EASING FINANCIAL BURDENS 5 ways your donations help
NEW YEAR, NEW WORKOUT 6 adventurous activities to try
WINTER 2018
GIVING VOICE TO PATIENTS’ NEEDS DR. NANCY NIXON HAS MADE IT HER MISSION TO IMPROVE CANCER PATIENT CARE
VITAL PARTNERS
THE ROLE OF PATIENT NAVIGATORS
HEALTH IN MOTION MOBILE TREATMENT & SCREENING OPTIONS FOR ALBERTANS
PM 40030911
THE NOURISHMENT ISSUE
DO YOU HAVE THE GUTS?
LEARN HOW FERMENTED FOODS HELP TO SUPPORT GUT HEALTH
BUST
A MOVE
2018
Join us on June 2nd for the Alberta Cancer Foundation’s 6th annual Bust a Move for Breast Health! For six energizing hours, bust out your moves through six different fitness sessions all in support of the Cross Cancer Institute.
Whether you’re a yoga master or step class disaster, we need you!
REGISTER TODAY BUSTAMOVE.CA
1.855.250.MOVE
#bamyeg
Interested in becoming a partner for 2018?
Contact Carrie Creaser at 780.643.4460 or carrie.creaser@albertacancer.ca
CONTENTS
16 WORKOUT The soothing wonders of winter walking, and some fun ideas for staying active indoors. 18 EXPERT ADVICE Our experts weigh in on how to offer support to a work colleague with cancer and what to consider financially following a diagnosis. 33 CARING In palliative care, it’s vital for patients to feel both heard and respected. 34 LIVING WELL Mobile mammography units and the Mobili-T device provide flexible options for Albertans, and the Look Good Feel Better program helps women with cancer feel like themselves again. 38 RESEARCH ROCKSTAR Through her work as a medical oncologist and her many research-related pursuits, Dr. Nancy Nixon is making a significant impact on cancer patient care. 42 TRUE CALLING As patient navigators, Carolyn Murphy and Tammy Koch bring comfort and support to cancer patients in Hinton, Alta.
FEATURES
20 THE NOURISHMENT ISSUE
An increased focus on mental, physical and emotional health in cancer care has led to a variety of exciting programs and initiatives across Alberta. We look in on some of the ways patients are receiving support in nurturing their minds, bodies and spirits. COLUMNS/DEPARTMENTS
10
7 FRONT LINE Dr. Jessica McNeil is studying the impact of lighter-intensity physical activity on cancer survivors. Plus, raising funds with the World’s Longest Hockey Game and more. 13 YOUR DONATION MATTERS Five ways your donations to the Alberta Cancer Foundation Patient Financial Assistance Program help to ease patients’ financial burdens.
14 FOOD FOCUS An introduction to fermented foods and a look at the connection between gut health and cancer prevention.
16
46 IMPACT Edmontonian Margaret Holt shares the personal story behind her participation in the Alberta Lung Cancer Screening Program. 47 WHY I DONATE Long-time donor Mary Pringle is passionate about supporting cancer research in Alberta. 49 MY LEAP When she learned of her grandfather’s cancer diagnosis, Leila Godfrey organized a fundraising run in his honour. 50 GAME CHANGER Every year, Lorry Spiker and his family hand-deliver a donation to Edmonton’s Cross Cancer Institute.
COVER PHOTO: COLIN WAY ILLUSTRATION PETE RYAN
myleapmagazine.ca WINTER 2018 LEAP 3
MESSAGE
Looking Ahead TRUSTEES
Thomas Hodson, Chair Christopher Burrows, Vice Chair Rene Aldana Dr. Stanford Blade Dr. Heather Bryant Jordan Hokanson Dr. Sandip Lalli Robert (Bob) McGee Andrea McManus Leigh-Anne Palter Dr. Matthew Parliament (Ex-Officio) Gelaine Pearman Jamie Pytel Rory J. Tyler
I am very pleased to be sharing my first Leap message as President and CEO of the Alberta Cancer Foundation. A few months into this role, I am reassured to see I am surrounded by so many people committed to making a difference for Albertans facing cancer. I am privileged to have already met so many people who are dedicated to making life better for Albertans. During my first few weeks on the job, I was honoured to take part at the kick-off announcement for the World’s Longest Hockey Game with several of the volunteers including their leader and host, Dr. Brent Saik. Brent is aiming for his sixth record-breaking hockey attempt when he takes to the ice in February (he also secured the record for the world’s longest baseball game). While I was at Saiker’s Acres, east of Sherwood Park, learning about the historical pediatric program this game will be raising money for, I was humbled by how everyday Albertans are rolling up their sleeves — or strapping on skates — to help others. You can read more about Brent’s heartwarming journey on Page 10. And while Brent is a long-time donor who knows how to rally a community around him, we also love meeting young philanthropists like six-year-old Leila “I am reassured to Rei Hunter Godfrey, who organized a fundraising run in see I am surrounded Calgary after learning her grandfather was diagnosed by so many people with liver cancer (page 49). It has been equally as impressive to discover more committed to making about the excellent world-leading treatment and care a difference for provided by our partners in Alberta Health Service’s Albertans facing CancerControl Alberta. You’ll read about the pioneering work done here to create a Screening for Distress tool cancer.” being used across this province that has been modelled in other provinces to make sure patients and families are set up as best as possible to cope with a diagnosis (page 22). You will also read how our donors help support innovation in mobile technology that brings mammography units or swallowing therapy after head and neck cancer right to patients’ homes — making it easier to access vital treatment that otherwise may have been difficult to obtain (page 34). It has been incredible to get to know about this innovation and the bright minds that drive progress here in Alberta. We still have much work to do, but a few months into my new role, I am awed and reassured by the talented people who are extremely committed to making a difference for Albertans facing cancer. I share that same urgency and am looking forward to making a difference.
GEORGE ANDREWS, PRESIDENT & CEO ALBERTA CANCER FOUNDATION
4 LEAP WINTER 2018
WINTER 2018
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VOL. 3
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NO. 8
ALBERTA CANCER FOUNDATION EDITORS
Phoebe Dey and Christiane Gauthier
EDITORIAL DIRECTOR Jill Foran ART DIRECTOR Kim Larson STAFF PHOTOGRAPHER Jared Sych CONTRIBUTORS Colleen Biondi, Bluefish Studios, Elizabeth Chorney-Booth, Min Gyo Chung, Shannon Cleary, Caitlin Crawshaw, Jennifer Dorozio, Spencer Flock, Christina Frangou, John Gaucher, Kaitlyn Hanson, Robbie Jeffrey, Mae Kroeis, Jennifer Madole, Liam Mackenzie, Fabian Mayer, Bryce Meyer, Dushan Milic, Karin Olafson, Pete Ryan, Paul Swanson, Jared Sych, Colin Way, Julia Williams PUBLISHED FOR
Alberta Cancer Foundation Calgary office Suite 300, 1620 29 St. N.W. Calgary, Alberta T2N 4L7
PROVINCIAL OFFICE
710, 10123 99 St. N.W. Edmonton, Alberta T5J 3H1 Tel: 780-643-4400 Toll free: 1-866-412-4222 acfonline@albertacancer.ca
PUBLISHED BY
Redpoint Media & Marketing Solutions 100, 1900 11 St. S.E. Calgary, Alberta T2G 3G2 Phone: 403-240-9055 Toll free: 1-877-963-9333 Fax: 403-240-9059 info@redpointmedia.ca PM 40030911 Return undeliverable Canadian addresses to: 710, 10123 99 ST. NW Edmonton, AB T5J 3H1
PRESIDENT & CEO Pete Graves PUBLISHER Joyce Byrne ASSOCIATE PUBLISHER Pritha Kalar CLIENT RELATIONS MANAGER Sandra Jenks PRODUCTION MANAGER Mike Matovich AUDIENCE DEVELOPMENT MANAGER Rob Kelly
As the official fundraising partner for the Cross Cancer Institute, Tom Baker Cancer Centre, and 15 regional and community cancer centres across the province, the Alberta Cancer Foundation is making life better for Albertans facing cancer by investing nearly $20 million/year in research, prevention, screening and enhanced care programs.
myleapmagazine.ca WINTER 2018 LEAP 5
FRONT BRIGHT MINDS | MICROBIOME CONNECTIONS | FUNDRAISING | BRA DAY
BRIGHT MINDS
Dr. Jessica McNeil is proposing that everyday, lighter-intensity activities should count in the Canadian Physical Activity Guidelines, and that it would make fitness more accessible to Canadians
D
r. Jessica McNeil, a postdoctoral fellow in the Department of Cancer Epidemiology and Prevention Research within CancerControl Alberta, has been researching the interplay of sleep, exercise and nutrition on overall health since her days as a graduate student at the University of Ottawa. Now 30, McNeil has been published in a variety of scientific journals and is currently heading a study that is evaluating the potential integration of lighter-intensity physical activity into the national exercise guidelines for breast cancer patients and survivors. The Breast Cancer & Physical Activity Level (BC-PAL) Study is assessing the effect of 300 minutes per week of lighter-intensity activity on a group of breast cancer survivors who are not overly physically active in their daily lives. “We’re targeting those individuals who may not be inactive, but have never stepped foot in a gym, have no interest in going to a gym, or maybe just don’t like physical activity or sweating,” says McNeil. >
DR. JESSICA MCNEIL IS LEADING THE BREAST CANCER & PHYSICAL ACTIVITY LEVEL STUDY IN CALGARY
PHOTOGRAPHY JOHN GAUCHER
myleapmagazine.ca WINTER 2018 LEAP 7
FRONT LINE
The BC-PAL Study is just in its pilot phase, but McNeil and her team are hoping to eventually see lighter-intensity activities considered as viable alternatives to the current statutes for more vigorous exercise recommended in Canada. Light-intensity activities, which can span from picking up around the house to golfing or just socializing with friends, aren’t currently recognized by the Canadian Physical Activity Guidelines as counting toward the recommended 150 minutes of mid- to high-intensity movement per week for those aged 18 to 64 years.
“Any activity is better than no activity,” says McNeil. “I just want lighter-intensity activity to be recognized as an alternative.” Her aim with the findings of the BC-PAL Study is to encourage more physical activity born out of what participants may already do day-to-day. “I find a lot of guidelines are one size fits all, and we have to recognize that, with physical activity, we can’t necessarily take that approach. What may work for one person may not work for another,” says McNeil. She first became interested in this line of research while examining factors of weight
AT A GLANCE Funded in large part by the Alberta Cancer Foundation, the BC-PAL Study examines two randomized exercise groups of breast cancer survivors and their fitness and self-reported quality of life outcomes. One group is undertaking 300 minutes of lighter physical activity per week, while the other is undergoing 150 minutes of higher-intensity physical activity per week, differentiated through heart-rate levels. The study is proposing that 300 minutes of light-moderate physical activity is on par with 150 moderate-vigorous physical activity minutes, which is the current national recommendation by Canadian Physical Activity Guidelines for adults between 18 and 64 years old. 8 LEAP WINTER 2018
loss and weight gain prevention at the University of Ottawa. When she relocated to Calgary to pursue her post doctorate work, she narrowed her focus to looking at physical activity levels in cancer patients after learning of fellow BC-PAL researcher and current supervisor Dr. Christine Friedenreich’s work. “Dr. Friedenreich has studied the role of physical activity in cancer prevention, control and survival for over 20 years, and she has led some of the largest exercise trials for cancer prevention,” says McNeil. “I was immediately fascinated by her work in physical activity and the positive results that she and her co-investigators have continuously shown in cancer populations.” For some doctors, the prospect of working on studies like BC-PAL — studies in which the results can often be inconclusive — is daunting, but McNeil has grown to relish it. “My supervisor for my master’s and my PhD always told me in a bit of a laughing way, ‘Business is booming in research, you’ll never run out of topics or ideas to study,’ and that really stuck with me because it’s true — there are so many different topics and research areas out there that are
EXAMPLES OF LIGHTER-INTENSITY PHYSICAL ACTIVITY è walking è biking è gardening è taking the stairs è golfing (no cart) è picking up around the house
worth exploring and require answers,” she says. When McNeil creates her studies, she uses a certain level of creativity, she says, by bringing technological innovation to traditional approaches to research. For example, the BC-PAL study is currently using wearable activity trackers for its participants, with positive outcomes being reported so far. “Since we designed the BCPAL trial to be a home-based intervention, we wanted to provide a readily available tool to participants to collect information on their physical activity time and heart rate values,” she explains. “[The trackers] provide the participants with prompt feedback on their physical activity intensities and heart rates and allow our team to access their data and provide personalized feedback on their progress.” McNeil is encouraged by the preliminary feedback she has documented from participants. Not only does it show an uptick in overall fitness, but improvements in other health markers as well, including body composition. The BC-PAL Study wraps up this winter, and key findings will be synthesized with the aim of publishing this year. LEAP — JENNIFER DOROZIO
EXAMPLES OF HIGHER-INTENSITY PHYSICAL ACTIVITY è jogging è lane-swimming è hiking è dance classes è cross-country skiing
The Polka Dot Jersey Team Among the 1,500 blue-and-yellowclad riders who took part in the 2017 Enbridge Ride to Conquer Cancer, Presented by EVRAZ, there were 10 cyclists who couldn’t be missed. Sporting white jerseys covered in black polka dots, this small group of standouts were being commended for their impressive fundraising efforts. Every year, the Polka Dot Jerseys are awarded to the first 10 Ride participants who reach the $15,000 fundraising mark; the jerseys are a sartorial symbol of determination and perseverance. Ride participant Mike Peters says he didn’t initially set out to get the special jersey, but he got excited once he realized he might be among the first to reach the fundraising threshold. Peters, who was diagnosed with kidney cancer in 2015, started wondering who else might be wearing the Polka Dot Jerseys alongside him on the two-day, 200-kilometre ride that sets out from Calgary every August. “I couldn’t help but wonder who they were and what their stories were,” says Peters. “You’re kind of surrounded by other people with a cancer story; it’s comforting.” Peters organized a photo shoot in hopes of creating some camaraderie among the group — and of having a bit of a keepsake. “Everybody agreed to do it, and we got together the night before the Ride,” says Peters. “It was neat to see who they were, and then it was even more inspirational to get them together.” The Ride raised $6.7 million for the Alberta Cancer Foundation in 2017 and celebrates its 10th anniversary in 2018. LEAP
The Polka Dot Jerseys are awarded to the first 10 Ride participants who reach the $15,000 fundraising mark.
— FABIAN MAYER
Cancer and the Microbiome The human microbiome — the vast collection of bacteria, fungi and viruses that live in our bodies — is a quickly evolving area of medical research. It’s estimated that the micro-organisms within our microbiomes number in the trillions, and researchers believe that, collectively, these organisms form mini-ecosystems vital to our health. Scientists began seriously investigating the role of the human microbiome around 15 years ago and have since associated
it with a number of conditions, including asthma, Crohn’s disease, diabetes and, more recently, cancer. Among the most prominent research into links between cancer and the microbiome is a 2016 study by Dr. Jennifer Wargo from the University of Texas MD Anderson Cancer Center. Dr. Wargo looked at fecal samples from patients suffering advanced malignant melanoma. Her results showed that patients who responded well to new immunotherapies had more diverse gut
bacteria than other patients, suggesting that factors in the microbiome can impact treatment effectiveness — and that it may be possible to treat cancer more effectively by altering the microbiome. Research on the microbiome and how it relates to cancer is still in the early stages, but, as interest continues to build, there is strong potential for new knowledge on cancer susceptibility, development and treatment. LEAP — FABIAN MAYER
myleapmagazine.ca WINTER 2018 LEAP
9
FRONT LINE
Winning the Long Game A program for individualized cancer treatment for kids teams up with a fundraising legend BY HIS OWN ADMISSION, HE’S MORE
of a baseball guy. But, every third February for the last 15 years, Dr. Brent Saik has laced up his skates for a game of hockey on an NHL-size arena he built in his yard in Sherwood Park — all for cancer research. There’s a subtle connection between hockey and cancer: you might endure one hit after another, but you persevere, and you never, ever, hang up your blades until it’s really over. In Saik’s case, that’ll be at least 10 days, 10 hours, three minutes and 22 seconds. That’s exactly two seconds longer than the current Guinness World Records’ “World’s Longest Hockey Game,” and it’s the target Saik and 39 other players will need to hit in order to reclaim their ownership of the record this February, which will be Saik’s sixth time hosting the event. Saik started the game in 2003 after his father died from cancer. A few months after that game, he hosted the event again after his wife, Susan, passed away from cancer, too. Each player in the World’s Longest Hockey Game, in fact, has some kind of tie to cancer. “The ultimate goal is to make sure the treatments and equipment we’ve supported are helping to cure people’s cancers, and, of course, helping to cure all cancer,” Saik says. In other words, he’s in it to win the long game. Saik hopes to raise $2 million this year, which would bring the total amount he’s helped to raise for the Alberta Cancer Foundation over the years to about $6 million. This year’s fundraising will benefit PROFYLE, an acronym for Precision Oncology
for Young People. Led by the Terry Fox Research Institute, PROFYLE is a national program that provides adolescents and young adults with individualized treatment. The process for determining and delivering this treatment varies, but, essentially, PROFYLE collects samples, sequences them genomically, and then provides personalized — or precision — treatment. “You look at the cancer at a molecular level and see if there might be some other answer,” says Patrick Sullivan, a B.C.-based lawyer and advocate of the program. For Sullivan, a cancer fundraising legend himself, PROFYLE is personal. His son, Finn, was 20 months old when he was diagnosed with rhabdomyosarcoma, a rare childhood cancer that took his life in October 2008. “When we were told Finn was incurable in 2008, [we didn’t have the technology] to do any of this,” Sullivan says about PROFYLE, which he’s been instrumental in helping to fund and develop. “It would have given us a chance at hope and maybe we would have [had] more time.” Saik is eager to support the work of PROFYLE and, though he acknowledges the upcoming World’s Longest Hockey Game will be painful, he knows there’s a purpose to it. “You have this very small feeling of what it’s like to suffer, and you’re all going through it,” says Saik, who also points out the game isn’t really about beating your competitor. When it comes to cancer, we’re all on the same team. LEAP — ROBBIE JEFFREY
The WLHG takes place February 9 to 18, 2018. To donate, visit albertacancer.ca/wlhg
PHOTO PAUL SWANSON
10 LEAP WINTER 2018
WORLD’S LONGEST GAME 82 HOURS Length of
the 2003 World’s Longest Hockey Game 250 HOURS The current record to beat 800 Number of volunteers for the game 25,000 Number of attendees 500 Number of cups of coffee consumed per day during the game 100 Number of sticks broken per game 4,473 Number of goals scored in the 2015 game -35°C Temperature at the start of the 2008 game FROZEN TOES Most common injury 20 Number of players with injuries serious enough to require hospitalization 1 Number of players who actually went to the hospital for their injuries $130,000 Money raised the first time Saik’s crew broke the world record $1.34 MILLION Money raised in the 2015 game $4 MILLION Money raised from all games
BRENT SAIK IS HOSTING THE WORLD’S LONGEST HOCKEY GAME EVENT FOR THE SIXTH TIME
myleapmagazine.ca WINTER 2018 LEAP 11
FRONT LINE
Empowerment Through Information BRA Day introduces breast cancer survivors to reconstruction options LAURA MCNEILL CONSIDERS
herself one of the lucky ones. After finding out she had breast cancer, she could turn to friends who’d experienced both cancer treatment and breast reconstruction surgery. “The doctor can only tell you so much — other people can tell you so much more,” she says. This first-hand knowledge, coupled with the expertise of her surgeon, allowed McNeill
to make educated choices about her surgery. She opted to have breast reconstruction at the same time as cancer surgery (a double mastectomy) to reduce the number of surgeries she would need to undergo. “I wanted to be one and done,” she says. Four years later, McNeill remains happy with her choice — and has no signs of metastasis. Not all breast cancer patients are as aware of
what’s available to them, says Calgary surgeon Dr. Claire Temple-Oberle, who performed McNeill’s reconstruction. “Patients still come to us and say, ‘I never knew I could have breast reconstruction [at the time of cancer surgery].’” But, by waiting until after their cancer treatment to look into reconstruction, patients miss out on a number of surgical options (the use of their own skin and preservation of their nipples, for instance). Hoping to empower patients with greater knowledge, Temple-Oberle helped bring Breast Reconstruction Awareness Day (BRA Day) to Calgary five years ago (it has since spread to Edmonton and Medicine Hat, too). Supported by the Alberta Cancer Foundation, and recognized as an international event, BRA Day brings together patients, survivors, and health-care practitioners for a day of education and connection. “We’re trying to normalize the conversation around breast reconstruction,” says Temple-Oberle. “We want people to know it’s not breast augmentation — it’s a part of breast cancer care that focuses on survivorship and quality of life. The goal is to give women good-quality, reliable information to help them make decisions.” McNeill began volunteering for BRA Day three years ago and now organizes the Calgary event, which draws hundreds of people to the
Foothills Medical Centre every October. In addition to lectures for both medical professionals and patients, the event offers patients the chance to speak with physicians about reconstruction options, as well as with survivors who’ve had breast reconstruction. The day is meant to support patients of all genders (not just women), as well as partners seeking information on how to better support them. “I hope patients will walk away with a comfort in knowing their options,” says McNeill. LEAP — CAITLIN CRAWSHAW
BRA DAY HIGHLIGHTS SHOW AND TELL LOUNGE FOR PATIENTS Breast cancer patients meet with survivors who tell their stories and discretely share the results of their breast reconstruction surgeries (or mastectomies, if they’ve opted to be flat-chested). SHOW AND TELL LOUNGE FOR PARTNERS Partners of current patients connect with partners of breast cancer survivors to learn more about how they can be a support during treatment. The lounge is open to partners of all genders and sexual orientations. ART PROJECT BRA Day events typically include a group art project. At the 2017 event, for instance, participants painted small tiles to contribute to a mosaic to be displayed at the Foothills Hospital. Another year, artists painted body casts of survivors, who presented the artwork and shared their stories.
The survival rate for female breast cancer patients in Alberta is 90 per cent. ILLUSTRATION JENNIFER MADOLE
12 LEAP WINTER 2018
5 WAYS
Your donation to the Alberta Cancer Foundation Patient Financial Assistance Program makes a difference for Albertans facing cancer Cancer can be a huge strain on the finances. People are often forced to cash in their retirement funds and use up their savings to make ends meet during treatment. The costs can be so overwhelming that some patients will decide against having life-saving therapy as they simply cannot afford the out-of-pocket expenses. With the help of donors and through the Patient Financial Assistance Program, the Alberta Cancer Foundation has been able to help ease financial burdens by covering some of the following expenses so that patients and families can focus on what matters most — healing.
GROCERIES
MEDICATION COSTS
RENT
ACCOMMODATION FOR PATIENTS RECEIVING TREATMENT OUTSIDE OF THEIR HOMETOWN
Learn more about how you can support the Alberta Cancer Foundation at albertacancer.ca
TRANSPORTATION AND PARKING
If you are an Albertan undergoing cancer treatment and would like to know whether you are eligible to access the Patient Financial Assistance Program, please contact your local Alberta Health Services cancer centre for more information. myleapmagazine.ca WINTER 2018 LEAP 13
FOOD FOCUS
Fermented Food and Gut Health A QUICK GLANCE AT ANY HIP RESTAU-
rant’s menu or list of current food trends will reveal that fermented foods are the big thing in culinary culture these days. Items like kimchi, from-scratch sourdough bread and ultra-thick varieties of yogurt are becoming increasingly popular, both due to their tangy flavours and their perceived nutritional benefits. Fermentation refers to the process of converting carbohydrates into an alcohol or an acid, usually through the introduction of micro-organisms such as yeast or other fungus or bacteria. Anyone who has seen a yeasty bread dough grow and rise has seen fermentation at work, though most foods that are considered “fermented” go through a much longer fermentation process. The technique tends to appear in culinary offerings from around the world — sauerkraut, cheese, miso, kombucha, vinegar, some varieties of pickles, dosa, and various Asian condiments like fish sauce and Korean gochujang are all made with fermentation. It’s definitely possible to ferment at home. Some items like sauerkraut can ferment via the lactobacillus that lurks on the surface of the vegetable. These ferments are fairly simple and can often be accomplished by simply packing vegetables like cabbage into a jar with some salt and spices and letting the bacteria do its work over the course of a few days.
Other homemade ferments require a bacteria “mother” or a SCOBY (symbiotic colony of bacteria and yeast) starter to get things bubbling. These starters are living, growing organisms that can often be purchased, or, if you have friends who ferment, divided and passed on to fellow fermenters. For recipes that require a SCOBY, the starter is combined with other ingredients and left to ferment, often for several weeks, depending on what you’re making. As for finding ready-made fermented items, if you’re looking for fermented foods beyond your typical sauerkraut and yogurt, Asian specialty stores and farmers’ markets are good places to start. Fermentation fans can also try health food stores like Earth’s General Store in Edmonton and the Light Cellar in Calgary, the latter of which also holds home fermenting workshops. Fermented foods have been associated with improved gut health — the idea being that the micro-organisms in the food encourage healthy bacteria in a person’s digestive tract, creating a healthy “microbiome” or bacterial community. Scientists are still researching just how beneficial the state of that microbiome is to one’s health and well-being (see page 9). But even while those studies are still underway, if you enjoy the taste of fermented foods and the way they make you feel, this is a good food bandwagon to jump on. LEAP
Maintaining a healthy gut Karly Arkko is a CancerControl Alberta dietitian with Alberta Health Services. She answers some questions about gut health and how it pertains to cancer care and prevention. What do we mean when we talk about gut health? A healthy gut is one where the digestive tract is working properly, where we can break down our food into nutrients that our body can absorb, that is free of diseases, and has a healthy population of gut bacteria. Are there particular concerns about gut health that patients need to think about when undergoing cancer care or recovery? In a treatment setting, a lot of chemotherapy agents act on cells that turn over quite quickly, and that includes the cells that line your GI tract. In that case, as dietitians we’re just trying to get you through the treatment and make sure your symptoms are being managed, knowing that you are going to struggle with GI problems like diarrhea or constipation. Are there recommendations for patients who have been through radiation or chemotherapy and are in the recovery or remission stage? I would definitely advocate that everybody, perhaps with the exception of those in active treatment, eat a plant-based diet that is high in fibre. That diet would be the same for someone who hasn’t had cancer before or has previously been in remission. Can maintaining good gut health help prevent cancer? I would say yes. A diet that promotes a good healthy gut includes things like eating lots of fibre, having probiotics in your diet, and moving away from the Western-style diet of more processed foods and red meat. We know that a lot of people who eat enough fibre have GI tracts filled with better bacteria, and that has been shown to be protective against cancer.
— ELIZABETH CHORNEY-BOOTH
Slow Cooker Dill Pickle Soup Not all pickles are fermented — use store-bought or homemade fermented pickles in this recipe for an especially tangy flavour. INGREDIENTS
USE D FERMENLETSE PICK 14 LEAP WINTER 2018
3 2 1 1 1 4 cups 1 4 / cup
small thin-skinned potatoes, chopped celery stalks, sliced medium leek (white and light green parts only), sliced large carrot, chopped jar (34 oz/1 L) fermented dill pickles, chopped with brine reserved chicken stock or ready-to-use chicken broth heavy or whipping (35%) cream
DIRECTIONS Combine potatoes, celery, leek, carrot, pickles and stock in a 4- to 6-quart slow cooker. Cover and cook on low for 6 to 8 hours or until vegetables are soft. Purée right in the slow cooker with an immersion blender (or in a conventional blender in batches) until the soup is as smooth or chunky as you like (we like it somewhere in the middle!). Stir in cream and reserved brine to taste. Serve hot. Serves 6. This recipe is from The Best of Bridge’s 2016 book and can also be made with unfermented dill pickles.
FERMENTED FOODS LIKE KIMCHI HAVE BEEN ASSOCIATED WITH IMPROVED GUT HEALTH
myleapmagazine.ca WINTER 2018 LEAP 15
WORKOUT
The Wonders of Winter Walking Don’t put away your walking shoes just because it’s chilly outside. Keep walking outdoors all winter long for physical, mental and social health benefits by KARIN OLAFSON
16 LEAP WINTER 2018
IT’S COMMON KNOWLEDGE
that regular exercise is an integral part of a healthy lifestyle, but you don’t need to take on a vigorous training regimen to reap health benefits. At the American Society for Clinical Oncology conference in June 2017, two new studies were presented showing how just 25 minutes of brisk walking per day could slow down cancer and significantly reduce the risk of death by the disease. Erin van Blarigan, a doctor and researcher working on one of the studies, recommends everyone — including cancer patients — gets around 150 minutes of exercise per week and says that brisk walking is a good form of exercise. Joining a walking group is one way to get motivated and keep moving throughout the winter season. Wendie Swirski, a personal trainer and manager of The Running Room’s Eau Claire location
in Calgary, says her store’s walking group was spearheaded by local walking enthusiast Alan Gregory more than 10 years ago. Today, more than 20 motivated walkers meet twice a week — regardless of snow, ice or freezing temperatures — to get outside and get walking, and to do it with a social, supportive group. Swirski believes that cold weather is not an excuse to put away your walking or running shoes. “When it’s cold outside, nothing changes. It’s just about being prepared,” she says. And for her, winter walking isn’t just about the numerous physical health benefits. It has mental ones, too. “Winter walking is fun. It’s refreshing and it’s invigorating,” says Swirski. “And I think it gives you a sense of being a superhero. There’s a feeling of, ‘If I can walk outside in the winter, I can do anything!’” LEAP
Winter Walking Gear Guide Wendie Swirski offers tips on essential gear for comfortable winter walking.
Base layer
“Choose a synthetic base layer or one that is wool or silk — no cotton, as it doesn’t wick away sweat.”
Jacket
“You’ll want to wear another layer on top of your base layer. I recommend The Running Room’s Extreme Balaclava Jacket.”
2 Scenic Walking Routes START AND FINISH
START AND FINISH
The Running Room Eau Claire, Calgary
Edmonton Dragon Boat Racing Club, Edmonton
Go west along the Bow River pathway to the pedestrian bridge just before 10th Street N.W. Return on the north side of the Bow River and cross through Prince’s Island Park to get back to Eau Claire Market.
Take the pathway through Dawson Park and Kinnaird Park to Wayne Gretzky Drive N.W. Turn around here, or cross the bridge and come back on the other side of the North Saskatchewan River.
ROUTE
TOTAL DISTANCE
3.2 kilometres
ROUTE
Good shoes
“Try Get a Grip ice joggers that slip over the bottom of your running shoe for more traction. Or try trail shoes, which have more aggressive treads than regular running shoes.”
TOTAL DISTANCE
6.1 kilometres
6 Adventurous Workouts to Try This Year Fitting in your 150 minutes of physical activity each week doesn’t have to be a chore. Find a new kind of workout that will push you out of your comfort zone. AERIAL ARTS
BOULDERING
Where to try it: CircoFit, Edmonton
Where to try it: Bolder Climbing Community, Calgary
This circus-inspired workout gets you off the ground and in the air. It incorporates elements of dance and gymnastics, and will help improve your strength and flexibility as you learn to work with straps, ropes and aerial silks. circofit.ca
Bouldering is similar to rock climbing, except there are no harnesses, no ropes and the walls aren’t as high. The goal is to complete a set route, not just get to the top of the wall. Bolder is Calgary’s only bouldering-specific gym. bolderclimbing.com
ILLUSTRATIONS SPENCER FLOCK
BUNGEE WORKOUT
Where to try it: Bungee Workout Canada, Calgary This full-body resistance-training workout first came to Calgary last fall. It’s similar to a dance class, except attendees are in a harness attached to a bungee cord, allowing for some gravity-defying moves. 403-399-8236
OBSTACLE COURSE RACING
Where to try it: InjaNation, Calgary Start training for a Reebok Spartan Race at this OCR-inspired facility. In addition to six training areas that have obstacles commonly found in OCR races (like monkey bars and balance beams) there is a trampoline park and multiple climbing walls. injanation.com
ROCK CLIMBING
Where to try it: Vertically Inclined Rock Gym, Edmonton While wearing a harness and remaining safely connected to a qualified belayer on the ground, climbers can test (and build) their strength and endurance by trying to get to the top of a 25-foot-tall wall. verticallyinclined.com
TRAMPOLINING
Where to try it: LaunchPad Trampoline Park, Edmonton Work every muscle group while jumping on a network of trampolines — and into the largest foam pit in Alberta. For something more formal, attend one of the 60-minute workout classes hosted in collaboration with 504 Fitness. launchpadtrampoline. com
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EXPERT ADVICE
place to start. If you know nothing about the disease and don’t have any personal family experience of cancer, the best option I see is to sit down with the person and say, ‘What’s that like? How are you feeling?’ Generally speaking, you’ll get some kind of answer, so you build up on that.
Q: How can I ensure I’m offering appropriate support to a colleague?
We ask the experts for advice on talking to colleagues with cancer and what to consider financially after a diagnosis by FABIAN MAYER
DR. GUY PELLETIER
HOW TO TALK TO A COLLEAGUE WITH CANCER CANCER IS DIFFICULT TO TALK ABOUT.
When an acquaintance or colleague receives a diagnosis, it can be especially hard knowing how to broach the topic and offer appropriate support. Dr. Guy
Pelletier, a psychosocial oncologist at the Tom Baker Cancer Centre, has been working with cancer patients and their families for 26 years. Here, Pelletier shares what he has learned about communication and offering assistance.
Q: What is the best way to approach the topic of a colleague’s cancer? My view of support is that the more concrete and action-based it is, the better off you’re going to be. It’s not a matter of going to the colleague and saying, ‘Oh my gosh, poor you.’ Most people feel that comes across as a form of pity. And if there’s one thing people don’t want, it’s to be pitied. If you know something about your colleague’s diagnosis, or have family experience with cancer, that’s a good
One misconception people have is that they can walk up to somebody who has cancer and say, ‘Just let me know if you need something, I’ll be there.’ It’s a nice gesture, but agreeing on something specific one can do for the person struggling with cancer is better. The more direct and concrete the offer is, the more supportive it comes across. If someone is unable to mow their lawn due to a diagnosis, you could offer to come Saturday morning and do it. This is very concrete, very direct, it has a time on it, it has an objective — and that’s the kind of offer that works.
Q: What if I don’t have very much time but still want to help? If you can’t help because you yourself are up to your eyeballs, that’s okay. Don’t make an offer you can’t keep. It’s going to be too hard on you and consequently hard on the cancer patient. Keep in mind that one of the greatest gifts you can give to anyone is the gift of your attention, especially in this day and age when sometimes people aren’t very available to listen. There are circumstances where it’s not so much a matter of doing something, it’s just a matter of being there. Learn more about AHS psychosocial services at ahs.ca
ILLUSTRATIONS JENNIFER MADOLE
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TRICIA HUTCHISON
coverage if they don’t have any.
Q: What kind of financial challenges do cancer patients face?
FINANCIAL CONSIDERATIONS FOLLOWING A CANCER DIAGNOSIS A CANCER DIAGNOSIS IMPACTS ALL
aspects of life, and staying on top of finances while dealing with everything else can be an enormous challenge. Tricia Hutchison, a CancerControl Alberta social worker with Alberta Health Services’ Community Cancer Centres, offers her advice on what to consider financially following a diagnosis.
Q: What is the first thing to consider financially after being diagnosed? It can be overwhelming to try to deal with the many details of the diagnosis. For those reasons, I think it’s important for people to come and talk to a social worker if they feel like they could use some support. They don’t have to be referred; they can request to talk to one. Social workers can help patients to understand some of the details and some of the next steps. In the early stages, when they’re looking at getting tests done and waiting to hear from a doctor about a plan, [it’s not yet clear] what medications might be the most appropriate — and some medications can be very expensive. We try to encourage patients to consider that early, so we can get them access to some kind of medication
A large majority [of patients] need time away from work to be able to look after themselves and get treatment. But there are extra expenses that go along with a cancer diagnosis, and your income is decreased if you’re not working. It can be a very difficult time, and it can impact people significantly in terms of being able to make monthly payments for a mortgage, utilities, car — those kinds of things. I generally try to encourage people to think about how they can simplify their expenses upon diagnosis if they are feeling financially stressed.
Q: What other steps should cancer patients take to manage their finances? If they are employed and have a confirmed diagnosis, they should speak to their employer about what kind of benefits the employer might have to offer. There may be sick benefits, there may be short-term or long-term disability. It’s encouraged to have those conversations early because the more the patient knows about what types of financial support there are, the better they can plan for things.
Q: How can patients determine if they have medication coverage? First, they need to find out from their employer if they have medication coverage [through work]. It’s important to be specific when asking, and to use the word “medication.” We’re not talking
about extra health-care coverage or about Alberta Healthcare — we’re talking specifically about coverage for medication. If patients don’t have coverage through their employer, there is a something called Alberta Blue Cross Non-Group Coverage, which gives access to an economical supplementary health benefits program. That application can take up to three months for coverage, which is why we need people to apply for it as soon as possible.
Q: What if they don’t have coverage through their employer? There is a sickness benefit through Employment Insurance, which is administered by Service Canada, but it’s important to remember that this sickness benefit only lasts 15 weeks. The Alberta Cancer Foundation’s Patient Financial Assistance Program is another fantastic program that helps with financial support, but people have to apply with the help of a social worker to qualify for it. LEAP To donate to the Patient Financial Assistance Program, visit albertacancer.ca or see pg. 13 to learn more.
THREE OTHER FINANCIAL STEPS TO TAKE BEFORE OR AFTER A DIAGNOSIS 1. Meet with your bank. Some mortgages or lines of credit have critical illness insurance.
2. Phone your credit card company. Some credit cards include critical illness benefits.
3. Look into private funding
that may be available from various foundations.
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THE NOURISHMENT ISSUE
MIND, BODY, SPIRIT ILLUSTRATION MIN GYO CHUNG
When it comes to cancer prevention, treatment and recovery, paying attention to a patient’s physical, emotional and mental well-being is vital. Here, we explore some of the ways Alberta scientists and clinicians are helping patients nourish their minds, their bodies and their spirits. >
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NOURISHING THE MIND
Exploring ways of keeping a healthy frame of mind during a cancer journey by S H A N N O N C L E A RY
More than 75 international cancer organizations have recognized distress as the Sixth Vital Sign in cancer care, after temperature, blood pressure, pulse, respiratory rate and pain. In Alberta, incorporating mental wellness into cancer care has helped patients cope more effectively with their diagnosis, and has empowered survivors to become partners in their own healing. >
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Screening for Distress SOME OF THE fundamental challenges a cancer patient faces may not be directly visible — anxiety, pain and grief don’t appear on an x-ray. The Putting Patients First (PPF) symptom reporting form is a screening tool used at all cancer care delivery sites under CancerControl Alberta to help patients and their health care teams identify and measure all of their symptom burdens, visible or not. Dr. Linda Watson is an oncology nurse with a PhD in nursing science, and the lead of Person Centred Care Integration with CancerControl Alberta. She believes the PPF symptom reporting tool is more than just a form. It’s about empowering patients
in a medically driven system. “We have to recognize that we are the experts in cancer treatment, but the patient is the expert in their life,” says Watson. “If we don’t pay attention to the patient’s life, their ability to participate in treatment is compromised.” At each clinical visit, patients complete the PPF form and rank symptoms like pain, nausea, numbness and tingling, as well as fears, worries and concerns. For the tool to be most effective, the clinical team and the patient must then break down those areas of distress and identify the underlying causes. Are there issues with finances, for instance, or with sexuality, identity or relationships?
A Patient’s Perspective on Screening for Distress
DR. LINDA WATSON
“Patients may indicate that they are struggling with something that their nurse or doctor can’t necessarily fix, which is daunting for a health care professional,” says Watson. “But, by talking to the patient about their concerns, the health care team can better understand how to support the patient, even if they can’t fix their problem.” The next phase of this process is developing a Patient Reported Outcome (PRO) Dashboard, a data program that will offer a quick and convenient overview of a patient’s reported symptoms. PPF forms will be entered into Alberta Health Services’ existing Electronic Medical Record (EMR) and analytic software, creating a “dash-
board” that displays symptom burden trends for each individual patient. Clinicians will then be able to log into this software to access the information. The project will give clinicians and patients a tangible, colour-coded graph of self-reported symptoms across their treatment timeline. Watson says the program is currently being tested at the Central Alberta Cancer Centre in Red Deer and has already helped clinicians and patients identify and address trends in pain, anxiety and other burdens. “Fundamentally, this is about how we as a care team ensure that the patient gets the support and symptom management they need in order to be as well as possible,” she says. LEAP
PHOTO BRYCE MEYER
AT AGE 32, Charlotte Kessler underwent
an awake craniotomy to remove a mass embedded along the motor sensory strip in her right frontal lobe. Pathology reports revealed anaplastic astrocytoma, a rare malignant brain tumour. Kessler’s treatment started quickly thanks to being part of a clinical trial. Treatment consisted of 33 rounds of radiation followed by 24 rounds of chemotherapy. She finished active treatment in November 2015 and remains stable. Today, Kessler serves as co-chair of the Patient & Family Advisory Council (PFAC) with the Calgary Cancer Centre Project, using her voice and experience to improve cancer care.
What impact does a cancer diagnosis have on someone’s mental health?
It’s life-changing. [My husband and I] had those initial moments of, “Why me?” And then we realized, is that what we want for whatever time we have left? We chose to face it as a challenge and stay positive. How did you take an active role in managing your mental health?
We integrated ourselves into the care team as an equally vital member of the decision-making process. How does the Putting Patients First (PPF) screening tool address mental health challenges?
If used effectively, it can be instrumental in helping the patient feel like part of the team, part of the journey, listened to, and helped — looking beyond just pain and nausea and the physical symptoms, and paying attention to fears and worries and concerns. How important is it for a patient’s mental health to have that empowerment?
For me, it was critical. I was fortunate that I had a care team [during my neurological trial] that encouraged me and got to know me and started treating me, the person, instead of me, the disease. LEAP
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Knight’s Cabin Cancer Retreats surrounding cancer recovery often includes the concept of fight. But for some cancer survivors, victory — and healing — has come in the form of retreat. Knight’s Cabin offers free weekend retreats for Albertans with any form of cancer, at any stage in their treatment, as long as they’re medically stable. Its goal is to promote behavioural changes that improve cancer survivorship. Dr. Lisa Belanger, founder and director of research at Knight’s Cabin, is a certified exercise physiologist and has a PhD in behavioural medicine. She says the retreats help cancer survivors and their caregivers transition to their “new normal” after a cancer diagnosis. “This is a complex challenge, and we don’t tend to arm people for that,” says Belanger, adding that patients struggle with a lot of personal questions throughout their cancer journey. “[They ask], ‘What do I do now? Can I go back to my job? Am I the same person within my family? What can I control? What does my new life look like?’” The retreats offer formal sessions on physical activity, nutrition, stress and sleep management. Belanger says attendees also benefit from informal interactions with volunteers, caregivers and fellow survivors with whom they can share their story. “Decreasing the isolation of the disease can tremendously help the mental health aspect of it,” she says. A cancer diagnosis can exacerbate preexisting conditions such as anxiety and depression. It can also create many new mental health challenges — 24 LEAP WINTER 2018
CAROLYN HENRY
fear of recurrence, strain in relationships, stress due to finances, and grief. According to Belanger, promoting psychological self-care to cope with these challenges, whatever their stage or pronouncement, is an essential part of cancer recovery. “As you have your oncologist, so should you have your therapist,” she says. Psychological distress is considered one of several modifiable risk factors in developing and surviving certain cancers, but pinpointing its statistical significance in cancer survivorship is difficult. Belanger cites a retrospective study in the Journal of Clinical Oncology that examined survivors of stages I-III colorectal cancer and the levels of post-diagnosis physical activity. According to the study, moderate physical activity was significantly associated with reduced recurrence and improved mortality. While this study examined physical activity, Belanger says it’s impossible to separate physical health behaviours from mental health. “We do know how much our stress level affects our inflammation, we do know how much our immune system can impact our mental health,” Belanger says. “Can we say it’s one and not the other? No. But we know it helps.” LEAP
PHOTO BRYCE MEYER
THE LANGUAGE
The Community of Practice Project DOES MINDFULNESS and meditation relieve the mental fogginess of “chemo brain?” Does music therapy reduce the anxiety of hospital appointments? Does a class in ceramics renew confidence, relationships and creative expression, post-diagnosis? Carolyn Henry, an oncology nurse and site manager at the Bow Valley Community Cancer Centre in Canmore, Alta., says that not only do these activities help with cancer-related symptoms, they improve overall patient outcome. “The diagnosis just comes like a bomb in your life,” says Henry. “The stress and the anxiety can create so many other problems. But if you have the right tools to support you, your brain and your body are more receptive to fight the disease.” Henry is part of the Bow Valley Community Cancer Centre’s Communities of Practice (CoP) project, which aims to pair patient needs with existing community resources. In Bow Valley, members of CoP identified a gap in awareness of — and access to — community programs. With the help of the Alberta Cancer Foundation, the Canmore & Area Health Care Foundation and community volunteers, the CoP developed and implemented programs such as music therapy, art therapy, yoga classes and meditation sessions. The main goals of these programs are to engage patients within their local community, to reduce or manage the physical and psychosocial symptoms of a cancer diagnosis, and ultimately to improve overall patient wellness. “The programs help to reduce the anxiety of treatment, manage pain, develop a greater acceptance and find peace in times of uncertainty,” says Henry. “It’s not just about the treatment,” she adds. “It’s way more than that. We want to make sure that everybody who comes here has all the tools to help them through their journey.” LEAP
From the longterm impact of longitudinal studies on cancer research to simple diet and exercise modifications, there are many options for patients looking to nurture their bodies during and after treatment by K A I T LY N H A N S O N
Cancer patients and survivors in Alberta have an increasing number of opportunities to improve their outcomes with diet and exercise. Thanks to ongoing participation in a study that provides better health research data to dedicated Canadian scientists, as well as an improved understanding of patient-centred nutrition and fitness programs, Albertans living with cancer are armed with knowledge to help them nourish their bodies. >
PHOTO JOHN GAUCHER
NOURISHING THE BODY
DR. JENNIFER VENA
Leveraging Data for Better Cancer Research DR. JENNIFER VENA, scientific director for Alberta’s Tomorrow Project (ATP), is excited about the huge potential of longitudinal studies in developing better cancer care. ATP, a program that began in the year 2000 and continues to be supported by the generous donors of the Alberta Cancer Foundation, is the largest research study of its type to be conducted in the prov-
ince. It is intended to follow the health of 55,000 men and women in Alberta over a 50-year period, collecting information via regular surveys as well as such things as blood, urine and saliva samples. The primary goal of ATP is to develop a better understanding of the causes of a number of conditions, including cancer, heart disease, diabetes and other chronic diseases. “It’s not just a one-time data >
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Taking a Holistic Approach to Fitness AS A CERTIFIED FITNESS
DR. JENNIFER VENA
collection,” says Vena. “It’s really important to look at people over time and see how things change. That’s how you make conclusions.” Vena says longitudinal studies can provide researchers with an invaluable bank of information. “Fifty years ago, we didn’t know that smoking caused cancer,” she says. “But now, thanks to longitudinal studies like the Framingham Heart Study, we also now know about the link between smoking and heart disease, for example.” “It’s really about creating a foundational data set that researchers can come to and use to create research questions,” adds Vena. “I’m hoping [with ATP] that we’ll be able to get better and better in terms of how we collect information — whether online or linking with other groups — and what we collect from our participants.” Since 2008, ATP has been part of the Canadian Partnership for Tomorrow Project, a consortium of five regional studies from across the country that offers insight into geographical trends related to health and well-being. It is important that the long-term focus of the study not only centres around people who do and do not develop cancer and other chronic conditions, but also around the various 26 LEAP WINTER 2018
factors that could influence how a patient responds to different treatments, Vena says “Sometimes we think about diet and exercise only as a way to prevent disease completely,” she says. “I think that what’s becoming increasingly appreciated is that diet and exercise can also affect how you respond to treatment.” As an example, Vena points to research that shows the healthier a patient is before going into a cancer treatment, the more likely the treatment will be successful. “People [should aim to] reduce their risk as much as possible,” she says. “We’re getting better at understanding how to do that.” Vena explains that a key challenge in building on this understanding is trying to pinpoint the future questions of researchers. Both e-cigarettes and the legalization of marijuana — issues that weren’t even on the radar when the study began — have been identified as factors that could impact cancer and chronic disease risk, so ATP is collecting data on their use now and in the future. “There are lots of really smart people doing really incredible work,” she says. “We can leverage everybody’s expertise.” LEAP
trainer with nearly 40 years in the industry, Michelle Gaulin knows how to motivate her clients to be the best possible versions of themselves. In recent years, Gaulin — who has operated Ageless Fitness & Health in Edmonton with her husband, Jack Taylor, since 2004 — has done an increasing amount of work with clients whose cancer is in remission. “Cancer is around all of us,” Gaulin says. “We’re surrounded by people who’ve had it, or have it now, and I think we’re running into more and more people who are suffering from the side effects of the treatments.” Gaulin, who became certified as a cancer exercise specialist in the summer of 2017, focuses on a holistic approach to exercise based on functional movement, strength, balance and range of motion. Many cancer treatments, she says, can exacerbate posture issues or restrict a patient’s movements. But exercise is one way to counter those effects. “Many doctors now are saying, ‘Try to take some exercise if you can, if your energy will allow it,’” she says. “There is something that can be done if you’re a cancer survivor and you have some side effects from surgery, radiation or chemo.” Clients who are cancer patients often battle a range of other challenges on their road to physical fitness, including fatigue and scar tissue related to surgery. “Cancer patients want to feel like they fit in, and also like they are making progress,” Gaulin says, adding that the notion of progress needs to be redefined for these clients. “It isn’t necessarily a linear kind of graph chart where things are going up all the time,” she says. “They may even have some baby steps backwards.” >
Gaulin works with her clients to set realistic goals in line with their specific needs and treatments. “If you are a current cancer patient, you can still exercise, but it has to be modified quite a great deal,” she says. For example, a person whose treatment plan has involved surgery or an amputation may experience limited range of motion due to heavy scarring. This, Gaulin says, is especially true of patients with breast cancer, as well as those who have experienced any type of abdominal surgery as part of their treatment. “The exercises we would do for someone like that would be to take you in the opposite direction that your body wants to go,” she says. “Instead of doing a crunch or a sit-up, we would work on some extension exercises, and those would have to be very, very gentle.” Gaulin says the key to delivering successful fitness programs for patients is compassion and encouragement. “We have to be [each patient’s] biggest cheerleader when it comes to any accomplishment they make, no matter how big or how small.” LEAP TO LEARN MORE ABOUT AGELESS FITNESS, VISIT AGELESSFITNESS.CA MICHELLE GAULIN
PHOTO COLIN WAY
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to be done,” Sterling says of his work with Marshall, who also provided him with a book of simple, high-calorie recipes. “She just said, ‘Hey, this is what can be done.’” “It’s really completely based on what the patient’s needs and wants are,” Marshall explains. “I’m just here to provide the support they need, the tools they need and the education they need to make informed decisions.” LEAP
MANAGING FATIGUE
Oncology dietitian Kallee Marshall on helping cancer patients manage fatigue through diet.
MEAL PATTERNS
Minimizing Cancer Complications Through Diet FOR MANY CANCER patients,
the side effects of treatment — including fatigue, reduced muscle mass and even malnutrition — can have a dramatic effect on their quality of life. Based out of the Central Alberta Cancer Centre — an outpatient clinic attached to the Red Deer Hospital — oncology dietitian Kallee Marshall takes a patient-centred approach to her practice. “In my practice, I really try to focus on educating individuals about the importance of nutrition and the role nutrition can play in their treatment outcomes,” she says. “If someone is not eating very well and ends up in the hospital with a lot of complications, their treatment may be delayed. But if we can help them stay nourished, there may still be complications that come about, but, hopefully, we can minimize them.” Patients seek out Marshall’s expertise at various points in their cancer treatment journey, and she works with them to develop individual programs that address their unique needs.
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“One example of someone coming to see me could be a patient who has lost a lot of weight, but doesn’t have much appetite,” she says. “So, in talking with that patient, we might discover that our goals are to stop any further weight loss and try to focus on maintaining their weight and muscle mass.” One such patient is 82-year-old Keith Sterling, who was diagnosed with mouth cancer in 1986 and had reconstructive surgery on his jaw in 2004. He still experiences the effects of his radiation treatment on his throat, and, in 2016, when he developed a bad infection in the tissue around his jaw that resulted in considerable weight loss, he was referred to work with Marshall. “I feel better now,” Sterling says. “My energy is a lot better.” With Marshall’s guidance, he has made small changes to his daily diet, such as adding hemp seeds and almonds to his morning bowl of porridge. And those small changes, which he tracks with the MyFitnessPal app, have helped him to stabilize his weight. “She did not lecture me about what had
Marshall works with patients to help them develop a regular eating pattern, to ensure they get the nutrition they need throughout the day. “They often feel so fatigued that they’re not going to prepare the same kind of meals they once were,” Marshall says. “They might even be feeling so fatigued that they’re going to skip meals.” With Marshall’s support, patients can plan meals and snacks in advance, which can help them stay nourished and on track during their treatment and recovery.
BALANCED OPTIONS Marshall advocates choosing balanced meals and snacks that provide long-lasting energy, especially for her patients who are struggling with fatigue. “For a snack, some Greek yogurt with berries is going to give you both carbohydrates and protein, and a little bit of fibre as well. That’s going to give you a lot more balance and energy than a few white crackers, for instance.”
STEER CLEAR OF SUGAR “One other thing we should mention is that really refined sugars — like having a lot of cakes, cookies and things like that — are going to give you a short burst of energy, but they are not really going to give you that long-lasting energy,” Marshall says. Instead, Marshall recommends seeking out treats like peanut butter and banana on toast, a smoothie made with frozen fruit, or hummus and veggies.
NOURISHING THE SPIRIT
Mind-body practices like meditation have become an important part of modern cancer care by J U L I A W I L L I A M S
Cancer and its treatment are notoriously difficult, with symptoms and side effects that challenge patients physically and emotionally. Treatments like chemotherapy and radiation attack the cancer, but cannot relieve its secondary conditions like insomnia, pain and anxiety — in fact, while treatments are vital, they can often make these secondary conditions worse. Increasingly, scientific evidence shows that non-medical tactics such as spiritual practices and mindfulness meditation can help manage negative symptoms and side effects. Over the last 20 years, oncologists have begun to incorporate such techniques into complete cancer treatment programs. >
The Power of Prayer “LONG BEFORE modern medicine, people were using meditation and prayer,” says Dr. Shane Sinclair. He’s an associate professor and cancer care research professor in the Faculty of Nursing at the University of Calgary, and he studies the art and science of compassion and spirituality and its effect on people with serious illnesses. He says spiritual practices can help patients manage distress and retain a sense of meaning before, during and after cancer treatment. In fact, many cancer patients turn to prayer and meditation instinctively, whether or not they belong to an organized religion, and whether or not these practices are part of their official treatment program. Sinclair says a study showed 52 per cent of cancer patients at the Tom Baker Cancer Centre pray at least once a week — a statistic that surprised even him. “A lot of patients use these practices more than physicians may know,” Sinclair says. “Patients want it, and patients use it.” A 2015 study that investigated the effect of religion and spirituality on physical health in cancer patients in the U.S. concluded that these practices are associated with better patient-reported
physical health. Moreover, they should be considered an important component of comprehensive cancer care — not because they cure the illness, but because they improve quality of life. Prayer and meditation can have physical and cognitive effects, reducing feelings of anxiety and distress while increasing resilience. Spiritual practices can give patients hope while connecting them to supportive communities, both of which can enhance a patient’s focus on self-care. “They can be thought of as the longest-standing healing practices,” Sinclair says. “They can bring an incredible amount of comfort to people.” Despite their history, spiritual and meditative practices have not always been part of modern oncology. “The biomedical model has been king for decades,” Sinclair says. However, he believes the mounting scientific evidence for meditation and prayer is opening minds. Word of mouth has also been effective: the more oncologists and practitioners see the positive results of such practices, the more open they become to incorporating them. In fact, Sinclair says many practitioners engage in spiritual practices to manage their own stress. LEAP
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The Science of Mindfulness
ILLUSTRATIONS PETE RYAN
MINDFULNESS IS a simple idea, according to Dr. Linda Carlson. It’s just being present, awake and aware in the moment — but that’s easier said than done. “Our natural state is not always that mindful,” Carlson says, explaining that we tend to dwell on the past or imagine the future, and the stress and difficulty of a cancer diagnosis distracts us even more. Carlson is a clinical psychologist and director of research in the Department of Psychosocial Resources at the Tom Baker Cancer Centre in Calgary and holds the Alberta Cancer Foundation’s Enbridge Chair in psychosocial oncology. She’s been developing and guiding mindfulness meditation programs for cancer patients for more than 20 years. “Being diagnosed with cancer is all about uncertainty, loss of control, change in routines, unpredictability, existential crisis,” she says. The treatment process often causes pain, nausea and insomnia, and survivors live with the fear of recurrence. Carlson says all of these symptoms and side effects are amenable to treatment with mindfulness, which helps improve focus, regulates energy levels and helps people deal with uncertainty. Carlson’s interest in yoga and meditation dates back to her student days in the 1990s, when a Buddhist monk classmate at McGill University introduced her to these practices. Carlson became inspired by the work of Jon Kabat-Zinn, an American scientist, writer, professor and founder of Mindfulness-Based Stress Reduction, or MBSR. “Mindfulness is a formal practice where you set aside time in your day, but it’s
also a way of being,” Carlson says. “It’s an attitude or a fundamental approach to life.” Later, as a post-doctoral fellow at the Tom Baker Cancer Centre in 1998, Carlson and three colleagues — Michael Speca, Eileen Goodey and Maureen Angen — developed a seven-week mindfulness meditation program, which they used to investigate the effect of this practice on the stress levels and moods of cancer patients. Carlson wasn’t surprised to learn that the program measurably reduced participants’ stress symptoms, but the magnitude of the changes was beyond what she had anticipated. “We saw huge improvements in people’s level of anger, anxiety, physical stress symptoms and fatigue,” she says. In subsequent studies, Carlson found mindfulness practices improved immune functioning and sleep. Other studies, not specific to cancer patients, have found meditation can affect neurological changes, lower salivary cortisol levels, improve immune functioning and reduce blood pressure. “There’s no question that there’s changes in the brain,” Carlson says. “We see changes in the nervous system, stress hormones, immune system and changes at the level of the cell.” Carlson’s original meditation program has become a nine-week program that combines intensive training in mindfulness practices with gentle hatha yoga. Tom Baker Cancer Centre patients can choose from three programs, offered on different days, three
times a year, and the sessions can accommodate 15 to 20 participants. Carlson also offers a weekly drop-in group for program “graduates” who want to continue their practice. Recently, the Tom Baker Cancer Centre also trained facilitators from Wellspring, a non-profit organization that supports cancer patients and survivors, so that it, too, can begin offering mindfulness meditation programming.
Mindfulness was once considered a complementary or alternative therapy, but that’s changed. Carlson says her program has had a wait list for 20 years, is included in the new patient orientation package at the Tom Baker Cancer Centre and is recommended by oncologists. Similar programs are offered across the world. None of this surprises Carlson, who has long understood the connection between mindfulness and physical well-being. “Everything that happens in your mind happens in your body,” she says. LEAP myleapmagazine.ca WINTER 2018 LEAP 31
AUSTIN’S MINDFULNESS RESOURCES Mindful.org A website with resources, advice and information about mindfulness practice.
YOGA CLASSES FOR CANCER PATIENTS
MindShift app Mindfulness tools focused on reducing anxiety.
If you’re seeking a mind-body practice, several yoga classes in Alberta are designed for cancer patients, survivors and support persons.
(Android, iOS)
Louise Ha Affirmations app Guided relaxation and positive affirmations.
YOGA THRIVE Various Locations in Alberta
Headspace Guided Meditation app Mindfulness coaching and guided meditation. LINDA AUSTIN
(Android, iOS)
Breethe app Guided meditation. (Android, iOS)
A Patient’s Perspective WHEN LINDA AUSTIN decided to take a mindfulness meditation program through the Tom Baker Cancer Centre, she was afraid she’d be made to sit in a circle and say “om.” She tried it anyway, and is now one of the program’s most enthusiastic advocates. The course taught Austin breathing techniques, body awareness, sensory awareness, being present, and relaxation through meditation and yoga. By the time the program ended in the summer of 2017, Austin hadn’t once said “om”— but she had experienced physical, cognitive, emotional and mental benefits. “I could see the difference in how I was coping with my everyday life,” Austin says. Austin was diagnosed with myelodysplasia (a type of leukemia that had claimed her father’s life) in 2013. She went through chemotherapy treatment, which 32 LEAP WINTER 2018
weakened her, and a stem cell transplant, which confined her to the hospital for five months with infections and complications. She was exhausted and reluctant to sign up for the weekly meditation program, which seemed like yet another medical appointment. Now she’s glad her care team at the Tom Baker Cancer Centre kept urging her to enroll. A program graduate, Austin engages in several seven-to-10-minute meditation breaks during the day to rejuvenate and focus. She says learning mindfulness has made a huge difference to her life. “I’m more at peace with my cancer journey than I have ever been,” she says. “I honestly believe I’m going to be okay now because not only have I accepted my new normal, I have learned to live with my new normal, which is a big difference.” LEAP
PHOTO JARED SYCH
(Android, iOS)
A research-based 12-week therapeutic program for cancer survivors and their support persons, Yoga Thrive originated in Calgary in the early 2000s and has trained more than 100 instructors across North America. The program is a modified version of hatha yoga that addresses conditions common to cancer survivors, such as pain, stress and fatigue. You can find Yoga Thrive classes in multiple locations in Calgary and across the province. There’s also a Yoga Thrive for Youth program for pediatric cancer patients and their siblings. ucalgary.ca/healthandwellnesslab/programs/yoga-thrive
IYENGAR YOGA CENTRE Edmonton This centre offers inclusive programs that can cater to students who are going through cancer treatment and help to address side effects like fatigue and anxiety. familyoga.ca
YOGA FOR MEN Wellspring Edmonton A gentle yoga program for cancer patients and survivors, this men’s program incorporates meditation and is designed to improve relaxation, flexibility and balance. wellspring.ca
CARING
The night before we were to fly to Ottawa for his exam, he couldn’t eat. He lay down on the floor to relieve a new pain in his side. “I can’t breathe,” he said. Bear with me if I skip the goriest details of what followed. I thought he would die in my arms as we waited for the ambulance. The next morning, a diagnosis came back, confirming that he nearly had died: cancer now lived in his liver, too, and caused a blood clot in a major vein.
He said he was very sorry that “ this was happening to us.”
Palliative Support Even in the worst situations for a patient and their family, it’s vital to have a say in what matters most in someone’s last months and weeks by CHRISTINA FRANGOU
WE MET OUR PALLIATIVE CARE DOCTOR ON ONE OF THE WORST
days of my life. Technically speaking, he was my husband’s palliative care doctor. But cancer is a disease with unique infectious properties: its cells eat away at the body of the person in whom they live and, as a side effect, they inject terror and grief into the people who love them. So, when the person you love needs a palliative care doctor, their physician becomes your palliative care doctor, too. On the day we met our palliative care doctor, we should have been at the airport, boarding a plane to Ottawa. Instead, we were dejectedly, unexpectedly, in a hospital room at the Tom Baker Cancer Centre. My 36-year-old husband, Spencer McLean, had been diagnosed with metastatic kidney cancer two weeks earlier — shattering our life plans. We were devastated and stunned. With our oncologist, we’d laid out a cancer strategy and set about getting Spencer through the last exam to complete his training to be an orthopedic surgeon.
We’d known cancer was killing him; we had no idea of its ferocity. The next morning when we met our palliative care doctor for the first time, we were terrified for what the next days and weeks might bring. Our doctor introduced himself by his full name but insisted we call him by his first, Brad. He pulled the chair close to Spencer’s bed and sat down. He said he was very sorry that this was happening to us. They were simple words, but substantial: When your life is about 5 a.m. blood draws and trips to the hospital basement for ultrasounds, you take comfort in sincere human exchanges. He said to us that unfortunately we could not change the path we’d been put on. But, he said, we “could control the way we walked on that journey.” I can’t recall now everything we spoke about with Brad on that first day or the 26 days that followed until Spencer died. We talked of many things: hockey; loved ones Brad had lost and we had lost; insomnia; student loans; pain medications. The three of us cried together and laughed, too. And those conversations made a difference. They influenced Spencer’s medical care — there was always a plan tailored to what Spencer deemed most important to him. Just as importantly, the conversations helped us lay out our priorities as he was dying. We wanted to spend as much time together as possible, as lucidly as possible; he wanted to ensure his student loans would not fall to me. I knew what mattered to Spencer, and he knew what mattered to me. When it became impossible for him to say what he wanted, I knew what to say. That matters when you and the people you love are facing the very worst. LEAP
ILLUSTRATION JENNIFER MADOLE
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LIVING WELL
Bringing the Hospital to the Patient Two very different programs have the same goal: reducing the distance between patients and their health care by ROBBIE JEFFREY IN 1991, WHEN SHE WAS JUST OUT OF
university, Joan Hauber landed a temporary job with the Cross Cancer Institute in Edmonton. As her term was coming to a close, she joined the Institute’s fledgling mobile mammography screening program, which originally consisted of sending a van full of screening equipment across north central Alberta and setting up in community centres or other buildings. “At that time, I didn’t even know what a mammogram was,” she says. Now, 26 years after taking that job, Hauber is the manager of operations for the Screen Test mobile screening program — and the difference that program makes to families across the province gives clues as to why 34 LEAP WINTER 2018
she would stay with it for so long. Mammograms, which look for small changes or abnormalities in the breast, are crucial for early detection of breast cancer, which increases survival rates. But, for Alberta-based women who don’t live in communities with mammography facilities, or for women who have disabilities or can’t drive, it can be difficult to get screened regularly. “If women can’t come to us, we’re going to take the mammograms to them,” Hauber says. And she means it. Thanks to the generosity of Alberta Cancer Foundation donors, two mobile mammography units were purchased so
that Hauber and her team can travel to around 120 communities in well-equipped trailers that serve as mobile clinics, working from 7:00 a.m. to 7:30 p.m. each day to schedule and screen as many women as possible. “Some women are thrilled because it saves them from driving,” Hauber says. “But for others, it truly enables them to do something they couldn’t do otherwise.” Dr. Jana Rieger has similar aims through her work. Rieger is a professor in the Faculty of Rehabilitation Medicine at the University of Alberta and the director of research at the Institute for Reconstructive Sciences in Medicine (iRSM), a joint initiative of the University of Alberta,
MAMMOGRAPHY BY THE NUMBERS Every year, the mobile units screen upwards of 15,000 women. Mammograms can detect breast cancers up to 2 years sooner than physical exams can. Between 2015 and 2016, 63% of Alberta women from ages 50 to 74 had a screening mammogram. It is recommended that women between ages 50 and 70 should have a mammogram every two years.
Covenant Health and Alberta Health Services. She studies the effects of head and neck cancer, and she says the overwhelming majority of patients with these forms of cancer have some kind of problem swallowing after they undergo treatment. That might seem like a mere inconvenience to outsiders, but it can cause immense disruption in patients’ lives. When Rieger began her research in 1999, she says “people were really focused on a cure, but no one was really talking about what the patients were left to live with after they got treatment.” She adds, “One of the most common things we hear from patients is that [problems with swallowing] stop them from socializing the way they did before. They’ve avoided social outings because it’s just too awkward for them.” The good news is that there’s intensive swallowing therapy, and it works. About 80 per cent of people can eat better after
the therapy, and 30 per cent of patients who had a tube in their stomach could, post-therapy, have it removed.
“ If women can’t come to us, we’re going to take the mammograms to them.” – Joan Hauber, manager of operations for the Screen Test mobile screening program
The bad news, however, is that the therapy requires the patient to go in for treatment every day, which about 90 per cent of patients wouldn’t do because of the time-commitment involved. “Even for patients in Edmonton, it’s almost a half-day event,” Rieger says. “People just weren’t doing it.” Enter something called Mobili-T. The
result of a $1.9-million investment from the Alberta Cancer Foundation, Mobili-T is a small, square interface device that replaces the large clinical equipment, allowing patients to do the therapy at home. Placed on the chin, and measuring just two inches by two inches in size, it records muscle activity and feeds the information back to an app that can be downloaded onto the patient’s phone. A clinician can then use that data to put the patient into specific therapy exercises and track how they’re progressing each day, week and month, to help patients hit targets. Mobili-T is currently in its clinical trial phase, and Rieger hopes the final product will wind up all across the world. “Our hope is to help more people enjoy more foods, swallow more safely, and get back to living a regular, normal life,” Rieger says. “Now they can go to a friend’s place without worrying about what kind of food will be on the table.” LEAP myleapmagazine.ca WINTER 2018 LEAP 35
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LIVING WELL
Regaining a Sense of Self The Look Good Feel Better program helps women face cancer with renewed strength and confidence by MAE KROEIS LOOK GOOD FEEL BETTER (LGFB) BELIEVES
that the best medicine doesn’t always come in a bottle. Recognizing how a diagnosis of cancer can rob a woman of her sense of self, LGFB, originally created by the beauty industry 25 years ago, helps women with cancer feel like themselves again. At the heart of LGFB is a complimentary beauty workshop that supports the emotional and psychological sides of cancer. “The workshop helps renew a feeling of womanhood,” says Michelle Pilon, Western Canada’s Regional LGFB Manager. “It’s a safe and welcoming environment for women dealing with similar issues and facing many of the same challenges. Being diagnosed with cancer is the common theme in the room. But [participants] get to put that aside somewhat and play and have a really wonderful couple of hours dedicated to them at a time when you can only imagine how intense the journey is.”
“ The workshop helps renew a feeling of womanhood.” – Michelle Pilon, Western Canada’s Regional LGFB Manager
The two-hour workshop offers women with cancer valuable tools and techniques to take control over how they look and, ultimately, how they feel. The first hour focuses on skin care and makeup and the second is dedicated to scalp and head coverings. Participants are given a complimentary kit with information, cosmetics and skin care products. They are also taught signature make-
up steps and skills, like how to draw eyebrows, which volunteer Cindy Kelly emphasizes as essential. “It’s going to take time and practice, but you’re going to want to know where your eyebrow is. You want to be able to just go shop and not have anyone look at you. You want to be able to just have a conversation and not have to tell anybody your story because you’re wearing a turban and so, therefore, you must be sick.” Kelly was first a participant in the LGFB program 14 years ago. “I got so much out of that program,” she says. “All the women were in a safe group to take their wigs or turbans off as they were putting on their makeup. People came in feeling down and out and scared, but when we left the program, we were pretty elated.” Now a volunteer program leader, Kelly gets to watch participants leave feeling beautiful. “Women who come in with no makeup and a turban now have makeup on, with a foxy little wig. They look 15 years younger and they’re so shocked. You’re glowing because you feel pretty. You feel normal,” she says. Kelly also hopes participants bring their new sense of empowerment with them to inspire others who are dealing with cancer. “I tell my ladies that when they go in for treatment, they should try to put on some lipstick, rock their bald head or put on a wig, and put on a little blush,” she says. “Go in on the ground floor, where all the patients are, looking good. Go in and work it. You’ll take the fear out of it. You’ll inspire people to think of this whole journey as something different.” Michelle Pilon echoes this sentiment,
and she believes that LGFB can be a major influence on women’s attitudes, hope and optimism, all of which impact cancer outcomes. “Participants come in and join a larger group of women who are experiencing the same thing, and they regain their sense of self,” says Pilon. The workshop is offered at the Cross Cancer Institute in Edmonton, and all women and teenagers with a diagnosis of cancer are welcome to attend. To enroll, phone 1-800-914-5665 or visit lgfb.ca. LEAP
A FEW ESSENTIAL INGREDIENTS TO FEELING BEAUTIFUL COLOUR
“Blush takes that sickly colour out of your skin,” says Cindy Kelly, volunteer program leader with LGFB. “You might wash your hair and put on a little concealer when you notice bags under your eyes. Then you put on a little blush and a little lip gloss and you’re good to go.”
EYEBROWS
Kelly emphasizes the importance of learning how to draw on eyebrows. “If you’ve been told you’re going to lose your hair, that’s such a fear for [women]. You can cover that up, but as you start to lose your eyebrows, your whole identity seems to disappear. To be shown how to put on your eyebrows — that’s huge.”
SCALP AND HEAD COVERINGS
“Are you a wig person? A hat person? Just rock it, own it. Wigs and hair alternatives make such a difference,” says Kelly. LGFB participants are given information at the workshop on where to find wigs.
ILLUSTRATION DUSHAN MILIC
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RESEARCH DR. NANCY NIXON aims to make a significant impact in cancer patient care by embarking on a variety of research-related pursuits
It’s
really no surprise that Dr. Nancy Nixon pursued medicine. She’s always loved the sciences (her undergrad was in biochemistry) and she grew up with two dedicated and passionate physicians as parents. Today, at just 31 years old, she has realized her goal of becoming a medical oncologist and researcher at the Tom Baker Cancer Centre (TBCC) in Calgary. Her practice focuses on breast cancer, a choice she made based on both a rewarding fellowship experience at the TBCC and a tragic, personal loss — Nixon’s mother died of breast cancer 23 years ago. “[Losing my mom to breast cancer] is one of the reasons I connect so well with my patients,” Nixon says. “I can empathize. I’m sensitive.” Nixon’s work takes place mostly in clinic settings, where she meets with new patients (four per week) and existing ones, all of whom are dealing with various stages of breast cancer and undergoing systemic therapies like chemotherapy, endocrine therapy, targeted therapy or immune therapy. She and nurse practitioner Camelia Lee spend almost an hour with each new patient they see, discussing the characteristics of the diagnosis, the rationale for the selected treatment, and the treatment and recovery process. They also talk about things like anticipated side effects and the jarring influence the disease may have on a patient’s lifestyle, well-being, employment and plans for the future. >
by COLLEEN BIONDI photography COLIN WAY
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DR. NIXON IS A MEDICAL ONCOLOGIST AND RESEARCHER AT THE TOM BAKER CANCER CENTRE
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“It is a both a privilege and a gift to walk with people during this time,” Nixon says, acknowledging that, in her clinic work, she sees patients who are dealing with some of the scariest and most vulnerable situations of their lives. In addition to her clinic responsibilities, Nixon consults with other members of her multidisciplinary team (such as surgeons, radiation oncologists, nurses and psychologists) at weekly patient review meetings, teaches second-year medical students about breast cancer and, perhaps most significantly, pursues another area of her practice that is critical to the future of cancer care — research. A mentor of Nixon’s once highlighted the importance of conducting research (in addition to clinical work) by pointing out that, in a medical practice, a doctor may see thousands of patients over a lifetime, but, with successful research, that same doctor has the potential to reach a wider audience and help hundreds of thousands of patients. “Research extends beyond the clinic,” Nixon says. “You can have an even more meaningful impact.” Among Nixon’s many researchrelated pursuits is the Canadian Metastatic Breast Cancer Priority Setting, a project she spearheaded during her fellowship year in 2016 to solicit feedback from patients and patient representatives about priorities in breast cancer research. “The goal is to give patients and their family members a voice in research,” says Nixon. “I hope this study will address common concerns for the people most affected by the disease.” As part of the project, Nixon — along with a steering committee composed of patients, physicians, patient advocates and allied health care professionals — constructed a survey and sent it out across the country to French- and English-speaking individuals. Hoping
FACT
for 500 responses, she received 650 and is in the process of measuring and interpreting the results. Early recommendations by participants include more research into alternative therapies, interest in immune therapy, and best practices associated with early detection of relapses, including re-examining current protocols. According to Nixon, it’s typical for big pharma, funders and researchers to dictate priorities, but it’s critical that patients also contribute to the discussion. And the global community agrees: she has already had positive feedback from a report she presented on her preliminary findings at a European Society of Medical Oncology meeting last fall in Madrid. In addition to her work on the Canadian Metastatic Breast Cancer Priority Setting, Nixon has also been a key member of some Alberta investigative studies, including one relating to transitioning breast cancer survivors back to primary care physicians after active treatment and another analyzing “development pathways” of drugs commonly used for breast, colorectal and non-small cell lung cancers. Both studies highlight the importance of resource utilization, says Nixon. “The first one recognizes the important role of family physicians as part of the cancer management team, and the second one identifies inefficiencies (in drug development) in order to improve the time and cost of getting new, effective therapies to market and to cancer patients.” Finally, Nixon contributes to work in the Translational Labs at the TBCC. This group examines the roles of biomarkers — such as proteins, nucleic acids and metabolites — in identifying and tracking the spread of cancer. Her current research here looks at bone turnover markers associated with a
group of women with metastatic breast cancer who are taking the drug palbociclib. The hypothesis is that the drug will re-introduce healthy bone development and decrease the likelihood of cancer absorption in the bones. Despite loving both the clinical work and the research, Nixon acknowledges there are difficulties working in the field of cancer. “I wish I had more time for each patient,” she says. “Sometimes I feel like I am being pulled in lots of different directions.” Nixon handles the stress by talking to colleagues who are dealing with similar issues and can relate to her challenges. She is also buoyed by the unflagging passion and commitment of her team members — such as Dr. Jan-Willem Henning, Dr. Alexander Paterson and Dr. Sunil Verma — to patient care and research. And they, in turn, are honoured to have her as part of the team. “Dr. Nixon is an amazing and dedicated professional,” says Dr. Henning. “She makes the most of every opportunity to advance as a clinician-researcher, ultimately benefitting her patients.” Having a diverse, out-of-work life is also critical to tempering job demands. Nixon is married to a software sales director and enjoys running, biking, spin and barre classes, and spending time with family and friends. She also admits to enjoying a bit of television. “If I said I never watched TV, my husband would call me out,” she says with a laugh. What is on the horizon for Nixon? She’s excited about possibilities for immune therapy in treating breast cancer — “It hasn’t reached prime time in breast cancer yet, but has the potential to” — and will also explore professional options relating to lung cancer. “It’s an exciting time to be an oncologist,” she says. “We are getting smarter and seeing such impressive changes. I am lucky to be in this field.” LEAP
Dr. Nancy Nixon recognizes the importance of philanthropic support to continue to fund research. She is co-captain of the Tom Baker Cancer Conquerors – a cycling team of more than 200 riders raising funds for the Enbridge Ride to Conquer Cancer, benefiting the Alberta Cancer Foundation. To date, The Tom Baker Cancer Conquerors have raised more than $2 million for clinical trials research at the TBCC.
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7
QUESTIONS WITH
DR. NIXON 1. Describe what you do in 10 words or less. Provide systemic therapies for cancer patients. Participate in cancer research. 2. What’s the biggest misperception about what you do? The biggest misperception about a career in oncology is that it’s depressing. There are certainly challenging moments, but being able to walk through the cancer journey with patients and their families is a powerful experience with lots of happy moments. 3. Where do you get your best ideas? Collaborating with colleagues, and listening to patients. 4. If you weren’t a medical oncologist and researcher, what would you be? Tough one! I recently had a conversation with my husband, who works in the technology field, and even though our jobs are very different, we’re both passionate about what we do because we get to solve problems and help people. Any job where I could do those two things, I think I’d be happy. 5. What is the hardest lesson you’ve learned? One of the toughest lessons in research is that for every success, there are a dozen roadblocks or failures. I think anyone involved in research knows that persistence pays off. 6. What motivates you? Having patients put their trust in me during one of the biggest challenges they will face in their lives motivates me to try to know everything, and to do anything I can to earn that trust. 7. Why does your research matter? I think it’s important to listen to our patients, and my research focuses on that.
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CAROLYN MURPHY AND TAMMY KOCH BRING PATIENT NAVIGATION SERVICES TO THE HINTON COMMUNITY CANCER CENTRE
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TRUE CALLING
SUPPORTING
CANCER PATIENTS IN RURAL ALBERTA Tammy Koch and Carolyn Murphy are guiding cancer patients in Hinton and its catchment area through the complexities of cancer treatment and survivorship by KARIN OLAFSON
WHEN TAMMY KOCH’S GRANDFATHER
was diagnosed with lung cancer, she saw first-hand how having a strong support system could help a cancer patient. Her grandfather moved from Holden, Alta., to Spruce Grove to live with Koch and her family, a move that helped to lessen his financial and social stresses and gave him much needed companionship during his cancer journey. Years later, when the opportunity to work in cancer care presented itself to Koch, she took it, knowing she could make others’ cancer experiences as positive as the one her grandfather had. >
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Similarly, when several members of Carolyn Murphy’s family were touched by the disease, Murphy witnessed them struggle to understand the medical jargon, and saw how they often felt confused and lost throughout their illness. A career helping cancer patients was a logical choice — Murphy wanted to assist them by eliminating that confusion and making them feel at ease. Today, both Koch and Murphy help to make rural Alberta cancer patients’ experiences a little less overwhelming. They are the only two nurses working at the Hinton Community Cancer Centre, located in the Hinton Healthcare Centre. According to Koch, as rural nurses they “wear a lot of hats.” Indeed, their roles and responsibilities shift quite a bit throughout a typical work week. Tuesdays through Thursdays, Koch and Murphy serve as oncology nurses in the Hinton Community Cancer Centre, doing patient assessments and administering chemotherapy. But on Mondays and Fridays, both nurses take on a different role in that same centre — that of cancer patient navigator. Essential for overall patient well-being, Alberta Cancer Foundation Patient Navigators provide support and assistance to patients in any way they’re struggling, whether those struggles are physical, spiritual, psychological or practical. “If there is anything that is causing patients stress when they’re going through their cancer journey, we want to be able to have some dedicated time to help them through it,” says Murphy, who was initially hired in October 2016 to cover a maternity leave and is now a casual clinic nurse and cancer patient navigator. For Murphy and Koch, addressing a patient’s stress can mean anything from letting them know what side effects they can expect during treatment (and how to ease those symptoms), to referring them to a mental health expert, to letting them know where they can get financial help or other resources they may need. And sometimes, it just means being there to chat when patients have no one else. In addition to providing navigation services to patients who visit the Hinton Community Cancer Centre, both nurses
TAMMY KOCH’S CAREER MILESTONES
CAROLYN MURPHY’S CAREER MILESTONES
APRIL 2000 Completed a Bachelor of Science in Nursing at the University of Alberta
MAY 2013 Completed a Bachelor of Science in Nursing from St. Francis Xavier University in Antigonish, N.S.
APRIL 2000 Moved to Hinton and started work at the Hinton Healthcare Centre in medical-surgical SEPTEMBER 2007 Started working at the Hinton Community Cancer Clinic in the Hinton Healthcare Centre APRIL 2013 Finished cancer patient navigation training and began a dual role as a clinic nurse and a cancer patient navigator
also assist patients in Hinton’s catchment area — which includes the towns of Jasper, Edson and Grande Cache — over the phone. As navigators, their commitment to each patient is extensive: it begins at diagnosis and continues right to survivorship or palliative care. Koch and Murphy keep in touch with patients throughout the course of their illness, so patients feel comfortable opening up to them. And the nurses both express how grateful they feel that patients are willing to let them into their lives. Koch has many stories of patients who have expressed how much easier navigation has made their cancer experience, but one story in particular sticks with her. “We recently had a patient who brought her sister [to the clinic]. The patient was diagnosed with cancer about a year ago and had gone through treatment with us,” says Koch. “And now her sister has been diagnosed with cancer and is going through it all. Our patient was telling her sister, ‘These guys are awesome — if you have any questions at all, they will answer
JUNE 2013 Moved from the East Coast to Hinton and began working at the Hinton Healthcare Centre in acute care OCTOBER 2016 Began cancer patient navigation training and accepted a position as a cancer patient navigator at the Hinton Community Cancer Centre, covering a maternity leave
them.’ It was just rewarding to see how much we helped. It felt really amazing.” Dorothea Presakarchuk is another Hinton resident who has been positively affected by the nurses’ cancer patient navigation services. Diagnosed with breast cancer in January 2017, Presakarchuk has been seeing Koch and Murphy since April. “Coming to see the girls at the Hinton Community Cancer Centre is like coming home. I’m free to talk about my concerns here — and not just the physical ones. Cancer gets into your heart and soul and the nurses help me with that, too,” says Presakarchuk. “They always accommodate our needs. I’m never just a patient.” This level of connection stems from the deep sense of empathy both nurses have for their patients. “I like sitting down and learning my patients’ stories. I like knowing where they’re coming from, what’s important to them and how I can make things easier for them,” says Koch. “Going into nursing, I knew I wanted that interaction. I wanted to know people.” PHOTOS BLUEFISH STUDIOS
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Today, one of Koch’s main goals as a nurse is to make sure no rural cancer patient drops through the cracks. “I want the Hinton Community Cancer Centre to be a known resource in our catchment area,” she says. “I want people to know that we are here. That’s really important to me, because as much as we try, there are still people that we miss.” Changes to funding at the clinic have helped Koch and Murphy provide their patients with a better level of care than ever before. While patient navigation isn’t a new concept, Hinton Healthcare Centre site manager Fiona Murray-Galbraith explains that the cancer centre began to receive funding from the Alberta Cancer Foundation in 2013. This funding allowed the centre to extend its hours and open five days a week, as opposed to just three. It also allowed the nurses designated time to spend with their patients. “We now have time to actually sit down with patients, see if they have any questions, see how they’re feeling and explore any other concerns,” says Murphy.
“ Cancer patient navigation is so important in helping people get through what is probably the most difficult time of their life.” – Carolyn Murphy
Recent renovations have also helped. Thanks to a $1.2-million provincial grant, the Hinton Community Cancer Centre has been able to modernize and double its size. Construction began in September 2015 and finished less than one year later, in June 2016. “Before the renovations, we had a very small space which we identified as having some patient comfort issues, patient confidentiality issues and also patient safety issues,” says Murray-Galbraith. Koch says the new space allows her and
Murphy to care for their patients to the best of their abilities. Not only are patients given more privacy, but, thanks to Alberta Cancer Foundation donor support, they are now made much more comfortable due to new clinic additions that include Cadillac chairs with heat and massage for those receiving chemotherapy, a TV and sound system, and a small kitchen. But Murray-Galbraith believes the new space is a bonus and that it’s the nurses, the physicians and all the staff who are the heart of the Hinton Community Cancer Centre. “I think we have exceptional nurses here who absolutely live the values of Alberta Health Services,” says Murray-Galbraith. “Both Tammy and Carolyn have a willingness to go above and beyond to help their patients. They both have a real passion for their job. They care for their patients and make their cancer journey as seamless and comfortable as they can.” LEAP
Learn more about the Alberta Cancer Foundation Patient Navigator Program at albertacancer.ca
Cross Cancer Institute
Golf Classic Congratulations on
30 years!
The Cross Cancer Institute Golf Classic is celebrating 30 years of bringing life-saving programs and equipment to Edmonton’s Cross Cancer Institute. To all tournament sponsors, participants, and volunteers who have been a part of this event over the past 30 years, thank you for your incredible support of the Cross Cancer Institute’s patients and their families.
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IMPACT
MARGARET HOLT IS PART OF THE ALBERTA LUNG CANCER SCREENING PROGRAM
Screening Programs: A Personal Experience as told to MAE KROEIS
Margaret Holt has been working at the Cross Cancer Institute in Edmonton for 14 years. In 2011, she experienced what it was like to be on the other side of the desk when she was diagnosed with ovarian cancer. As a survivor, Margaret feels compelled to do what she can to contribute to research and stay cancer-free. A smoker, she is currently participating in the Alberta Lung Cancer Screening Program, a pilot project in partnership with the University of Calgary and the Alberta Cancer Foundation, with a goal to catch cancer early, when curative treatment is still an option. Here, she shares her cancer journey.
“In 2011, I was diagnosed with ovarian cancer and became a patient at the Cross, not just a staff member. I don’t think even working there can prepare you for the emotional and physical part of the journey. I had surgery and then chemotherapy and came back to work. I’m very fortunate that I am one of the few ovarian cancer survivors. Then I heard about this new program for early detection for lung cancer from a colleague. I am always signing up, always trying to figure out what I can do to not feel caught off guard. 46 LEAP WINTER 2018
I felt very blindsided by being diagnosed with cancer at age 48. When I was diagnosed, I was the only one in my family [to have cancer]. Then I had one cousin diagnosed with colon cancer and two other cousins and an aunt diagnosed with breast cancer. My doctor forwarded my referral on to the genetics clinic at the University of Alberta to test for the breast cancer gene, because I wanted to take steps in order to not develop other cancers. The results were negative, so it was a process for me to understand that I am just one of those people walking down the street who got cancer. And for me, it wasn’t just one cancer. When my doctor did my surgery for ovarian cancer, she found endometrial cancer as well. So now I feel very strongly that I need to do everything that I can to be tested, to not get blindsided again. The criteria for the Alberta Lung Cancer Screening Program is smoking or having smoked and being 55 to 80 years of age. You then get a CT scan once a year that checks for earlier detection of lung cancer. I had my first scan in July [2017] and they did not see anything, so I’ll have another scan in one year’s time. If you sign up for the program and they see something, you are agreeing to a biopsy. To receive a phone call saying, ‘We saw something on your chest CT, we need you to go for a biopsy,’ would be a scary thing, but I prefer to do that over being caught by surprise again, or being told there are no more options. I believe in research. I believe it’s what’s going to change the outcome for a lot of people. I feel a personal obligation to help in any way possible to continue research, especially for people who have had cancer. The Alberta Cancer Foundation has backed so many things, it’s incredible. They listen to people who come in and talk to them about where they feel the money and research needs to be. Every patient or family member just wants their voice heard, and it’s nice to see that the donations we make to the Alberta Cancer Foundation are staying in Alberta. I hope that when I retire and my time comes, that I will leave a legacy to the Foundation and the programs.” LEAP The Lung Cancer Screening Program has reached its goal of recruiting 800 eligible patients for the study, and the project has identified 13 cancer patients, all detected at an early stage. PHOTO LIAM MACKENZIE
WHY I DONATE
A Lifetime of Love by CAITLIN CRAWSHAW
May Pringle and her late husband began donating to the Alberta Cancer Foundation in 1991, shortly after the couple’s first encounter with cancer. Twenty-seven years later, she remains a passionate supporter of cancer research in Alberta >
PHOTO BRYCE MEYER
myleapmagazine.ca WINTER 2018 LEAP 47
BY THE TIME MAY PRINGLE GOT MARRIED,
she was 31 years old and had been a bridesmaid for six different weddings. “I wasn’t exactly a child bride,” she says with a laugh. While many women of her generation married young, Pringle says she was too busy living her life. “I wasn’t going to get married just for the sake of getting married.” Born in Calgary and raised in Carseland, Alta., she attended secretarial school in Edmonton before travelling the world and launching a career in the energy sector that led to a three-year post at Halliburton’s Los Angeles office. Everything changed when she returned home and took on a job at West Canadian Oil & Gas Inc. There, she met William (Bill), a chartered accountant who shared her love of politics, investing and outdoor adventuring. Pringle describes their love affair matter-of-factly. “We started going out and decided we wanted to live with each other,” she says. In 1963, the couple got married and remained happily so for 52 years. But their happy life was interrupted by cancer on many occasions, beginning in 1987, when Pringle asked her obstetrician to run some tests to find out why she was feeling so unwell. On a Friday night, the doctor phoned her with shocking news: she had uterine cancer. Fortunately, Pringle was referred to an oncologist at the Tom Baker Cancer Centre who soon removed the tumour and confirmed that it hadn’t spread. “I was lucky — they got it right away and I didn’t need any other treatment,” she says. Surviving cancer opened Pringle’s eyes to the world of cancer treatment and research, and motivated her to give back to the hospital that had cured her. After taking a six-week training course, she began a 28-year volunteer career at the 48 LEAP WINTER 2018
MAY PRINGLE IS A LONG-TIME SUPPORTER OF THE ALBERTA CANCER FOUNDATION
Tom Baker Cancer Centre, starting with the hospital’s gynecology outpatient clinic. Her work centred around supporting newly diagnosed cancer patients, and she often held patients’ hands during appointments. “I just seemed to fit in there really well,” she says. In 1991, she and her husband decided to give back financially, as well, with yearly donations to the Alberta Cancer Foundation. After Pringle’s cancer experience, the couple went on to share several happy and healthy decades together. They travelled the world, camped and hiked, and enjoyed time with friends and family. Then, a decade ago, cancer reappeared in their lives when Bill was diagnosed with prostate cancer, which doctors easily treated. Not long after, Pringle was diagnosed with her second cancer — melanoma — which was also treated successfully.
But, four years ago, Bill became seriously ill while the couple was vacationing in Victoria, B.C., and doctors discovered he had pancreatic cancer. This time there were limited treatment options and, in 2015, Bill died in hospice. Losing Bill has been tremendously difficult for Pringle. “He was my best friend,” she says. As much as she’s grateful for five decades with a wonderful partner, she still feels like their time together was cut short by cancer. Two years since his passing, Pringle remains committed to supporting the Alberta Cancer Foundation with yearly donations, and she has also named the Foundation in her will. For Pringle, the decision to donate is an easy one: “We need money for research — that’s the only way we’ll beat cancer and improve diagnosis and treatment.” LEAP
MY LEAP
LEILA GODFREY AND HER GRANDFATHER, EMILIO, SHARE THE SAME STRONG-WILLED DETERMINATION
Walking for Nonno Six-year-old Leila has big plans for helping people with cancer by SHANNON CLEARY
THE DAY GIULIA GODFREY LEARNED THAT HER FATHER, EMILIO, HAD
cancer, she drove to her children’s school with a decision to make. Should she tell her then-five-year-old daughter, Leila, that “Nonno” was sick? Godfrey decided that, yes, Leila would want to know. And she was not at all surprised when Leila announced that she wanted to help. “She just very matter-of-factly said, ‘Well, we need to do something,’” recalls Godfrey. After that day in June 2017, Leila and her family got to work. Inspired by Terry Fox, Leila decided to organize a charity run to save her Nonno. “I wanted to run around the whole world,” Leila says. After some practical considerations, Leila chose a shorter route through Downtown Calgary, and the Tiny Prancer vs. Liver Cancer 5km Run was born. With an original fundraising goal of $5,000 and just two months until the big event, Leila began a busy campaign of fundraising on social media and within her school community. She documented her donation progress and ran updates on her event web page, involving as many people as possible in her fundraising journey. “Not only did she have the support of her family and friends, but
also the support of the community and the school,” says Godfrey, adding, “Leila can be very convincing.” By the day of the race — August 12, 2017 — the Tiny Prancer vs. Liver Cancer 5km Run had raised $6,100 for the Alberta Cancer Foundation in support of the Tom Baker Cancer Centre in Calgary. Leila ran alongside her mother, her grandparents and 35 other supporters. Nonno Emilio was very proud of his granddaughter. “He said I’m doing good,” says Leila. According to Godfrey, her father, who completed treatment on October 18, 2017, possesses the same strong-willed, almost stubborn determination she sees in her daughter. “Leila is very much his character,” says Godfrey. “She’s going to move mountains, this kid.”
“ I learned that I can help my community. I can make a difference.” – Leila Rei Hunter Godfrey
Godfrey knows her family’s experience has taught her daughter one of life’s difficult lessons: cancer can affect anyone, at any age. But it has also taught her something wonderful. “I learned that I can help my community,” says Leila. “I can make a difference.” LEAP myleapmagazine.ca WINTER 2018 LEAP 49
GAME CHANGER
The Family Way Small business Spiker Equipment makes yearly donations to the Cross Cancer Institute a family tradition by JENNIFER DOROZIO
FOR THE LAST 20 YEARS, LORRY SPIKER, OWNER OF SPIKER EQUIPMENT
in Morinville, Alta., has set aside a day in the week between Christmas and New Year’s to bundle up in a warm winter coat and, alongside his family, hand-deliver yearly donations to charities across Edmonton. The giving route the family takes each year is always the same. First, they drive from their home in Morinville down to Edmonton’s Cross Cancer Institute to present the Institute with a cheque, then they head south, park at Southgate Centre, and ride the LRT to the Stollery Children’s Hospital for the second cheque drop-off. After catching the LRT back to their car, their final stop before suppertime is a drive to North Pointe Community Church, where they present their year-end tithe donation. Spiker says he chooses to support the Cross Cancer Institute every year because he has lost family members to the disease. Both of his grandfathers died from cancer, and his older brother, Jason, was diagnosed with leukemia as an infant and passed away before Spiker was born. Spiker’s parents never really shared much with him about Jason’s life, but the combined losses of the brother he never knew and his 50 LEAP WINTER 2018
grandfathers keep him motivated to donate to cancer research and patient support. “I hope, if nothing else, for people with cancer to have relief, and, ultimately, to live longer,” he says of the intent behind his annual donation. But it isn’t just his own ties to cancer that keep Spiker donating to the Cross Cancer Institute — he and his children are also drawn in by the enthusiasm and warmth they are always shown by the Institute’s staff when the family arrives to present their cheque. In the early years, Jane Weller, development director for the Alberta Cancer Foundation at the Cross Cancer Institute, would ask that Spiker call ahead just so that she could be there to receive the group and their donation in person. “Jane was always the welcoming recipient of our giving. She had an everlasting effect on me and on my children as they started understanding what we were doing there and what the Cross Cancer Institute does,” says Spiker. “She would always type out a special letter to me and my family thanking us for the visit and donation. It may seem like a small gesture to some, but it goes a great distance. I have numerous letters from Jane framed and some displayed in my office.”
“ I hope, if nothing else, for people with cancer to have relief, and, ultimately, to live longer.” – Lorry Spiker How much Spiker and his family donate each holiday season varies depending on factors related to Spiker Equipment’s year-end review, but the cheques dropped off at the Cross Cancer Institute over the past 20 years now total more than $33,150. Dealing in pre-owned heavy equipment trade, rentals and sales, Spiker Equipment is not a large company; in its busiest season, the store will employ up to five workers, but it generally keeps three full-time employees. Despite his company’s size, Spiker makes sure to prioritize giving back and believes that donating is an important practice to model to his children. “In the future, if they are blessed like I have been, they will do the same,” he says. “They will keep donating so they can help others.” LEAP
Once again, we would like to extend a huge thank you to our clients, vendors, the Rangeland herd, and the Alberta Cancer Foundation for supporting the Rangeland Engineering annual Cameron Daye Golf Invitational. We had our best year ever and raised over $110,000 in support of the Cameron Daye Sarcoma Fellowship, enabling full time sarcoma cancer research at the Tom Baker Cancer Centre.
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