Health organizations in BC are creating Clinical Nurse Specialist, Indigenous Health and Cultural Safety (CNS IH;ICS) roles. This collaborative partnership intends to convene expert knowledge holders to ensure the CNS IH;ICS leaders are leading an impactful, nurtured, and sustainable workforce. The BC Indigenous Health Nursing Research Chair has generated knowledge into the practice of Indigenous health nursing and the Providence Health Care and BC Cancer research team conducted a study examining the CNS roles. Our research activities include hosting a two-day Symposium to bridge these two parallel pathways of knowledge to generate share and mobilize research findings that will inform, nurture, and sustain the CNS IH;ICS roles in BC. Formalizing this partnership and collaboration will address the health human resources crisis by identifying pathways for a collaborative research inquiry to increase structural frameworks that inform Indigenous health policy and program development. Indigenous health systems require a distinct approach that recognizes the authentic voices and experiences of Indigenous nurses in health leadership and provides opportunities for intergenerational research mentorship and training.
Research Location: BC Cancer
Matriptase-Selective Radiotheranostics for Metastatic Carcinoma
Metastatic cancer, in which cancer cells invade healthy distant tissue, is the leading cause of death in Canada. Epithelial breast, colon, and prostate cancer of the outermost tissue lining are the most prevalent forms of metastatic cancer and require better tools to prevent life-threatening outcomes. Treatments such as surgery and chemotherapy are either impractical for metastases, invasive, or toxic. The goal of this work is to develop a radioactive molecule that targets matriptase, an enzyme which supports tumor growth and metastasis. A set of molecules will be made, labelled with a radioactive tag, and screened for binding. Conveniently, the radioactive source is interchangeable for imaging or targeted radiotherapy. Using a specialized camera, tumor radioactivity can be noninvasively tracked to classify disease progression. Using a different radioactive tag, radiation can also be delivered to exclusively kill matriptase-positive tumor cells. The lead candidate is expected to enable tumor staging and improve patient outcomes by impeding tumor growth and spread. It may also be used to monitor response to therapy and guide clinical decisions, representing a major advance in the management of metastatic epithelial cancer.
Advancing Equitable Cancer Care: A Innovative Approach to Transformative Action in BC
In BC, some groups face unfair barriers in receiving adequate cancer care due to factors like racism, stigma, discrimination, poverty, mental health and substance use challenges, and/or disabilities. Over the next five years, my research aims to tackle these disparities. First, we will team up with people who know these issues firsthand to form a community-engaged research team. Together we will identify what research is most needed and lead innovative studies to address cancer-related inequities. Our primary focus involves developing a new approach to caring for cancer patients. We will create an equity model of care based on principles of equity-oriented healthcare, integrating trauma-informed care, cultural sensitivity, and strategies for addressing substance use health. Additionally, we will gather patient feedback to continually improve care quality. These new approaches will be piloted in specific cancer clinics to assess their effectiveness. Success means more equitable and improved cancer care for the diverse communities we serve in BC.
BC Familial Pancreatic Cancer Program-Improving access to germline testing at time of diagnosis
Hereditary factors are identified in 10-15% of patients with pancreatic ductal adenocarcinoma (PDAC). Of the estimated 800 new diagnoses of pancreatic cancer in BC each year, only 20% are referred for a consultation to the provincial hereditary cancer program (HCP). Mainstream testing holds promise for personalized oncologic care and may reduce the significant variability in testing rates based on patient geography and ethnicity.
We will conduct surveys to gain understanding of why providers choose not to refer patients or offer mainstream testing. We will provide targeted training to provider and patients on the benefits and uses of genetic testing. We will compare new pathology diagnoses to testing rates over the study period and explore novel care delivery pathways, including a direct patient contact model that informs patients about test availability.
This research program will foster greater collaborations with health care providers and increase knowledge and use of genetic testing in BC. We envision through this research program, a provincial framework/registry for genetic assessment of PDAC at point of diagnosis.
Advancing Equitable Cancer Care for Incarcerated Populations
An estimated 40,000 individuals are imprisoned in Canadian correctional facilities at any time. Incarcerated people, often individuals from marginalized populations, bear an unequal burden of cancer because they experience chronic disabilities, mental health concerns and substance use disorders. Increased risk factors also include family violence, childhood abuse, housing insecurity, lack of education, low-income status, high rates of suicide, high-risk sexual behaviors, and physical injuries. Despite international recognition of the importance of palliative and cancer care as a shared universal right, a health equity gap exists between the general and carceral populations in Canada. Incarcerated people face significant health inequities before, during and post incarceration.
This project aims to address BC Cancer’s goal of promoting high-quality cancer services that are equitable, accessible, and respectful for all British Columbians.
The specific objective is to provide evidence-based recommendations for advancing equitable cancer care for incarcerated populations in BC by examining barriers in access to cancer treatment and care.
End of Award Update – September 2024
Results
During the Fellowship, I conducted an environmental scan of Canadian literature and 11 interviews with oncology leaders and healthcare providers to understand how justice-involved people in the province access and receive cancer care.
Impact
Not applicable, as the analysis is still underway.
Potential Influence
The results of this project can inform policy and practices related to access and quality of health care for justice-involved people who live with life-limiting illnesses. Driven by my findings, the health care provided behind and beyond bars can become increasingly proactive, preventative, and encapsulating various stages of one’s health trajectory.
Next Steps
The research conducted within the Fellowship will inform my doctoral dissertation. Further research will focus on understanding how justice-involved individuals access and receive palliative care when faced with life-limiting illnesses. The findings from both studies will be submitted for publication. In addition, I will disseminate the study’s results using the BC Center for Palliative Care ECHO model.
Exploring Health Professional Attitudes towards Parent-of-Origin-Aware Genomic Analysis: Hereditary Cancer and Beyond
Genetic changes can cause hereditary syndromes, and genetic testing can detect these changes. Parents may pass genetic changes to their children, and these changes can run in families. Unfortunately, if a parent cannot be tested, it is harder to understand test results, counsel patients, and test other family members.
Parent of Origin Aware Genomic Analysis (POAga) is brand new test which may predict which parent has passed down a genetic change. This prediction may work even when the parent cannot be tested. Vancouver researchers reported on POAga earlier this year, and we hope that it will lead to faster testing and better counselling. POAga should still be discussed with the health professionals who order genetic testing. This includes geneticists, genetic counsellors, and medical oncologists.
This project will help bring this brand-new research from the laboratory to the genetics clinic. After watching a short video about POAga, participants will be able to ask questions. Then, we will lead focus groups gathering their own questions, concerns, and opinions. The information we learn will help us develop future educational resources for these professionals.
Embedded Knowledge Mobilization: Strengthening Oncology Nurses’ Capacity for Effective Advanced Care Planning Conversations
Advance care planning (ACP) is a process that supports patients to reflect on their personal values and preferences towards care, and share these preferences with their healthcare team. ACP supports patient- and family-centered care, ensuring the care a patient receives aligns with their goals and preferences. Recent research conducted at BC Cancer aimed to learn how to better support oncology nurses in conducting ACP across the cancer journey. Study findings provide important insight into (1) local barriers and facilitators for oncology nurses to conduct ACP and (2) changes needed to support nursing-led ACP at BC Cancer.
To translate these findings into clinical practice, we will assemble direct care nurses, nursing leaders, patient and family partners, and relevant knowledge users to inform a nursing practice change that enhances oncology nurses’ ability to conduct ACP. Our approach will involve key activities, including the establishment of a provincial ACP working group to oversee all activities, engagement sessions with direct care nurses to identify barriers and facilitators to the proposed practice change, and targeted implementation strategies such as educational sessions to promote awareness and build ACP proficiency.
Predictive biomarkers for ovarian cancer treatment: Analysis of patient of derived xenografts under treatment at single cell resolution
Each year in Canada, around 3,000 women will be diagnosed with high grade serous ovarian cancer (HGSOC) — the most common type of ovarian cancer. Despite good responses to first line treatments for many women, it comes back as a resistant disease. Targeted treatments such as PARP inhibitors (PARPi) have made a big difference to HGSOC that is deficient in a DNA repair pathway (Homologous recombination repair), but this only benefits around 50 percent of women with HGSOC. PARPi combinations with drugs that target angiogenesis and the immune response remain under investigation. This project will investigate how chemotherapy vs. targeted therapies differentially affects the DNA damage and immune response in cancer and how effective non-chemotherapy combination treatments work, including different doses and schedules. Also, which patient might benefit from which treatment and when for example should the targeted therapies be given before or after the chemotherapy? Creating models similar to humans, we will transplant patient tumors (removed at surgery) on the skin and inside the abdomen of mice and analyze the molecular nature (at single cell level) of these tumors before/after treatment. Results of these studies will inform future clinical trials.
Integrating clinical, functional and chemical genomics to understand lung cancer biology
Lung cancer is the leading cause of cancer mortality worldwide, suffering from a late stage of disease at the time of diagnosis and a paucity of effective therapeutic strategies to treat advanced tumors. However, with our increasing understanding of lung cancer biology has come the advent of targeted therapies to combat this devastating disease. These therapies target mutated components of key cellular pathways on which tumors have become dependent on for survival, yielding drastic initial response rates without the major side effects of traditional chemotherapies. Despite these successes two major problems remain: first, the majority of lung cancer patients have tumors without mutations in targetable genes and; second, all patients eventually develop resistance to treatment with these targeted agents. In addition, since lung tumors commonly have hundreds of mutated genes, it is difficult to pinpoint those that are responsible for tumor growth and resistance to therapy, creating a clear bottleneck in the translation of laboratory findings to a clinical setting.
I propose an integrative strategy to address these issues. Through analysis of the genomic profiles of human lung tumors, I aim to identify novel genes and pathways that are altered during lung cancer development. Furthermore, by combining this information with the characterization of mice genetically engineered to develop lung tumors, I attempt to elucidate the key genes driving lung cancer initiation, progression and response to therapy. Lastly, by screening libraries of chemical compounds across lung cancer cells, I aim to characterize novel inhibitors of these identified genes and their corresponding pathways that show promise for use as targeted therapies. Together, this work will further our understanding of lung cancer biology and create insight toward the development of new approaches to diagnose and treat patients suffering from this disease.
Transforming adolescent and young adult cancer care in BC in partnership with patients and cancer care allies
In Canada, approximately 7,600 adolescents and young adults (AYAs) aged 15 to 39 are diagnosed with cancer each year, representing 4 percent of annual cancer diagnoses. Currently, cancer care systems have limited capacity to meet the complex needs of AYAs and survival outcomes for AYAs are often worse when compared to children and adults over 40.
This research program will use the principles of participatory action research (PAR) and patient-oriented research (POR) to meaningfully engage AYAs and cancer care allies (healthcare professionals, decision makers, researchers, and community organizations) to better understand AYA cancer care and explore how cancer care systems can respond to the unique, complex needs of AYAs with cancer. Led by a researcher with lived experience of cancer as an AYA and 15 years of experience conducting PAR, the work seeks to inform AYA cancer care research, policy, and practice in BC and beyond. Initial research funding from the Vancouver Foundation, MSFHR, and British Academy is in place, as are collaborators from Royal Roads University, BC Cancer, BC Ministry of Health, Young Adult Cancer Canada, the BC SUPPORT Unit, Callanish Society, InspireHealth, Innovation Support Unit, and AYAs with cancer.