good at the bedside, meaning the person who is emotionally available for the patient and And empathic. will become the important and good doctor because AI will soon take over a lot of the diagnostics and everything else. And ultimately, it's how you interact with the patient and how you communicate to them and get them through their journey that will become the distinguishing feature of who is a good doctor in the future. Now, talking about good doctor, I also must ask you that if you can talk also about your relationship and working with your patients. Do you remember any interesting story? I mean, I think in a way that's what drives me, honestly, to do what I do every day. I started out as a heart failure and transplant doctor, and that is still half my job. And then I do I do cardio oncology. As you can imagine, these are a patient population that is extremely vulnerable, right? They have bad diagnoses that often lead to premature death. I have been very fortunate in following these patients through their entire journey and really building some very deep relationships with my patients, many of them. end up successful, you know, in the heart failure world, many end up with a transplant or they end up with an artificial heart pump. And that gives them an extension of their life, the ability to complete important landmarks, you know, for their children, their families. But there are others who don't make it, you know, and part of our job is to allow them a dignified death, and in many cases, even help them. manage their personal affairs at the end of life. You know, many people, you'll be surprised, have been ill their whole life, but have never thought about a will, have never thought about guardianship for their children, have never thought about, you know, their finances and making their spouse aware. So part of our job as you build these relationships is not just Taking care of their medical problem, but also helping them navigate the end of life in a humane and dignified way. And I feel very privileged, actually, to be, you know, so included in people's lives and their personal affairs to be able to get close enough to them to manage them holistically in a way. So what are some of the questions, like when you go to these, you know, say terminal patients and all, what are some of the questions they ask you and how do you respond to them? This must be a very tough time as well as the tough questions. I mean, people ask you, you know, how long will I live? That's the most probably most common question. When am I going to die? You know, what will it be like when I get sicker? You know, do you think I'll make it? Do you think I'll get a heart? You know, that kind of thing. Like people are obviously very, very unsettled, right? Because it's very unpredictable what will happen to them. I think our job is to be sort of realistically optimistic, right? So you give them hope, but at the same time, make them aware of all the things that could go wrong so that they're, you know, hopeful for the best, but prepared for the worst, right? Right. In some sense. That's the best way to handle these situations. I think different doctors have different perspectives. You know, some people don't like to give bad news because they feel that that would remove any hope from the patient, remove their will to live. I'm a strong believer that providing people with information is very important because if they know that and then they know what you can do, it gives them a better grounding on which to move forward. And it also allows their families to plan accordingly. Now, living in that environment, has ever this thought crossed your mind, you know, that, oh, what is life and what is going to happen to me and what is the purpose of life? Just being a little bit philosophical. I'm very much a person who likes to live in the present, you know, because I've seen so much, so many people like not do well as part of my career. So I always tell people the Rumi quote, you know, life is a gift. Every day is a gift. That's why it's called the present. So I think that you make the most of what you have, you plan for the future, but you never know what life brings you. So you have to be prepared for anything that happens, right? You can only control so much. So I'm a strong believer in living in the moment. So now, I mean, it's a very interesting topic and we can go on and on on this philosophical side. And I'm glad you mentioned Rumi because I'm a big fan of Rumi and what an understanding of life and he has and happiness and everything else. So now one question I want to ask you is when you are not in the hospital, when you are not working with the patients, how you entertain yourself, how you live in the present? I'm a big fan of movies and music and theater, so I love to do that, especially now that I'm in New York, I'm taking full advantage of the city with regards to that. In Boston, as you know, the Indian community is huge, and I'm very social, so I used to spend a lot of time with my friends, you know, entertaining myself in that way. So, you know, it's normal things that everybody does. Now, two things come to my mind. Number one is, if you can just talk briefly about your stay in Boston, like how many years you lived here and how your journey progressed, work-wise, which hospital did you work? And I do want to come back to the movies and Bollywood later on. Okay, so I came to Boston in 1986 to go to college. I was there through Harvard undergrad, I went to Harvard Medical School, I subsequently went to Yale New Haven in Connecticut for my residency and chief residency, and then I came back to do my fellowship in cardiology and my subspecialty training in heart failure and transplant at Brigham and Women's Hospital. I also did a master's in clinical epidemiology at Harvard School of Public Health. I was a faculty member in the cardiology division at Brigham and Women's for many years until last year, until earlier this year, actually. And I also was an adjunct faculty at Dana-Farber in my role in cardio-oncology as the director of cardio-oncology there since 2009. So, I was in Boston for a total of about 40 years. So, now since you have moved to New York, now you are still, you like Patriots and the Boston sports team? Bimbo, you're... You know, I am still a Boston fan. The funny thing is that in 40 years, I had never been to a Pats game in person. And then when I was leaving Boston, I told my brother, I said, you have to take me to a Pats game. I can't go leave Boston without going to a Pats game. So I did go to a Pats game just before I left last winter. But I'm not a big sports person, but if I did have allegiance, it would be to the Boston teams. All the Boston teams. All the Boston teams. Excellent. That's good to know. And since you mentioned your brother, it's Nitin Nohria, who was formerly the dean of the Harvard Business School. Right. Yeah. Excellent. So now let's come back to, you mentioned about movies and so what type of movies you like Thank No, I like every movie. Honestly, I truly grew up as a Bollywood kid. I like, you know, regular Dhoom Dhamaka movies. I like sentimental movies. you I like art movies. I like them in all languages. very You know, I'm a big, big movie buff. So I pretty much... Who are some of your favorite actors or actresses too? much. I really like Ranbir Singh right now. I think Rocky or Rani was one of my favorite movies in in recent years. I like Alia Bhatt. I like Deepika Padukone. I love movies in general. And what about some songs? Do you hum some songs or sing some songs? Yeah, no, I like the whole, I'm like an Antakshari type singer, you know, so I do enjoy that. Oh, excellent. So many things I didn't know about you. That's good too. Thank So now coming back to some other serious stuff now is So if you look at life, you know, there is always a role model, there is always a mentor. What do you think, person who has really inspired you and why? you. So I would say I've been very lucky to have many mentors along the way. So when I started out, You know, I think obviously your parents are your biggest mentors, right? My parents always put a big emphasis on education, always put a big emphasis on integrity, you know, doing your best and then hoping that the result is good. But as long as you knew you did your best, it really doesn't matter what the result is. So I think we grew up with a very strong foundation in that. I think when I was an undergrad, I was very fortunate to work in the lab of a woman called Deborah Peaty, who was a researcher at the School of Public Health. And I think she really was an amazing mentor at a very formative point in my life because she really taught me the value of research. She really took me under her wing and, you know, gave me all the fundamentals that were needed for research. And then through my years as a faculty member and as a fellow at the Brigham, I was fortunate enough to be mentored by Lynn Stevenson, who's one of the clinical pioneers in the field of heart failure. And at that time, there weren't that many women in cardiology in particular, and she really was a maven in clinical care in heart failure. And she. I think gave me the knowledge that to be an effective person, you don't have to necessarily be a basic science researcher, that even just learning from your patients and answering questions that pertain to clinical care can lead you to have a big impact in whatever you do. And so I would say these have been the two main mentors in my life, but I've always been surrounded by colleagues who have been amazing clinicians, amazing researchers, and I've always had that intellectual curiosity to learn from them and live up to a high standard. And one lesson you learned from your father? My father is a very patient person. I think the one lesson that I've learned from him is one, patience, and B, to move with the times. He's 94 and he's... adapted very well with the times, you know, he uses chat GPT and everything. So I feel like the one thing that I've learned from my father is you have to move and evolve with the times. Don't be stuck. One lesson from your mother. The lesson from my mother is actually to live life to its fullest and not worry about what will happen tomorrow. My mother was very much a person who who lived in the present, she actually died of metastatic cancer and She said, I'll do treatment once, but if it doesn't work, this is not a life I want to live and you guys should let me go. And we did. So I think she informed my clinical practice as well. Now, I'm going to reverse this question here is, since you mentioned your brother, Nitin Nahoria, what is one thing you have taught him? He's my older brother. You know, I can't say I've taught him too much. So I would say he's a much more serious person than I am. So maybe the one thing that I've taught him is the value of levity, you know, the value of humor. I think I've definitely lightened up the family conversations. So I've taught him that. And what you have learned from him? I think the one thing I've learned from him is to be tolerant, you know, to accept different points of views. I think I've learned from him the value of finding what you're passionate about and then really pursuing it. I've learned from him the value of being diplomatic, although I haven't been able to live through that lesson too well. I haven't been able to imbibe that as well as him. And really just, you know, he's a very good. Brother and son, so kind of the value of family. Excellent. And the last question, Anju, for you is, what is one advice you will give to today's doctors and tomorrow's doctors and physicians? I think the one advice I would give is that, you know, you go into medicine because you truly want to help others. It's not a profession that you should go into because of money or any other such, right? I think. It's truly a service profession, so you should go into it if you have that desire to really help others. I think you have to be passionate about whatever you do. You should choose an area that you think you have a passion for, ask important questions, and then apply those answers to improve the care of your patients. Excellent. On that note, Anju, thank you so much.