Mr. J. Joseph Mahany Jr.

Although J. Joseph Mahany Jr. has been involved in several different areas of healthcare over his more than 30-year career, his work with cancer patients participating in Phase I trials has been some of the most interesting and rewarding.By investigating and monitoring how patients cope with newly-created drugs, Mr. Mahany is able to provide the hands-on, personal care he believes is so important to his patients.

Today, as a physician assistant at the Institute for Drug Development at the Cancer Therapy and Research Center in San Antonio, Texas, Mr. Mahany works with the Phase I trials, and he explains that his role involves both clinical research and hands-on patient care.Mr. Mahany describes Phase I trials as the first clinical step in the development of new drugs for human consumption that are offered to people diagnosed with various types of cancer, the majority of whom have solid tumor malignancies."We offer therapy to patients who have no known standard therapy as well as to those who have failed a number of standard therapies for the treatment of their disease," explains Mr. Mahany.Patients who have exhausted all other treatment options may choose a Phase I trial, and these trials are to determine dose-limiting toxicity and maximum tolerated dosages."We are always hopeful for a possible positive response; however this is not an endpoint for Phase I trials."Typically, patients are started on low doses of a new drug, and their symptoms and reactions are closely monitored by PAs like Mr. Mahany.These trials are an essential part of the research process because they are the first step toward finding new treatments for the future.

During the Phase I trials, Mr. Mahany's role as a sub-investigator is listed on all of the trial's official paperwork.He participates in the initial review of the protocols and analyzes all the study's paperwork for clarity and to determine any conditions that might limit the trial in any way.The Institute for Drug Development is the largest Phase I program in the world, and each year approximately 500 patients undergo Phase I trials in oncology at the Institute for Drug Development.Mr. Mahany explains that there are typically more than 40 trials accruing patients simultaneously, and a patient may be involved in more than one trial.Before a patient is placed in a Phase I trial, however, it is Mr. Mahany's job to thoroughly evaluate the patient's medical history and to review their previous medical record as it relates to prior therapies.Mr. Mahany describes his typical day as being filled with direct patient care, including evaluating symptoms related to the drug therapies, performing physical exams, reviewing labs and other diagnostic studies, documenting the effects of experimental therapies, writing prescriptions and medical orders for patients.Other duties include recruiting patients for upcoming Phase I trials, educating patients about new therapies that are available and obtaining informed consent from patients who wish participate in Phase I studies."I spend a great deal of time talking with patients about their expectations for the trial, the time commitment they are willing to put in and the potential risks of the trial," he says.Once a patient actually begins receiving a new drug as part of the Phase I trial, Mr. Mahany sees them at least once a week to evaluate any toxicities that may have developed.He monitors patients for a variety of symptoms that may arise during the administration of therapy along with monitoring their overall response to these new therapies, ultimately determining whether or not the therapy was beneficial in each particular patient.

Although Mr. Mahany has worked in oncology since 1994 and in Phase I trials since 1999, he also has experience as a dialysis technician and in the areas of nephrology, internal medicine and emergency medicine.In 1972, after graduating from college and while working as a dialysis technician, Mr. Mahany met one of the first four physician assistants to graduate from the PA program at Duke University.This meeting was a turning point in Mr. Mahany's career, and he describes how, "After talking to him at length, I began to investigate the possibilities of becoming a PA.I subsequently went to work for a nephrologist who was Duke-trained and who participated in training the original PAs."Because this mentoring greatly influenced Mr. Mahany's career path, he, in turn, has mentored PA students in the past, and he hopes to continue to be involved in the mentoring process in the coming years.

During the more than 30 years Mr. Mahany has worked as a PA, he has seen many changes occur in the field.For the most part, he believes changes have had a positive impact on the profession, but there are also some current trends that he finds disconcerting including the ever-increasing number of PA programs surfacing across the country.Although Mr. Mahany believes that PAs are indeed in greater demand than they were several decades ago, he worries about the quality of education many of the newer PA programs offer."There is a real demand for PAs these days because of cuts in funding for medical care," says Mr. Mahany, "and people are trying to deliver a high quality of healthcare for a low cost."Although Mr. Mahany believes this is a worthy and necessary goal, his overall concern is that the quality of education may be lacking, and some new PAs may enter the field without the necessary tools to perform their jobs effectively.Because the length of PA programs vary at different institutions, it can be difficult to determine a standard of education across the board.However, Mr. Mahany does offer some advice to students who are considering a career as a physician assistant."Don't look at this as a stepping stone to medical school," he cautions.Describing the importance of taking the time to thoroughly review the needs of each patient and the previous programs they have participated in, Mr. Mahany emphasizes that PAs truly need to care about their patients and must be dedicated to providing the highest level of care to them."Staying objective in oncology is difficult, but you truly need to focus on the needs of the patients and their families.If you can't, then oncology is not a career path you want to take," he explains."Oncology is a very tough and demanding field of medicine.You need to have a tough skin and a warm heart.Sooner or later, you are going to get both broken by a patient."

The challenge of dealing with emotions is not the only difficult part of being a PA.Mr. Mahany finds that, as with so many other jobs in the medical field, the technology and science he uses every day is constantly changing.Describing how the science is "steaming along," Mr. Mahany admits that, at times, it can be difficult to stay on top of the latest research."The greatest challenge I face at the present time is keeping up with the rapidly expanding amount of scientific data that is being discovered on a daily basis," he explains."The amount of knowledge related to cellular biology, the human genome project, bio markers, cellular pathways and therapeutic pathways seems to double almost daily."In addition to keeping on top of all this information, he adds, "This is to say nothing about all of the new drugs and therapies that are now available for the treatment of a variety of disease states that I do not deal with on a regular basis."

In conjunction with his life's work, Mr. Mahany is also involved with several professional organizations, including the American Academy of Physician Assistants, the Association of Physician Assistants in Oncology, the American Association for Cancer Research and the American Society of Clinical Oncology.He attends the annual meeting for Physician Assistants in Oncology and has delivered a number of lectures at the American Academy of Physician Assistants' annual conferences.He believes that it is important for PAs and other medical professionals to become involved in professional organizations that support their work and he urges his colleagues to investigate opportunities for professional growth and networking.In addition to providing an outlet for sharing ideas and new information, he describes how meetings and professional organizations help increase the PA field's prominence and how word-of-mouth can eventually translate into even better care for patients.Through these organizations Mr. Mahany is able to network with professionals in other fields and, as a result of this interaction, is able to pass along information about studies and trials in other disciplines or areas of the country that may benefit his patients.Mr. Mahany urges his patients to investigate all of their options, and through networking he is sometimes able to find comparable trials for patients that are being performed closer to their hometowns.

Help!In the future, Mr. Mahany expects to see a greater dependency on nurse pract>