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Fighting the Good Fight

Guneet Sarai, MD, finds inspiration in her brain cancer patients

LOUISVILLE Growing up in Chandigarh, India, Guneet Sarai, MD, would often go with her father to his work at the local hospital. Now deceased, he was an anesthesiologist who took great pride in his work and the role he played in patient care. His job mattered to him, and it was a lesson he wanted his daughter to learn.

“He would take me with him to the hospital to see what he was doing,” says Sarai. “Just looking at how satisfied he was from his job, very early in childhood I decided that I wanted to become a physician.”

Sarai stayed on that path, attending the Government Medical College and Hospital in Chandigarh before coming to the United States. In 2011, she completed an internal medicine internship at Johns Hopkins Good Samaritan Hospital in Baltimore, where she also did her residency in internal medicine in 2013. She finished a neuro-oncology fellowship at the University of Virginia in 2023, then joined UofL Health – Brown Cancer Center as the director of neuro-oncology in August 2023.

Sarai specializes in the treatment of brain and spinal cord tumors. It is an area of focus she was drawn to during her time at Johns Hopkins.

“When I was rotating, I would go to the neuro-oncology clinic and work with my attendings,” she says. “I would see patients with brain tumors in the clinic. I started doing research on neuro-oncology and I found how challenging it was — the diagnosis, the treatment of brain tumors, talking to the patients, trying to help them with the symptoms they had. I also found out how we established a relationship with the patients and helped them through this journey with treatment. It gave me a sense of satisfaction to help them through their journey. That’s when I decided this was the fellowship I wanted to do.”

Yes, just like her father, Sarai found a profession that brought her satisfaction. She understood the value of that and continues to do so, on a daily basis, at the UofL Health – Brown Cancer Center, where she already feels right at home.

“When I interviewed here, I found this to be a really good group,” says Sarai, whose husband, Bikram Saini, MD, recently joined the University of Louisville School of Medicine Department of Family and Geriatric Medicine. “We have excellent neurosurgeons and radiation oncology doctors. I found the team not only to be excellent in what they do, but also very personable. I knew they would be excellent coworkers.”

Collaboration and Multidisciplinary Care

These team members meet mid-day as part of what they call the “tumor board,” a multi-disciplinary board that discusses all the patients that have been or will be seen that day. In addition to Sarai, the tumor board includes neurosurgeons, a neuro-radiologist, a radiation oncologist, and a neuropathologist.

Prior to the meeting, Sarai sees brain tumor patients at her clinic in the UofL Health – Brown Cancer Center. After tumor board, she is part of a multidisciplinary afternoon clinic in which the patient stays in one room and is seen individually by the various specialists involved in that patient’s care. Sarai also sees patients in the hospital if her opinion is needed. Patients with brain tumors often present with seizures or stroke-like symptoms and are diagnosed via MRI.

“Most brain tumors end up needing surgery, and that’s where the neurosurgeons come in play,” says Sarai. “When surgery is not possible, we take a small tissue sample to test called biopsy. Once we have this diagnosis,

the next step, though not all patients need it, would be radiation. We then send the patient to the radiation oncologist here at UofL Health. Once the radiation is over, they come back to me to get chemotherapy if needed.

New Treatment Options. More Hope.

Many times, Sarai’s first meeting with the patient is a difficult one.

“Sometimes when the patient comes to me, they are not even aware that they have a brain tumor or they are not sure and awaiting the final results,” she says. “Unfortunately, that’s when we have to break the news that there is a brain tumor. After I introduce myself, then we talk about the diagnosis and why it is a higher or lower grade diagnosis, whether it is a primary brain tumor, or brain tumor that comes from cancer elsewhere in the body. Then we talk about the treatment options. The outcomes really depend on what kind of tumor it is. Some lower grade tumors have really good outcomes. For higher grade tumors, we are in the process of developing better chemotherapy and better treatments.”

While there is hope due to significant advancements in treatment, as well the new information gained via ongoing clinical trials, Sarai knows all too well how difficult it is for a patient to hear that they have a brain tumor.

“The next question is the most difficult question that a neuro-oncologist has to deal with — ‘What is the prognosis?’” says Sarai. “It’s always very difficult. Not sometimes. Always.

Patient Empathy Is Key

Sarai shares the good news with her patients that brain tumor patients are living longer and that new techniques and treatments are showing promise. There is hope, but she understands how crippling the diagnosis can be. How does she get through the process of sharing this news on a regular basis?

“By having empathy and understanding how difficult it is for the patient to even know that they have a brain tumor,” she says. “This is the most difficult situation in their life, and this is a human being who is depending on me to help them through their journey. It’s my responsibility to do that. The patients themselves are so resilient. Despite the difficult diagnosis, their attitude toward life — I mean, there’s so much to learn from my patients. Even if it’s a poor prognosis, they want to make the best of their life, they want to spend their time with their family. This is what gives me the courage. That’s what keeps me going.”

It also helps that Sarai can often offer genuine signs of hope. New therapies and treatments are producing better outcomes. She is involved in three clinical trials, actively seeking more information and examining new treatment plans.

“Diagnosis of brain tumor is not the end; it’s the beginning of the journey, actually,” says Sarai. “We can offer more clinical trials here; even if the tumor comes back, we do have more chemotherapies available as a second line. We can do genetic testing of the tumor and try newer treatments available.”

Sarai cites immunotherapy and the use of tumor treating fields — mild electrical fields that are sent through the patient’s scalp to disrupt the cancer’s spread — as promising treatments developed and enhanced in recent years.

“We also have advances in knowing the gene mutations involved in tumors with meningioma and treat them accordingly,” Sarai says. “We have better chemotherapies for central nervous system lymphoma, another difficult to treat brain tumor. All of these are advances in treatment.”

Despite the encouragement of improved treatments and clinical trials, Sarai knows that the diagnosis of a brain tumor can be devastating and the course of treatment daunting. It’s a long journey, but one she is committed to taking with her patients.

“Helping my patients through this difficult diagnosis and the treatment gives me a sense of gratitude,” says Sarai. “It gives meaning to my life, that I have done something meaningful and have helped these patients through the most difficult diagnosis — and actually the most difficult treatment — that you can ever imagine. This is the right place for me. This is what I wanted to do from day one when I became a physician.”