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This piece is presented by South Dakota Biotech.
Most physicians aren’t also researchers.
Most researchers don’t treat patients.
At Sanford Health, there are only a half-dozen physician-scientists.
“And it’s hard for those folks,” said Jill Weimer, who co-leads the Children’s Health Research Center at Sanford Health. “They feel like they’re never giving 100 percent to both jobs. But Sam gives 100 percent to both jobs. He essentially wears two full-time hats and gives them both 100 percent.”
Sam is Dr. Sam Milanovich, a pediatric oncologist at Sanford who also researches leukemia stem cells.
“My passion is to improve care for children with cancer,” said Milanovich, whose roots in the Dakotas run deep.
Milanovich knows firsthand how cancer can affect a family.
In 1992, when he was 12, Milanovich lost his father, Sam, to melanoma.
The elder Sam, a basketball coach at Dickinson State University in North Dakota, had been among the top players in Augustana University history when he played there in the early 1970s.
When it came time for college, his son also chose Augie.
“It was a really good experience for me,” Milanovich said. “I made a lot of great friendships, and it helped me find my way into medicine.”
He was a student assistant coach for the basketball team and through his basketball ties landed a job as a nurse aide at then-Sioux Valley Hospital, which became Sanford.
“Then I was awarded a scholarship from Sioux Valley when I went to med school, and that kept Sioux Valley on my radar,” he said. “I knew I wanted to do pediatric cancer, and it was around that time that Sioux Valley became Sanford and had plans to build the children’s hospital.”
After finishing a post-doctoral fellowship at the Medical College of Wisconsin, Milanovich returned to Sioux Falls.
“A number of things fell together,” he said. “My roots in the Dakotas, going to Augustana, and Sanford is a growing research program with a particular focus on children. So to me it was a great opportunity to be part of something that had that momentum and that trajectory.”
Milanovich was inspired to pursue research through his clinical experience.
“What we noticed with leukemia patients is that often we can achieve remission with chemotherapy, but too many times the leukemia will come back,” he said. “It might be months or years later, and we don’t have a good way of predicting why sometimes it comes back and sometimes it doesn’t.”
The answer exists in leukemia stem cells. If they aren’t all killed with treatment, they cause recurrence.
“So we’re trying to understand the processing underlying those cancer stem cells,” Milanovich said. “We’re trying to understand different genes that are important in making leukemia stem cells and how they work and lead to cancer stem cells.”
Sanford is a founding member of the pediatrics consortium as part of Cancer Breakthroughs 2020, a global collaborative initiative focused on testing immunotherapy protocols in combination with other treatments. The mission is to turn cancer into a chronic disease that can be treated.
“The fact that Sanford, Dr. Milanovich and his fellow researchers are at the forefront of this international effort is so significant for South Dakota,” said Joni Johnson, executive director of South Dakota Biotech. “The research and collaborations occurring here are going to have far-reaching impacts.”
Milanovich is among the national experts using comprehensive cancer molecular diagnostic testing to study pediatric cancer.
“We’re fortunate to be part of that and give access to children and families in our region,” he said. “Through that group, we’re looking to apply this cutting-edge technology to better understand the biology of different kinds of tumors and use that research to learn what makes these tumors tick.”
That knowledge can lead to better treatments and be used in designing clinical trials, he said.
“Hopefully we’ll start to make improvements for certain groups of pediatric cancer patients,” he added. “What I think a lot of people don’t realize about pediatric cancer is that through decades of research and clinical trials we’ve raised the bar for most of our patients. Over 80 percent of pediatric oncology patients we see, we’ll be able to treat their disease and have it not come back.”
The road to get there, though, “is still far from ideal,” he said. “Treatments have a lot of side effects both during treatment and later in life. We can still do better by those kids. And the other ones where we don’t have long-term survival rates, we have to offer something better.”
Milanovich is a humble leader with a lot of energy at Sanford, said Weimer, who supervises his research.
“He’s one you know is always going to say yes, but not in a yes-man sort of way. He will make sure there’s relevance to his research program, but he’s going to say yes with a smile and you know it’s going to be done with high quality,” she said.
An off-hand comment about a haircut led him to tell her he donated his hair to Locks of Love, which provides wigs to cancer patients.
“Most people are posting that on Facebook and bragging about it,” Weimer said. “For him, it’s just another day. He never boasts. And his science is like that, too. He sits between two next-gen area with some really cutting-edge science in leukemia.”
He “learns a lot from the kids,” Milanovich explains.
“Because of their honesty and openness. Kids will face this with a lot of positivity, and I feel like parents and other adults around them can learn from some of these kids.”
In the almost three years he has been at Sanford, Milanovich and his work have blossomed, Weimer said.
“I know how important it is for our people to go away and come home, and I see that in Sam. And seeing him come back to help transform medicine in our community and bring cutting-edge trials to Sioux Falls is really important.”
Milanovich keeps the ties that originally brought him to town, too. He speaks to genetic counseling students at his alma mater, Augustana, which has a relationship with the Sanford Imagenetics program.
In June, an event at Augustana will honor his father’s legacy for the 25th consecutive year. The Augustana Sam Milanovich Golf Tournament, or The Sammy, raises funds for scholarships in every men’s and women’s sport and has amassed a $500,000 endowment.
“It kept getting bigger and bigger and has become a pretty big fundraiser for Augustana athletics,” Milanovich said. “I think it speaks a lot to the Augustana family and the sense of community there.”
Looking back, coming back was the right choice, he said.
“I think this was the right decision. I’ve had great opportunity to be involved in these projects and grow my own career well in an environment that fits me,” he continued.
“All of us are touched by cancer at some point. If you don’t get it yourself, eventually somebody you love will. So wanting to understand that was always part of my drive to go into medicine. It’s very tough but it’s also very rewarding.”
At Sanford Health, there only are about six physician-scientists. Dr. Sam Milanovich is one of them. And for him, the role is about giving back and coming home.