BENCH TO BEDSIDE
Getting Treatments to Patients Faster
SPOTLIGHT ON CHEMO Exactly What the Process Entails
PREVENTION PLAN Eat This to Stay Healthy
FALL 2019
THE PARTNERSHIP ISSUE
PASSING THE TORCH
DR. TONY FIELDS HAS BEEN A MENTOR TO MANY YOUNG DOCTORS, INCLUDING DR. JENNIFER SPRATLIN
PM 40030911
UPCOMING EVENTS In support of the Alberta Cancer Foundation
November 1-30
November 17
February 2020
Station #4 Novembeard
Running for Patient Financial Assistance Program
Westlock Bowl for Cancer
Calgary, AB
November 1
Magical Moms Comedy Night Strathmore, AB
November 3
WEM Walk Against Cancer
Las Vegas, NV
December 21
Picture Butte Battles Breast Cancer Picture Butte, AB
Edmonton, AB
January 2020
November 10
Ringette Scores on Cancer
Bald-Faced Cocktail Competition
Edmonton, AB
Calgary, AB
For more information about these events and to find out how you can get involved at the Alberta Cancer Foundation please visit albertacancer.ca/get-involved. *Please note event dates are subject to change.
Westlock, AB
February 13, 2020
U of A Engineering Head Shave Edmonton, AB
March 4-6, 2020
Bellerose Composite High School Bike-a-Thon St. Albert, AB
CONTENTS 42
34 CARING The Provincial Breast Health Initiative is improving care for breast cancer patients. 36 LIVING WITH CANCER Scott Gammer is living with gratitude and courage. He’s also living with cancer. 38 RESEARCH ROCKSTAR Oncology researcher Dr. Lynne Postovit is driven by the hope that her work will have a lasting impact on people living with cancer.
FEATURES
42 TRUE CALLING Pathologist Dr. Sveta Silverman has an above-andbeyond approach to teaching.
22 THE POWER OF PARTNERSHIPS We explore the creative, collaborative relationships across cancer care in Alberta that are fueling innovation in treatment, research, care and more.
46 IMPACT Cancer survivor Jamila Moloo shares the story of her cancer journey.
COLUMNS/DEPARTMENTS for patients. Plus, what you need to know about radon, lung cancer screening and Shaw Birdies for Kids.
7 FRONT LINE Dr. Faisal Khan’s benchto-bedside approach is improving treatment options COVER: PHOTO RYAN PARKER THIS PAGE: GLENN HARVEY
13 YOUR DONATION MATTERS Your donations to the Alberta Cancer Foundation are fueling new immunotherapy treatment options for patients across the province.
14 FOOD FOCUS With Alberta Health Services’ new website healthiertogether.ca as our guide, we look at what to eat to practice prevention.
17
17 WORKOUT Maximize your workout time with high-intensity classes and recover more quickly with foam rolling. Also, our picks for the latest digital devices will help keep you on track.
47 WHY I DONATE Ron Daye and Rob Pearson joined forces to create the Cameron Daye and Catherine Pearson Sarcoma Fellowship Fund.
20 ASK THE EXPERTS We take a closer look at caregiver burnout and exactly what the process of chemotherapy entails.
50 GAME CHANGER Doull Site Assessments and Capstone Oilfield Services support cancer patients through the Alberta Cancer Foundation’s Albertans Helping Albertans program.
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MESSAGE
The Power of Partnerships TRUSTEES
Rene Aldana Dr. Stanford Blade Dr. Heather Bryant Dr. Greg Cairncross Dr. Chris Eagle Brenda Hubley Dr. Mark Joffe Chris Kucharski Bob McGee Brian McLean Dr. Matthew Parliament Gelaine Pearman Jamie Pytel (Vice Chair) Cathy Allard-Roozen Rory J. Tyler Mark Zimmerman
There’s a well-known quote by Helen Keller that says, “Alone we can do so little; together we can do so much.” The essence of those words could not be more true in our field. Our very purpose at the Alberta Cancer Foundation — to create more moments for Albertans facing cancer by inspiring our community to give to innovation in detection, treatment and care — focuses on bringing people together to work toward this meaningful cause. This issue of Leap looks at the power of partnerships and how, among other things, they can lead to an easier cancer journey and improved outcomes for patients. Take Dr. Tony Fields, for example. His name is revered, not just in the hallways of Alberta hospitals, but across Canada and the world for his contribution in the oncology field. In the feature “Leading by Example” (pg. 22), Dr. Fields talks about the importance of sharing knowledge with younger oncologists and how, through that mentorship experience, he has learned just as much from those he informally mentored. His leadership has led to many physicians modelling their compassionate delivery in the Dr. Fields way. You’ll also hear from a few participants in our Enbridge Ride to Conquer Cancer who speak to the power of community partnerships and how joining a team has changed their lives (pg. 32). We witnessed that power first-hand this summer as we cheered on 1,300 riders across the finish line in Calgary, raising almost $6 million for improved research, treatment and care across the province. We also tell the story of partnering with patients. In this case, how the Calgary Cancer Centre has listened to a strong patient voice throughout the design process for the new facility (pg. 26). Listening to those Albertans who have spent hours receiving treatment in cancer centres will help create a warming, calm and healing space for those who walk through the doors when it opens in 2023. As always, we are humbled by the people who continue to share their stories with us, and with you. We hope you are as inspired by this issue as we are.
Your friends at the Alberta Cancer Foundation
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4 LEAP FALL 2019
FALL 2019
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VOL. 10
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NO. 1
ALBERTA CANCER FOUNDATION EDITORS
Phoebe Dey and Christiane Gauthier
MANAGING EDITOR Meredith Bailey ART DIRECTOR Kim Larson STAFF PHOTOGRAPHER Jared Sych CONTRIBUTORS Andrew Benson, Colleen Biondi, Isabelle Cardinal, Elizabeth Chorney-Booth, Charles Burke, Jennifer Dorozio, Spencer Flock, Jennifer Friesen, Samantha Gryba, Glenn Harvey, Aiden James, Nathan Kunz, Jennifer Madole, Fabian Mayer, Bryce Meyer, Karin Olafson, Ryan Parker, Silvia Pikal, Aaron Pedersen, Colleen Seto, Bluefish Studio, Paul Swanson, Colin Way, Julia Williams, Sean Young 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
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It’s time to be bold. It’s time to save lives. Making life better for Albertans facing cancer. As the official fundraising partner for the Cross Cancer Institute, Tom Baker Cancer Centre, and the 15 other CancerControl Alberta centres across the province, the Alberta Cancer Foundation is making life better for Albertans facing cancer by investing in research and initiatives that reduce risk, detect cancer earlier, improve quality of life, and provide better treatment options.
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FRONT LUNG CANCER SCREENING | EVICT RADON | SHAW BIRDIES FOR KIDS
BRIGHT MIND
Dr. Faisal Khan is developing better treatments and tests for lymphomas and leukemia
O
ne of the stark realities of cancer research is that many of the drugs, treatments and tests currently being developed won’t be available to patients for years. Some researchers, however, are placing an emphasis on improving treatments for today’s patients. Dr. Faisal Khan is among those researchers. Khan is an associate professor in medicine at the University of Calgary, where he is the Barb Ibbotson Alberta Children’s Hospital Foundation Chair of Pediatric Hematology. He is also the director of the Molecular Hematology Lab and associate clinical director of the Histocompatibility and Immunogenetic Lab with Alberta Public Laboratories (south). At the U of C, Khan is the director of the Hematology Translational Lab, where his team studies hematologic malignancies — a group of cancers affecting the cells that make up blood. The lab’s specific focus is developing better treatments and tests for lymphomas and various types of leukemia, which is a type of blood cancer. >
DR. FAISAL KHAN STUDIES CANCERS THAT AFFECT THE BLOOD
PHOTOS BRYCE MEYER
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FRONT LINE
DR. KHAN AND HIS TEAM HAVE A BENCH-TO-BEDSIDE APPROACH TO TREATMENT
“It’s not just research that’s going to benefit patients 20 years from now,” says Khan. “The entire goal is to build a translational research program that can have both short-term and long-term impacts.” Khan and his research team recently took a big step toward reaching their goal of helping patients as quickly as possible. In September 2017, the Alberta College of Physicians and Surgeons accredited their lab to perform testing for clinical interventions in Alberta. The clinical accreditation means research labs, like Khan’s, can use newly discovered methods and biomarkers as clinical tests, within just three to six months, compared to a standard of one to three years for other labs. “It means that the biomarkers and tests we develop in the 8 LEAP FALL 2019
research lab are able to reach patients much faster compared to before, when we had to transfer those tests to a clinical lab for clinical validation,” says Khan. The bench-to-bedside approach is already improving the treatment of certain cancers in the province. In 2017, Khan’s lab developed a new method of sequencing the myeloid tumours of those suffering from acute myeloid leukemia (AML). This blood and bone marrow cancer is the hematologic malignancy with the worst prognosis. Roughly 200 Albertans are diagnosed with AML each year and the two-year survival rate is just 35 per cent. Khan’s lab’s new sequencing method is now used to evaluate treatment options for every new AML patient in the province.
Armed with precise information on the makeup of the tumour, clinicians are better able to determine whether a patient should receive a cell transplant, chemotherapy, or be placed in clinical trials that target specific mutations. Khan and his team are also investigating the prevention of relapse for AML patients. Thanks to donor support from the Alberta Cancer Foundation, Khan is developing and validating a diagnostic tool to accurately predict the risk of relapse, enabling medical teams to select high-risk patients that may benefit from protective treatment to decrease relapse rates. Matching patients with the best treatment options is central to Khan’s research program. Another one of his team’s studies focuses on improving the system that matches cell-transplant donors and patients of different hematological malignancies. Around 90 to 110 stem cell transplants are performed each year in Alberta, with donors and recipients being matched using a set of genes known as human leukocyte antigens (HLAs). HLAs are protein-markers that the immune system uses to differentiate self from nonself. Right now, patients are matched with donors that are a 10 out of 10 HLA match, meaning that the doctor currently looks for 10 HLA markers (5 HLA genes with two copies of each gene) and selects a donor who has the same set of 10 HLA genes as the patient. Despite the 10/10 matches, complications still occur fairly often. For example, 40 to 50
per cent of patients develop a potentially fatal complication known as graft-vs-host disease, while a further 20 per cent suffer a relapse of the cancer. In an attempt to improve these outcomes, Khan and his team have identified additional immunogenetic factors that, if present in donors, or matched between donor and recipient, will then lead to less adverse outcomes. Donors are still 10/10 HLA matches, but now they are also matched on additional immunogenetic criteria to help reduce complications and ideally lead to more successful transplants. The study, which is specific to Alberta, is still in the early phases, but initial results show that identifying these specific immunogenetic factors in the donor and recipient, in combination with HLA matching, greatly improves the chances of the host body accepting the cell transplant without complication. A multi-centre study is planned to confirm the results. “If it turns out to be true, we can change the donor selection algorithm, where a donor is not just selected based on human leukocyte antigen match, but also based on these other immunogenetic factors so that we can prevent complications after transplant,” says Khan. With new ways to understand the specific makeup of tumours and the genetic factors that lead to treatment success, in addition to biomarkers that can provide an early and accurate prediction of relapse, Khan is helping push survival rates in the right direction, both in the future and today. LEAP — FABIAN MAYER
PARTICIPANTS AT SHAW BIRDIES FOR KIDS TEE OFF
BY THE NUMBERS
SINCE ITS INCEPTION IN 2015, SHAW BIRDIES FOR KIDS HAS RAISED $24.2 MILLION
78 professional golfers participate each year
An average of 44,000 spectators come to watch the tournament Participating charities come from as far north as Fort McMurray, and as far south as Medicine Hat
Giving More Shaw Birdies for Kids supports children and youth-based charities THIS PAST FALL, MORE
than 42,000 spectators, sporting ballcaps and sunscreen, cheered on 78 professional golfers at Canyon Meadows Golf & Country Club for the Shaw Charity Classic in support of Shaw Birdies for Kids presented by AltaLink. Originally called Birdies for Charity, the fundraising program started in 1971 at
the John Deere Classic. It was adopted by the Shaw Charity Classic, a professional golf tournament on the PGA Tour Champions, in 2015 and renamed Shaw Birdies for Kids to better fit the mandate of supporting children and youthbased charities in Alberta. Since 2015, Birdies for Kids has raised $24.2 million. Participating charities
come from every corner of the province and include the Alberta Cancer Foundation, the Alberta Children’s Hospital, the Calgary Police Foundation, KidSport, the Boys & Girls Club and more. This year, proceeds to the Alberta Cancer Foundation will be directed toward the Adolescent and Young Adult (AYA) Patient Navigation Program. This program helps guide young adults who have been diagnosed with cancer (aged 15-29) through the complex cancer system by addressing their unique needs and providing assistance in accessing resources and community supports. The Birdies for Kids’ matching pool program makes the event unique. Charities apply to participate in the program and fundraise themselves. Whatever money they fundraise is then matched by up to 50 per cent through the sponsors, supporters and tournament proceeds. The participating charities receive 100 per cent of the donations. “We provide each of the charities with an online
donation platform and pay the associated credit card fees. We take care of tax receipting, act as a liaison with the donors, and then provide them with matching dollars,” says Victoria Murray, Birdies for Kids coordinator. “We support them so they can focus on their programming for children and youth.” Often children involved with participating charities will stop by the family-friendly event in hopes of connecting with one of the professional golfers. In past years, golf pros such as Mark O’Meara, Fred Couples, and Shaw Charity Classic twotime defending champion Scott McCarron have hit the fairway. “[The tournament] is an avenue to raise dollars for charity, but it’s also a way to inspire kids, whether it be in sport, or by encouraging them to bring philanthropy into their own lives,” says Lauren Calvert, stakeholder and marketing manager at the Shaw Charity Classic. “We want to help as many kids across Alberta as we possibly can.” LEAP — SAMANTHA GRYBA
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FRONT LINE
ILLUSTRATIONS CHARLES BURKE
10 LEAP FALL 2019
Best Practices A lung cancer screening program is improving outcomes for patients by catching the disease earlier DETECTING CANCER EARLY
is crucial to improving outcomes, and it is particularly important when it comes to lung cancer. More Albertans die from lung cancer than any other type of cancer because it can be hard to detect in its early stages, may take years to develop, and symptoms are not immediately apparent. And, when it is detected, treatment can be difficult. Screening for lung cancer was long thought to be ineffective. However, new technologies and recent research are changing minds in the medical community. Evidence is mounting that lung cancer screening can catch more cases earlier and reduce mortality. The latest study to show how screening can help save lives was conducted in Alberta by Dr. Alain Tremblay and his team at the University of Calgary. The five-year study was launched in 2015, is funded by the Alberta Cancer Foundation, and has already
BY THE NUMBERS
26
number of cancers detected over the course of the study so far
screened 800 Albertans for lung cancer.
THE GOAL Tremblay and his team wanted to demonstrate how a lung cancer screening program might work in Alberta. The researchers also aimed to determine who should be eligible for screening and the best methods for identifying tumours.
THE PROCESS Since 2015, 800 participants from Edmonton, Calgary and Fort McMurray have been screened for lung cancer. Some participants were selected based on traditional risk criteria, such as
75% percentage of those cancers detected at an early stage, when curative treatment is still possible
smoking history and age, while others were selected with the help of a lung cancer risk “calculator” developed at Brock University. This method takes into account additional factors such as ethnicity, education level and body mass index. Each participant received three lowdose CT scans of their chest to look for cancer, including one initial scan and then one each year for two years.
THE RESULTS The researchers’ findings showed that screening was effective at detecting cancers early. Three-quarters of the 26 cancers detected were found at an early stage, greatly increasing the chances that they can be treated through surgery or radiation. The study also found that the risk calculator method for determining eligibility was more accurate than relying solely on the more traditional risk criteria.
125,000 people in Alberta who Dr. Tremblay estimates would be eligible for lung cancer screening
“We’re confirming this can be done in Alberta efficiently and properly,” Tremblay says.
NEXT STEPS Tremblay believes the findings from this study help strengthen the case for a publicly funded, province-wide lung cancer screening program. He estimates that 125,000 Albertans are eligible for lung cancer screening and that such a program would help reduce lung cancer deaths in the province. “We really have that expertise and local knowledge base to make this successful,” he says. LEAP — FABIAN MAYER
2,000
number of Albertans expected to be diagnosed with lung cancer this year alone
800
people from Calgary, Edmonton and Fort McMurray who have been screened for lung cancer as part of the study
myleapmagazine.ca FALL 2019 LEAP 11
FRONT LINE
Evict Radon An Alberta project seeks to eliminate the second leading cause of lung cancer from Canadian homes RADON GAS EXPOSURE IS
the leading cause of lung cancer in non-smokers. On average, one Albertan is diagnosed with radon-induced lung cancer every day. Invisible, odourless and tasteless, this radioactive gas is created when radium in soil and rocks breaks down. Radon is a naturally occurring chemical element, and, unfortunately, it is also a category 1 carcinogen. Western Canada contains some of the highest radon-generating soils on the planet. As the radioactive gas is emitted, it seeks a point of zero or negative air pressure to escape from beneath the surface. Any building constructed over soil with high levels of radon can trap the gas in potentially deadly concentrations. “The primary way most of us are exposed to the type of radiation that causes cancer is by inhaling it in the form of radon gas in our homes, our schools, and our workplaces,” says Dr. Aaron Goodarzi, a radiation biologist with the University of Calgary’s Cumming School of Medicine and co-founder of Evict Radon. 12 LEAP FALL 2019
Launched in 2017, Evict Radon is an Alberta-made — and now national — interdisciplinary project. The project’s goal is to bring awareness of, and defeat to, Canada’s radon-induced lung cancer problem through gathering data and understanding what types of people and buildings are more at risk. It is a non-profit initially funded in part by Health Canada, the Alberta Real Estate Foundation, the generous support of Alberta Cancer Foundation donors and more. Evict Radon is led by Goodarzi (who is also the Canada Research Chair for Radiation Exposure Disease) and includes scholars from B.C., Alberta and Saskatchewan — all of whom urge western Canadians to test their homes for radon. Once a home is tested through the Evict Radon program, researchers use the resulting data to understand how factors such as home architecture, geography and the residents’ own genetics influence radon exposure. “We have 16,000 houses tested all across Alberta and Saskatchewan,” Goodarzi says. “All of the data that our citizen
scientists consent to share with us is fuelling research.” So far, key findings from Evict Radon’s research shows 18 per cent of homes in Western Canada (or one in six) tested high for radon. Also, homes built in the past 25 years had 31.5 per cent higher average radon levels compared to homes built before 1992. “One of our missions at Evict Radon is to figure out what we’re doing wrong in North America with our built environments, and then fix it,” Goodarzi says Evict Radon’s researchers are also trying to understand who among the general population is most at risk for radon-induced cancer. “We know that 1 in 30 adults are known to be radiation-sensitive,” Goodarzi says. “And we know that all children, especially infants, are particularly sensitive to radiation exposure.” Goodarzi says all Canadians should test if their homes are high in radon, and if so, remediate them. Testing is easy. The size of a hockey puck, the testing
unit requires no electricity. A homeowner places it in the basement or lowest level of the home for at least 90 days during the winter. The testing is done in winter (October to the end of April) because that’s typically when people spend the most time indoors with windows closed and the heat on. These factors significantly influence the amount of radon concentration in homes. If the air in your home is more than the maximum allowable by Health Canada — 200 becquerels per cubic metre — a minor renovation can vent the gas to the outdoors. Goodarzi says that any home measuring over 100 Bq/M3 should also be remediated, as those levels can still cause cancer. He adds that the radon remediation system is in Alberta’s building code and should be roughed into any home built after 2016. The remediation system costs approximately $2,500 to install, on average, and is low-impact. Goodarzi recommends using a C-NRPP (Canadian National Radon Proficiency Program) trained professional to ensure the highest possible reduction is achieved from the remediation. “The good news about radon is it’s not addictive like tobacco,” Goodarzi says. “It’s an easy fix, and once the home is mitigated, it’s mitigated forever.” LEAP — SEAN YOUNG
Visit EvictRadon.org to learn more.
4 WAYS
Your donation to the Alberta Cancer Foundation is improving cancer treatment options for patients across the province. Significant strides have been made in the field of immunotherapy — using the immune system to attack cancer cells — and it has become a game-changing treatment option for many types of cancer. Many experts view it as one of the most promising new cancer treatments available. Here are some examples of immunotherapy projects taking place throughout the province thanks to the generosity of Alberta Cancer Foundation donors.
IMMUNOTHERAPY RESEARCH
MELANOMA AND IMMUNOTHERAPY
Immunotherapy clinical trials at the Cross Cancer Institute in Edmonton have changed treatment for late-stage melanoma patients. Since the study began in 2014, survival rates have increased from 20 to 60 per cent.
A team of researchers in Alberta is creating a new orally available form of immunotherapy that will treat cancer accurately, with fewer sideeffects for patients. Researchers are continuing to test and tweak the drug to ensure it is safe for patients and have added an international expert in medicinal chemistry to help navigate this phase of the process. This step will bring the research team closer to producing an effective drug that could transform the way we treat patients.
CAR-T CELL THERAPY
SARCOMA AND IMMUNOTHERAPY
Learn more about how you can support the Alberta Cancer Foundation at albertacancer.ca
Car-T cell therapy is personalized medicine whereby a patient’s “T-cells” are removed, modified in the lab to attack malignant cells, and then returned to the body, where they destroy cancer cells. An Edmonton clinical trial is seeking to develop a cost-effective way to manufacture Car-T cells.
A group of Calgary researchers is working to develop new and more effective therapies for patients with sarcoma — cancer of the connective tissues — using immunotherapy. The long-term goal is to create clinical trials for sarcoma patients who currently have few therapies available.
With your support, the Alberta Cancer Foundation has invested more than $100 million in cancer research in the past five years.
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FOOD FOCUS
Healthy Habits In the spring of 2019, Alberta Health Services (AHS) launched a new website called HealthierTogether.ca, which details how healthy habits can help protect against a number of common medical problems, including some forms of cancer. While many cancers are not related to controllable factors, eating right can offer some defense against these common types of cancer. by ELIZABETH CHORNEY-BOOTH
ESOPHAGEAL CANCER THE ISSUE: NOT EATING ENOUGH FRUIT AND VEGETABLES IS LINKED TO 40 PER CENT OF NEW CASES OF ESOPHAGEAL CANCER. THE RECOMMENDATION: To protect yourself from esophageal cancer, World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) recommend eating at least five, 400g servings of fruit and non-starchy vegetables every day. AHS dietitian Caitlin Wallis describes a starchy vegetable as something like potatoes, squash and parsnips. To get those servings of non-starchy veg, reach for items like zucchini, cucumber, carrots or spinach. Wallis says that it’s also important to eat a wide range of fruits and vegetables in order to incorporate a variety of vitamins and nutrients into your regular diet. One way to “eat the rainbow” in a single dish is to make a fruit and veggie-packed salad: combine a few handfuls of spinach with fresh, sliced strawberries or apples, avocado, cucumbers and grated carrots and toss with your favourite dressing.
14 LEAP FALL 2019
STOMACH CANCER
PUT DOW THE SALTN SHAKER !
THE PROBLEM: TOO MUCH SALT IN THE DIET IS LINKED TO ABOUT 12 PER CENT OF NEW STOMACH CANCER CASES.
COLORECTAL CANCER THE ISSUE: NOT GETTING ENOUGH VITAMIN D IS LINKED TO NINE PER CENT OF NEW COLORECTAL CANCER CASES. THE RECOMMENDATION: Vitamin D is commonly acquired though sun exposure, but unfortunately, sunlight doesn’t give us all the vitamin D we need. Most foods offer a limited amount of vitamin D at best, though it is found in fish like arctic char, pickled herring, rainbow trout and salmon, as well as milk and eggs that have been fortified with the vitamin. Wallis recommends that both children and adults take a vitamin D supplement to ensure they’re getting enough. Talk to your health-care provider to discuss the appropriate amount.
THE RECOMMENDATION: Health Canada recommends anyone over the age of 14 years consume less than 2,300 mg of salt per day — but it can be hard to measure how much salt we’re eating, since so much is hidden in restaurant meals and processed foods. Wallis recommends choosing foods that are fresh, unprocessed and homemade as often as possible and getting in the habit of seasoning recipes with fresh herbs and lemon rather than salt.
ORAL CANCER THE PROBLEM: DRINKING ALCOHOL IS LINKED TO 17 PER CENT OF NEW CASES OF ORAL CANCER. THE RECOMMENDATION: From a cancer prevention perspective, it’s best to cut out alcohol consumption completely, but WCRF and AICR recommend that people who do enjoy the odd alcoholic drink limit themselves to no more than one (for women) or two (for men) servings a day. Those avoiding alcohol should be careful not to replace alcoholic beverages with sugary juice or soda — Canada’s Food Guide recommends making water your drink of choice, adding muddled berries, freshly torn herbs or a drop of vanilla extract for flavour if desired.
OUR LIMIT YH L O ALC POTION M U S N CO
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FOOD FOCUS
Q&A:
Food Combining The concept of food combining — eating or not eating different food groups in combination in an effort to control digestion and promote weight loss — has been on trend for a few years now. There are different variations on the diet, but it usually involves not eating protein and starches together and eating fruit on its own. Is this a scientifically sound way of eating or just another diet fad? AHS dietitian Caitlin Wallis has some answers: Q: When people talk about food combining, what exactly does that mean? A: It’s an eating pattern where foods are supposed to be eaten in a certain order and combination. It’s supposed to be a way to achieve optimal digestion, based on the idea that different foods digest at different rates in the body and they need different digestive environments. The main claim is that protein and carbohydrates are digested by different enzymes and that if you eat them together it causes digestive issues.
16 LEAP FALL 2019
Q: Does it actually work? A: No. It really doesn’t make a difference. Most foods are a combination of nutrients like carbohydrates and protein within themselves. Our digestive system is designed to break down meals, and your nutrients are absorbed at different spots along your digestive tract. If you eat carbohydrates and protein together, they’re not competing for absorption. Everything’s going to be digested fully and absorbed along your digestive tract.
4
Q: Do you see any benefits to this kind of diet? Is it potentially dangerous? A: I don’t think it’s potentially dangerous, but it’s not necessary and I think it creates a lot more anxiety and worry about eating when you have to follow so many rules. That takes away from the social aspect of eating, which is so important. Sitting down as a family or with friends to have meals in a relaxed environment is really important to help enjoy quality time with others, share food traditions and/or explore new healthy foods you might not normally try. LEAP
QUICK TIPS FROM CANADA’S FOOD GUIDE TO CREATE AND MAINTAIN A HEALTHY DIET
1.
EAT PLENTY OF FRUITS,VEGGIES, WHOLE GRAIN FOODS AND PLANT-BASED PROTEIN
2.
DRINK MORE WATER
3.
LIMIT HIGHLY PROCESSED FOODS
4.
COOK AT HOME MORE OFTEN AND SHARE MEALS WITH FRIENDS AND FAMILY LEARN MORE AT CANADA.CA
WORKOUT
Train Smart Whether it’s working out more efficiently, incorporating wearable technology, or helping your body recover, here are some useful tips to train smarter this fall > by KARIN OLAFSON
ILLUSTRATION ANDREW BENSON
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WORKOUT
FALL CAN BE BUSY, BUT EVEN WITH A JAM-PACKED itinerary, you can still work out hard and recover well. Here, we explore how to get a great workout when you only have a few minutes to spare and highlight how to foam roll effectively, so you recover faster. We also showcase wearable technologies to help keep your fitness goals on track. But remember, always consult with your health-care team before beginning any workout program.
HIIT UP A NEW WORKOUT Looking for a time-efficient workout for your busy schedule? Try high-intensity interval training, or HIIT What is HIIT? This high-energy workout will get your heart rate up fast. The goal of a HIIT session is to exert your body and push it out of its comfort zone. But you’re not exercising at that intense level for long: you push hard in intervals, for a period of between 30 seconds and three minutes. (And yes, you need to push hard to get the benefits.) Then you rest, recover and repeat. Because of the high intensity, a full HIIT session can last as little as 10 minutes and is usually no longer than an hour.
The benefits of HIIT? HIIT workouts are adaptable. You can do the intense bursts with any type of cardio you like, and you can also incorporate bodyweight-based strength exercises like burpees, mountain climbers and jumping lunges to create a circuit for a full-body workout. And no equipment is required, so you can do this workout anywhere. HIIT sessions will improve your cardiovascular fitness, help your body burn fat efficiently and strengthen muscles. Plus, they’re time-efficient: you’ll experience the benefits without logging hours in the gym.
3 Places to Try HIIT in Alberta KINETIC INDOOR CYCLE AND FITNESS This studio offers a full-body HIIT class that combines cardio, strength training and core. 1251 2 Ave. S., Lethbridge, kineticfitness.ca STUDIO 85 HIIT & YOGA These HIIT sessions end with relaxing yoga. 218, 333 Aspen Glen Landing S.W., Calgary, studio85.ca XTHERAPY This studio’s HIIT workout includes battle ropes and kettlebells. 10041, 103 St. N.W., Edmonton, xtherapy.co
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SMART SELF-CARE
4 Tips for Effective Foam Rolling Massage therapy eases muscle pain, relieves tension and increases blood flow to promote muscle healing. And, according to Dr. Ryan Emmons, chiropractor and co-owner of Cadence Chiropractic, Sport & Health in Calgary, you can think of foam rolling as self-massage. He recommends rolling once per day, for five to 10 minutes, to improve muscle function, help prevent injuries and speed up recovery.
1. Get the Right Roller The density of your foam roller is key. “It has to be of therapeutic density,” Emmons says. “If there is inadequate depth to the massage, then it’s much less beneficial and minimally therapeutic.” Emmons recommends using
something like the Travel Roller, a portable roller with three thickness levels, which is dense enough to provide that deep, therapeutic massage.
2. Know How to Roll Right Big movements aren’t effective — they are both less controlled and less concentrated on the muscle, meaning the massage isn’t as deep or targeted. Use the method Emmons created: it’s called Roll Release Technique and it’s a segmental, controlled approach to foam rolling. “Envision the muscle as a line, and imagine it broken into pieces. Then, you roll each of those pieces of the muscle, one after the other,” says Emmons. “Instead of big movements, you’re rolling about an inch of muscle at a time at a medium pace.”
ROL IMPROLVING MUS ES FUNCTCIOLE N
Wearable technology can help you track your progress and improve your fitness goals.
4 HIGH-TECH PRODUCTS TO ELEVATE YOUR WORKOUT
Use wearable technology to keep up with your exercise regimen, track your progress and chase those fitness goals GARMIN VÍVOSPORT GREAT FOR Those wanting an
3. Position to Roll Safe Like any therapeutic massage, foam rolling can be a little uncomfortable. But it should never be painful. “Rolling should be safe on your whole body,” says Emmons. “If you compress your muscle too hard against the roller, you can cause harm. Like any exercise, rolling is all about building up tolerance and advancing properly.”
4. Perfect Your Form If you need a little more guidance to make sure you’re rolling safely and effectively, consider downloading Emmons’ Foam Roller Techniques app. It’s $3.99 and offers a stepby-step guide with instructional videos to help you properly foam roll at home.
efficient tracking device without the bulk of a GPS watch. WHY WE LOVE IT This GPS device packs a lot of punch for its size. It has all the essential features you need to track your workout — the GPS band tracks your heart rate and your activity — and the stress testing feature brings awareness to a user’s emotional and physical well-being and gives wearers the option to do stress-reducing breathing exercises.
MOOV NOW GREAT FOR Runners interested in improving their technique. WHY WE LOVE IT This device needs to be used with a smartphone because it doesn’t have a display. But, what it lacks in a screen it more than makes up for in highly-specific
running technique analysis — it comes with an ankle strap to monitor your stride — and it’s affordable.
MOTIV RING GREAT FOR Anyone wanting a subtle, stylish fitness device. WHY WE LOVE IT This ring tracks your activity, sleep and heart rate, and thanks to the discrete design, you can easily wear it 24/7. It also has a three-day battery life and charges in 90 minutes.
SAMSUNG GEAR FIT2 PRO GREAT FOR When you want to track your pool workouts. WHY WE LOVE IT This wearable fitness gadget is water-resistant up to about 50 metres. It integrates with the swim app Speedo On to measure your time per lap, how many strokes you take per lap and your efficiency in the water. LEAP
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ASK THE EXPERTS
Q: What is caregiver burnout?
We ask the experts about recognizing and avoiding caregiver burnout, and exactly what the process of chemotherapy entails by SAMANTHA GRYBA
LORNA SCOTT
DEALING WITH CAREGIVER BURNOUT For family caregivers, the challenges of balancing the regular demands of work life and home life with the oftenimmense stresses of caring for a loved one with cancer can be exhausting, and may even lead to caregiver burnout. Lorna Scott, who lives in Medicine Hat, began her journey as a caregiver in 2005 when her husband, Callum, was diagnosed with colorectal cancer stage 3 C. After Callum’s cancer metastasized in 2008, Scott began blogging
and later wrote a book, Walking the Journey Together…Alone: Finding Peace, Hope, and Joy in the Middle of the Sh**. Callum passed away in 2011. Today, Scott is still an active member of the caregiver community through The Caregiver’s Lighthouse, a program she created to support caregivers by providing resources such as coaching and workshops. She also facilitates a caregiver group called The Kitchen is Open. Here, Scott shares how to recognize the symptoms of caregiver burnout and offers strategies for how to mitigate it.
Q: Who is a family caregiver? A family caregiver is someone who is caring for a family member or close friend who has a chronic disease, illness, disability, aging, cognitive issues, etc. But what I’ve discovered is people don’t see themselves as a family caregiver, it’s part of their life, and yet the impact [on that person] is huge. So, that part of my language has changed a little bit. These are people who are caregiving. It is something that they are doing, more than something that they are being, because they are still a whole person.
Caregiver burnout is when the person who is caregiving is very isolated, completely exhausted and may not be making good decisions. They are unaware of how serious things are, even when all evidence points to that. One of the causes [of caregiver burnout] is financial — sometimes the [treatment] choices for patients can cause financial strain. Another cause is lack of social support. Many people want to help but don’t know what to do. [And there’s also] the stress of having to work while continuing to provide care.
Q: What are some of the symptoms of caregiver burnout? Isolation, loneliness and feeling hopeless and helpless. Many [caregivers] are diagnosed with depression. Sometimes people will look very frazzled, because they are very tired and not looking after themselves. Other symptoms include overeating, undereating, gaining weight and losing weight. Not sleeping is also one of the biggest ones.
Q: What are some tips to avoid burnout? Keep a to-do list of things you can’t do on your own for when people ask, ‘What can I do?’ Physical activity is also really important. Another piece of avoiding burnout is having your employer on board and being at a workplace where they have some understanding of what you’re going through. And later on, respite. Find out within the medical community whether palliative care is right [for your family] and take advantage of that. Don’t be afraid of those referrals when they come, see them as opportunities. Learn more about resources for caregivers at the Family Caregiver Centre at Alberta Health Services and the Alberta Caregivers Association, and through online resources such as caregiversalberta.ca. ILLUSTRATION JENNIFER MADOLE
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STEPHANIE DUFFY
THE PROCESS OF CHEMOTHERAPY Chemotherapy is one of the most common and effective ways of treating cancer, yet the process can often seem intimidating or complicated for someone who has never experienced it. Stephanie Duffy, a nurse clinician at the Tom Baker Cancer Centre who supports patients for systemic treatment and radiation treatment, explains what chemotherapy entails and what a cancer patient can expect while receiving treatment.
Q: What is chemotherapy? There are many different ways to treat cancer: there’s surgery, radiation, and systemic treatment. Systemic treatment is any medication that travels through your body in the bloodstream to find, damage and destroy cancer cells. Chemotherapy, or chemo, is one type of systemic treatment. Chemotherapy is a medication that finds cancer cells, attacks them and causes the cancer cells to die. Chemotherapy also prevents the cancer cells from dividing and making more cancer cells. The three main goals of chemotherapy are to become cancer-free; to get control of and stop the cancer from growing or spreading to other parts of the body; or to relieve or reduce the symptoms caused by cancer, such as pain or shortness of breath.
Q: What does the process entail? Before each chemotherapy treatment, people will have blood work completed and will be assessed by the medical oncology health-care team. Supportive medications, such as anti-nausea medications, are often prescribed for people to take before and after receiving chemotherapy. Chemotherapy can be made up of a single drug or a combination of drugs. In general, it is given in cycles, which means the chemotherapy is given and then there is a rest period of days or weeks before giving the next treatment. This allows the chemotherapy to attack the cancer cells and also gives the body a break to recover from the side-effects before the next cycle.
Q: How is it administered? Chemotherapy is given in many ways. It can be given through an intravenous, or an IV, which is when the medicine is put directly into a vein. Most patients get a temporary IV inserted that is removed at the end of the treatment appointment. Others get a central line that is inserted into a vein and stays in until the treatment is no longer needed, so it is more of a long-term option. Sometimes we administer the chemotherapy by a needle into a muscle or just under the skin tissue. Occasionally, chemotherapy is given as an oral medication in pill form or liquid swallowed by mouth. An oncologist will prescribe accordingly based on your treatment needs.
Q: What does a typical day-in-the-life look like for someone going through chemotherapy? In Calgary, most chemotherapy is given at the Tom Baker Cancer Centre in our Systemic Treatment Unit by nurses. Every treatment is very different. Some people get one medication, and others will get several. Appointments can range anywhere from 30 minutes to several hours.
Some people receive all their medication in one day, while others will come in for several days in a row or get different medications on different days. It varies depending on the type of cancer and the treatment prescribed.
Q: What are the most common side-effects of chemotherapy, and what causes them? Chemotherapy works on the fast dividing cells in our bodies. Cancer cells divide quickly, but so do some of the healthy cells in our body, such as our hair, skin, nails and blood. Chemotherapy cannot tell the difference between cancer cells and healthy cells, so side-effects happen when the chemo attacks the healthy cells. Side-effects are very different for everyone. Each chemotherapy causes [varying] side-effects, and they can happen anytime during treatment. Regardless of the type of chemotherapy, fatigue seems to be a common side-effect. It’s best treated with regular exercise and good nutrition, but our health-care team has many strategies to help cancer-related fatigue. Other common side-effects include decreased blood counts, appetite changes, nausea, hair loss and skin and nail changes. Side-effects, regardless of what they are, are usually temporary. The health-care team goes into great detail explaining what side-effects to expect, and how to manage or prevent them before we start the actual treatment.
Q: How has chemotherapy evolved or changed over the years? [One example is] in recent years we have seen more immunotherapy given for the treatment of cancer. Immunotherapy is a different type of systemic treatment. It is an intravenous medication that helps the body’s immune system find, fight and kill cancer cells. LEAP myleapmagazine.ca FALL 2019 LEAP 21
THE POWER O F PA R T N E R S H I P S
PA R T N E R S H I P S
In the complex world of cancer research, treatment and care, partnerships are key. From patients joining forces to fundraise and researchers across disciplines working together on new treatment options to the inspiring connection between a mentor and mentee, collaborations create opportunities for innovation and advancements.
DR. TONY FIELDS AND DR. JENNIFER SPRATLIN
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LEADING BY EXAMPLE ONCOLOGIST AND CANCER CARE VISIONARY DR. TONY FIELDS MODELS PROFESSIONALISM AND LEADERSHIP WITH DR. JENNIFER SPRATLIN > by JULIA WILLIAMS + photography by RYAN PARKER
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PA R T N E R S H I P S
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HEN DR. JENNIFER SPRATLIN MET DR. TONY Fields in 2004, she was at the beginning of her medical career and he was one of the most prominent gastrointestinal oncologists in the country. For two years, their desks sat side by side at Edmonton’s Cross Cancer Institute. The doctors came from different backgrounds, but shared a sense of curiosity and commitment to their work. Fields, who immigrated to Canada from Barbados in the 1960s, is considered a visionary leader in cancer care in Alberta. At the time he and Spratlin met, Fields was the vice president of medical affairs and community oncology at the Alberta Cancer Board and former director of the Cross. Spratlin was a bright, accomplished young oncology resident planning to pursue an academic career. As they got to know each other, a mutual admiration developed. Fields recognized Spratlin’s promise and she was impressed by the breadth of his experience. “He’s so wise. When Dr. Fields gives you advice it’s not something you take lightly,” Spratlin says. As she navigated her career, she began to seek Fields’s advice on decisions and professional challenges that medical school hadn’t prepared her for. Gradually, Spratlin looked to Fields as her mentor. In 2006, Spratlin was trying to choose between three fellowship programs in the U.S. Each opportunity was tempting, and each represented a slightly different direction for her career. Fields acted as Spratlin’s informal advisor. He was familiar with each program and knew many of the people involved, and he also understood Spratlin’s goals. Spratlin valued Fields’s knowledge and she also appreciated his impartiality; he didn’t try to urge her in any particular direction. “His agenda was what would be best for me at that time as a young, budding medical oncologist,” she says.
“ H E HAS A WAY OF CALMING PATIENTS WHEN HE WALKS INTO THE ROOM. IT’S NOT SOMETHING YOU CAN TEACH, BUT IT’S SOMETHING YOU CAN MODEL.” – DR. JENNIFER SPRATLIN
After Spratlin made her selection, Fields also helped her choose between two funding opportunities for the fellowship. Just as importantly — if inadvertently — Fields helped to show Spratlin the direction she wanted to go. One key reason she chose to specialize in gastrointestinal oncology was because she was inspired by her mentor’s passion for the work.
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A good mentor is usually a product of other good mentors. As a medical student at the University of Alberta in the 1970s, Fields says he learned not just from his studies, but from the conduct and bearing of his teacher, Dr. Allan Gilbert. Later in his education, Fields learned about how to behave with principle from Dr. Joe Marotta, the head of neurology and chief of medicine at St. Michael’s Hospital in Toronto, where Fields trained in internal medicine prior to his medical oncology training at the Princess Margaret Hospital. From observing his mentors, Fields saw how a physician could use his authority not just to heal a patient’s body, but to ease their mind. “Cancer isn’t just a disruption in the body. You have to help patients find equanimity in the space they’re in now,” Fields says. Like his own mentors, Fields taught this quality by example. Spratlin was impressed by Fields’s constant professionalism, his demeanour with patients and his sense of compassion. “He has a way of calming patients when he walks into the room. It’s not something you can teach, but it’s something you can model,” Spratlin says. Fields also credits Marotta with shaping the values and style of his leadership. He says the residents who worked under Marotta at St. Michael’s Hospital felt needed and appreciated, and, in turn, they were committed to the institution. It’s a lesson Fields has passed on to Spratlin, who says she has been influenced by his remarkably respectful approach to all members of his health-care team. “A medical oncologist’s role is very important in the life of a cancer patient, but so is the role of the nurse, the pharmacy, the clerks who book the appointments and the administrative assistants. I think that’s lost on some people, but it’s never lost on Dr. Fields,” she says. Spratlin and Fields agree that mentorship is a title better earned than assigned: it’s an alchemical product of admiration, emulation and connection. It takes time for a teacher or colleague to be elevated to the role of mentor, and Spratlin says you can’t force it. Fields never mentored her in a formal or official capacity, but his influence on her career has been deep and lasting. Fields, who has influenced many upand-coming medical professionals in the course of his career, believes this bestowed responsibility is more meaningful than any title. “It’s interesting the difference between assuming a role that carries the word ‘mentor’ and actually having someone say years later, ‘Yes, he was my mentor,’” Fields says. Spratlin had the rare opportunity to step into her mentor’s shoes in 2008, after she completed her fellowship and returned to Edmonton. Fields would soon become vice president of cancer care at Alberta Health Services and was in the early stages of helping create what would become an influential, evidence-based drug review process. He needed to scale back his
clinical practice to make time for administrative duties, which would mean handing over his patients to another physician. Fortunately, he knew a brilliant young oncologist whose goals he understood and whose compassionate approach to cancer care he shared — and had played a role in shaping. Fields asked Spratlin to take over most of his practice. “I knew that my patients would receive the ideal I have always cherished,” Fields says. As a junior, female member of the clinical group, Spratlin worried that Fields’s patients — accustomed to being seen by the most senior member of the group — would struggle to accept her. “It’s hard to compare yourself to Dr. Fields,” she says. Displaying his professionalism once again, Fields prepared
his patients for the transition and made himself available to Spratlin for ongoing questions and advice. Today, Spratlin is a respected oncologist and researcher, particularly in the field of pancreatic cancer, as well as an associate professor at the University of Alberta and a member of the gastrointestinal tumour group at the Cross. To Spratlin, Fields’s support has made all the difference — back when they sat side by side and now that she’s forged her own path. “He impressed on me that it’s not just about the job, it’s about the person you are in the job,” Spratlin says. LEAP
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PA R T N E R I N G W I T H PAT I E N T S TH E C A L G ARY C A N C E R C E N T RE G I V E S PAT IE NT S A V ITA L V OICE
PA R T N E R S H I P S
by JENNIFER FRIESEN + Illustration by GLENN HARVEY
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FTER A THREE-HOUR DRIVE FROM MEDICINE Hat to Calgary’s Foothills Medical Centre, Charlotte Kessler walked into her doctor’s appointment in 2013 thinking she was out of the woods. She’d recently had what was believed to be a benign, one-and-a-half-inch mass removed from her frontal lobe, and was assuming her appointment was just a follow-up. But that sense of security was shattered when a doctor she’d never met walked into the room. “We should start treatment, then,” he began. Taken aback, she asked, “Treatment for what?” “Oh, you have cancer.” It was a shocking moment for Kessler, and one of the experiences that inspired her to become a vocal advocate for the patient experience. As the volunteer co-chair for the Patient and Family Advisory Council (PFAC) for the new Calgary Cancer Centre (CCC), Kessler, who completed active treatment for her cancer in 2015, is helping give patients a voice. Set to open in 2023, the CCC will be a first-rate cancer treatment and research centre for Albertans. The PFAC, which is made up of patients, family members and CCC staff, was created to address and improve the patient experience from the very beginning of the CCC’s design process in 2014. Through regular feedback, PFAC volunteer members have helped shape everything from the CCC’s overarching design principles to wayfinding and the space’s amount of natural light. Alberta Health Services also plans to engage PFAC in the centre’s continued operational planning. Kessler joined PFAC as one of the original members at the Tom Baker Cancer Centre in 2014. She had finished radiation and one year of chemotherapy and had one more year of chemo ahead of her. The committee gave her the chance to turn her experiences — unpleasant and otherwise — into an opportunity. “I had a wide variety of experiences as a patient,” she says. “From terrible to exceptional and everything in between. This was a way to make something positive out of my experiences while also having a hands-on influence on the future of cancer care.”
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Once she joined PFAC, she found that other members shared similar stories. “It was definitely a great foundation for building trusting relationships and mutual respect,” she says. “It imbedded our common goal, to ensure the patient’s voice is heard, really quickly.” Now, as the co-chair of PFAC, Kessler has spent the last five years working with other patient and family advisors through engagement sessions, focus groups and meetings. With monthly meetings from September to June, along with other consultations as needed, PFAC works in partnership with Alberta Health Services staff, clinicians, administration, the design builder and Alberta Infrastructure. “I feel humbled and proud all at the same time to know that our voices are being listened to so intently,” she says. “To see everything coming to light, and see that it’s not just a promise, but it’s actually happening – it’s exciting.” PFAC has provided feedback on many design features for the CCC, including patient rooms, interior design and clinical spaces. Kessler was also specifically involved with the group working on the design of the radiation unit. By nature, the space is required to be in the basement, but feedback from patient and family advisors noted that the current space can feel “cold and distant.”
“IT WAS DEFINITELY A GREAT FOUNDATION FOR BUILDING TRUSTING RELATIONSHIPS AND MUTUAL RESPECT.” – CHARLOTTE KESSLER
Through PFAC and staff recommendations, the CCC’s new radiation space has been designed to be open and bright. The waiting area will include both social and more private spaces for patients, as well as window wells for natural light “to give you a sense that there’s still a world out there,” Kessler says. As you walk into the radiation room, it will be brighter, have art on the walls and include a chair, coat hook and shelf to hold patients’ belongings. “Those things may seem small,” she says. “But when you’re in that world for such a long time, those little things really add up.” There’s plenty of work left to be done before the CCC is complete, but Kessler is certain it will all be worth it when the doors open to Albertans. “When it’s 100 per cent built, it’s going to be incredible. I look forward to being with my fellow patient and family advisors on that day. We’ll be there to support each other like we have done this whole time.” LEAP
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PA R T N E R S H I P S FROM TOP: HANALYTICS SOLUTIONS’ SHANEEL PATHAK AND CORY KAPSER
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A HIGH-TECH PA R T N E R S H I P THE A L BE RTA C A N C E R F O U N D AT I O N A N D C A LGA RY TECH STA RT- UP H A N A LY T IC S SO L UT I O N S A R E WO R K IN G TO G E T H E R T O O FF E R A L B E RTA CA N CE R PAT I ENT S A N EMP O W E RI N G D IGITA L ALTE RN AT I VE T O T H E PAT I E N T J O U R NA L by KARIN OLAFSON + photography by COLIN WAY
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HANEEL PATHAK VIVIDLY REMEMBERS THE information overload that accompanied his wife’s lung cancer diagnosis in 2013. There were medications to remember, appointments to make, questions to ask physicians, and symptoms to track and analyze. Pathak and his wife, Heing Taing, tried their best to organize it all as efficiently as they could. They jotted down observations in paper notebooks and wrote down notes in the patient journal provided by the Alberta Cancer Foundation, available at Alberta’s cancer centres. They typed up reminders in Taing’s phone, graphed her health data in Excel and kept photos in an electronic album. But that important data was scattered, and it was difficult to provide the best information to their health-care team. “I found that data was so important to us to advocate for Heing’s health and treatment, but the problem I found was that we were using a diverse set of tools,” says Pathak. “It was never streamlined. It was all fragmented.” During Taing’s five-year cancer journey, Pathak was inspired by the journaling she did and saw how the data she collected helped her self-advocate. He began looking for a digital solution for data compilation and found a few options, but they weren’t exactly the right fit. Sure, they could have helped, but they left something to be desired. Also, he could only find American companies and had concerns about not knowing where the data was stored. As a caregiver who experienced the difficulties of information overload first-hand, and with a background in computer engineering, Pathak realized he could leverage technology to improve this experience. “As the patient or caregiver, you are the hub of information for service providers. The more accurate information you can provide, the better they can serve you,” says Pathak. Pathak founded his software service company HAnalytics Solutions in 2015 with a focus on creating tools for patients for health-care management. Sadly, Taing passed away in 2017. Fuelled by his wife’s tenacity and driven to help other cancer patients use journaling and data to improve their quality of life, Pathak and his
business partner, Cory Kapser, devoted the business to developing a digital patient journal. The digital journal is currently in the testing phase and Pathak describes it as a secure software service that can be used anywhere there’s an internet connection, and is accessible via smart phone, tablet or desktop. It’s an elevated and streamlined journaling experience. Pathak explains the digital patient journal as being an easyto-use solution for patients and caregivers to efficiently log all information related to their cancer experience, whether that’s questions, observations, photos or consultation notes. It can keep track of appointments, medications, supplements and dosages in a streamlined way. And the analytics tool allows users to graph any symptom, track any medication or measure any personal data such as weight changes, steps taken, or blood pressure. This all helps patients and caregivers find patterns and better understand their cancer experience. Pathak adds that the digital journal also condenses all the information into a report, making it easy for patients’ health-care teams to review at appointments. “The digital patient journal focuses on patient-derived information. It’s so the patient can tell their health story more effectively,” says Pathak.
“THE DIGITAL PATIENT JOURNAL FOCUSES ON PATIENT-DERIVED INFORMATION. IT’S SO THE PATIENT CAN TELL THEIR HEALTH STORY MORE EFFECTIVELY.” – SHANEEL PATHAK
Around the same time that Pathak and Kapser began working on HAnalytics Solutions’ digital patient journal, the Alberta Cancer Foundation was working to address a similar problem. According to James Yip, senior investment development officer at the Foundation, the team there had developed a patient health journal in 2010 to help patients track their cancer journeys. But the 200-page, spiral-bound book had its limitations and the Foundation looked into digitizing its own branded patient journal. “These journals are available through all of the cancer centres in Alberta but distributing them can be a challenge. It’s not easy to supply them to rural areas and not all the patients know about these journals, so it’s very difficult to market them,” says Yip. >
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PA R T N E R S H I P S
When the Alberta Cancer Foundation heard what Pathak and Kapser were working on, it saw a partnership opportunity. And, in 2018, they began talking. Instead of addressing the same problem in isolation, Yip says the Foundation saw value in tackling the problem together.
“ A S MY WIFE’S CAREGIVER, I’D THINK ABOUT HOW A DIGITAL SOLUTION HELPS ME IN MY SPECIFIC SITUATION.” – SHANEEL PATHAK
“Having information written in a printed journal is one thing. But to be able to put all your cancer journey information into one digital tool and apply the analytics capabilities, that just takes it to the next level,” says Yip. For the Alberta Cancer Foundation, this partnership is appealing because HAnalytics Solutions offers more than the technical know-how. HAnalytics’ digital patient journal was designed knowing what its future users will need. “Working with a web developer with such a passion for making life better for Albertans facing cancer has been great. Shaneel Pathak is in our ecosystem and also has the expertise to pull this off,” explains Yip. That’s a point Pathak makes, too: HAnalytics’ digital patient journal is based on his experience as a caregiver and Taing’s experience as a cancer patient. “As my wife’s caregiver, I’d think about how a digital solution helps me in my specific situation,” recalls Pathak. The Alberta Cancer Foundation and HAnalytics Solutions began working together in December 2018. According to Yip, details of this partnership are still in the works, but HAnalytics and the Foundation plan to launch the digital patient journal in the next few months. Then the Foundation plans to make the digital tool available to Albertans in addition to its print patient journal. For the Alberta Cancer Foundation, this partnership offers a high-tech solution to ease the cancer journey. For HAnalytics Solutions, it provides essential funding, which helps with additional development costs, and the Foundation’s belief in the project lends credibility to its value. But at its core, this partnership will benefit Albertans living with cancer and their caregivers, empowering them to make the best personal choices as they navigate the information-heavy health-care realm. LEAP
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EXPLORING POSSIBILITIES COLLABORATION IS THE FIRST STEP IN THE COM PLEX WORLD OF CANCER RESEARCH by COLLEEN SETO + Illustration by SPENCER FLOCK
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N LIFE, WE MAY NOT ALWAYS MEET OUR GOALS, BUT that doesn’t make the journey any less valuable. In the complex world of cancer research, a promising result in the lab may not lead to a viable treatment, but the research process itself can give rise to groundbreaking collaborations, new funding and facility partnerships, and the uncovering of uncharted territory for further exploration. While such elements may not have been the primary objective, they are critical to achieve a cancer-free future. Glioblastoma multiforme (GBM) research has proven particularly challenging. GBM is the most common and most aggressive type of malignant primary brain tumour. Approximately four to five people per 100,000 are diagnosed with GBM every year. Fewer than five per cent of these patients survive beyond five years, with an average survival period around 15 months. Canada’s first national GBM research project, led by worldrenowned brain cancer researcher Dr. Gregory Cairncross of the University of Calgary, aimed to extend this survival period. The project involved partners from across the country working to develop new GBM therapies. Initiated by the Terry Fox Research Institute (TFRI) in 2012, the project was co-funded by the Alberta Cancer Foundation, Alberta Innovates, The BC Cancer Foundation, Genome BC and Genome Canada to launch a nationwide GBM research effort. TFRI approached Cairncross to put together the inaugural national research team — one that would include partners such as the Ontario Institute for Cancer Research, Queen’s University, the Hospital for Sick Children in Toronto, the University of Calgary and the University of British Columbia. The research team began to explore the possibility of new drug treatment options for glioblastoma patients. “One of the legacies of this project will be teams across the nation studying together — scientists and clinicians [working in partnership] on this very difficult problem,” Cairncross says. “It was an important first collaboration — groundbreaking in that sense, really. We took a number of ideas from the lab to clinical trials in Canada and elsewhere, and that’s an accomplishment.” Unfortunately, there are no guarantees in research, and encouraging potential treatments discovered in the lab did not bear out in clinical trials. “One thing we learned is that the behaviour of cancer in the dish and the behaviour in mouse models are different,” Cairncross says. “Then in humans is another jump. There is
no perfectly predictive system. Patients are different, cancers manifest differently. We don’t have a way to model that, but we’re trying.” Cairncross says that although the team did not move the needle on improving outcomes, scientifically speaking, a strong foundation for ongoing collaborative GBM research was built. Bringing together multidisciplinary partners from across the country allowed for a new level of GBM research using a number of different approaches. “There is no one centre that has all the scientific knowledge and tech,” says Cairncross. “All of us are very grateful for the investment the funders made. Our lab programs together and separately are much stronger.” The national GBM research project allowed the team to harness its collective resources and lay critical groundwork for
future collaborations. In fact, many of the team members continue to work together even though the official project ended this past June. For instance, a new research project is now underway because the team discovered a non-cancer drug — one that was originally developed to discourage excess alcohol consumption — as a potential new GBM treatment. “Quite surprisingly, it had some anti-GBM properties,” says Cairncross. “That shows an interesting drug might come from somewhere that you weren’t expecting.” Dr. Stephen Robbins, a co-investigator on the project who worked with Cairncross, and a professor in the department of oncology at the U of C, agrees that the legacy of the team’s work continues to be incredibly valuable. “The project broke down provincial barriers in terms of access to funding, but also allowed for open access to and the sharing of data between the members of the group,” Robbins says. “Part of the legacy is that the data will live on and it can be re-analyzed dependent on the new projects that continue to be created.” Ultimately, the sustained teamwork among GBM researchers means scientists are inching closer to a cure, and simultaneously improving existing therapies for GBM. “Partnerships of this kind are important to advancing the science,” Cairncross affirms. “The continued effort will lead to better treatments for brain cancer. We see evidence of it in other cancers. Cancers that weren’t treatable a decade ago now are. And GBM treatments are much better now even without a magic bullet.” Surgery has improved, radiation is more precisely targeted, and drugs are both easier to administer and easier for patients to take, causing fewer side-effects — all of this improves the lives of patients with GBM. “It’s not as if we’re only working on the science for a future cure,” says Cairncross. “We’re also improving the here and now.” LEAP
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MEET TEAM ONE AIM TH I S C A L GA RY-B A S E D E N B R IDGE RID E T O CO N Q U E R C A N C E R TEAM I S PA RT N E RS H IP -P O WE R E D
PA R T N E R S H I P S
by JENNIFER DOROZIO + Illustration by ISABELLE CARDINAL
G
REAT TEAMS HAPPEN ON PURPOSE. THE ONE Aim Team, a group of cyclists who have participated in the Enbridge Ride to Conquer Cancer in support of the Alberta Cancer Foundation for a decade, is a shining example. One Aim was officially formed in 2010 from a training group that took part in the inaugural 2009 Enbridge Ride to Conquer Cancer. That first year, the team had 18 riders and raised more than $75,000. Today, the Calgary-based team consists of 58 riders, including 15 cancer survivors, and it completed its 10th 200-kilometre Ride this past August. Like the name suggests, the team’s one aim is to end cancer, and, to date, it has raised over $2.7 million for the Alberta Cancer Foundation. What makes it unique is its focus on inclusivity. It welcomes everyone from beginner to veteran cyclists, regardless of age, size and athletic ability, and is focused on teamwork and building community. Here, two of One Aim’s captains share exactly what makes the team so special.
KEVIN JONES, LEADING BY EXAMPLE
Now one of One Aim’s four team captains, Kevin Jones showed up to his first training cycle for the Enbridge Ride to Conquer Cancer in 2009 with a heavy mountain bike, the wrong gear and a bone to pick with cancer. This moment was significant for Jones, who lost his little sister to cancer 15 years before. He says it was fellow rider Dr. Nigel Brockton — One Aim’s original captain and a research scientist in molecular cancer epidemiology — who encouraged him on that first ride and exemplified what partnerships can do. Now, Jones participates every year.
“I definitely wouldn’t have been prepared in any way, shape or form for the [Enbridge Ride to Conquer Cancer] that year if it hadn’t been for Nigel having training rides, and that became the foundation for our team. Nigel worked to make training rides accessible, open and enjoyable. The more training you do, the better you’ll be prepared for the Ride, so by removing challenges people have in getting out training, showing them how it’s done and making it enjoyable, he helped many people train much more than they would have.
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“We accept anybody [on One Aim]. A lot of people who sign up to do this are signing up because of the cause, not because they are a strong cyclist, and just like myself, they need someone to get them ready. Someone to tell them, ‘You need different shoes, you’re going to need a rain jacket and maybe pump your tires some more,’— all the little things. It’s really something you learn by doing. “Accessibility is really important. We say ‘No Drop’ (meaning no-one gets left behind), and we mean it. You can show up [to one of our three weekly training rides] completely unprepared — like I was that first time. We’re ready to usher you through the process. “A big part of what makes our team ‘sticky’ in terms of people joining us and sticking around is that after almost every one of our training rides we have ‘rehydration’ at either a clubhouse or a pub where you sit face to face and that really creates a team atmosphere. “Fundraising is important but what ties it together for me is creating a culture where people are living lives in which they are less likely to get that cancer diagnosis in the first place.” PHIL FAAS, FINDING SUPPORT
Phil Faas’s wife, Cindy, was in the process of chemotherapy for breast cancer in 2014 when she stumbled upon information about the Enbridge Ride to Conquer Cancer and Team One Aim at a spin fundraiser event at Southcentre Mall. A year later, after completing chemotherapy, a double mastectomy and radiation, Cindy was declared cancer-free. In celebration, the couple took part in the 2015 Ride as part of the One Aim Team and have continued to ride together ever since.
“Cindy received top-notch treatment at the Tom Baker Cancer Centre in Calgary, and everyone we dealt with was absolutely amazing. Participating in the Ride was a way to pay it forward and say ‘thank you’ for all the treatment we received. “[That first year] we were welcomed with open arms. The whole ethos of One Aim is everyone is welcome. Like, even when we were in the bike shop my wife was texting Nigel, ‘Here’s what they are showing us.’ We were about to spend $2,500 on a pair of bikes, so it was nice to have someone backing us up. “As team captain, I try to put new riders at ease by explaining my backstory. I mention I’m not a lifetime cyclist, I started five years ago and smoked right up until the time my wife got diagnosed with cancer. I’m not like a lot of cyclists you see. [But] anyone can do this, and everyone starts at the beginning. If there’s a new person training, we [captains and other experienced riders] stick with them for the first ride because we know how daunting it can be. “In a lot of ways, cycling and One Aim saved my life. There’s no way I could go back to my old lifestyle because I’ve fallen in love with cycling, and the friends we have made are lifetime friends, not just cycling friends. There’s such great people and we’re all here for the same cause. That bond goes a very long way.” LEAP
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CARING
ANGELA ESTEY, EXECUTIVE DIRECTOR OF THE CANCER SCN
PHOTO PAUL SWANSON
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A Unified Focus The Provincial Breast Health Initiative is improving care for breast cancer patients by COLLEEN SETO
FINDING A SUSPICIOUS LUMP IN YOUR
breast is disconcerting. Waiting to meet with a health-care provider for the diagnosis and treatment of the lump can be even more nerve-racking. “The diagnostic period is highly stressful for women,” says Dr. May Lynn Quan, co-medical lead, Provincial Breast Health Initiative. That’s why expediting diagnostic assessment is one of the key areas addressed by the Provincial Breast Health Initiative. Set in motion by the AHS Cancer Strategic Clinical Network (SCN) in October 2016, the initiative began with a provincial stakeholder meeting — with patients, surgeons, oncologists, radiologists, nurses, primary care physicians and support staff — to review every aspect of a breast cancer patient’s journey and find ways to improve it. Stakeholders included many committed and knowledgeable partners within AHS, but also outside of AHS, too. From that meeting, a number of goals were identified along the pathway, including shortening wait times to diagnosis and increasing recovery options after surgery. Following that initial meeting, the Provincial Breast Health Initiative kicked off across Alberta with the goal of implementing best practices to improve the way care is delivered to women and their families. One of the new practices involves simultaneously notifying a patient’s family physician and the breast health program as soon as that patient receives a recommendation from a radiologist to undergo a biopsy. “By notifying the breast health program at the time a biopsy is recommended, an appointment can be booked shortly after the biopsy is done,” says Quan. This allows for expedited surgical consults for patients with highly suspicious breast lesions. As part of the initiative, a breast health nurse coordinates the appointment and is also available to offer emotional support and answer questions. Once the appointment for the surgical consultation has been made, a
notification is sent to all parties. “The new diagnostic pathway was implemented in Calgary and Edmonton, and shortened wait time from biopsy recommendation to surgical consult from 19 days to six days,” says Angela Estey, executive director of the Cancer SCN. “There’s a lot of anxiety during that wait time so it made a real difference in improving access.” Another major element of the initiative is implementing same-day mastectomies. “Most patients with breast cancer go on to have surgery,” explains Quan. “The initiative aimed to improve the quality of recovery, allowing women to go home the same day as a mastectomy. Returning home on the same day is safe and well-accepted. Our research shows that patients were very comfortable recovering at home.” Through the support of Alberta Cancer Foundation donors, new educational materials were created to ensure patients and their families were well-informed before and after the surgery to safely recover at home. “Educational materials have been standardized for breast surgery so patients, wherever they are in Alberta, can access all the information on myhealth.alberta.ca,” says Estey. The number of mastectomy patients who return home on the same day as surgery has increased from five per cent in 2014/15 to 54 per cent today. At-home recovery also has the added benefit of opening up hospital beds for others in need. The Provincial Breast Health Initiative has also introduced a new data collection process to improve outcomes for future patients. This measurement system was developed to measure and track the initiative’s progress to continually improve the care that breast cancer patients receive. The data is collected and reported on a dashboard for administrators, funders and health-care providers to review and see what’s working and what may need improvement. “The fundamental component is that we have a way to measure to ensure that we’re making a positive difference,” says Quan.
BY THE NUMBERS
IMPROVEMENTS MADE THROUGH THE PROVINCIAL BREAST HEALTH INITIATIVE
60%
Wait time (between suspicious imaging and surgical consult referral) down 60 per cent from 19 days in 2016 to 6 days in 2018
90%
of patients satisfied with information received
5% to 54%
Percentage of mastectomies performed as day surgeries increased from 5 per cent in 2014/15 to 54 per cent today
821
hospital bed days per year released
$802,000
estimated savings in patient care
“It’s ongoing, so data will continue to be reported, and centres can continue to make progress.” Earlier this year, the Provincial Breast Health Initiative received a 2019 AHS President’s Excellence Award for quality improvement. These awards are given to AHS programs and people that demonstrate the highest standards in innovation, collaboration and patient-centred care. “The success of this initiative really has been the involvement of many patients, administrators, clinicians and front-line staff,” says Quan. “It was a massive provincial undertaking, but we showed it can be done.” Ultimately, the learnings from this initiative could be applied to other types of cancer patients, too. “We’re hoping that what we’re doing can be exported to other cancers and improve the journey for all cancers,” says Quan. LEAP myleapmagazine.ca FALL 2019 LEAP 35
LIVING WITH CANCER
Meet
SCOTT GAMMER In our new photo series, we capture the bravery, strength, honesty, hope and resilience of Albertans living with cancer by SAMANTHA GRYBA
IN LATE SUMMER OF 2013, SCOTT GAMMER,
SCOTT GAMMER AT THE CROSS WHERE HE VOLUNTEERS
who was 44 at the time, noticed a lump on his stomach. After an ultrasound, doctors discovered a large tumour that ultimately turned out to be cancer. Gammer received surgery and began chemotherapy. In October 2014, after Gammer experienced odd symptoms including vertigo, doctors discovered malignant tumours around his carotid arteries and brain stem. He was given two months to live. But Gammer exceeded doctors’ expectations, and, in January 2015, he received a stem cell transplant and went through multiple rounds of different types of chemotherapy to help shrink the tumours. Today, Gammer, who is on long-term disability, enjoys spending time with his two sons, Cole and Brett, and his wife, Terri-Lynn. He is also an active volunteer at the Cross Cancer Institute, where he regularly connects with other cancer patients and shares his story. “[Before the cancer diagnosis] I was working my butt off and not really noticing the stars, the sunsets, the sunrises, and all of the beautiful things all around me, including my kids, my wife and trying to make memories with them. I know my longevity has been impacted, but I’ll tell you, the impact that it has made on my life has been way more valuable than if I had never got cancer.” LEAP
PHOTO BLUEFISH STUDIO
36 LEAP FALL 2019
ancer Founda rta C tio e b n Al
Anabell Marroquin
Kelly & Kelly Liebe
Thank you for your support of the 20th annual Cash & Cars Lottery! Since 2000, the Cash and Cars Lottery has invested over $33 million into cancer research and care right here in Alberta. Thank you for creating more moments for Albertans facing cancer.
May has promised a gift of life. Her 52-year marriage cut short, May wants future generations to be free from cancer. A gift through her Will can honour her late husband and help save lives. This will be part of her legacy.
Thank you May!
LEGACY GIVING
Leave a legacy. Consider a gift of life in your Will. albertacancer.ca/legacy
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by SILVIA PIKAL photography AARON PEDERSEN
RESEARCH R O C K S TA R DR. LYNNE POSTOVIT AND HER TEAM ARE IMPROVING OUTCOMES FOR WOMEN WITH BREAST AND OVARIAN CANCER
W
hen Dr. Lynne Postovit is in the lab, she says seeing something new is exhilarating. She’s made many discoveries in the course of her career, all with the goal of improving quality of life for women living with breast and ovarian cancers. “Some of the victories are seemingly small, but if you add them up across the province and the country and the continent and then the world, they’re actually pretty impactful,” Postovit says. >
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Postovit is an oncology researcher at the University of Alberta and co-director of the Cancer Research Institute of Northern Alberta (CRINA). She is also the current chairholder of the Sawin-Baldwin Chair in Ovarian Cancer, funded in part by the Alberta Cancer Foundation. In 2013, she was recruited from Western University to lead a team at the U of A to work on identifying a biomarker for ovarian cancer so it can be found in a test at a regular check-up. There is currently no early screening for ovarian cancer, so it’s usually discovered when it’s too late. Last year, her team made an exciting discovery in the lab. They identified a way to accurately distinguish between different types of ovarian cancer — high-grade serous carcinoma (the most common and deadly form of ovarian cancer) and endometrioid carcinoma. Typically, without knowing the exact type of cancer present, oncologists haven’t been able to recommend the most effective treatment for the disease. In their study published in April 2019 in the Clinical Cancer Research journal, Postovit’s team found eight protein biomarkers that will allow pathologists to distinguish between a high-grade serous and endometrioid carcinoma with 99.2 per cent accuracy. “We were able to increase the specificity from 90 per cent to almost 100 per cent, which is pretty big for these particular patients,” Postovit says. Postovit hopes to see the test being used in the next few years, since it was designed to be implemented quickly without a need for new technology. The test can give oncologists more precise information to assist with diagnosis and improve patient outcomes. For example, a patient who is accurately diagnosed with endometrioid carcinoma, which has a better prognosis, could respond to less aggressive therapies other than chemotherapy. Making a real impact in the world is what has driven Postovit throughout her life. Growing up in Ontario, she was an inquisitive child. She loved being creative, whether it was in the form of writing poetry or dreaming up solutions to a problem presented in science class. While she wasn’t exactly sure what she wanted to be when she grew up, she knew she wanted to make a difference and help people. 40 LEAP FALL 2019
After high school, Postovit went to Queen’s University in Kingston, Ont., where she received a bachelor of science, with the plan of going to medical school to be a physician. In her final year of the program, she participated in a research project and was struck by the joy of discovering something new in the lab. That was when her career goals pivoted from being a doctor to being a researcher. “With research, you can help people beyond your community for generations and generations to come all over the world,” she says. Postovit went straight into a PhD in anatomy and cell biology at Queen’s University under the supervision of Dr. Charles Graham. During her doctoral training, she discovered that supplying cancer cells with nitric oxide would slow tumour growth — tumour growth can be caused by hypoxia (low oxygen levels), and nitric oxide can combat the effects of hypoxia. Together with Graham and her collaborators, Postovit patented an approach that makes use of nitric oxide to treat cancer, which progressed into clinical trials. From 2004 to 2007, she completed her post-doctorate training at Northwestern University in Chicago under the supervision of Dr. Mary J. C. Hendrix, a leading cancer researcher in the United States. Hendrix was interested in the concept of plasticity, which refers to cancer cells co-opting stem cell-like features so they can adapt to their environment, resist therapy and spread in the body. Since Postovit was trying to understand how low oxygen causes cells to behave a certain way, she thought it would be a perfect fit to work with the Hendrix lab on what would drive cancer cells to behave like other cells. “We discovered that cancer cells make a very primitive embryonic protein called Nodal,” Postovit says. “And that was the first description of that in cancer [research].” Nodal was discovered in aggressive breast cancer and melanoma cells by Postovit and the Hendrix team, and since then has been found in other cancers by researchers around the world. Since Nodal is specific to cancer, it could be detected in the blood early on, and also be targeted by medication. “It’s not expressed in normal adults because it’s silenced early on. So you can imagine if cancer started to make it, we
can come in and target it without as much toxicity,” she says. In 2007, Postovit started her own research program at Western University in London, Ont. Her team discovered that Nodal promotes the formation of new blood vessels, invasion and metastasis (cancer spreading to another location in the body) in breast and ovarian cancer cells. They also found that hypoxia (low oxygen) enhances how Nodal works. In 2018, at the U of A, and in collaboration with other investigators, her lab discovered that Nodal seems to help ovarian cancers become more resistant to cancer therapy like carboplatin (a chemotherapy drug). By developing a drug that blocks Nodal in cancer cells, chemotherapy could become more effective on those cancers. “These metastatic breast cancers or advanced ovarian [cancers] are going to be very, very hard to crack, and every patient might be a bit different,” Postovit says. “And so, we have to keep discovering things to keep a pipeline to help these people.” Postovit is excited to see what comes from a new research team she is going to be a part of — a “dream team” of researchers who will work together to improve outcomes for women with metastatic breast cancer. The team will be supported by Stand Up To Cancer, an initiative that funds collaborative research teams across Canada through the support of donors including the Alberta Cancer Foundation. Led by Dr. Nahum Sonenberg at McGill University, this dream team will be conducting a clinical trial with patients in Edmonton and across Canada. Postovit and her colleague, Dr. John Mackey, are collaborating principal investigators on the project and represent the Edmonton team. They’ll be looking at mRNA translation (the process of building protein molecules from the genetic code of cells) and will have access to a compound that can help prevent some of the abnormal translation that occurs in cancer cells. The trial has yet to be approved and will likely start in a year or so. On top of her research work, Postovit has been co-director of the Cancer Research Institute of Northern Alberta (CRINA) since November 2014. CRINA is focusing on linking U of A researchers
with other cancer research institutes to synergize and leverage their knowledge to answer the hardest questions in cancer. It also involves bringing people from various other fields and backgrounds — including computer science, engineers who are developing new devices, mathematicians, scholars in sociology, nurses and more — together in teams to work collaboratively to improve cancer research. “So, as really cool discoveries happen, we can help facilitate more rapid translation and development,” Postovit says. “It’s all about research and collaboration.” Dr. David D. Eisenstat is the chair of the department of oncology at the U of A. He was one of three original co-directors of CRINA from 2014 to 2017 and currently serves on CRINA’s steering and oversight committees and meets with Postovit on a regular basis to ensure strategic alignment. “Lynne has a tremendous vision for her research in the present and future,” Eisenstat says. “She is foundationally strong in basic science and doesn’t cut corners. Her mind is ‘razor sharp’ and she is able to explain difficult concepts such as epigenetics and stem cells to funding agencies and her colleagues/ peers.” Eisenstat says that Postovit excels at leading by example and supporting her colleagues and trainees in the lab. Postovit’s research team usually has 12 to 13 lab members comprised of research associates who are training for their MDs, MSCs, PhDs or completing post-doctoral training. Some members of the lab are also career scientists and direct independent research projects within the research themes of the lab. One of her favourite parts of her job is mentoring the research associates and seeing them grow, especially when they share knowledge that’s completely new to her. “It makes me feel like I’ve actually done my job,” Postovit says. She feels like with each step, they are getting closer to discovering what drives cancer cell plasticity. What keeps her going is the idea their work will have a lasting impact on people living with cancer. LEAP
7 QUESTIONS WITH
DR. LYNNE POSTOVIT 1. Describe what you do in 10 words or less. Work to improve outcomes for women with breast or ovarian cancer. 2. What’s the biggest misperception about what you do? That what we do as scientists is really isolated and not very social. We actually work closely with people in the lab, with patients to try to understand what their needs are, and collaboratively with scientists and researchers around the world with similar goals to make the best impact for our patients. 3. Where do you get your best ideas? In our laboratory we look at developmental model systems, like how a zebrafish might develop, or systems like a placenta and how it knows how to invade and then stop, and then use those models to see cancer differently. And reading broadly — art, poetry, philosophy — there’s a huge creative aspect to what we do. 4. What’s the hardest lesson you’ve learned? I think the hardest lesson is how important it is to clearly communicate what needs to get done with the members of
the team, and take the time to make sure that you’re all on the same page. 5. What motivates you? To make a difference. In cancer we do keep making small victories as a community. And to see patients now who can live a good life with cancer that maybe couldn’t have even 10 years ago. 6. What do you do to recharge? Running and using that time to get in my head without interruptions. I like to write poetry. To get those ideas down on paper and see how the words flow together. 7. Why does your research matter? In the case of breast cancer, it’s still the number one cancer that afflicts women, and despite incredible advances, there’s still a lot of women who suffer critically and then eventually pass from this disease. We’re trying to understand why that is, and why some of the cancers come back and to prevent that, which I think improves the lives of a lot of women. And in the case for ovarian cancer, we’re improving treatments and preventing some of that resistance that’s occurring.
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TRUE CALLING
by NATHAN KUNZ photography PAUL SWANSON
DR. SVETA SILVERMAN AT HER LAB AT MISERICORDIA HOSPITAL
42 LEAP FALL 2019
LEARNING, TEACHING AND HEALING It took Dr. Sveta Silverman over a decade and a move around the globe to find her true calling as a pathologist and educator
D
ESPITE FINDING SUCCESS IN THE
operating room, Dr. Sveta Silverman says she didn’t find her true calling until nearly 15 years into her medical career. Having built a reputation in pediatric surgery through her work at the 9th State Pediatric Hospital in the then-Soviet Union, Silverman was sent back to square one when she immigrated to Edmonton in 1991. With around $120 to her name and without the credentials necessary to work as a medical professional in Canada, Silverman worked her way back into medical school for the second time, this time at the University of Alberta (U of A). >
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There, she chose to study pathology. “Anytime I look in the microscope, there’s something new, there’s something interesting — it’s never boring. One case is never the same as the other case, even if the diagnosis is the same,” says Silverman. “It’s so tantalizing, it’s so awesome, and it’s also beautiful under the microscope, despite it being cancer.” Pathology is centered around getting to the root of diseases and delivering a diagnosis. For Silverman’s work as a surgical pathologist and breast specialist, this means analyzing cells in removed tissue from patients with breast cancer and other breast diseases under microscopes, finding abnormalities and diagnosing accordingly. Where other clinicians use blood tests and physical examinations, pathologists see the disease and diagnose precisely. A more precise diagnosis allows for a more precise treatment. Rather than applying a “shotgun” approach, pathologists can zero in on the diagnosis, resulting in a more targeted treatment. Today, Silverman splits her work in Edmonton between the Cross Cancer Institute, Misericordia Community Hospital and the U of A. Her designations include surgical pathologist breast pathology consultant at Misericordia and the Cross, and associate clinical professor and director of the breast pathology fellowship program at the U of A. An average day sees Silverman working directly with clinicians and surgeons, taking breast pathology cases in the lab of Misericordia Hospital as they come. When she’s not at the Misericordia, Silverman is on call for her consultation practice with the U of A’s breast cancer program, completing research reviews for the Cross or 44 LEAP FALL 2019
conducting her research on her own personal time. Silverman enjoys all aspects of her work, but she’s particularly passionate about her own research. Currently, she says she is “crazy” about research related to the antioxidant effects of Nrf2 activation. The Nrf2 gene is related to the body’s natural antioxidant defense system and can be potentially activated through medication to further protect against damage from injury and disease. Another current focus, mitochondrial health, ties in as well. Mitochondria, parts of the cell that break down nutrients into energy, can also experience benefits from Nrf2 activation. One research interest often bridges to the next for Silverman, who says Nrf2 research is what made her take a deeper look into mitochondria. Her desire to learn has been a constant throughout her life. “Whatever I can learn about cellular and body health, I will,” she says. A WINDING ROAD
While the path leading to pathology was far from direct, Silverman says there was never any doubt she would end up working in health care. Her mother was a well-known physician in the Soviet Union who specialized in pediatrics and rehabilitation. In her childhood, Silverman looked up to her, calling it a “no-brainer” that she would follow in her mother’s footsteps. “My mom was a natural born healer,” says Silverman. “She is my hero. She is my it.” Upon completing her medical degree at the Sverdlovsk State Medical Institute in 1987, Silverman began her career as a pediatric surgeon. After two and a half years of working in
the operating room, she made the decision to leave the U.S.S.R. The destination, she explains, had less to do with destiny and more to do with necessity. “I wanted to get out, and Canada was one of the choices,” says Silverman. “It just happened. I would not have lived in the Soviet Union.” Following two more years of travelling, Silverman settled in her new home of Edmonton in 1991. Without credentials and in need of work, she began working as a housekeeper at the Fantasyland Hotel. “Immigration is always painful and never natural, whether you’re coming to a new country with money or without money,” says Silverman. From there, Silverman found work as a sessional instructor at the U of A — as her credentials from the U.S.S.R. allowed her to teach medicine in Canada, but not practice. At the university, Silverman taught lectures in several levels of anatomy, from gross anatomy dealing with what’s visible to the naked eye, down to its counterpart of histology, which studies anatomy at a microscopic level. It was during her initial years with the U of A when she first met (and taught) Dr. Karen King, who was then in her first year of medical school. “She was very passionate about [teaching medicine] and inspired a lot of us to carry on,” says King of Silverman as an instructor. “She’s been a big part of what got me where I am.” King, now a medical oncologist at the Cross and a chair of the Northern Alberta Breast Cancer Program, has worked alongside her former instructor for the past 15 years. She says while Silverman encouraged her as a student, King also made an effort to encourage Silverman to return to medical school, which she
would do in 1996 at the U of A. “Did I want to go to med school? No,” says Silverman “But you’ve got a goal, you go for it.” Silverman admits it was difficult to return to medical school. She says while a love of learning and teaching has driven much of her career, particularly in pathology, she has never been fond of exams. Her choice to pursue pathology came from two places of origin — a desire to stay close to her past work in the operating room, and the opportunity to avoid long hours away from home at the hospital. “Being an ex-surgeon, I really didn’t want to spend the rest of my life in the operating room. But I wanted to be very close to the operating room,” says Silverman. “To me, pathology is the best discipline in medicine.” A NATURAL TEACHER
Silverman’s choice of words displays a keen ability to describe the most complex topics in simple terms. Often, her lectures and panel appearances, along with blog posts on her website, askdrsilverman.com, are rich with metaphors and similes, which simplify concepts that can often feel like a different language. “I need to explain the most complex things the way that a young child will understand it,” she says. “And, if I can do it in a clear, concise, very simple
way, my mission is accomplished.” King says Silverman has maintained an above-and-beyond approach to teaching, and recalls her spending time with students in the lab afterhours and on weekends. “No questions asked, she will teach you,” says King. “And as she teaches you something, you can see how much passion she has for it.” Silverman also regularly contributes to the Northern Alberta Breast Cancer Program, including as a guest lecturer. “Anytime I ask her to give a talk or give a presentation, she’ll always say ‘yes,’ sometimes even before she can check the timing of it,” says King. Silverman’s website is an extension of her teaching. On it, she answers questions from people and blogs about her latest research findings and fascinations. The site was in part inspired by her own mother, who passed away from cancer with little explanation. In her journey for answers, Silverman began researching outside the realm of conventional medicine, looking to learn as much as she could to pass on the knowledge to others. “I’m still learning every day,” she says. “For whatever I learn, I teach.” It’s this desire to learn and teach that has guided Silverman’s holistic approach to medicine. “In this day and age, we have so many more of the means to educate
ourselves,” says Silverman. “Everyone is responsible for their health, everyone is responsible for their well-being.” On her blog, Silverman advocates for healthy lifestyle choices, including information on superfoods, natural supplements, the importance of maintaining mental health and more. While she notes that she has been successful in pathology, she sees her legacy existing through her education contributions. “My legacy is in teaching people health,” says Silverman. “If I managed to teach them to change their lifestyle, and eat better, and exercise more, and think happy, that’s what I’m most proud of — changing lives.” Despite the tribulations and inherently unnatural transitions that came with starting over following immigration, Silverman says she has no doubt she found her true calling with pathology. Similarly, she doesn’t hesitate when expressing her inspiration to continue working, learning and teaching. “I love doing research in breast cancer, absolutely love it, because I think, finally, we’re getting to the point where we can solve it,” says Silverman. “I’m so inspired by the people I help as they do better. I thrive from human inspiration.” LEAP
DR. SVETA SILVERMAN’S CAREER HIGHLIGHTS • Began work as a
pediatric surgeon at the 9th State Pediatric Hospital in Sverdlovsk, Russia in 1987.
•C ompleted two
Doctors of Medicine, first in the U.S.S.R. in 1987, and again at the University of Alberta in 2000.
•C ompleted her an-
atomical pathology fellowship/residency from the Royal College of Physicians and Surgeons of Canada in 2005.
•E arned numerous
designations, including chair of the provincial breast SIG (specialty interest group) and director of the U of A’s breast pathology fellowship program.
•D eveloped expertise
and became an accomplished author and presenter on breast cancer, Nrf2 activation and mitochondria.
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IMPACT
CANCER SURVIVOR JAMILA MOLOO IS GRATEFUL FOR HER FAMILY AND FRIENDS
Welcoming Help as told to COLLEEN BIONDI
In March 2018, 41-year-old Jamila Moloo of Edmonton was diagnosed with breast cancer. The traumatic news was a complete shock, but she faced it head-on with the help of her supportive family and friends, as well as her care team at the Cross Cancer Institute. Throughout 2018, Moloo underwent chemotherapy, a bilateral mastectomy and radiation. Today, the mom of three is grateful for the return of her health and shares her story here: “I was taking a shower and noticed a bump in my left breast. I knew that wasn’t right. You could actually see it protruding from my skin. I got a requisition for a mammogram and ultrasound. The radiologist was kind and calm but said he didn’t like what he saw. Things started moving quickly after that. “I [was diagnosed with] stage 3 breast cancer. I took chemotherapy — a session every three weeks for a total of six sessions. On Sept. 24, I had a bilateral mastectomy. My surgeon didn’t want to remove both breasts, but I convinced him, as we have strong cancer histories on both sides of our families. Four weeks later, I started radiation.
“It wasn’t easy. I lost my hair with the chemo, had lower body pain and couldn’t eat due to that metallic taste in my mouth. I was weak. Recovering from surgery took some time. And the follow-up to the radiation treatment was surprisingly tough. The sessions don’t hurt, you would think it would be easypeasy. But after the series was over, the skin over my breasts started blistering and peeling. I developed open sores. It was very painful. “What got me through was the support of my husband, our extended families and the mothers from my kids’ school. My husband took the kids to school, picked them up every day and took them to their extracurricular activities. He never once complained. He was my rock. His mother and brother and my mom made meals, stayed for dinner and helped with bedtime routines. The school moms dropped off food after chemo sessions. It was hard for me to accept help — I am usually the one helping — but these people were truly angels. There is no way I could’ve looked after my children alone. “And the staff at the Cross were there from beginning to end. They are specialists and shared information, advice and support. I was frequently on the phone to my oncologist or nurses from the triage line. They helped me trust the journey and the process. I decided I would do what I could do and leave the rest up to their healing hands. “I heard my husband say to a friend recently that this experience was hell for our family. I actually didn’t feel that way. I just got down to business and knew it was a temporary situation. But now that he is relieved that all is well and moving on, I’m still struggling with processing the emotional side of a cancer diagnosis. I am going to reach out to [my health-care team] for support to work on this. “There was a silver lining to this experience — we learned that we have people in our circle who care deeply about us and are there for us. I also live more in the moment now and appreciate every day.” LEAP PHOTO BLUEFISH STUDIOS
46 LEAP FALL 2019
WHY I DONATE
An Honourable Legacy by COLLEEN BIONDI
Ron Daye and Rob Pearson join forces to give back > PHOTOS COLIN WAY
myleapmagazine.ca FALL 2019 LEAP 47
RON DAYE (LEFT) AND ROB PEARSON ARE INVESTED IN SARCOMA RESEARCH AND TREATMENT
CALGARIANS ROB PEARSON AND RON
Daye are passionate fundraisers and donors — individually, the two men have raised significant funds for new cancer research and treatment. This summer, the pair made the decision to join forces to considerably expand their fundraising impact. Pearson and Daye created a strategic partnership to increase awareness about — and fund research for — sarcoma, a rare form of cancer that attacks the connective tissues. Both Pearson and Daye have lost loved ones to the disease. Pearson’s wife, Catherine, died of muscle tissue uterine cancer in 2009. Daye’s son, Cameron, died of spindle cell sarcoma, a connective-tissue cancer characterized by under-the-skin tumours, in 2014. After their respective losses, both men were inspired to give back and independently approached the Alberta Cancer Foundation to discuss fundraising frameworks. In honour of Catherine, Pearson, a retired land man and former owner of Pearson Resources Ltd., held the Catherine Pearson Charity Rodeo, alongside his family, from 2009 to 2014 at the Wild West Event Centre in Calgary. Approximately 2,000 annual attendees enjoyed contests like cow riding and goat dressing (youngsters trying to put t-shirts on goats). A total of $500,000 was generated from silent auctions, team fees and donations. 48 LEAP FALL 2019
This money became the principal for the Catherine M. Pearson Studentship in Sarcoma Research. When Cameron died, Daye, who is the president and chief executive officer of Rangeland Engineering, donated $1.5 million over three years to create the Cameron C. Daye Cancer Research Clinical Fellowship. Since 2014, an additional $80,000 has been raised annually at the Cameron Daye Memorial Golf Invitational in Kananaskis, boosting the principal to almost $2 million. Since their inception, five per cent of both funds has been divested annually for cancer research. In 2013, when Cameron’s wife, Elizabeth, was investigating collaborative fundraising options, she met Pearson and introduced him to her father-in-law. Since then, the two men have connected for the odd lunch, beer or coffee to discuss sarcoma research. One year ago, during one of those conversations, a light bulb went on — what would happen if they pooled their funds? In the summer of 2019, they entered into a new agreement with the Alberta Cancer Foundation with the creation of the Cameron Daye and Catherine Pearson Sarcoma Fellowship Fund. Valued at approximately $2.7 million, the fund will be put toward groundbreaking sarcoma research initiatives. Funds will be spent
on projects in Alberta — one of the first is immunotherapy treatment research, conducted by Dr. Michael Monument at the University of Calgary’s Cumming School of Medicine — across Canada and abroad. Pearson and Daye will receive annual updates about who has been selected for the fund, what the research is about and what the results are. “I am looking forward to some serious research being done,” says Pearson. “Sarcoma represents only one per cent of cancers, but 15-20 per cent of cancers in young adults under the age of 35,” adds Daye. “Once you start telling that story, it is easier to generate the support.” The goal is for the fund to reach up to $20 million in value — Pearson and Daye hope to attract other generous donors to make this possible. That way, more money will be available for annual distribution, more donors will be committed to the cause and more researchers will be able to investigate treatment and curative solutions for sarcoma. Pearson and Daye would like to thank the Foundation, staff at the Tom Baker Cancer Centre and all research fellows for their dedication to the fund and its vast potential. They look forward to spearheading progressive research that will improve the lives of individuals experiencing sarcoma — an honourable legacy in memory of Catherine and Cameron. LEAP
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GAME CHANGER
FROM LEFT: RYAN CAMPBELL, ROB GRAEFER AND RYAN DOULL AT THE CALGARY DONATION EVENT
Albertans Helping Albertans Doull Site Assessments and Capstone Oilfield Services work hard to give back by JENNIFER FRIESEN
FOR RYAN DOULL, HELPING OTHERS IS AN UNDISPUTED PRACTICE
that he picked up from his parents, Kerry and Miriam. Doull’s parents both grew up in the same small farming community and were raised to lend a hand to their neighbours. That generous philosophy followed them into business when they began what is now known as Doull Site Assessments Ltd. (DSA) in 1988. The Alberta-based company runs testing and monitoring services for the energy and environmental sector along with its parent company, Capstone Oilfield Services Ltd. DSA always made room in the budget for charitable giving and continued to do so after Doull took over as president in 2016. The contributions often changed year-by-year, but this spring DSA and Capstone decided to make a longer commitment by becoming the first corporate partner of the Alberta Cancer Foundation’s new funding program called Albertans Helping Albertans. “Everybody in our organization has been affected by cancer in one way or another, so we wanted to do something long-standing,” says Doull. “We do a lot of work in Alberta, so we felt like this program was the best fit.” The Albertans Helping Albertans program isn’t affiliated with funding one specific tumour group, but instead, supports all types of cancer in areas of greatest need. This immediately piqued the interest of both Doull and the president of Capstone, Dwight
Bulloch, because they wanted to support cancer funding but didn’t want to narrow their focus to one form. Also, Doull’s mother was recently diagnosed with a rare blood cancer called myeloma, so supporting cancer programs was personally important to him. When the opportunity to support Albertans Helping Albertans arose, he says he knew right away that the time was right. “Everything just came together and we knew,” he says. “[My parents] are very proud. They agree that a program like Albertans Helping Albertans is the right one with a good, broad-spectrum approach to help people who are struggling. It’s going to change lives.” DSA and Capstone have committed to donating a portion of proceeds from every job they complete to the program. While DSA and Capstone have chosen this donation route as a corporate partner, other individuals and companies are also able to contribute to the Albertans Helping Albertans initiative. Other donors are free to choose how they would like to raise money for the cause, including hosting fundraising events such as bake sales or charity runs. Doull estimates the annual contribution for 2019 will be between $15,000 and $25,000, and the money will be donated quarterly. Doull says the entire team is looking forward to handing over the cheque, knowing that their hard work will benefit those who need it most. “We’re excited to see what our work will help contribute towards,” says Doull. “As research uncovers new treatments and cures and [the funding] goes toward a research-based approach, or patient care, or facilities, [we know] it will go where it’s needed. We’re wide open to seeing what the program will contribute to and how it will impact Albertans.” This may be the first time DSA is contributing to charity on a partner level, but Doull says the team is already feeling the rewards of the decision. “I think this shows that Albertans, both corporately and individually, can contribute with their daily activities without even realizing that it’s making a difference,” he says. “Then, at the end of the day, you can see that you’ve had a positive effect on thousands of people. That’s something to be proud of.” LEAP PHOTO AIDEN JAMES
50 LEAP FALL 2019
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