Several years ago Dr. Robert E. Bristow had a revelation while looking at the findings of a study he and his colleagues conducted on 10,000 U.S. women with ovarian cancer. The study found that women who received treatment at high-volume hospitals (hospitals that treated at least 20 cases of ovarian cancer a year) survived longer than women cared for at low-volume hospitals.
But Bristow—a gynecological oncologist, expert in gynecological surgery and a leading authority on ovarian cancer treatment—examined the data more closely. He found that African-American women and those from lower socioeconomic levels were much more likely to die of the disease after adjusting for other variables.
“I was staring at this Excel spreadsheet and thought, ‘This is not right,’” Bristow recalls. “Here in Orange County, a patient from Santa Ana, who has safety-net insurance, should have the same opportunity to survive her disease as a patient from Newport Coast. That is a basic truism.”
Bristow, who is the UC Irvine Health director of gynecologic oncology services, now focuses his time on leading the charge to provide the highest-quality care—not just to UC Irvine Health patients, but to women with ovarian cancer everywhere in the world. He is the author of more than 200 scientific publications, two medical textbooks on ovarian cancer and two books for patients.
He also co-hosts an annual international medical conference on ovarian cancer to teach doctors the latest methods for fighting the disease. The conference location alternates between UC Irvine and the United Kingdom. In the summer of 2016 he also hosted a course in the Philippines to teach ovarian cancer surgery to gynecologic oncologists in that region of the world.
“That is beyond gratifying to know we are making a difference not just for the patients sitting in our waiting rooms but for women halfway around the world.”
The highest standards of care
Ovarian cancer ranks fifth in cancer deaths among women. Because it produces few overt symptoms, many women are diagnosed with late-stage cancer, which is difficult to cure.
However in recent years survival rates have nudged upward, even for women with advanced disease, due to better surgical techniques and new drugs. The innovations include therapies that “target” the specific molecular mechanism that is driving the cancer’s growth and intraperitoneal chemotherapy (IP)—chemotherapy placed directly into the abdomen to destroy cancer cells hidden in abdominal tissue.
“The improvements in ovarian cancer have been incremental over time,” he says. “The chances of survival calculation starts with whether a woman receives state-of-the-art treatment or not. That is the first stepping stone.”
But, he adds, “If a woman with stage III ovarian cancer gets very successful surgery and is afforded access to IP treatment, the median survival for those patients is 10 years, which is a crazy number. You never thought you would hear that number 10 years ago.”
Identifying the greatest need
The progress is heartening to Bristow, who initially chose to become an obstetrician and gynecologist because he enjoyed delivering babies. He grew up in the Bay Area, the son of a highly respected internist and researcher, Dr. Lonnie Bristow—who later became the first African-American president of the American Medical Association.
But when Bristow started his residency at The Johns Hopkins Hospital in Baltimore, his career took a sharp turn.
“I started my residency on July 1, 1991. By July 4th I had decided oncology was what I needed to do,” he says. “The patients were so sick and they needed someone the most. At the end of the day, you have that feeling that you made a contribution to helping someone.”
Bristow enjoys the opportunity to care for patients, teach and conduct research. He emphasizes providing individual patients with personalized care that treats “the whole person.” At the same time, he remains keenly focused on research on large populations of patients that will highlight disparities in care and elevate treatment standards.
A few years ago he was attending the annual ovarian cancer conference, held that year in the U.K. He struck up a conversation over dinner with a physician from Northern Greece who was attending the conference.
“This doctor said to me, ‘I want to thank you for writing your book on ovarian cancer surgery. That is our bible. I want you to know how much that impacts our patients,’” Bristow recalls.
“I would like to think somewhere in Northern Greece there is a 43-year-old mother of three kids who has survived ovarian cancer because she got the right surgery and right treatment because of that book we wrote and because some doctor there read it and implemented the proper techniques,” he says. “That is beyond gratifying to know we are making a difference not just for the patients sitting in our waiting rooms but for women halfway around the world.”