Get to Know...Bhavana Bhatnagar, DO

Bhavana “Tina” Bhatnagar, DO, director of Hematology and Medical Oncology at the West Virginia University Cancer Institute at Wheeling Hospital, sat down with Blood Cancers Today for a deep dive into her career trajectory and clinical interests. Dr. Bhatnagar discussed why she pursued a career in hematology-oncology, her current research on rural disparities in acute myeloid leukemia (AML), and the differences between working at an academic medical center versus a community-based setting.

Where did you grow up, and when did you know that you wanted to become a hematologist-oncologist?

I grew up in a suburb of Pittsburgh. It was a really nice, idyllic childhood. My mom is a neurologist, so medicine has always been a part of my life for as long as I can remember. My mom used to take me along with her when I was much younger, so I had a chance to go to hospitals and see patients when I was under the age of 10.

I knew early on that I wanted to be a physician. I leaned away from neurology because I’ve always had a special place in my heart for people with cancer, which was sparked by things I would watch on TV when I was younger. I would watch human interest stories on patients and families struggling with cancer. I remember as a kid thinking, “When I grow up, I’m going to help those people.”

During my college years and in medical school, I had impactful interactions with patients who had acute leukemia. Those patients are usually in the hospital for such a long period of time when they’re initially diagnosed, which is unique in oncology because most patients with cancer are treated in the outpatient setting. But acute leukemia patients spend several weeks in the hospital, and if you’re a rotating medical student or a resident, you develop very powerful, intimate relationships with the patients and their families from the time they’re diagnosed to the time they leave the hospital and beyond. It was those relationships and the opportunity to care for those people that drove me.

Were there any mentors who shaped your career path?

I’ve been fortunate to have many mentors in different areas of hematology help shape my career. When I was a resident at the Cleveland Clinic, I had the opportunity to work with Drs. Mikkael Sekeres and Anjali Advani as their intern. That was the first time I rotated as a resident or as an intern on the acute leukemia service, so I got a chance to see stylistically how they practiced and how they spoke to their patients. I got to understand their thought processes, which only deepened my interest for acute leukemia.

Then, I moved to fellowship and had the opportunity to work with Drs. Maria Baer and Ashkan Emadi, who allowed me to participate in several fellow-led retrospective studies looking at hypomethylating agents [HMAs] and their place in the management of patients with acute leukemia and myelodysplastic syndromes. I then went on to my first faculty position at the Ohio State University and had a chance to work with the late Dr. Clara Bloomfield on several prognostic studies in the AML space.

I also worked under the tutelage of Drs. John Byrd, Ramiro Garzon, and Sharyn Baker, who helped provide a senior level of mentorship and guided my career. I have countless people to thank for getting me to where I currently am.

My practice setting has now moved. In my initial faculty position at the Ohio State University, I was a specialist in acute leukemia and acute lymphoblastic leukemia, as well as several other chronic leukemias and myeloproliferative neoplasms. For family/personal reasons and the opportunity to translate my skills from an academic center to a more community setting, I now work at a regional affiliate of West Virginia University Cancer Institute called Wheeling Hospital.

What are your current research interests?

While at Ohio State University, I was the lead author on a plenary presentation for the 2020 American Society of Hematology Annual Meeting & Exposition. The publication pertained to survival disparities and differences in genetics in AML between young Black AML patients and young White AML patients. That developed my interest in disparities research, and I now work primarily in Appalachia, which is diverse in the sense that this is a rural population.

There are significant issues with resources and the financial status of a lot of the patients who work here. It’s a different type of setting. I’m trying to study AML biology—which seems to be a little bit worse here in Appalachia compared to other large places I’ve worked—and trying to determine if there are any occupational exposures or environmental exposures that could be responsible for the worse disease biology of the patients I have taken care of.

I’m also very interested in studying the incidence of clonal hematopoiesis mutations in the Appalachian population. West Virginia only has a population of 1.7 million, but there’s a disproportionate amount of cancer in the region. One of my theories is that there’s a lot of clonal hematopoiesis mutations, but it has not been deeply explored. I have some research projects that intend to look at clonal hematopoiesis in rural populations.

What are the differences between working at an academic medical center versus a community-based setting?

There are countless resources and staff at an academic medical center, which helps facilitate the care of those patients more smoothly. It’s easier and faster to get a lot of things done. In a community setting, I had to transition a bit. I’m the only person in my practice to take care of patients with AML. While I still focus on acute leukemia, I did have to branch out and start taking care of patients with other types of blood cancers, which was very good for me because I got a broader scope within hematology.

Because you don’t have the same staffing, laboratory-based resources, or infrastructure in a community setting, you’re also trying to juggle so many other things. It’s a little more challenging, and it takes longer to figure out the ropes. But my patients are very happy that I’m here because they don’t have to travel very far to see somebody who specializes in blood cancers.

How has AML treatment shifted throughout your career?

It has shifted dramatically. When I was in medical school, every patient got 7+3 chemotherapy, which is a 4- to 6-week–long inpatient hospital stay. There was very little you could do for patients over the age of 65 with AML and people who had lots of comorbidities. Often times, it was hospice or low-intensity chemotherapy that wasn’t very effective in treating those patients.

The biggest shift I’ve seen is the introduction of HMAs and targeted therapies that are designed to treat AML with specific gene mutations like IDH1, IDH2, or FLT3. The advent of venetoclax and HMAs has been a huge game changer. I administer a lot of that in the community and have had very good results with it. It’s amazing how many drugs have gotten approved.

It’s nice to have options for patients now. Earlier in my career when patients relapsed, we always had to have the hospice talk or say, “There’s nothing more I can offer you.” Now, it’s much more gratifying to tell patients that I have potential options for them, and even if we’re not able to cure their disease, we can give them more time, which allows them to do things that they might want to accomplish in their lifetime. Right now, that’s a win. Hopefully, we’ll move towards even better survival outcomes in the future.

The long-term survival for patients with AML, whether they’re younger or older, is still not quite where we would like it to be. I would like to see more well-tolerated treatments and treatments that keep patients out of the hospital when they’re initially diagnosed. Patients with AML spend a lot of time in the hospital for either induction chemotherapy, complications related to infections, or if they move on to transplant. Having AML is such an onerous responsibility for the patient, so I’d like to see treatments that are easier and allow patients to have a good quality of life and achieve good disease control.

Do you have any hobbies outside of work that most people would be surprised to learn?

My main hobby is tutoring my kids. I have three young children aged 8, 6, and 3. Typically, my life is centered around taking care of my patients and taking care of them.

I’m hoping that once I get to a stage where they don’t need me as much, I’ll have a little more time on my hands. I’m hoping to develop my interest in photography and scrapbook making. I want to make each of my kids a scrapbook every few years, so they can have something to share with other people when they get older. It’s nice to tap into whatever creative faculties you have and make good memories!