In Memoriam: A Tribute to Daniel J. Sargent, Ph.D.

Dan Sargent was 46 years old when he died unexpectedly on September 22, 2016, during a brief hospitalization at theMayo Clinic. He grew up in Rochester, Minnesota, where his family runs a successful landscaping business, before completing his undergraduate and doctoral degrees at the nearby University of Minnesota. While an undergraduate there, he caught the attention of Don Berry, the Bayesian statistician who works now at MD Anderson Cancer Center. Dan credited Don with luring him away from his childhood ambition to be an astrophysicist and convincing him to dedicate himself to biostatistics. I also credit Don with teaching Dan to love his work and to do it outside the boundaries of the field’s conventions. Dan returned toRochester in 1996as anewly minted Ph.D. assigned to support the gastrointestinal (GI) program at the Mayo Clinic Cancer Center,whichwe led together.Wemetonhis first day atwork. In response to his admission that he knewnothing about GI cancer, we spent our first hour reviewing the American Joint Committee on Cancer staging manual for colorectal cancer. Twenty years later, his knowledge basewas such that we worked together as members of the panel charged with revising the staging manual for its eighth edition. Our work together over 20 years has been a highlight ofmy life and led to 90 coauthored publications and many shared hours poring over databases, performing analyses, writing abstracts and papers, and presenting our work. Amongthemany importantthingsthatdefinedDanweretwo critical events that occurred in his youth. One was meeting his future wife, Becky, who became a veterinarian as he was getting his doctorate. Despite his early death, they had the good fortune ofenjoying a partnership that spanned a fewdays less than three decades. Becky and their two children, Alec and Paige, were a highlight of Dan’s life to whom he was highly devoted and by whom he never ceased to be amazed and delighted. Another event that indelibly shaped Dan into the man he becamewasadiagnosis ofHodgkin’sdiseaseas an11-year-old, followedbya relapse6months later.Hesurvived thediseaseas a consequenceof themultimodality therapy (surgery, radiation, andchemotherapy) thathewouldspendhisadult lifeevaluating and refining. That experience changed him physically and intellectually.Those of you who are keen observers would have noticed that he did not fill out the collar on his shirt, a consequence of mantle radiation delivered while he was still maturing physically. Invisible to us, his friends, he also endured changes in his cardiopulmonary status that were a subsequent governor on his physical capacity and likely contributed to his early exit. Those of us who worked with him and read his work know that his perspective as a cancer survivor profoundly influencedhis researchandhowheconductedit, justas itdid the restofhis life.Hisbrother,Nick,notedatthecelebrationofDan’s life that hewas not a doctor himself but that he attributed his brother’s early death to that childhood cancer. An example of how Dan applied both his innovative bent and his personal experiencewith cancer to his work occurred at the outset of our collaborations in the late 1990s. At that time, we were designing and running trials comparing the activity of irinotecanand oxaliplatin-based therapiesforpatientswithadvancedcolorectalcancer. Early in the days of computer monitoring and in the infancy of electronic mail (e-mail), Dan designed a program that monitored in real time grade 3 and higher toxicity events. We both received an automated e-mail every morning updatingusonseveresideeffectsamongpatients being accrued at more than 100 sites in the United States and Canada. With this primitive dashboard, we were able to discern unexpected toxicity, some of which led to fatal outcomes, and to intervene inourownstudyandother trialsbeingconductedacross the world. Subsequently, that trial led to the new indication of treatmentofmetastaticcolorectalcancerwithFOLFOX(folinicacid, 5-fluorouracil, oxaliplatin) and, together with scores of coauthors, we published more than 35 reports and evenmore abstracts and presentations spawned by that trial. Reports using that database are still being published almost 2 decades after the trial opened. This approach is a prototypical case study illustrative of Dan’s passion to be sure that we extracted as much useful information as possible fromevery patient whowas treated in a clinical trial. He discerned the value of collecting information from across studies that led us to pool clinical trial-derived data. He spearheaded this effort long before the term “big data” was born. He initiated the ACCENT group, which pools Daniel J. Sargent, Ph.D.