“Rightfully a lot of attention is paid at the time of diagnosis and active treatment,” Dr. Al-Khaifi said. “Many breast cancer survivors have told me that while they felt they had a lot of information and support during their active treatment, once treatment stopped, they lost the continuity of care with the physician.”

It means patients are often left wondering what to expect, what to watch out for with respect to cancer recurrence, and what to do about ongoing side effects of treatment.

“After treatment ends, it’s very common for side effects to continue,” Dr. Al-Khaifi said. “It’s not just a ‘return to normal life.’ Pain. Lymphedema. Anxiety. Depression. Self-image changes. Sexual dysfunction. Menopausal symptoms that are caused by cancer treatment. And the fear of the cancer coming back. All of these contribute to the patient’s quality of life.”

Long-term survival rates after the diagnosis of breast cancer are improving, with a 5-year survival rate in Canada of 90 per cent.

“The continuing improvement in survival rate, coupled with an aging population, contribute to an increase in survival population. As a result, follow-up care with a focus on quality of care is increasingly important,” Dr. Al-Khaifi said. “Research shows that a quarter of breast cancer survivors report anxiety, depression and fears around recurrence, and anecdotally based on my experience with breast cancer patients, I believe the rate is much higher.”

Dr. Al-Khaifi wanted to improve the lives of breast cancer survivors and that’s why she developed and proposed the Sunnybrook Breast Cancer Survivorship Care Clinic. Currently she is the physician lead of the survivorship program at the Louise Temerty Breast Centre.

“I met a patient who had completed treatment and had a good prognosis. She was so acutely anxious of cancer recurrence and her self-image was so low after her body changes that she told me she didn’t leave the house. As a healthcare team, we have to support the whole person. We have to provide women like this with more support and resources after their active treatments like chemotherapy and radiation end.”

Dr. Al-Khaifi works with patients to create an action plan and address their side effects and concerns, and promote a healthy lifestyle to help reduce the risk of recurrence. She also works closely with family doctors to assist in the transition of care back to the community physician.

“Research shows family physician-led survivorship care is as good as specialist care with no difference in recurrence-related serious clinical events. Patients are generally more pleased with their care because it’s closer to home and more comprehensive, and their quality of life improves.“

The care is also individualized, she adds.

“Everyone is different, and everyone responds and reacts to cancer treatment differently. We use a practice-based, evidence-based and personalized approach to help support the whole person through their cancer journey.”

The approach can also have an impact on the healthcare system, she adds, by helping open up cancer physicians’ caseloads for active treatment patients.

“Plus, educating patients on what’s ahead and providing follow-up plans can help reduce fears, which reduces the demand for unplanned care and the amount of imaging, and the costs associated with that.

“So, this approach can be cost effective and beneficial for the healthcare system as well as patients. Further, this may support better coordination between cancer teams and family physicians through treatment summaries and survivorship care plans.”

The post Dr. Muna Al-Khaifi on closing the gap in breast cancer treatment appeared first on Your Health Matters.

Rates of lung cancer are decreasing, and strategies such as enhanced screening and detection methods can lead to an earlier diagnosis, which can result in better patient outcomes. Recognizing these improvements (in addition to decreased incidence of cigarette smoking), enhanced treatments, and the latest forms of radiation technologies, Sunnybrook experts recently reiterated the White Ribbon Project’s message that it is indeed “time to change the lung cancer story.”

The White Ribbon Project’s advocacy is based on promoting lung cancer awareness, in addition to altering the public perception of the disease rooted in years of misleading campaigns. At the last Sunnybrook Speaker Series event, guest presenters Surgical Oncologist Dr. Calvin Law (Chief of the Odette Cancer Centre), Radiation Oncologist Dr. Alexander Louie, Respirologist Dr. Harvey Wong, and Thoracic Surgeon Dr. Negar Ahmadi highlighted the advances in treating lung problems and malignancies that have contributed to a significant improvement in outcomes over the past few decades.

Innovations in Lung Cancer Treatments

Innovations in cancer treatment include various new trials taking place at Sunnybrook that involve SBRT (Stereotactic Ablative Body Radiotherapy). New surgical approaches for treating early cancers are also available, and becoming more minimally invasive, including robotic surgery, and removing smaller portions of diseased lung (i.e., segmentectomy rather than lobectomy).

At Sunnybrook, outpatient Interventional Pulmonology programs such as LDAP (Lung Diagnostic Assessment Program), are helping to expedite the work of patients with suspicious findings for lung cancer. This in turn results in quicker cancer treatments for patients, resulting in better patient outcomes. Minimally invasive methods are now available to confirm the diagnosis of lung cancer (i.e., scopes with ultrasound capabilities, in conjunction with navigation software, result in a painless and incisionless tissue sampling). While these innovations are currently in use, there are also newer technologies (i.e., Robotic Bronchoscopy) that are not yet available in Canada, but are being actively investigated and explored internationally.

Minimally invasive interventions are also available to manage complications related to lung cancer such as airway dilatation and the debulking of tumors from central airways. Another outpatient Interventional Pulmonology program, the EPIC (Effusion Procedural Interprofessional Clinic), inserts indwelling catheters so patients can have the fluid that forms around the lung drained in the comfort of their own home, rather than requiring frequent visits to the hospital.

Positive Outcomes from New Lung Cancer Innovations

• Enhanced treatment for patients
• Improved patient support and home care collaboration
• Faster treatment of cancer complications
• Increase in minimally invasive removals
• Enriched patient experience

Early Screening Saves Lives

Those between the ages of 55 and 74, with a current or former history of smoking (or who have quit smoking within last 15 years), are advised to talk to their primary care physician to see if they quality for lung cancer screening via CT scan. Lung cancer screening saves lives, and Sunnybrook continues to ensure that patients have the latest and most successful options.

Recommended Readings from our Experts

Offering perspectives from lung cancer patients, physicians, and on navigating the Canadian health care system.

• “The Emperor of All Maladies” by Siddhartha Mukherjee
• “When Breath Becomes Air” by Dr. Paul Kalanithi
• “Taking Charge of Cancer” by Dr. David Palma

The post Advances in Lung Cancer Treatment: Changing the Lung Cancer Story appeared first on Your Health Matters.

Treating cervical and other gynecological cancers used to require an uncomfortable procedure and overnight stay at the hospital. Now, with the help of an innovative imaging and operating suite at Sunnybrook, some patients can receive treatment in hours rather than days – all with minimal discomfort.

Sunnybrook’s specialized MRI-Brachytherapy Suite combines the power of magnetic resonance imaging (MRI) with an operating room and radiation bunker. In this space, doctors can pinpoint tumours and place a radiation source directly into cancerous tissue, while using MRI to observe the treatment “in real time,” says Sunnybrook radiation oncologist Dr. Eric Leung.

The entire procedure, known as gynecological interstitial brachytherapy, can be performed in adjoining rooms, rather than transporting a patient between imaging and operating suites across the hospital. This has turned a lengthy treatment, which previously took up to 48 hours, into an outpatient procedure that is quicker and less painful.

During a gynecological interstitial brachytherapy, MRI is used to guide the placement of a tube-shaped applicator and around 20 thin needles that deliver large doses of radiation to the vagina, cervix or uterus while avoiding healthy, sensitive tissue.

Prior to the suite, patients would have to wait for a few hours – awake – with the applicator inserted, which many people found uncomfortable or painful. They were also awake for the applicator removal.

“Importantly, the treatment can now be done while a patient is under anesthesia,” Dr. Leung says.

Sunnybrook’s efforts to improve the treatment haven’t stopped there. Ananth Ravi, PhD, lead brachytherapy medical physicist, is testing new electromagnet technology to guide needle placement and increase precision during the procedure.

“Our brachytherapy team is excited by this leap forward in the evolution of our program,” Ravi says. “The efforts of our team and the introduction of innovative technologies enable us to deliver not just effective, but [also] truly compassionate, patient-centred care.”

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Losing someone you love presents a choice.

Jason Fiorotto knew he could let his grief consume him, or he could try to channel his pain into something positive.

He remembers the night in 2017 when he gathered with family and friends to choose the latter option. Still reeling from the loss of his beloved wife of 14 years to breast cancer just a few months earlier, Jason’s agenda that evening was clear.

“We came together to decide how we could honour Tory in the best way possible,” he remembers. “I knew we could either let grief take over us, or use it to benefit the lives of others.”

And so The Tory Day Fund was created to fulfill one of Tory’s final wishes: to bring comfort to patients undergoing cancer treatment.

Even within a world-class treatment facility like Sunnybrook’s Odette Cancer Centre, Tory experienced first-hand just how gruelling chemotherapy and radiation treatment can be. She learned how any comfort, no matter how small, could ease the toll of treatments.

Since that night in 2017, The Tory Day Fund has raised more than $250,000 for initiatives that bring more comfort to cancer patients – including $70,000 for patients at the Odette Cancer Centre – making it one of Sunnybrook’s largest community-driven fundraising campaigns.

At the heart of it all is Tory, and the riotous laughter and limitless love that Jason says made her an extraordinary wife, mother and friend.

A tribute to Tory

Jason says the remarkable fundraising success of The Tory Day Fund is due to the ability of his family and friends to share who Tory was in the most authentic way possible.

“When we’re fundraising, our first task is making sure that people who didn’t know Tory get a sense of who she was,” he explains. “And we want to share her story in a positive way, because that is most true to her.”

Jason with his late wife, Tory, and daughter, Kate. Photo courtesy of Jason Fiorotto. (Photo courtesy of Jason Fiorotto)

For Jason, Tory always made everything better.

She could kick any party into high gear, he says. She would go to great lengths just to get a laugh out of a friend.

“She loved nothing more than just stirring it up, just bringing total lunacy into our lives,” Jason says.

It made perfect sense when one of Tory’s oldest friends suggested calling The Tory Day Fund’s signature annual fundraising event the “Night of Nonsense,” a raucous evening of silliness to raise money for a great cause.

“Of course, you can’t manufacture nonsense,” says Jason of the event-planning process. “Nonsense has to happen organically, so we make sure the night celebrates all the things Tory loved. We have a glass of bubbly at the door for everyone with pink candy floss on the rim – it was Tory’s favourite colour and whimsical, just like her.”

Tory was also a ’70s girl, raised on disco, classic rock and her favourite, Stevie Wonder. That means no Night of Nonsense is complete without a live band playing “Sir Duke” and “Superstition.”

“We want people to come for Tory, but as with most fundraising events, we know the raw emotion can wear off after the first year,” Jason says. “The fact that we’ve been even more successful in our second and third year is a testament to Tory and how she was always able to bring people together.”

Comfort and care

Tory cared deeply about others, even those she’d never met.

In the advanced stages of her disease, Jason remembers how fortunate Tory felt to have a bed to rest in while receiving her chemotherapy. She knew that this option wasn’t always available, given limited resources, and that sometimes that meant receiving treatment in a chair that didn’t recline.

“Tory wanted more people to have the opportunity of a comfortable experience, because we both knew there were a small number of beds,” Jason adds.

By 2019, The Tory Day Fund had donated 16 padded, reclining chemotherapy chairs to the Odette Cancer Centre at Sunnybrook, allowing patients to rest comfortably as they undergo treatment.

Tory also knew the difference a buddy could make, Jason says.

Back in 1997, on her first day at computer hardware company IBM, Tory had the serendipitous fortune to be randomly assigned a “work buddy” to show her around the office. It was Jason. “It became our nickname for each other,” he says. “I was her buddy, and she quickly became mine.”

Their steadfast partnership continued over the years that followed as they built a life together that eventually included their daughter, Kate. From the extraordinary highs of parenthood to the unspeakable lows of cancer, they were a team. Tory’s first day of cancer treatment echoed her first day at work so many years earlier – Jason by her side, every step of the way.

Still, it wasn’t easy.

“It was intimidating and overwhelming when we arrived for Tory’s first chemotherapy session. Nothing can prepare you for it. We wanted to change that,” Jason explains.

When Jason spoke to the Sunnybrook Foundation about ways to bring more comfort to patients with cancer, he learned the hospital was piloting a navigation program. The program would help cancer patients find their appointments, provide coffee, a snack and a chat while they waited and provide information about available community supports. With funding from The Tory Day Fund, the program was launched in November 2017 and named the Patient Buddy Program – in honour of how a boy met a girl one morning nearly two decades earlier.

Making a difference

Today, Tory’s community is fulfilling her wish in an even bigger way than she had imagined, making the cancer journey easier for thousands of patients.

Jason says life without Tory isn’t easy, but there’s still comfort – and even joy – to be found. The day the chemotherapy chairs were unveiled at the Odette Cancer Centre was one of the happiest in recent memory for Jason. They were exactly what Tory would have wanted.

“Speaking for myself, our daughter and Tory’s friends and family, I can say that if we hadn’t taken on this effort, we would not be in the positive place we are today,” Jason says. “In 10, 15, 20 years, we’ll look back at the tragedy of losing our mother, wife, sister and friend, and I think we’ll see the impact that we’ve had on thousands of cancer patients at Sunnybrook and elsewhere – the impact Tory helped us have.”

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In September 2019, Alice Lam was leading a busy life: reading, cooking, meditating, working on her photography skills and doing small projects around her Scarborough, Ont., home. Despite having Stage 4 breast cancer (meaning that the cancer has metastasized, or spread to other parts of the body), the 55-year-old was determined to live life to the fullest.

But that changed when, seemingly overnight, Alice went from working out at the gym to barely being able to walk. Weakness in her legs, back pain and numbness immobilized her. She found it impossible to even use the washroom.

“It happened so fast,” she says. “It didn’t take a month. It just took a few days.”

Believing it was a nerve issue, Alice’s family rushed her to a downtown Toronto hospital, where she received devastating news: a metastatic tumour had grown larger despite chemotherapy and was pushing on her spine – an exceptionally challenging area to treat. There was nothing they could do for her. Paralysis would be her new normal.

Fortunately, one of the doctors offered to get Alice a second opinion. He sent an e-mail with her MRI results and physician’s report to Dr. Jeremie Larouche, an orthopaedic surgeon at Sunnybrook. It was 3 a.m., and Alice was sent home.

She didn’t have to wait long. Within nine hours of receiving the e-mail, Dr. Larouche had not only read about Alice’s condition, but he had also coordinated a detailed treatment plan. She would have surgery the very next day. Alice says she was amazed by the speed of Dr. Larouche’s response.

“I’m a fast person, but he acts even faster!” she says, laughing.

The innovative surgery Alice was going to receive wasn’t meant to remove the entire tumour, however. Dr. Larouche would be performing “separation surgery,” a minimally invasive procedure that shears away a portion of the tumour from the spinal cord, potentially reducing recovery time, length of stay at the hospital and surgical complications.

“To see what we can offer [these patients] in their last years of life – it’s an unbelievably, intrinsically rewarding type of surgery.”
– Dr. Jeremie Larouche, orthopaedic surgeon at Sunnybrook

The surgery creates a two-to-four millimetre margin between the tumour and the spinal cord. That extra space is needed in order to protect the spinal cord from the second part of the procedure – radiation.

“Traditional radiation is limited in terms of the duration of benefit, so in select patients a new technique known as stereotactic body radiotherapy, or SBRT, is increasingly offered,” Dr. Larouche explains. “SBRT is an intense and targeted form of high-dose radiation, and for the spine, it is optimally delivered if there is some separation between the spinal cord and the cancer.”

Orthopaedic surgeon Dr. Jeremie Larouche performs separation surgery on a patient with metastatic spinal disease. (Photography by Doug Nicholson)

With SBRT, radiation therapists and oncologists pinpoint the cancer’s exact location and shape using sophisticated, 3D-imaging technology. Once mapped, numerous radiation beams are focused at the tumour from hundreds of different angles simultaneously.

While this combination of minimally invasive, debulking surgery and SBRT does not cure cancer, it does give an 80 per cent to 90 per cent chance that the tumour will stop growing and be controlled for the rest of the patient’s life. Furthermore, the combination of neurologic recovery and tumour control with SBRT can lead to better quality of life by maintaining mobility and decreasing pain.

Rather than spending their last few months bedridden with spinal-cord compression and nerve pain, many people are now able to walk, garden and even leave the house to visit friends.

But the technique has also required that surgeons and radiation oncologists at Sunnybrook develop a new mindset about how to best care for palliative cancer patients. In the past – and in many cancer centres to this day, as Alice discovered – Stage 4 patients have been considered too high risk for spinal surgery. Because of this perceived risk, and the fact that traditional radiation generally isn’t as effective when the disease is compressing the spinal cord for Stage 4 patients, many doctors wouldn’t consider surgical intervention an option.

“But now we have new tools and new techniques,” explains Dr. Larouche, who, along with Sunnybrook radiation oncologist Dr. Arjun Sahgal, has been leading the way for separation surgery, not just at Sunnybrook, but also in North America.

“Really, what I’m trying to bring is a change in mentality and attitude about surgical skills, such as less-invasive or minimally invasive surgery, to achieve our goals,” he says.

Dr. Sahgal, a recognized international leader who pioneered spine SBRT for Canada, adds that SBRT technology is often a very good “next step” for the right candidates, because it delivers extremely precise, very intense radiation doses aimed to destroy cancer cells while minimizing damage to healthy tissue.

“As early adopters, we and a few other centres globally have really promoted the idea that if you’re going to put somebody through a major operation, then why would we not follow it up with an equally aggressive radiation treatment?” Dr. Sahgal says.

In addition, rather than having to undergo five or even 10 radiation sessions, SBRT for the spine often requires only two sessions. For palliative patients, fewer trips to the hospital are a boon.

Dr. Sahgal notes that Sunnybrook leads the field internationally with respect to SBRT technique and outcomes, and he and his colleagues have published several studies in medical journals and led several clinical trials in this domain.

“In fact, we teach radiation oncologists and surgeons globally how to perform spine SBRT safely,” he says.

Alice says she’s incredibly grateful for Dr. Larouche and Dr. Sahgal’s commitment to helping patients like her get back on their feet again – literally.

Orthopaedic surgeon Dr. Tan Chen (foreground left) and Dr. Larouche (foreground right) during separation surgery. (Photography by Doug Nicholson)

One month after surgery, Alice was able to walk with minimal assistance. Soon after receiving her doses of radiation, she was able to walk quite naturally. That’s a far cry from how immobile she was before undergoing separation surgery and SBRT.

“Alice has just got this spirit. She’s indomitable and she’s done fantastically,” says Dr. Larouche. “This is a hard patient population to work with, because these awe-inspiring people are palliative. But to see what we can offer them in their last years of life – it’s an unbelievably, intrinsically rewarding type of surgery.”

While Alice knows the procedures were not meant to cure her, she says they have given her the next best thing – hope at a time when she felt hopeless.

“I prayed for experienced doctors, a proper diagnosis, and effective and timely treatment,” she says. “And I got all of those from Sunnybrook.”

The post Innovative approaches are providing an improved quality of life for palliative cancer patients appeared first on Your Health Matters.

Going through cancer treatment during the holidays can completely change your perspective during what should be one of the happiest times of the year. Patients and families struggle with how they can celebrate when they or someone close to them is coping with cancer. Patients wonder if they will feel well enough to enjoy the holidays when they going through radiation treatment, receiving chemotherapy or recovering from surgery. There are questions about whether they will have the energy to participate in family celebrations and worries about what the coming year will bring. While everyone else is moving ahead with holiday preparations and celebrations, our patients are facing a very uncertain future. They may feel pressured (by themselves or others) to carry on with the traditional holiday rituals, even though they may not have the physical or emotional energy to do so.

As the holiday season gets into full swing, here are some tips for families affected by cancer.

Focus on your own well-being.

Whether you are a patient or a caregiver, first and foremost you have to focus on your own wellbeing.  Eat well, ensure that you get your rest — including naps — and stay hydrated. Do not abandon your regular routines to accommodate the hectic holidays as these routines are what have helped you cope so far. Allow yourself to do less than you are accustomed to doing during this season and allow yourself to ask for help, whether that is with picking up gifts or bringing in food or helping with decorating and cleaning.

It’s OK to say no.

Remember that it is OK to say no. You do not have to accept every invitation or accommodate every request.  Most importantly, be flexible and know that, even if plans have been made, you may have to reschedule or change plans depending on how you or your loved one is feeling that day – and let people know that when you accept or offer an invitation.

Plan ahead.

Clinic closures may be a source of stress for you or your loved one. It is important to know what dates the cancer centre is closed over the holidays and who to contact in the off hours if you run into difficulty. Ensure that you have enough of all your prescription medication to last through the holidays

Prepare for questions.

Inevitably, family and friends you see over the holidays may ask questions about your diagnosis and how you are doing. Allow people the benefit of the doubt that their questions are expressions of concern. But know also that you do not need to explain your medical situation or provide any information beyond what you are comfortable disclosing. It may be helpful to coordinate an exit plan with one of your caregivers if you feel their questions or inquiries are becoming overwhelming.

Remember things may be different – but try not to focus on those differences.

This holiday season is not like all the others so do not pressure yourself to make it so. Give yourself the time and the permission to make changes and create new traditions this year that make it easier for you to participate. Instead of making the whole Christmas dinner, offer to host a potluck. Or hand the tradition to a sibling or child.  Try not to focus on what might be missing, on what tradition wasn’t kept, or on what might be different about this year’s holiday season from those in the past. Rather, try to focus on the moment and enjoy your celebration in whatever form it takes. Remember what the holidays are truly about – a time for being thankful and sharing with others.

If you have concerns about how to cope with the stress of the holidays, talk to your health care provider and let them know how you are feeling.  Support is available through the Patient and Family Support Program at the Odette Cancer Centre. Wellspring also has various support programs available.

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