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.  

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.

Novel carbon fibre breast positioning device (CARA) for reducing toxicity in breast radiotherapy

Radiation therapy is used to reduce the chance of breast cancer recurrence after surgical removal of the primary cancer in approximately 2,000 British Columbian patients and approximately 2 million women around the world annually.  Because the breast is a mobile organ sitting over the lungs and heart, these organs and other normal tissues may receive unwanted radiotherapy dose leading to serious side effects. Our group has designed a carbon-fibre device suitable for breast positioning in radiotherapy to optimize the position of the breast during treatment to reduce these side effects. Initial tests in our clinic are very promising. To bring this device into widespread use for patients, further work is required to improve the quality of the device to meet the highest standards for patient care and those set by Health Canada. Carbon fibre devices are very challenging to make when complex shapes are required, as is the case for this breast support. We will work with a research group specializing in carbon fibre to find the best materials and manufacturing process for the device, and then get  the improved device into the hands of leading experts in breast cancer treatment for further evaluation in the clinic.

Moving towards a biology-based care model in germ cell tumors

Testicular germ cell tumors (GCTs) are the most frequent solid tumors in young men. Chemotherapy can cure most patients even when the tumor is advanced. However, there are still two main issues of concern.

  1. Survivors have an increased risk of developing other diseases (e.g. heart disease, new tumors, strokes, etc.) as results of the late side effects of chemo- and radiation- therapies.
  2. Current methods to detect GCTs rely on a CT scan and blood work for tumor markers which are not specific enough for GCTs. This means there are patients who are falsely considered as having the tumor and more importantly, being treated unnecessarily with chemotherapy, radiation or surgery.

Our research program aims to reduce this uncertainty by analyzing some small RNA fragments (micro-RNAs) in the blood of GCTs patients that are produced only by the GCTs cells. Although several small studies have demonstrated those micro-RNAs are better than the CT scan and serum tumor markers to detect GCTs, we still need to validate this test in a larger number of patients before it can routinely be used in clinical practice. We have therefore designed two clinical trials to validate the clinical utility of micro-RNAs in the management of GCTs.

Interpreting and addressing barriers impeding effective care transitions for women diagnosed with breast cancer in British Columbia

The number of Canadians diagnosed with cancer is rising with a growing and aging population and we need to ensure our healthcare system is equipped to meet this growing demand. As the most common female cancer worldwide, breast cancer is the second leading cause of cancer deaths in Canadian women. In recent decades, advancements in breast cancer screening and treatments have resulted in approximately 87% of Canadian women diagnosed with breast cancer surviving 5 years after diagnosis. Increased survival rates are due in part to adjuvant endocrine therapy (AET) (e.g., tamoxifen), which is used to treat early-stage, hormone receptor-positive breast cancer, representing the large majority of breast cancer diagnoses. Women prescribed AET are recommended to take this medication everyday for 5-10 years depending on their diagnosis, which results in the need for increased follow-up care over a long period of time. Previous research, however, has shown there are many issues associated with transitions in care, particularly as breast cancer survivors move from receiving care from their oncologist back to seeing their family physician or nurse practitioner in the community. The objective of this project is to improve transitions in care to better support women diagnosed with breast cancer and also the healthcare providers that deliver care to these women. The goal is to meet the supportive care needs of breast cancer survivors as they transition through the healthcare system to support them in living well beyond their breast cancer diagnosis.

Improving the methods of economic evaluation to support decision-making: CAR-T, uncertainty, and real-world evidence

The emergence of novel technologies in health care is associated with promising opportunities to improve patient health outcomes. Advances in health technologies also come at a substantial cost. New gene therapies have been estimated to cost between $300,000-$4,000,000 per patient. These new therapies offer promise, but do not offer certainty; decision-makers have to choose whether to reimburse the therapy with little evidence for how it might work in the real-world.

Health economics can be used to assess the value of a new therapy compared to current therapies. While the use of health economics seems to be supported, the extent to which it impacts decisions seems to be limited. The proposed research will improve health economics analyses to support decision-makers at BC Cancer. The approach will incorporate real-world evidence, expert and patient opinion, and effective communication with decision-makers. Chimeric antigen receptor T-cell (CAR-T) therapy will serve as a case study as it is promising, but is associated with high costs and uncertainty about long-term effectiveness.

This project will bridge the gap between the type of evidence that is provided by standard health economics analyses and that required by decision-makers.