When initially he started as the first and only oncologist at MUSC in 1985, he had few options to offer his cancer patients, and treatments for blood cancers were limited. There was no cancer center at MUSC, let alone one with a National Cancer Institute designation.
“I tell people that I feel like Moses,” Stuart said. “You know, Moses wandered in the desert for 40 years, and then he saw the Promised Land, and he couldn’t enter. That’s similar to what’s happened here. After decades of frustration, there’s been an explosion of successful cancer medicines in just the last five or ten years.”
Stuart was influential in the establishment of a cancer center at MUSC and getting that cancer center NCI designated. He’s been a part of revolutionizing treatments in blood and marrow transplant (BMT) — and in an odd twist of fate saw those developments used to save his wife’s life when she was diagnosed with acute myeloid leukemia.
Stuart, who celebrates his retirement on June 25 with a reception at MUSC Hollings Cancer Center Pearlstine Healing Garden, recently received the Order of the Palmetto, South Carolina’s highest civilian honor presented for a lifetime of extraordinary achievement, service and contributions. It’s the latest in a line of awards for a physician who has helped the MUSC BMT program to become a top 10% blood and marrow transplant program in the country, based on survival rates, and helped to land a 2018 Press Ganey Team of the Year award for exceptional care and communication in treating adult and pediatric patients.
Raymond N. DuBois, M.D., PhD, director of Hollings Cancer Center, said Stuart’s contributions to cancer care in South Carolina are unparalleled.
“Rarely has an academic clinician-scientist spent an entire career dedicated to delivering lifesaving care, discovering the best and most effective care for his patients, reaching across borders to establish the most up-to-date care delivery in his field in other countries, training the next generation of care providers and establishing state-of-the-art stem cell transplant therapy for the entire population of South Carolina,” DuBois said. “Dr. Robert Stuart has done all of these things and more.”
MUSC President David J. Cole, M.D., FACS, agreed with DuBois that Stuart would be leaving a profound mark on MUSC and the state.
“A life-long advocate for his patients, Rob’s vision and dedication have led to high-quality, state-of-the-art cancer care for the entire state. He is arguably the most important figure in the history of clinical cancer medicine in South Carolina to date.”
Building cancer care at MUSC from the ground up
Stuart came to MUSC in 1985 as an eager and ambitious doctor from Johns Hopkins Hospital in Baltimore. When he arrived, he became the first board-certified oncologist on the full-time faculty at MUSC. Over the coming years, Stuart would forge a path toward improving cancer care and patient outcomes while also pushing the envelope of what could be achieved through cancer medicine.
“I spent the first year every day thinking ‘What have I done? This was not a good idea,’” Stuart said of the early days and the growing pains in oncology services. He stayed on, though, because he felt his colleagues were pulling for him and wanted him to succeed.
Three decades ago, cancer care was very limited. “The old paradigm was you cut the cancer out; it came back. You radiated it; it came back. Then you gave chemotherapy. So when I started in oncology, basically all of our patients were hopeless, and they all died.”
Stuart had lofty goals at MUSC, including the creation of a training program for future oncologists, improving treatments offered to people in South Carolina and launching a bone marrow/stem cell transplant program.
“One of my first projects was creating a chemotherapy infusion center, and the hospital helped with that,” he said. “It was gratifying to me.”
In 1986, Stuart successfully lobbied the MUSC medicine chair to allow him to apply for an oncology and hematology fellowship program to attract and train some of the most talented doctors in the country. Despite not having the actual program in place, the application was accepted.
“Of all things, my application reviewer was a self-described Jewish grandmother who was a retired pediatric hematologist oncologist, and she approved the program,” Stuart said. “We had never had anybody in training, and it was certified July 1, 1986. The first two fellows were residents from our own school.”
Now that program has graduated 116 physicians, specializing in hematology and medical oncology, many of whom now practice in South Carolina.
In 1987, Stuart moved on to perform a bone marrow transplant at MUSC — the first ever transplant in South Carolina. The facility wasn’t fancy — just a single room in the old hospital that utilized a large mobile air purifier machine — but from the beginning, the results couldn’t be ignored.
“We had an aplastic anemia patient, and we delivered the processed bone marrow by IV infusion. The patient had been in the hospital about a month and was having an average of two or three platelet transfusions a week. After the bone marrow transplant, he had just two more transfusions, and he recovered. He’s been in remission now since 1987.”
Stuart knew he would need to build a team around him if they were to continue the success. By the fall of 1987, a transplant team was in place. Three bone marrow transplants were done at MUSC that first year, a number that has now grown to more than a total of 2,400.
Ben Hagood, a former patient of Stuart, said the Hollings’ transplant program saved his life.
“My family and I, and the thousands of other South Carolinians who have received bone marrow or stem cell transplants at MUSC, are indebted to Dr. Stuart and the teams of physicians, nurses and other practitioners that he has trained,” Hagood said.
The making of a cancer center
With a fellowship program in place, bone marrow transplant center up and running, and signs of improving cancer treatment options, the time had come to form a cancer center in Charleston. Stuart was approached by MUSC leadership in 1988 about the idea, and later that year met with the staff of then-U.S. Sen. Ernest “Fritz” Hollings in Washington, D.C.
“We went to a small conference room, and I’m going over this proposal and explaining the things and how this was just an initial step,” he said.
The senator’s staffers were impressed, and so was Sen. Hollings. That year, Sen. Hollings added a line item in the budget for a $9 million energy efficient demonstration cancer center in Charleston — it was approved. “That got the building. Let me tell you, once you’ve got a building, people start taking you seriously,” Stuart said.
In 1993, MUSC Hollings Cancer Center was founded. Stuart knew that in order to support future growth, new ideas and perspectives would be needed at Hollings. Ten years after becoming the first oncology and hematology division director, Stuart stepped down. “It was not because I didn’t want to do it anymore but because I knew that is how you get new resources and new energy,” he said.
In 1997, Stuart was named chairman of the Department of Oncology at the King Faisal Specialist Hospital and Research Centre in Saudi Arabia. Just four years later in 2001, he returned to Hollings as director of the hematological malignancies program and medical director of the clinical trials office (CTO).
Getting personal with cancer and patients
Cancer wasn’t just a disease that Stuart dedicated his life to — it also was one he experienced personally. In 1993, Stuart became a patient, following a kidney cancer diagnosis. His outcome was good, but he credits that period for changing how he approached his patients.
“That changed my empathy a lot,” he said. “There are some little things that they don’t teach you in medical school. I think the most important thing you can develop is the capacity to listen to your patient.”
Listening is something Stuart has done a lot of with patients over his career. It’s one of the reasons he receives such high patient satisfaction scores and why his peers have elected him as one of the Best Doctors in America since 1996. Stuart’s patient interactions have gotten the attention of co-workers over the years, including Tricia Bentz, director of Hollings CTO, and Shanta Salzer, CTO program manager.
Bentz said it’s magical watching him enter a patient’s room. “As soon as he opens that door and that patient is sitting in front of him, he lights up,” she said. “He’s holding hands, asking how their kids are doing. It’s like there is nothing else in the world other than that patient. In such a dark state, when people are hearing about a cancer diagnosis or going through therapy, it helped make a lot of patients feel comfortable and supported by him.”
Salzer agreed with Bentz’ description. “I don’t think I’ve met a patient who doesn’t have something good to say about Dr. Stuart,” said Salzer. “No matter how their conditions have gone with their diseases, he’s always been one to look at treatment options. He’s not one to give up easily.”
Hollings nurse practitioner Laura Milligan, R.N., who has worked with Stuart for years, said she stills remembers the first time she was present when he had to tell a patient there were no more available therapies.
“He sat on the bed and held the patient’s hand, and those two grown men shed tears together,” Milligan said. “The bond you form with your patients in oncology is intense. I have been impressed with Dr. Stuart’s ability to form that bond with patients over and over again.”
Stuart said those patient interactions have had profound impacts on him since becoming a doctor.
“I am amazed continuously by the graciousness of people,” he said. “I have had patients for whom we fought hard for and did everything we could, and the patient died. Then I get a letter from the surviving spouse just full of gratitude and compliments and love.”
In 2000, while still in Saudi Arabia, cancer struck close to Stuart again. Charlene, his wife, was diagnosed with acute myeloid leukemia. The Stuarts returned to Charleston for a treatment regimen at Hollings that included a bone marrow transplant — the same program Stuart helped to create, and Charlene supported as hospital director and CEO of the MUSC Medical Center, in the 1980s.
“As of November 2020, she is a 20-year survivor,” Stuart said. “That’s pretty gratifying.”
In the 1980s, success stories in patients with acute myeloid leukemia would have been few and far between. Stuart said the turnaround over the years proves just how far cancer treatments have come in his lifetime.
“To me, treating acute leukemia in the mid-1980s was like climbing Mount Everest without oxygen. It was the ultimate challenge. Now I have high expectations of my patients’ outcomes.”
Paving the future for improved care at Hollings
Instrumental in helping the cancer center to receive the highly sought-after designation from the National Cancer Institute, Stuart paved the path for broader use of clinical trials. The breadth of successful research and clinical trials at Hollings was one of the contributing factors to becoming a National Cancer Institute-designated cancer center in 2009.
Bentz said Stuart always held the vision of being more inclusive of clinical trials. “Dr. Stuart changed the culture,” Bentz said. “He was a really big advocate for what clinical research is and how that benefits cancer care. He was really a pioneer.”
During his time at Hollings, Stuart has served as primary investigator in over 350 clinical trials and has helped to enroll more than 1,200 patient volunteers for trials. His clinical research team contributed to trials that led to FDA approval of six of the seven new treatments for acute myeloid leukemia, the condition that threatened his wife’s life.
“Dr. Stuart has always been a big proponent of clinical research and really jumped into any patient-care activity or leadership role that the cancer center needed,” Bentz said. “I think he had this overarching vision of what the cancer center could be.”
Stuart believes treatments being offered at Hollings, like targeted therapies, CAR-T-cell therapy and bone marrow transplants, will continue to improve and save more lives in the coming years. “Bone marrow/stem cell transplants are often used to treat otherwise fatal conditions and you win big or you lose big, and we’ve been winning,” he said. “It is the most exciting time in my career, and it’s just amazing.”
Though it’s hard for him to leave Hollings, he is proud of the bright minds that have been recruited to the cancer center and the amazing staff in the BMT program. He feels confident in the team he leaves at Hollings.
Stuart and his wife have big plans for retirement that include a four-month-long trip that will take them to destinations like Portugal, the Canary Islands, Morocco, Malta, Spain and France. Stuart doesn’t rule out a part-time return to medicine in the future but said he is dedicating more time to travel and family.
“It’s the most gratifying career that I could have ever had,” he said. “The support I have received at MUSC has been incredible, and I’m forever grateful.”
Though colleagues will be sad to see him go, they relish the lessons they’ve learned from him. Cindy Kramer, R.N., program director of BMT at Hollings, said Stuart never accepted no as an answer and always pushed for better treatment options and cures. As he leaves, doctors and researchers at Hollings will continue pushing cancer care forward.
“He is always thinking about the next highest level of care we should be delivering,” Kramer said. “He would say, ‘Don’t ever get complacent with what you’re doing now because it can always be better. We should never be comfortable while there are still patients that we cannot cure.’”