Research on the front lines of cancer care

A series of RCN grants is looking at ways to improve the delivery of care across the network

Last fall, the RCN awarded six Cancer Quality and Innovation Research Grants, totalling $550,000. By creating partnerships across RCN hospitals to investigate pressing issues, the project teams aim to impact cancer care by using a network approach to problem solving. Three projects were profiled in the Spring 2015 issue of RCN Update (available online at mcgill.ca/rcr-rcn); the last three projects, profiled here, target barriers to optimal care and support for patients.

Faster treatment for oesophago-gastric cancer patients

Surgeon Lorenzo Ferri has a hunch that ramping up coordination is the best way to improve care for patients with oesophago-gastric cancer — and he's hopeful this will ultimately improve survival, too.

“Unfortunately stomach and oesophageal cancers are among the most aggressive we treat,” explains Dr. Ferri. “They’re also some of the more symptomatic. The difficulty eating associated with these cancers can interfere with our ability to effectively treat these patients. One of our primary goals is to shorten the time between diagnosis and the initiation of treatment.”

To achieve this, Dr. Ferri, the principal investigator of the STOP-Cancer Initiative (STOP stands for Streamlining the Trajectory for Oesophago-gastric Patients), wants to first put in place a navigator, “someone with a vested interest in helping patients navigate the healthcare system;” and second, “to have physicians and allied health professionals speak to each other and work on the same level.” 

The changes in patient flow will make a huge difference to all patients, but especially those from out of town. “They're here for a day or two and we coordinate their gastroscopies, endoscopic ultrasound, CT scan and all the visits of the surgeons, oncologists and radiation oncologists within a 24-hour period,” says Dr. Ferri. “That way, by the end of 24 hours, they know exactly what their treatment plan is going to be.” Treatment will then be carried out at a hospital closer to home, if possible.

The STOP-Cancer team, based at the McGill University Health Centre (MUHC), is measuring quality of life, anxiety and how long it takes patients to work their way through the system with the goal of improving in all three areas. “We see an average of 250 people a year with stomach and oesophageal cancer; it's the largest program in Canada,” says Dr. Ferri. “We've been active for six months and over 120 people have been involved in the study.”

MUHC-JGH-SMHC Team: Dr. Lorenzo Ferri will lead a team which includes Dr. Thierry Alcindor, Dr. Gad Friedman, Dr. Gaetano Morelli, and Dr. Kevin Waschke.

Mapping the “new normal” for survivors

“Survivorship is very challenging,” explains Rosana Faria, a psychologist at St. Mary's Hospital Center. “Patients feel they are left to themselves without a lot of resources to learn skills to deal with their 'new normal.'” Cancer patients need roughly the same amount of time to recover from treatments as they spent being treated, yet they are offered little guidance in the post-treatment phase. Faria and her team are looking at ways to improve this in an innovative participatory research project, entitled Looking Forward.

The Looking Forward research team is made up of five patients who are in the survivorship phase of their cancer experience and seven health professionals from St. Mary's and the MUHC. “Patients will have the same potential power in terms of their opinions, evaluations and propositions,” explains Faria. Together they will design and produce an experience-based intervention program for patients completing treatment. The program will then be piloted at oncology clinics at St. Mary’s and the MUHC.

The method chosen for data collection is participatory as well. The focus groups and co-design session with patients and health care professionals have helped form an idea of what information patients need and prefer. Important priorities include physical recovery, emotional changes, and returning to work. Delivery methods such as face-to-face meetings with a health professional, websites, and videos have been discussed.

Connecting survivors with community services is another big part of the project. “We will come out with a list of available resources which have been evaluated by our patient collaborators,” says Faria. In addition, seasoned survivors will share their experiences in post-treatment areas such as exercise — a difficult lifestyle change — to help more recent survivors find ways to stick with it.

SMHC-MUHC Team: Ms. Rosana Faria will lead a team which includes Dr. Tarek Hijal,Dr. Susan Law, Ms. Manon Allard, Dr. Joan Zidulka, Dr. Sergio Faria, Ms. Lisa Kathryn Goldenberg, Dr. Marc David, Dr. George Michaels, Dr. Laurie Hendren, Danielle Potas, Monique Ferland, and Givette Volet.

Prostate cancer guidelines and the disease management puzzle

Could the increasingly complex management of castration-resistant prostate cancer (CRPC) be making it tough for oncologists to follow national clinical guidelines? That's what McGill health economics & health outcomes researcher Dr. Alice Dragomir is attempting to investigate. Her two-year study aims to figure out to what extent this is the case and what effect it has on outcomes.

“The problem with this late phase of prostate cancer is that, because of the high number of medicines that are now used in its management, it is very complex and in continuous evolution,” explains Dr. Dragomir. “In 2013, new Canadian clinical guidelines were issued for CRPC, so we wanted to assess the quality of care received by our patients by measuring adherence to these guidelines.”

The team is looking at the charts of around 500 CRPC patients from the MUHC and the Jewish General Hospital (JGH). So far, the preliminary analysis of the MUHC data indicates that, indeed, patients did not always receive treatment in the sequence recommended by the national guidelines. Further work will be done to explain the observed differences.

“For example, the clinical guidelines state that symptomatic patients should receive abiraterone [CRPC drug] only post-docetaxel (chemotherapy), however there are some patients that received it prior to docetaxel.”

Adding even more complexity are physicians' own preferences for certain medications and patients' private health insurance plans that allow for different sequences of treatments, in addition to newer drugs that haven't yet made it onto the provincial formulary. Dr. Dragomir and her team are also looking at these factors to see if they lead to inequities in access.

MUHC-JGH Team: Dr. Alice Dragomir will lead a team which includes Dr. Franck Bladou, Dr. Fabio Cury, Ms. Olga Guerra, Dr. Wassim Kassouf, and Dr. Marie Vanhuyse.

 

 

 

 

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