June is Seniors’ Month, a good time to reflect on health issues particularly concerning to older adults – including the risks associated with soaring temperatures – like those being felt across Canada this week – and other climate-related events.

At the latest Sunnybrook Speaker Series, experts shared their insights about how climate change is impacting our health. Dr. Rajin Mehta, a geriatrician and internal medicine specialist and former head of Sunnybrook’s Division of Geriatric Medicine, shared his insights on how climate change, including extreme heat, can impact seniors’ health and well-being.

Temperature and its impact on the body

Temperature affects how humans feel and how bodies function.

“Humans can handle colder temperatures better than heat,” said Dr. Mehta. “The slightest change of just a few degrees in temperature elevation can impact the cells in our bodies, and in turn affect our organs.”

Neurological, liver, cardiac, and renal systems can all be affected by increased temperature, Dr. Mehta said. For older adults, who often have a number of illnesses or health conditions at once (known as multi-morbidity), this can be particularly concerning.

“Higher temperatures affect the function of these very important organs and if someone has more than one impairment in these systems, it can become very complicated, very fast,” said Dr. Mehta.

As people age, it also becomes more difficult for their bodies to regulate temperature, a process known as thermoregulation. Seniors have a decreased ability to thermoregulate, which makes it harder for them to adjust to hotter temperatures, even if the elevation in heat is minimal. This can lead to things like dehydration or heat stroke.

Unfortunately, not all seniors have access to things like air conditioning that can help minimize the effects of extreme heat.

“A person’s socioeconomic status is a critical aspect to consider because it has a direct correlation to one’s health and well-being.”, said Dr. Mehta.

Seniors can also be at increased risk of heat-related illnesses if they are taking certain types of medication, such as anticholinergic drugs which are commonly used to treat bladder and gastrointestinal conditions. These medications can impair the body’s ability to sweat, which is a natural way to cool down when temperatures rise.

Indirect Impacts to Health: Food Insecurity & Displacement

 A concern that’s top of mind for many, especially seniors who may already have limited finances, is food insecurity.

“We cannot forget that global issues impact us locally as well,” said Dr. Mehta.

“Seniors are disproportionately affected by poverty, and many are faced with the decision of paying for food or other costs of living like rent.”

Older people are also at a greater risk of displacement due to climate change, Dr. Mehta said. In the event of an environmental emergency such as a tornado or a flood, older people with limited mobility are more likely to face barriers getting to safety.

Given the increase in climate-change related natural disasters, it is important for seniors to have a safety plan in place in the event of an emergency, Dr. Mehta said, especially if there are underlying health concerns or mobility issues.

Key Takeaways

It is crucial to remember that climate change impacts all of us, but the senior population faces heightened risks.

However, there are steps older adults can take to protect their health, such as remembering to stay hydrated and cool, and talking to a health-care provider about how things like extreme heat events may impact their health or interact with their medications.

For seniors experiencing food insecurity, community resources like food banks can provide help. Some organizations also offer support for delivering food bank services to people who have limited mobility and are unable to leave their homes.

Seniors with limited mobility can also make a plan for family or friends to check in on them or help them find alternative living arrangements in the case of an extreme weather event or hazard.

Climate change impacts everyone, but seniors are especially at risk. Offering support, planning preventative measures, and talking openly about the issue can help lessen the risks and impacts caused by climate change among the senior population.

The post The Impact of Climate Change on the Senior Population appeared first on Your Health Matters.

Sunnybrook Health Sciences Centre is home to the Odette Cancer Centre, the second largest cancer centre in Canada. The centre is leading the way in innovative cancer care that is designed to meet the unique needs of individual patients living with cancer.

At the latest Sunnybrook Speaker Series, experts from the centre shared their insights about personalized cancer care and how it is evolving.

Dr. Calvin Law, chief of the centre, described the transformative future of personalized cancer care as the health-care system moves away from a “one-size-fits-all approach” and instead focuses on each individual’s experience and treatment needs in order to achieve the best possible outcomes.

“At the end of the day, it is the individual patient who we are serving,” said Dr. Law. “The personalized care we provide needs to get better every day.”

How do Genes Play a Role in Personalized Cancer Care?

Tracy Graham, genetic counsellor and manager with the Odette Cancer Centre Genetics Program, shared her insights on how a person’s genes can play a role in the personalized cancer care they receive – something many patients might not be aware of.

“All cancer is genetic because there has to be genetic mutations occurring within the cells of our body for cancer to occur,” explained Graham. “But only five to ten percent of cancer is hereditary.”

Genetic testing can be done for both hereditary cancers (germline mutations) and those which are acquired throughout a person’s lifetime (somatic mutations) to help determine the most effective treatment options.

Often conducted with a simple blood or saliva test, genetic testing can also provide patients with a sense of closure by answering the question, Why was I diagnosed with cancer?, said Graham.

“For example, for a patient who is diagnosed with colorectal cancer in their 20s – which is a young age – finding out there is a hereditary genetic reason behind it sometimes gives them that explanation they are looking for.”

Genetic testing and counselling can also help guide screening and early detection for other types of cancer a person could be at risk of developing, as well as for their family members.

The Future of Precision Oncology

Dr. Eileen Rakovitch, program research director with the Odette Cancer Centre, explained that experts are trying to better understand why standardized cancer treatments are more effective for some patients than others.

A key goal for the future of cancer care is to shift towards personalized treatment for each individual, as opposed to the same approach being used for all patients with the same type of cancer.

Thanks to breakthrough scientific technologies, cancer researchers can now pinpoint the molecular profile of cancers in order to recommend optimal personalized treatment plans.

“With molecular profiling, we now can see this individual with breast cancer, for example, has a different molecular profile than others,” explained Dr. Rakovitch. “Once you do that, you can match and individualize the best drug or radiation treatment for that specific individual.”

Added Dr. Rakovitch: “This is going to enable us to direct better and more effective treatments to patients and help them avoid side effects of treatments that are ultimately not going to be effective. This is the future of cancer treatment.”

Targeting Cancer with Personalized Radiotherapy

Dr. Deepak Dinakaran, a radiation oncologist with the Odette Cancer Centre and scientist with the Sunnybrook Research Institute, discussed how advances in radiation treatment are also contributing to personalized cancer care.

Radiation therapy, also called radiotherapy, uses high energy X-rays targeted at the cancer site to damage cancer cells in the hopes of stopping the future growth and spread of the disease.

“Thanks to technological advances over the past 10 to 20 years, radiation oncology has evolved to better target the site of cancer and significantly reduce how much radiation is going to the rest of the body,” said Dr. Dinakaran. “This precision radiotherapy has allowed us to evolve what we can do clinically to help patients.”

The next frontier of radiation treatment, he said, is adaptive radiotherapy. This aims to adjust a patient’s treatment plan on any given day based on sudden changes within the body. In simple terms: If the tumour or cancer site requiring treatment has suddenly moved, instead of directing radiation where it may no longer be needed, a more accurate site of the body can be focused on.

“Currently it is very hard to adapt to those kinds of internal shifts, but that is what adaptive radiotherapy aims to do by leveraging leading-edge equipment and artificial intelligence for image analysis,” explained Dr. Dinakaran.

“All of this happens within minutes while the patient is still on the bed. It is still new and evolving, but it will really open up new opportunities in how to use radiotherapy.”

The post Better Understanding the Complexities of Personalized Cancer Care appeared first on Your Health Matters.

Ever since it was ushered into widespread use during the pandemic, virtual healthcare has become a much more common tool — including for virtual urgent care.

Sunnybrook Health Sciences Centre partners with University Health Network (UHN) to provide Toronto’s Virtual Emergency Department.

The service offers same-day appointments seven days a week for adult Torontonians with an urgent medical concern that is not life threatening (e.g. body aches, rash, nausea), and who are unable to make an appointment with a family doctor or nurse practitioner.

At Sunnybrook, roughly 6,000 patients have been seen through the virtual urgent care program since it began in December 2020. Most express appreciation for the convenience, privacy, and flexibility it offers.

“Virtual emerg is a great idea…It’s convenient, efficient and it’s working well. Thank you for seeing patients in virtual ER!” – Patient

For patients from equity-deserving groups – i.e. communities that face barriers to opportunities, resources, or services such as healthcare – virtual urgent care is seen to provide additional benefits.

At the latest Sunnybrook Speaker Series, Dr. Sander L. Hitzig, Program Research Director and Senior Scientist at the St. John’s Rehab Research Program at the Sunnybrook Research Institute, spoke about why that is the case.

“The number one benefit of virtual urgent care is that people from equity-deserving populations feel more control over their care experiences,” he said. “They feel safer in terms of their physical and mental health compared to past in-person encounters where they felt prejudiced against.”

Examples of underserved or equity-deserving populations include people who are low-income, people with disabilities, refugees, Indigenous or racialized persons, or members of 2SLGBTQIA+ communities.

Dr. Hitzig, whose research often evaluates new technologies and models of care, began examining the use and impact of Sunnybrook’s virtual urgent care program shortly after it was launched, in partnership with Dr. Justin Hall, Emergency Department physician and Program Lead of the Virtual Emergency Department.

Initial data suggested people from equity-deserving populations faced barriers accessing the service, such as not having reliable Internet access or a private space for their online appointment. Low digital literacy or English fluency were also common barriers.

Drs. Hitzig and Hall, and their colleagues, decided to dig deeper to learn more. Together with Access Alliance, a multicultural health and community services partner, they designed a qualitative study with the goal of better understanding how virtual urgent care met the physical, emotional, and social care needs of equity-deserving patient populations.

The researchers interviewed patients over the age of 18 who self-identified as belonging to equity-deserving groups. Many identified aspects of virtual care that could be improved – such as technical requirements that could be challenging for people with a learning disability.

But most of the patients who were interviewed also had favourable things to say about the service.

“One of the things that came out loud and clear was that people really welcomed the convenience and flexibility of virtual urgent care,” Dr. Hitzig said. “And they appreciated not having to wait a long time to be seen.”

The option to avoid a long wait in a crowded emergency department was especially appealing to people with chronic illnesses who might be immuno-compromised, Dr. Hitzig added.

Some patients who were interviewed also noted the financial benefits of virtual urgent care, such as not having to pay for transportation or parking.

Many also liked the focus and attention they received from staff during virtual appointments and the professionalism of the care providers, Dr. Hitzig said.

He added that several patients said they preferred virtual urgent care to past experiences at physical emergency departments when they had felt belittled or discriminated against.

“There is more work that needs to be done to better understand how virtual models of care can be better tailored to people from equity-deserving populations,” Dr. Hitzig said. “But overall, it is seen as a compassionate tool that is making healthcare more accessible.”

Asked what makes him most excited about the future of virtual urgent care, Dr. Hitzig said it is the sense of empowerment that patients described after accessing the service.

“Having more options to give people greater control over how and when they access healthcare is important because we want to be partners with the patients we are treating,” he said.

“If people have more positive experiences, that will lead to better outcomes for the patient and the healthcare system.”

The post How virtual urgent care works – and where it fits in the future of emergency medicine appeared first on Your Health Matters.

While telemedicine already existed to some extent prior to 2020 – whether through pilot projects or routine phone consultations with a doctor or registered nurse – the pandemic accelerated the practice. Physical distancing requirements forced many care providers, including specialists, to shift more of their appointments to virtual platforms.

While pandemic restrictions are now lifted, many patients and care providers see virtual care as part of the future of health care because of the convenience and opportunity for interprofessional collaboration that it provides.

This is the case at Sunnybrook’s Odette Cancer Centre, where virtual care continues to be offered as part of the overall network of quality patient care – even in surgeons’ offices.

At the latest Sunnybrook Speaker Series, Dr. Calvin Law, Chief of the Odette Cancer Centre, spoke about why this is the case. He outlined why virtual care is especially beneficial when it comes to complex cancer surgeries.

In Ontario, high intensity cancer surgeries such as those for liver and pancreatic cancer are treated by teams of experts organized into regionalized ‘centres of excellence’. These allow doctors, nurses, and specialists from across the province’s health-care system to share data like medical images and lab results as they map out a patient’s care plan. This model has been found to help improve patient outcomes.

However, because most of these regionalized centres are based in southern Ontario, access has been challenging for people living in other parts of the province or even surrounding areas.

“Although a lot of the population is concentrated in the southern part of Ontario, that’s still a lot of kilometres for people to travel even in that area,” said Dr. Law.

That’s where virtual cancer care comes in.

[mks_pullquote align=”left” width=”650″ size=”22″ bg_color=”” txt_color=”#000000″]“What’s changed is we’ve made the journey a little bit easier,” said Dr. Law. “Virtual care gave us an opportunity to do something new.”[/mks_pullquote]

Dr. Law explained that in a patient’s cancer care journey, many appointments with specialists are devoted to analyzing test results or discussing surgical options rather than physical examinations or procedures.

“A lot of times you come in to speak to your surgeon or your other provider and it’s a lot of talking and exploring,” said Dr. Law. “Sometimes there’s the gentle touch on the shoulder but a lot of it is a conversation.”

Virtual appointments can be a good option for such times, saving people multiple in-person trips that can take up a lot of travel time and money for things like parking or gas.

But Dr. Law stressed that virtual appointments work best when conducted over online video platforms that still allow for visual communication between the doctor and patient.

“We think that seeing you not only has human communication value but there is also medical assessment value,” he said. “There’s a lot of things we can tell just by looking at you.”

Once patients are at the stage of deciding pre-operative treatments and planning, in-person visits are best – and often occur in a seamless transition from previous visits that were conducted virtually.

“Even though it’s the first time we’re meeting in person, we already feel like we know each other,” Dr. Law said. “Hopefully, we’ve established some rapport and trust and we kind of get to know each other’s personality.”

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Patients who prefer to have all of their appointments take place in person can still request to do so, but Dr. Law said many seem to appreciate the benefits of a hybrid approach to their cancer care.

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“As the patient you’ve just saved yourself a whole lot of trips while still getting the same value of care and the same human interaction,” he said.

The post How virtual care will fit in the future of cancer care appeared first on Your Health Matters.