Clinician investigator reflects on her decades spent improving lung cancer treatment around the world

Frances Shepherd (MD ’70) has been a leader in lung cancer research for over 30 years. Today, she is a highly sought-after mentor, a professor at the University of Toronto, the Scott Taylor Chair in Lung Cancer Research at the Princess Margaret Cancer Centre, a mother and a grandmother.

Becoming a doctor had been her dream since she was 5 years old, and she felt fortunate to have a family that supported her in pursuing that dream.

“When I was a child, I would take my crayons and grind them up with a pencil sharpener. I'd put all the different colors in egg crates, mix my father's shaving cream with it and then apply it as potions to my sick dolls,” says Shepherd. “I was less interested in dressing the dolls up than I was in curing their ailments with my homemade potions.”

Growing up in the 1950s, she does remember receiving some dismissive comments about her aspirations, including from her family doctor when her mother mentioned her career goals to him.

“He said, ‘she'll just be Mrs. MD,’ meaning that I would take up a spot in medical school, get married and never work,” she remarks. “Clearly, this was not the case!”

Following residency, Shepherd began her career as a medical oncologist at Toronto General Hospital (TGH) where she worked closely with the hospital’s renowned thoracic surgery team. Her eventual journey into lung cancer research was driven by a combination of opportunity and timing.

“There was a relatively new site-specific clinical trial research group supported by the US National Cancer Institute called the Lung Cancer Study Group, which focused on post-operative treatments,” she says. “I became involved in these studies with our group, which was one of only half a dozen members in North America. That was my introduction to clinical trials.”

At this time, many physicians were hesitant to enter the field of lung cancer due to a lack of effective treatment options.

“The drugs were toxic. Patients often had to be admitted to the hospital because of nausea and vomiting, and the treatments were not very effective,” says Shepherd. “The survival gains were modest. That was a phrase we used a lot — modest survival gains.”

Despite the discouraging results, the team was determined to continue trialing new approaches, seeking better outcomes.  Shepherd’s leadership within the lung cancer study group later led to her appointment as lung cancer site chair for the National Cancer Institute of Canada (NCIC) Clinical Trials Group.

During her time as chair, the group conducted trials of post-operative chemotherapy that led to an absolute 15 per cent improvement in the cure rate. She also led trials of the first molecularly targeted agent ever to improve survival in advanced lung cancer. These studies changed practice worldwide. As a result of the trials conducted during Shepherd’s 19 years in the role, lung cancer treatment today is dramatically better than when she began working as a medical oncologist.

When asked if being a woman has impacted her career, Shepherd recalls applying to medical school when the number of women in the program was capped at 20 out of 120. Despite stating that being a woman impacts all aspects of one’s life, she feels that it hasn’t held her back in her professional life, nor has being a doctor negatively affected her personal life.

Her secret to managing it all? Prioritizing and delegating tasks. After having her first child, Shepherd discovered there was no maternity leave available to her as a resident, so she took two weeks of holiday and two weeks of sick leave before returning to work while she and her husband hired a nanny to assist with child care.

“I think that delegation comes a little easier to men. It’s important for women to learn how to prioritize what's important to us and how to delegate the things that are not absolutely necessary for us to do,” she says. “We should still supervise closely, as we must ensure that the jobs we delegate are done to our standard, but you have to seek and accept help.”

In addition to her significant contributions to lung cancer research, Shepherd has dedicated time to teaching the next generation of clinicians and researchers in hematology and medical oncology. She has mentored more than 50 national and international post-graduate clinicians and clinician-scientists, many of whom now hold prominent positions worldwide.

She asserts that her approach to pushing her mentees to succeed is tough love and encouraging them to finish the projects they start whenever possible.

“Submitting an abstract takes almost no time. Presenting at a meeting takes no time. It takes discipline and the true support of a mentor to drive the process through to publication in a journal,” she says.

For Shepherd, contributing to the change from toxic chemotherapy with low response rates to oral molecularly targeted therapies that can achieve response rates of 75 to 80 per cent is what has motivated her to keep pushing the boundaries of lung cancer research. She is driven by the potential to improve patient outcomes and continue innovating in the fight against lung cancer.

Shepherd has received numerous awards for her achievements in research and teaching. To her, the pinnacle of these include becoming an Officer of the Order of Canada in 2015 and receiving the Canada Gairdner Wightman Award in 2018 for her work developing and evaluating new treatment modalities at the local, national and international level for patients with both small cell and non-small cell lung cancer.

“To see my work change practice at a global level and have that work recognized nationally and internationally is incredibly meaningful to me,” she says.

This article was originally published by the U of T Department of Medicine.