Leap Spring 2016 by Venture Publishing

CLINICAL TRIALS

SPRING 2016

From idea to standard of care, the clinical trial process brings new cancer treatments to the forefront

Thanks to a clinical trial, Edmonton researchers make a breast cancer treatment breakthrough

PLUS: Cash and Cars lottery winners, an update on the Alberta Lung Cancer Screening Program, how to journal and more...

The scoop on how this nametag helps spread knowledge P.22

HOW DOES YOUR GARDEN GROW? Tips for getting your garden in tip top shape this spring

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GAME CHANGER

RIDE WITH US IN 2016!

This summer, join thousands of cyclists of all abilities for The Enbridge® Ride to Conquer Cancer benefiting the Alberta Cancer Foundation presented by Evraz. Together, on August 6th – 7th, we will make a difference for Albertans facing cancer at the Tom Baker Cancer Centre, the Cross Cancer Institute and the 15 other cancer centres across the province.

BE EPIC AND REGISTER TO RIDE • CONQUERCANCER.CA BENEFITING

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CONTENTS

SPRING 2016 • VOL 7 • No. 1

ON THE COVER: Sabine Moritz

Photographed by Don Molyneaux

SPRING SPOTLIGHT CLINICAL TRIALS

DEPARTMENTS 4 OUR LEAP

A message from the Alberta Cancer Foundation

42 29

11 12

FOREFRONT A step-by-step guide to journaling, improve your running form, cancer-detecting animals, ten activities to get your kids more active and cancer care for kids

NEXT GEN A team of young researchers set out to improve rehabilitation for head and neck cancer patients

BEYOND CANCER New study compares mindfulness and tai chi in cancer care

13 SMART EATS

Eating for prevention: a healthy diet is one of your greatest weapons in preventing cancer

ASK THE EXPERT Eating street food on vacation, maintaining a local diet in the off seasons and what to do with a friend undergoing chemotherapy

Alber ta Cancer Foundation

Cancer researchers at the Cross Cancer Institute make a breast cancer treatment breakthrough using clinical trials

22 WORTH A TRY

Clinical trials are a critical step toward advancing cancer treatment

25 WHAT EXACTLY IS A CLINICAL TRIAL? A step-by-step look at what goes into a clinical trial

FEATURES 28 A GIFT IN THANKS

One donor’s choice to support an early detection program for lung cancer

29 WHOLE LOTTO LOVE

The Cash and Cars lottery makes life better for Albertans with – and without – cancer

BREATHE DEEP The Alberta Lung Cancer Screening Program continues to recruit participants in 2016

33 APRIL SHOWERS BRING…

A guide to getting your garden ready in Alberta’s spring climate

24 PATIENT ENGAGEMENT

38 A LIFETIME OF COMMITMENT

42 TOP JOB

Involving patients and families improves the outcomes of cancer research

THE HEART OF CANCER CARE

CORPORATE GIVING Fundraising for cancer research is all in a day’s work for Calgary’s NGX

50 MY LEAP

Emily Cinats’ commitment to fundraising has guided her through cancer diagnoses and beyond

A dedicated Edmonton couple have spent 26 years giving back to the Alberta Cancer Foundation

Ann Vlahadamis constantly seeks ways to improve patient care

46 RESEARCH ROCKSTAR

Dr. Paula Robson is at the helm of Alberta’s largest long-term study on cancer prevention

spring 2016

Message • alberta cancer foundation

A Rich History of Clinical Trials TRUSTEES Angela Boehm, Chair Calgary Gary Bugeaud Calgary Christopher Burrows Edmonton Steven Dyck Lethbridge Thomas Hodson Calgary Jordan Hokanson Edmonton Dr. Sandip Lalli Calgary Katie McLean Calgary John J. McDonald Edmonton Andrea McManus Calgary Matthew Parliament Edmonton (ex-officio) Brent Saik, Vice Chair Sherwood Park

Barely a day goes by at the Alberta Cancer Foundation without mention of the words “clinical trial” in some capacity. We are a proud supporter of Alberta’s clinical trials program – one of our flagship investments that continually changes practice around the world. In this issue of Leap, we focus on these clinical studies and how some of the brightest minds are asking the most innovative questions in order to develop new treatments for those facing cancer. You will read about a sampling of these advancements inside, including a groundbreaking trial that studied heart weakening in cancer patients taking the drug Herceptin (pg. 18). The findings for the new intervention have been excellent and are poised to change the way care is delivered around the world. As rich as our investment history is with clinical trials in this province — more than $20 million in the last five years alone — we have to go way back to trace the historical evolution of these studies. The Old Testament recorded the first documented trial at 605 BC, when King Nebuchadnezzar II ordered the children of royal blood to eat only meat and wine for three years. But Daniel requested that he and three other children be allowed to eat legumes and water. A few weeks in, the latter group was noticeably healthier and more vivacious to those relegated to a wine and meat diet. Then, in 1571 a Renaissance surgeon, Ambroise Pare, unknowingly carried out a clinical trial when he suddenly found himself unable to boil oil for This long-standing drive open wounds. He concocted his own mixture of egg and human curiosity has led yolk, turpentine and oil of rose and noticed soldiers to the creation of thousands given the impromptu treatment had less pain and of new treatments in modern swelling than those given the standard care. medicine, including many In 1747 James Lind, considered the originator of the clinical trial, conducted the first conthat have made life better modern-day trolled trial on a group of sailors suffering from scurvy. for Albertans facing cancer. He placed them all on the same diet, but added cider and vinegar to one group and lemon juice to another group. Within six days, the group given the lemon juice recovered. This long-standing drive and human curiosity has led to the creation of thousands of new treatments in modern medicine, including many that have made life better for Albertans facing cancer. Clinical trials distinguish the handful of discoveries that prove to be true advances in therapy. We are proud to be a partner in such an important program and are excited to see what new innovations will develop next. Myka Osinchuk, CEO Alberta Cancer Foundation

Angela Boehm, Chair Alberta Cancer Foundation

Sandy Slator Edmonton Greg Tisdale Calgary

spring 2016

myleapmagazine.ca

SPRING 2016 VOL 7 • No. 1

ALBERTA CANCER FOUNDATION EDITOR: PHOEBE DEY CALGARY OFFICE Suite 300, 1620 - 29 Street NW Calgary, Alberta T2N 4L7 PROVINCIAL OFFICE 710, 10123 - 99 Street NW Edmonton, Alberta T5J 3H1 Toll-free: 1-866-412-4222 Tel: 780-643-4400 acfonline@albertacancer.ca VENTURE PUBLISHING INC. PUBLISHER: RUTH KELLY MANAGING EDITOR: LYNDSIE BOURGON ART DIRECTOR: CHARLES BURKE GRAPHIC DESIGNER: ANDREW WEDMAN PRODUCTION MANAGER: BETTY FENIAK PRODUCTION TECHNICIANS: BRENT FELZIEN, BRANDON HOOVER WEB & SYSTEMS ARCHITECT: GUNNAR BLODGETT DISTRIBUTION: KAREN REILLY CONTRIBUTING WRITERS: Lisa Catterall, Julie-Anne Cleyn, Sue LeBreton, Michelle Lindstrom, Trina Moyles, Shelley Newman, Dawn Smith, Willow White, Shelley Williamson CONTRIBUTING PHOTOGRAPHERS AND ILLUSTRATORS: Buffy Goodman, Cooper + O’Hara, Don Molyneaux, Ewan Nicholson, Darryl Propp, Kelly Redinger ABOUT THE ALBERTA CANCER FOUNDATION The Alberta Cancer Foundation makes life better for Albertans facing cancer by providing access to the best technologies, treatments and care. We are the official fundraising partner for all 17 cancer centres in Alberta, including the Tom Baker Cancer Centre in Calgary and the Cross Cancer Institute in Edmonton. Through this partnership, we are able to make the most significant impact for patients, right at the point of care.

Leap is published for the Alberta Cancer Foundation by Venture Publishing Inc., 10259-105 Street, Edmonton, AB T5J 1E3 Tel: 780-990-0839, Fax: 780-425-4921, Toll-free: 1-866-227-4276 circulation@venturepublishing.ca

The information in this publication is not meant to be a substitute for professional medical advice. Always seek advice from your physician or other qualified health provider regarding any medical condition or treatment. Printed in Canada by Mitchell Press Limited. Leap is printed on Forest Stewardship Council ® certified paper Publications Agreement #40020055 ISSN #1923-6131 Content may not be reprinted or reproduced without permission from Alberta Cancer Foundation.

Alber ta Cancer Foundation

spring 2016

Forefront • prevent, treat, cure

Run Right

Take your jog from slog to new heights by placing an emphasis on your form

Your eyes should be focused on the ground about 10 to 20 feet ahead of you. Don’t look at your toes!

Keep your posture straight and erect. If you feel yourself slouching, poke your chest out.

Your arms should be held at waist level, at a height where they could brush your hip. Be sure to keep them tilted to 90 degrees.

Keep your arms by your side – arm swinging can lead to bad posture, meaning you won’t be breathing as effectively.

To keep your hands relaxed, imagine that you’re gently cupping an egg. Clenching can lead to tightness in the arms, shoulders and back.

As you run, try to ensure that you land mid-foot and roll through to the front of your toes. Any other way can cause injury or just wastes energy.

spring 2016

Make sure that your feet are pointing straight ahead – running with toes pointed in or out could also lead to injury.

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Message of Hope Calgary nurse Anna Cruz snapped this picture from Rockyview General Hospital’s respiratory unit last December. Chris Whittaker left the message to raise the spirits of patients inside. Whittaker’s brother, Michael, has Stage 4 renal cancer. “I have watched him endure chemo treatments and all the other health issues that have debilitated his body, but he still has a smile on his face,” says Chris. “He has been the most influential person in my life and I know within a few months he may not be with us anymore.” The uplifting message garnered more than 200 likes on Cruz’s Instagram feed (@anna_scruz).

Rebecca Katz’s Nourishing and Healing Tea INGREDIENTS: • 1/3 cup sliced peeled fresh ginger, cut 1/4 inch thick • 10 cups water • 3 tbsp coriander seeds • 1 1/2 tbsp cardamom pods • 4 cinnamon sticks • 5 whole cloves • 1 1/2 cups rice milk or almond milk • 1 to 3 tbsp maple syrup • 1 tsp vanilla extract

NOTES: The tea will keep in the refrigerator for up to two weeks without the milk and sweetener, so you may want to set some aside prior to adding the milk and sweetener. Recycle the spices that are strained out of the tea and use them to make another, smaller batch of tea. They’ll keep in the refrigerator for four to five days. To make more tea, combine the spices

and six cups of water and bring to a boil. Add two tablespoons of peeled fresh ginger slices. Simmer for 30 minutes, then strain the tea and discard the spices. Add sweetener and milk to taste and reheat without boiling for two to three minutes. Remove from the heat and stir in the vanilla before serving. Source: The Cancer Fighting Kitchen

DIRECTIONS: Combine the ginger and water in a saucepan, and bring to a boil. Lower the heat, cover and simmer for 30 minutes. Add the coriander, cardamom, cinnamon and cloves and continue to simmer for an additional 20 minutes. Strain the tea through a fine-mesh sieve into a clean saucepan. Add the rice milk and maple syrup and gently reheat without boiling for two to three minutes, until warm. Stir in the vanilla, then taste. Add more milk or sweetener if you like. Serve hot or cold.

Alber ta Cancer Foundation

spring 2016

Home Is Where the Treatment Is Nurses at the Alberta Children’s Hospital provide cancer treatment to kids at home Over the past three years, Alberta Children’s Hospital has pioneered the Hospital at Home program. The program, which began in 2012, allows children in the Calgary area to receive some of their cancer treatments, including chemotherapy, without having to go to the hospital. At the beginning the program only serviced a few patients, but now there have been hundreds of children treated and there are two registered nurses that work each day to provide care and comfort to children and families in crisis. Shelaine Semmens is one of the nurses who works for Hospital at Home. During a regular day, Semmens drives to a child’s home, provides a physical exam and then administers their treatment – the whole process takes about an hour. The program allows children to receive their treatment while playing with their favourite toys and resting in their own bed. It also saves

parents from the emotional and often physically demanding task of bringing their child into the hospital for long periods of time, preserving the family’s schedule and sense of normalcy. On an average day Semmens visits up to four families. “The care in the home really reduces the family’s stress and the kids tolerate [treatment] so much better than when they’re in the hospital and that’s such a joy to see,” says Semmens, who has spent most of her career working in hematology and oncology. “These are all families that are in crisis. Our job is to ease crisis and provide them with the highest quality care and I think we do a great job at that.” Currently, Hospital at Home has funding until March 2017. There is a high demand for the program, and Semmens hopes the program will be able to expand its services in the future.

How to Journal Finding peace through artistic journaling

Journaling can be a successful self-care method, especially during times of crisis. Kathie MacDuff, an art instructor at Wellspring Calgary and the Tom Baker Cancer Centre, is an expert in journaling techniques and believes that it can help patients find peace: “I remind people that it’s the process. They’re being honest and open and vulnerable and that’s what makes the difference,” she says. Try some of MacDuff’s tips to get your journal started: 1. Mix mediums: No need to keep your paintbrushes separate from your pens. Go ahead and draw, write and paste pictures in your journal. 2. Find a friend: Consider reading a segment of your journal to a friend, and have them read from their journal to you. 3. Pick a generic topic: Lost for words? Pick a topic like nature and you may be surprised where the idea leads you. 4. Write down everything: Don’t be afraid to write down your grocery lists, budgets and reminders. Your journal should be a one-stop-shop for everything in your life. 5. Look online: With the explosion of online DIY projects, there’s no shortage of inspiring examples to be found. 6. Schedule a time: Make a date with yourself to ensure that you actually get to your journal each day. 7. Buy an inexpensive journal: An expensive journal will just increase your fear of messing up. 8. Just do it: MacDuff’s most important tip of all? “The important thing is just to do it.”

spring 2016

myleapmagazine.ca

The Taste of Generosity A Sherwood Park liquor store owner rallies his community to raise funds for prostate cancer research In 2003, Che Bechard’s father passed away from prostate cancer. Six years later, Bechard was inspired to hold the first fundraiser for prostate cancer research at Baseline Wine & Spirit Co., his wine boutique in Sherwood Park. Since 2009, Bechard has held two fundraisers a year there, one in November and one in April, with all proceeds going to the Alberta Cancer Foundation. At the fundraiser, guests can participate in a wine tasting and silent auction. Nearly $65,000 has been raised to date for prostate cancer research. Bechard takes very little personal credit for the fundraiser and is quick to recognize the generous contributions of people in his industry and community: “I like to acknowledge that we always get different reps or sales agents in our industry who not only donate their time, but donate the product that they pour,” Bechard says. “We have a huge table in our tasting room that has silent auction items that are donated by various people in the community.” Offering encouragement to other small businesses interested in holding fundraisers, Bechard explains that the event had modest beginnings. “The event wasn’t always so huge,” he says. “In 2009 we started out quite small, we just handed out leaflets in the store here. We probably had between 50 and 75 people. As the years go by, more people hear about it and it grows and grows.” Now, Bechard’s fundraiser is an established community event that will continue supporting prostate cancer research for years to come.

The Smell Test Calgary dogs are being trained to sniff out cancer – literally

Believe it or not, trained dogs can detect certain types of cancer with almost perfect accuracy. This is old news – in fact, the first recorded case of a dog smelling its owner’s cancer was in 1989. Yet 27 years later, the potential of this research has yet to be fully realized. Tracie Nielson, the research director of Calgary’s Canine Cancer Detection Centre (a branch of her business, Clever Canines), began training dogs in 2014 after partnering with Pure North S’Energy Foundation, a preventive health nonprofit organization, with the goal of bringing dog cancer detection to the public. Currently, Nielson works with seven dogs of various ages and breeds, all of which are owned by families in Calgary and trained to detect lung cancer. In the next few months, the dogs will be trained to identify prostate, colon and breast cancer. The Canine Cancer Detection Centre hopes to officially open its doors to the public in mid-2016. The benefit of dog cancer detection is the ability to diagnose the disease in its early, most curable stages. Nielson explains that those at high risk of cancer could easily get tested: “It’s so easy breathing into a tube. It doesn’t hurt.” Once a sample is collected, it is shown to a variety of trained dogs. With a likely recommendation from the dogs, a person could minimize their hospital visits and maximize the likelihood of an early diagnosis.

Researchers at the University of Iowa also recently trained pigeons to identify malignant and benign breast tumours when looking at a mammogram or biopsy slide.

Alber ta Cancer Foundation

spring 2016

Top 10

Getting kids active may feel like a daunting task, but it doesn’t have to be. Try these 10 simple, family-focused activities that don’t even feel like exercise

WALK THE DOG

Don’t have a dog? Not a problem. Ask to borrow your neighbour’s pet. You’ll be doing your neighbour a favour and you’ll get some fresh air.

PLAY HIDEAND-SEEK

Whether indoors or outdoors, hide-and-seek involves plenty of running and climbing. Plus, the suspense is sure to engage kids of all ages (and adults too.)

GO TO THE PARK

This may seem obvious, but is there anything better than dangling off of the monkey bars?

4. 5.

Let the kids pick out the seeds and help plant them. Watering, weeding and harvesting duties will keep the family busy all summer. (for more on spring gardens, see pg. 33)

PLAY WITH SIDEWALK CHALK

Whether you’re playing hopscotch, drawing a picture or writing a story, sidewalk chalk provides endless play possibilities.

JUMP IN THE POOL

Visit your local recreation centre and go for a swim.

GO TO YOUR LOCAL MUSEUM

PLANT A GARDEN

COOK TOGETHER

Go to the market and walk up and down the aisles for inspiration. Then, prepare a meal together with everyone completing a different task.

Art galleries and museums are often free for children and they allow for an educational walk.

VISIT A PROVINCIAL PARK

In Alberta, you’re always less than one hour away from a provincial park or protected recreational area.

10.

USE THE JUMP ROPE

Try a round of double Dutch. 10

spring 2016

myleapmagazine.ca

Next Gen • supporting young minds

MAKING IT MOBILE

Three young researchers improve therapy for head and neck cancer patients BY JULIE-ANNE CLEYN Head and neck cancers, with their low survival

rates and drastic physical consequences, are one of the most traumatic cancers a patient can go through. Often, treatment requires the removal of parts of the patient’s skull or face, making it difficult to do things like eat, drink and speak as they had before. Afterwards, they undergo intensive therapy and rehabilitation: clinicians may ask patients to come in as often as three times a week, and therapy requires patients to exert a lot of effort in order to see an improvement. Edmonton’s Institute for Reconstructive Sciences in Medicine (iRSM), a clinic and research body, has been working to ease the effects of cancer treatment by advancing the science behind reconstruction and HIGH TECH SOLUTIONS: Gabi Constantinescu (left), rehabilitation. Right now, the Alberta Cancer Li Liu (centre) and Daniel Aalto (right) are combining forces Foundation is fundraising $2 million for a trio of to improve swallowing therapy. researchers that are working to develop a swallowing therapy device that will allow patients to complete therapy at home. Gabi Constantinescu is a speech pathologist and effects of her work on patients. “It’s the patients and their stories that motivate PhD candidate, on education leave from her clinical me,” she says. Her work has introduced patients to design concepts and possible options for position at iRSM. She noticed seven years ago that patients were having difficulty attending their swal- what is known as “biofeedback swallowing therapy.” For this therapy, clinicians lowing therapy appointments. They either couldn’t use surface electromyography (sEMG), a type of visual feedback that involves take the time off work, they had conflicting appoint- attaching sensors to the patient’s skin, which detect muscle contractions while ments or they couldn’t drive to the clinic in Alberta’s the patient is doing exercises. It allows the patients to assess their efforts and sometimes less-than-ideal driving conditions. The determine next steps. The team’s work is ultimately centred on improving patient quality of life. For clinicians also couldn’t always fit them in three Liu, a graduate student in chemical and materials engineering at the University of times a week. Since then, Constantinescu has been researching Alberta, this means improving a key part of treatment: the mobile swallowing what patients want and need from a mobile swallow- device that patients use has an adhesive pad that often irritates the skin and leaves a residue. Since patients must ing device. Along with wear the device several times a day, Liu is Daniel Aalto, who is using “It’s the patients and their stories that working to pioneer a reusable adhesive mathematics to detect motivate me,” says Gabi Constantinescu. that’s comfortable. when a patient swallows, In developing an improved adhesive, Liu has been researching which silicone and Li Liu, who is helping to develop an adhesive that places the device under the chin, her work at iRSM is gel needs to be used and how thick it should be. Liu was introduced to Rieger supervised by Dr. Jana Rieger. Through one-on-one when her supervisor learned that Rieger wanted to develop a new adhesive. “I interviews with patients, Constantinescu has worked find it interesting to develop something new and [to] help the patient,” says Liu to determine the facilitators and barriers to unsuper- of what motivates her in her work. After completing his PhD in mathematics, Aalto set out to find a way to apply vised home therapy. “[Gabi] was the clinician who originally came to me his skills – now, he’s developing an algorithm for the mobile swallowing device and said, ‘Hey, wouldn’t it be neat if we could develop that will detect when a patient swallows. His work will determine how to provide a mobile device?’ ” says Rieger. “So, she deserves a immediate feedback to the patient after they swallow. He’s also helping the lab lot of credit.” With a background in biochemistry and turn their assessment into 3D images by tracking jaw movements. “What motivates me is seeing these powerful mathematical tools change how genetics, Constantinescu began her work in speech therapy because she wanted to see the immediate things happen,” he says.

Alber ta Cancer Foundation

spring 2016

Beyond Cancer • stories of survivorship

The MATCH Study Comparing mindfulness and tai chi for cancer health BY LINDA E. CARLSON, PHD ENBRIDGE RESEARCH CHAIR IN PSYCHOSOCIAL ONCOLOGY Over the years I’ve written in this column about a number of complementary and mind-body therapies, including mindfulness meditation, tai chi and Qigong. Mindfulness-based cancer recovery (MBCR) is an eight-week program we developed at the Tom Baker Cancer Centre in Calgary, which trains participants in mindfulness meditation and gentle yoga, while tai chi and Qigong (TCQ) are a form of martial art derived from traditional Chinese medicine that involves a series of slow specific movements or “forms,” done in a meditative fashion. Both MBCR and TCQ programs have a growing evidence base showing they are useful adjuncts to usual care for improving quality of life and treating symptoms such as anxiety, depression, fatigue, sleep problems and pain. However, researchers have rarely compared different mind-body therapies head-on, to see which is better for helping with specific problems. So that is exactly what we are doing in the newly funded MATCH study. The study compares the effects of MBCR to TCQ on a range of psychological m e a s u re s , p hys i c a l f i t n e s s o u tco m e s a n d biomarkers, which may be important for cancer progression. Psychological measures include anxiety, depression, quality of life, sleep patterns and pain, while assessments of strength, balance and endurance will be the physical markers. Biomarkers will include immune function, stress hormones, cell aging and gene expression. We will also look at whether participating in these interventions provides cost-saving measures to the health-care system and society in general, by helping people function better. It will be the first study of its kind to directly compare these interventions on such a broad range of outcomes. The trial also takes into account the importance of patient preference in determining how well people respond to therapies. We will be asking potential study participants if they have a clear preference for either mindfulness or tai chi, and if they do, they will participate in the therapy that they prefer. If not, we will assign them randomly to one or the other. In this way, we will be able to compare the effects of these 12

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two programs for people who really want them compared to people who are just interested in mind-body therapies more generally. We will also take into account the effects of more general patient qualities on outcomes, like gender, age, ethnicity, type of cancer, stage and other personal characteristics. In this way we can move towards more “personalized” behavioural treatments for cancer-related symptoms, prescribing interventions that appear best suited to specific types of people and problems.

The More You Know This groundbreaking and innovative study is being conducted by a large study team in Alberta, Ontario and the U.S., and will be offered to patients in the Calgary and Toronto areas. We will be looking for people diagnosed with all types of cancer from the Calgary area who have completed primary cancer treatments to participate in the study beginning this summer. For more information call the Department of Psychosocial Resources at 403-355-3207 or visit www.tbccintegrative.com

myleapmagazine.ca

Smart Eats • food for life

Eating for Prevention A healthy diet is one of your strongest weapons when it comes to preventing cancer BY SANDRA CHRISTIANSEN, NUTRITION SERVICES PROGRAM LEADER AT ALBERTA HEALTH SERVICES

There are many factors that contribute to your risk of cancer – genetics, environmental exposure, inactivity and smoking, for instance. But by eating healthy, you can take proactive steps to reduce your risk of developing the disease. Here are some tips to guide your choices: Follow a plant-based diet: Choose non-starchy vegetables, fruit, whole grains, beans and legumes with no sugar or salt added. Most vegetables are non-starchy, like broccoli, eggplant, bok choy, carrots, rutabaga, turnips, peppers and green leafy vegetables. Examples of starchy vegetables that are not protective against cancer include potatoes and corn. Choose whole grains like brown rice, barley, oats, millet and whole grain wheat instead of refined grains, white flour and white pasta. Cancer-fighting nutrients: Phytochemicals (plant chemicals) and other plant-based nutrients may help to reduce your risk of cancer. For example, lycopene is found in many red or orange vegetables and fruits like tomatoes and carrots, and may be associated with a reduced risk of prostate cancer. Cruciferous vegetables (broccoli, cabbage and Brussels sprouts) contain a compound called sulforaphane that may also reduce your risk of certain types of cancers. An easy way to get in the habit of eating more vegetables is to fill half of your plate with vegetables and fruit. Stir-frying peppers, carrots and onions in olive oil with a bit of ginger and garlic is a quick way to include vegetables on your supper plate, and a simple cucumber and tomato salad is also an easy option when you’re in a rush.

Alber ta Cancer Foundation

Foods to limit: Last year, the World Health Organization (WHO) stated that eating processed meats (which have been salted, cured, smoked or fermented) is associated with an increased risk of colorectal cancer. It also reported that eating red meat may be associated with an increased risk of colorectal cancer. In 2007, the WHO recommended that people who eat red meat (beef, pork, lamb) should eat less than 18 ounces (500 grams) cooked weight each week, and that recommendation still stands. That equals about seven servings from the meat and alternatives food group in Canada’s Food Guide, or about three six-ounce (170 gram) steaks a week.

Take-Home Tips: • Pre-cook and freeze unprocessed meat, poultry and fish in individual portions so that it can be used in quick and easy meals like wraps, stir fries and casseroles. • Try a meatless meal at least once a week. Beans, lentils and tofu are high in protein, contain fibre and cost less than meat and poultry. Add chickpeas or beans to salads and soups and make a meatless chili or quesadilla with black, kidney or white beans. You can also try sautéing tofu with vegetables to create a stir-fry or dicing tofu and adding it to tomato sauce with spaghetti for a quick meal. • Substitute lentils for half of the ground beef in recipes, such as pasta sauces, chili, soups and casseroles. Be sure to boil lentils for 10 minutes before adding.

spring 2016

Ask the Expert • a resource for you

NEED TO KNOW We polled the pros about eating street food on vacation, how to maintain a local diet in the off-season and what activities to do with a friend who’s undergoing chemotherapy treatment BY LYNDSIE BOURGON

I’m travelling somewhere warm this spring break. What do I need to know about eating street food?

Chasing the sun and lounging on beaches are common reasons for travel during spring break, and trying new cuisine is often a big part of the travel experience. And while market stalls and street vendors offer a range of food and beverage selections, it’s recommended that travellers avoid these options and choose establishments that cater to foreigners and have a steady stream of customers. “The most common cause of illness when visiting a developing country is travellers’ diarrhea,” says Stephanie Scott, clinical development nurse at Calgary Traveller’s Health Service. That diarrhea is most often caused by eating or drinking contaminated food and beverages. “Because the health standards are different in developing countries – and street vendors do not have kitchen facilities to practise proper hand hygiene – travellers are advised to follow some general precautions in order to stay healthy when eating abroad,” she says. This includes eating 14

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fruits and vegetables that are peeled or cooked, food that is served hot and fresh, avoiding unpasteurized dairy products, undercooked or raw meat and seafood. The general recommendation for travellers is “boil it, cook it, peel it or forget it!”

Visit travel.gc.ca to obtain general travel health recommendations, information on security advisories, entry and exit requirements, locations of yellow fever vaccination centres and more. It is best to visit a travel health clinic about six weeks prior to travel. A list of Alberta Health Services travel clinics is available at albertahealthservices.ca.

myleapmagazine.ca

What activities can I do with a friend who’s undergoing chemotherapy treatment?

How can I maintain my local diet during the winter and spring, when we’re in between harvest seasons? According to Kate Stenson, co-chair of the Calgary EATS! Stewardship Group, there are lots of fun and easy ways to eat locally during the winter and spring. “Local farms are able to store and sell vegetables like potatoes, carrots, onions, beets and squash, and offer meat and eggs all winter long,” she says. “Some even have Community Supported Agriculture (CSA) programs that deliver such produce regularly through the winter. Talking directly to producers at year-round farmers’ markets is a great way to get advice on how to best eat locally.” Indoor growing is also experiencing a wave in popularity, which means you can look for microgreens and aquaponically grown lettuce and herbs. And getting creative in the kitchen with recipes that draw on the strengths of locally available ingredients and celebrate regional and traditional cuisine can be a fun way to pass the winter months. “While eating food made, baked, grown, processed and sold in Alberta is a key principle of creating a sustainable food system, so too is taking a hybrid approach that balances locally produced food with imports,” says Stenson. “So during the winter months, it may be worth extending ‘local’ to include food from places like B.C.”

Alber ta Cancer Foundation

According to Dr. Marilyn Hundleby, psychologist and director of programs at Wellspring Edmonton, a friend going through treatment may want a break from thinking about talking about cancer, so an activity that provides a diversion can provide an uplifting element to their day. “It can be simple things that make the most difference, like going for a walk together,” she says. “Many years ago, I came to know a wonderful group of women, all of whom had gone through breast cancer. They wanted to help one of their friends, who was having a difficult time during her chemo treatment. Since many in the group had originally been members of a dragon boat team, their first thought was to get outside and exercise and they encouraged their friend to walk around the block with them. On their first outing they came across a coffee shop and decided to stop and have a cinnamon bun together. From then on they called themselves the “Cinnabunnies” and every week the walks got longer – and they came to know some of the best places for cinnamon buns in the city.” Hundleby also recommends watching a funny movie. “Many years ago, [the author] Norman Cousins was diagnosed with a very painful disease called ankylosing spondylitis. He found that laughter seemed to help reduce his pain,” she says. Laughter produces feel-good chemicals called endorphins, and any activity that fosters a mind-body-spirit connection has a benefit to our overall well-being. Colouring books have also recently become very popular for adults. “You may remember as a child how you lost track of time as you coloured,” says Hundleby. “Bookstores now have tables filled with these books. It is a great way to de-stress because we focus on the activity and not our worries and anxieties.” Plus, you can become engrossed in this activity with a friend and colour and talk at the same time.

Ask our experts questions about general health, cancer prevention and treatment. Please submit them via email to letters@myleapmagazine.ca. Remember, this advice is never a substitute for talking directly to your family doctor.

spring 2016

ONE DAY. ALL CANCERS. REGISTER TODAY! ONEWALK.CA 403.879.9802

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SPECIAL REPORT:

CLINICAL TRIALS

he Alberta Cancer Foundation has a commitment â&#x20AC;&#x201C; to invest $10 million into clinical trials that focus on cancer care across Alberta. But what exactly goes into the clinical trial process, and why is it so important? This issue of Leap takes a special look at the advancements in cancer treatment that clinical trials have made possible.

Alber ta Cancer Foundation

THE HEART OF CANCER CARE Cancer researchers at the Cross Cancer Institute make a breast cancer treatment breakthrough using clinical trials

WORTH A TRY Clinical trials are a critical step toward advancing cancer treatment

WHAT EXACTLY IS A CLINICAL TRIAL? A step-by-step look at what goes into a clinical trial

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PHOTO: COURTESY UNIVERSITY OF ALBERTA

Clinical trials

Cancer researchers at the Cross Cancer Institute make treatment breakthroughs using clinical trials BY MICHELLE LINDSTROM 18

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BREAKTHROUGH TRIAL: Dr. Edith Pituskin and Dr. Ian Paterson worked on a clinical trial that made great strides in cardio-oncology.

n October 2011, Sherwood Park resident Deb Cameron went in for a routine mammogram. She had none of the symptoms typically experienced by breast cancer patients, such as a burning feeling, rash or change in her nipples. She also had no family history of the disease. Still, at the age of 56, Cameron was diagnosed with an aggressive form of breast cancer. Before her diagnosis, Cameron was very active and feeling good, which added to her shock. Turning to her radiologist, she said, “If you had told me that I had colon cancer, I probably would have been less surprised.” Cameron was 29 when her mother was diagnosed with a form of colon cancer that doctors said could be genetic. Her mother passed away three years and three surgeries post-diagnosis. In late November 2011, a nurse at Edmonton’s Cross Cancer Institute, Diane Bodnar, met Cameron at a regular post-diagnosis appointment. Bodnar discussed the potential of Cameron joining a clinical trial. Cameron agreed, and a month later she met Dr. Edith Pituskin,

Alber ta Cancer Foundation

an assistant professor of nursing and oncology at the University of Alberta’s nursing and medicine departments, for her first chemotherapy treatment at the Cross. Pituskin is a co-investigator on the clinical trial known as MANTICORE. “My mom joined a chemo clinical trial when she was diagnosed,” Cameron says. “Knowing that my mom participated in a trial definitely made me feel that if my mom can do it, I can do it.” Her husband and two daughters were also supportive of her joining a clinical trial. “We all felt that, with every advancement that’s been made in cancer treatment, somebody else has probably gone through a type of trial to advance the levels of treatment.” One of her daughters was pregnant when Cameron was diagnosed, and her third grandchild was born soon after letting the whole family know she had cancer. She says her new baby grandson became her comfort, something else to focus on when he visited her during chemo treatments.

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Clinical trials

Pituskin was involved in developing the MANTICORE trial, but it actually began years earlier. In 2006, Dr. John Mackey, a professor in medical oncology at the University of Alberta and director of the Clinical Trial Unit at the Cross Cancer Institute, and Dr. Mark Haykowsky, a physical therapy professor in the Faculty of Rehabilitation Medicine at the University of Alberta, were studying heart weakening in cancer patients taking a drug called Herceptin. They wondered if exercise could play a role in prevention, and invited Dr. Ian Paterson, a cardiologist at the University of Alberta Hospital, to join them in a small study to test the connection, while Pituskin recruited the study’s patients. “We found that exercise did not prevent the heart changes as we had hoped it would,” Paterson says. As a cardiologist, Paterson’s go-to remedy typically involves giving patients medication. “Giving pills is easier than convincing someone to do exercise,” he says. So he started a new study that used heart medications to prevent Herceptinrelated heart weakening. His randomized, placebo-controlled clinical trial was called MANTICORE, an acronym for Multidisciplinary Approach to Novel Therapies In Cardiology Oncology Research. “It also happens to be a creature from the game Dungeons & Dragons,” Paterson says, “and thus, a tribute to my nerdy adolescent years.” Funding support for the trial came from the Canadian Institutes for Health Research as well as other groups including the Alberta Cancer Foundation. “The [typical] approach in cardiology is that we give heart pills after the problem has developed,” Paterson says. “But in this case, we wanted to see if giving pills as a prevention strategy from day one of their chemo, which is also day one of Herceptin in their case, would help prevent heart weakening and ultimately heart failure.” The MANTICORE study began in December 2010, with Paterson as lead investigator and Pituskin as co-investigator and study manager. Pituskin recruited patients, like Cameron at the Cross, and met with them during their treatments. The study included 99 breast cancer patients from Edmonton and Winnipeg who were HER2-positive, in the early stages of the breast cancer and had no prior heart problems. Cameron fit all of those requirements. HER2-positive breast cancer is a more aggressive form of the disease that affects roughly one in five breast cancer patients. These patients receive standard cancer treatments (like chemotherapy and surgery, if needed) in addition to Herceptin, an effective drug to treat breast cancer that can also weaken a patient’s heart. About 90 per cent of the patients in the study were receiving treatment in Edmonton, with the rest in Winnipeg. At the time, many sites were approached to partner in the study, but some didn’t have timely access to a cardiac MRI. That equipment was necessary for the study to enable investigators to effectively monitor patients’ hearts throughout their cancer treatment. Investigators routinely checked participants for any heart muscle weakening or function, which can happen not only during cancer treatment but also years later. Patients were asked to participate in the trial for two out of the five years it ran, between December 2010 and December 2015. For the first year, patients took Herceptin, greatly to the point where people with early breast cancer received regular chemo treatments and also took one of three randomly selected drugs: are now at a higher risk of cardiovascular disease than a placebo, a beta blocker or an ACE inhibitor. Beta blockers and ACE inhibitors are used they are of recurrent breast cancer.” to treat heart failure in addition to several other conditions. During the second year, paOver the two years she was tients returned for heart checkups and had blood the trial, Cameron says samples taken to monitor their health. “Cancer treatments have improved involved she had four MRIs of her heart. The drugs in the study, meant to take a preventive approach to heart failure, were made to greatly to the point where people with “Every time we had our MRI, Dr. look identical, called “blinding.” early breast cancer are now at a higher Paterson would explain to us what “A proper study is randomized so people have risk of cardiovascular disease than they saw, and for me, he said there were only minimal changes and an equal chance of getting all the treatment opthey are of recurrent breast cancer,” those could have been just because tions and it’s blinded,” Pituskin says. “The medisays Dr. Edith Pituskin. of decreased activity during my cations were made by an outside group, and there chemo,” she says. was no way to know what the study capsules conThe randomized selection of drugs was blind to the tained – whether it was a placebo or one or the other medications.” The drug types were split evenly among the group, with 33 patients each getting one patients as well, even after its five-year span concluded in type of the study’s drugs for the first year they were involved in he trial – and it’s game December 2015. “My heart function still seems to be very healthy,” Cameron says, guessing she received something changing findings – garnered interest from oncologists around the world. “We think this is a whole new field,” Pituskin says. “Cancer treatments have improved other than a placebo, although she doesn’t know for sure. 20

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PHOTO: COURTESY UNIVERSITY OF ALBERTA

HEART MONITOR: Dr. Ian Paterson checks up on Deb Cameron, who participated in the Herceptin clinical trial.

Patients will be notified in the upcoming year which drug they actually received. “I had already agreed to take a drug that could be harmful to my health (Herceptin) and by participating in the clinical trial, I could be getting something that would offset that harmful effect,” Cameron says, adding that the clinical trial was a “no brainer” to her, considering it offered her the chance of helping herself and future generations. “Being part of a clinical trial brought me in contact with other cancer patients, which led to a lot of open discussion because it’s hard to talk to people that haven’t been there and just don’t get it,” Cameron says. “Meeting people in the clinical trial gives you more areas of support, but I also felt there was another set of professional eyes watching me from a different perspective.” Paterson says during the trial he learned a lot about cancer, cancer treatment and patients, since his work prior had not been in oncology. “I think a study like this helps raise awareness for cancer patients, oncologists and cardiologists and that there may be effective ways to prevent heart weakening,” he says. Pituskin agrees: “Cardio-oncology is going to be an entirely new and increasingly important area of care,” she says. “And this study is one of the first to show that this is important.” Cameron had a mastectomy and reconstructive surgery in August 2013. “There are no signs of active cancer in my body,” she says, adding that she is basically in remis-

Alber ta Cancer Foundation

sion but with her type of cancer, she’ll never be considered “cancer-free.” “In the last three years, between my treatment and reconstruction, I don’t think I’m back to the same physical strength that I was then, but I’m also getting older, so it’s hard to know,” Cameron says. She’s back to running, walking and doing yoga to stay active. “The future for me is to continue to be active, health-conscious and stay involved with my family and with other survivors,” she says. “But mainly, just trying to live my life beyond cancer.”

For more information on clinical trials, and how to get involved, visit www.albertacancerclinicaltrials.ca

spring 2016

Clinical trials

LOOK CLOSER: A button campaign spreads the word about clinical trials at the Tom Baker Cancer Centre.

spring 2016

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Clinical trials are a critical step toward advancing cancer treatment

BY SHELLEY WILLIAMSON

PHOTO: DON MOLYNEAUX

“The life expectancy for my arm of the trial is a median abine Moritz wants you to ask her about clinical cancer trials. When she’s at work, the clinical research manager at the Tom Baker of 14 or more years, so it definitely extended my life Cancer Centre wears a button that says, “Please ask me about clinical trials.” expectancy quite a bit,” she explains. “The doctors have Along with oncologists and other staff members, Moritz wants to spread the said that they have no reason to believe I wouldn’t be on word about the important work that clinical trials do in cancer care. There are currently the long end of that.” She does her part to eat right, exercise when she can about 200 trials being conducted out of the Tom Baker in conjunction with other and stay as healthy as possible, but she credits the trial facilities around the world – 90 of which are actively recruiting. The button campaign helps prompt patients to ask about non-traditional treatment with her improved outcome. She also suggests others options. “A lot of our physicians are close to clinical trials, but they may not think about facing a cancer diagnosis consider a clinical trial if given [mentioning] a clinical trial every time they see a patient,” Moritz says. “It will actually the option. “I definitely think there are huge advantages encourage patients to ask their physician about a clinical trial option. That could be a to the clinical trials,” Kessler says. “I think that if a person is comfortable I strongly encourage them to wonderful introduction to something that they’ll want to discuss.” Along with access to the latest in pharmaceuticals, which are commonly provided partake. We saw it as a chance to help make some by drug companies at no cost to patients, participation in clinical trials means better advances and find out what does work … If nothing else, access to specialized care, Moritz says. “The patients who are participating in trials you are advancing the care.” are seen by our clinical trial nurses, so the attention that patients receive on a clinical trial is enhanced compared to other patients who receive standard care. There is really As part of her work at the Tom Baker, Moritz a closer evaluation of the outcomes, so in terms of ensuring a patient is safe, the kind of ensures all patients are aware of the risks, and she tries to dispel some of the myths surrounding clinical trials. supervision that patient would be receiving in a clinical trial is higher.” “Some people still think While trials are just that – an unproven treatment people are being option being sampled among a select group – they can “We saw it as a chance to help that used as guinea pigs, and sometimes yield better results than traditional cancer treatment. Before getting the green light, all trials must be make some advances and find out I explain the changes we approved by an ethics committee that includes lawyers, what does work … If nothing else, have seen [over the years] and better successes and oncologists and patients, says Moritz. you are advancing the care,” outcomes,” she says. There is also no question that having access to the latest says Charlotte Kessler. “When a patient is faced treatments helps advance cancer care, which benefits with a diagnosis of cancer, both patients and the oncology field. “It really is a winwin situation in that they present state-of-the-art treatment for a patient,” says Moritz. the only way to improve is to improve treatments, “It also means that the institution gets familiar with this new treatment that hopefully and the only way to do this is through clinical trials. will be coming down the road, so when it has been approved by the FDA it will become [Survival rates] have improved significantly due to available. Having the early experience using these treatments enhances the ability of clinical trials.” Not all clinical trials are financially supported by large oncologists and nurses to use these new treatments.” pharmaceutical companies – for this reason, the Alberta Charlotte Kessler is grateful to have been part of a clinical trial. Previously Cancer Foundation and its donors invest $1 million to healthy, the 34-year-old had a grand mal seizure on the soccer pitch in her hometown $1.2 million annually to the clinical trials unit at the Tom of Medicine Hat in September 2013. Soon afterwards, Kessler was diagnosed with Baker Cancer Centre. “They are specifically providing a grade three anaplastic astrocytoma in her right frontal lobe. After surgery at funding so we are able to run clinical trials that fall into Calgary’s Foothills Hospital, her doctor offered her a spot in a clinical trial out of the category of academic or co-operative group trials,” the Tom Baker Cancer Centre. The two-year drug trial, which involved 24 rounds of says Moritz. “When we are considering these trials, chemotherapy, wrapped up last November. Though the official trial period is over, she we really have to look at the cost involved. It can be will be monitored by physicians for the rest of her life, undergoing an MRI every three several thousand dollars per patient on trial, so having the Alberta Cancer Foundation provide funding allows months to check for new tumour growth. While she was initially given just a few years to live, the trial has added years to her life us to run these trials, make treatment options open to expectancy. As is often true of brain cancers, hers will never be in remission, but Kessler patients and address these important questions that is grateful for the extra time she’ll have with her husband and five-year-old daughter. will eventually help us improve treatment.” Alber ta Cancer Foundation

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Engagement • giving patients a voice Hallmarks of cancer

Engagement Redux Patients and their families bring much-needed “aha! moments” to engagement research BY JESSICA DOLLARD

The best thing about my job is the little surprises. Without question, every time I believe I know exactly what a patient or family advisor will say about any given topic, I am wrong. I hear this from the health-care teams I work with too: there’s always an “aha! moment” of insight. There’s always something we didn’t think of that our patients and families did. For that reason I have invited one of our inspiring, committed and clever patient advisors to share his story about a clinical study. “My wife Cheryll and I were very fortunate to participate in a controlled study that examined the impact of nutrition and exercise on the symptoms experienced by head and neck cancer patients. Many patients, including me, require radiation therapy to the neck, making it difficult to eat and intake adequate nutrition. This increases the risk of muscle wasting, which causes increased treatment recovery times and decreased quality of life for many patients. Concurrent with chemo and radiation treatment, Cheryll and I attended formal exercise and education classes at the University of Calgary’s Thrive Centre and Wellspring Calgary, while following a prescribed exercise program at home. My nutritional intake and fitness level was assessed throughout the study period as well. The exercise and education components of the study helped both of us manage the stress that comes with the surprise of a cancer diagnosis and the physical and emotional challenges of treatment. Although I was active and reasonably fit before my cancer diagnosis, 33 radiation and three chemotherapy treatments had left me feeling nauseous and physically weak. The exercise program helped to stimulate my appetite and minimize muscle loss, making my recovery faster and easier. Without a doubt the most positive impact of the controlled study for me and Cheryll was the opportunity to meet other head and neck cancer patients and their caregivers. The study created an instant community with others who were experiencing the same side-effects from treatment. We received so much support and information from others, which continues to this day, and it helped us better understand common treatment and recovery sideeffects and how others were managing them. Our advice to cancer patients and families is to seek out and actively participate in as many support programs as 24

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possible. Ask your medical team about educational sessions, exercise programs and support programs that are currently available for your type of cancer. Participation in programs like this made our journey much easier and provided a more holistic treatment of my cancer.” – Doug Caldwell, patient advisor, Calgary Cancer Patient and Family Advisory Council See what I mean? There’s nothing like the power of a story to help us know what’s working so that we can amplify and learn from it. For me, the “aha! moment” in Doug’s story came when he spoke about the community that developed during his study. Before hearing his story I knew that clinical studies and trials were advantageous, but I didn’t fully realize how multifaceted the benefits could be. The Patient and Family Advisory Council created strategic priorities this year and “research” was among the top three. I believe that Doug’s story and passion was a driving force in this, and I hope that the advisors can work with researchers, providers and families to share more success stories. Jessica Dollard is the patient-centred experience advisor on the Calgary Cancer Project. As a consultant in engagement and patient experience, as well as an actor, film and theatre producer, programmer, medical skills trainer and executive certified coach, she brings a creative background to this work.

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Clinical trials

There are many different types of clinical

trials, but all follow a series of steps, known as phases. If a trial is successful in the first phase, it moves on to the next â&#x20AC;&#x201C; for safety reasons, it takes three successful phases before a drug is ready to be distributed to the public. Clinical trials are usually sponsored by a pharmaceutical company, university, clinic or cancer research centre, but each trial is led by an individual doctor, known as the lead or principal investigator.

Hereâ&#x20AC;&#x2122;s what happens during the clinical trial process

Alber ta Cancer Foundation

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Clinical trials

THE PHASES PHASE I: This phase is all about determining safe dosage levels, determining how treatment should be given and noting how it affects patients. Between 15 and 30 people participate in a clinical trial’s Phase I. PHASE II: During Phase II, researchers aim to determine if the new treatment has an effect on a particular cancer and how that treatment affects patients. Less than 100 people participate in this phase. PHASE III: During Phase III, the new treatment will be compared with current standard cancer treatments. This phase can see lots of participants – between 100 and several thousand. Once a drug is distributed to the public, researchers continue to assess the long-term safety and efficacy of a new treatment or drug. This can include several hundred to a thousand participants.

PHASE I Between 15 and 30 participants

PHASE II Less than 100 participants

PHASE III Between 100 and several thousand participants

NUMBER OF CLINICAL TRIALS IN ALBERTA, BY TRIAL TYPE: Co-operative (academic, government or NGO-based trials):

205

Industry (pharmaceutical based trials):

325

In-House (driven by independent researchers)

373 PATIENT KNOW-HOW

• Before you start a trial, ask lots of questions: – Why is the trial being done? – How might this treatment be different from current standard of care? – What costs will my provincial health insurance cover? – How could the trial affect my daily life?

• Only an individual with a valid licence to practice medicine can act as a clinical trial investigator.

• Know that if you sign up for a particular phase in a trial, you don’t have to participate in all of them.

• Even after you sign an informed consent form, you are free to leave a clinical trial at any time.

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• Clinical trials follow strict guidelines and are closely monitored by Health Canada, the centre where the trial takes place and an ethics board.

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PLACEBOS: Placebos are used in some clinical trials to test whether a new drug or treatment is better than no treatment at all. These placebos look just like the drug being tested but donâ&#x20AC;&#x2122;t contain any active ingredients, and are administered to randomly selected participants for the duration of the study. Patients are informed if a placebo is being used in a clinical trial, but not if they have been selected to take one.

CANCER TRIALS IN ALBERTA, BY THE NUMBERS: Breast:

18 Head and Neck

Hematology:

Melanoma:

TRIAL TERMINOLOGY:

The number of clinical trials expected to open in Alberta this year

600

Patients will take part in those trials

The clinical trials units at the Cross Cancer Institute and Tom Baker Cancer Centre now employ more than 100 medical professionals

Alber ta Cancer Foundation

CONTROL GROUP: A group of participants that is receiving the current standard of care, the tested treatment or a placebo, whose results are used as comparison against the clinical trialâ&#x20AC;&#x2122;s participant group. INVESTIGATOR: The person responsible for conducting the clinical trial. Often, they are responsible for managing a team of researchers that work on the trial with them. PROTOCOL: A document that outlines and describes the objectives, design, methodology and organization of a trial. The protocol also often gives the background and rationale for the trial. INFORMED CONSENT: The process that a participant goes through in order to confirm their willingness in participating in a clinical trial. STANDARD OF CARE: The current treatment being used to treat a disease or condition that is accepted.

PARTICIPATE If you are interested in taking part in a clinical trial, speak with your health-care team and inquire about open trials that you may be eligible for. The Alberta Cancer Foundation has committed to investing $10 million over the next five years to bring innovative cancer treatments to Albertans faster. Your donation to the Foundation can help one of these trials get off the ground. Visit http://albertacancer.ca/investment- priorities/clinical-trials for more information on how to donate.

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A Gift inThanks One donor’s choice to support an early detection program for lung cancer BY LISA CATTERALL

ohn Poyen (known to friends and family as “Jock”) died of metastatic lung cancer in early February 2014. Jock was an energetic man, with an open heart and an endless zest for life. His optimistic and enthusiastic demeanour helped him to develop a widespread network of friends and family across the globe. He was passionate about spending time with those he loved, and spent hours playing golf with friends and participating in family events and activities. He enjoyed spending time outdoors no matter the season, even as his health began to decline in recent years. “We just attributed all of his health problems to diabetes and gastrointestinal issues,” says Janet, his wife of nearly 50 years. “He began to suffer a lot, but because he loved being with friends and family, he kept going, trying to do what he could to stay involved.” CUT FOR THE CAUSE: Family members support John Poyen (second from right) Following a trip to Asia in fall 2014, Jock’s health by cutting their hair short. deteriorated rapidly. Janet and Jock were avid travellers, always looking forward to their next journey. This time, though, Janet knew something was wrong – Jock was falling frequently, and was feeling major pain in his bones. the Poyens. Despite countless visits with specialists and medical professionals over the previous years, Jock’s lungs had not been examined. By the time the cancer was In December, Janet brought him to the emergency room. “We were so focused on everything else that it never discovered, it was too late to be fought off. “Early detection can have a huge impact,” says entered our minds that it might be cancer,” says Janet. Janet. “If Jock’s lung cancer had been diagnosed at an earlier stage, our story could have “At first they thought it was a tropical disease or related been completely different.” Before Jock passed away, his will was amended to diabetes, but numerous to leave a gift to the Tom Baker Cancer Centre tests provided no answers. “Early detection can have a huge to reflect his profound gratitude for the care Finally they ordered a impact. If Jock’s lung cancer had been he received from Dr. Wu and the palliative care bone scan, which revealed extensive cancer from his diagnosed at an earlier stage, our story team. Janet consulted with Pema Lektsog, senior of major gifts at the Alberta Cancer head down to his hips. Jock could have been completely different,” director Foundation, to find an appropriate way to honour was immediately referred to says Janet Poyen. Jock’s wishes. Lektsog explained to Janet that the fast track program at the the gift could be designated to a priority area Tom Baker Cancer Centre, under the care of the wonderful Dr. Jackson Wu and his of interest to the family, and given Jock’s story, recommended the early detection lung cancer screening program which would allow lung cancer to be detected earlier when it is palliative team.” Over the course of a week, Jock received five most treatable. When Janet heard about the Alberta Cancer Foundation’s In Gratitude of treatments, which brought him considerable relief and Caregiver program, she knew it was the perfect way to honour her husband’s memory and allowed him to enjoy time with loved ones over the holiday help individuals across the province with lung cancer. “This program allows patients and donors to acknowledge their gratitude for season. The Poyen family was impressed with the quality exceptional care provided by their caregivers and is a meaningful way to recognize the of care that Dr. Wu and the palliative team provided. The discovery that metastatic lung cancer was at the many dedicated caregivers who work in our 17 cancer centres throughout Alberta,” says root of Jock’s medical problems, and that it had gone Lektsog. “We are grateful to Janet and her family for this gift – it will make life better for undetected for months, perhaps years, was difficult for other Albertans facing cancer.”

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PHOTOS: DON MOLYNEAUX

HOME SWEET HOME: Grand Prize winner Robert Park celebrates his Cash and Cars lottery win with his mother.

Whole

Lotto Love The Cash and Cars lottery makes life better for Albertans with – and without – cancer

onnie Sawatzky’s life has been touched by cancer far too many times. All three of her brothers passed away from cancer, as did her sister-in-law. And in January 2014, her husband, Aldon, was diagnosed with Hodgkin’s lymphoma. “I cannot say enough about our doctors, our nurses and our patient navigator, who made such a hard time bearable,” says Sawatzky. And when her husband experienced a complication, the Cross Cancer Institute in Edmonton was able to help the family reduce the cost of the medicine he required. “We had a fantastic supportive local team and when we had to travel to Edmonton [from

Alber ta Cancer Foundation

BY SUE LEBRETON

Drayton Valley] once for care, it reinforced how blessed we were to be able to do the treatment near home.” So it was almost inevitable that Sawatzky would buy another lottery ticket for the Alberta Cancer Foundation’s Cash and Cars and You Win 50 lotteries, which she had been supporting since 2002. She recalls looking at the Cash and Cars brochure just before the draw and noting that they needed a new vehicle. “But I had forgotten about the 50/50 draw,” she says. So when the call came in to say she had won $737,500 in that draw, she didn’t pick up the unknown number. When a Foundation employee finally reached her, she initially thought it was a friend pranking her, so she put the call on speaker phone so her husband could hear. Lotteries like these raffle off big-ticket items like houses, cars, vacations or the opportunity to leave financial worries behind. The Alberta Cancer Foundation has been running the Cash and Cars lottery for 16 years and added the You Win 50 component

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three years ago. As major fundraisers, lotteries enable the Foundation to donate to all 17 cancer centres across the province. But a lottery offers more than just the chance to win cash, vacations or jewelry: it also sells hope – hope that the funds raised will have a significant impact on the many Albertans dealing with cancer, and hope that cancer patients will be able to return to their lives.

“After a rough year of dealing with chemo in 2014, to win this in 2015 feels like we have gone the rounds. We are celebrating our blessings,” says Connie Sawatzky. Funds raised through the Cash and Cars Lottery and You Win 50 help Albertans with cancer have better care, better facilities and better outcomes. This year’s lotteries offered over 3,000 prizes valued at $4.7 million. The Cash and Cars Lottery and You Win 50 are well-backed by Albertans, many of whom have had cancer experiences. Excited about her winnings, Sawatzky plans to buy a Jeep Grand Cherokee, build an outdoor horse riding area and secure her retirement. “After a rough year of dealing with chemo in 2014, to win this in 2015 feels like we have gone the rounds,” she says. “We are celebrating our blessings.” Also celebrating his blessings is Robert Park, the winner of the grand prize package. His winning bundle includes a 3,700-square-foot contemporary house in Calgary, a 2016 grey Acura ILX and $10,000 in cash. As a lifelong resident who farms in the Three Hills area, Park plans to sell the Calgary house which he modestly describes as, “quite nice.” Robert, a father of three children, was on the road for his job as an AMA appraiser when his mother broke the news that he had won. “It took a while to sink in. I wondered if it was true. Then other people kept calling me to congratulate me,” he says. When asked if 30

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he plans to retire, Park laughs and says, “Not quite, but this certainly will make retirement easier, or happen sooner.” A periodic supporter of the Cash and Cars lottery, Park also has a personal connection to cancer and the work of the Alberta Cancer Foundation. His mom, Alice, a regular lottery supporter herself, was diagnosed with breast cancer more than a year ago. Doing well now, Alice speaks highly of the care she received at the Tom Baker Cancer Centre. “Everything was so well-organized that in just about a month I had my surgery and was back home. The staff were kind and caring,” she says. Alice intends to keep buying tickets to assist the Foundation in the future. “It’s for a good cause. I want to support them so that they can continue to learn more about cancer and possibly find a cure.” Plus, there’s always the lure of winning: “You never know,” says Park, who suspects that quite a few people he knows will buy tickets now that they personally know a winner. GET READY Tickets for the Cash and Cars and You Win 50 lotteries go on sale in August, and can be purchased online, over the phone or at select locations. For more information, visit www.cashandcarslottery.ca

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PHOTOS: EWAN NICHOLSON

TARGETED STUDIES: Dr. Alain Tremblay’s Alberta Lung Cancer Screening Program seeks previous or current smokers.

The Alberta Lung Cancer Screening Program continues to recruit participants in 2016 BY SHELLEY NEWMAN

Alber ta Cancer Foundation

udy Wiebe credits the Alberta Lung Cancer Screening Program with saving her life. In her dayto-day routine the 78-year-old great-grandmother is active and healthy, and she’s employed part time as the accounts payable and receivable clerk for the Village of Longview, her hometown. But Wiebe smoked for over 50 years, and she is well aware of the toll it must have taken on her body. “When I smoked it was very socially acceptable, and it seemed like everybody was doing it,” she recalls. “But you just can’t abuse your body like that without having it impact your health.” In August 2015, she saw a notice that the Alberta Lung Cancer Screening Program was looking for research participants, and she felt it might be a fit for her. “I thought it looked like a good program and maybe I could contribute,” she says. “I filled in the application and submitted it for review.”

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STUDY SUBJECTS: 150,000 people in Alberta meet the high-risk criteria for lung cancer.

Things progressed quite quickly after that: Wiebe was informed she qualified for the program shortly after applying, and travelled to Calgary for her first CT scan. “I understood that I would have one each year as part of the screening program,” she explains. “Then I got a letter and a phone call indicating that they’d found something irregular, so I went back in for another CT scan, as well as a PET scan and a breathing test.” A month later, Wiebe learned she had a small, 16-millimetre lesion – or lung cancer – in the centre lobe of one of her lungs. By October 27, she was having surgery to remove it. Wiebe was among the early participants and the first to be diagnosed with lung cancer in the study, which is supported by the Alberta Cancer Foundation. Organizers of the multi-year screening program began the recruiting phase of the project in June 2015, with the goal of enrolling 800 people over a two-year period. Dr. Alain Tremblay, principal investigator for the screening project and professor of medicine in the Division of Respiratory Medicine in the Cumming School of Medicine at the University of Calgary, notes the program targets previous or current smokers who meet a range of criteria. “For certain types of cancers, like colon or breast cancers, age is a major determining factor for screening,” he says. “In lung cancer screening, it’s important to focus on the most at-risk population, and smoking is a big factor in a person’s risk.”

“It’s great to find cancer early through screening, but it’s better if people don’t get it at all,” says Tremblay. The screening team uses a multi-faceted approach to further determine a person’s risk. As basic entry criteria, potential participants must be between 55 and 80 years old. People who are interested in participating are required to complete a questionnaire, which the researchers use in a prediction model to determine a person’s risk of developing lung cancer over the next six years. “We expect about onethird of the people who apply will qualify for the program, based on their meeting the entry criteria and their level of risk,” Tremblay says. Those who qualify will have three yearly CT scans to screen for lung cancer or other abnormalities. The scans will be conducted either in Calgary, where Tremblay is the study lead, in Edmonton, where Dr. Eric Bédard is the lead, or Fort McMurray. The overall team is much larger, however, with 25 to 30 investigators and clinicians working on the project spread out across the country. “When we first designed this five-year 32

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project, one of our goals was to establish a provincial pilot program for screening,” Tremblay says. “It’s important for us to design the processes and to establish what might be required for a large screening program. Currently, there isn’t funding for provincial screening, but it is on the radar for Alberta Health Services.” Another aspect of the Alberta Lung Cancer Screening Program is a smoking cessation component. “It’s great to find cancer early through screening, but it’s better if people don’t get it at all,” Tremblay says. “We’ve partnered with Alberta Quits to provide counselling opportunities to help people quit smoking.” Half of the research participants – determined by a randomized system – will receive seven sessions of telephone counselling to help them quit. Follow-up calls will be made at specific time increments to see if the individuals have been successful. “Right now, we haven’t analyzed any data, as we’re just starting the third year of the program and our participant numbers are going to increase dramatically in 2016,” Tremblay says. Another related study, the Screening of Alberta Asbestos Exposed Workers for Lung Cancer and Mesothelioma, also began in January. This study is funded by the Alberta Cancer Foundation and the Western Canada Mesothelioma Foundation, and it will target individuals who worked with asbestos at least 10 years ago. “The process will essentially be the same for this as for the larger study, but in this case we’ll also be screening people for mesothelioma, which is a cancer of the lining of the lung,” Tremblay says. An important part of the process, whether in the primary lung cancer screening program or the asbestos screening program, is the potential to discover lesions before participants develop symptoms. This was the case for Wiebe – she didn’t have any symptoms because the lung cancer was so small it hadn’t yet impacted her health. “This was far better than what I would have gone through otherwise,” she says. “Lung cancer can really sneak up on a person, and by the time I would have noticed anything was wrong, I expect it would have been too late.” As it was, her surgery and recovery were manageable things that Wiebe took in stride. “I had options for surgery because the lesion was small. I chose to have a section of the lung taken out, because the recovery time was shorter.” She was in the Foothills Medical Centre for two days and then headed back to work the following week. Wiebe’s involvement in the screening program isn’t over, as she’ll have a followup CT scan in April, with more to follow. “I received great care from wonderful people,” she says of her experience. “I highly recommend that smokers and former smokers look into the program.”

For more information on the Alberta Lung Cancer Screening Program, visit http://www.ucalgary.ca/lungscreening

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• • •

spring 2016

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Alber ta Cancer Foundation

spring 2016

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Help make life better for Albertans facing cancer. Consider a gift through your estate plans and leave a legacy.

For more information visit www.albertacancer.ca/planned-giving or call us toll free at 1-866-412-4222.

Why I Donate â&#x20AC;˘ stories of giving

BEING THERE: Rita Bosch (left) has spent 26 years volunteering for various Alberta Cancer Foundation events and fundraisers.

spring 2016

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Lifetime OF Commitment A

A dedicated Edmonton couple have spent 26 years giving back to the Alberta Cancer Foundation BY DAWN SMITH

herwood Park couple Donald and Rita Bosch’s volunteer career with the Alberta Cancer Foundation began more than two decades ago. That’s when Donald entered the Cross Cancer Institute Golf Classic, which recently celebrated its 27th anniversary of raising funds for cancer research and medical equipment. After golfing in the tournament for a few years, the Edmonton-area businessman convinced his wife to volunteer, and the rest, as they say, is history.“It has become our annual event,” says Rita. “It was so much fun and we met a lot of friends. Each year, it is just like meeting family over again.” The Cross Cancer tournament isn’t the only commitment the couple, who are now retired, have made in their cancer fundraising. Over the years, Donald and Rita have sponsored, golfed in and volunteered for several other golf tournaments that benefit the Alberta Cancer Foundation, including the Don Andrews Memorial Golf Tournament, which wrapped up its 10th and final season this year; the Boston Pizza Golf Classic; and the Uniglobe One Travel tournaments, which have brought golfers to Mexico for the past six years in a unique fundraising opportunity. All told, the couple has helped raise between $1.2 and $1.3 million per year for the Alberta Cancer Foundation. “It’s wonderful,” says Donald, noting it’s great to know everyone is involved in the tournaments to have a good time and raise money for a worthy cause. “You walk away meeting good people. And you walk away with a good feeling in your heart.” But the couple doesn’t reserve their volunteerism only for golf tournaments. As part of a network of volunteers, they assist at numerous Alberta Cancer Foundation fundraisers every year, including concerts, and are thrilled to see their work pay off. “It’s just a good feeling to know how many people out there give out of the goodness of their heart,” says Rita.

Alber ta Cancer Foundation

spring 2016

Why I Donate • stories of giving The couple’s commitment to fighting cancer has roots that go back decades. It all began in 1957, when Rita, then just four years old, began to complain of leg pain so severe that it kept her up at night. She recalls her dad rocking her to sleep because the pain was so upsetting, but her small-town doctor attributed it to growing pains. In what proved to be a lucky occurrence, Rita’s dad brought her along when he visited a doctor in Edmonton. The checkup ended with the preschooler being admitted into the hospital for three months after doctors discovered a bone tumour in her leg. Rita remembers little of the ordeal, but she does recall her mom staying with her in the hospital. She also remembers three other children suffering from cancer in the ward. “My mom kept in contact with them, and I was the only one left by the time I was 12,” she says. Rita said the ordeal included surgery and, afterwards, numerous checkups to ensure she was cancer-free. “Early detection [was] key,” she says. She is adamant that her personal experience with the disease hasn’t hampered her: “I have done 11 marathons,” says the proud mother of two and grandmother of three. “Every time I have done a marathon, I say ‘Thank you legs for letting me do it.’ ” Donald gets emotional when he speaks about the mark the cancer left behind. “She has this scar on her leg an inch wide and eight inches long,” he says. “It’s the most beautiful scar in the world.” Still, that’s not the only experience the couple has had with cancer. Rita’s mom died of cancer, and Donald lost his best friend to prostate cancer in 1999. “That’s why we pushed a little harder to donate our time – not just because of people who are special to us, but because of everyone out there,” says Donald. “If we can save one person per year, it’s worth it.”

include a presentation showcasing technology and breakthroughs at the Cross Cancer Institute. Both Donald and Rita have come to admire those professionals, both through their volunteering and personal experiences. “It takes special people,” says Rita. “Watching all those nurses and doctors care for our loved ones, it is very difficult, but it is also heartwarming.” Although Rita and Donald have both suffered loss to cancer, they remain optimistic about future treatments, such as the specialized equipment capable of finding minute tumours in patients at the Cross Cancer. “This machine is incredible,” says Donald, about the PET-CT that can detect cancer in its minute form and scan more patients than ever before. Thrilled with the outcome of their volunteerism, the couple is committed to carrying on. “We don’t know how or who it has impacted,” says Rita. “You hope it’s not personal, but you never know who it will impact, so we just keep doing it.” They encourage others to volunteer for the Alberta Cancer Foundation. “Pick up the phone or go on the Internet to albertacancer.ca, because they have so many events,” says Rita. “They are constantly looking for people to come out and help. It might be something as simple as sitting at a table and giving information, or simply being present.” “I have done a lot of volunteering ... and this organization is one that you almost feel like you are getting back more than you are giving,” says Donald. “It’s very, very rewarding.”

“You walk away meeting good people. And you walk away with a good feeling in your heart,” says Donald Bosch. Being an avid golfer with 38 years of experience, it was a natural fit for Donald to enter the golf tournaments, but what kept both him and Rita involved was the knowledge of where their money was going. Over the years, they have helped raise money to purchase equipment and fund world-class cancer research and treatment at the Cross Cancer Institute, which both Don and Rita consider one of the best cancer treatment facilities in North America. They have also been privileged to see the groundbreaking technology available at the facility and speak with the doctors and researchers who are making a difference in cancer patients’ lives. “That’s the best part, seeing the technology firsthand,” says Rita, noting the golf tournaments often 40

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COMMITTED COUPLE: Donald and Rita Bosch pose for photos during a day at Disneyland in California.

The Alberta Cancer Foundation holds the annual Cross Cancer Institute Golf Classic, as well as many companion events across the province. For more information on the 2016 tournament, check in at albertacancer.ca.

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Corporate Giving • working for a cause

BUSINESS AS USUAL BY DAWN SMITH

Calgary’s NGX turns a regular day of work into a massive fundraising opportunity

ALL IN A DAY’S WORK: NGX employees present their donation to the Alberta Cancer Foundation.

In 2014, Gary Gault, vice-president of Calgary’s NGX, was medical facility motivated NGX to host a charity trade donation day in diagnosed with late-stage pancreatic cancer. Gault, who started working March of 2014 in memory of Gault. As well, NGX donated a significant portion of the revenue received for NGX in the 1990s after the Alberta government deregulated the province’s natural gas market, was one of the company’s key players. from business activity on March 14, 2014, and raised an astounding A popular, friendly member of the company, Gault spent 18 years with $275,000 thanks to their customers. It was a positive experience for NGX’s approximately 70 staff members, NGX, helping to build and maintain its client base, thanks in part to his with the results far exceeding their expectations. “We were elated at our ability to form and maintain relationships. “He was a great guy, gregarious,” says Jim Oosterbaan, president and customers’ response,” Oosterbaan says. CEO of NGX. He adds that Gault was But the company’s generosity able to provide excellent service and towards the Alberta Cancer “It’s about the society you want to live in, Foundation didn’t end there. On meet customers’ needs as well. “He and corporate donations are part of that. October 15, 2015, the company played a huge role in the company.” That’s one of the reasons why repeated its fundraising efforts, It’s important,” says Jim Oosterbaan. NGX, which provides electronic splitting the money between three trading, clearing and data services to the North American natural gas and local organizations including the Alberta Cancer Foundation, which electricity markets, has undertaken a massive fundraising effort for the received $85,000 earmarked for the Tom Baker. Alberta Cancer Foundation. Over the past two years, NGX has donated Oosterbaan says the company was very appreciative of its customers’ $360,000 to Calgary’s Tom Baker Cancer Centre, which is southern support, especially during the recent tough economic times. The Alberta’s main facility for providing cancer prevention, research and company’s employees were proud to give to the deserving organizations, treatment programs. “[Corporate giving] is just part of being a part of the especially during the recent downturn in the economy, which affects the community that you are living and working in,” says Oosterbaan, noting bottom line of both charities and businesses, including NGX. that NGX has been operating for 21 years. “It’s about the society you want Despite the challenging conditions, Oosterbaan believes being a to live in, and corporate donations are part of that. It’s important.” The good corporate citizen sends the right message of the importance of company chose to donate to the Alberta Cancer Foundation after Gault’s giving back. “All of these non-profits are doing good work. They make diagnosis and death soon afterwards. the city and the region a better place,” he says. “There is an intrinsic According to Oosterbaan, Gault, a father of four, also contributed reward; you can’t help but feel good. greatly to his hometown of Calgary, so his illness and subsequent “There are so many opportunities for people to get involved,” he adds. passing came as a huge blow to many. “We are a close-knit group, so “Do what you can and recognize that your employees are doing their own it was a huge loss,” he says. Gault received world-class treatment at charity work as well. A company can support and enable that wherever the Tom Baker, and the outstanding work of the professionals at the they can.”

Alber ta Cancer Foundation

spring 2016

Top Job

Critical Thinker,

CLINICAL MIND Ann Vlahadamis constantly seeks ways to improve patient care BY LISA CATTERALL

/ PHOTOGRAPHY BY COOPER + O’HARA

hen Ann Vlahadamis began working as a medical

secretary at Edmonton’s Cross Cancer Institute in the 1980s, she had no idea that it would be the beginning of a distinguished and long career in oncology. After graduating from high school, Vlahadamis had enrolled in a medical terminology course to prepare her for a future in health care. She didn’t know it yet, but one of her teachers was about to ignite her passion – and introduce her to a place that would change the course of her future.

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Alber ta Cancer Foundation

spring 2016

Top Job “I had a teacher who promoted the Cross, who told us that we should come and work here,” she says. “I don’t know what her connection to it was, but she said it was a great place to work. And she was right.” While working in the department of radiation oncology, Vlahadamis was inspired by the excellence in care that she saw every day. She eventually enrolled in a nursing program to take the next step in her career and upon graduation she returned to the Cross to continue pushing the hospital’s quality of care forward. That was just the beginning of Vlahadamis’s work in oncology. After working at the Cross for one year as a nurse, she moved to Vancouver to further her education, broaden her horizons and start a family. But after a decade in British Columbia, she returned to Edmonton with her sights set once again on working at the Cross. “I’ve just been so fortunate, and have been able to surround myself with such excellent practitioners here. Of course I came back,” she says. While at the Cross she was presented with the opportunity to pursue her master’s degree in nursing, which would qualify her to become a nurse practitioner. She continued to work throughout her schooling, applying her newly obtained knowledge to the systems and practices in place. Now, after nearly 30 years of honing her expertise in oncology, Vlahadamis is a nationally recognized leader in the field. In 2015, she was awarded not only the Pfizer Award for Excellence in Nursing Clinical Practice by the Canadian Association of Nurses in Oncology, but she was also named a Friend of Pharmacy by the Alberta College of Pharmacists for her work in creating collaborative patient care

“You can have a great career, but life is about so many other things. Ann just really exemplifies what it’s like to have balance in life,” says Krista Rawson. models. Over the last several years, Vlahadamis has worked closely with a number of pharmacists and pharmacy residents, inviting them to become directly involved in patient care. “She enjoys working with others, and she’s interested in not only what works for the patients but also what works from a collaborative sense across roles,” says long-time friend and colleague Krista Rawson. “She’s thinking about what’s happening in the tumour groups, or in the health-care system in a way that is very creative and collaborative.” “What I really strive to do is collaborate with others – I don’t just stick to nursing colleagues. I really enjoy practising with the physicians and pharmacists. You can’t do this on your own,” Vlahadamis says. “Everybody needs to work together, and the end result is always with the patient in mind. There are challenges, but it’s your team that gets you by.” This collaborative spirit and creative approach to medicine has had a major impact on her colleagues, and on patients’ experiences. “Ann is somebody who’s always striving to further her knowledge, which enables her to provide better-quality, more well-rounded care. She’s driven by a desire for awareness and understanding,” says Rawson, who now works with Vlahadamis as a senior practice consultant for advance practice nursing at AHS. Throughout her career, Vlahadamis’s thirst for knowledge has never slowed. In 2009, she began working with the Northern Alberta Breast Cancer Program, and turned a critical eye to the practices in place. Though her new role was challenging, it was an engaging area where 44

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Vlahadamis could make use of her expertise. “The hallmark of a good nurse practitioner is somebody who works themselves out of a job. Somebody who continues to improve something. And that’s Ann,” says Rawson. “She’s not somebody who rests. She’s constantly questioning the way we work to make it better.” As part of her position in the breast cancer program, Vlahadamis worked closely with a clinical pharmacist to create a group medical clinic for patients. Prior to the development of this group model, breast cancer patients who were eligible for endocrine therapy would meet individually with physicians to learn about treatment options. For physicians, this meant largely repetitive workloads and busy schedules, but for patients this often meant long wait times and limited contact with physicians. “With patients, I was just giving the same information back to back to back... It was taking a lot of time,” Vlahadamis says. “As a team we just decided there was a better way to do things.” So they spearheaded group clinics, run bimonthly with Vlahadamis and a clinical pharmacist who would provide an hour-long information session for up to 12 patients at a time. Following the session, Vlahadamis would follow up individually with half of the patients to answer personal questions, while the clinical pharmacist would work individually with the other half. Through the clinics, the breast cancer team was able to save time for both oncologists and patients. The group model also provided an opportunity for patients to connect and develop support

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COMMUNITY BUILDER: Ann Vlahadamis has excelled at bringing nurses and pharmacists together.

supportive services for patients. “Sometimes when you see a new patient in a clinic, you can see the look where they’re not processing information anymore – at that point, patients need a break, and need to wait until their next appointment to learn more,” she says. “Patients need reassurance that their care provider will be available to them for ongoing support and reassurance, that they’ll communicate honestly, address their concerns and answer questions. I imagine developing a program in my new role to address supportive care needs of both patients and their families. This may or may not be a “group format” but it will be collaborative.” Vlahadamis also leads an exemplary After more than five years life outside of work. Outside of working with the breast cancer “Everybody needs to work together, and the hospital walls, she is a devoted group, Vlahadamis made the difficult the end result is always with the patient mother, dedicated wife and active decision to move into a new field of in mind. There are challenges, but it’s community member. With two sons, practice. Now working with a team both avid hockey fans, Vlahadamis that treats lung tumours, Ann has the your team that gets you by,” says Ann is constantly on the go. She is also opportunity to evaluate and enhance Vlahadamis. an eager participant in Bust a Move, the level of care offered to patients the Alberta Cancer Foundation’s annual fitness fundraiser for breast living with lung cancer. “I would like to create a similar program with the lung group, and I’m cancer. Through her work and her involvement in the community, she is really optimistic that I can make some positive changes to make care an inspiration to many. “You can have a great career, but life is about so many other things,” more efficient for patients and my colleagues,” she says. Vlahadamis recognizes the challenges faced by newly diagnosed patients, and says Rawson. “Ann just really exemplifies what it’s like to have balance hopes that in her new role she’ll be able to create more comprehensible, in life.” networks where stories and advice could be shared in an understanding atmosphere. Dr. Karen King, medical oncologist and chair of the breast cancer program, worked closely with Vlahadamis throughout her time with the program. “Ann is an excellent and innovative nurse, teacher and mentor,” says King. “She’s a great resource for oncologists, and takes incredible care of our patients. It’s not easy to pass on the care of patients that you have looked after for many years, but I never had any reservations about putting my patients in Ann’s care.”

Alber ta Cancer Foundation

spring 2016

Research Rockstar

spring 2016

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Power of Prevention

The

Dr. Paula Robson is at the helm of Alberta’s largest long-term study on cancer prevention BY TRINA MOYLES

PHOTOGRAPHY BY KELLY REDINGER

hy are men more likely than women to develop cancer?

Why is there a higher incidence of cancer in Eastern Canada than in the West? Why do 80 per cent of patients who develop breast cancer have no family history of the disease? What if society better understood the complex causes of cancer and who was the most susceptible to developing the disease in their lifetime?

For the past decade, Dr. Paula Robson has been working as the principal investigator of the Tomorrow Project, one of Alberta’s largest long-term studies on cancer prevention, to answer these big questions. The study began in 2000 and is currently funded by the Alberta Cancer Foundation, Alberta Innovates – Health Solutions, Alberta Health Services and the Canadian Partnership Against Cancer. The questions are just a small part of Robson’s work to “untangle” the factors that contribute to cancer including genetics, human behaviour and environment. Her work strives to help reduce the future burden of cancer on individuals, families and society.

Alber ta Cancer Foundation

spring 2016

Research Rockstar

IN IT TOGETHER: The Tomorrow Project hopes to answer this big questions about cancer through research today.

Today Robson and a team of 22 researchers are gathering, analyzing and documenting evidence from 50,000 Albertans and following them for 50 years. Statistically speaking, some of the participants are likely to develop cancer – in Alberta, it’s predicted that 50 per cent of men and one in three women will be diagnosed with cancer in their lifetime. By comparing the data of people who are diagnosed with cancer versus those who aren’t, Robson and her team hope to identify key indicators in what causes the disease.

“Soon we’ll have international sample sizes to tease out the minutia of what’s causing different kinds of cancers. It’s a very exciting time,” says Dr. Paula Robson. “We’re trying to understand what’s going on in people’s lives,” Robson says from her office in downtown Edmonton, “what they eat, where they live, what they do for a living and the interactions between those things. If we better understand who is more likely to develop the disease, we can put preventative strategies in place.” It’s the kind of research that could take years, or even decades, to produce results. But Robson is hopeful the 48

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Tomorrow Project will have a lasting impact on future society. Growing up, she never would have dreamt of being part of the Tomorrow Project – let alone living in Canada for as long as she has. Gazing out at the nearly frozen North Saskatchewan River from her office window, Robson is far away from the place where she was born. She grew up in a small town along the scenic coastline of Northern Ireland, outside Belfast. Robson completed her postsecondary education and went on to earn a PhD in nutritional sciences at the University of Ulster. In 2004, she crossed the Atlantic Ocean for the first time after her husband, a colorectal surgeon, accepted a fellowship in surgical oncology in Calgary. The couple didn’t anticipate staying in Canada for longer than two years, and had always planned to return to Ireland. But shortly after their arrival, Robson was hired as a researcher for the Tomorrow Project. In 2006, after two years with the study, Robson was invited to step into the role of principal investigator. Since then, she’s dedicated her life’s work to the project. Since 2006, Robson has helped expand the volume of research participants in Alberta from 30,000 to 50,000. Participants share detailed information about their background, medical history, physical health, livelihood and lifestyle. Initially, Robson admits that critics argued they’d struggle to find enough participants for a 50-year study. But she argues that there’s many “altruistic” Albertans who wanted to make a difference by engaging in this type of research. “People understand that there’s little benefit for themselves [in the short term], but there will be benefits for their children and grandchildren,” she says. Participants also consented to provide the study with biological material, including blood, urine and saliva samples, for analysis. Over 30,000 biological samples are securely stored in freezers at

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-80 C – the largest sample of biological material for research analysis ever collected in the province. Robson says the shift to include biological material in their study is essential to determining cause. “Years ago, researchers used to focus on one risk factor – diet, for example, or physical activity. But the literature today is telling us that we need to get beyond single risk factor investigations,” she says. “Diet is influenced by very many environmental factors, and diet will also influence many metabolic factors. It’s like trying to put together the pieces of a jigsaw puzzle.”

“She believes in doing what’s right, whether it’s more challenging or time-consuming. She’s a humble, effective leader. She lets others shine all the time.”

The most difficult aspect of Robson’s research is proving that prevention is important. Focusing on prevention is less tangible than looking at the cure or finding new treatments. But Robson argues that by identifying risks of cancer in Alberta and around the world, governments and policy-makers can put controls in place to reduce risks and the numbers of people developing the disease. She points to a 1954 case study in the U.K. that found individuals who smoked cigarettes were more likely to develop lung cancer than individuals who didn’t smoke. It took governments (and the general public) decades to take the research seriously. But since the Canadian government put controls on smoking (through taxes and In 2008, the Tomorrow Project joined forces public health campaigns), the number of adult smokers in the population has dropped with similar research “cohorts” located in British significantly from 45 per cent to 19 per cent. As a result, the incidence of lung cancer Columbia, Ontario, Quebec and the Atlantic provinces. (particularly in men) has also reduced. “It’s hard for people to see that prevention may Together, they created have an impact,” Robson says. “But it’s equally as the Canadian Partnership “It’s hard for people to see important as other kinds of cancer research.” for Tomorrow Project After 15 years of collecting and documenting (CPTP), with the goal of that prevention may have an impact. information from Albertans, the Tomorrow Project increasing the number But it’s equally as important as other kinds is ready to share its extensive data with other of research participants, of cancer research.” researchers seeking to understand cancer risk harmonizing their data factors. Those with ethical approval will be given collections and opening access for analysis. “There’s power in numbers,” says “controlled access” to information, along with blood, urine and saliva samples. Robson. “We came together to recruit Canadians to Dr. John Lewis from the University of Alberta and the Alberta Cancer Foundation’s participate in the study. We were able to go out nationally Frank and Carla Sojonky Chair in Prostate Cancer Research, were the first local researcher and collect information and biological samples from to access data from the Tomorrow Project. Lewis is conducting a study with the researchers Canadians. Three hundred thousand people said yes.” goal of developing an improved screening test for detecting prostate cancer, and accessed Sharing data is essential to advancing knowledge 1,000 samples from men who didn’t have the disease. Robson says she’s already fielding of the causes of more rare types of cancer, including inquiries from researchers looking at improved screening and early detection for breast and glioma, a devastating brain tumour that typically causes lung cancer. death 18 months to two years after diagnosis. “We “We know we can’t do it alone, so we’re reaching out to other researchers to say, won’t see enough cases in Alberta to [compare data] ‘Here’s what we’ve done in Alberta,’ ” she says. “We’re a part of an international data and understand what causes glioma, but by working consortium. We want to advance knowledge about cancer control and prevention collectively and accessing larger sample sizes, we strategies in the ways that we can.” have the power to investigate,” says Robson. Under her leadership, the Tomorrow Project also recently joined the U.S. National Consortium, a collective of 56 research cohorts from around the world. “We’ll likely be invited to join other very large studies and contribute information that can be pooled together,” she says. How do you connect with your Irish roots in Edmonton? “Soon we’ll have international sample sizes to tease out I chat with family members by Skype almost every week, keep abreast the minutia of what’s causing different kinds of cancers. of news from my hometown and I love listening to Irish music. It’s a very exciting time.” Challenge is inherent to Robson’s long-term study. Where is your favourite place to travel? It’s no easy feat following, documenting and managing I have lots of places that I still want to get to, particularly across the information of 50,000 Albertans for 50 years. She Canada. I feel that I need to get to know my adopted home a lot says her team is constantly re-evaluating questions they better than I do right now. Alberta has so much to offer. need to change or add over time, and trying to stay on track of emerging literature. “Sometimes I feel we need What are your favourite pastimes? a crystal ball,” she jokes. I love cooking. I also enjoy reading about travel and spending time Despite the challenges, Robson is leading the project outside in Edmonton’s fantastic river valley. forward to success. Amanda Wasney, strategic director at the Tomorrow Project, has worked alongside Robson Looking back, what advice would you give to your younger self for more than three years. During that time she says about working as a researcher? Robson has excelled as a leader, researcher and mentor. Always keep the long view in mind – and keep going! There is no “Dr. Robson has the unique ability to easy answer right now. We have a lot to learn, but every new piece think big science and big connections, while keeping of knowledge takes us further down the road. her feet planted firmly on the ground,” says Wasney.

Finding Her roots

Alber ta Cancer Foundation

spring 2016

My Leap • inspiring individual

PHOTO TREVOR BOLLER

TEAM SPIRIT: Emily Cinats (centre) and her Bust-a-Move Team comprised of University of Alberta MBA students.

It’s a Marathon, Not a Sprint

By Trina Moyles

Emily Cinats’ commitment to fundraising has guided her through cancer diagnoses and beyond It’s hard to keep up with Emily Cinats. Over the past 10 years, she’s taken giant strides to support cancer research in Alberta. Whether she’s running, swimming or walking, Cinats is always ready to push herself to the limits for a cause she holds close to her heart. Cinats was only 17 years old when her aunt was diagnosed with breast cancer, in 2004. Motivated to make a difference, she and her parents, Dr. John and Cindy Cinats, came up with the idea to create a Breast Impression Calendar to raise funds and awareness for the Alberta Cancer Foundation. “A group of breast cancer survivors participated in the calendar,” says Cinats. “We painted images on their breasts, imprinted them onto canvases and created a beautiful calendar.” For four years, Cinats and her parents involved more than 50 breast cancer survivors in the annual creation of the calendar. Sales of the calendars raised over $80,000 for the Foundation, and Cinats credits early exposure to fundraising for inspiring her to join the Alberta Cancer Foundation sponsorship committee, volunteering her time to help plan other fundraising events. From 2006 to 2013, she participated in the Weekend to End Women’s Cancer, a gruelling two-day, 60-kilometre walk that she completed alongside her mother. It wasn’t just a walk in the park, says Cinats, who recalls her sore, blistered feet. It was the camaraderie of walking with her mother and aunt that kept her going. “Family and friends would meet us at the checkpoints along the way. My dad walked in a bright pink tutu for a portion of the walk one year. Despite the difficulty, it was a lot of fun.” In 2012, Cinats’ mother was diagnosed with breast cancer. And while she will never forget the fear and pain she felt that day, she also 50

spring 2016

warmly recalls the empathy and compassion she received from fellow volunteers at the Alberta Cancer Foundation. “It’s more than a fundraising committee,” Cinats says. “It’s a loving community of people who understand what you’re going through.” Today, her mother and aunt are breast cancer survivors, but she hasn’t given up her fundraising commitment. In 2015, she and her father entered the 1st Annual Allan Beach Triathlon as a team. Cinats dove into the swimming portion, while her dad ran and biked. She says every length of the pool, every lap and step, have been worth it to see the impact her fundraising has made at the Cross Cancer Institute. “When you’re at the Cross Cancer Institute and you have a family member receiving treatment, you really see and feel the tangible benefit of fundraising and volunteering,” says Cinats. After 10 years of being involved in fundraising and advocacy for cancer research, she has no plans of giving up. If there’s anything Cinats has learned, it’s that the race to develop new treatments and find a cure is a marathon, not a sprint.

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