Navigating Career Crossroads: Insights from Hope Rugo’s Journey as a Woman in Oncology

Hope S. Rugo, MD, FASCO

Reflecting on her own extensive career journey as a breast medical oncologist, along with the personal challenges, career transitions, and changes to the field she experienced along the way, Hope S. Rugo, MD, emphasizes the need for open dialogue and mentorship to empower women when balancing personal aspirations with professional obligations and underscores the importance of supporting all women in both their careers and personal lives. As a leader in the field, Rugo’s insights offer invaluable guidance for women embarking on similar paths.

“One thing I learned from the [panel] is that we need to be sharing our stories. We need to be talking, and we need to help women with their careers and all the things they want to do, whether that’s [starting a] family or having a partner, [regardless of gender or orientation],” Rugo stated during an interview with OncLive® regarding her participation in the Women in Oncology panel during the 41st Annual Miami Breast Cancer Conference.

In the interview, Rugo, the Winterhof Family Endowed Professor in Breast cancer at the University of California San Francisco (UCSF), as well as a professor of medicine in the Division of Hematology and Oncology, director of Breast Oncology, director of Clinical Trials Education, and director of Cancer Infusion Services at the UCSF Helen Diller Family Comprehensive Cancer Center, detailed the personal experiences that shaped her career path, highlighted challenges wofmen face in advocating for their own needs and goals when fulfilling professional obligations, and provided valuable insights on navigating career transitions and building support networks within the oncology community.

OncLive: Could you describe your journey to becoming an oncologist?

Rugo: I wanted to be a doctor from when I was a little kid watching television shows. When thinking about what I wanted to do in medicine, I was considering international health and infectious diseases, but when I was training, I became fascinated by oncology. We had a lot of exposure to malignant hematology, rather than solid tumor oncology, when I was training, because that’s the inpatient side. When I was training, we didn’t have a lot of the outpatient subspecialty clinical exposure that people do now.

I thought oncology [necessitated] treating the whole patient and understanding biology and scientific advances. It was the combination of being a doctor treating the whole person, but at the same time having the translational academic component where you’re trying to tailor treatment to further understanding. When I went into oncology after my fellowship, I [first] went into malignant hematology because I was interested in the immune system from work in the laboratory.

Coming from an initial background in hematologic malignancies, what drew you to the breast cancer field?

It’s funny how it’s all come full circle. I worked in malignant hematology and bone marrow transplant, started a stem cell harvesting program, and did selection studies for myeloma [during] the early days of autologous transplants. We also joined the National Marrow Donor Program and did unrelated marrow transplants, which is still a difficult and fascinating [process].

During that time, we were doing autologous transplants for breast cancer, and I became interested in the biology of breast cancer. When I was a medical student, my mother had been diagnosed with stage I breast cancer, and endocrine therapy wasn’t given [to patients with] small tumors in 1982. She developed recurrent disease before my first child was born. Shortly after, studies suggested that patients with stage I tumors benefited from adjuvant endocrine therapy, but it was early days [with that research].

My mother developed metastases in the bone. Being involved in her treatment and understanding what was going on with her cancer, compared with the patients I was seeing in clinic for transplant, made me feel as though the treatment for breast cancer was quite complex. It was the most common cancer in women worldwide, and there was so much to understand about the biological differences between different tumors. We had just learned about HER2 overexpression from studies in the late 1980s.

What unique challenges did you experience when transitioning between different career stages or roles?

My mother eventually died of her disease, but the course of her treatment was difficult. I had little kids and was working all the time, and I felt that [the breast cancer field] didn’t have the [best] understanding of what we were doing. We weren’t managing the [disease], we didn’t have as many treatment options [as we do now], and we didn’t understand how to manage toxicities.

The oncologist who took care of my mother was a lovely person. I had moved [my mother] out [of her house], and she lived with us when she was sick, so [an oncologist at UCLA took care of her]. [However,] they didn’t really manage the process of progressive disease and pain management.

At that point, I made a lateral career move. I thought I could do something that may be more meaningful to me [in a disease] where I could contribute more than what I was doing [in hematologic oncology]. I moved to breast cancer approximately 25 years ago, and it was a fabulous career move. [I made the move] after my mother died, but I still attribute that [decision] and the tremendous opportunities I’ve had to my relationship with my mother.

That was an interesting time. [Going from being] mid-level in my career and knowing what I was doing, to [moving] somewhere where I didn’t know anything except for what I learned from transplants was one big challenge I had. Certainly, the challenge of being in academic medicine, caring for an ill parent, and having small children is enormous, and for women, it is still a huge issue. There is not a lot of flexibility in academic medicine. That’s improving now.

We have more women in academics, and there’s a push to allow people the time off they need. There’s maternity leave, which [was not provided when I was] hired and when I had kids. Now, people routinely take time away from work, which is important, and they’re given the bandwidth to care for sick parents. My father eventually got quite ill and died [when he was] elderly. That is another area where you want to spend the time [with your family], but it’s hard to balance that with your work.

What does work-life balance look like to you, and what difficulties do women experience navigating the balance between professional aspirations and personal obligations? What about when professional goals conflict with each other?

The challenges [of being a woman in oncology include] how to approach work-life balance and difficult interactions in the workplace. How do you balance your own passion for work and help other people within your group? How do you understand your goals in your work? Do you move to have additional leadership opportunities? Do you stay where you are because it’s better for your family not to keep moving? How do you balance all those things? Later in your career, [the question is:] what do you want to accomplish with the remaining years you have in your career? How do you balance that with what’s feasible and right for your family? There are many challenges as you go through [your career].

For all of us, it’s also a challenge balancing the academic part of our work with patient care. Patient care always comes first, and we must manage that. There is an increasing emphasis on revenue generation in academic institutions. They’re always losing money, so most places have a relative value unit–based model. How many half days you have at the clinic is balanced depending on your goals, so you can have people who are more clinically focused who can see patients and enroll them in trials.

However, most people in academics want to be doing something more academic as well. For people rising now in academics, balancing the number of half days you’re in clinic against your goals of doing clinical trials and moving forward [in your career] is an increasing issue. [Another issue is] balancing the investigator-initiated trials, which are looked upon as being important parts of any cancer center but are generally not moneymakers, against the need to do sponsored trials where you may be contributing more to treatment changes. [You may contribute] less to the understanding of disease biology, but you may generate more revenue. These are all challenges we’re facing, but I think they’re doable.

What is the importance of mentorship programs for women in oncology?

One of the key things to communicate is the need for mentors and feedback. Mentors can be both at your institution and outside your institution, and that’s important. Sitting on the panel for the Women in Oncology event was fascinating [for me]. Understanding the challenges my colleagues also dealt with over time, [how they discovered their] passion to work within the field of oncology and women’s health, [and what] drove them to overcome a lot of obstacles was inspiring. We want to support people within [this community] and understand that [pursuing personal goals and fulfillment] doesn’t mean you can’t have a career in academics or in community practice.

As the facilitator of the discussion on Pursing Leadership & Career Growth, what insights did you glean when discussing support networks with your colleagues, and how important are these in facilitating successful career transitions for women in this field?

It was interesting hearing about what [research] people were interested in and where they wanted to go [in their career journies]. [For example], how does somebody who’s left community practice to go into a more academic role that is clinically heavy at the age of 50 years deal with that? How do you get involved in trials? There were also people busy at academic centers who have a huge amount of clinical work. How do they balance their life outside work?

There are recommendations we can provide that are more individualized, [because] it’s hard to make a global recommendation. The main idea is to go forward with ideas. You have to start to move forward. You must have a leader within your group who supports what you want to do. That’s key. If you have somebody who doesn’t support you, and you know for sure that you don’t want to do exactly what you’re doing now, then you need to leave that institution and go somewhere that will support you.

Let’s say you go to the leaders of your group and say you want to do more trials, and they [respond by saying that] you’re a clinician, so you can’t do trials. [In that scenario,] you have to think about how important that part of you is and balance it against where you are [in your career] and what’s right for you and your family, whatever that family looks like. Then, [you must] make some difficult decisions.

What are unique challenges that women face when transitioning between different career stages or roles? What advice do you have for someone considering moving to a new institution?

A lot of the time, if you’re [highly enmeshed] in a certain place, it’s hard to move. If you are enrolling patients in trials, you can [request to] bring a sponsored trial into your group and champion the trial. If you enroll well in a trial talk to the trial leadership, there are possibilities of proposing sub-analyses of patient subgroups. That [research] could be [focused on] anything. Since you’ve contributed to the study in a big way, you then have the power to ask about [related opportunities of interest.]

Another thing we talked about [during the event] is that you must have contributed something to get something back. The cooperative groups are also a place where people can propose studies and be successful, although it takes a long time. [Lastly], somebody else might have an investigator-initiated trial at another institution [that you can] join. Then you can potentially propose a sub-study. If you take that approach, you must get that set up early, because the sub-studies [will often] go to the junior people at the institution running the trial.