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Event Overview

Speaker & Participant Remarks

Dr. Kara Laing - Monday, April 12th, 2010

I'm delighted this pan Canadian dialogue on cancer is starting here on the east coast --it is fitting it is starting here today as we are celebrating the 30th anniversary of the Terry Fox Marathon of Hope as. It was here 30 years ago that Terry began his journey. I was a very young girl then and my mom and dad did take me down to see Terry as he started his journey. As my children learn about Terry in school they asked is that why you became a cancer specialist and I said, no it would be a great story but it was much later that I made that decision until much later. But as I thought about it I was reminded of how inspirational Terry's story, his courage, his whole journey has been for me throughout my life. It is really quite amazing to think of all the things that the beginning of his journey has brought us to now 30 years later and in fact just this gathering this evening.

As we think about patient-centred care in a personalized treatment world, I'm reminded of how every day the patients that I interact with inspire me. I think that because of that it's very important that we have a dialogue that includes the patients. Because I think there is a lot we can learn from each other and that if we are going to move forward and continue to have excellence in cancer care in our province, in Atlantic Canada and across the country then we need to be talking to each other. As so we are going to change how we have been thinking and think about cancer care within in the broader and what that means. When we talk about patient centred care we have to be very careful about what that really means; it's not a mission statement or a nice phrase we should throw around. But that we really should think about the patient being informed so that they have information about their own health, their cancer their diagnosis and their choices and that they have access to that information and the various options that may be available for them. That's the only way they are going to be at the centre and be able to make a choice because they really need to be empowered to do that and we have a responsibility within the health care system to empower our patients to be able to make those choices and they obviously need quite a lot of support and at many levels.

When we talk about personalized care we've gone from generic cancer treatment, chemotherapies and radiation, to stratified so we start to think about people as having hormone receptor positive HER2 negative breast cancer, so we're going to talk about things very specifically so you're going to know a lot of detail about your cancer. My research colleague showed me a bar code where every little piece of the bar code was another piece of the puzzle or another set of unique identifiers that makes the cancer patient very unique. A lot of times as healthcare professionals we think about the disease characteristics, so what kind of cancer it is, we just don't talk about colon cancer any more we talk about very specific types of colon cancer and we tend to focus on those kinds of things that make the cancer unique. But we also have to realize there are things about the patient that makes their treatment choice very unique. Where do they live, where are they going to get their cancer surgery or treatments, what mindset or what experiences are they bringing forth at the time of their diagnosis? Who relies on them at home, are they a primary care giver, are they looking after grandchildren--what is it about them that makes them unique and they are just as unique as their cancer is, and then of course which resources are available to offer those treatments

One of the most important things of course is integrated care and coordinated care. We think about a multi-disciplinary team who's involved with cancer care within the health care system; some of that is very much within the cancer care system and some of that outside be it the surgeons the person who made your initial diagnosis or your family doctor who is going to be responsible for your ongoing care and your survivorship days. And also the importance of recognizing alternative and complementary medicine and how we pay attention to how important that is becoming to our patients. We talk about patient navigation. Nova Scotia has done a lot of work in this area and the Canadian Partnership is looking at this. This is a very complex system that is involved with moving patients very quickly and efficiently through the whole trajectory of their cancer journey from their abnormal screen or their symptoms on through to their survivorship or to bereavement. We think about it as being very complex, but we also have to remember about the very simple parts of that. I had an email from a colleague asking how we deal with getting frail and sick patients into our cancer centre. And I thought, well you drive up to the front door and you let them out and there's wheelchairs there .But where he works its in a hospital once you get dropped off you have make your way down a corridor and then take an elevator and take an elevator to the 7th floor to get your treatment. We have to remember in that patient navigation we have to not to lose sight of the simple things. Health information-extremely important for our patients. We need to have the information out there up to date, protected yet accessible to those who need to know what's going on and in fact I think eventually the patient should be the gate keeper and you'll go around with a memory stick with all your information on it.

With think about clinical trials and how important they are. I guess I've always been involved in clinical trials as a way to let patients have earlier access to new therapies, but when we think about doing trials now the resources are limited, we don't have a lot of core funding and the trials, particularly in Atlantic Canada, we need to make sure that they're available to our patients to participate in but also that they're very applicable to the population and I think about genetics in that situation. We think about guidelines and how that affects care. Guidelines are recommendations of things that should be involved or could be involved in a patient's care and it's very important that we adapt those locally to the environment that we find ourselves in and when we look at standard what things should be out there I think it's extremely important that we start looking at those as indicators and as a way to show that our outcomes are better because what we do.

The biggest thing about being part of a larger health care system, is what about the limited resources? To me I think this is one of the biggest areas where I see the importance of having the patients, and their families, the survivors and the public engaged, because now in oncology we evaluate new treatments as they come along, but maybe we should be having a look at things that we're doing to make sure that looking at we're still doing things that are effective and that things that we adopted because of clinical trials are really still showing that benefit. We need to set priorities and allocate limited resources but I think that you need to be involved in that dialogue and you need to become engaged with us because as time goes on we're going to have some tough treatment choices to make.