The Current State of Lung Cancer and its Promising Future

Lung cancer is the leading cause of preventable cancer deaths worldwide, with over 1.5 million deaths per year. It claims more lives each year than colon, prostate, ovarian, and breast cancers combined [1]. It is a complex disease and usually considered as a result of smoking effects and multiple genetic variations. To add to this, lung cancer has a poor prognosis, with no major improvements in the 5-year survival rate for the past 30 years [2].

In the United States alone, an average of 425 people die from lung cancer each day [3]. When looking at lung cancer statistics and distributions, monitoring and surveillance is recommended for women as development rates are disproportionate between men and women. Mortality rates are projected to increase significantly in the coming years. Women are one-and-a-half-times more likely than men to develop lung cancer, and those who have never smoked are more likely to develop lung cancer when compared to men who have never smoked [4]. Controlling for age, the global lung cancer mortality rate among women is estimated to increase by over 40% from 2015 to 2030 [5].

Having explored the current burden of disease, let us better understand risk factors and the complexity of lung cancer, along with promising interventions to aid and curtail this disease. There are a number of factors that may increase the chance of getting lung cancer, some are controlled and others are uncontrollable [6].

Controllable risk factors:

  • There is a dose-response relationship between the risk of lung cancer and smoking: the risk of lung cancer increases with the length of time and number of cigarettes smoked. Quitting, even after smoking many years, can significantly reduce the chances of developing lung cancer.

 

  • Second-hand smoke exposure. Smoking causes lung cancer by damaging the cells of the lung. When cigarette smoke is inhaled, whether it be first or second-hand, the lung tissue changes almost immediately. With each repeated exposure, the damage causes cells to behave abnormally, creating tumor cells.

 

  • Radon gas exposure. Radon is naturally occurring, and its radioactive gas is created from the decay of uranium in minerals present in rock, soil and water. Radon is the leading environmental cause of cancer, the leading cause of lung cancer in non-smokers and the second leading cause of lung cancer in smokers. The World Health Organization estimates around 14% of all lung cancer deaths globally are due to radon exposure. This represents 225,000 of the 1.5 million people that die annually from this disease [7].

 

  • Asbestos and carcinogens exposure. Asbestos and other carcinogens – such as arsenic, chromium and nickel – can increase the risk of developing lung cancer, particularly for smokers.

 

Uncontrollable risk factor:

  1. Family history. Individuals with a parent, sibling or child with lung cancer have an increased risk of the disease.

Unfortunately, there is no guaranteed way to prevent lung cancer. Only risk factors can be controlled to mitigate their effects. Strategies to reduce risk include stopping smoking, avoiding second-hand smoke, testing living environments for radon, avoiding carcinogens, and living a healthy lifestyle.

The complexity with lung cancer is that it typically does not cause signs and symptoms in its earliest stages. Individuals at risk of getting lung cancer should screen for the disease regularly. The US Preventive Services Task Force recommends annual screening for lung cancer in current and former smokers aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years [8]. Note that smoking is the number one risk factor, but it is not the only one. To reduce the burden of disease, a screening test must be able to detect lung cancer at an early stage to allow prognosis modifications, present a low percentage of false-positives, minimize adverse effects (i.e., cancer-induced radiation), and be cost-effective for the health system.

Currently, the most effective method to screen for lung cancer is through low-dose computed tomography (LDCT). LDCT is a unique CT scan technique that computerizes x-ray equipment to produce multiple, cross-sectional images or pictures of the lung. This screening tool has many benefits, including [9]:

  •  reduced deaths from lung cancer by 20% for high-risk patients [11]
  • a lower radiation dose than standard chest CT scans
  • ability to locate smaller cancers compared to x-rays.

 

There is variability in cancer, and lung cancer is no exception. Lung cancer is typically divided into two major types based on the appearance of its cancer cells. Treatment decisions are then made by the healthcare team based on the type of cancer diagnosed. The two types of cancer include:

    • Small cell lung cancer (SCLC). This type is a less common type of lung cancer (about 10% – 15% of all lung cancers) [12] and occurs almost exclusively in heavy smokers. SCLC is a cancer without a specific treatment and often spreads early. Traditional treatment methods, such as chemotherapy, radiotherapy, and surgery allow about 6% of patients to survive five years post-diagnosis. Recently, researchers have gained insights into gene activity in human SCLC tumors [13]. This finding will allow for the development of personalized medicine approaches to target this form of lung cancer.

 

  • Non-small cell lung cancer. This type encompasses several lung cancer types that behave in a similar way, these include squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.

Currently, the main modalities of lung cancer treatment include surgery, radiation, and chemotherapy. Similar to other cancers, early stage lung cancer is treated with surgery (e.g. video-assisted thoracoscopic surgery and robotic surgery), and more advanced cases are managed with chemotherapy and/or radiation therapy. Typically, a team of specialists from different fields work together to determine the most appropriate treatment options for the patient. The care team may include various types of oncologists, pathologists, nurses, pharmacists, and health administrators. Having a multidisciplinary team is especially beneficial when it comes to coordinating complex treatment protocols involving multiple therapies.

 

There is continuing efforts to improve the survival of patients with lung cancer, focusing on achieving an earlier diagnosis along with developing new targeted or personalized therapies for this disease. The International Association for the Study of Lung cancer has recently highlighted the importance of immunotherapy, a form of personalized medicine and an encouraging treatment method to fight against lung cancer [14] Lung cancer patients who respond poorly to standard chemotherapy now have more options: most recently two immunotherapy drugs were approved by the U.S. FDA for lung cancer therapy [15]. Even though the survival rate for many lung cancer types still remains low, new targeted therapies and immunotherapies have the ability to change these statistics and are providing new hope.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing

 

Equicare Health enters its fourth year as one of BC’s Fastest Growing Companies

Vancouver, CANADA – Nov 1, 2018 Equicare Health, the leading provider of oncology care coordination and patient navigation solutions, is pleased to announce that it has been recognized as the 59th fastest growing company on the list of the Top 100 Fastest Growing Companies by Business in Vancouver (BIV) for British Columbia.

“We would like to thank Business in Vancouver for this award for a fourth year. This recognition is a constant encouragement for our team at Equicare who continues to innovate and find new solutions in delivering cutting-edge solutions in oncology care coordination,” says Len Grenier, CEO at Equicare Health.

Equicare Health was previously recognized in the 2013, 2015 and 2017 BIV Top 100 list.

About Equicare Health
Equicare Health is the industry’s leading provider of comprehensive care coordination solutions.  Equicare’s flagship solution EQUICARE CS™ (ECS) is a Multi-facility web-based software tool that facilitates patient engagement including patient-reported outcomes, patient navigation, survivorship care and a number of other clinical tools, i.e. MDT, Clinical trials, a suite of educational material, etc.. In additional to the clinical toolset, Equicare also offers an administrative suite of worklists and reports for managing adherence to accreditation standards including Meaningful Use, Commission on Cancer (CoC), NAPBC, QOPI, OCM, etc… ECS enables cancer centers to influence clinical outcomes for patients, optimize revenue streams, and increase operational efficiency. www.equicarehealth.com

 

For more information, please contact:

Celina Lam
Marketing Communications Specialist
celina.lam@equicarehealth.com
604-398-2956

Exploration of Non-systemic Cancer Treatment Modalities

Globally, 18.1 million new cases of cancer and 9.6 million cancer-related deaths have been estimated for 2018 [1]. With the number of people worldwide diagnosed with cancer rapidly growing, there is much effort in aiming to curtail cancer progression. All sectors of the cancer community, from research to care, are actively working towards meeting this goal through discovery of novel interventions and their application in cancer care settings.

The type and stage of cancer, along with the needs and wants of cancer patients inform the trajectory of care. Some patients may have to go through a combination of treatments, and interact with more than one oncologist, in order to destroy or manage the tumor cancer cells. As mentioned in our last article, there are three main branches of oncology that consist of systemic and non-systemic cancer therapy regimens. Medical oncology treatment measures fall under systemic treatments, where substances travel through the bloodstream in order to reach and affect cells all over the body. Surgical and radiation oncology involve non-systemic therapies, where surgical and radiation oncologists lead the healthcare team through the informing, planning, and administration phases of care. We will continue by exploring the fields of surgical and radiation oncology.

Within cancer therapies, surgery was the primal treatment method where innovative surgeons pushed boundaries to find a cure. Typically the cancers amenable to surgical treatment are called solid organ cancers, for instance, cancers involving the mouth, intestinal system, breast, brain and bone. In nearly all of these cases, a surgical oncologist performs surgery to obtain a diagnosis or get rid of the tumor mass. This therapy can be used alone, or in combination with other treatment methods. To this day, surgery remains a promising cancer therapy modality as new technologies have supported more precision in surgical care. Some of the latest advances which have been incorporated into practice are:

1) Organ preservation surgery – This form of treatment is performed in combination with radiation and/or chemotherapy to shrink tumors. This method allows for a less mutilating but equally effective operation. A usage of this method has been for rectal cancers. In the past, a colostomy was needed for patients with rectal cancers that resulted in a complete removal of the colon and the placement of a permanent bag to drain intestinal content. Now, oncologists are able to shrink tumors with radiation or chemotherapy, leading to a majority of patients having a normal intestinal passageway.

2) Laparoscopic surgery – Cancer surgery used to regularly involve open large incisions. However, numerous studies have shown that surgery using laparoscopic techniques is equally as effective, has similar cure rates, is less painful and has a quicker recovery period when compared to open surgery [2]. Laparoscopic surgery is a specialized technique that uses several 0.5 – 1 cm incisions, called a “port”, to insert specialized instruments and a camera to allow the surgeon to perform the

same operations as traditional surgery but with smaller incisions. Laparoscopic surgery is routinely offered for cancers of the esophagus, stomach, large intestine and for gynecologic cancers (uterus and cervix).

3) Robotic surgery – This novel technology assists oncology surgeons through a computer interface to perform meticulous surgeries, particularly for abdominal and chest cancers. Through a small incision, the surgeon performs the surgery by sitting at a console that controls the robotic instrument inside the patient. The surgeon has complete control over the robot. The advantage of this robotic technology is that it allows surgeons to reach the narrowest of spaces to clear the tumor, resulting in better visibility and preservation of nerves and critical structures. In addition, less blood is lost by the patient and their recovery time is reduced, when compared to laparoscopy an open surgery. As a newer from of minimally invasive surgery, its costs, limited availability, and need for specialized training are current barriers.

Radiation therapy is an important mode of therapy and treatment, where approximately 50% of cancer patients receive radiation therapy in their cancer care continuum and contributes to 40% of all therapeutic treatments for cancer. The main goal of radiation therapy is to kill cancer cells through targeted radiation beams. It aims to reduce the number of healthy cells that are lost during treatment, when compared to systemic therapies, by only targeting the areas of the body affected by cancer. High-energy radiation damages the genetic material of cells, which causes cell death. Unfortunately, the radiation still affects the healthy cells surrounding cancer cells, but the healthy cells have the ability to heal themselves at a faster rate following treatment and retain normal functioning.

The birth of radiation therapy took place in 1898, when Marie Curie discovered radium as a source of radiations [3]. Through the years, radiation therapy has evolved. Ongoing advances in techniques and in understanding the biology of cancer cell responses to radiation have led to increased survival and reduced treatment side effects for cancer patients.

Currently, there are two ways of delivering radiation to the cancer site:

1) External beam radiation is delivered from outside the body by aiming high-energy rays, such as photons, protons or particle radiation, to the tumor site. This method is currently the most common approach in the clinical setting.

2) Internal radiation or brachytherapy [4] is delivered from inside the body by a radioactive implant, sometimes called a seed or capsule. This form of delivery allows a higher dose of radiation in a smaller area that might be feasible with external radiation treatment.

 

It is technological advances, such as new imaging modalities, more powerful computers, and new delivery systems, that have helped advanced the goal of radiotherapy [5].

Some of these advances include:

3D conformal radiotherapy (3DCRT) is an imaging technique that allows accurate localization of the tumor and critical normal organ structures. 3DCRT allows for optimal beam placement and shielding.

 Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that uses computer-controlled linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. IMRT allows radiation oncologists to deliver radiation dosages that conform more precisely to the three-dimensional shape of the tumor by controlling the intensity of the radiation beam.

Image-guided radiotherapy (IGRT) uses X-rays and scans to identify the size, shape, and position of the cancer as well as the surrounding tissues and bones. This advancement is beneficial when treatment margins become tighter and more conformal as a positional error would lead to inadvertent radiation of normal healthy organs. IGRT eliminates this unintended consequence as it obtains accurate information through pre-radiotherapy imaging.

Stereotactic body radiation therapy (SBRT) delivers very high individual doses of radiation from many different positions around the patient’s body, while meeting at the tumor. In turn, the tumor receives a high dose of radiation and the tissues surrounding it receive a low dose. SBRT has shown excellent results in the treatment of early stage non-small cell lung cancer in patients unfit for surgery. Other tumors include in the prostate, head and neck, hepatic, renal, spinal and pancreatic.

Proton beam therapy, also called proton therapy, uses a machine that speeds up protons. These high-speed protons create high energy that gives the targeted radiation dose in the tumor. Proton therapy is becoming more prevalent as it is the most advanced form of radiation available [5]. This method of treatment eliminates exit radiation, so radiation oncologists are able to increase dosage to more powerfully and precisely target tumors. Clinical studies have shown that proton therapy has proven to be a cost-effective treatment for pediatric brain tumor patients [6].

Without a doubt, it is an exciting time for oncology. Rapid progress in this field continues to be boosted by technological advances. While mentioned, and more, treatments methods have already transformed cancer care, the growing understanding of the biology of cancer will take therapy to an entirely new level in the coming decades. The hope is for these tools to address the complexity of cancer – the combination of patient-specific characteristics that drive the development of each person’s disease, response to therapy and long-term toxicities. We look forward to tracking and learning more about these advances, and the dynamic interplay between the three pillars of oncology: medical oncology, surgical oncology, and radiation oncology.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Equicare Health introduces Equicare CS (ECS) 4.9 at the ASTRO 2018 Annual Meeting

Vancouver, CANADA – October 18 2018 – Equicare Health, the leading provider of oncology care coordination and patient navigation solutions, will introduce the latest release of their product, ECS 4.9, at the ASTRO 2018 Annual Meeting in San Antonio.

“Every year, ASTRO showcases the best of oncology technology and we are excited to showcase our latest release at this year’s event. ECS 4.9 introduces some significant additions to our software, including support for several languages in the Patient Portal: Spanish, Portuguese, Simplified Chinese, French and English (US, GB, AU, CA),” says Malcolm Wright, VP of Product at Equicare Health. “With this release, we’ve also extended the Worklist feature in ECS, providing powerful new tools for Oncology Departments to manage adherence to standards like MIPS, Commission on Cancer (CoC), and NAPBC.  We’ve also re-designed the Single Sign-On feature, so that Oncology patients can seamlessly access their Equicare account from a hospital’s enterprise patient portal.”

ECS 4.9 is available now.

ASTRO attendees and registrants are encouraged to visit Equicare during exhibit hours; October 21 to 23 from 10:00 a.m. to 5:00 p.m. in Booth #2841 to learn more about Equicare’s products and services.

About Equicare Health

Equicare Health is the industry’s leading provider of comprehensive care coordination and patient navigation solutions. Equicare’s flagship solution EQUICARE CS™ (ECS) is a multi-facility web-based software tool, which enables cancer centers to influence clinical outcomes for patients, optimize revenue streams, and increase operational efficiency. ECS facilities patient engagement through patient reported outcomes, patient navigation, and survivorship care. The software provides other clinical tools (including MDT, Clinical trials, education material, and patient engagement) as well as an administrative suite of worklists and reports for managing adherence to accreditation standards (including Meaningful Use, Commission on Cancer (CoC), NAPBC, QUOPI, OCM). ECS enables cancer centers to influence clinical outcomes for patients, optimize revenue streams, and increase operational efficiency. To learn more, please visit www.equicarehealth.com.

 

For more information, please contact:
Celina Lam
Marketing Communications Specialist
celina.lam@equicarehealth.com
604-398-2956

From Diagnosis to Medical Oncology

The cancer care continuum begins at screening and diagnosis and continues onto treatment. Some cancer types— such as skin, breast, and prostate— may be detected by routine self-exams or other screening measures. Cancer may also be diagnosed incidentally when investigating or treating other medical conditions. Further examination is required when abnormalities are noticed by either the patient or a healthcare professional.

This investigation involves a thorough physical exam and is enhanced with laboratory studies. When the presence of a tumor is suspected, imaging tests, such as X-rays, computed tomography, magnetic resonance imaging, and endoscopy examinations are ordered. In the final step, to confirm diagnosis, a biopsy is performed in which a tissue sample is removed and studied to identify the presence of cancer cells. These actions help the physicians and the care team determine the cancer’s stage, location, and size.

It is generally during the diagnosis stage that physicians – primary care doctors, gynecologists, dermatologists and others – refer suspected or confirmed cancer patients to oncologists. As cancer is complex, its treatment often requires a mix of therapies in addition to lifestyle changes. Depending on the type and stage of cancer, the patient may need a special type of oncologist, or even more than one kind. There are three basic types of cancer treatment doctors [1]:

1) Medical Oncologists

2) Surgical Oncologists

3) Radiation Oncologists

Throughout the duration of the cancer care continuum, patients may go through a combination of treatments to slow tumor growth or eradicate it. It is the cancer and treatment type that will dictate the patient’s main doctor. The relationship built between the cancer care doctor, care team, and patient will most likely last through treatment and into survivorship.

In this article, we will focus on the scenario that the care team recommends systemic therapies – such as chemotherapy or immunotherapy – to get rid of cancer cells. We will explore the role of a medical oncologist in providing care along with the latest innovations in medical oncology.

Medical oncologists are a core member of the cancer care multidisciplinary team, and offer cancer patients a comprehensive and evidence-based approach to treatment and care. They aim to use safe and cost-effective cancer drugs, while maintaining the quality of life of cancer patients throughout the cancer journey. Contributions of medical oncologists are essential in integrating information, at all levels and settings.

For most referrals of suspected or confirmed cancer cases to a medical oncologist, the patient is unsure whether they have a malignant tumor. Understandably, when patients learn that they might have cancer, they want to ensure that they receive the best possible care and treatment. Therefore, good communication and effective patient engagement strategies will facilitate the transmission of realistic information.

It then becomes the oncologist’s role to manage a patient’s care throughout disease. This includes:

  • Explaining the cancer diagnosis and stage of cancer
  • Talking about all treatment options – may be one or a combination of oncology specialty treatment options – and the preferred option for the patient
  • Delivering continuous quality and compassionate care throughout all phases of care
  • Assisting with symptom management and

Medical oncologists aim to treat cancer using systematic approaches, which target the entire body. Based on the type and stage of cancer, the medical oncologist may suggest one or a few treatment options [2]

1. Chemotherapy

Chemotherapy is the traditional anti-cancer therapy. Chemotherapy drugs circulate throughout the bloodstream and disperse to destroy cancerous cells in multiple locations. Due to its nature, chemotherapy is often used to treat cancers that have spread beyond their original point of development.

Chemotherapy is a useful approach for: treating cancer, keeping cancer from spreading and slowing the growth of a tumor. In most cases, chemo increases survival time. Nevertheless, it is accompanied with acute and insidious side effects. Colon and breast cancer tumors have seen an improvement in survival using chemotherapy, but these benefits have to be weighed against the impact of persistent symptoms such as fatigue or neuropathy [3]. In addition, a significant proportion of cancer patients suffering from cancer types, such as melanoma and renal cell carcinoma, may not respond to chemotherapy or relapse after treatment. For these cancers, patients have received minimal benefit but significant toxicity

 

2. Immunotherapy

Immunotherapy – also called biotherapy – uses biologic agents, concentrated amounts of the body’s natural substances, to boost the immune system to fight cancer cells. The immune system is the body’s defense mechanism. When it detects a threat or abnormal behavior, it reacts. This is called the immune response. At times, the immune system is not strong enough. This is where immunotherapy enhances the actions of the immune system to fight cancer cells.

Kames Allison, of the United States of America, and Tasuku Honjo, of Japan, won the 2018 Nobel Prize in Medicine for pioneering this ground-breaking cancer treatment approach [4]. They laid the foundation for the development of a number of medicines now approved by the Food and Drug Administration to treat cancers.

In 2011, the FDA approved ipilimumab, an anti-CTLA-4 antibody, as a treatment for late-stage melanoma. This drug results in the stimulation of an immune response against melanoma. Even though, there are still a handful of side-effects that need to be monitored by the cancer care team during and post-treatment.

Vaccines, medicines that can train the immune system to recognize and destroy unwanted substances, are being utilized to prevent and treat cancers. With regards to cancer treatment vaccines, it may prevent the cancer from recurring, destroy any cancer cells still in the body after other treatments have ended, or stop a tumor from growing or spreading. Researchers are currently testing vaccines for several types of cancers in clinical trials, including breast, cervical, and prostate cancer.

3. Hormone Therapy

Hormone therapy uses drugs, and in some cases surgery, to stop cancer cells from growing. This treatment method works in two ways:

1) Prevents the production of abnormal hormones that can cause cancer;
2) Alters the actions of hormones.

Hormones are produced by many glands in the body, and act as the body’s chemical messengers. They travel throughout the body to regulate the activity and behavior of cells and organs. In women, estrogen and progesterone, produced by the ovaries, play a role in a woman’s reproduction functions as well as sexual characteristics, which can also trigger the growth of breast cancer.

In men, testosterone and dihydrotestostrone, produced by the testicles and adrenal glands, play a role in regulating a man’s sexual development and function. When too many of these hormones are made, prostate cancer may occur.

Hormone therapy uses synthetic hormones or drugs to disrupt the action of the body’s natural hormones. It aims to stop the flood of hormones to the affected tissues and prevents the cancer cells from growing.

The type of hormone therapy used is unique to the cancer type. For instance, a form of treatment for breast cancer may require Tamoxifen, which is a drug that blocks the receptors on the breast cancer cell. This blockage prevents estrogen from binding to cancer cells. Hormonal therapy in breast cancer has improved disease free survival by 10% in 10 years [5]. Similarly, for prostate cancer, there are several types of hormone therapy measures used to treat prostate cancer, including surgery that removes the testicles. As surgery is a permanent treatment, many patients may resort to medical castration, using drugs to lower the amount of hormones made by the body [6].

 

4. Targeted Therapy

Targeted therapies use drugs to interact with cancer cells by targeting specific molecules, such as genes and proteins, involved in cancer growth and spread. These therapies are different from traditional cancer drugs used in chemotherapy, which act on all fast-growing cells. As oncologists are able to match targeted treatments to the patient’s tumor characteristics, these therapies may work more effectively, with fewer side effects. Our previous article explores targeted therapy as a precise method of fighting cancer with drugs.

It is clearly evident in our exploration of the field of medical oncology and its main systemic therapies that this field has made incredible advances and will continue to evolve. With strategic collaboration and documentation of information at all levels of care, shortcomings can be alleviated.

In our next article, we will explore non-systemic therapies in the fields of surgical and radiation oncology, and discuss how the continuous emergence of health technologies is confronting the growing cancer burden worldwide.

 

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

 

Exploring Cancer Treatment Strategies — Target Therapies

The global cancer burden is driving technological advances in cancer research and treatment. Currently, nearly nine million people a year lose their lives to cancer. This equates to approximately 22,000 cancer deaths per day [1]. This burden is expected to grow as the world’s population expands and ages. There is a clear urgency to finding better treatments for current and future cancer patients navigating through the phases of cancer care.

The number of new US Food and Drug Administration (FDA) approved therapies and new uses of cancer therapies have been increasing dramatically in recent years. Majority of these improvements are associated with enhancements in patient survival and/or quality of life. Over the next few weeks, we will explore the pertinent cancer care areas of targeted therapy [2], medical, surgical, and radiation oncology.

Advances in cancer care and research allow for precision, and targeted therapy is the foundation of precision medicine. Targeted therapy aims to treat cancer by targeting the changes in cancer cells that help them grow, divide, and spread. This cancer treatment uses drugs and is different from traditional chemotherapy. It works by targeting specific genes and proteins related to cancer growth and spread of tumors.

To better understand the “targets” of targeted therapy, it is beneficial to know how cancer cells grow. Cells are the building blocks of every tissue in our bodies. There are many different cell types with different, yet specific functions. Cancer starts when a cell has a mutation – certain genes of healthy cells change. Genes play the most critical role as they tell cells how to function. If genes are altered, so is the functionality of the cell, it might either divide abnormally or live too long. When cells grow out of control, tumors form.

As knowledge and findings about cellular level changes increases, cancer researchers are able to design intricate and promising therapies that target erroneous changes and ultimately block their effects. These aim to:

1) Block or turn off signals that tell cancer cells to grow and divide
2) Prevent cells from living longer than normal
3) Destroy the cancer cells

There are two main types of targeted therapy:

1) Small-molecule drugs: these drugs aim to block the process that helps cancer cells multiply and spread. An example of this type of targeted therapy is angiogenesis inhibitors. These drugs keep the tissue around the tumor from making blood vessels. Hence, anti-angiogenesis therapies starve the tumor by keeping new blood vessels from forming.

2) Monoclonal antibodies: these drugs block a specific target on the outside of cancer cells. They can also send toxic substances directly to cancer cells.

It is important to remember that not all cancers type are the same, and not all tumors have the same targets. Therefore, targeted therapies must match the mutation. For instance, if an individual has colorectal cancer, they are tested for the KRAS mutation. This mutation controls the growth and spread of a tumor, and about 40% of colorectal cancers have this gene. When this mutation is present, some targeted therapies are not effective. This identification helps the cancer care team provide the most effective treatment, and protects the patient from unnecessary side effects or treatment costs. With advances such as targeted therapy, healthcare professionals have the ability to match every tumor to the best possible treatment.

In the case of breast cancer, approximately 25% of all cases have too much of a protein called human epidermal growth factor receptor 2 (HER2). This protein induces tumor cell growth [3]. Fortunately, if the type of breast cancer is HER2 positive, then several targeted therapies are available to stop and limit its functionality. HER2-targeted therapies include Trastumab, Pertuzumab, and Neratinib. Some are taken in combination with one another, or along with chemotherapy.

Nearly all novel interventions have their own set of limitations and challenges, and targeted cancer therapies are no exception. One limitation is that cancer cells may become resistant to the therapy, meaning that this method will no longer be effective. This may happen if the target changes itself through mutation, or if the tumor finds a new alternative way to induce tumor growth. It is because of this limitation that most targeted therapies may work best in combination with multiple targeted therapies, and/or in combination with one or more chemotherapy drugs. A challenge is that drugs for some identified targets are difficult to develop as the target’s structure and its pathway are regulated within the cell and are not easily accessible.

One expected goal for targeted therapies is for them to be less toxic than traditional chemotherapy drugs. However, they too can have side effects that need to be tracked by healthcare professionals. Patients may easily assist in reporting their symptoms through patient-reported toxicity questionnaires. This sharing of knowledge and information will further assist the refinement and enhancement of targeted therapies.

Considering these identified obstacles, targeted therapies remain a novel and growing approach to curtailing cancer progression. Cancer care and research are no longer approached through a one-size-fits-all model. Care and treatment have become much more personalized. Doctors and the cancer care team now know that one cancer, whether it be colorectal or breast, can come in many different genetic types. Targeted therapy through the use of drugs and other substances has the ability to more precisely identify and attack cancer cells, providing a promising conduit to diminish or eliminate the cancer care journey altogether.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing

Equicare Health: Bridging Gaps and Enhancing Networks of Cancer Care

A comprehensive cancer care system encompasses the entire spectrum of care – from prevention and screening to diagnosis, treatment, and survivorship. At the secondary prevention stage, screening is utilized to detect potential cases. At diagnosis, the presence or absence of cancer is confirmed, and the patient is directed to the best course of treatment. Survivorship commences at diagnosis and continues onto long-term survival.

Early detection through cancer screening is paramount to the control and management of cancer cases. Each cancer type has a different screening procedure, making it imperative to understand the different modalities. The differences range in the administration of procedure to its specificity, sensitivity, and unintended consequences.

Once screening procedures are available and accepted, patient engagement initiatives play an important role in helping health professionals attract patients and better tailor treatment plans to specific tumor characteristics. As individuals move through the cancer care continuum – from screening to the stages of care – clear communication and access to education tools improve patient engagement.

Currently, digital technologies are utilized to enhance engagement with patients, physicians, and allied healthcare professionals by ensuring that accurate information is gathered and transferred throughout the health system in an efficient manner. For instance, patient reported outcomes (PROs) and questionnaires allow self-reporting of symptoms that provide invaluable information for timely risk management and assessing the overall effectiveness of cancer interventions. These tools have proven that enhanced communication and a well-coordinated system is not only advantageous for the patient, but also the medical team, and healthcare system.

Equicare Health – a leading provider of comprehensive care coordination solutions  – aims to assist patients and the medical team through the cancer care continuum. The key is a platform that bridges the gaps and seamlessly connects health professional team members to each other and their patients. For patients, through the patient portal, they can connect with their care team and engage in their healthcare journey. The portal facilitates patient activation and engagement. Once patients receive an invitation letter to sign up, they will be welcomed to Equicare Health’s portal. There, the dashboard guides patients to access resources such as health information, test results, educational material, and appointment schedule. Regular visits to the portal will help patients and their caregivers keep up-to-date on the progress of their treatment and maintain contact with their care team.

The healthcare team enhances patient activation by selecting the appropriate resources available within Equicare CS (ECS). For instance, a physician and/or allied healthcare professional can assign questionnaires to a patient based on the disease site and topic of concern (i.e. depression screening, sleep disorders screening, and/or distress screening). In addition, care teams can assign relevant education covering topics from pre-treatment to survivorship care to assist patients in their own care management. By doing so, patients become actively involved in their own health, and conversations between the care team and the patient are facilitated.

In addition to the care team guiding patients and processing referrals to specialists and health services, they can efficiently coordinate tasks within the care team through Equicare CS. The platform assists with navigation referrals and consults to medical services (i.e. imaging, surgery, radiation oncology), and support services (i.e. counseling, pain management, nutrition, and hospice care). This results in streamlined communication within and between departments and services, making it easier to support patients and enhance the care they need within the many facets of a healthcare team. Once ECS is adequately utilized, patient navigation reports and provider productivity reports can be generated to evaluate quality of care provided to support goals and compliance standards.

The key functionalities of navigation platforms and informatics tools described include the ability to:

 1) Do distress management for CoC accreditation

2) Track navigation activity to support the navigator role to administrator

 3) Standardize documentation throughout departments

 4) Provide timely information to patients

 5) Communicate to the entire cancer care team through the platform

Care becomes more difficult during survivorship, as patients are often lost to follow-up or unaware of the heightened health risks that arise post-treatment. This disconnect with the health system proves to be a challenge in managing patients’ medical and psychosocial concerns. Hence, electronic communication tools are imperative to maintaining contact both during and after active care: within the healthcare team and between the team and the patient.

Each step of cancer care is complex and multimodal. There is a need to create a chronic care model to improve clinical outcomes for patients as well as to maximize the operational efficiency for cancer centers. To date, Equicare Health has served over 250,000 oncology patients and 300 cancer centres who continue to utilize the diverse tools that ECS has to offer. With ECS, care coordination and center specific goals are supported through the Service Team and Workflow Specialist at Equicare, who connect with cancer centers and healthcare professionals to assist them in reaching their goals (i.e. number of PROs filled, meeting accreditation standards, and/or enhancing patient engagement). ECS supports patients and healthcare professionals through the care continuum. With its efficient communication tools, tailored educational content, and patient reported outcomes, ECS gathers information, data and education into a comprehensive platform that empowers healthcare providers, patients, and caregivers in the healthcare journey.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing

Survivorship: Transitioning in a New Way of Life

Diagnostics, workup, and treatment may be complete, but the journey across the cancer care continuum will continue through survivorship management. There are currently over 15 million cancer survivors, and that is to increase to 20.3 million (a 31% increase) by 2026 in the United States alone [1]. In contrast, statistics from about 50 years ago was a count of 3 million survivors in 1971. This dramatic increase is primarily attributed to an aging population, earlier detection, and advanced treatment [2].

The concept of cancer survivorship is not new; it has been over 30 years since Dr. Fitzhugh Mullan described survivorship as a unique phase of cancer care and introduced the idea of “seasons of survivorship. [3]” Since then, this concept has evolved and continues to create some controversy with regards to its exact onset and duration [4]. These can generally be categorized into three categories:

  • Phase 1 – acute survival –  time from diagnosis to completion of initial treatment
  • Phase 2 – extended survival – time from completion of treatment to remission, with careful observations of outcomes from treatments
  • Phase 3 –  long-term survival

Our focus and attention will be on the period following final treatment and prior to the development of cancer recurrence – long-term survival. Historically, this stage has not been a focus of the care continuum and has several areas of concern, including a less frequent check-in with healthcare providers. Once primary treatment is completed, many patients are often lost to follow-up; are unaware of the heightened health-risks and are ill prepared to manage their medical and psychosocial concerns.

Part of the difficulty with this phase is that it is unique not only for each cancer, but also its various types. For instance, the 5-year survival for breast cancers diagnosed during 2010-2014 is 90.2% in the United States. Its hazard of reoccurrence is highest during the first 5 years at approximately 10%, with the estrogen receptor positive disease maintaining a significant recurrence rate beyond 5 years [5]. For prostate cancers in the United States, the 5-year survival is nearly a 100% [6], with a wide recurrence of 30% – 90% [7]. The high variety of survival rates along with the range of cancer reoccurrence informs the need for tailored surveillance programs.

Follow-up care concerns have become more pertinent in recent years as the new generation of cancer survivors are living longer due to improved access to effective screening, diagnosis, and treatment initiatives. Consequently, the health care delivery system is looking at solutions to efficiently and effectively navigate the long-term and late effects of cancer care as well as other chronic conditions, while taking into account the demands for patient-centered quality of care across the cancer care continuum.

The transition from active treatment to post-treatment care is a critical period for maintaining and enhancing long-term individual and population health. Evidence-based strategies need to be implemented across health systems to ensure that optimal health outcomes are met. Quality of care during survivorship is dependent on essential components of care, as well as ease of access to comprehensive and coordinated care.

Cancer survivorship encompasses:

  1. Prevention through screening of new and recurrent cancers
  2. Surveillance of cancer recurrence
  3. Monitoring of medical and psychosocial late-effects, incorporating interventions for intended and unintended consequences of cancer treatment
  4. Coordination of care between health professionals to ensure that all the health needs of survivors are met

In order to deliver optimal cancer survivorship care, fundamental changes are needed to ensure that all survivors receive care that is safe, timely, effective, efficient, patient-centred, and equitable. Leading health care systems foster and embrace the creation of an infrastructure to support evidence-based practices. In a world that is complex and continuously enhancing, leading health care systems utilize information technology to better assist health care professionals and patients with cancer care navigation.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing

Patient Reported Toxicities

In a given year, over 1.5 million new cases of cancer are diagnosed in the United States alone [1]. Their journey on the cancer care continuum starts with screening and continues through survivorship, getting matched with the most appropriate form of care. Radiation, chemo, or hormonal therapy as well as surgery, all have side-effects that are experienced first-hand by the patient and impact their families.

Currently, traditional biomedical outcome measures, such as survival and disease-free survival rates, are widely used to track the effectiveness of cancer treatment interventions [2]. Symptomatic toxicities are often underreported when collected by healthcare professionals [3]. In a chemo radiation cancer study, comparing patient-reported outcomes (PROs) with hospital charts of acute symptoms, the patients reported diarrhea and inflammation approximately 20% more often than clinicians [4]. Patients generally report symptoms earlier and more frequently than clinicians. They are also able and willing to self-report their own adverse symptoms, even when severely ill. [5]

In one clinical trial, it was concluded that physician reporting is neither sensitive or specific in detecting common chemotherapy adverse effects [6]. To enhance current assessment measures, novel approaches to evaluating symptomatic toxicities associated with cancer treatments (e.g. headaches, nausea, vomiting) need to be incorporated into the health tracking systems. The aim is to better capture the rate of toxicity of interventions at a personalized level.

Direct patient reporting through electronic platforms offers a mechanism that will enhance the efficiency and precision of current approaches. Accurate knowledge of the potential harms and risks of cancer treatment modalities is important to decision makers including patients, researchers, health professionals, and regulatory authorities. Patient reported toxicities help guide healthcare professionals in real time in an effort to reduce treatment-related side effects. Patients are also better able to identify baseline symptoms related to pre-existing conditions, and misinterpretation or transformation of information is avoided. Undoubtedly, they will receive more accurate information based on their own reporting and previous experiences of their peers, and will be more at ease about the care provided. Tools developed that enable the translation of side effects, from the patient perspective, would allow tremendous improvements in risk-benefit analyses.

A systematic collection of patient-reported outcomes has been proven to be a valid, reliable, and sustainable approach in obtaining symptomatic toxicities. E-platforms have the ability to positively complement clinician toxicity reports. The widespread adoption of patient-reported outcome toxicity monitoring in oncology care is on the rise. Companies including Equicare Health try to address the need through comprehensive patient-reported outcome questionnaires. They aim to address the previously dominant challenges pertaining data collection logistics, validated analytical approaches, and resource utilization.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing

Patient engagement and empowerment tools enhance cancer care process

According to a recent survey, approximately 90% of patients with chronic illnesses need assistance with disease management, and 70% need healthcare providers to supply them with more educational resources [1]. However, the tools that have traditionally been in place do not provide the optimal level of assistance and communication to meet the needs of patients.

In essence, to improve health outcomes, patients and caregivers need to have access to tools that provide prognosis and procedural education, allowing for effective communication with the cancer care team. When patients are informed, they are able to express the urgency of their needs to better navigate through their care continuum.

In oncology, controlling and treating cancer ranges across a combination of surgery, radiation, and chemotherapy. Treatment measures can be effective in stopping tumor progression, managing pain, and extending life. These may be accompanied with unintentional side effects, ranging from short-term and transient to long-term and persistent that can arise years after the first treatment.

Patient portals containing electronic personal health records linked to health systems, patient reported outcomes, and patient-centered education are currently recognized as promising tools to enhance health outcomes. Studies show that patient engagement throughout diagnostic, workup, and treatment, improves patient-provider relationships, enhances patient safety, and empowers patients and their caregivers [2].

Portals allow health professionals the ability to efficiently “track preventive measures such as screening tests and immunizations [3]”, and enable shared-decision making between health professionals and the patient. Communication between patients and the care team is enhanced with careful documentation of each interaction. A study by Easley et al. highlights that better communication among health professionals and with patients is the most common factor contributing to a positive experience within cancer care coordination [4]. When health professionals are given suitable tools to further enhance health literacy and promote self-management – patient outcomes throughout cancer treatment and survivorship planning improve.

Patient safety is further enhanced through the usage of portals that allow the tracking of stages of care in a centralized manner [5]. When supplemented with other software tools (i.e. tailored evidence-based educational articles, and patient reported outcomes and questionnaires) patients are able to monitor their health and efficiently report their status to the care provider.

 

Equicare Health is amongst the leading patient navigation health IT companies, currently serving over 250,000 oncology patients at over 240 cancer centers across the globe. Equicare Health provides efficient communication tools, a platform of educational content, and patient reported outcomes and questionnaires. The aim is to empower oncology navigation teams, caregivers and their patients.

The educational content provided is personalized for the patient and their care team. Equicare’s partnership with Oncolink and the inclusion of comprehensive drug fact sheets provides patients access to an extensive set of cancer educational content. Equicare has integrated Oncolink’s Education Library into their system to allow for timely and appropriate education provision.

Patient reported outcomes and questionnaires are measurements of any aspect of a patient’s health status that are provided directly from the individual [6]. They can provide invaluable information for timely risk management and assessing the overall effectiveness of cancer interventions. Cancer care organizations have begun integrating patient reported outcomes into their routine clinical practice. The hope is to improve cancer symptom screening and management across their jurisdiction.

Informal patient reported outcome measures in cancer care have always been in play. However, it has only been recently that there is growing interest on collecting information in a systematic and efficient manner through electronic collection and e-patient reported outcomes. Electronic collection yields reliable data that are of higher quality than health professional reported data that, in turn, facilitate conversation and increase patient involvement in their care.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing. 

Top