Aleks Kostic joined OrACORe as a research assistant after graduating from Princeton University with a…
This is the first in a series of profiles we are doing to highlight the work of our collaborating physicians.
Dr. Andrew Schoenfeld is an orthopedic surgeon, specializing in spinal surgery, at Brigham and Women’s Hospital. He has been doing research at OrACORe since joining the Brigham as a clinician scientist in 2015.
The STrIDeS (Spinal metastasis TReatment In DEtermining ambulatory Status) project, which is in the final stages of data analysis and manuscript preparation, has been a focus of his time here. The study examines how patients with spinal metastases approach treatment decisions and the implications that non-operative vs. operative treatment may have for their ability to independently walk. (To learn more about this study and read its publications, click here.)
We sat down with Dr. Schoenfeld to discuss STrIDeS, balancing clinical and scientific work, and fashion!
What is the focus of your research?
“My main area of research interest involves decision making for patients with spinal metastases. This has been the core of the work I’ve performed within OrACORe and in collaboration with [Drs. Katz and Losina]. I have been able to perform this work due to a K23 award from NIAMS and both [Drs. Katz and Losina] are mentors on that award, which is finishing in this coming year.
Since I’ve been at the Brigham, I’ve [also] developed a lot of research around sustained prescription opioid use after surgery, with a focus on an orthopedic population. I would not have anticipated that opioid use would be a focus of my research, but it came about organically, which is the beauty of being in a place like this.”
What led you to start the STrIDeS project?
“The STrIDes project arose because I was interested in the intersection [between] patient valuation of quality of life and decision making in orthopedic surgical care. Originally, I thought I would focus on hip fractures, which are also very important; however, as I was on the cusp of returning to the Brigham, there was a happy coincidence in that my future spine colleagues within the orthopedic department were initiating research on spinal metastases.
We developed a scoring system for spinal metastases that gained good traction and was the basis of funding from the Orthopedic Research and Education Foundation. That project dovetailed nicely with the goals for my K23 grant, [which provided the funding for STrIDeS].
As a spine care practitioner, these research projects ended up intersecting well with my clinical practice. My personal experience with OrACORe has been wonderful, and collaborating with [Drs. Katz, Losina, and Collins] and several research assistants has been great!”
How do you balance your clinical and scientific work?
“It’s really healthy for me to have both, and I’m very passionate about academics and research. I love conducting research projects and publishing the findings, and I’m also engaged on the editorial side with several journals. While we still receive rejections, whether it’s from grants or submissions to journals, it’s very helpful and personally therapeutic to transition to clinical care when overly-stressed.
My work week is broken up so that every other day is a research day versus a clinical day. The clinical environment is focused on helping people and talking with patients about their medical problems. In the clinic, I set the research world aside. Clinical care, as you can imagine, can become stressful too, and so it’s nice to come back to the research side.
There is an intersection in a conceptual way between my two work worlds, but they are also mutually exclusive sectors, and each acts as a respite from the other. Always having my hand in the research world allows me to stay current on the latest developments, and this prevents me from becoming antiquated in the clinical care we provide.”
If there was one thing you wanted people to know about your research and practice, what would it be?
“It can be difficult, for both clinicians and patients, when dealing with a condition as challenging as spinal metastases because there is often a limited life expectancy and treatments are not curative. It is incredibly important, though, to be thoughtful about patient goals and expectations and to wed them so that an individualized treatment approach can be formulated. It is also critical to ensure that patients understand the risk-benefit paradigms before embarking on a treatment course.[Similarly,] from the opioid side, [you need to understand that] patient, societal, community, hospital, prescribing, and surgical factors play a role in the proclivities for post-surgical opioid use that could ultimately transition into addiction and opioid misuse. Those should also be properly weighed by the care team upfront, even before the surgery is performed, to develop an effective post-operative pain management plan that minimizes the potential for adverse consequences to occur within the patient and the community.”
What do you like to do outside of work?
“I do exercise quite regularly, but probably my number one hobby is fashion. I have a lot of ties, sport jackets, suits, and shoes, and this interest often surprises many people. One of the hardest things about the COVID quarantine is that I don’t get to see people in the way where you can appreciate their whole ensemble. I also love college sports, football and basketball primarily. I have a mental catalogue of all the mascot names!”
Where do you see your career going in the future?
“I will absolutely continue in these various areas of research and my goal is to transition to an independent research program, and to contribute what I’ve learned to the next generation of clinician scientists.”