Managing nutrition and dysphagia with patients with head and neck cancers receiving chemoradiation therapy

Investigators:  Dr. Ryna Levy-Milne, Dr. Jonn Wu, Dr. Cheryl Ho, Angela Bowman, Valerie Stringer

Dr. Ryna Levy-Milne
Dr. Ryna Levy-Milne

Head and neck cancer (HNC) patients are at high risk for malnutrition due to the cancer and side effects of treatment. Major side effects include poor appetite and swallowing problems, resulting in weight loss and malnutrition. This can lead to increased risk of infections, depression, and a poor prognosis. At BC Cancer, more than a third of HNC patients who received chemoradiation lost more than 10 per cent of their pretreatment weight at treatment completion which continued at  4-6 weeks post-treatment. This is an indication that these patients continue to struggle to meet their nutritional needs.

There is a need for a more comprehensive approach to manage nutrition related symptoms through treatment and recovery that also engages patients and their families to be active participants in their care. BC Cancer dietitians and speech language pathologists have developed an evidence-based patient-centred model of nutrition and swallowing care to address these symptoms. The purpose of this proposal is to implement this model of care at two cancer centres to reduce the number of HNC patients experiencing critical weight loss and to improve their swallowing ability and quality of life.

Investigators: Regina MacKenzie, Dr. Alan Bates, Dr. Philip Crowell (shown above)

This project will bring a full-time Spiritual Care Specialist, in collaboration with patients, family members, and inter-disciplinary colleagues and others, to lead BC Cancer’s development of a comprehensive and sustainable Spiritual Care program for cancer patients in B.C., over the next three years.

“We are proud to announce the BCCA Spiritual Care in Oncology project that will add a sustainable Spiritual Care program,” says Regina MacKenzie, Provincial Director, Psychosocial Oncology & Practice Leader, CounsellingPatient Experience and Interprofessional Practice at BC Cancer.

In order to ensure growth and sustainability, the existing Spiritual Care internship program will be expanded and the Spiritual Care Specialist will establish linkages with spiritual and religious leaders as well as network with Spiritual Care services within the Provincial Health Services Authority (PHSA).

Educational opportunities in Spiritual Care will be created for all BCC staff in order to improve the Agency’s overall ability to respond to spiritual distress and existential suffering experienced by many of our patients. This project is in tune with recommendations of the BC Patient Safety & Quality Council’s Health Quality Network to prioritize improvements in accessibility, effectiveness, and safety of care of patients with chronic and/or terminal illness and the Ministry of Health Spiritual Care Framework (2012).

A new BC Cancer Foundation award will support a BC Cancer team’s objective to test cancer prevention strategies in the clinic. The GENOVA Study, spear-headed by Dr. Anna Tinker, medical oncologist, BC Cancer, is setting out to proactively screen women diagnosed with endometrial and ovarian cancer for a hereditary genetic link.

Identifying families with a hereditary cancer is very important as individuals in these families can face up to 40-fold greater risk of developing cancer than the general population.

The GENOVA Study will proactively identify women with ovarian and endometrial cancer who are eligible for referral to the BC Cancer Hereditary Cancer Program (HCP) educate clinicians and patients about both hereditary cancer syndromes and the strategies available to prevent or detect cancers early.

The goal of this three year initiative is to increase the referral rate of all eligible cases of ovarian and endometrial cancer to >80 per cent.

“We are honoured to be the recipients of this Clinical Innovations award,” says Dr. Tinker. “These funds will allow us to develop an outreach program to educate caregivers and patients about the risks of hereditary cancer syndromes that are associated with certain types of ovarian and endometrial cancers, and to encourage referral of all eligible patients and families to the Hereditary Cancer Program at BC Cancer.”

The GENOVA study is one of four new awards totalling $1.5 million in donor support to advance innovative clinical research and improve patient outcomes and experience.

GENOVA Study Investigators: Dr. Anna Tinker, Dr. Janice Kwon, Dr. Sophie Sun, Dr. Intan Schrader, Dr. Dianne Miller, Dr. Blake Gilks

Investigators: Dr. Tamara Shenkier, Dr. Stephen Chia, Dr. Dan Le, Dr. Caroline Lohrisch, Dr. Donald McKenzie, Dr. Stuart Peacock, Dr. Christine Simmons, Dr. Sophie Sun, Cheri Van Patten

The number of patients being diagnosed and surviving breast cancer in British Columbia will increase over the next 10 years. Long term endocrine therapy can significantly improve survival for women, but adherence is a major problem. A new model of care is needed to address the array of unmet survivorship needs of this population.

This project will create a new clinic for women who are on adjuvant hormonal therapy for breast cancer. It will be run by a nurse practitioner and focus on the unique needs of these women including strategies to enhance hormone therapy adherence and evidence-based clinical surveillance.

The clinic will also focus on addressing side effects of treatment and improving overall health and wellness through education, nutrition and exercise and serve as a hub for referral to other healthcare professionals (e.g. counselling, osteoporosis, sexual health) as needed.

The original oncologist will remain involved to provide medical advice.

“We hope that this pilot will provide the foundation for an integrated and comprehensive survivorship program with the ultimate goal of improving the quantity and quality of life of breast cancer survivors on adjuvant hormonal therapy.”

Strategic Priority Fund Awards

Seven promising research projects are underway at BC Cancer with support through the BC Cancer Foundation’s Strategic Priority Fund Awards.

$1.5 million will propel advancements in early detection, diagnosis and cancer care for the people of B.C.   

Receiving a Strategic Priority Fund award will allow Dr. Connie Eaves, distinguished scientist, and her colleagues Drs. Davide Pellicani and Martin Hirst to embark on their project, titled Identification of mechanisms of human breast cancer initiation from epigenomic changes caused by aging and introduced oncogenes. 

Project Summary

Aging in women is associated with dramatic changes in the properties and behavior of their breast cells. Recent research has shown that this is accompanied by changes in the genes that these cells express. In addition, as women age, their risk of developing breast cancer also becomes very high - more than one in twenty are diagnosed. It is therefore possible that the changes in gene expression that occur in all women as they age may predispose their breast cells to the development of breast cancer before their acquisition of mutations that are known to cause breast cancer.

To test this possibility, this project will compare the mechanisms controlling gene expression in the breast cells of older and younger women and see if and how they may overlap with those seen in human breast cancer cells. Dr. Eaves anticipates the results will lead to new diagnostic indicators and novel therapeutic targets.

Other institutions associated with this team are UBC and the Mayo Clinic in Rochester, MN.

“We know getting older increases the risk and that the biology is complex. Now we will be able to mount a team approach to use the new tools and methods we have developed to begin an exploration of this critical and uncharted area. The goal is to identify events that can reduce the risk or treatments that will target early changes,” says Dr. Eaves.

Dr. Dean Regier, scientist, BC Cancer Agency, will use the support from a Strategic Priority Fund award to embark on his Personalized Onco-Genomics focused research project, entitled Resource and Health Impact of Personalized Oncogenomics.

Project Summary

Cancer is a genetic disease. It is caused by mutations in the DNA of genes that control how cells grow and develop. The term “genome” refers to the complete set of DNA. Recent innovations allow us to examine the entire cancer genome. This knowledge can inform therapy that targets mutations to kill a patient’s cancer. The Personalized Onco-Genomics (POG) Program of BC uses whole genome analysis to inform therapy for patients with treatment-resistant cancers. Whole genome analysis is expensive. In budget-constrained health systems, decision-makers want to know that the cost of adopting this level of analysis is met with improved patient health.

Dr. Regier and team’s goal is to support healthcare decisions by generating evidence on the patient and economic impacts of POG-guided cancer treatment. To achieve this, we will ask POG patients about the value they attach to genomic knowledge and its health outcomes. This information will be combined with cost and health outcomes to inform the cost-effectiveness of POG vs. current care.

“BC’s POG program is a leader in precision care for patients with incurable cancers. I’m excited about this award because it will allow us to understand the patient-centred impact of POG – in particular, we will look the quality of life impact of POG-guided care compared to its cost,” says Dr. Regier. “This research is crucial because it will support the implementation of POG into our healthcare system.”

Support from the Strategic Priority Fund Award will allow Dr. Haishan Zeng, distinguished scientist, to embark on his project titled Improving periphery lung cancer detection by endoscopic laser raman spectroscopy.

Project Summary

Early detection is crucial for increasing the survival rate of lung cancer and reduces the cost of treatment. If lung cancer can be detected early in the pre-invasive stage, the 5-year survival is greater than 90 per cent. However, with current diagnostic techniques, lung cancer is generally asymptomatic until it has reached an advanced stage, when the treatment outcome is poor. Periphery lung lesions are usually spotted by CT scans as nodules on the images. Then radial ultrasound imaging (under bronchoscopy/virtual CT guidance) plus biopsy are conducted to determine if a nodule is cancerous. However, this procedure has high false positives.

This project will develop a technology called Laser Raman Spectroscopy (LRS) for improving lung cancer detection. LRS probes molecular vibration and gives fingerprint-like spectral features. It has high accuracy for differentiation between malignant and benign cells/tissues. Dr. Zeng and team hopes to develop LRS into a new clinical tool for improving periphery lung cancer diagnosis.

“I am so thankful to the BC Cancer Foundation for the award,” says Dr. Zeng.

Dr. Pierre Lane, senior scientist, will use the support from his Strategic Priority Fund award to embark on his research project titled Novel image-guided biopsy devices for peripheral lung nodules.

Project Summary

With advances in CT scanning, potentially cancerous lung nodules can be found earlier than ever before. However, there is an outstanding problem locating and sampling these nodules for treatment planning as they are often located in airways too small to be accessed safely via current techniques. The objective of this proposal is to develop tools to safely and accurately sample suspicious lung nodules in the small airways of the lungs. These tools will be guided by novel tiny 3-D optical imaging probes developed by the group.

The team will design and manufacture tools that complement the size of existing imaging probes. Dr. Lane and his team will test their tools in lab models to verify their safety and effectiveness. Success of this proposal will improve lung health for Canadians by improving the safety, accuracy and speed of lung cancer diagnoses to reduce patient anxiety, reduce follow-up procedures and provide faster referrals for treatment.

This project is also affiliated with Simon Fraser University, School of Engineering science and UBC, Biomedical Engineering Program.

“I am very honoured and humbled to receive this award from the BC Cancer Foundation,” says Dr. Lane. “The Strategic Priorities Fund is an important new program that will further enable new discoveries by scientists and clinicians at the BC Cancer Agency. My award  will enable the development of an image-guided biopsy tool that will improve the diagnostic yield of tissue samples collected during bronchoscopy, leading to more timely and accurate diagnosis of lung cancer.”

Dr. David Huntsman, Dr. Chew Wei memorial professor of gynecologic oncology and director of the BC's ovarian cancer research team (OVCARE), will use his Strategic Priority Fund to advance his project titled Proteomic based approach to address diagnostic challenges in cancer, with a focus in ovarian cancer.

“The Strategic Priority Fund will support an exciting new direction for our research that stemmed from a collaboration between OVCARE, and the mass spectrometry core at the BC Cancer Research Centre. Our goal is to discover, develop then implement a suite of new biomarkers to aid in the diagnosis and management of ovarian cancer.”

Project Summary

The critical first step in cancer management is correct diagnosis, made by microscopic examination of tissue removed through biopsy or surgery, which leads to the appropriate choice of treatment and interpretation of further studies such as genomic tests. Although most common cancers can be accurately diagnosed, there are several tumour types that remain challenging. This is because different tumours can look alike at the microscopic level and we lack diagnostic aids, such as antibodies to help with their differentiation. As a result, one type of tumour may be mistakenly identified as a different type of tumour, which can lead to improper treatment of the patient.

This project proposes to perform an analysis of total protein expression in 20 tumour type pairs that are difficult to distinguish from each other, yet require unique management strategies. Antibodies to proteins that distinguish look-alike tumours will then be developed into diagnostic aids and translated into practice.

In addition to the BC Cancer Foundation, the project was enabled by VGH and UBC Hospital Foundation.

Support from the Strategic Priority Fund Award will allow Dr. Dirk van Niekerk, medical director, Cervical Screening Program, to embark on his project titled Using an online intervention for self-collection based HPV testing to improve cervical cancer screening rates in the Fraser Region of BC.

Project Summary

Despite the success of British Columbia’s cervical cancer screening program, women who do not regularly attend screening are at higher risk for cervical cancer. New strategies are needed to overcome barriers for conventional screening and improve uptake among non-attenders. This research project will test the feasibility of expanding a highly successful online sexually transmitted infection testing platform to include self-collected cervical cancer screening.

The pilot will be conducted in the Fraser Valley  where screening rates are the lowest in the province. Participants who test positive for high risk strains of human papillomavirus (HPV) will be contacted and referred for further testing and care. This approach can improve access and acceptability of screening and prevent cervical cancer among high-risk women. As the province plans for the shift to HPV-based screening, the findings of this research project will have significant policy and clinical impacts.

Support from the Strategic Priority Fund Award will allow Dr. Peter Lansdorp, distinguished scientist, BC Cancer Research Centre, and his colleague Dr. Intan Schrader, co-director of the BC Cancer Agency's Hereditary Cancer Program, to embark on their project, Identifying structural variation and haplotypes in single cancer cells

Project Summary

The human genome, representing the entire DNA sequence of a human, is a map that researchers and healthcare providers use to identify and highlight important regions, such as those that cause cancer. This map has revolutionized research, with new landmarks being identified that broaden the understanding of biology and disease. The current map represents an ‘average person’, but what is an average person? All humans are different, and so we each have our own unique map. Furthermore, cancer cells often reshuffle, remove or add to their genomes, making the map in these cells very different from the map of normal cells from the same person.

Dr. Lansdorp and team have developed technology that rapidly characterizes changes to these maps in individual cells and finds changes that are inherited together in a particular pattern (called a haplotype). The project proposes to study the changes to the genome and haplotype of cancers, with the goal to find causes that are difficult to identify using conventional techniques. 

This work will be done in close collaboration with the European Research Institute for the Biology of Ageing in the Groningen, the Netherlands.

"This award allows Dr. Schrader and myself to explore structural variations in the genome as a source of familial cancer predisposition using our unique single cell sequencing approach.”

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