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.

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.

Dementia is an umbrella term used to describe a decline in thinking abilities that is severe enough to interfere with one’s day-to-day activities. While some degree of forgetfulness is completely normal as we age, the memory loss experienced in the context of dementia is much more severe.

AD is the most common cause of dementia, and is defined by the abnormal build-up of two proteins in the brain: amyloid plaques and tau tangles. The build of these proteins leads to the death of brain cells, which causes the brain to shrink and impacts memory and thinking abilities.

There are many risk factors for dementia. Some, like older age and genetics, can’t be changed. But recent research has shown that up to 40 per cent of dementia cases are linked to risk factors that people can control.

Vascular Risk Factors

Vascular Risk Factors (VRF) are conditions that affect the health of blood vessels that supply oxygen and nutrients to the brain. These include high blood pressure, high cholesterol, obesity, diabetes and smoking. Each of these conditions on their own can increase the risk of dementia, and when they present together, the risk is even higher.

The good news is that we know how to treat VRF. If you have been prescribed medication for high blood pressure, high cholesterol or diabetes, take it as directed and keep up with routine doctor visits. Eat a healthy diet and exercise regularly, as these lifestyle changes can reduce the risk of these conditions. There are also effective strategies to manage obesity and smoking, so don’t hesitate to reach out to your health care team. A good rule of thumb is that what’s good for the heart is good for the brain!

Cognitive Reserve

Cognitive reserve refers to your brain’s ability to cope and keep working, even in the face of damage from diseases like AD. Research has suggested that engaging in mentally stimulating activities throughout own’s life can help build up a high cognitive reserve, offering some protection from AD and other dementias.

Because of these findings, researchers now recommend keeping your mind active throughout your whole life, especially after you retire.

It’s not clear which activities may be most beneficial for the brain, so choose any challenging activity you enjoy. Some examples include playing chess, learning a new instrument or language, doing a puzzle or even socializing with family and friends.

Physical Activity

Several studies have shown that regular exercise can significantly reduce the risk of developing dementia. In our own research, we found that people who engaged in regular physical activity – even in older adults with Alzheimer’s changes in their brain – had less decline in their memory over time compared to those who were sedentary.

It doesn’t really matter what type of physical activity you engage in, as long as it elevates your heart rate. We know that people are more likely to exercise if they participate in activities they enjoy. Choosing social activities, like walking and dancing, can have the added benefit of exercising the body and the mind. Current guidelines suggest doing at least 150 minutes of moderate intensity activity per week, but remember that some movement is always going to be more beneficial than nothing.

Sleep

All of us know that a bad night’s sleep can impair our ability to think the following day. Research has also shown that getting too few hours of sleep may also increase the risk of  developing AD and dementia. It appears that sleep acts like a dishwasher, helping clear out harmful toxins – including amyloid –  from the brain.

To optimize quality sleep, try to go to bed at the same time each night and get up at the same time each morning. Make sure your bedroom is quiet, dark and at a comfortable temperature. Avoid using electronic devices two to three hours before going to sleep. Also, engaging in physically activity during the day can reduce the time it takes to fall asleep at night.

For people who gravitate towards naps, keep in mind that in some cases they can be a sign of a larger health issue or insufficient stimulation during waking hours. Generally, naps can be restorative, as long as they are limited and don’t interrupt your normal and healthy wake/sleep cycle.

The post How your lifestyle can protect you from dementia appeared first on Your Health Matters.

Find simple ways to move

If you have hip or knee osteoarthritis, staying active can be a challenge.

But staying active can help you manage your pain. Consider incorporating the options below in your daily routine:

• Aim for 3,000 steps a day. If you are able, you can work your way up to 6,000 steps or more! Use hiking poles or a cane to ease any pain and improve your walking pattern.
• To put less of a load on your hips or knees, biking and water-based exercises are great options.
• Mind-body exercises like Tai Chi can help to improve strength, balance and your mood.

It’s important to remember that aiming for 30 minutes of moderate exercise per day is a great way to start. “This doesn’t have to be one 30-minute chunk — you can exercise in 10-minute intervals throughout the day too,” says Patricia.

You might also consider attending a GLA:D Canada Hip and Knee Arthritis Exercise Program after consulting with your family doctor or arthritis specialist.

Get the most out of your virtual care experience

“Some aspects of your care might be a little different, so you might need to prepare a little more,” highlights Patricia when speaking of virtual care. As we continue to navigate the changes brought on by COVID-19, virtual care is a great avenue to improve your access to care while staying in the comfort of your own home.

For the best virtual consultation experience, here are a few tips:

• Dress in loose, comfortable clothing so you can move around easily.
• If your appointment will occur over the phone, think about how to best describe what your joint looks like.
• In the case that your appointment will be over a video call, make sure you are in a space where you can move comfortably and show your joints.
• Try to log in early so you can check your internet connection!

Watch Patricia’s full presentation in the archived video of September’s lecture:

For more information and resources on osteoarthritis, check out some of the resources below:

• A guide for patients having hip or knee replacement
• The Arthritis Society
• Health Quality Ontario, Quality Standards “Care for Adults With Osteoarthritis of the Knee, Hip, or Hand” Patient Reference Guide

The post Living well with hip or knee arthritis: A Speaker Series summary appeared first on Your Health Matters.

Watch the archived webcast video above, and then test your knowledge below by taking our short quiz.

Learn more about upcoming Speaker Series events »

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Protect

Using protective strategies can help prevent cuts and fractures, decrease wear and tear on the joints, decrease strain on muscles and tendons and reduce pain. The key is incorporating these suggestions into daily tasks as you do them.

If you have to do tasks that require repetitive movements, your tendons and joints may suffer some trauma, possibly leading to repetitive strain injury. Take frequent breaks, or modify how you are doing a certain task. For example, alternate between various fingers when using a computer mouse. Also try to avoid static holds, such as holding a phone to your ear for prolonged periods of time with one hand. Switch hands, or look for hand-free alternatives.

Avoid putting excessive pressure on your hands and wrists. When using a tool, you should be able to naturally overlap your thumb over your pointer finger. If a tool is too large or small, you’ll have to exert more force to get the job done. There are many foam or plastic devices available that can modify the shape of handles on things like cutlery and tools. Try using levers to do tasks like opening doorknobs, which can reduce the pressure on small muscles in your hands and fingers. Using larger joints is another a good option. For example, when carrying heavy groceries, use your elbow joint and not just your fingers, and split the weight over both sides of your body.

Sometimes doing a task in a new way can help prevent injury. When hammering a nail, why not hold it in place with a clothespin or pliers rather than your fingers? When using a knife, ensure the blade is sharp as that’s easier to control, and work with the blade away from your body. Whatever the task, avoid rushing which can lead to injuries and mistakes. Slowing down can also prevent falls, which are one of the top causes of wrist fractures.

Whenever possible, keep your hands and wrists in a neutral, or natural, position. Angling them too far up, down or sideways can lead to pain and injury over time. Maintaining good posture is key, as there is a close connection between posture and upper extremity function. When using your hands for precision, they will work better if your posture is straight and your shoulders are pulled back.

If you experience pain, don’t ignore it and avoid any activities that cause excessive discomfort. Generally, a task is likely too stressful on your joints and muscles if you still feel pain more than one hour after completing it. Making note of what causes your pain in a journal can be helpful in tracking patterns. If an activity is a trigger for pain, modify those movements, take breaks or allocate them to someone else to do.

Use aids

Local medical supply stores have many device options to help protect your wrists and hands while doing daily tasks. Well-fitting gloves can offer grip and friction, and may also protect your hands from cuts, burns, cold and vibration. If you have arthritis, there are specially designed gloves that offer slight compression and may provide relief from symptoms like pain and swelling.

Hand and wrist braces or splints can provide joint stability, and allow certain joints to rest and recover. It’s important to see a health professional to ensure you wear one that’s right for you.

General management

Exercise is key to maintaining hand mobility and strength. If you have a specific condition, you’ll want to consult with your physiotherapist or occupational therapist to ensure the exercises you do are right for you.

If you feel stiffness in your hands, range of motion exercises may work well for you:

• Finger opposition: Keep your thumb bent and touch each finger to the tip of your thumb. You can add speed to improve your coordination and reverse the order of your fingers as you work through the exercise. Moving forward and then reversing is considered one repetition. Start with 6-8 reps as many times throughout the day.
• Wrist movements: Do as often as you can, reverse the direction after a few rotations and move them up and down. For each movement try 10 repetitions, at least three times a day.
• Hand circuit: Start with your hand straight, then transition into a hook (four fingers curled down and pressed together and the thumb in a neutral position), then make a duck bill, move into a fist and finish with a table top (four fingers pressed into your palm with your thumb out). Start with three to four cycles, rest and repeat. Do this at least three times a day.
• Stretch: The point isn’t to feel pain, but rather to feel tension. Hold each stretch for at least 30 seconds. With the palm down, pull each finger up gently in the opposite position of the way it bends. For your wrist, you can stretch it against the edge of a table. Stretch each area for three to six repetitions as often as you feel you need to during the day.
• Strengthening: If appropriate for you, you can strengthen your fingers by squeezing a small stress ball or rolled up towel to practice your grip. Try squeezing 10 repetitions, hold for three seconds, rest and repeat at least two to three times a day. Pinching putty between your fingers also works. Pinch each finger six to eight times, at least two to three times a day. Or, take an elastic band and wrap it around your fingers and thumb, and then open and close your fingers to push against the tension of the rubber. Try eight to 10 repetitions, rest and repeat at least two to three times a day.

For general management, heat can help relax muscles before movement. Cold can reduce inflammation. For either approach, be sure to wrap the pack in a towel and avoid putting these into direct contact with your skin.

Watch the whole Speaker Series event:

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When most people in a community are immune to a contagious disease, it can’t spread easily. That’s why it’s important to make sure you are up-to-date with all of your recommended vaccines throughout life. Also, our immune systems gradually get weaker as we age. This natural occurrence makes it harder for our bodies to protect against or fight infections, making vaccines a key part of staying healthy. 

Pertussis 

Pertussis is a bacteria that causes whooping cough, and it’s highly contagious through coughing and sneezing. Pertussis can cause intense coughing accompanied by a telltale “whoop” sound. While it’s more common in infants and young children, adults and seniors can also be affected. Pertussis vaccination is available in combination with tetanus (Tdap), and it’s recommended all adults get one dose in adulthood. This is especially important if there is contact with an infant, as they can suffer severe complications from pertussis, including brain swelling and seizures. So if you are a grandparent, make sure to ask your doctor about this. And if you are pregnant, it’s recommended you get a Tdap vaccine during each pregnancy between 27-32 weeks gestation. 

Pneumonia

Pneumococcal pneumonia can cause a serious cough, fever, shortness of breath and fatigue, and is a leading cause of death and illness. People affected by other health conditions or chronic illnesses, like asthma, are at higher risk. Pneumonia can spread to other parts of the body, including the blood and brain. The highest risk of complications happens in people under two years old, and those older than 65 years. 

There are two types of pneumococcal vaccines available: Pneumovax23 and Prevnar13. It’s recommended that all adults aged 65 and older get one dose of Pneumovax23, regardless of their risk factors. People at high risk of pneumonia are recommended to get one dose of each of these vaccines; Prevnar13 should be given first, followed by Pneumovax23, as the two together provide the best immunity. 

Check with your health provider to see which option is best for you. 

Shingles 

Also know as herpes zoster, shingles causes severe nerve pain, itching and a blistering skin rash. It’s caused by a reactivation of a previous chicken pox infection, and the risk of developing it increases as you age. Some of the complications associated with shingles, including chronic nerve pain in the area that’s affected, are also much higher in people over the age of 50. About 1 in 3 Canadians will develop shingles in their lifetime, so it’s so important to do what you can to protect yourself. 

It’s recommended everyone over the age of 50 should be immunized for shingles. 

There are two different shingles vaccines available in Canada. Zostavax II is a one-dose live vaccine, so it can’t be given to people who are pregnant or immunocompromised. Overall, it’s about 51 per cent effective, and the effectiveness wanes after about three to five years. Shingrix is a recombinant vaccine, meaning it contains a booster that will help your body with the uptake of it. It’s given over two doses, and is about 96 per cent effective. Studies show that people are protected for at least four years, and possibly as long as nine years afterwards. 

Flu 

Every year, the flu poses a health threat to our community, and those aged 65 and older are at a much higher risk for suffering flu-related complications. Getting your flu vaccine can protect you, your loved ones and the general community. Often, higher doses of the flu vaccine are offered to those over age 65 to compensate for their bodies decreased ability to amount an immune response in older age. 

No matter what vaccine you are considering, be sure to talk to your health care provider. They can inform you about any associated costs, and what the best options are for you. 

Watch the full Speaker Series webcast, including Andrea Payne’s talk on Vaccines Needed in Adulthood:

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