QEII Times - Summer 2021

SHINING A LIGHT ON THE QEII HEALTH SCIENCES CENTRE, ITS STAFF, VOLUNTEERS AND DONORS

SUMMER 2021

A QEII FOUNDATION PUBLICATION IN ASSOCIATION WITH THE CHRONICLE HERALD

YOUR QEII Local cancer patient makes a big impact

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QEII New Generation project looks to the future 4-5

Pocket Talker technology at the QEII

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Chris Ronald, RBC’s regional president, Atlantic Canada — pictured here with QEII Foundation president and CEO Susan Mullin — says “the demand for free and accessible mental health services has never been greater.” QEII Foundation

Demand for free, accessible mental health services ‘has never been greater’ RBC Foundation donates $600,000 to QEII Foundation to support e-mental health program in Nova Scotia

RESEARCH & INNOVATION Genetic sequencing in the fight against cancer

Discovering diversity in mood disorders

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Nova Scotia’s new organ donation legislation 12

ALSO Philanthropy a catalyst for health research

How donations help fuel funding for research and advancing care Page 7

Lighting the way

By Heather Laura Clarke Many Nova Scotians have suffered mental health trauma over the last year, between the ongoing COVID-19 pandemic and the tragic mass casualties of last April — drastically increasing the need for free, on-demand health services in the province.

That’s why RBC Foundation has donated $600,000 to the QEII Foundation to help launch critical e-mental health services that can be accessed from anywhere, without the need for a doctor’s referral or an in-person appointment.

Nova Scotia’s new e-mental health program is the first of its kind, providing immediate help with improving mindfulness, building coping skills, reducing stress and resolving addiction.

The province partnered with the Mental Health Commission of Canada to undergo this health system transformation, and the evidence-based program is being modelled after a successful version already up and running in St. John’s.

QEII Foundation president and CEO Susan Mullin says the frightening early months of the pandemic set many Nova Scotians on a distressing path, and she’s glad there are now virtual options for people to access at their own pace.

“The needs were always there, but through COVID the needs have just been amplified — and mental health is just as important as physical health,” says Susan. “We’re proud that RBC Foundation really has led the

charge on this so dramatically, and we’re very grateful for their support.”

This is about making mental health services free and available to all Nova Scotians, no matter where they are.

EARLY INTERVENTION PROGRAMS Chris Ronald, RBC’s regional president, Atlantic Canada, agrees the province has been through a lot over the last year, and says “the demand for free and accessible mental health – Susan Mullin, services has never been greater.”

QEII Foundation Supporting the QEII Foundation’s president and CEO e-mental health initiative was an easy decision, he adds, because RBC’s commitment is focused on prevention and early intervention programs.

“One of the factors that affects a young person’s ability to achieve success is their mental well-being. Because 75 per cent of mental illness is diagnosed between 16-25 years of age, services like these that can be accessed anytime and anywhere are crucial in providing youth “Technology-based programs with the tools they need to like this will provide Nova succeed,” says Chris. “We liked the Scotians, particularly youth and fact that it’s an evidence-based those living in rural communities, model, it fills a real and widening timely access to knowledge, gap in our province, and it’s free supports and care when and — making it more accessible to where they need it,” says Chris. those who need “We are incredibly proud to it most.” partner with the QEII Foundation Through this partnership on this initiative which positions with the QEII Foundation and our province as a leader in virtual Nova Scotia Health, Chris says mental health service delivery.” everyone at RBC is glad to help To learn more about Nova Scotia’s provide immediate and free e-mental health program and ‘A LEADER IN VIRTUAL MENTAL mental health supports and the QEII Foundation’s campaign HEALTH’ services to help address barriers to fund these services, visit Funds raised will help the QEII often faced by youth when Ourtrying specialized Teepa Snow Dementia training QE2Foundation.ca.

Foundation continue to build on to access the care they need. enables our caregivers to appreciate what is

DEMENTIA

QEII neurosurgeons use new drug during brain tumour surgery Page 11

e-mental health programming.

Susan says the gesture is just as important because of the message it sends.

“I’ve worked in mental health before, and I know how important it is for corporations like RBC to step up and align themselves with mental health,” says Susan. “If someone’s struggling with a mental health issue, it’s empowering to see a big corporation publicly step up and say, ‘This matters, and we want to help.’ It goes a long way towards destigmatizing mental health issues.”

While in-person treatments are required for some people, e-mental health programming can be helpful for people experiencing mild to moderate disorders — and can also be used in conjunction with more acute care, or while waiting to receive in-person care.

“We’ve been having a lot of conversations about how we support mental health, and the reality is that this isn’t a service delivered specifically within the four walls of the QEII Health Sciences Centre,” says Susan.

“This is about making mental health services free and available to all Nova Scotians, no matter where they are.”

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A QEII Foundation publication in association with The Chronicle Herald, QEII Times is designed to shine a light on the QEII Health Sciences Centre community.

Editor Paula Bugden Communications, QEII Foundation Jenn Coleman-Ford Senior Manager Page Production Claudia White Senior Graphic Designer Julia Webb Contributors Allison Lawlor Brandon Young Emma Keevill Heather Laura Clarke Joey Fitzpatrick Sara Ericsson Photographers QEII Foundation © The Chronicle Herald 2021 All rights reserved. No part of this publication may be reproduced, stored in retrieval systems or transmitted in any form or by any means without prior written consent from the publisher.

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A word from the QEII Foundation Taking health care to new heights amid the COVID-19 pandemic

By Susan Mullin, president & CEO, QEII Foundation “Remember, the last part of any marathon is the hardest.”

These words, spoken by Dr. Robert Strang, chief medical officer of health, encouraged Nova Scotians to stay strong as the province was thrust into its third wave of COVID-19 this spring.

While we may have grown weary, it’s because we are fighting and refusing to give up — part of our East Coast DNA. The pandemic has united us. Our circumstances and struggles may look a bit different, but together we’ve been living through something for which there is no roadmap.

It’s been nearly a year since I joined the QEII Foundation team, helping to advance health care for our communities. While I’m thrilled to be back in Nova Scotia, it’s certainly been an interesting, often challenging, year.

Words previously foreign to us — physical distancing, selfisolation and PPE — have become part of our everyday vocabulary.

Wearing a face mask to the grocery store has become second nature. Virtual connections have taken centre stage, from business meetings to kitchen parties to family gatherings.

Throughout these past few months, I’ve been inspired by our communities, who continue to step up to support patients and healthcare teams. Individuals and businesses, kids and kids at heart, from all corners of our province and beyond, Nova Scotians rallied to support the QEII COVID-19 Response Fund, directly impacting care needs in the QEII’s COVID-19 units and supporting patients after they return home.

And COVID-19 aside, remarkable shifts are happening in our healthcare system, thanks to thousands of donors. Over the last year, we’ve delivered better mental health services,

funded new cancer treatments and diagnostic imaging scans and helped open brand-new interventional radiology suites for minimally invasive procedures from head to toe.

All of these milestones were reached during a global pandemic — and that says something really special about the people in our communities.

As plans for QEII New Generation take shape at what is currently the QEII’s Halifax Infirmary site (check out the photo essay in this issue), the QEII Foundation has aspirational goals to take health care to new heights, now and into the future.

We are committed to supporting the changing healthcare needs of Atlantic Canadians.

We all know that health care is about more than new buildings; it’s thousands of people delivering exceptional care every day. With support from our communities, the QEII Foundation will provide next generation technology to advance

diagnoses and treatment for patients from across Atlantic Canada.

But the real transformation will be in what is enabled by both the new facilities, including the ability to recruit world-leading physicians and staff, and by community support for the QEII Foundation’s investments in new ways of delivering care, both in and through the QEII. And it will elevate the QEII’s research, innovation and discovery mandate to new possibilities.

As we continue to make our way through the pandemic, I want to acknowledge the front-line healthcare workers who step up to the plate every day to care for those of us in need; the support teams working behind the scenes; individuals and organizations who continue to support our health heroes in creative ways; and each and every Nova Scotian working to stop this virus in its tracks.

We’ll get through this.

Together.

A starfish story

How a local cancer patient made a big impact in the QEII unit that became his QEII family

By Emma Keevill For Terry Thorne, receiving a cancer diagnosis amid the pandemic showed just how shockingly fast a life can be changed.

In spring 2020, things were going great for Terry — spending time with his loving and happy granddaughters, a new grandchild on the way, a loving marriage of 40-plus years, golfing with friends. For a pandemic, life was feeling pretty sweet.

Things changed in June when

Terry started to feel unwell; his appetite was gone and he knew something was off. At first, he was scared it could be COVID-19 and started to think about the loved ones he’d been in contact with recently. He booked a test that came back negative. He was relieved.

By Canada Day, Terry still wasn’t feeling like himself. He and his wife decided this strange flu was going on a little too long, so they took a trip to the QEII’s

Charles V. Keating Emergency and Trauma Centre.

Things moved quickly from there. Terry was diagnosed with acute myeloid leukemia (AML), an aggressive form of cancer of the blood and bone marrow.

Terry was admitted into the QEII’s Hematology, Medical Oncology and Blood and Marrow Transplant Unit, 8A and 8BMT, where he started treatment.

Grateful for his care team and the experts who supported him

through his cancer journey, Terry was compelled to give back in a meaningful way. He said he wanted to make an impact in a space that impacted him so profoundly.

Terry always lived his life by the old fable of the starfish and the little boy walking the beach.

As the story goes, a little boy walks along a beach with millions of starfish washed up around him.

STARFISH – Page 3

SUMMER 2021

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Starfish Continued from Page 2

He picks up a single starfish and throws it back in the water.

A man comes along and tells the boy there are millions of starfish washed up and he won’t be able to make a difference. The little boy picks up another starfish, throws it in the water and says, “I made a difference for that one.”

On March 22, 2021, after battling his cancer for more than 10 months, Terry passed away at age 66. Terry is survived by his wife, Linda Thorne, their children and grandchildren. With him every step of the way through this journey, Linda has continued to honour Terry’s fundraising efforts.

“Terry was always the type of person to create change and be a leader,” says Linda. “It was natural for him to take charge of a project. Terry had an ability to connect with people and really inspire them.”

Due to gathering restrictions with COVID-19, Terry opted to create a virtual fundraising page through the QEII Foundation’s do-it-yourself (DIY) online fundraising platform. He shared his story and the generosity of his community has been extraordinary.

“The fundraiser was something we talked about every day. It was something positive that he could keep track of and focus on. We

would get so excited when we got an email with a virtual high-five for a new donation,” says Linda.

Terry explained in an interview before his passing that when you enter this type of treatment protocol, you leave behind everything familiar to you. In a patient’s vulnerable state, there is a heightened sense of the world-class expertise, compassion, kindness and generosity of those who are caring for you.

Through his treatment, Terry saw his doctors, nurses, nursing assistants and support staff all work as a team. He saw a real sense of family within his unit.

From Terry’s initial chemo treatment on July 3, bone marrow transplant with his brother Bill as the donor, up until March 5, Terry had spent more than 70 days in the hospital.

Terry also felt lucky to have his wife able to visit throughout the pandemic; he felt that having one support person made a big difference.

“I was blown away by the incredible care at the QEII. The level of personal connection that the staff have with patients and their families is something special. I felt like they genuinely cared about how we were coping, how we were dealing with all of this,” shares Linda.

“We felt supported as we left

In spring 2020, Terry Thorne (right) was diagnosed with acute myeloid leukemia. Grateful for his care at the QEII, Terry and his wife, Linda (left), began fundraising to help other families like theirs. Since Terry’s passing in March 2021, Linda, along with Terry’s friends, are carrying on his legacy in this year’s Ride for Cancer event. Contributed

the hospital after Terry’s bone marrow transplant. It was his journey, but I was on it with him and it was comforting to know that he was getting the best care.”

Terry and Linda’s shared goal is for the money raised to improve capacity for care teams at the QEII, so they can do their job in the most effective manner possible. The fundraiser has already raised more than more than $37,000 and that number continues to climb, with Linda carrying the fundraiser forward in Terry’s honour.

Terry shared that his journey took him to a very spiritual place and he spent a lot of time focusing on making the most

It was his journey, but I was on it with him and it was comforting to know that he was getting the best care.

– Linda Thorne

of his time here, “healing any cracks,” he said. Terry felt that he lived a very blessed life and decided very early on that he was going to focus on being happy and optimistic through whatever

life threw his way. A promise he kept to his dying day.

Terry’s legacy lives on and will have a tangible impact for others battling cancer here at home in Atlantic Canada. Part of Terry’s legacy will be the number of lives he will touch through his fundraising efforts.

Terry’s friends are coming together as Team Jellybean — his youthful nickname — to raise funds for cancer care by participating in this year’s Ride for Cancer powered by BMO Bank of Montreal. To help carry on Terry’s legacy, you can support Team Jellybean at fundraise.yourrideforcancer.ca/ fundraisers/jellybean.

Giving the gift of new eye technology Patient’s generous donation allows the QEII to acquire an Oculus Pentacam AXL Wave

By Allison Lawlor A gift to the QEII Foundation has given Ted Stenton and his wife Holly the prospect of helping thousands of people across the Maritimes while also recognizing the necessary and great work that is done at the QEII Health Sciences Centre’s ophthalmology department.

An Oculus Pentacam AXL Wave — the first in Atlantic Canada and soon to arrive at the QEII — will greatly improve the diagnosis and treatment of eye disorders affecting the cornea, the clear outer layer at the front of the eye, and dramatically reduce the number of patients requiring difficult corneal transplants.

Last year in Halifax, Dr. Darrell Lewis, an ophthalmologist and cornea specialist, and his colleagues at the QEII performed 230 corneal transplants on patients from the Maritimes.

“The Oculus Pentacam AXL Wave is the industry leader in looking for a condition called keratoconus,” says Dr. Lewis.

“It is a frequent condition that we see in patients and it often requires a corneal transplant.”

Keratoconus occurs when the cornea thins and gradually

bulges outward into a cone shape, often causing blurred vision. By detecting keratoconus earlier, with the help of the Oculus Pentacam AXL Wave, QEII eye specialists will be better able to stabilize the condition before a transplant is required.

“The Pentacam revolutionizes the way these patients are taken care of through early detection,” says Dr. Lewis.

Undergoing a corneal transplant is a long, hard process for patients. Sixteen stitches are placed on the surface of the eye and patients often undergo 18 months of recovery before they can see well again.

“It really is a big deal to go through a corneal transplant. It’s really a nice gift that there are going to be fewer patients that need it,” says Dr. Lewis.

The Oculus Pentacam AXL Wave’s technology is new for the QEII’s ophthalmology department. It exceeds the capabilities of the QEII’s current equipment, the optical coherence tomography (OCT), which is a non-invasive imaging test.

“The wave portion of it adds new diagnostic capabilities

that we never had before,” says Dr. Lewis. “It is actually three technologies built into one.”

It works by mapping the cornea and the eye. Using tomography, the imaging by sections with a penetrating wave, the technology allows specialists to look at corneal thickness, elevations and depressions.

“It is very impressive technology.

It gives accurate information very quickly that we can’t obtain with other devices. We’re very excited to be able to have this technology,” says Dr. Marcelo Nicolela, head of ophthalmology at the QEII. “It will allow for early diagnosis of cornea diseases and planning for difficult surgeries in patients who have challenging diseases.”

Adding the Oculus Pentacam AXL Wave to the ophthalmology team’s diagnostic and planning tool kit will also enhance research at the QEII. The new technology will be integral to any studies on keratoconus that are conducted, says Dr. Lewis.

It will also become a critical component in how specialists fit specialized contact lenses for patients who come to the QEII’s

Dr. Darrell Lewis (left), an ophthalmologist and cornea specialist, and Dr. Marcelo Nicolela (right), head of ophthalmology at the QEII, are enthusiastic about adding the Oculus Pentacam AXL Wave to the ophthalmology team’s diagnostic and planning tool kit. This new diagnostic equipment was generously funded through a gift to the QEII Foundation. Contributed

eye clinic from throughout the Maritimes. The images generated from the Oculus Pentacam AXL Wave will make it easier for the eye clinic to modify and partially manufacture contact lenses considered the most difficult to fit.

Ted and Holly are elated that their generous donation will directly provide QEII eye care specialists, like Dr. Lewis, with advanced technology that will allow them to better help patients and strengthen eye care across

the Maritimes.

“Dr. Darrell Lewis is inspirational. He is clearly patient focused,” says Ted. “The whole department is just spectacular.”

For Dr. Lewis, it’s not every day he has patients giving thanks in such a meaningful and beneficial way.

“I am quite honoured that they were interested in donating to the corneal services at the QEII,” he says. “It’s quite a special thing for me.”

Mak ake k time for a routine check-in.

There’s no denying the heal alth l benefits of relax axing x by the sea, plunging into the chilly Atlantic, or sharing a meal all of fresh, local all seafood with loved ones. Mak ake k time for a round of golf, or a wal alk l on our beautifu ful u sand beach. Gather around the evening bonfire and meet other beach-minded people.

Enjoy live entertainment in the Lounge before fal alling l asleep to the lullaby of crashing waves. Check-in with yourself and feel your shoulders drop.

Follow the nature trail. Nap aft fter t lunch. Ski kip i stones. Try ryy paddle boarding.

Play tennis. Meet our beekeeper. Do a little yoga. Paint beach rocks ks. s Get Chef to pack a lobster roll picnic for a hike at Keji Seaside.

Or, sit on the porch with a cold local all brew and be thankf kfu ful u for the same ol’ marv rvelous v routine at White Wh h Point.

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QEII New Generation Health care in our province is changing. These changes will impact each and every Atlantic Canadian now and in the future. This real, system-wide transformational change is a once-ina-generation opportunity. After many years of planning, the future of the QEII Health Sciences Centre is taking shape.

The QEII is the adult community hospital for Halifax and surrounding areas. It is the most advanced, leading academic and research health sciences centre in our province, seeing over 1.1 million patient visits each year. The QEII is also the major referral centre for specialized, complex care for Atlantic Canada and beyond.

The redevelopment and expansion of the QEII’s Halifax Infirmary campus will move acute inpatient care services to one site, becoming one of the largest health sciences complexes in the country. The construction of a second outpatient centre, the Bayers Lake QEII Community Outpatient Centre, is scheduled to be complete in 2023.

The QEII New Generation project is working to build a new generation of innovative, breakthrough care. This project is a tremendous undertaking – the largest healthcare infrastructure project in Nova Scotia’s history – and will positively impact our province for decades to come.

But buildings alone do not deliver care. That superior care is supported by brilliant healthcare experts, by advanced equipment, and by world-leading research that make medical miracles possible. With the QEII Foundation’s vision and financial support, QEII New Generation will include next generation technology – the newest version that is more powerful and smarter than the previous. It will be about recruiting and retaining physicians and staff – giving them the best opportunity to practise medicine.

Note: All images are for illustration purposes only and are subject to change.

QEII Health Innovation, Research and Discovery Hub

In this view from Bell Road and the North Common, the new QEII Health Innovation, Research and Discovery Hub takes centre stage. This space will make it easier for health professionals to learn, collaborate virtually and in-person, and advance clinical care through research.

Seated above the Hub are the QEII Halifax Infirmary Outpatient Centre (centre-left) and the QEII Cancer Centre (right). There will be a pedestrian pedway that connects a new parking structure directly to the new buildings to improve the patient wayfinding experience.

New specialized area for surgical preparation

The construction of the new QEII complex will completely alter the current Robie Street face of the QEII’s Halifax Infirmary site and includes new construction directly in front of the current Charles V. Keating Emergency and Trauma Centre.

This space includes a new medical device reprocessing unit, where surgical tools are cleaned and sterilized before surgeries. With the addition of new operating rooms, this space will be ready to support an increased number of surgeries.

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Improving the patient care experience

QEII New Generation will increase access to modern, patient-centred, quality care and leading-edge health technologies, all while improving the patient care experience. A foundational principle of the QEII New Generation project is to create a healthcare experience that is comfortable and welcoming for everyone – patients, their families and visitors.

This illustration shows an aerial view of the new QEII that will include covered patient dropoff areas, lots of natural light, open greenspace, self-serve kiosks, and improved patient and family-centred wayfinding.

QEII Cancer Centre and QEII Halifax Infirmary Outpatient Centre

The new QEII Cancer Centre – Atlantic Canada’s largest cancer treatment centre – will be built facing Robie Street.

By co-locating the new cancer centre with the QEII Halifax Infirmary Outpatient Centre, the new inpatient building and surgical suites, cancer care will be more efficient and more comfortable for patients, providing more than 260 cancer treatments every day.

The new QEII Halifax Infirmary Outpatient Centre will provide outpatient care to residents of peninsular Halifax and to patients from across Nova Scotia. This outpatient centre will feature an 18-station renal dialysis clinic; the QEII Eye Care Centre; Heart Health Centre; services that require patient sedation, such as colonoscopies, oral surgery and pain block procedures; the Medical Day Unit, Diagnostic Imaging and many other clinics.

Inpatient building and surgical suites

At the corner of Robie Street and Veterans Memorial Lane, the new inpatient building and 12 new surgical suites will be built. New inpatient rooms will be mostly private with an abundance of natural light, and lifts for patient comfort and staff safety.

The operating rooms (OR) will feature innovative, leading-edge technology to support excellence in surgical care and improved patient outcomes. Including the current inpatient and OR capacity in the QEII Halifax Infirmary building, the future QEII will have over 600 patient beds and 23 ORs.

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Talking technology QEII Foundation grant eases communication for hearing-impaired patients via Pocket Talker devices

By Sara Ericsson Understanding a doctor explaining a medical procedure can be difficult for anyone. It becomes even harder for people when communication is impaired.

Pocket Talker technology is now available for patients with hearing impairments at the QEII Health Sciences Centre through a QEII Foundation Comfort & Care Grant. And the timing could not be better, with greater than normal need as COVID-19 pandemic protocols, like mask wearing, affect communication.

Dr. David P. Morris, an otologist (ear surgeon) at the QEII, says this simple yet effective technology means patients can fully understand and consent to procedures and make better-informed decisions as they navigate their healthcare journey — both during and after the pandemic.

“It’s a relatively simple, noninvasive intervention which is proven to be effective. We know it works,” he says.

Funded by generous donors, the QEII Foundation Comfort & Care Grants were established in 2005. These grants support QEII projects that don’t typically receive funding from the health centre’s main budgets and that show a direct benefit to patients and their families.

Dr. Morris says the benefits of Pocket Talker devices are in the simple technology and universal results. The devices have been around for years and consist of

a sound amplifier and analog technology, which includes a volume knob that wearers can easily adjust to their comfort level.

“The beauty of this device is in its simplicity and cost. It’s relatively cheap — around $300 to $400 — and is basically one size fits all,” says Dr. Morris.

“Those who like it, like it a lot.

We’ve even had some patients purchase these for themselves, as they’re much more affordable than a hearing aid.”

More Pocket Talker devices were needed in the Division of Otolaryngology — Head and Neck Surgery outpatient clinic, as patients have had to sometimes share devices or the clinic would use them in conjunction with the Nova Scotia Hearing and Speech test centre.

Dr. Morris says his QEII colleagues, audiologist Duncan Floyd and otolaryngology division administrator Brenda Oake, discovered and applied for the Comfort & Care Grant, through which four Pocket Talker devices were purchased.

“These devices will be used at the clinic and on our floor at the hospital, for general use or even by post-op patients, who often experience temporary hearing loss,” says Dr. Morris.

Ready access to Pocket Talker devices ensures patients with some limitations to their hearing abilities are able to communicate with doctors, according to Dr. Morris.

Dr. David P. Morris (left), QEII ear surgeon, and Duncan Floyd (right), QEII audiologist, show off new Pocket Talkers, a simple device to help patients with hearing impairments hear and understand crucial information to help them navigate their healthcare journey. The Pocket Talkers were funded through the QEII Foundation’s Comfort & Care Grants. Contributed

“Most of us don’t think twice about the beauty of our ability to hear clearly. When it becomes a challenge, hearing-impaired people spend an inordinate amount of energy trying to understand what people are saying to them,” he says.

“Speech isn’t just tonal sounds, beats or whistles; it is complex and nuanced and it doesn’t take much to lose its meaning. When you lose it, the effort required to concentrate on every word is absolutely exhausting.”

With personal protective barriers and mask-wearing protocols in place since the onset of COVID-19, sound and facial speech cues have been drastically limited, leaving people with hearing impairments at a loss during day-to-day tasks and communication, including at medical appointments.

The use of Pocket Talkers

The difference is being able to be engaged or not at all, so that might translate into someone being able to be fully informed in the consenting process.

– Dr. David P. Morris

circumvents this, meaning those who use them can not only understand what doctors are speaking with them about, but can practise informed consent with respect to their medical procedures. It also means patients are able to hear and understand instructions for post-procedure care when they go home.

“The difference is being able to be engaged or not at all, so that might translate into someone being able to be fully informed in the consenting process,” says Dr. Morris.

That’s why Dr. Morris and his team are so thankful for the QEII Foundation’s support in granting them this funding. They know it will make a difference for countless patients.

“These devices are a real lifeline. We’re just so grateful for this support and that this grant exists,” he says.

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Dr. Gail Tomblin Murphy (left), Nova Scotia Health’s vice-president of Research, Innovation and Discovery and Chief Nurse Executive, and Dr. Steven Beyea (right), scientific lead at the Biomedical Translational Imaging Centre (BIOTIC), have witnessed first-hand how donor investments in research have a direct impact on advancing care for patients. Contributed

Philanthropy a catalyst for health research How donations help leverage additional funding for research and advancing care for Nova Scotians

By Allison Lawlor Dr. Gail Tomblin Murphy, Nova Scotia Health’s vice-president of Research, Innovation and Discovery and Chief Nurse Executive, knows philanthropy is an important catalyst for research and a critical means of leveraging other funding dollars for research projects, especially during a crisis.

This combined power of philanthropy and collaboration is currently at work within the Nova Scotia COVID-19 Health Research Coalition, an alliance formed among several healthcare partners, including the QEII Foundation, to support research studies focused on health system decisions, vaccine development, novel treatments, and social response to the pandemic.

“In a matter of just over two weeks, a shared investment of approximately $1.5 million in COVID-19-focused research was launched,” says Dr. Tomblin Murphy. “In my 35 plus years in health care and health research and innovation, I have never seen such a unified, impactful response to a crisis.”

Since then, several research teams funded through the Nova Scotia COVID-19 Health Research Coalition have been successful in attracting additional funds.

Dr. Lisa Barrett, an infectious disease expert at the QEII Health Sciences Centre, is just one example. Her team recently obtained a $1.9-million federal grant to examine vaccine effectiveness in older people.

She is also part of a team of researchers funded by the Canadian Institutes of Health Research to examine clinical characteristics and outcomes of confirmed and suspected hospitalized cases of COVID-19 infection.

“Local funding from healthcare foundations, because of the generosity of donors, can make a critical difference in supporting the important work of researchers and innovators,” says Dr. Tomblin Murphy.

Dr. Steven Beyea, scientific lead at the Biomedical Translational Imaging Centre (BIOTIC) for the QEII and the IWK Health Centre, has witnessed first-hand how donor investments in research not only facilitate research, but allow researchers to use that funding to leverage more money to advance the quality of care for patients and create long-term changes in the way care is delivered.

In 2014, a new 3T MRI arrived at BIOTIC at the QEII, thanks to $3.1 million raised by the QEII Foundation, including a $2.5-million gift from the David and Gauthier families. The advanced imaging capability of the 3T MRI allows for new clinical and research studies not previously possible in Nova Scotia.

Along with the immediate impact to patient care, the 3T MRI resulted in an Atlantic Innovation Fund award of close to $3 million.

It also led to the development of a research partnership with

GE Healthcare and Toronto’s Synaptive Medical, a company focused on a variety of medical devices for studying the brain.

“Dr. Beyea’s work in this area is a great example of how donor dollars have led to innovative health research in Nova Scotia, garnering national and global attention,” says Dr. Tomblin Murphy.

Since then, the 3T MRI has made countless research projects possible, supported the development of new technologies, attracted incredible people to work at the QEII, and helped train students, creating opportunities for them to work in Nova Scotia’s growing biomedical technology sector.

“Equipment is critical when it comes to either health care or it comes to research. It is enabling,” says Dr. Beyea. “This high-impact equipment pulls in high-impact people.”

As an example, he points to Dr. Kimberly Brewer, a Maritimer who went to work at Stanford University in the U.S. but was drawn back to Halifax to work as a scientist at BIOTIC and pursue her research in imaging. She is driving research with Nova Scotia companies to better understand how vaccines work, says Dr. Beyea.

Having the 3T MRI at the QEII ignited a partnership with Synaptive Medical. The QEII is now evaluating the impact of an MRI instrument the company designed, which could provide diagnostic information

Dr. Beyea’s work in this area is a great example of how donor dollars have led to innovative health research in Nova Scotia, garnering national and global attention.

— Dr. Gail Tomblin Murphy

Local funding from healthcare foundations, because of the generosity of donors, can make a critical difference in supporting the important work of researchers and innovators.

— Dr. Gail Tomblin Murphy

for patients arriving in the emergency department with acute neurological symptoms.

About a year ago, the first of Synaptive Medical’s EvryTM MRI was placed in the QEII, about five metres away from the 3T MRI. “It is now driving an entirely new area of imaging research, at which Nova Scotia is at the absolute forefront,” says Dr. Beyea.

Radiologist Dr. Adela Cora is analyzing whether the new rapid screening technology can be used to detect strokes in some patients. While a computerized tomography (CT) scan is the standard of care in detecting stroke, MRI is sometimes more sensitive in detecting strokes in certain patients.

“The EvryTM MRI has the opportunity to potentially play a very important screening role,” says Dr. Beyea. Knowing the coronavirus has acute and longterm neurological impacts, the EvryTM MRI could help doctors during the pandemic. “There is opportunity for this device to possibly play a role screening for neurological effects due to COVID,” Dr. Beyea explains.

Dr. Tomblin Murphy understands donors of the QEII Foundation are integral in making these advances happen.

“Without them, we would not be able to provide quality care for patients, their families and communities across our province, which is grounded in applying health research and innovation to enable positive health outcomes.”

SUMMER 2021

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In the fight against cancer Retired infantry sergeant battles stage four cancer and comes out on top, thanks to targeted therapy and genetic sequencing technology at the QEII

By Emma Keevill

Diagnosed with stage four metastatic melanoma in 2016, Graham Wade is now cancer free. Graham and his wife, Kayla, are grateful for the care he received at the QEII, including isolating the DNA in his cancer tissue to find out more about his unique cancer using genetic sequencing technology. Contributed

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Graham Wade spent 18 years in the military, specializing in infantry and leadership coaching before retiring at 36 years young. The father of four spent the last five years of his career with the military in leadership coaching. It was in these last years of his service, and as he and his wife were expecting their fourth baby, that he got sick.

His journey with cancer started with a bang when he collapsed at work and was rushed to the hospital. After his assessment, his care team discovered five golf ball-sized masses throughout his body, including his liver, back, lungs and pancreas.

That’s when Graham was diagnosed with stage four metastatic melanoma, a life-threatening type of skin cancer where the cancer spreads throughout the body to the organs. Graham’s masses were doubling in size every two weeks.

“After a career in infantry, this was just another battle for me. I made a conscious decision to think like a gladiator,” says Graham. “I kept a positive mindset and put all my energy into beating this thing.”

Graham’s oncology team was unable to surgically remove the masses due to a high risk of them hemorrhaging. That’s when he met Dr. Ravi Ramjeesingh, a medical oncologist at the QEII Health Sciences Centre, who, like many oncologists in Halifax, specializes in the key role that genetics plays in cancer care and treatment.

Dr. Ramjeesingh requested a sample of Graham’s cancer tissue and the pathology department isolated the DNA to find out more about his unique cancer using genetic sequencing technology.

This innovative technology looks for mutations in the genetic makeup of a patient’s unique cancer to identify targeted therapies that could be used for treatment using precision medicine.

Through this genetic sequencing, Dr. Ramjeesingh found that Graham’s cancer harboured a particular type of mutation identified as BRAF. With this information, Dr. Ramjeesingh was able to identify a personalized combination of targeted therapy that would best respond to this specific mutation.

“He started on a combination treatment and had a dramatic response,” says Dr. Ramjeesingh. “After nine months of using the targeted therapy, he went into surgery to remove two remaining masses that had become small enough to operate on. The biopsy results declared those tissues as cancer free. This indicated that the targeted therapy had a 100 per cent response.”

Not only did Graham go from stage four cancer to cancer free, thanks to this technology, but he also experienced little to no side-effects from his treatment.

“Looking back, I was more fatigued than I thought at the time, but I was able to live my life and continue working through my battle with cancer, which I am really grateful for,” says Graham.

After surgery, Graham started a oneyear plan for immunotherapy — a form of cancer treatment that uses one’s own immune system to fight cancer. He was cancer free, but his team wanted to be safe. He completed that therapy plan at the end of 2017 and now sees Dr. Ramjeesingh every four to five months for scans and is doing very well.

“When it comes to this technology, it was a game-changer for me and I know it could be for other patients, too. At best, I was hoping that this treatment would buy me some time, but today I’m cancer free. We’re talking about identifying new, better treatments — wonder drugs as I

call them — for cancer patients and giving them less invasive treatment options as well. This technology helped me carry on with my regular life with my kids, my wife and even my job. If this disease did end it for me, at least I was able to live life to the fullest for longer.”

In 2021, Ride for Cancer powered by BMO Bank of Montreal is leading the charge to introduce a new, best-in-class genetic sequencing machine at the QEII. This new technology will be able to sequence the entire human genome in a single day, like reading an instruction manual for the disease that identifies more cancer-causing mutations than ever before.

This latest model is also significantly faster than the QEII’s current model, requires fewer patient samples and can sequence multiple tests simultaneously — meaning the QEII will be able to better meet the increasing demand for nextgeneration sequencing and precision medicine.

“Technology changes all the time,” explains Dr. Ramjeesingh. “Anyone who has a computer right now knows that after several years it’s outdated. Older technology becomes obsolete as new tech is rolled out. Our current machine is much smaller than the one we are raising funds for. We aren’t able to do what we call large panel analysis on the current machine, which means we can’t run a lot of patients at the same time and we’re not able to do the testing on all the new diseases. Over time, new mutations are identified, there are new drugs, new research being done.

We have to evolve with the times and this technology will allow us to do that.”

At best, I was hoping that this treatment would buy me some time, but today I’m cancer free.

– Graham Wade

This new and improved technology will have the capacity to sequence more data, identify more mutations and will even qualify the QEII for clinical trials to bring the best, most innovative treatments to our region’s cancer patients.

Better outcomes, fewer side-effects, access to new therapies — these are all benefits this technology brings to cancer patients here at home. It can even spare patients from unnecessary treatments that their cancer’s genetic makeup won’t respond to. This is a game-changer for those patients facing late-stage cancers, like Graham.

With one in two Atlantic Canadians facing a cancer diagnosis in their lifetime, the time is now to identify the most targeted and effective treatments for cancer patients at the QEII. In the fight against cancer, the genetic makeup of a patient’s unique cancer type holds the key and with the community’s support, the QEII can identify personalized treatment plans by knowing how an individual’s cancer might progress and the treatment it may best respond to. You can help fund the fight against cancer today at YourRideforCancer.ca.

SUMMER 2021

9

Dr. John G. Hanly, attending staff rheumatologist at the QEII and professor in the Division of Rheumatology at Dalhousie University, and his colleagues at Dalhousie University and the IWK Health Centre are taking a closer look at how and why patient responses to treatment for inflammatory conditions vary. QEII Foundation

Piecing together progress Research team works toward better, more personalized rheumatoid arthritis treatments

By Brandon Young People with inflammatory conditions, such as rheumatoid arthritis, are usually treated with medications that normally help calm arthritis, causing their joint symptoms to diminish or disappear completely.

However, despite many treatments, they are not effective for all patients and are in some cases associated with sideeffects on top of persistent inflammation — the body’s process of fighting against things that harm it, such as infections, injuries, and toxins, in an attempt to heal itself.

This has led researchers in Halifax to take a closer look at how and why patient responses to treatment vary.

Working together, health researchers from the QEII Health Sciences Centre, Dalhousie University and the IWK Health Centre are leading an international team of physicians and scientists to investigate the role inflammation plays in conditions like rheumatoid arthritis — the most chronic, long-term inflammatory type of arthritis.

The Restitution Enhancement in Arthritis and Chronic Heart Disease (REACH) study — funded by the Canadian Institutes of Health Research (CIHR), The Arthritis Society and local funding support — is a Dalhousie University-based research initiative funding various projects, with a common goal of understanding how inflammation resolves. The study began in 2015.

“We’re very fortunate to have clinician investigators, as well as basic scientists, who were able to come together to make a compelling application,” says Dr. Jean Marshall, professor in the Department of Microbiology and Immunology at Dalhousie University.

The contrast in patient outcomes fuelled the group’s desire to determine the differences between people who suffer from ongoing inflammation and those who do not. Their goal is one that could help physicians identify the best treatments for individual patients.

Dr. John G. Hanly, attending staff rheumatologist at the QEII and professor in the Division of Rheumatology at Dalhousie University, identified 150 newly diagnosed rheumatoid arthritis patients presenting with pain, swelling and disability involving multiple joints for the first time, and enrolled these patients in the study.

Agreeing to share medical information about their arthritis and provide their blood for examination, the experiences of the patients participating in the study were otherwise similar to the clinical care received by those not in the study.

The study’s major findings resulted from an extensive investigation of the immune system through blood samples collected from these patients. Researchers found that the patients who didn’t improve had a different type of immune response in their peripheral blood — red blood cells, white blood cells and platelets.

Although not everyone improved with anti-inflammatory and immune-

modifying therapies, this observation has been extremely useful, showing a different pathway exists in about half of the patients.

“That’s really the clinical issue: to better understand which drugs will work in which individual patient,” says Dr. Hanly, who notes rheumatoid arthritis costs the Canadian healthcare system millions annually. “It’s a bit of a holy grail in this area of medicine right now and these sorts of studies are designed to try to unravel that.”

Results of the study were published in Arthritis & Rheumatology in July 2020.

While the results are preliminary, the team believes the research findings could be advantageous to future research in identifying the best treatment for patients.

“It’s one piece that helps support the goal of getting patients on the best treatment as early as possible, personalizing the treatment,” says Dr. Thomas Issekutz, professor of immunology at Dalhousie University and Department of Pediatrics.

Dr. Marshall likens their field of study to a puzzle.

“You’ve got this big jigsaw puzzle, which is us trying to understand the disease and how to get the best therapy for it,” says Dr. Marshall. “What this study has done has shone a light on a particular part of that jigsaw puzzle and showed there’s a greater likelihood of finding something in this part of the jigsaw puzzle than many other parts. It tells us where to look.”

While they remain hopeful, further research is needed. “I don’t think we’re at a stage where we can say we can use this as a marker to predict a response or no response,” says Dr. Hanly. “This is a step forward in trying to personalize and match the correct therapy for the correct patient as early as possible in the disease.”

“Of course, these are early studies, so a larger population of patients still needs to be investigated to confirm or substantiate these results,” says Dr. Issekutz. “But there is literature coming out from other laboratories supporting what we’ve found as well.”

Noting a strong tradition of collaboration between the QEII, Dalhousie University and the IWK, the team says the medical community is fortunate to include many researchers, investigators and clinician scientists with an interest in inflammation.

“There are unique opportunities in this environment for clinicians and basic scientists, who approach the same problem from different perspectives, to work collaboratively together,” says Dr. Hanly. “You don’t have to go to Harvard or Toronto to see that level of successful research come to fruition; it’s happening right here in Nova Scotia.”

“Programs such as this enhance education and training of younger residents and students to understand the latest in the research and treatment of these diseases and foster the provision of cutting-edge medical care,” says Dr. Issekutz. “That research synergizes with the clinic by bringing new innovations to patients in a timely manner.”

You don’t have to go to Harvard or Toronto to see that level of successful research come to fruition; it’s happening right here in Nova Scotia.

— Dr. John G. Hanly

Meanwhile, the team members, who collectively have more than 100 years of experience in their respective fields, have seen the progress of therapies for rheumatoid arthritis throughout the decades and remain hopeful their preliminary study will lead to greater advancement in treatment.

“We certainly have a bright future for continuing this type of collaborative research between the hospitals and the university in this area,” says Dr. Marshall.

“The experience we’ve had, which has been quite positive, is something we can build upon.”

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SUMMER 2021

10

Developing a ‘culture of nutrition’ Study will look at expanding More-2-Eat program across Nova Scotia

By Joey Fitzpatrick Malnutrition has a significant impact on Canada’s healthcare system. Recent research has shown that malnourished patients have 34 to 53 per cent longer hospital stays and cost the system 31 to 55 per cent more than well-nourished patients.

Malnutrition has also been shown to increase mortality and the risk of readmission to hospital.

Dr. Heather Keller, Schlegel Research Chair in Nutrition and Aging at the University of Waterloo, began researching malnutrition in Canadian hospital patients in 2010, with a study involving 18 hospitals across eight provinces.

“We found it was occurring in about one in three patients or one in two, depending on the unit,” says Dr. Keller. “People were coming in and were not being identified as malnourished.

We then found that they were lingering and not making progress.”

Malnutrition is commonly underdiagnosed and undertreated because it’s not routinely screened for when patients are admitted to hospital, says Dr. Leah Cahill, a QEII Health Sciences Centre affiliate scientist and Howard Webster Department of Medicine Research Chair at Dalhousie University.

“Screening patients for malnutrition when they are admitted results in assessments and treatments,” says Dr. Cahill.

“This has been shown to reduce infections, pressure sores, length of stay, falls, fractures, hospital readmission and mortality.”

Created in 2014, the national response to patient malnutrition is called the Integrated Nutrition Pathway for Acute Care (INPAC).

It’s an evidence and consensusbased pathway, designed to guide healthcare professionals

in the prevention, detection and treatment of malnutrition in medical and surgical patients.

Following INPAC protocol, new patients are screened within 24 hours of admission by a designated professional using the Canadian Nutrition Screening Tool (CNST): Have you lost weight in the past six months without trying to lose weight?

Have you been eating less than usual for more than a week?

Patients identified to be at risk receive a diagnosis to confirm malnutrition. A Subjective Global Assessment (SGA) is recommended for making a diagnosis and triaging further nutrition care, including intake monitoring, mealtime support and nutrition discharge planning.

“We know how to treat malnutrition once it’s been identified,” says Dr. Keller. “The questions then become: Can you implement this program? And, if you do, does it change practice and change outcomes? Is it sustainable?”

To help answer those questions, the QEII’s Victoria General site became part of a national project in 2018. The More-2-Eat project was designed to implement the INPAC toolkit at 10 hospitals across the country and has been successfully piloted at Unit 9A, the Victoria General’s main general surgery unit.

As approximately 650 patients were screened for malnutrition, the process of implementing More-2-Eat on the ward was a team effort, says Sonya Boudreau, a clinical dietitian at Unit 9A. “It involved nurses, social workers, pharmacy and physiotherapy,” says Sonya.

“I think everybody on the floor is more aware of the importance of this and we’ve developed a real culture of nutrition.”

In order to scale up More-2-Eat

With the help of a QEII Foundation TRIC grant, Dr. Leah Cahill (left), QEII affiliate scientist and Howard Webster Department of Medicine Research Chair at Dalhousie University; Sonya Boudreau (centre), a QEII clinical dietitian; and Dr. Heather Keller (right), Schlegel Research Chair in Nutrition and Aging at the University of Waterloo, are working together to improve healing and recovery for patients through proper nutrition. Contributed

and roll it out to hospitals across Nova Scotia, it’s necessary to confirm whether this model of implementation is sustainable for the long term and the investment and resources required.

Earlier this year, co-principal investigators Dr. Cahill and Tina Strickland, director of policy and planning for Nutrition and Food Services, received funding from a QEII Foundation Translating Research Into Care (TRIC) grant with team members Brenda MacDonald, senior director of Food and Nutrition at Nova Scotia Health, Sonya Boudreau, and Dr. Keller for a study called More-2Eat Nova Scotia Implementation Phase 2.

Dr. Cahill’s role will be to analyze the data as the program is implemented at four hospitals across the province: Hants Community Hospital, Windsor (general medicine); Glace Bay Hospital (general medicine and surgery); Cumberland Regional Health Care Centre, Amherst

Our vision for the future is that all patients admitted to general medical and surgical units in Nova Scotia will be screened for malnutrition and receive appropriate nutritional care.

– Dr. Leah Cahill

(general surgery); and Valley Regional Hospital, Kentville (general surgery).

“We will keep More-2-Eat going at Unit 9A, as we roll it out to the other areas,” says Sonya, who will be the research co-ordinator for the study. As

she has now been through the process as site champion with the original implementation on 9A, Sonya will be able to share some of the findings and best practices with her colleagues around the province.

“We will have a community of practice, where we meet every month during the study and support each other with the different challenges that come up,” says Sonya.

If proven effective and sustainable, the long-term goal is that INPAC will be integrated as a standard of care for patients admitted to general medical and surgical units across Nova Scotia Health, explains Dr. Cahill.

“Our vision for the future is that all patients admitted to general medical and surgical units in Nova Scotia will be screened for malnutrition and receive appropriate nutritional care,” adds Dr. Cahill. “This project will be a large step toward this long-term goal.”

Discovering diversity in mood disorders Dr. Abraham Nunes is the latest recipient of the Ruth L. Wagner Memorial Endowed Fund

By Allison Lawlor When Capt. (Ret’d) Earle Wagner’s wife died in 2007 from acute leukemia after decades of suffering from bipolar disorder, he knew he had to do something to help alleviate the pain caused by the mental illness.

He established the Ruth L. Wagner Memorial Endowed Fund in 2011 with a $50,000 donation to the QEII Foundation, which was generously matched

by Dalhousie University’s Department of Psychiatry. Each year, medical students, residents and fellows can apply to the fund to support their research to advance the treatment and care for people like Ruth, who are living with severe mood disorders.

“I hope it does some good,” says Capt. Wagner. “She lived a miserable life. I saw what she went through; I would call it hell.”

Dr. Abraham Nunes is certain the fund is doing some good.

With its support, he is working toward a future where patients living with bipolar disorder can be treated in a more precise way, to better alleviate the crushing symptoms of the disorder.

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs known as mania, or depressive lows.

“Bipolar disorder can range anywhere from one to 2.5 per cent of the population,” says Dr. Nunes, who will begin his role as assistant professor of psychiatry at the QEII’s Mood Disorders Clinic in July 2021.

“It is a very serious illness. It can be managed but it does require quite a lot of care.”

Dr. Nunes was a senior resident in psychiatry at the QEII Health Sciences Centre, with a background in business and computer science, when he received funding from the Ruth L. Wagner Memorial Endowed Fund to conduct several studies and publish his research through Open Access, an online service that makes research more easily accessible.

Dr. Nunes delved into the heterogeneity — or diversity — of psychiatric disorders and developed a unique technique for how it can be measured. He found that not everyone who has bipolar disorder has the same pattern of symptoms or gene differences, and discovered there is much diversity within one disorder.

“We might not be looking at a single condition, but many different conditions,” he says.

By being able to measure diversity in disorders, such as bipolar, medical scientists will

be better able to study how this diversity arises and, from there, develop more accurate tools for personalized diagnosis and treatment.

By using the heterogeneity measurement technique that he developed, Dr. Nunes was able to develop a genetic prediction model to identify which individuals with bipolar disorder would respond well to the drug lithium, one of the most commonly used medications for treating the mood disorder.

“But only 30 per cent with bipolar will actually respond remarkably well,” he says.

For patients whose clinical presentations include features that are highly predictive of lithium response, Dr. Nunes will recommend the medication right away. For those patients who fit the pattern they discovered of not responding well to lithium, he won’t start them on the medication. By making this decision, he hopes to prevent those patients from having to endure some of the difficult sideeffects associated with lithium.

The heterogeneity measurement technique — inspired by the work of ecologists, economists, and physicists — developed by Dr. Nunes is enabling him to continue his research to improve the treatment of patients with

Dr. Abraham Nunes (left) is working toward a future where patients living with bipolar disorder can be treated in a more precise way. His work has been supported with funds from the QEII Foundation’s Ruth L. Wagner Memorial Endowed Fund, set up by Capt. (Ret’d) Earle Wagner (right) in memory of his late wife’s struggles with bipolar disorder. Contributed

Anything that will bring us closer to being able to understand what these conditions really are will help us to treat individual patients more precisely.

–Dr. Abraham Nunes

bipolar disorder and other mood disorders.

“Anything that will bring us closer to being able to understand what these conditions really are will help us to treat individual patients more precisely,” says Dr. Nunes.

Capt. Wagner is hopeful Dr. Nunes and other researchers will continue to make strides in psychiatric medicine, to better help patients who are suffering the way he knows Ruth did.

Fortunately, in the last decade of her life, Ruth found some relief from bipolar disorder after she started seeing a young psychiatrist at the QEII, who took a keen interest in her care. She was prescribed new medication and her life improved. Instead of spending hours curled up on the couch, she played cards and enjoyed time with her friends and family.

“This is a worthwhile scholarship,” says Capt. Wagner.

“I felt I had to do something.”

SUMMER 2021

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In February 2021, Dr. Sean Barry (left) and Dr. Adrienne Weeks (right), QEII neurosurgeons, became the first in Nova Scotia to operate on a glioblastoma brain tumour using 5-ALA, a drug that helps surgeons distinguish tumour tissue from healthy brain tissue. Contributed

Lighting the way QEII neurosurgeons use new drug during brain tumour surgery for the first time in Nova Scotia Pictured: Raymond with members of his QEII radiotherapy team, Sarah MacIntyre (left) and Jeannine MacArthur (right).

By Sara Ericsson A new drug is lighting the way during glioblastoma brain tumour surgeries at the QEII Health Sciences Centre.

In September 2020, Health Canada approved 5-ALA, a drug that helps surgeons distinguish tumour tissue from healthy brain tissue. Five months later, two QEII neurosurgeons became the first in Nova Scotia to operate on a glioblastoma brain tumour using 5-ALA. Dr. Sean Barry, a QEII attending neurosurgeon and assistant professor at Dalhousie University, says using the drug to find and safely remove more of the tumour has shown improved patient outcomes.

“This certainly makes surgery safer and allows surgeons to clearly distinguish cancer from healthy tissue, giving us more confidence when we’re doing these procedures,” says Dr. Barry.

Glioblastomas are aggressive and fast-growing malignant brain tumours that, unlike other types of tumours, have edges — or margins — that can be hard for surgeons to distinguish from healthy brain tissue. As a result, they can be difficult to remove during surgery.

Dr. Barry says that patients drink a mixture containing the drug a few hours before their surgery. The healthy and cancerous cells absorb 5-ALA differently and, under a fluorescent light during surgery, the tumour cells have a pink glow, while the healthy cells glow blue. This difference in colours allows surgeons to find and safely remove more of the tumour with less risk to the patient.

“The principle is simple, but it’s a very powerful tool. This is the first specific drug for this specific tumour, which is really quite exciting,” says Dr. Barry.

Dr. Adrienne Weeks, a QEII neurosurgeon and assistant professor at Dalhousie University, says the first surgery using 5-ALA, which she and Dr. Barry completed together, felt both effective and useful.

“We identified bits of tissue that were still tumour and took as much as we could.

Then, we went back in and found more little dots of tumour to take out,” says Dr. Weeks. “This is important because it’s these tricky areas of the tumour margin where glioblastoma tumours can easily recur.”

This certainly makes surgery safer and allows surgeons to clearly distinguish cancer from healthy tissue.

–Dr. Sean Barry

More Nova Scotians accessing this drug will mean a greater number of safer, more effective procedures. It will also mean greater quality of life for patients.

“These cancers are not curable, but we are seeing that the more tumour is removed safely at surgery, the better a patient can do and the better chance they have at a longer life,” Dr. Weeks says.

Dr. Barry says the scientific community agrees that patient survival is extended by the removal of as much tumour as possible, so even though a complete cure still does not exist for these malignant tumours, this drug is making a big difference in patients’ lives.

“In terms of a game-changer, 5-ALA is a really important advancement from a technical standpoint especially,” he says. “We hope it means that patients will do better with cancer treatments they receive post-operatively, which is generally a combination of radiation and chemotherapy.”

Dr. Barry says it was a real team effort from QEII surgeons like Dr. Weeks, as well as neurosurgery nurses, administrative assistants, pharmacists and so many others to bring 5-ALA to the QEII. “This will be the first of many patients this drug is used for in this province, I have no doubt,” says Dr. Barry.

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SUMMER 2021

12

Making life-giving decisions Nova Scotia adapting to new organ donation legislation

By Joey Fitzpatrick It was on a return flight to Halifax when Christa Webber first suspected something was amiss. In July 2017, she and some friends were returning from a concert weekend in New York.

“It felt like I couldn’t breathe,” she recalls. “I wasn’t quite sure what was happening. I thought maybe it was just the excitement of getting home.”

When she got home and went for tests at the Dartmouth General Hospital, Christa was told she had fluid building in her lungs. The real problem: she was in heart failure.

“I had dilated cardiomyopathy — at age 43.”

She was referred to the Cardiac Transplant and Advanced Heart Failure Clinic at the QEII Health Sciences Centre in Halifax and, in early 2020, went on a waiting list for a new heart. Her O blood type meant she could only accept a heart from an O donor.

“I looked it up on the National Organ Waitlist,” she says. “The average wait time for an O heart was 497 days.”

For patients waiting for a transplant, timing is crucial.

On Jan. 18, 2021, Nova Scotia became the first jurisdiction in North America to adopt a “deemed consent” system for the donation of organs and tissues.

While people can still opt out, the Nova Scotia Human Organ and Tissue Donation Act will help Nova Scotians waiting for a transplant get one sooner.

Changing the law is just the beginning of the process, says Dr. Stephen Beed, medical

research on donation-related issues,” Dr. Beed adds. “We’ve also worked with our IT people to develop a database that will be part of a new donor-audit tool.”

Two years ago, the team began site-based education and public awareness campaigns at regional hospitals.

“We wanted to raise the level of public awareness on the importance of organ and tissue donation,” says Cynthia Isenor, health services director for the QEII’s Critical Care Program.

“This is not something that changes overnight. Knowledge about donation, and how to integrate that into end-of-life care, becomes an art over time.

It’s about both honouring the individual who is, unfortunately, dying, while also incorporating donation into the conversations with family members.”

The impact of organ and tissue donation is immense. A single individual can potentially donate two lungs, a heart, two kidneys, a pancreas, liver and small bowel.

“You can save eight lives by donating your organs,” Dr. Beed points out. “A tissue donor can provide up to 80 tissue grafts, so that can be life-enhancing for a great many people.”

Many donor families have expressed that, when coping with the loss of a loved one, the thought of something positive coming out of the situation is often an important part of their healing.

In late January 2020, Christa was told to have a bag packed and be ready to go on short notice.

On Feb. 15, 2020, the call came.

director of the Nova Scotia Organ Donation Program and the lead on a study by the Legislative Evaluation: Assessment of Deceased Donation Reform (LEADDR).

In July 2020, Health Canada invested $1.1 million in the study to gather evidence to inform legislation and to evaluate the impact of implementation.

“There’s been a huge transformation happening in the background to support the new law,” says Dr. Beed. “If this new law becomes part of a system change, then you have reason to believe we are moving toward a better place.”

While the legislation took effect in January, Dr. Beed’s team has spent the past 18 months preparing for the new reality. For example, donation-physician roles, in which critical care physicians are recruited to serve as local resources for donationrelated issues, have been put in place in several zones around the province. This model has proven effective in other jurisdictions.

“We know from other very successful programs, such as in Spain, that front-line critical care physicians can profoundly influence donation success,” says Dr. Beed.

More organ donation coordinators have been recruited, education for front-line healthcare providers has been revamped and a family support liaison has been put in place.

“With assistance from Nova Scotia Health and Health Canada, we’ve become quite involved with

In 2017, Christa Webber was diagnosed with heart failure at only 43 years old. Receiving a heart transplant at the QEII in early 2020, Christa says she’s grateful for the donor and their family. Contributed

Nothing really prepares you for that.

I couldn’t stop thinking about the donor and their family.

– Christa Webber

A donor heart was available and the transplant could take place the following day at the QEII, the specialized care centre for

organ transplantation in Atlantic Canada.

“Nothing really prepares you for that,” she says. “I couldn’t stop thinking about the donor and their family.”

Now, more than a year later, Christa is climbing stairs, carrying her own groceries and even dancing. She was on the waiting list for just 19 days, but she is aware of how fortunate she was and is 100 per cent supportive of the new legislation.

“It’s going to save countless lives,” she says. “I don’t judge anyone who chooses not to donate, but I don’t think I would have survived for 497 days.”

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