A Desire For Holistic Medicine Drives Nathaniel Myall’s Treatment of Lung Cancer Patients
Nathaniel Myall, MD
According to Nathaniel Myall, MD, a good doctor is one who looks at medicine holistically.
“Holistic medicine for me is not defining a patient by XYZ conditions, but looking beyond that,” he says.
This view of medicine developed, in large part, from Myall’s own experience as a patient. He was born with a rare genetic condition called Nager syndrome, which leads to underdeveloped bones in a person’s face, hands, and arms. This can cause delayed speech development and feeding and breathing problems during childhood, along with hearing loss.
“I wanted to use that experience in a productive way and apply it knowing what the patient experience is like,” says Myall, who grew up in Redwood City and received all of his childhood care at Stanford Medicine. “I learned how important it is in medicine to see our patients as full people.”
Myall’s experience as a patient and his fascination for medicine spurred him to become a doctor. He took premed courses as an undergraduate at Stanford and then attended Stanford School of Medicine. After graduating in 2012, he started his residency in internal medicine at Stanford, where he was exposed to the inpatient oncology ward. This experience motivated him to specialize in oncology, and he spent four years following his residency as a hematology/oncology fellow with Heather Wakelee, MD, who concentrates on lung cancer treatment.
“Once he started his fellowship, he really distinguished himself in his humanism. He’s just so caring and thoughtful, and has an incredible depth of medical knowledge,” says Wakelee.
For the past two years, Myall has been a clinical assistant professor at the Stanford Cancer Institute, where he focuses on non-small cell lung cancer (NSCLC)—one of the two major types of lung cancer that make up about 85% of all cases.
“I knew I wanted to be in an area of medicine where I could really have strong relationships with my patients,” Myall says. “There’s that relational aspect where you really have to walk alongside your patients and get to know them as individuals—what their goals are, who they are as people. That really informs how they approach their treatment.”
A Focus on Lung Cancer
The “non-small cell” part of NSCLC refers to how the cancer cells look under a microscope. Unlike the cells in small cell lung cancer, which appear small and round, the cells that make up NSCLC are larger and typically grow at a slower rate.
Myall also sees patients with neuroendocrine tumors, which are cancers that begin in the specialized neuroendocrine cells that produce hormones and allow the body to function properly. Most of these tumors occur in the appendix, small intestine, rectum, pancreas, and lung — which is where Myall focuses his efforts.
He was drawn to lung cancer, in part, because of the variety of treatment options, including chemotherapy, immunotherapy, and other oral drugs that target specific genetic mutations that may appear in lung cancer. “We can tailor those treatments based on any one person’s type of lung cancer and genetics,” Myall says.
“Holistic medicine for me is not defining a patient by XYZ conditions, but looking beyond that."
– Nathaniel Myall, MD
In a typical week, he spends two days seeing patients in his thoracic oncology clinic (which focuses on cancers in the chest area). Additionally, he spends about 12 weeks per year doing inpatient work for cancer patients who are admitted to Stanford Hospital, which includes managing chemotherapy treatment and medical complications of cancer.
As a clinical assistant professor, he teaches medical residents and fellows who rotate with him in the thoracic oncology clinic. Along with teaching the basics about proper lung cancer treatment, Myall works to educate the new generation of doctors about holistic care.
“My goal with holistic medicine is to build trust—to let them know that I care,” he says. “It’s a team effort. It’s not me just telling them to do something; it’s about being open and honest and having a dialogue.”
Testing Vital Drugs
That amount of work would be enough for most doctors, but Myall does even more.
On top of his clinical work, Myall has been an investigator for a phase 1 trial on two drugs, afatinib and necitumumab, to see how effective they are in treating patients with a specific type of NSCLC where the gene for epidermal growth factor receptor protein (EGFR) has mutated.
EGFR is a regulatory protein that serves as an on-off switch and helps control cell growth, explains Wakelee, who has worked closely with Myall since his residency. Many times, cancer begins because a regulatory protein is switched on all the time, leading to uncontrolled cell growth and division.
There are oral medications that can turn off mutated proteins like EGFR, but over time the cancer cells may develop secondary mutations that change the way these drugs bind to them, making them resistant to treatment. This is one of the reasons why it’s so important to test the efficacy of new drugs, Wakelee explains.
Myall has been an author on three studies that were published in 2022, which range from a case study on an NSCLC patient who received a novel type of therapy, to an evaluation of 120 NSCLC patients whose cancer spread to other parts of the body, to a comparison of two types of treatments for NSCLC patients with another specific type of gene mutation.
My goal with holistic medicine is to build trust—to let them know that I care. It’s a team effort. It’s not me just telling them to do something; it’s about being open and honest and having a dialogue.
– Nathaniel Myall, MD
“Dr. Myall did extra work during his fellowship to learn how to be a clinical investigator,” Wakelee says. “He has kept his work as a clinical investigator an important priority now on top of shouldering a lot of clinical responsibilities as an attending physician. But he never complains; he keeps going. He’s an amazing team player.”
Myall admits that, as a newer attending physician, he is still trying to figure out the best way to balance his research with his clinical duties. He notes that he is lucky to have a team filled with amazing physician assistants, nurse practitioners, and nurse coordinators who help to lighten his load. “I’m fortunate to have a great support group in the clinic,” he says. “That makes a huge difference.”
At the end of the day, Myall’s main goal with his research is to better serve his patients. “I try to tie all my work together. The research informs what I’m doing in clinic. It helps to look at it that way: It’s all interconnected,” he explains.
There are still plenty of knowledge gaps in the field of NSCLC, and the more that doctors know, the better informed the recommendations and treatments for their patients are, Myall notes.
Wakelee sees that Myall’s personal experience in the medical system has given him deeper insight into what it means to be a patient, thereby allowing him to be a more attentive and knowledgeable doctor. But, at the same time, she says, “he would be this way regardless of his background. He is just a warm, caring, and brilliant person.”