Cancer Featured Patient stories

How Sunnybrook is providing care for colorectal patients 50 and younger

Written by Lindsay Smith

March is Colorectal Cancer Awareness Month. Historically, 90 per cent of colorectal cancer diagnoses have been in patients older than 50 years of age, but in recent years, there have been an increasing number of colorectal cancer cases in patients younger than 50.

While a cancer diagnosis at any age is scary, patients who are diagnosed at a younger age face specific challenges. Dr. Petra Wildgoose, clinic lead of Sunnybrook’s Young Adult Colorectal Cancer Program, supports these patients throughout their cancer care journey.

The role of the clinic

“The aim of the clinic is to address the complex and unique needs of young adult patients under age 50 who have been diagnosed with colorectal cancer, and the concerns they have to live with in the decades after having had that diagnosis,” says Dr. Wildgoose, who started the clinic with Dr. Shady Ashamalla, surgical oncologist at Sunnybrook, in 2019.

Some of the issues addressed include fertility concerns, sexual health and identity, family life (e.g. having young children at home), impact on work, relationships and psychological stress.

Dr. Wildgoose meets with patients for an initial consultation where she aims to learn their specific needs.

“We address mood, exercise, diet, sleep, fatigue, bowel habits, financial concerns, social concerns like child care, education if they’re still in school, or else their occupation and ability or plans to take time off,” Dr. Wildgoose says. At that point, she asks patients to complete a standardized symptom assessment tool that provides her with a baseline for the months ahead.

Follow up varies because it is patient- and treatment-dependent, but Dr. Wildgoose is available via email or phone for patients if they have questions, concerns or need referrals to other health-care professionals.

Aside from psychosocial concerns, Dr. Wildgoose also answers any questions patients have about their surgeries.

“It may be their first time going to the operating room, which is very scary and overwhelming. And even though it might be months away, it’s something people have on their mind,” says Dr. Wildgoose.

Providing resources and support

Andrea Rubino was referred to Dr. Wildgoose following a colorectal cancer diagnosis in March 2021, when he was 47 years old.

Andrea Rubino and his family. Photo provided courtesy of Andrea Rubino.

Andrea had been experiencing unexplained weight loss and other symptoms, but he hadn’t seen a doctor. After months of symptoms and feeling unwell, at his wife’s insistence, Andrea went to Sunnybrook’s Emergency Department. Doctors found a large tumour in his colon that would require radiation and chemotherapy to shrink it before he would need surgery to remove it.

Andrea had a long road ahead of him, and he says the support and resources he received from Dr. Wildgoose helped during a really difficult time.

“Dr. Wildgoose was so great to me and my family. She made it a lot easier for us,” Andrea says. “When you’re going through something like that, it’s literally the worst time of your life and there was someone there to help us, who always had our back and it’s nice. I’m so appreciative of that.”

Besides managing patients’ physical and mental health symptoms and treatment-related side effects, Dr. Wildgoose also connects patients and their families with cancer-related resources and supports.

“We work as a team, so I will refer patients to other health-care professionals, whether it’s spiritual care, psychiatry, dietitian, social work,” says Dr. Wildgoose. “And also the wonderful groups we work with outside the hospital.”

Andrea says those referrals and resources made such a difference for him, his wife and his three children. For example, Dr. Wildgoose was able to help the family get involved with Gilda’s Club, an organization that provides support to cancer patients and their families.

Coping with a life-changing diagnosis

“I hope that by providing those answers and helping patients navigate their cancer care that I am able to alleviate even a small proportion of their burden, which is quite heavy given that they are also trying to manage their work and families alongside their cancer diagnosis and treatment,” says Dr. Wildgoose. “It’s also helping them wrestle with bigger questions as well:  what does having a colorectal cancer diagnosis at such a young age mean to me? How do I frame this in the context of my life and move forwards? It’s a life-changing diagnosis.”

Andrea has lived that firsthand.

“It definitely changes you. When you’re in your 40s, you’re not generally thinking about life being over soon,” he says. “When you get [a cancer diagnosis], it changes your perspective on life a little. Makes you appreciate things a little bit more.”

In the midst of wrestling with a cancer diagnosis, treatments and surgery, Andrea says being able to reach out to Dr. Wildgoose at the Young Adult Clinic meant he and his family weren’t stressed out by trying to find resources or support.

“She just has a lot of the answers you need and sometimes those answers are hard to find when you’re dealing with cancer,” says Andrea. “It makes the whole thing easier and helps you to focus on what you need to do, which is just to get better.”

Dr. Wildgoose says the clinic is always evolving to better understand and address the needs of young adult colorectal cancer patients. But one thing that remains constant is the support and resources offered to patients during a difficult time in their lives.

“I don’t have all the answers, but I can help to direct you or find an answer for you so you don’t feel like you’re navigating this new world alone,” says Dr. Wildgoose.

Raising awareness for colorectal cancer

She also says she hopes the clinic will bring continued awareness of colorectal cancer in younger adults, to both patients and health-care providers.

“I think it’s important that patients feel empowered, so we need to bring education and awareness to them so they can feel knowledgeable about their own symptoms and the care they require,” says Dr. Wildgoose. “And we need to empower family doctors with the knowledge they need to identify colorectal cancer symptoms in younger adults sooner.”

One year after his treatment and surgery, Andrea says he is feeling pretty good. His scans don’t show any cancer.

“Even as bad as things are when you get a cancer diagnosis, things can get better,” he says. But he encourages people to see their doctor about screening or unusual symptoms as soon as they can.

“It’s totally not worth going through something like this to avoid an uncomfortable test,” he says. “If it’s going to keep you healthy, then just do it. The sooner, the better.”

Screening recommendations from Cancer Care Ontario for colorectal cancer can be found here.

About the author

Lindsay Smith