Several trials have established breast conserving surgery (BCS) followed by radiation has equivalent or improved survival to mastectomy for early breast cancer, yet mastectomy rates are rising globally. It is thought patients perceive mastectomy to improve survival and reduce worry of recurrence, however recent advances in patient-centered care have measured patient reported health-related quality of life (HRQoL) among breast cancer patients, and early studies report higher HRQoL among BCS patients.
BCS rates in British Columbia are below the national average. Further clinical and HRQoL data are needed to understand factors influencing the BC mastectomy rate and inform clinical recommendations for BCS.
A patient cohort will be recruited from Providence Breast Centre and classified into BCS, mastectomy by patient preference, and mastectomy medically necessary to compare postoperative complications, oncologic outcomes, and patient reported psychosocial and HRQoL outcomes.
By linking oncologic and HRQoL outcomes, this study will provide novel information to facilitate more informed preoperative surgical counselling, and guide institutional and provincial policy for development of Canadian breast cancer surgery quality indicators.
Most people living with type 2 diabetes (T2D) do not achieve enough physical activity and miss benefiting from the powerful health benefits of exercise. “Exercise snacks” are short bursts of exercise lasting 1 minute or less, which can be done sporadically throughout the day. These snacks can be easily performed anywhere using stair-climbing or simple body weight exercises. Incorporating exercise snacks into the daily routine could help to break up sedentary time, regulate blood sugar, and improve blood pressure and fitness levels. This research program aims to explore the positive effects of exercise snacks in individuals living with T2D. Through a combination of lab-based studies and a real-world clinical trial that will deliver an exercise snacks intervention via a Smartphone “app”, we will test if exercise snacks can lower blood sugar and improve cardiovascular health in people with type 2 diabetes. In order to maximize the reach and impact of our research, we will also develop infographics and videos to help teach individuals with T2D how to incorporate exercise snacks into their day. This research aims to empower people living T2D to improve their health, one exercise snack at a time!
Sleep is important for health, yet little is known about sleep in foster and kinship families. In my postdoctoral fellowship, I will lead research to learn about the sleep health, how best to support sleep, and the connection between sleep and caregiver-child relationships for foster/kinship families. In Study 1, we will synthesize research on children’s sleep in foster and kinship care. In Study 2, we will interview foster and kinship caregivers of children aged 0-5 years to learn about the caregiver and child’s sleep, and how sleep influences the caregiver-child relationship. In Study 3, we will compare sleep in foster and kinship families with other families in Canada. In Study 4, foster and kinship caregivers will help us design and test a sleep resource. We are creating an advisory panel to work with us to create research that is useful and interesting to the foster/kinship community, and respectful of different cultures and family dynamics. With the advisory panel, we will share the results in journal articles, at conferences, via webinars, and through foster/kinship organizations. This research will help healthcare professionals and policymakers understand, and help support, the sleep of families in foster and kinship care.
Problem
As individuals age, they have a greater risk of limited mobility, or difficulty in getting around safely in one’s environment. Limited mobility is linked to illness, disease, and decreased quality of life.
Recent research show increasing physical activity by 6-minutes per day can improve mobility and prevent future disability. Despite the positive impacts on health, many older Canadians do not perform sufficient physical activity. Health coaching, a person-centered process to change behaviors with goal-setting, action planning, and feedback, is effective at improving physical activity participation in older adults. However, none of the previous health coaching studies included older adults with limited mobility.
Research
This study aims to address this knowledge gap to evaluate if health coaching can improve mobility and increase physical activity in older adults with limited mobility. We will conduct a 6-month study comparing health coaching to health education on improving mobility in older adults aged with limited mobility.
Potential Impact
Increasing physical activity through the use of health coaching has the potential to improve mobility and decrease the negative health impacts of limited mobility in older adults.
Prostate cancer is expected to be the most commonly diagnosed cancer in British Columbia (BC) by 2030. Modern patient management requires cancer genetic testing in order to understand cancer prognosis, choose effective treatments, and inform on cancer risk for patient family members. However, prostate cancer genetic testing is underused in routine care due to difficulties in obtaining representative and high-quality tumour material. In addition, we do not yet know which genes are the most important to test. Our existing tests in BC also do not cover all possible genetic changes, so clinically-meaningful results may be missed.
This research will optimize and apply a comprehensive genetic test in over 3000 people with advanced prostate cancer, predominantly from BC. To make an accessible and practical test, we will use patient blood samples and will use new technology to analyze the tumour DNA that cancers shed into the blood. Results of this study will tell us about the frequency and clinical importance of specific genetic changes in the BC population, and demonstrate feasibility of routine blood-based testing. Results will be translated to next-generation clinical-grade tests offered to BC patients going forward.
People with spinal cord injury (SCI) often experience problems with their bladder function, resulting in symptoms like urine leakage. The bladder and its associated structures are controlled by neural circuits located in the lower part of the spinal cord. This area also contains neural circuits that help control leg movements and sensation. Studies in animals showed that sensory input from the legs can affect muscles controlling urinary function. There is also evidence for such connections between these two systems in humans. For example, gait rehabilitation and electrical stimulation of nerves in the lower leg may help with bladder symptoms in people with neural injury. The reasons for these effects are unclear. However, our recent studies indicate that the pelvic floor muscles, which are crucial for maintaining continence, are activated when people with SCI walk with the help of an exoskeleton. To better understand these phenomena, this proposal will examine how sensory input from the leg affects pelvic floor muscle activity in able-bodied individuals and people with SCI, as well as the potential of using this neural connection to develop rehabilitation-based approaches to manage urinary dysfunction after SCI.
Most parents struggle with their baby’s sleep in the first year. Severe and persistent sleep difficulties can harm parent-child relationships and infant and parental mental health. Parental education, individual consultations, and/or group sessions can help parents improve their baby’s sleep but parents are often overwhelmed with rigid or conflicting advice. Canadian families are diverse, and what works for one may not work for others. For example, a family may be impacted by depression, poverty, or both, and these intersecting factors will affect what educational content and delivery will work best. The SLeep solUtions to proMote Better Early childhood Relationships (SLUMBER) program will give families options to meet their specific needs to get everyone sleeping better. Each part of the program will be designed in partnership with parents. We will develop groups of program options (portfolios) and test them to see who, how, and why they help. This personalized approach will prevent and/or lessen sleep problems with the added benefit of supporting parent-infant relationships and infant mental health. Having a baby is stressful, and this research will support sleep as a foundational pillar of family mental health and well-being.
Stressors encountered in daily life such as family conflicts contribute to the risk of experiencing mental health issues such as anxiety. Conflicts between parents and their children increase in adolescence, but research has focused primarily on its mental health implications for adolescents and not also parents. Parents of adolescents go through their own developmental transitions (e.g., midlife) that bring significant stressors with them. Therefore, both parental and adolescent developmental status and mental health need to be understood to help families develop healthy communication and conflict skills, which may benefit the mental health of both individuals. We need to identify which types of emotion patterns are associated with increased risks, or protection from, the development of mental health issues in response to stressors. We aim to identify parent-adolescent emotion dynamics in the context of stress that are associated with both parents’ and adolescents’ anxiety. The primary impact will be to refine an existing community-based intervention for parents of anxious adolescents and to promote its accessibility by involving families and counsellors in the redevelopment process.
Colon cancer is a leading cause of death, disability and healthcare costs in BC. This emphasizes the importance of removing polyps during colonoscopy, which are pre-cancerous growths in the colon that develop into cancer over time.
Large polyps (LPs) are especially important. They are common and are more likely to be cancerous at the time they are removed. A number of techniques have been created to safely remove LPs during colonoscopy, including those which can cure early cancers. These techniques, called minimally-invasive endoscopic resection techniques, stop patients from undergoing unnecessary surgery which can lead to disability and death. However, many patients with LPs are still undergoing unnecessary surgery in BC and worldwide.
We propose a research program on LPs with two key goals: 1) identifying the best techniques to safely remove LPs; 2) Incorporating these techniques into everyday clinical practice. These goals will be achieved by collaborative research projects with national and international experts within this field including the BC Colon Screening Program.
Achieving these goals has the potential to improve the health of patients in BC and reduce healthcare costs.
Physical activity is safe and beneficial for children, adolescents, and young adults diagnosed with cancer. However, few physical activity programs are available for young people diagnosed with cancer. This is partly because cancer is rare in young people, and so it is hard to create programs that can be accessed by everyone. In my research, I create and test physical activity programs that consider the needs of young people diagnosed with cancer. Over the next 5 years, I will work with children, adolescents, and young adults diagnosed with cancer and their parents, cancer support organizations, fitness professionals, healthcare providers, and researchers to create online physical activity programs that are safe and accessible. I will then implement and test these physical activity programs with young people diagnosed with cancer across Canada. My work will lead to new physical activity opportunities with the potential to improve the health of young people diagnosed with cancer across the country.
