20 IN 2020
Alberta’s Cervical Cancer Screening Program celebrates two decades
SUMMER 2020
WATER WORKS 4 Paddling Sports to Try
TEXT4HOPE
Supportive text messages can improve mental health
GAMECHANGERS ISSUE
CANCER CARE CHAMPION DR. DON MORRIS IS MOTIVATED BY CHALLENGE AND PASSIONATE ABOUT PATIENT CARE
+ A WALK IN THE WOODS
THE HIDDEN BENEFITS OF NATURE
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CONTENTS
46 34 CARING Alberta’s Cervical Cancer Screening Program celebrates 20 years of early detection and prevention. 36 LIVING WITH CANCER Ian Robinson shares his unique perspective on living well with cancer. 38 RESEARCH ROCKSTAR Cell biologist Dr. Luc Berthiaume is leading an upcoming clinical trial exploring a potentially life-saving new drug. 42 TRUE CALLING As the medical lead of the Calgary Cancer Project, Dr. Don Morris is working to progress cancer care in the province.
FEATURES
22 T HE GAME-CHANGERS ISSUE
46 IMPACT Atieh Behravesh shares her experience with the Breast Cancer Supportive Care Clinic.
Meet the revolutionary people, programs, ideas and initiatives that are transforming cancer treatment, care and support in Alberta and beyond.
COLUMNS/DEPARTMENTS cancer patients. Plus, what you need to know about forest bathing and text-based supports for mental health.
7 FRONT LINE Hematologist Dr. Jason Tay is working to improve treatment options for blood COVER: PHOTO JARED SYCH THIS PAGE: SCOTT CARMICHAEL
13 YOUR DONATION MATTERS Your donations to the Alberta Cancer Foundation are enhancing care and transforming treatment options for women’s cancer.
14 WORKOUT Work out on the water with our suggestions for four popular paddling sports to try this summer.
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17 FOOD FOCUS Learn why sustainable seafood is good for your health and the planet. Plus, we round up the top eco-friendly Canadian fish varieties to eat today. 20 ASK THE EXPERTS Understanding the benefits of community supports for people impacted by cancer, and how cancer patients can make a blood or organ donation.
47 WHY I DONATE Elisabeth Mühlenfeld remembers her husband, Reinhard, and his extraordinary generosity to the Alberta Cancer Foundation. 49 MY LEAP The Give’r Projects’ online platform encourages Albertans to give where they live. 50 GAME CHANGER West Edmonton Mall’s Walk against Cancer raised $50,000 in support of the Alberta Cancer Foundation.
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MESSAGE
TRUSTEES
Dr. Chris Eagle (Board Chair) Rene Aldana Cathy Allard-Roozen Brian Bale Dr. Stanford Blade Dr. Heather Bryant Dr. Charles Butts Rajko Dodic Brenda Hubley Dr. Dianne Kipnes Chris Kucharski John Lehners Brian McLean Dr. Don Morris Dr. Matthew Parliament Gelaine Pearman Jamie Pytel (Vice Chair) Rory J. Tyler Heather Watt Mark Zimmerman
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Game-Changers It’s hard to believe we’re heading into the final few months of 2020. We, like many organizations, have gone through a lot of change since we rang in the New Year. One of those pieces was the recruitment of a new CEO to the Alberta Cancer Foundation, so please allow me to say an official hello in my first issue of Leap magazine. I am glad to have Dr. Eagle by my side, not just in this publication, but over the last few months as I have been warmly welcomed into the Foundation. Yes, Covid-19 has changed the way we all do business, but it has also given us the space and time to reflect on where we truly want to be as an organization. While some things have changed, everything we do remains driven by our purpose: to create more moments for Albertans facing cancer by inspiring our community to give to innovation in detection, treatment and care. Before we all faced a global pandemic, 53 Albertans heard the words “you have cancer” every day. Those numbers haven’t changed. The need for philanthropic support continues. These are our families, our friends, our neighbours. We are so proud to support these Albertans — no matter what type of cancer they have, or where they live in the province. We have seen an urgency to provide more support to patients and families through this pandemic as many have faced job loss, have to travel for treatment or need additional support during this extraordinary time.
We may have to connect with our community in new ways now, but we continue to celebrate the meaningful impact all our partnerships provide. You will see some of those examples throughout this issue of Leap. One such story is on the Foundation’s largest estate gift of $10 million, received through the estate of a prominent — and very generous — Calgarian committed to making a difference to cancer in this province. You can read about Mr. Robert Dixon (pg. 30) and how his family’s legacy now supports transformational research and care in this province. Among other stories of progress, you will read about how immunotherapy has offered a revolutionary option to traditional cancer treatments. The work being done by researchers right here at home has already changed the lives of so many Albertans, many facing dismal outlooks before immunotherapy. We are grateful to our donors for funding these clinical trials you’ll read about (pg. 22) that have since changed the way cancer is treated in Alberta and around the world. We are appreciative of the time we have had this year to reflect on how we can provide the most value to our donors and partners by delivering the greatest impact to Albertans facing cancer. We hope you enjoy this issue of Leap as much as we enjoy sharing these powerful stories with you.
VISIT
a/leap/ albertacancer.c n leapsubscriptio DR. CHRIS EAGLE, BOARD CHAIR ALBERTA CANCER FOUNDATION WENDY BEAUCHESNE, CEO ALBERTA CANCER FOUNDATION
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ALBERTA CANCER FOUNDATION EDITORS Phoebe Dey and Christiane Gauthier MANAGING EDITOR Meredith Bailey ART DIRECTOR Kim Larson STAFF PHOTOGRAPHER Jared Sych CONTRIBUTORS Andrew Benson, Bluefish Studios, Diane Bolt, Robert Carter, Elizabeth Chorney-Booth, Charles Burke, L. Sara Bysterveld, Scott Carmichael, Alicia Chantal, Emily Chu, Jennifer Friesen, Colin Gallant, Nathan Kunz, Jennifer Madole, Fabian Mayer, Karin Olafson, Ryan Parker, Aaron Pedersen, Sara Samson, Keri Sweetman PUBLISHED FOR Alberta Cancer Foundation Calgary office Suite 300, 1620 29 St. N.W. Calgary, Alberta T2N 4L7 PROVINCIAL OFFICE 710, 10123 99 St. N.W. Edmonton, Alberta T5J 3H1 Tel: 780-643-4400 Toll free: 1-866-412-4222 acfonline@albertacancer.ca PUBLISHED BY Redpoint Media & Marketing Solutions 100, 1900 11 St. S.E. Calgary, Alberta T2G 3G2 Phone: 403-240-9055 Toll free: 1-877-963-9333 Fax: 403-240-9059 info@redpointmedia.ca PM 40030911 Return undeliverable Canadian addresses to the Edmonton address above. PRESIDENT & CEO Pete Graves EDITORIAL DIRECTOR Jill Foran
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FRONTLINE FRONT E X PA N D I N G T R E A T M E N T | T E X T 4 H O P E | F O R E S T B A T H I N G
BRIGHT MIND
Dr. Jason Tay is exploring improved treatment options for blood cancer patients
C
ancer research often focuses on the development of new drugs and technologies to treat the disease. In recent years, however, more oncologists and researchers are starting to consider the way doctors employ currently available treatments. They are examining standard clinical practices, wondering if they really are the best treatment options, and exploring if these practices can be improved for the benefit of the health-care system and patients alike. Dr. Jason Tay is one such researcher. The University of Calgary hematologist specializes in blood cancers and is the principal investigator on multiple studies that consider how treatments are currently implemented — a line of inquiry that Tay says often starts with patients themselves. “I think most of us take our ideas based on observations we have in patient care, and also conversations we have with our own patients,” says Tay. “They might ask: ‘Do I really need to come to the hospital, find parking, and wait half an hour for a five-second injection?’” >
DR. JASON TAY IS A HEMATOLOGIST AT THE UNIVERSITY OF CALGARY
PHOTOS JARED SYCH
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FRONT LINE
DR. TAY IS WORKING TO CREATE MORE CHOICES FOR PATIENTS RECEIVING TREATMENT
That very question is what led Tay to one of his current studies — whether or not blood cancer patients can self-administer chemotherapy at home. For example, patients with myeloma, a type of cancer that begins in bone marrow, require a weekly injection of bortezomib, a chemotherapy drug, during their treatment. The drug is administered with a subcutaneous injection, the same way diabetics sometimes self-administer insulin into the layer of tissue between the skin and muscle. Tay sees real benefits in giving patients the option to perform this injection themselves. “This is important from a health-care perspective in terms of administration time and cost savings,” says Tay. 8 LEAP SUMMER 2020
“But it also empowers the patient to look after themselves if they want to, and I think this is particularly useful.”
ed with pre-filled syringes from pharmacies at the Tom Baker Cancer Centre and Cross Cancer Institute. Tay stresses that patients who prefer receiving the injection at a cancer centre will always have that option, but that others may prefer this new method. “The opportunity to have more choices, in my opinion, generally leads to better quality of life and better health outcomes,” says Tay. Just as choice is important to patients, so it is for doctors and nurses providing treatments. Another of Tay’s ongoing studies looks at how blood cancer patients receiving stem cell transplants are supported with blood transfusions, and if there might be a better way. The strong chemotherapy and radiation currently used
“ The opportunity to have more choices, in my opinion, generally leads to better quality of life and better health outcomes.” — DR. JASON TAY
Through the pilot study, which began in May in Calgary and begins in Edmonton in the next few months and is funded by the R.K Dixon Family Award established through the generous gift to the Alberta Cancer Foundation from Mr. & Mrs. Dixon’s estate, willing patients are shown how to administer the injection. They are provid-
for blood cancer patients kills fast-growing cancer cells, but it also kills the body’s own quickly growing cells such as bone marrow. Patients typically require a stem cell transplant and often have low platelet counts in the blood. Platelets are produced in the bone marrow and are responsible for blood clotting. With
the help of Canadian Blood Services, patients, even the ones who may not need it, are given platelet transfusions as a preventative measure to reduce the risk of potentially dangerous bleeding during surgery. But there are drawbacks to this approach. “If you give platelets to people who don’t [necessarily] need them, someone else who might need them would have less of an opportunity to [access them],” says Tay. “The question then becomes, is there an alternative way of providing platelets or not providing platelets while ensuring patients undergoing stem cell transplantation will be safe?” Tay and his colleagues from across Canada are attempting to definitively confirm findings from previous studies that show that a medicine called tranexamic acid can be an equally effective way to prevent bleeding in transplant patients. The researchers plan to enroll over 600 patients in the pan-Canadian study over the next five years. If tranexamic acid is proven equally as effective as platelet transfusions, doctors across the country will have a new tool in their arsenal that doesn’t rely on blood donors. “We wanted to provide a patient-centred, safe, reasonable, cost-effective alternative,” says Tay. LEAP — FABIAN MAYER
Text4Hope is an SMS Lifeline The free service helps subscribers cope with COVID-19 IN EARLY APRIL, A CONSORTIUM OF
public health organizations led by Alberta Health Services and the Mental Health Foundation — and with support from the Alberta Cancer Foundation — launched Text4Hope, a free SMS-subscription with messages supporting mental health. The service, which helps subscribers develop healthy coping skills and resiliency in response to the global COVID-19 pandemic, sends out daily messages written by mental health therapists using cognitive behavioural therapy methods. Text4Hope CancerCare (T4HCC), a cancer-specific arm of the initiative, was recently launched in May. Like the general Text4Hope initiative, users receive three months of daily messages upon subscribing. While many of us are experiencing the same anxieties due to the pandemic, T4HCC aims to address mental health from a cancer-specific lens. “With a lot of people who are diagnosed with cancer, the default thinking is that they are going to die, whereas the general population is largely worried about jobs, the economy and possibly being infected by the virus,” says Dr. Vincent Agyapong, program lead of Text4Hope. “For people with cancer, the doom and gloom is more ominous. That’s what we are trying to deflect attention from — because the more ominous you are thinking, the more depressed you become.” Cancer-specific messages that subscribers receive include both tips and prompts for personal reflection. For example, one daily text reads, “Having cancer and dealing with COVID-19 is a lot to cope with. Try to carry on with your normal routine
as much as you can. Get up and dressed every day.” Text messaging as a means of health care has a rich, if recent, history. Agyapong has dedicated his career to improving access to mental health by studying this subject and building systems with demonstrable success. Agyapong holds two doctorate degrees from Trinity College Dublin, the University of Dublin in Ireland: a research MD in Clinical Psychiatry and a PhD in Global Mental Health. He first researched whether text-based supports could help supplement existing in-person supports during these studies, and the answer was a resounding yes. “The results of the testing indicated that patients who received supportive text messages as part of their treatment fared better than those who did not,” he says. These would become consistent findings in his work over the next eight years. Agyapong relocated to Fort McMurray in 2013, and recalls, at the time, the average
wait time for access to a mental health therapist was around 14 weeks. He saw this gap in accessibility as an opportunity to apply his Dublin findings to a care approach that would also yield additional research on the subject. So, he ran randomized control trials in both Fort McMurray and Grande Prairie. The success of those trials led to the launch of the Text4Mood program in January 2016 and later, after Agyapong moved to Edmonton that year, Text4Support, a referral-based texting program with specialized messaging relevant to diagnoses. Agyapong says participants in all these initiatives have reported improvements to their mental health, and that access to text-based care reduces costs to both the health-care system and individuals. Text4Hope continues this research and users can consent to be part of that when they sign up. LEAP — COLIN GALLANT
Text “CancerCare” to 393939 for cancerspecific messaging, or “Covid19Hope” for the general service. myleapmagazine.ca SUMMER 2020 LEAP 9
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FRONT LINE
Forest Bathing Exploring the benefits of being in nature SPENDING TIME IN THE FOREST IS A
soothing and rejuvenating experience. The air seems more refreshing, and the sounds of birds singing and leaves rustling can help to calm our overwhelmed minds. As scientists around the world study the benefits of time spent in nature, there is increasing evidence that these benefits may be greater than we had expected. Shinrin-yoku (known in English as “forest bathing”) is the Japanese practice of experiencing the forest through all of one’s senses. It was developed in the 1980s as a form of nature therapy. “Forest therapy is an embodiment practice,” explains Ronna Schneberger, a forest therapy guide and owner of Forest Fix, an outdoor experience company in Canmore. As in other embodiment practices like yoga, the aim of forest bathing is to bring us back into our bodies. Forest therapy guides, who take specialized training in order to be certified in the evidence-based therapeutic practice, invite participants to move intentionally and mindfully through nature. “The forest really gives us an oppor-
tunity to slow down through our senses. When we take time to be in each sense, our minds slow down, our bodies start to rest at ease — which is our natural state of being — and our whole system starts to align with the present moment and the forest. It’s in those moments that there is this recalibration that happens within us,” Schneberger says.
phytoncides can increase NK cell activity for as much as seven days following a forest walk. Schneberger, who led forest-based sessions for almost two decades before completing her forest therapy guide training in 2016, has long been aware that beneficial effects arise from slow, mindful sessions in the forest.
“ The forest really gives us an opportunity to slow down through our senses.” — RONNA SCHNEBERGER
There is evidence that spending time among trees may help to improve sleep, lower cortisol levels, pulse rate and blood pressure, and even promote natural killer (NK) cell activity. NK cells are a type of white blood cell with the reported ability to kill tumour cells. Scientists theorize that the increase in NK cell activity observed following a long walk in the forest is due to the presence of phytoncides, or essential oils naturally emitted by trees. Studies show that exposure to
“When I read the science, I started to understand why these profound moments were happening for people,” she says. “Their cortisol levels are going down, their heart rate is going down, their blood pressure is going down, their nervous system is resetting itself and their executive function gets a break. Basically, we’re coming back to ourselves — a deep sense of self, that maybe we don’t feel every day. And that, in itself, is profound.” LEAP — L. SARA BYSTERVELD
THREE EXCEPTIONAL SPOTS FOR FOREST BATHING Though Schneberger explains that to experience the highest level of phytoncides, it’s best to be among evergreens in a warm, humid climate, she also says, “One tree is enough!” Even without a guide, you can reap the benefits of being in nature on your own by immersing yourself in the nearest accessible natural area. Here are three forested areas in Alberta to consider as forest bathing destinations:
CYPRESS HILLS This interprovincial park in southeastern Alberta is home to forest dominated by lodgepole pine, as well as white spruce and aspen. This is a great spot for hiking and camping.
WASKASOO PARK Red Deer’s river valley boasts over 100 kilometres of pathways. Visit McKenzie Trails Recreation Area to relax among some of the city’s oldest trees.
ELK ISLAND NATIONAL PARK Located 35 minutes east of Edmonton, this is a perfect spot to experience Alberta’s boreal forest and, if you’re lucky, spot bison, elk, or some of the park’s many resident bird species.
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5 WAYS
Your donation to the Alberta Cancer Foundation is enhancing care and transforming treatment options for women’s cancers Thanks to generous donors like you, the Alberta Cancer Foundation invests in the most promising clinical trials, research initiatives and innovative technology that seek to improve the treatment and care of women facing ovarian, cervical and breast cancer. We holistically support patients across the province by focusing our efforts on reducing risk, detecting cancer earlier, improving treatment and enhancing quality of life. Here are some examples of how your support makes a difference.
SYANTRA DX BREAST CANCER A Calgary-made blood test called Syantra DX Breast Cancer, developed by Syantra, has the potential to change breast cancer screening protocol for women. This accurate and non-invasive test could become a key tool for detecting breast cancer, allowing Albertans to be diagnosed earlier. Clinical trials are underway and Syantra plans to make the test available in 2021.
ALBERTA CANCER EXERCISE (ACE) PROGRAM: HEAL-ME APPLICATION This easy-to-access, at-home program offers personalized exercise, physiotherapy and nutrition programs for cancer patients and survivors. Studies indicate it reduces treatment side-effects and improves fitness outcomes after one year of participation.
IMPROVING THE DETECTION OF METASTATIC BREAST CANCER A Calgary-based research team has identified bloodbased biomarkers that are associated specifically with bone metastasis (cancer spread to bone). The study aims to identify breast cancer patients who are at risk of, or have already developed, bone metastasis before symptoms arise. Earlier detection will yield targeted treatment plans and improved outcomes.
Learn more about how you can support the Alberta Cancer Foundation at albertacancer.ca
BRACHYTHERAPY Image-guided brachytherapy is optimizing the treatment of cervical cancer. This innovative approach delivers small radioactive sources at an optimal dose to a precise treatment area, reducing the toxicity of traditional radiation, limiting possible damage to surrounding tissue and improving patient quality of life.
STAND UP TO CANCER INITIATIVE A “dream team” of researchers across Canada is working collaboratively to share resources and data that will help guide breakthrough research for women facing advanced breast cancer. In Alberta, this initiative is supporting pre-clinical work that will guide alterations and improvements in a metastatic breast cancer clinical trial.
Thanks to the generous support of donors, breast cancer patients in Alberta whose tumours have the genetic profile HER2-positive now have access to an effective, potentially life-saving drug. Read more on page 33.
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WORKOUT
Work Out on the Water Beat the heat and try a paddling sport on the reservoir, lake or river this summer by KARIN OLAFSON LYNDA ROBERTS first tried paddling in 1984. Now, as manager
of the Calgary Canoe Club, a non-profit that provides training in paddling disciplines, she is still drawn to the water. “I think paddling is so much more than a workout,” she says. “You’re getting outside, there’s preparation and planning involved, and there’s an element of adventure, no matter what paddling discipline you choose.” Paddling is a low-impact sport that challenges the body’s cardiovascular system and improves muscular strength and endurance — and not just in the upper body. Roberts says the stabilization and balance paddling requires works the lower body and the core muscles. Here, Roberts shares her tips for four popular paddling sports to try.
1.
CANOEING WHY TRY IT Canoeing is a sport the whole family can enjoy together. The boat’s larger size means that kids can sit between the stern and bow seats during a trip. Roberts says that canoeing is also a great way to introduce kids to water safety as well as basic strokes that can be applied to all paddling sports. EXPERT TIP “If you’ve never canoed before, a lesson will come in handy,” says Roberts.
“You’ll learn how to stabilize a canoe, balance and steer it.” WHERE TO CANOE Calgary’s Glenmore Reservoir is a controlled place for beginners to gain confidence, as the only motorized boats permitted on the water are safety boats. And if you continue paddling to the west side of the reservoir to the Elbow River and up into the Weaselhead, you’ll feel like you’re far from the city.
2. 3. KAYAKING
WHY TRY IT Try kayaking with a friend in a tandem kayak or venture out alone in a solo kayak. Many kayaks often have foot pedals to help with steering, so you’re not only relying on your paddle to direct your vessel through the water.
EXPERT TIP “Posture is important with every form of paddling, but it’s especially important in a kayak,” says Roberts. “With good posture, you are engaging your core muscles as opposed to just paddling using your arms. You won’t fatigue as quickly that way, because now you’re using the bigger muscles in your trunk.” WHERE TO KAYAK Roberts recommends beginners avoid fast-flowing rivers where steering and balance can be tricky. Instead, get that sense of outdoor adventure by kayaking in lakes in Central Alberta, like Buffalo Lake, Gull Lake and Sylvan Lake.
STAND-UP PADDLEBOARDING WHY TRY IT Stand-up paddleboarding (SUP) is a full-body workout that’s similar to surfing, but easier to master. The goal is to propel yourself with a paddle while standing and balancing on the board, which looks like a surfboard but is wider and more stable. EXPERT TIP “Balance is such a huge component with SUP. You’ll be falling off [as you learn], so start off in a controlled environment where the water is calm and where it’s easier to build up the skills,” says Roberts. “It’s also really important that you can easily switch between standing and kneeling. I recommend squats and core exercises to train your body.” WHERE TO SUP Quarry Lake just outside of Canmore is a calm, safe spot to learn, making it a popular choice for recreational paddlers. Plus, you’ll be rewarded with incredible mountain views.
ILLUSTRATION ANDREW BENSON
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WORKOUT
4. DRAGON BOATING
WHY TRY IT Dragon boating is a team sport, typically made up of 10 paddlers, a drummer and a steersperson, and it’s all about camaraderie. It’s also a worldwide symbol of breast cancer awareness. In 1996, Vancouverbased scientist Dr. Don McKenzie formed a dragon boating team made up entirely of breast cancer survivors, and monitored the women for lymphedema, or swelling. In 1998, he published a study disproving the myth that intense, repetitive upper-body exercise was harmful to breast cancer survivors.
WHY CANCER SURVIVOR GILLIAN RUTHERFORD LOVES DRAGON BOATING After a year of chemotherapy and radiation, Gillian Rutherford was cancer-free and looking for a form of exercise that was both a great workout and a fun environment. She joined Breast Friends, a dragon boat team in Edmonton specifically for breast cancer survivors, in 2008 and has been part of the team ever since. Dragon boating was physically beneficial following cancer treatment — it helped her regain strength and mobility on her right side where she’d had a lumpectomy. Now, it’s mostly the social environment that keeps Rutherford training hard. “Following a cancer diagnosis, it’s really empowering to feel strong and meet other women who’ve been through what I’ve been through,” says Rutherford. “We don’t sit around and talk about cancer — we just work out together and support one another.”
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EXPERT TIP “The most important element of dragon boating is timing,” says Roberts. “If the team is out of time, it won’t be as fast or efficient. It’s essential to work together as a crew.” WHERE TO DRAGON BOAT The best way to get involved in this form of paddling is to join a team. While Roberts trains the Calgary Canoe Club crew out of the Glenmore Reservoir, she says you’ll find teams in Northern Alberta paddling on Telford Lake and on the North Saskatchewan River, too.
STAYING SAFE ON THE WATER 1. TAKE A LESSON If you’ve never paddled before, book a lesson with an expert. “You want paddling to be a positive experience,” says Roberts. “Going in circles is not fun!”
2. PLAN AHEAD Check the weather conditions ahead of time and be prepared for sudden weather changes. “Pack a windproof shell and some-
thing warmer, just in case,” says Roberts.
3. BRING THE RIGHT SUPPLIES Wear a personal flotation device, pack a dry bag with a cell phone and some extra clothes, and make sure you have all the required safety items. “That includes your whistle, a spare paddle and a bailer,” says Roberts. LEAP
FOOD FOCUS
Sustainable Seafood Ocean-friendly choices that are good for you and the planet by ELIZABETH CHORNEY-BOOTH
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FOOD FOCUS
MANY CANADIANS HAVE HEARD
about about the health benefits of eating fish and seafood, but sitting down to a pescatarian meal can be a cause of concern for anyone concerned about the health of our planet. While most dietitians will recommend incorporating fish into your diet for a necessary hit of vitamin D and omega-3 fatty acids, consumers are becoming increasingly aware of the damage that overfishing can do to ocean ecosystems. Enter the concept of sustainable seafood. Ocean Wise, a global conservation organization based out of Vancouver, defines sustainable seafood as “species that are caught or farmed in a way that ensures the long-term health and stability of that species, as well as the greater marine ecosystem.” Ocean Wise monitors the method, targeted species, and location of fisheries to determine if its product is causing as little harm to the environment as possible. Packaged seafood and restaurant items that pass muster get labeled with a logo to help consumers make ocean-friendly choices. Advocating against infractions like overfishing and the by-catch of endangered species is good for ocean ecosystems. Still, consumers aren’t always clear if choosing sustainable seafood is also good for their bodies, especially when it comes to the prevention of diseases like cancer. Private registered dietitian Rory Hornstein says that there’s no evidence that sustainable seafood is lower in chemicals or contaminants than non-sustainable options or that it has a higher content of vitamins and minerals. Even so, she says that anything that encourages people to feel good about regularly eating fish and 18 LEAP SUMMER 2020
seafood is positive in her books. “It’s important to look at what fish has to offer in general before looking at the sustainability factor,” Hornstein says. “Fish is high in protein and generally contains so many vitamins and minerals. Higher fat fish that’s high in omega-3 is believed to have health benefits when it comes to heart health and research has also linked omega-3s to the prevention of certain cancers like liver cancer.” Hornstein says that choosing sustainable seafood is actually quite easy to do in Alberta — she says it’s often more readily available than non-sustainable seafood, especially for shoppers who are willing to buy canned fish or species they’re less familiar with. As with fresh vegetables or fruit, she encourages consumers to learn to expand their seafood repertoire to incorporate less common or popular species when they’re available.
can help in the fight against climate change and keeping fisheries sustainable means that we will all be able to enjoy the health benefits of seafood for generations to come. Coupled with a burgeoning bioplastic industry — which involves the development of plastics made from underwater vegetation that will biodegrade rather than pollute ocean habitats — Kostyniuk says that more and more people are seeing value in protecting the oceans. “I firmly believe that what we do to the oceans we do to ourselves,” she says. “It’s a bigger-picture view, but we know that the oceans are the largest producers of the oxygen we breathe. If heavily intensive industrial fishing practices damage ocean ecosystems, the oceans will not be as resilient and won’t be able to support us to their greatest abilities.” Kostyniuk says that Ocean Wise products are available at nearly 800
“ It’s important to branch out and create a market for underutilized fish and to help the environment.” — RORY HORNSTEIN
“Choose a fish variety that’s in season rather than just sticking to salmon year-round,” Hornstein says. “It’s important to branch out and create a market for underutilized fish and to help the environment.” While making the conscious decision to buy sustainable seafood doesn’t necessarily have a direct correlation to physical health, it can give consumers peace of mind while digging into a plate of seafood. Ocean Wise’s Seafood Program Manager Sophika Kostyniuk argues that protecting the oceans
unique businesses across Canada and about 3,100 storefronts. She advises customers to look for the Ocean Wise logo on seafood cases at grocery stores like Sobeys and Save on Foods, as well as independent fish markets. Many fine-dining chefs in Alberta make a point of cooking exclusively with Ocean Wise products, but customers can also find sustainable seafood at chains like Hula Poke and Moxie’s Grill & Bar. For a full list of Ocean Wise partners, visit seafood.ocean.org. LEAP
PAN SEARED SALMON WITH BLOOD ORANGE FENNEL SALAD Recipe courtesy of Ocean Wise INGREDIENTS 8 oz Ocean Wise recommended salmon fillet 5 oz oyster mushrooms 1/2 pint heirloom cherry tomatoes 1 bulb of fennel 1 blood orange 2 cloves of garlic, minced extra virgin olive oil salt and pepper
SUSTAINA SEAFOODBLE IS GOO YOU ANDD FOR OCEAN THE
DIRECTIONS 1. Preheat oven to 500 degrees F. 2. Roast cherry tomatoes in 500-degree oven with salt, pepper and good olive oil until blistered. Set aside. 3. Next, sauté mushrooms with olive oil, garlic and season with sea salt and fresh cracked pepper. Keep warm and set aside. 4. Segment one blood orange and keep juices. Trim fennel, remove core and slice thin. 5. Mix fennel, blood orange juice, olive oil, salt and pepper and let sit. 6. Heat cast iron pan on medium-high, add a drizzle of olive oil. Add salmon to pan once hot, laying salmon down away from yourself to avoid splashing the oil. Sear salmon skin side down for 2-3 minutes then flip and cook 3-4 minutes on other side until internal temp of 145 degrees F. 7. Let salmon rest while plating the fennel salad and sautéed mushrooms and cherry tomatoes. 8. Place salmon on top of salad and finish with fennel fronds and extra virgin olive oil.
TOP CANADIAN OCEAN WISE SEAFOOD Many of Canada’s fisheries adhere to Ocean Wise standards and some of our country’s native fish rank highly on the organization’s list of sustainable species. Seek out these Canadian varieties to feed your body and protect the ocean:
ARCTIC CHAR
This easy-to-grill pink-fleshed fish is caught sustainably off the coast of Nunavut and also farmed worldwide.
SALMON Chum and pink salmon are caught wild in the Pacific and sockeye salmon is very carefully managed by fisheries.
COD Versatile and mild in flavour, Pacific cod can be caught sustainably through a variety of methods.
PICKEREL Caught in the Great Lakes, this lean freshwater fish has a mild and sweet flavour.
HALIBUT There are catch limits for Pacific halibut in the U.S. and Canada, but when available, this firm white fish is incredibly popular.
RAINBOW TROUT Also known as steelhead trout, this freshwater fish is a great alternative to salmon.
SPOT PRAWNS These delicate prawns from B.C. are a favourite of restaurant chefs and are only available for a short window in the spring. LEAP
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EXPERT ADVICE
Q: What are some of the programs patients can access?
We ask the experts about the benefits of community-based support programs, and how cancer patients can donate organs and blood
PATTI MORRIS
COMMUNITY-BASED SUPPORT by ALICIA CHANTAL
Studies have shown that individuals whose lives are impacted by cancer benefit from community-created support outside of the health-care system. Patti Morris, CEO of Wellspring Calgary, a communitybased, registered non-profit cancer support centre, explains why communitycreated support is vital to the cancer journey, and how Wellspring Calgary works to create a comfortable, non-clinical environment.
Q: What is Wellspring and what does it offer? There is a wise focus within the medical
system on patient-centred care. Wellspring Calgary is an expression of this. We are co-founded by three cancer survivors who all received excellent medical care, but also recognized the need for additional and complementary supports and resources to help people pick up the pieces after a cancer diagnosis. Our Wellspring community, both physical and online, is distinctly safe, warm and welcoming; a place where people living with cancer can gather for support, compassion and information. Our programs and resources are evidenceinformed, non-medical and non-clinical.
Q: Why do you think community support is vital to the cancer journey? Those who come to us almost universally describe a great benefit. We’ve been exceptionally fortunate to profit from patient-led research through the Patient and Community Engagement Research (PaCER) unit of the O’Brien Institute for Public Health at the University of Calgary, that studied what works at Wellspring Calgary and how. These patients were motivated to capture the many benefits they experienced through Wellspring Calgary and their overarching assessment was that Wellspring empowers patients and caregivers to more actively engage in their own health and wellness.
Wellspring Calgary offers 90 different evidence-informed programs, available at no cost to anyone living with any type of cancer and at any point on their cancer journey. [Some examples include] educational, movement and meditation, expressive arts, one-on-one peer support, a stream just for young adults, as well as programs for children and caregivers. We are fortunate to have program leaders who are professionals and experts in their field leading our programs.
Q: How else is communitybased support useful for people facing cancer? There is important research originating out of Alberta, led by Dr. Barry Bultz [at the U of C], that recognizes distress in cancer patients as the 6th vital sign. [This addresses] physical, emotional, practical and/or informational issues and concerns that may impact a patient’s wellness. These important needs may be best met through clinical supports, such as the psychological counseling offered through CancerControl Alberta’s psychosocial team. Many patients and caregivers, however, may not have the need for clinical supports and therefore may find their needs are best met in a community-based setting, like Wellspring. We often hear that people appreciate our warm, welcoming approach. Many welcome a break from a hospital setting.
Q: During this time of social distancing, how is Wellspring connecting with its community? We’ve begun offering programs and support through video conference and by phone in response to the pandemic, but also as part of our bigger plan to extend our services to those living with cancer in southern rural Alberta. Reach out and join in. No one should have to face cancer alone. Wellspring Edmonton offers support and services to the northern part of Alberta. ILLUSTRATION JENNIFER MADOLE
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Q: Why is there a waiting period to donate blood?
DR. MINDY GOLDMAN
BLOOD AND ORGAN DONATION by JENNIFER FRIESEN
Cancer patients can spend days, weeks and even years inside of hospital rooms, often on the receiving end of life-saving blood donations, plasma transfusions or stem-cell transplants. Many cancer patients and survivors know the importance of blood and organ donation first-hand and many are keen to give back. Four years ago, cancer survivors were unable to donate blood, but Dr. Mindy Goldman, medical director of donor and clinical services at Canadian Blood Services, explains how to donate now, following changes implemented in 2016.
Q: Can a cancer patient or survivor be a blood or organ donor? Most cancer survivors can donate blood five years after they end curative treatment, as long as they meet all other eligibility criteria. For organs and tissues, anyone can be a potential donor regardless of age or medical condition. Even individuals with serious illnesses may sometimes be donors. All potential donors are evaluated on an individual, medical, case-by-case basis. Our message to Canadians is to not rule yourself out!
The five-year waiting period for blood donation is a precaution. Until 2016, Canadian Blood Services had a permanent deferral from blood donation for most types of cancer. We applied to Health Canada for the reduction to five years following a large Scandinavian study that provided convincing evidence that cancer cannot be transfusion transmitted [passing blood from one person to another]. This has resulted in a significant increase of eligible donors and shows the importance of re-evaluating criteria. We re-evaluate eligibility criteria as new data becomes available, and we are considering a future submission to Health Canada to reduce the waiting period to 12 months. The latest updates to eligibility criteria can be found at blood.ca.
Q: Are there any restrictions on being a donor based on what kind of cancer someone has had? Unfortunately, survivors of blood cancers and melanoma are currently ineligible to donate, and they still have a lifetime deferral, which is precautionary.
Living organ donations are assessed in consultation with a physician and based on recipient consent on a case-by-case basis. Similarly, for deceased donation, each case is assessed on a case-by-case basis and reviewed at the time of death. Based on a range of factors, the deceased donor’s organs and tissues (such as corneas or skin) may be eligible for use.
Q: What are the specific concerns for organ or tissue donation? There are many factors for organ and tissue donation, but some of the main concerns include the donor’s remission status, the type of cancer the donor had, and the health of their organs – which can be negatively impacted by cancer treatment. Generally speaking, cancer survivors are not eligible to be living donors, but the medical team may determine it’s safe to proceed with donation depending on these factors. Importantly, to ensure organ donation is considered at time of death, we ask all Canadians to talk to their families about their wish to become an organ donor, and to register their wishes in their province. LEAP Learn more at blood.ca
A LIFE-SAVING GIFT According to Canada Blood Services, a single deceased organ donor has the potential to provide as many as eight organs for transplant. Currently, there are approximately 4,400 Canadians waiting to receive a life-saving organ or tissue transplant. Learn how you can register to become an organ or tissue donor at organtissuedonation.ca
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GAME-CH ALBERTAN CANCER SURVIVORS LORNE COCHRANE (left) AND CAM LANE (right)
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ANGERS photography A A R O N P E D E R S E N
A game-changer is a person, idea or practice that operates outside the box, challenges the status quo and is inspired by the question, ”How can this be better?” When it comes to cancer treatment, support and care, Alberta is blessed with a plethora of revolutionary people, practices and ideas. From transformative donors to evolving best practices, we explore some of the province’s top game-changers.
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T R E AT M E N T
THE IMMUNOTHERAPY REVOLUTION IMMUNOTHERAPY HAS EMERGED AS THE GAMECHANGING TREATMENT OF THE PAST DECADE, WITH APPLICATION IN ALBERTA AND BEYOND SHOWING LIFE-SAVING RESULTS » by NATHAN KUNZ photography AARON PEDERSEN
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DR. JOHN WALKER
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r. John Walker doesn’t mince words when he describes the immunotherapy movement. “We’re in a position today where nearly half of the patients we will see in our cancer centres may qualify for one of these immunotherapies,” says Walker, a medical oncologist and associate professor in the department of oncology at Edmonton’s Cross Cancer Institute. “Revolution is absolutely the right word for it.” Worlds apart from other “traditional cancer therapies” like chemotherapy, immunotherapy involves assisting a patient’s immune system to better fight cancer. Cancer cells have been found to express a molecule onto white blood cells that triggers the natural “off switch.” Immunotherapy helps reverse this action by introducing laboratory-raised monoclonal antibodies that bind to white blood cells known as T lymphocytes, or “T-cells,” that disable the connection between the cancer and the T-cells, turning off the “off switches” and allowing them to fight the cancer cells. Though Walker doesn’t hesitate to call immunotherapy game-changing, he does note there’s still plenty of work to be done. “We haven’t really seen the full impact of immunotherapy, which is really what’s most exciting,” he says. Today, Walker says much of the exciting immunotherapy research in Alberta focuses on using immunotherapy drugs along with other agents to treat patients who haven’t seen benefit from the treatment alone.
With an abundance of Alberta Cancer Foundationbacked immunotherapy research projects taking place, patients remain at the core, undergoing unprecedented clinical trials to help advance cancer care. We spoke with Albertan cancer survivors who share their inspiring experiences with immunotherapy. LORNE’S STORY
Despite feeling healthy, Lorne Cochrane decided to go for a check-up shortly after his twin brother, Lloyd, underwent a lower lobectomy in 2012. Lung cancer had been prevalent in the Cochrane family, though history didn’t make Lorne’s stage 4 diagnosis any less surprising. “When they told us that he was past surgery and onto palliative, and that he’d only have a short time to live, we were shocked,” says Lorne’s wife, Mary Cochrane. Lorne was given 12 to 13 months to live after beginning palliative chemotherapy treatment in summer 2012. Lorne and Mary began actively searching for alternative treatments, asking Lorne’s oncologist to consider him for any clinical trials. “I said ‘I’m young, I’m healthy, I feel good. If any clinical trial or anything comes up, throw it my way,’” says Lorne, who was 52 when diagnosed. Chemotherapy was proving ineffective and following a CT scan in mid-August 2013, a halt was put on treatment, and Lorne was told to head home to enjoy the remainder of his days. Just weeks later, however, the Cochranes received a phone call — a clinical trial had come up. Lorne was entered into a randomized process to decide if he would undergo further chemotherapy or an immunotherapy trial. When his oncologist told them it would be the latter, they felt hopeful. “It was a celebration knowing it was not chemo,” says Lorne. For the trial, the Cochranes made the five-hour round trip from their acreage north of Edmonton to the Cross Cancer Institute every two weeks. Within eight weeks, the congestion in Lorne’s lungs began to clear, an early sign that his body was taking to the treatment. A CT scan at week 15 delivered concrete proof — the majority of his more than 25 active cancer spots had shrunk down to a point of immeasurability. “It was just disbelief that it worked that fast,” says Lorne.
Positive results continued from there, and after carrying on with treatment for two more years, Lorne made the choice to stop in 2017. He’s since been monitored regularly through CT scans, which show no signs of cancer returning. Since 2017, the Cochranes have stayed in the realm of cancer care. Recently, they’ve been working with lung cancer-specific foundations to discuss stigma and raise awareness about the disease. Lorne also shares his hopeful story through media appearances, social media and more. “Probably the most rewarding thing about living through this is realizing that [other patients] aren’t going home and living in doom and gloom,” says Lorne. “There is hope.” CAM’S STORY
After an initial diagnosis in 2007, Cam Lane says his experience with melanoma became a seemingly endless loop of minor operations to remove lesions on his right leg. “It was basically cut and scan, cut and scan,” says the Edmonton native, who was 35 at the time of diagnosis. “[I was always] checking in, ‘Are there oncology treatments
CAM LANE
LORNE COCHRANE
that would be available to me other than the chemotherapy?’ The answer was always no.” In late 2013, his cancer had progressed to stage 4 after spreading to his lungs. Research showed that survival rates for stage 4 melanoma were low with the treatment options available at the time. Even when Dr. Walker, who was Lane’s oncologist, first approached him about taking part in an immunotherapy trial in December 2013, there was still no indication that treatment would work. “It was hopeful that it would do something, but there was no evidence,” recalls Lane. Despite the uncertainty, Lane underwent testing and was found to be eligible for the trial after the largest spot in his lung had grown just beyond the required threshold. The trial began with weekly IVs, lasting about two hours at a time. One week in, Lane’s right leg swelled up to roughly twice its normal size, and more than 20 blisters appeared on his skin. Dr. Walker assured him that the reaction was positive — it indicated his immune system was fighting cancer microsites. Following a CT scan at the three-month mark, Dr. Walker showed Lane a picture from the scan of the target lesion, which he says was roughly 90 per cent gone. “It looked like someone had just taken an eraser to it and just scrubbed it out,” says Lane. “It was the first time I felt ‘Hallelujah. I might actually get through this.’” In July 2014, Lane was told he was the first patient on the trial to have a complete response, with no active trace of cancer showing up on his scan. He kept up with treatments for the next three years and by 2017 decided to step away. Six years later, he says cancer isn’t something he worries about anymore. Like the Cochranes, Lane has stayed connected to cancer care. He’s found a spot on the National Cancer Board of Canada as a patient representative and shares his story through speaking engagements and other initiatives. “Hopefully it’s helpful for other people, but it’s almost been like a form of therapy for me,” says Lane of sharing his story. “Something could emerge up in the future, but right now, I’m enjoying life and being able to contribute back.” LEAP myleapmagazine.ca SUMMER 2020 LEAP 25
MORE MOMENTS THANKS TO IMMUNOTHERAPY, HENRY SCHUETZ HAS MORE TIME WITH HIS FAMILY Henry Schuetz had never heard of immunotherapy when his doctor brought up a clinical trial in 2014. “I didn’t have a clue what it was,” says Schuetz, who was diagnosed with stage 4 renal cell carcinoma in late 2013 at the age of 40. “[My oncologist] never said it would save my life. But he wanted to prolong it.” The eight months preceding had been difficult. A painful backache, paired with fatigue and weight loss, led Schuetz to get tested on December 13, 2013. That same day he was told he had two years to live. “It was my worst nightmare,” says Schuetz. “[My] first thought was ‘I’m not going to see my daughter graduate, or my son get married, or my grandkids.’” Beyond an operation that removed his kidney where the cancer began, Schuetz was kept off treatment for the next several months, allowing him to spend time with his family while monitoring continued. Eight months after his diagnosis, he was approached about taking part in a clinical trial at the Cross Cancer Institute, an opportunity he jumped at. Schuetz underwent three out of the four scheduled sessions in the six-week trial, stopping after having side-effects that required additional medication that made him ineligible for the final dose. Treatments were delivered intravenously, taking about 26 LEAP SUMMER 2020
an hour at a time. Through it all, Schuetz wore a Superman shirt — a nod to his late father who shared his love of the superhero. While Schuetz worried that not taking part in the fourth session would affect his outcomes, three proved to be enough. At the end of the trial, he was shown his initial and final scans, which displayed how cancerous spots on his lungs had largely shrunk, and in many cases, fully disappeared. “I honestly don’t think without the clinical trial that I would have survived,” says Schuetz In December 2019, Schuetz underwent a non-invasive operation to remove a tumour found in his brain, and in April 2020, he had a follow-up operation that used a gamma knife treatment to help remove additional cancer cells in the area. In July, he underwent surgery to remove a tumour on his tongue, and ongoing tests have shown no current active cancer cells. Today, Schuetz lives in St. Albert with his girlfriend, who, along with his mother and the rest of his family, he credits as being a much-needed support system. In summing up the experience, one word comes to mind. “Relief,” says Schuetz. “I [got to see] my daughter graduate and my son get married [and I got to meet] my three grandkids.” LEAP
PAT I E N T W E L L- B E I N G
FOUR DECADES OF INNOVATION IN PALLIATIVE CARE SINCE THE 1980s, ALBERTA-BASED PALLIATIVE CARE RESEARCH HAS IMPROVED THE QUALITY OF LIFE FOR INDIVIDUALS LIVING WITH ADVANCED CANCER » by KARIN OLAFSON illustration SCOTT CARMICHAEL
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anet Vandale, a clinical nurse specialist in palliative care in Calgary, met Dawn (not her real name) last spring, shortly after Dawn’s advanced cancer diagnosis. For more than a year, with Janet’s support, Dawn was able to voice her fears and anxieties, her symptoms were managed, and practical end-of-life arrangements were made in advance, all of which improved her well-being as she lived with cancer. Palliative care, a medical specialty that emerged in the mid-1960s, helps improve the quality of life for individuals like Dawn, their families and their care team. According to the Canadian Medical Association Journal, palliative care includes “preventing, screening for and relieving pain and distress associated with the challenges of living with a life-threatening illness.” It provides pain and symptom management, as well as psychosocial, emotional, spiritual and practical support. For over 30 years, groundbreaking research in palliative care, how it is offered and how it can improve the well-being of cancer patients, has taken place in Alberta. And the research continues today, helping ensure that holistic care can reach more cancer patients, sooner. >
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PIONEERING PALLIATIVE CARE
Dr. Eduardo Bruera has worked in palliative care for 36 years, entering the medical specialty when it was in its infancy. He was driven by a desire to limit the pain, emotional struggles and other distresses he saw among cancer patients. “During my training as an oncologist [in Buenos Aires, Argentina, in the 1970s and 1980s], we were all focused on curing cancers,” says Bruera, now the chair in the department of palliative, rehabilitation and integrative medicine at the University of Texas MD Anderson Cancer Center. “But I was seeing patients in terrible physical and emotional suffering. Oncologists knew nothing about how to support those patients.” It was then that Bruera decided to focus on research, making discoveries that would help improve the way cancer patients lived with the disease. “I wanted to learn more [about eliminating cancer patients’ distress]. I sent 52 letters to different institutions around the world, [gauging] interest in bringing me on as a research fellow in palliative care,” says Bruera. He got one response. In 1984 Dr. Neil MacDonald, another palliative care pioneer and director of the Cross Cancer Institute (CCI) in Edmonton, recruited Bruera to the CCI’s palliative care research program to work as a clinical research fellow. The huge amount of work Bruera put in while at the CCI in the 1980s and 1990s was instrumental in reducing cancer patients’ distress. For example, his research led to the creation of the Edmonton injector, an inexpensive and easy-to-use pain-relief contraption. He did extensive research on pain medications, discovering uses for new opioids and finding less invasive methods of administering them. He found that rotating opioids, instead of prescribing only one, also was more effective at mitigating patients’ pain. “We did a lot of studies [and the results] ended up becoming part of the daily practice in palliative care, not only in Canada but in many other countries,” says Bruera. Since 1984, Bruera has published more than 1,200 papers and trained hundreds of palliative care specialists around the world. And the work he did at the CCI was influential in directing how palliative care is practiced today. ADVANCING PALLIATIVE CARE TODAY
Current research in Alberta aims to get patients this lifeimproving care as soon as possible. 28 LEAP SUMMER 2020
“I think the earliest attempts at palliative care were looking for quality at [a patient’s] end of life. These days, palliative care is looking [to improve] quality of living, after diagnosis and right through to end of life,” says Dr. Jessica Simon, an associate professor and division head of palliative medicine in the department of oncology at the University of Calgary. Simon says, typically, patients receive palliative care only within the last two months of their life. And at that point, they can be in serious pain and distress. “I think one of the difficulties is that, in many people’s minds, palliative care is still associated with end of life, on the final days and hours, rather than the final months and years,” says Simon. “But the research evidence tells us that when we do provide palliative care earlier, people enjoy a better quality of life and they have better symptom control for longer. So we’re trying to change that perception.”
“ Our long-term vision is that all patients with advanced cancer, and patients with any life-limiting disease, benefit from early palliative care.”— DR. JESSICA SIMON In 2017, Simon began working on the province-wide Palliative Care and Early Systematic (PaCES) project, researching how integrating palliative care earlier — provided in conjunction with cancer treatment — can improve quality of life for patients diagnosed with advanced colorectal cancer. One element of this project was the designing of an early palliative care pathway, which aims to get patients referred to palliative care specialists two months after diagnosis or sooner. Simon hopes the results, expected in 2021, will prove that earlier palliative care is integral to reducing physical, emotional and social distress for anyone diagnosed with a serious illness. “Our long-term vision is that all patients with advanced cancer, and patients with any life-limiting disease, benefit from early palliative care,” says Simon. “We can’t forget that lots of people live with cancer for many years. We need to make sure that everybody living with cancer gets the best quality of life they can.” LEAP
P E R S O N - C E N T R E D CA R E
PATIENTS ARE PEOPLE FIRST PERSON-CENTRED CARE RECOGNIZES THAT NO TWO CANCER EXPERIENCES ARE ALIKE » by KARIN OLAFSON illustration SCOTT CARMICHAEL
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r. Linda Watson knows that patients are the experts in their own lives. And for patients to live as well as possible with cancer, it’s imperative to consider how those lives are lived outside the four walls of the cancer centre. That’s where person-centred care comes in. “Person-centred care is about integrating the patient’s life experience, as well as their symptoms and health concerns, into the care we provide,” explains Watson, scientific director of applied research and patient experience at CancerControl Alberta. “Person-centred care considers what other supports someone needs alongside their treatments.” In the early 2000s, Alberta scientists identified that chemotherapy, radiation and surgery didn’t address all of a cancer patient’s needs. “Person-centered care came from a psychosocial area, of trying to describe what those unmet needs were. Between 2005 and 2010, there was this growing momentum and this shift in care was happening everywhere across Canada,” says Watson, explaining that health-care providers began moving away from a disease-centric model of care. Person-centred care addresses the individual challenges each patient experiences during their cancer journey, including challenges beyond those that can show up in a scan or blood test, like pain level, anxiety and fatigue. One way this is delivered in Alberta is through a symptom-screening tool. In 2015, Watson and her team launched a form called Putting Patients First. By filling out the form, patients communicate what is concerning or troubling
them, ranking symptoms like pain, nausea and fatigue, on a sliding scale. They also identify any emotional, social and practical concerns, which helps the health-care team refer them to other specialists including social workers, psychologists, palliative care specialists and more. To understand patients’ well-being on a deeper level, the Putting Patients First tool has recently integrated technology. Now, a Patient Reported Outcome (PRO) Dashboard connects to an individual’s electronic medical record and those reported concerns are plotted in a colour-coded graph. This makes distress easily visible and easier to address. Currently, the team is working with Alberta Health Services to design a patient portal, which will allow patients to report their concerns from home, helping physicians better prepare for the next appointment. The result is holistic care that considers each patient’s unique experience with their disease. In fact, interest in the Putting Patients First tool goes beyond cancer centres — and even beyond Alberta. “We are leveraging our learnings out to other provinces, in terms of how to graphically report this information and integrate it into care,” says Watson. “We are also bridging out of cancer, to other [medical specialties] that want to forge relationships with patients over time using a similar approach.” LEAP myleapmagazine.ca SUMMER 2020 LEAP 29
D O N AT I O N S
A LASTING LEGACY ROBERT (BOB) DIXON LIVED HIS LIFE WITH A MISSION OF SPREADING POSITIVITY AND SUPPORTING CAUSES DEAR TO HIM. THROUGH A $10 MILLION ESTATE GIFT TO THE ALBERTA CANCER FOUNDATION, HIS PHILOSOPHY LIVES ON » by NATHAN KUNZ illustration ROBERT CARTER
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obert (Bob) Dixon passed much to the next generation, including advice, perspective and potential. Throughout Bob’s life, a mantra remained at the core of nearly everything he did: “Attitude is everything.” “I don’t remember him ever being down or showing us that he was feeling anything but positive,” says Dixon’s daughter, Sue Rasmussen. “That was his outlook on life, and he hoped he could spread it.” A born Calgarian and prominent CEO in the Alberta oil and gas industry, Dixon lived with Hodgkin’s lymphoma for the last 25 years of his life after receiving a diagnosis in the early 1970s. His own experience guided his philanthropy, and he served as co-chair of one of the Alberta Cancer Foundation’s first capital campaigns, Project Alpha, from 1988 to 1990. The campaign helped raise funds for the Southern Alberta Cancer Research Centre at the Heritage Medical Research Building near the Foothills Medical Centre in Calgary. Its underlying goal was to conquer cancer by providing the necessary resources to researchers in the province. Today, 25 years after Dixon’s death in 1995, his legacy lives on through a game-changing gift to the Alberta Cancer Foundation — a $10 million donation from his estate, presented in his name in 2015, following the passing of his wife, Kathleen (Kay) Dixon.
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“The Dixon family’s generosity is unprecedented for our foundation,” says Alberta Cancer Foundation manager of legacy giving, Christy Soholt, who acts as a liaison between the organization and the family. Soholt says that the donation represents the largest estate gift in Foundation history. The donation was left in the hands of the Foundation to find appropriate use, with the guideline that it stays in the realm of hematologic oncology research or education to pay tribute to Dixon’s experience with Hodgkin’s lymphoma. The Foundation chose to use the money to fund potentially groundbreaking research in the field, with a call going out to researchers in late 2018 for funding proposals for the newly minted RK Dixon Family Award in Hematologic Oncology Research. “We wanted to go out to the community and seek out the best projects with the biggest potential,” says Soholt. “[Something] scientifically sound [that] will make the most impact for patients facing cancer and will have a great impact in Alberta as well.” So far, five projects have been approved for funding through the award: a study exploring self-administered chemotherapy options at home for patients (see pg. 7 to learn more); a Canada-wide study into alternative treatment to reduce bleeding after undergoing autologous stem cell transplantation treatment for blood cancer; a study identifying early predictors ahead of blood stem cell transplantation to avoid relapse that is potentially untreatable; a clinical trial aimed at reducing the debilitating and sometimes deadly graft vs. host disease (an attack of the transplanted immune cells against the recipient’s tissues) for bone-marrow transplant patients; and a study into breaking down barriers that prevent blood cancer patients from accessing palliative care earlier on. These projects are just the beginning of potential change that may come thanks to the RK Dixon Family Award, with Soholt noting that more funding is still available for future proposals.
ROBERT (BOB) DIXON LEFT A $10 MILLION ESTATE GIFT TO THE ALBERTA CANCER FOUNDATION
“With any sort of generosity from donors, but this size in particular, we’re able to now provide the opportunity for exploration to begin, and some of it could lead to very transformational change for anybody facing a diagnosis,” says Soholt. “[Researchers tell us that] ideas are plentiful, the potential is great — they just need the funding in order to test things out and try new things.” Through it all, the Foundation has worked to maintain the family connection to the award, with Rasmussen taking part in reviewing proposals for projects submitted for funding. “These estate gifts are gifts from families,” says Soholt. “Because it was such a significant gift with the potential
for transformational impact, we want to make sure that we include everybody who is involved.” Rasmussen says involvement in the process has helped her feel closely connected to the change that’s being created thanks to her family’s gift. Along with Dixon’s four grandchildren, Rasmussen says she’s proud to see the legacy her father created live on and continue to foster positive change. “This helps me feel connected to him. He passed in ’95 and there’s not a day that goes by that I don’t think of him,” says Rasmussen. “Being included in the review process makes me feel like I’m there for him. As his daughter, I’m proud to see how it’s being put to use.” LEAP myleapmagazine.ca SUMMER 2020 LEAP 31
D I AG N O S T I C S E RV I C ES
STREAMLINING CARE THE BENEFITS OF A COORDINATED, PROVINCE-WIDE DIAGNOSTIC PROGRAM » by DIANE BOLT illustration EMILY CHU
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ews of a cancer diagnosis came to thirty-sixyear-old mechanical engineer Corina Valencia on a sunny but chilly day in early December 2018. Three months earlier, Valencia had begun experiencing neck pain, but, as she was 24 weeks pregnant, she attributed it to her body changing. But, when her husband found a lump in her neck, Valencia went to see her family doctor. An ultrasound showed an inflamed lymph node, and the decision was made to investigate further once her baby was born. At a routine prenatal checkup in late November, Valencia was rushed to hospital for an emergency C-section because her baby’s heart rate was low. While baby Oliver, who is healthy and happy today, lay in the neonatal intensive care unit, Valencia underwent a lymph node needle biopsy to her neck. The results of the biopsy showed suspicious cells indicative of Hodgkin’s lymphoma. Valencia was exhibiting other symptoms consistent with Hodgkin’s but a biopsy to confirm the diagnosis came back negative, and without a positive cancer diagnosis, she was unable to access the services and support at Calgary’s Tom Baker Cancer Centre. Valencia was sent for an X-ray, which revealed a mass in her chest, but a bronchoscopy to take samples directly from her lungs also came back negative. Finally, following a CT-scan guided biopsy, Valencia was diagnosed with stage 4 Hodgkin’s lymphoma. “It was a very stressful time,” says Valencia, who is now, thankfully, cancer-free. Dr. Douglas Stewart is the senior medical director of the cancer strategic clinic at the Tom Baker. He believes a coordinated program is needed to better serve not only patients like Valencia, but also health-care professionals.
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“With the current system, patients may experience distress caused by diagnostic delays, unnecessary tests and a lack of support. Likewise, the primary care providers experience variability in access to tests and specialists, referral processes and levels of communication,” he says. Fortunately, things are changing. Stewart is one of the leads of the Alberta Health Services Cancer Strategic Clinical Network (SCN) team, which is developing a province-wide cancer diagnostic program called the provincial Accelerated Cancer Diagnosis program (ACD). The Cancer SCN team is made up of a variety of stakeholders including government agencies, universities, patients and more. The goal of the ACD program is to streamline, coordinate and standardize processes across all types of cancer, to lessen delays and provide education and support. Thanks to the generous support of Alberta Cancer Foundation donors, Phase 1 of development of the ACD program began in 2019. There are existing province-wide coordinated cancer-specific diagnostic programs in Alberta, including programs to diagnose lung cancer and breast cancer, with colorectal and lymphoma programs in development. Eventually, these existing programs will continue to operate under the umbrella of the ACD program. Stewart is hopeful the ACD program will also eliminate unnecessary tests. Family doctor referrals would go to the centralized program and patients would be triaged to the appropriate cancer pathway. Rather than tests and procedures happening in a linear sequence, multiple processes could happen at the same time to expedite diagnosis while also providing peer support. Stewart hopes that the game-changing ACD program will be in place for all cancers within the next five years. LEAP
C L I N I CA L T R I A L S
HEALTHY HEARTS HOW AN ALBERTAN CLINICAL TRIAL MADE BREAST CANCER TREATMENT SAFER FOR WOMEN ACROSS THE COUNTRY » by JENNIFER FRIESEN
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ince 1998, the drug known as Herceptin has played an integral role in effectively treating Canadian breast cancer patients. Originally used in combination with chemotherapy for women diagnosed with stage 4 breast cancer, Herceptin proved successful in preventing the recurrence and spread of cancer. But it also became clear that the medication had a dangerous side-effect. The treatment caused a strain on patients’ heart health — especially if they were predisposed to cardiovascular issues. In 2005, the use of Herceptin, which is still almost always used in combination with chemotherapy, morphed from late-stage cancer treatment to the curative standard for early-stage breast cancer patients, bringing consistently positive results. However, along with the positive results, it was apparent that the heart damaging sideeffects were a consistent downside. Dr. John Mackey, professor of oncology at the University of Alberta and director of clinical trials at Edmonton’s Cross Cancer Institute (CCI), says that rates of heart failure in breast cancer patients using Herceptin “ranged as high as five to six per cent.” In addition to possible future heart concerns, the cardiac health issues of women during their Herceptin treatment would often interrupt their progress as they grappled with their diagnosis. Mackey says that, while breakthroughs in breast cancer are positive, it’s important to keep the rest of the body healthy simultaneously. “People have their hearts forever,” he says. “Hopefully their breast cancer is behind them after treatment, so if you can prevent that extra damage in the first place, they’re less likely to have heart problems in the future.” For more than two decades, Dr. Edith Pituskin has been working at the CCI, where she’s treated both breast cancer patients and heart failure patients as a result of Herceptin treatment. A long-time colleague of Mackey’s, Pituskin approached him in 2010 with an idea to start a clinical trial to get to the root of the problem. “Instead of patching people together after the heart
damage has been done, we asked if there was a way to prevent the heart damage in the first place,” says Mackey. Joining forces with Dr. Ian Paterson, a cardiologist with expertise in heart imaging, the trio launched the MANTICORE clinical trial at the CCI. Funded in part from the generous support of Alberta Cancer Foundation donors, MANTICORE — an acronym for Multidisciplinary Approach to Novel Therapies In Cardiology Oncology Research — brought in 104 breast cancer patients from Alberta and Manitoba between 2011 to 2014. One-third of patients received a beta-blocker to lower adrenaline and stress on the heart, the next third received Perindopril, which is a common medication to lower blood pressure, and the final third received a placebo. “The idea of the study is that everyone’s going to go on Herceptin,” says Mackey. “We know they have a risk of getting heart damage, but instead of waiting for them to get heart damage, we’ll give them those heart recovery medications upfront, or a placebo, to see what works.” Throughout the process, patients underwent cardiac MRIs to provide images of the heart and monitor their cardiac health over time. “It was honestly a surprise at the end,” says Mackey. “When we went in, I think we would have bet on Perindopril winning, but it was actually the beta-blocker. But, no one had ever asked that question before. That’s why clinical trials are so important.” Since the MANTICORE clinical trial was published in March 2017, it has become a part of the Canadian guideline for medical professionals. When breast cancer patients with cardiovascular risks are prescribed Herceptin, they are also treated with the beta-blockers recommended by the MANTICORE trial. “Thousands of women are treated with Herceptin every year to prevent recurrence,” says Mackey. “I’d say that a quarter of those women are receiving MANTICORE-type drugs to prevent heart damage. We had an idea that seemed far-fetched, but it turned out to be a good one. So, to actually find something new and surprising that helps people, that’s wonderful, because that’s the whole reason we do clinical trials – to help people.” LEAP Thanks to Alberta Cancer Foundation donors, scientists in this province played a big role in testing a combination of treatments to learn that the breast cancer drug Herceptin only works on women whose tumours have a genetic profile called HER2-positive. That knowledge changed standard practice in Alberta and improved the lives of many Albertans and women around the world. myleapmagazine.ca SUMMER 2020 LEAP 33
CARING
20 in 2020
Alberta’s Cervical Cancer Screening Program celebrates two decades of early detection and prevention by ALICIA CHANTAL
WHEN IT COMES TO CERVICAL CANCER,
Alberta women have access to one of the most robust screening programs in Canada. This year marks the 20th anniversary of the Alberta Cervical Cancer Screening Program (ACCSP), one of Alberta Health Services’ (AHS) three population-based cancer screening programs. The other two programs screen for breast and colorectal cancers. Cervical cancer is preventable, which makes screening vital. Today, women between the ages of 25 and 69 are automatically included in the ACCSP, and are sent letters reminding them to get a Pap test from their health-care provider. A Pap, the main screening test for cervical cancer, checks the cells of the cervix to ensure there are no abnormalities present. Following testing, women will receive a result letter from the program letting them know if their results are normal, unsatisfactory (meaning the lab was likely unable to read the sample) or abnormal. If abnormalities are found, a woman is contacted by her doctor or nurse for follow-up testing. Depending on the type of result, this may include a repeat Pap test, HPV reflex testing, where the sample is tested for human papillomavirus (HPV), or a colposcopy, a procedure similar to a Pap that examines the cervix using a special microscope. During a colposcopy, a biopsy may be taken from areas that appear abnormal for additional testing. The ACCSP began in 2000 in the former Calgary and Palliser Health Regions and has since grown to include the entire province, an expansion that was made possible thanks in part to an $800,000 grant from Alberta Cancer Foundation donors in 2011. “In 2000, we started with two health regions, in 2011 it truly became provincial, and now we’re at 2020, and this is a well-established program that continues
to evolve based on clinical practice guidelines and changes,” says Monica Schwann, director of Screening Programs for AHS. “I think one of the things we take pride in is being quite innovative and trying to adapt as evidence changes.” EVOLVING BEST PRACTICES
New research was behind a significant shift to the program in 2009, when healthcare providers were encouraged to raise the starting age for screening from 18 to 21. In 2016, new guidelines suggested the age be increased to 25, where it remains today. For women who have normal Pap test results, the program also moved from annual screening to testing every three years. These changes were made in response to findings that HPV, the virus that causes most cervical cancer, takes a fairly long time to move from infection, to dysplasia (the presence of abnormal cells), to cancer.
The addition of the Cancer Screening Status Report to Netcare in January 2019 allows doctors to see the screening status of their patients and plan accordingly. Colposcopy reporting is also now available through Connect Care in the Edmonton zone, with plans to expand as other zones come online. Recently, the program also worked with the College and Association of Registered Nurses of Alberta (CARNA) and provincial labs to enable registered nurses to use their identifiers to submit Pap test samples. This gives nurses who perform screening the ability to follow up with patients directly, resulting in streamlined care, which is particularly beneficial for women in rural and Indigenous communities. Faster care will also contribute to the program’s goal of being the first in Canada to have 90 per cent of women, whose Pap results show moderate to severe cell changes, be seen for colpo-
“ WOMEN DON’T HAVE TO DIE FROM CERVICAL CANCER AND [THEY] DON’T HAVE TO HAVE ADVANCED CERVICAL CANCER. BY SCREENING REGULARLY AND FINDING ABNORMAL CELLS EARLY, WOMEN CAN BE TREATED BEFORE IT EVEN BECOMES CANCER.” — MONICA SCHWANN
“Support from other agencies and specialties, and our own evidence, suggests women generally get infected early in their lives and 80 per cent or higher will resolve HPV on their own,” says ACCSP’s program manager, Gordon Kliewer. “[In shifting the timing of screenings], we’re really looking at benefit versus harm — the question is why are we over-screening women when we can produce less anxiety and provide much better care [without the need for intervention].” Electronic reporting has also played a significant role in the ACCSP’s evolution.
scopy within six weeks. Five years ago, only 11 per cent of women were seen within this timeframe; today, that number is 60 per cent. “Women don’t have to die from cervical cancer and [they] don’t have to have advanced cervical cancer. By screening regularly and finding abnormal cells early, women can be treated before it even becomes cancer,” Schwann says. “That’s really the guiding principle around our work.” LEAP Visit screeningforlife.ca to learn more about cancer screening in Alberta. ILLUSTRATION EMILY CHU
34 LEAP SUMMER 2020
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IN OUR ONGOING PHOTO SERIES, WE CAPTURE THE BRAVERY, STRENGTH, HONESTY, HOPE AND RESILIENCE OF ALBERTANS LIVING WITH CANCER
PHOTO JARED SYCH
36 LEAP SUMMER 2020
LIVING WITH CANCER
Meet
IAN ROBINSON As told to COLIN GALLANT
Career journalist Ian Robinson always had a passion for exercise until he developed a nagging pain in his neck that wouldn’t go away. A few doctors’ appointments later, he learned that not only had he been walking around with a broken neck, it was caused by previously undiagnosed stage 4 prostate cancer. Robinson’s diagnosis may have changed how he spends his days, but it has also made him more grateful, emotionally unfiltered and motivated to make every day count. IN HIS OWN WORDS:
“I was actually, literally, dying when I was diagnosed. I got pulled back out of the grave, basically, so I immediately went to a place of being grateful. If you take your eyes off that and allow the losses to fill your mind, that can get pretty dark and overwhelming. “I have a pretty rigorous spiritual practice to which I adhere to keep that at bay. I read from three books every morning [the King James Version of the Bible, Meditations by Marcus Aurelius and Strunk & White’s The Elements of Style] and I have a prayer and meditation routine. I started doing that very early on in my cancer saga and I found that it focuses my mind on what’s important. And part of the prayer routine is I give thanks for what I’m grateful for. “Going to Wellspring Calgary [a communitybased support centre for cancer patients, family members and caregivers] and being surrounded by people who get you is huge for my mental health. I write a blog for Wellspring, in a way that is just basically stripped naked, fully vulnerable, tell the entire truth, all the time — because I want to appall men into getting tested. “I tell every guy I meet to get the prostatespecific antigen (PSA) test. You should take men’s health seriously.” LEAP Read more about Ian’s journey at wellspringcalgarym2m.wordpress.com
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by KERI SWEETMAN photography RYAN PARKER
CELL BIOLOGIST DR. LUC BERTHIAUME IS DEVELOPING A POTENTIALLY LIFE-SAVING NEW DRUG DR. LUC BERTHIAUME DOESN’T GIVE UP EASILY. For the last 25 years, the University of Alberta cell biologist has been working “outside the box” in a relatively unexplored area of cancer research — and convincing national funding agencies and pharmaceutical firms to back this research has been a challenge. In graduate school, Berthiaume became fascinated by a biological process called myristoylation, where proteins are modified by a fatty acid named myristate. During his post-doc studies, he was further intrigued by the idea that an inhibitor of this process could become the cornerstone of a new form of anti-cancer drug, and this has been one of his major focuses ever since. Today, his laboratory at the University of Alberta is one of only five in the world focusing on the study of myristoylation. “[To advance cancer research,] you need to look somewhere other than where everyone else is looking,” Berthiaume says. “But by doing something novel, you complicate your own life because no one knows what to do in terms of evaluating your research. Fortunately, I am very persistent.” >
38 LEAP SUMMER 2020
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HIS PERSEVERANCE HAS PAID OFF. Later this year, or early in
2021 (due to a pandemic-related delay), clinical trials will begin on a promising new cancer drug, known as PCLX-001, based on myristoylation inhibition research done in Berthiaume’s lab. Canadian cancer centres in Toronto, Vancouver and the Cross Cancer Institute in Edmonton will take part. Early studies of PCLX-001 were very promising. Thanks in large part to $1.4 million from the Alberta Cancer Foundation, Berthiaume’s lab was able to first test the drug in the lab and on pre-clinical models. In four of five studies, the lead compound completely eradicated blood cancer tumours, and in the fifth study, it removed 95 per cent of the tumours. Up to 25 days later, none of the tumours had returned once the drug treatment ceased.
HOOKED ON SCIENCE
PROMISING RESEARCH
Berthiaume, whose first language is French, describes research as his raison d’être or “reason for being.” He was born in Montreal and raised by hard-working parents who wanted him to study medicine. “But,” he says, “as an extremely curious child and later a fairly adventurous adult, I was always more interested in understanding the causes of diseases and finding cures for diseases, more than personally treating the patients directly.” As a teenager, Berthiaume had a knack for biology and chemistry. When he received 100 per cent on a cell biology exam in Grade 9, his teacher told him it was the first time in 35 years of teaching that she’d given a perfect mark. The class gave him a standing ovation and he was hooked on the idea of a career in science from that point on. Berthiaume did his undergraduate
In the early years, Berthiaume’s team studied the role of protein fatty acid modification in cellular targeting, signalling and metabolism. They had a significant breakthrough about 10 years ago when they hypothesized that the levels of enzymes carrying out the myristoylation process (called NMT1 and NMT2 enzymes) could be altered in cancerous cells. They discovered that blood cancer cells carried only NMT1, rather than the two enzymes found in healthy cells. If they could find an NMT inhibitor to target cells with only NMT1, they would, in effect, be killing cancer cells while sparing healthy cells. After scouring the literature, Berthiaume found a team at the University of Dundee in Scotland that had developed an NMT inhibitor to treat African sleeping sickness. He contacted the principal researcher, Dr. Paul Wyatt, about obtaining some of the compound, called DDD85646, to test its ability to kill cancer cells. Royalty-sharing arrangements were made between the two universities and the compound was shipped to Edmonton, where laboratory studies quickly began. After obtaining promising results with DDD85646, Berthiaume and his team asked Dr. Wyatt if there was an analog of the compound more specific towards human NMTs, which there was, and it was called DDD86481. It is this compound, which Berthiaume’s team renamed PCLX001, that will be tested on patients in the upcoming clinical trials. Dr. John Mackey, an oncologist and director of clinical trials at the Cross Cancer Institute, has partnered with Berthiaume to set up Pacylex, a University of Alberta spinoff company that is developing PCLX001. While most new drug development projects have about a one-in-a-million chance of being successful, because the Berthiaume lab and Pacylex have successfully completed five of the first seven steps of taking a drug to market, Mackey believes PCLX-001 now has a roughly one-
“ [TO ADVANCE CANCER RESEARCH,] YOU NEED TO LOOK SOMEWHERE OTHER THAN WHERE EVERYONE ELSE IS LOOKING.” — DR. LUC BERTHIAUME Moreover, the drug selectively kills cancer cells while sparing normal cells, “the holy grail of cancer therapy,” as Berthiaume puts it. He is hopeful there will be similar results in humans. “We are really indebted to the Alberta Cancer Foundation and especially all the donors who gave money to the Foundation because they are all part of this promising therapy,” he says. The human trials are being funded by $5 million from angel investors, $2.3 million in donations from the researchers themselves, their family and friends, and almost $500,000 raised during the World’s Longest Baseball Game charity event in Sherwood Park last summer. The Phase 1 trials will evaluate the safety of the drug, focusing on those with advanced lymphoma, as well as a smaller group of patients with breast, lung and other cancers. 40 LEAP SUMMER 2020
studies in biochemistry at the University of Sherbrooke and went on to do his PhD in biochemistry at the same institution, completing his doctorate in 1991. From 1991 to 1995, he did post-doctoral studies at the Memorial Sloan Kettering Cancer Center in New York, one of the top cancer centres in the world. The focus of his research there was the modification of proteins by fatty acids and what role that plays in cancer. After finishing his studies, Berthiaume had several job offers and made the decision to move to Edmonton and continue his work at the University of Alberta. “I’ve never regretted it, although it was an adaptation,” he says. “But now Alberta is home to me.” He celebrated 25 years at the university on July 1. In addition to his research work, Berthiaume teaches a senior-level course called Cell Biology of Diseases.
6
QUESTIONS WITH
DR. LUC BERTHIAUME 1. Describe what you do in 10 words or less. Fight cancer through research, education and a company I co-founded. 2. What’s challenging about what you do? Scientifically speaking, there are only five laboratories in the entire world that are focused mainly on studying myristoylation as a research topic. This makes getting grants through the peer-review process very difficult. So I guess that makes me one in a billion! 3. Where do you get your best ideas? Most often I get new ideas in my office after seeing new results from my trainees or after reading a cutting-edge scientific article. Some ideas also come to me when I sleep during periods of stress.
in-three chance of having a positive impact on the lives of cancer patients. He credits Berthiaume for sticking with his ideas. “Dr. Berthiaume is very much an independent thinker,” says Mackey. “He has devoted his career to studying a relatively unexplored aspect of cancer biology that is far from the mainstream. And despite the considerable skepticism with which his ideas have been met over the years, it seems he is right – inhibitors of myristoylation very much deserve to be tested in people with cancer.” In the future, Berthiaume hopes to investigate other applications for PCLX001, including more research into its action in breast and lung cancers, and even some diseases other than cancer. For now, he is happy to be back in the lab after a six-week COVID-related pause. He has already received a $1 million Award in Hematological Cancers’ Research in Memory of Dr. Rachel Mandel in 2020, which will allow his team to complete their laboratory
studies to understand the mechanism of action of PCLX-001 in lymphoma and to expand their research into its effects on other blood cancers, such as leukemia. The award given by the Alberta Cancer Foundation, and aligned with CRINA’s Rachel Mandel Scholarship in Lymphoma and Other Blood Cancers, is named for Edmonton optometrist Dr. Rachel Mandel (the daughter of former Edmonton mayor Stephen Mandel), who passed away in 2017 of lymphoma. Berthiaume is excited to get the upcoming Phase 1 clinical trials underway with no further delays. The trials will likely last one to one and a half years. Phase 2 research further evaluating the efficacy of PCLX-001 on lymphoma and leukemia patients will probably take another $40 million in funding. But he doesn’t seem fazed by that prospect. “I’m somewhat fearless,” he says. “I’m not afraid to do stuff that no one else has done.” LEAP
4. If you weren’t a cell biologist, what would you be? If I absolutely have to name something, it would have to include some aspect of science, research and discovery, so something like archaeology or palaeontology could work. Alternatively, I played varsity soccer and was offered some professional contracts. Life as a professional soccer player could have been fun, too! 5. What motivates you? My ardent desire to make a difference in this world though education, research and developing a cure for cancer(s) to help others. 6. Why does your research matter? The odds of developing cancer through one’s lifetime are about one in three. By developing a new cancer therapy, we could have a significant humanitarian impact, first locally in Alberta then globally. From a practical viewpoint, when successful, our new drug, originating from our basic research program in the department of Cell Biology at the University of Alberta, will hopefully create jobs locally and contribute much-needed diversification of the Alberta economy.
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DR. DON MORRIS’S TITLES INCLUDE MEDICAL LEAD FOR THE CALGARY CANCER PROJECT
42 LEAP SUMMER 2020
TRUE CALLING
A CALLING ACROSS CANCER CARE Through his expertise in research, teaching, clinical work and as an administrative leader, DR. DON MORRIS has worked across the board to advance cancer care in Calgary by NATHAN KUNZ photography JARED SYCH
F
OR DR. DON MORRIS, THE CONCEPT OF ”JUST
another normal day at the office” doesn’t exist. With current designations that span the cancer care spectrum, Morris is an oncology expert, facing challenges as they appear on a daily basis across his several positions. The number of balls he has in the air is a large part of why he loves what he does. “There are very few average days, and that’s why I like coming to work,” says Morris. “You know, apart from getting out of bed, taking the dogs for a walk, having a cup of coffee and getting into the car — that’s pretty standard. [But] once you hit the doors here, there is always something unexpected.” Described by his long-time colleague Dr. Douglas Stewart as a “quadruple threat,” Morris holds a laundry list of high-ranking designations in the research, clinical, administrative and teaching worlds. >
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Today, his titles include facility medical director for Calgary’s Tom Baker Cancer Centre, department head for the clinical department of oncology in the Calgary zone, medical lead for the Calgary Cancer Project, associate senior medical director for CancerControl Alberta, and professor and head of the department of oncology at the University of Calgary’s Cumming School of Medicine. Having a foot in each area, Morris explains, is an extension of a philosophy he looks to imprint on everyone he mentors, including his own children. “I tell my kids, ‘If an opportunity presents itself, even if it’s a bit scary for you, but would challenge you, then do it,’” he says. A FORTUITOUS PATH Originally from Toronto, Morris never planned to work in clinical cancer care, or even practice medicine for that matter. “Was medicine something that was preordained from high school that I was going to do? The answer would be absolutely not,” explains Morris. “The motivations for me were more fortuitous.” Morris was always interested in science, and true to his underlying philosophy of jumping at opportunity, he undertook summer positions in the cancer realm while completing his biology/biochemistry undergrad at Queen’s University in Kingston, Ont., giving him a first glimpse into the cancer path he would ultimately pursue. After completing a PhD in 1989 in cancer immunology at Queen’s, Morris faced a decision. He had been offered a post-doctoral fellowship at the University of California, Los Angeles (UCLA), though funding at the time was scarce for new investigators, leading to hesitation from the research-centric Morris. Taking note from a PhD supervisor (an MD trained immunologist) that a medical degree would provide increased opportunities, Morris decided to head to Calgary to study medicine at the University of Calgary rather than moving south to the U.S. 44 LEAP SUMMER 2020
DR. DON MORRIS IS ALSO FACILITY MEDICAL DIRECTOR FOR THE TOM BAKER CANCER CENTRE
While cancer research remained largely at the core of what Morris loved, it was the human interaction that drove him as he progressed through medical school, internal medicine and medical oncology. “Developing relationships with patients/families and pursuing better outcomes,” explains Morris, “is truly addictive.” WORKING AT THE INTERSECT After medical school, existing at the crossroads between clinical work and research would occupy a large component of what Morris did for several years. Practicing translational research at the Tom Baker Cancer Centre leading first-in-human reovirus clinical trials, Morris worked both in a clinician role, where he would see patients and understand the unmet needs of cancer patients, and in a research role, where he looked into solutions.
“It was ideal for me because I could actually take the problems that I would see in the clinic, and then be thoughtful about them, and try to answer some of those questions within the laboratory area to take back to the patients,” says Morris. “That’s kind of been my mantra for many, many years.” In the research realm, Morris has held particular interest in the development of new cancer therapeutics, oncolytic viruses, immuno-oncology and translational research involving breast and lung cancers. A prolific force in the field, Morris has acted as local site lead for more than 45 clinical trials, national chair for multiple trials, and has published more than 250 peer-reviewed publications and abstracts. Through it all, he’s not only watched, but played a part in bringing immunology treatment to the forefront in cancer care. Specifically, he notes fond memories from
leading a first-in-human oncolytic virus trial, in which he worked with a naturally occurring virus with anti-tumour properties as a therapeutic option. He says the project holds even greater significance as it took place during the SARS viral outbreak, creating an extra level of difficulty in running a trial that effectively saw researchers injecting patients with an environmental unattenuated virus. Today, the work of the trial has paved the way to other oncolytic viral strategies and spun off into a small biotechnology company that has continued to run studies based off the initial work. LAYING A FOUNDATION Dr. Douglas Stewart, who is a medical oncologist at the Tom Baker Cancer Centre and senior medical director for the cancer strategic clinical network, has worked with Morris for more than 20 years. Through the years, he says Morris’s leadership skills have shined brightly, noting his particular aptitude for identifying and utilizing individual strong suits. “He’s able to provide that mentorship and lead by example, which is great, but also he understands that different individuals have different strengths,” says Stewart. “He’s got his eye on the target all the time — on where we need to be. And a lot of that you know really focuses on optimal patient care, but also support for the staff.” While Morris continues cementing his own legacy day to day, he’s also laying a
groundwork for the future. Among his career highlights, he says, has been helping to foster a thriving oncology department at the University of Calgary, which he’s had a hand in since first being recruited as an assistant professor in 1997. Adding to his investment in Calgary’s oncology future, Dr. Morris is currently the medical lead of the Calgary Cancer Project, which will carry over into a
in his leadership role with the Calgary Cancer Project. “He’ll have great ideas as far as how to operate the building, both clinically and academically, and how to do the best to merge the two,” says Stewart. Morris says the Calgary Cancer Project, along with his mentorship and teaching work at the U of C, represents a chance to leave a lasting impact. Beyond his own
“ THE NEW CANCER CENTRE IS BRICKS AND MORTARS, BUT IT REPRESENTS AN IDEA. IT REPRESENTS A COMPREHENSIVE CARE PLATFORM FOR BEST PATIENT CARE.” — DR. DON MORRIS
tenure as the new Calgary Cancer Centre’s first medical director after it opens, which is anticipated for 2023. “[The new Cancer Centre] is a wonderful opportunity to truly make Calgary, Alberta, Canada, really something special from a cancer point of view,” says Morris. Morris sees the new centre as a sort of “living laboratory,” with research taking place simultaneously with treatment, and the different departments guiding one another to help ensure top-notch care. Echoing that sentiment, Stewart says he is confident that Morris’s past experiences across cancer care will be a helpful asset
professional contributions, Morris sees the opportunity for legacy in the foundation he and others are helping to lay down today, which he hopes will cement Calgary as a cancer care capital for years to come. “My only legacy that I would like to leave would be really smart, engaged people that we’ve recruited, and to let them carry the torch,” says Morris. “The new Cancer Centre is bricks and mortars, but it represents an idea. It represents a comprehensive care platform for best patient care. And that’s only going to happen with good people.” LEAP
DR MORRIS’S CAREER HIGHLIGHTS 1997: Appointed as Staff Medical Oncologist, Tom Baker Cancer Centre(TBCC) 2000-05: Program Director, Medical Oncology Training Program, and Chair,
Oncology Training Programs Committee 2002: First-inhuman oncolytic viral cancer therapeutic (Reolysin) 2005: Recipient of the Watanabe
Distinguished Achievement Award for Overall Excellence, Faculty of Medicine, U of C 2007: Named Clinical Investigator of the Year, TBCC
2011-19: Director, Translational Laboratories, TBCC Dept of Oncology 2013-20: Division Chief and Section Head, Medical Oncology, AHS and U of C
2020: Facility Medical Director, TBCC, and Dept Head, Dept of Oncology, U of C, and Medical Lead, Calgary Cancer Project, and Associate Senior Leader, CancerControl Alberta
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IMPACT
ATIEH BEHRAVESH WITH HER DOG, MEELO
Moving Forward Atieh Behravesh reflects on the support she received from the Breast Cancer Supportive Care Clinic as told to SARA SAMSON In February 2019, Atieh Behravesh, who was 37 at the time, was diagnosed with stage 4 Invasive Lobular Carcinoma (ILC). Despite multiple exams, ultrasounds, and a mammogram, and Behravesh’s insistence something was wrong with her breast, her cancer went undetected for nine months. She began her cancer treatment shortly after diagnosis at the Tom Baker Cancer Centre in Calgary, including multiple rounds of radiotherapy and chemotherapy and a double mastectomy. Currently, Behravesh is on hormone therapy and is continuing to take oral chemotherapy from her home in Calgary to help manage her disease. Behravesh admits that, at first, she was angry that it took so long to receive a diagnosis. But through the support she received at the Breast Cancer Supportive Care Clinic, she’s finding ways to move past her anger. To help cope, she’s found connection and purpose through social media, specifically through Instagram. There, she shares her cancer journey and has found a solid support network of peers she can relate to. Today, Behravesh is committed to advocating for early detection and is sharing her story to help others, while encouraging people to know, and listen to, their bodies.
“I’ve always had a fibrocystic breast, so I go for checkups every six months and have an ultrasound to check the size of the cyst. It had been normal for about seven years. But one day in August [2018], I felt something hard in my right breast. It wasn’t obvious to see but when you touched it you could feel something. “I went to my doctor five or six times and he sent me for an ultrasound [and a mammogram] but [they] weren’t showing anything. I said, ‘I know something is wrong.’ But my doctor said, ‘Maybe you hit yourself on something, let’s wait and see.’ Finally, at the end of January, I went to the breast centre [at the Foothills Medical Centre], and within 30 seconds of looking at me the breast surgeon said, ‘Oh, this is concerning, let’s do the biopsy.’ “And that’s when my journey started. We did the biopsy and they told me, ‘Yes, it’s cancer.’ I was angry at the medical system. From August until January I was concerned and insisted something was wrong, but no one wanted to believe me. Why had I waited that long? “The main thing that helped me [work through my anger] was being introduced to the Breast Cancer Supportive Care Clinic. It’s an organization in Calgary run by female physicians who [specialize in breast cancer care.] They do consultations because your doctor doesn’t always have time to explain every detail to you, so they can access your records and explain everything in a way that you can understand. “My doctor there, Dr. [Ardythe] Taylor, I call her my angel. She explained everything to me: why this happened, why I had to wait six months. And it helped ease my anger so much. This ‘why’ question, which happens to everyone when they get diagnosed with cancer, was a big one for me; she gave me answers. I couldn’t appreciate it more. She even told me how to make a connection with my oncologist. She told me [what questions to ask] and now my relationship with him is great. “People need to know their bodies. Don’t ignore anything that feels wrong, talk to your doctor. I could have ignored it easily, but I feel like I saved my life. And everyone can do that as well.” LEAP PHOTO JARED SYCH
46 LEAP SUMMER 2020
WHY I DONATE
ELISABETH MÜHLENFELD AT HER HOME IN EDMONTON
A Duty to Share Elisabeth Mühlenfeld honours her husband, Reinhard, and his extraordinary generosity by DIANE BOLT
PHOTO BLUEFISH STUDIOS
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WHY I DONATE
PHILANTHROPISTS AND ENTREPRENEURS
Elisabeth and Reinhard Mühlenfeld were perhaps destined to meet. Following the Second World War, they each moved to England from Germany. Years later, they met in Gloucestershire as a result of the matchmaking endeavors of Elisabeth’s mother. The couple wed in 1962, had three children together and were married for 56 years until Reinhard’s passing in early 2018. “My husband was a quiet, caring and humble man. He was very generous and was proud of his success,” says Elisabeth. “He also had incredible leadership qualities and his approach to treating people honestly and respectfully never wavered.” Prior to Reinhard’s arrival in England in 1952, he worked as a farm labourer in Germany, saving his wages so he could study agriculture. He was later chosen to manage a farm in England, looking after pedigree Friesian dairy cows. Realizing that there wasn’t a future in farming unless you had enough money to buy your own farm, Reinhard changed direction and studied industrial engineering. Initially, he worked for a large cotton mill in Lancashire and went on to manage production at the Imperial Typewriter Company in Hull, Yorkshire. When that company moved to the Netherlands, he had the opportunity to relocate there with his family or to take up another offer: a two-year contract to build a canola plant in the northern Alberta town of Sexsmith, located about five hours northwest of Edmonton. “We decided it would be an adventure for the family to move to Canada and, once there, the kids loved it. [At the end of the contract] Reinhard had an offer for another year, and after that, well, we didn’t want to go back,” says Elisabeth. The family settled in Edmonton, and Reinhard started his own business in feed mills. He became aware of a gap in the market for dog food, and he founded Champion Petfoods in 1985. The company quickly became an enormous success and today has more than 500 employees. Its award-winning Acana and Orijen pet foods are distributed across Canada and in more than 90 countries around the world. 48 LEAP SUMMER 2020
Throughout his career, Reinhard was the recipient of numerous awards, including Entrepreneur of the Year for Western Canada, Manufacturer of the Year for Western Canada and Canada’s Export Award. But perhaps the award he was most proud of was the Alberta Order of Excellence, which he received in 2014. “He would wear his pin, but if anybody asked him what it was for, he would just smile and say, ‘Oh, it’s just something I earned,’ and I would have to tell them,” says Elisabeth. When the couple decided to retire in 2010 and accepted an “extremely good offer” for the business, their thoughts immediately turned to how best to share their wealth with the various charitable organizations in their community. “Reinhard’s motto was that if you have enough, you should share. That’s how he looked at it,” says Elisabeth. “He was a big bursary contributor at the university because education was important to him. And, we felt hospitals and organizations such as the Alberta Cancer Foundation never have enough money, and the staff
are so incredibly caring and passionate about people.” The Foundation has been the recipient of the Mülenfelds’ generous philanthropic support towards the positron emission tomography (PET) imaging program at the Cross Cancer Institute. The funds were put towards the purchase of a PET CT and a PET MR for the cancer centre in Edmonton. These two pieces of technology allow researchers to provide advanced imaging and more precise therapy for patients. Reinhard would always shy away from any attention given to his charitable donations. Still, Elisabeth speaks fondly of the immense pleasure he took from giving back and how happy he was to share the wealth from his success. She hopes that he wouldn’t mind too much that she continues to honour him posthumously. “Reinhard would always make something of every opportunity, and we had a wonderful life together. I told him the sky was his limit,” says Elisabeth. “But he went past that, and he touched the stars.” LEAP
MY LEAP
ANDREW GREGORY HAS PARTICIPATED IN THE RIDE SINCE 2009
Giver for Cancer The Give’r Project invites Albertans to give where they live by MEREDITH BAILEY
THE 2020 ENBRIDGE RIDE TO CONQUER CANCER WOULD HAVE
marked Andrew Gregory’s 12th year in a row participating as a team captain for the two-day cycling event in support of the Alberta Cancer Foundation. Since 2009, Gregory has ridden as captain of team Give’r, which he founded, and then as captain of team Alberta Cancer Foundation and co-captain of team Cross Cancer Institute. He’s crossed the finish line many times, but, as a cancer survivor himself, he feels like his work is never done. “From my perspective, until we have a world free from cancer, there is no finish line,” he says. In 2005, when Gregory was 37 years old, he was diagnosed with testicular cancer. He underwent surgery and three rounds of chemotherapy to treat it in Vancouver, where he was living at the time. In 2012, after five years of regular monitoring, he was declared cancer-free. “I really feel as though my life was saved by the people who dedicated themselves to cancer research,” he says. The Ride is the Alberta Cancer Foundation’s biggest annual fundraising event — the money it raises helps support the research, treatment and care Gregory is so grateful for. This year, however, the social distancing measures in place to prevent the spread of COVID-19 made the 2020 event impossible and, in April, the Foundation announced that an in-person Ride event would be deferred until 2021. (Since that time, the Foundation announced that a virtual Ride campaign has been organized with a virtual rally taking place on August 29, 2020.) “I thought, ‘What can I do differently to support the Foundation at this time of particular need?’” Gregory says. In addition to his more than 13-year-long volunteer commitment to fundraising for cancer research through cycling, Gregory, who
has lived in Edmonton with his family since 2014, also spent several years working as the director of corporate engagement for the Foundation. Luckily, he had a strong sense of how to organize a fundraising campaign. Inspired by the peer-to-peer fundraising model of events like the Terry Fox Run, Gregory decided to create an inclusive, online-based fundraiser for Albertans still committed to supporting cancer research and the Give’r Project was born. Hosted on the online platform OneCause, the fundraiser allows Albertans to commit to a goal and raise money as they move toward meeting it. Gregory says the online platform is easy to use and takes as much time to register as it would to order a soccer ball from Amazon. Once registered, people can join an existing team, create a new team or contribute as an individual. Participants can then set a goal for themselves and ask their social network to donate as they work toward completing it. Gregory will represent team Cross Cancer Institute as a co-captain for the Give’r Project, and has committed to cycling and running 8,000 kilometres over a year, the distance across Canada, which he plans to complete by April 2021. But fundraising goals aren’t limited to physical activity. People can participate in whatever way is meaningful to them. “For their Give’r Project, they can commit to open water swimming or gardening or walking or even learning to play the piano,” Gregory says. Another benefit of the flexible model is that participants can be explicit about where they want funds to go. “Someone can go to the Give’r Project website, start their Give’r Project in Fort McMurray and dedicate their funds to the Fort McMurray Community Cancer Centre or really, wherever their local cancer centre is in Alberta,” he says. Gregory is hopeful that other Albertans, committed to the vision of a world free of cancer, will find meaning and purpose in the campaign. “Hopefully, the thousands of people all around the province who have been affected by cancer and are already going for runs or rides or walks ask, ‘What if we had a higher purpose for this thing that we do?’” he says. “If your heart wants to support the Alberta Cancer Foundation, join the Give’r Project and give where you live.” LEAP To be part of the Give’r Project visit: albertacancer.ca/ GiverProject or to follow the Give’r Project or learn more join the @teamgiver Facebook page, follow @TeamGiver on Twitter and join “Team Give’r” cycling club on Strava myleapmagazine.ca SUMMER 2020 LEAP 49
GAME CHANGER
PARTICIPANTS OF WEM’S WALK AGAINST CANCER
Walking for a Cause West Edmonton Mall’s Walk against Cancer supports the Alberta Cancer Foundation by DIANE BOLT
ON A CHILLY SUNDAY MORNING IN NOVEMBER 2019, 220 PARTICIPANTS
along with some local celebrity mascots, including Hunter from the Edmonton Oilers, took part in West Edmonton Mall’s (WEM) inaugural Walk against Cancer. The five-kilometre route covered each wing of the mall and both floors. “It was exciting to see how many people came out to support the event and that we were all connected by a common bond: our fight against cancer,” says Daniel Person, the vice president of specialty leasing and partnerships at Triple Five Group, the company that owns the shopping centre. “Believe it or not, we didn’t even walk the entire mall, as it’s so big — we were pretty surprised by that. Next year, we’d like to double participation and, hopefully, the dollars will take care of themselves.” The event was planned by Team WEM Cares, a volunteer organization that was created about three years ago to help to improve the lives of those in the local community. The organization is made up of WEM staff who are passionate about doing good in the community and includes everyone from frontline workers and executives to security officers and marketing and accounting staff. “It’s a very diverse group of people and every division is represented,” says Person, who celebrates 21 years with the company this year and also chairs Team WEM Cares. Since its inception, Team WEM Cares has organized a number of events, from a garbage 50 LEAP SUMMER 2020
clean-up around the property and surrounding streets, which resulted in the collection of 23 bags of trash in 2019, to a tree-planting initiative with Edmonton’s Roots for Trees to a dog adoption program held in the mall. WEM’s Walk against Cancer event came about during a roundtable discussion with the Team WEM Cares committee. The idea was inspired by Triple Five’s sister property Mall of America, located in Bloomington, Minn., which has held similar walks. The committee decided to partner with the Alberta Cancer Foundation as the organization resonated with so many of the staff, and its donation platform made it easy to fundraise. “We’ve lost some great employees to cancer over the last number of years. We also have people who have lost family members and friends to cancer, and so the Alberta Cancer Foundation is very easily identifiable to many of us,” says Person. A friendly competition to see who could raise the most money in support of the walk emerged amongst the various WEM departments. When the Ghermezian family, the owners of the Triple Five Group, found out what the team was doing, they agreed to match any donations raised to the first $20,000. When all was said and done, $50,000 was raised for the WEM Walk against Cancer event in support of the Alberta Cancer Foundation. Before the event took place, Person and some members of the Team WEM Cares committee had the opportunity to go on a tour of the Cross Cancer Institute and see some of the work that is funded thanks to donations to the Foundation. “Ultimately, $50,000 may not be a ton of money, but it goes towards saving lives, and raises awareness of the amazing work of the Alberta Cancer Foundation and the researchers, doctors and nurses who are out there treating cancer every day,” says Person. “The event also brought our company together. It’s our goal to grow Team WEM Cares into something that WEM and its network of tenants and partners can participate in to contribute to our city.” LEAP