Ever since she was a child herself, Smita Bhatia, M.D., has known that she wanted to be a pediatrician. “I have always enjoyed working with kids,” she said. “And then my father’s colleague’s son died from a bone tumor. This was a half-century ago, when outcomes from pediatric cancers were not good. That led me to the amalgamation of pediatrics and oncology.”
Today, Bhatia is director of the Institute for Cancer Outcomes and Survivorship in the UAB Heersink School of Medicine, vice chair for Outcomes in the UAB Department of Pediatrics, and senior adviser for Cancer Outcomes Research at the O’Neal Comprehensive Cancer Center at UAB. She is internationally renowned for her research in cancer survivorship and outcomes, serving on several journal editorial boards and on Study Sections of the National Cancer Institute. “She is a star and has single-handedly raised the profile of the Department of Pediatrics, the Heersink School of Medicine and UAB,” said Mitchell Cohen, M.D., Katherine Reynolds Ireland Chair of Pediatrics and physician in chief at Children’s of Alabama.
For the past 20 years, Bhatia has been focused on several areas of research:
- studying racial and ethnic differences in outcomes in children with acute lymphoblastic anemia;
- uncovering the molecular basis of treatment-related complications and how they can be mitigated; and
- creating a cohort of 10,000 survivors of childhood cancer across the country “and then following them across the whole landscape of complications and trying to see if we can develop interventions for them,” she said.
“She is a star and has single-handedly raised the profile of the Department of Pediatrics, the Heersink School of Medicine and UAB …. She has and will continue to change the field.”
— Mitchell Cohen, M.D., Katherine Reynolds Ireland Chair of Pediatrics and physician in chief at Children’s of Alabama
“Each of these contributions has had broad impact on researchers, clinicians and policymakers — such that the research findings have directly influenced clinical practice,” Cohen said. (To learn more, see “Making a difference,” below.) “She has and will continue to change the field.”
Bhatia’s contributions in research and mentorship, along with her service to UAB and the profession, have earned her the annual Distinguished Faculty Lecturer Award. This is the highest honor bestowed by the academic health center on a faculty member who has advanced the frontiers of science and made outstanding contributions to education, research and public service.
“Dr. Smita Bhatia has committed her career to research that will improve the lives of people with cancer,” said Seth Landefeld, M.D., chair of the Department of Medicine. “For example, she made groundbreaking discoveries about the development of breast cancer in women who had been treated for Hodgkin’s disease and about the importance of meticulous adherence to therapy to the survival of children with leukemia. When we recruited her to UAB, Dr. Bhatia founded the Institute for Cancer Outcomes and Survivorship to build a team of physicians and scientists committed to these same goals. She has been a magnet that has drawn incredibly talented junior faculty to UAB, and then she has worked with them to develop a new generation that is already making further discoveries that improve the lives of people with cancer. She sets the standard for excellence both in mentoring and in discovery.”
‘Colliding opportunities and options’
Bhatia will deliver her Distinguished Faculty Lecture in February 2022. Her theme, she says, will be the journey that has led her to this point. Despite the fact that she is doing what she dreamed of since she was a child, Bhatia did not have all this planned in advance, she said: “Ideally, you would want to say that you charted your path out from the beginning, but I don’t think anyone does that. Instead, you navigate through colliding opportunities and options.”
“She has been a magnet that has drawn incredibly talented junior faculty to UAB, and then she has worked with them to develop a new generation that is already making further discoveries that improve the lives of people with cancer.”
— Seth Landefeld, M.D., chair of the Department of Medicine
After earning her medical degree and completing her residency at the All India Institute of Medical Sciences in New Delhi, Bhatia traveled to the University of Minnesota for fellowship training in hematology/oncology and bone marrow transplantation (where she also received a Master of Public Health degree in epidemiology). By this time, the early 1990s, survival rates for children with cancer had improved dramatically. “Pediatric oncology is about 20 years ahead of adult oncology in terms of improvements in survival rates,” Bhatia said. (Today, more than 85 percent of children survive cancer, compared with 60 percent of adults, she notes.) “Attention in the field was changing to look at the quality of survival,” Bhatia said. “Did they have complications in later life? Were they being able to achieve all of the metrics of health success?”
Bhatia’s mentor at the University of Minnesota, Les Robison, Ph.D., was a leader in these efforts, and Bhatia developed her own research program at the University of Minnesota and then at City of Hope in California, where she also was asked to create and lead a Department of Population Sciences. “They had faith in me,” Bhatia said. Then, she and her husband, Ravi Bhatia, M.D., were recruited to UAB in 2014 — Ravi as director of the Division of Hematology-Oncology and Smita to found the Institute for Cancer Outcomes and Survivorship.
‘Creating a family’
Starting from scratch, Bhatia has built the institute by recruiting 16 faculty members, “very much in collaboration with the division directors and department chairs,” she said. She likens it to “creating a family of these young ones — they all have their own little niche they want to pursue and are passionate about. What excites me is making sure they develop their wings and learn to fly.”
Her team of young investigators have research interests including:
- developing algorithms to guide clinicians in how aggressive they should be in use of cancer therapies to balance treatment and quality of life;
- tackling questions around the “forgotten tribes” of 15- to 39-year-olds who fall in the middle between childhood cancers and adult cancers, and have unique needs, including fertility preservation;
- understanding and addressing “chemo brain” and other long-term side effects of cancer treatment; and
- focusing on end-of-life care in children with terminal cancer.
“During my pediatric hematology/oncology fellowship at Stanford, one of my mentors connected Dr. Bhatia and me, given my interest in health disparities research. She was a fantastic distance mentor for me while she was at City of Hope — helping me identify the gap my research should fill and guiding me through the early grant process. When she moved to University of Alabama at Birmingham, she began recruiting me here. I initially laughed at her; no way was I moving from California to Birmingham. However, once I realized that Birmingham is a great place to raise a family and the amazing career opportunity it would be, it was a no-brainer.”
— Emily Johnston, M.D., assistant professor of hematology/oncology in the Department of Pediatrics
‘Nothing gives me more joy than mentoring’
Mentorship has always been important to Bhatia. She still meets weekly with Robison, her own mentor, who is now at St. Jude Children’s Research Hospital in Memphis, Tennessee. “Nothing gives me more joy than mentoring a young researcher,” Bhatia said. “Watching them get their aha moments, discovering what they are going to become in life, is better than any achievement of my own.”
“She is a primary mentor for seven faculty in pediatrics and over 18 faculty within UAB and across the country,” Cohen said. “This is not an assigned responsibility; it is a labor of love. Because she is so committed to making her mentees successful, she has turned down other leadership roles in order to maintain her commitments to them. In addition, as vice chair of Pediatrics, she has assumed a secondary mentorship role for more than one-third of the aspiring research faculty in the department and most of the aspiring women faculty.”
The Institute for Cancer Outcomes and Survivorship is “an ideal environment for junior investigators such as myself,” said Emily Johnston, M.D., assistant professor of hematology/oncology in the Department of Pediatrics. “I am surrounded by others at similar career stages, so have peer mentorship, collaboration and, when necessary, commiseration. There is also phenomenal institutional support for grants management, administrative support, database support. Dr. Bhatia has been central to my early success at UAB — she has advocated for sufficient protected time for research, refined countless manuscripts and grants, and helped me navigate maternity leave. I could not ask for a better mentor.”
Bhatia enjoys helping young researchers from the “smallest of the small tasks, like how to format a table, all the way to promoting them and connecting them to the world outside so they can really rise,” she said. That includes helping her mentees find their place in science and negotiate the tricky balance between career and family.
“Some come with an amorphous sense of what they want to do, and your role is to help them sharpen that,” Bhatia said. “Others come really blank. I tell them, ‘Go read, read a lot and identify where the gaps are. You want to find a field that is an inch wide and a mile deep.’ Focus becomes such a big issue, because they want to do 100 million things and you don’t end up succeeding in any one.”
Bhatia’s attitude to family responsibilities and timekeeping as a leader “is shaped by my own experience,” she said. “I had my second child during my postdoc, and I didn’t want to put my child in day care at 3 months old. I had finished my six weeks of maternity leave and four weeks of vacation time and two weeks of paternity time for Ravi, and we had no parents or family in the country to help us. My mentor allowed me to work from home and gave me a laptop when not everyone had one so I could continue working.”
At City of Hope and now at UAB, “I decided I would have no meetings before 8 a.m. or after 5 p.m., because that’s when parents with children need to drop them off and pick them up,” Bhatia said. “We are as flexible as possible with maternity leave. It’s not whether you are walking in at 8 in the morning and leaving at 8 at night that matters. It’s your productivity, not when and how you do it.”
Pediatrics Chair Mitchell Cohen, M.D., explains three ways that Bhatia’s work has changed the field of pediatric oncology:
Disparities in cancer outcomes: “Smita has changed the field by her studies of disparities in cancer outcomes. She has demonstrated the critical role for adherence to oral chemotherapy in preventing relapse in children with acute lymphoblastic leukemia. Ethnic and racial differences in adherence to oral chemotherapy explained disparities in survival. She has recently completed a phase III national trial to enhance adherence to oral chemotherapy and reduce these disparities.”
Understanding treatment-related outcomes: “She discovered an increased risk of breast cancer among adolescent girls exposed to chest radiation for the treatment of Hodgkin's lymphoma. This resulted in a reduction in the dose of radiation commonly used for managing Hodgkin's lymphoma in girls during their teenage years. She has recently completed a multi-institutional trial to examine the role of pharmacologic agents as a breast cancer risk-reduction strategy. Some drugs that kill cancer cells can also have deleterious side effects, e.g., anthracycline chemotherapy can damage heart muscles and cause heart failure in some patients. Smita has identified the role of specific genes that interact with anthracycline chemotherapy in increasing the risk of heart failure in childhood cancer survivors. She is currently developing a diagnostic assay (a blood test) to identify cancer patients who would be at high risk for heart failure if exposed to anthracycline chemotherapy.”
Establishing multi-disciplinary care for survivors: “At UAB, she has developed multidisciplinary survivorship clinics for survivors of childhood cancer, breast cancer, and head and neck cancer — providing state-of-the-art care to the survivors in the setting of research.”