Tuesday, June 8, 2021

Mentorship and sexual harrassment

When a prominent and highly published medical oncologist left the Mayo Clinic in Minnesota in 2018, there were no details as to why. Axel Grothey, MD, a specialist in gastrointestinal cancers, "has decided to leave," the institution told its staff in an email. 

It's only now, 3 years later, that details have emerged of unethical sexual relationships that he had with two women — an oncology fellow and a junior faculty member. 

A timeline of the events was reported in detail by The Cancer Letter, a newsletter for oncologists in academia. 

The inappropriate sexual relationships with mentees only came to light once medical licensure boards in three states reprimanded him last year, events first triggered by additional women at Mayo filing their grievances with the Minnesota Board of Medical Practice, causing related documentation to be made public. 

The Cancer Letter notes that the GI oncologist was reported to Mayo's human resources department, which conducted an internal investigation. This found that Grothey's "pattern of conduct demonstrated a failure on his part to establish and maintain appropriate professional boundaries with people who viewed him as a mentor." 

However, this finding was not made public, and Grothey was given a choice between resigning and being terminated, the newsletter reported. 

Grothey chose to resign, and he moved to the West Cancer Center, which has fellowship and residency programs in Germantown, Tennessee, as director of GI cancer research. He was also appointed medical director of OneOncology Research Network's clinical trial site management organization. 

Until last week, he also retained his position as co-chair of a National Cancer Institute steering committee, which influences which clinical trials in GI oncology get funded. However, he was removed from that position May 27, with NCI director Ned Sharpless, MD, stating: "We cannot and will not tolerate sexual harassment within the agency, at research organizations that receive NIH funding, or anywhere else NIH-funded activities are conducted."

The Oncoalert Network, a global network of oncology professionals, said it has zero tolerance for sexual harassment or abuse and acted immediately after double-checking facts and allegations, removing Grothey from the network on May 1. 

Fight CRC, an advocacy group for colorectal cancer patients, also removed Grothey from its medical advisory board, it announced last week. 

Grothey did not respond to a request for comment. 

Charanjit S. Rihal, MD, chair of Mayo Clinic's personnel committee, said in a statement to Medscape Medical News that "all instances of sexual harassment are reported to the board of medical practice..." and that it also "provides truthful information about corrective action taken when references are requested and credentialing inquiries occur..." 

The revelations triggered a stream of social media responses. 

Some suggested that this behavior is common. Shruti Patel, MD, an incoming oncology fellow at Stanford University and former resident at Mayo Clinic, tweeted: "#MedTwitter If you think this hasn't happened at your institution, you are [probably] wrong." 

Sarah Temkin, MD, an oncologist and executive producer, 1001 Cuts, a forthcoming film about women surgeons, tweeted: "Off the top of my head I can think of a half dozen nearly identical stories. All the perpetrators are still working. Many of the victims are not. If our professional calling is supposed to be 'do no harm,' we ought to clean up the house of medicine." 

Another medical oncologist said rumors about Grothey were longstanding. "Heard from many colleagues that this behavior was known in the field and went on for years. Years," tweeted Charu Aggarwal, MD, MPH, from the University of Pennsylvania in Philadelphia. However, Aggarwal also said she was "shocked" by the news, as did others. 

Estela Rodriguez, MD, of the Sylvester Comprehensive Cancer Center in Miami, Florida, asked oncologists to contemplate harassment and abuse of power in the workplace. "Medical training is so long that you witness a lot of inappropriate abuse of power, sexual harassment, racism, bullying. Mentor-mentee, doctor-nurse, resident-resident. If anything, take this time to reflect on your part," she tweeted. 

Sexual Harassment in Oncology

The public airing of Grothey's story comes at the same time that a new study of sexual harassment in oncology has been released as an abstract as part of the run-up to the 2021 American Society of Clinical Oncology (ASCO) annual meeting, which starts later this week. 

In the previous 12 months, 70% of American oncologists reported sexual harassment from peers and/or supervisors, according to the survey of 271 full-time clinicians. 

Women oncologists had a higher incidence than men (80% vs 56%), a difference that was statistically significant (P < .0001). 

The investigators queried respondents about three types of sexual harassment (gender harassment, unwanted sexual attention, and sexual coercion), as defined in a 2018 report from the National Academies of Sciences, Engineering, and Medicine. 

The survey results are "sobering," lead author Ishwaria Subbiah, MD, of the University of Texas MD Anderson Cancer Center in Houston, told Medscape Medical News. The full study will be presented as an oral presentation at ASCO. 

"Sadly, both timely and timeless," tweeted medical oncologist Tatiana Prowell, MD, of Johns Hopkins University in Baltimore, Maryland, about the new study. 

The Grothey news triggered multiple examples of public storytelling by women who have endured harassment. 

Martina Murphy, MD, a medical gynecological oncologist at the University of Florida in Gainesville, posted on Twitter a germane story: "I was sexually harassed as a resident by an attending, something I learned was repeated behavior. I complained despite fearing jeopardizing my chance to match in fellowship. He was ultimately fired — when another man revealed his research misconduct." 

Sangeetha Kolluri, DO, a breast surgeon at Austin Cancer Centers in Texas, responded to Murphy. "You were braver than I was. I did not report sexually harassing behavior by a prominent surgical oncologist until after I completed my breast surgery match and my program director was…unsupportive. I was labeled manipulative at my exit interview."




  1. A new survey of sexual harassment among US oncologists has found that 70% reported incidents from peers and/or supervisors in the previous 12 months.

    The incidence was higher among women than men (80% vs 56%), a difference that was statistically significant (P < .0001).

    However, after experiencing sexual harassment from co-workers, men and women were alike in terms of reporting similarly negative outcomes in mental health, sense of safety, and turnover intentions (eg, leaving or quitting).

    "Our findings demonstrate that the impact of sexual harassment on both men and women is tangible and is not different," said lead author Ishwaria Subbiah, MD, a medical oncologist at the University of Texas MD Anderson Cancer Center, in Houston, Texas, during her presentation of the study on June 5 at the American Society of Clinical Oncology (ASCO) 2021. The meeting was held virtually because of the pandemic.

    "The survey's recall period [about harassment] was in the previous 12 months. The respondents weren't reflecting on a lifetime of events," Subbiah told Medscape Medical News. "That's part of what makes the findings that much more sobering."

    The release of the survey results roughly coincided with a furor within oncology circles over details that have now come to light about Axel Grothey, MD, a high-profile medical oncologist who was forced out of the Mayo Clinic in Rochester, Minnesota, after having unethical sexual relations with mentees ― only to move on to another major center with more mentees.

    The new survey, which included 153 women and 118 men, was conducted in 2020.

    Overall, 69% of respondents reported gender-based harassment, 17% reported unwanted sexual attention, and 3% reported sexual coercion from peers/supervisors. For the three types of sexual harassment, women reported higher rates of incidence; the greatest proportional disparity was in unwanted sexual attention (22% of women vs 9% of men).

    The types of sexual harassment are defined in a landmark 2018 report from the National Academies of Sciences, Engineering, and Medicine. Gender harassment is nonverbal or verbal behaviors that are hostile, objectifying, and excluding of or conveying second-class status about a gender. Unwanted sexual attention is advances, including touching, and seeking a sexual relationship despite discouragement. Sexual coercion involves seeking compliance with sexual demands by making job-related threats or promising job-related benefits.

    The commonality in the three harassments is their being "unwanted," Subbiah explained.(continued)

  2. (continued)Sexual harassment is a tool of power that one person yields over another.

    Another commonality is that "sexual harassment is a tool of power that one person yields over another," commented Marina Stasenko, MD, a gynecologic oncologist at NYU Langone's Perlmutter Cancer Center in New York City.

    Stasenko led a 2018 study that found that 64% of US gynecologic oncologists reported sexual harassment during training or practice, a much longer recall period than the 1 year in Subbiah's study.

    However, things may be changing regarding sexual harassment ― at least in terms of victims speaking out, said Stasenko. Perhaps discussing personal experience "is becoming less taboo," she told Medscape Medical News. "The media spotlight on sexual harassment within medicine has been bright [recently]."

    That was borne out last week ― a number of oncologists who had been harassed told their stories on Twitter in reaction to the report about Grothey at one of America's top medical centers. Also, in another sign of the moment, an academic oncologist publicly said that rumors about Grothey were long-standing. "Heard from many colleagues that this behavior was known in the field and went on for years. Years," tweeted Charu Aggarwal, MD, MPH, from the University of Pennsylvania, in Philadelphia Pennsylvania.

    Other outcomes seem to make Grothey's behavior at Mayo, which multiple oncologists said has occurred at every center, a watershed moment. Namely, he has been muted or dismissed by an array of organizations since the story broke.

    ASCO disallowed Grothey from making presentations at the annual meeting (he was an author on 12 studies), the National Cancer Institute removed him from his position as co-chair of an influential steering committee that helps determine grant funding for research, and the OneOncology community care network dropped him as medical director of their research arm, as reported by The Cancer Letter. He was also removed from the OncoAlert Network, a global network of oncology professionals, and from the medical advisory board of Fight CRC, an advocacy group for patients with colorectal cancer, as reported by Medscape Medical News. His current employer, West Cancer Center, in Germantown, Tennessee, has also started an investigation.

    In her presentation, Subbiah acknowledged a changing landscape, with "increasing attention in recent years" to sexual harassment thanks to the "broader cultural movements" of #metoo and #TIMESUP social media-based campaigns.

    Another oncologist nodded to the recent news about Grothey at the Mayo Clinic and suggested Subbiah's study was part of a historic struggle for equity for women. "Sadly, both timely and timeless," tweeted medical oncologist Tatiana Prowell, MD, of Johns Hopkins University, in Baltimore, Maryland, about the new study.

    Academia Has a Problem

    To conduct their survey, Subbiah and her co-investigators reached out to 1000 randomly selected US members of ASCO via the organization's research survey pool, as well as through Twitter and Facebook. The invitation to participate described the survey as being about the "workplace experience of oncologists" and that it aimed to mitigate response bias.