LEAP Summer 2018

BACK TO WORK

Tips for returning after treatment

THE ENBRIDGE RIDE TO CONQUER CANCER 5 ways your donation makes a difference

SMOOTHIES 101 Sip your way to a balanced diet

SUMMER 2018

THE PROGRESS ISSUE

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CONTENTS

34 LIVING WELL A new program adds physical activity to cancer treatment plans, and an annual, province-wide event brings much-needed support to patients seeking resources and advice post-cancer.

38 RESEARCH ROCKSTAR At the Cross Cancer Institute, Dr. Michael Smylie conducts international immunotherapy clinical trials for melanoma patients — with encouraging results.

42 TRUE CALLING Through their highly specialized pathology work at the Edmonton Zone Immunohistochemistry Laboratory, Dr. Gilbert Bigras and his team play a key role in cancer diagnoses and patient treatment plans.

FEATURES

20 THE PROGRESS ISSUE From advances in screening methods and prevention initiatives to the development of promising new clinical trials, we take a closer look at some of the recent strides Alberta scientists and health-care professionals have made in cancer research, treatment and care.

COLUMNS/DEPARTMENTS marks its 50th anniversary, work on the Calgary Cancer Centre continues, and more.

7 FRONT LINE Dr. Wajid Sayeed works to improve outcomes for patients with brain tumours, Edmonton’s Cross Cancer Institute

13 YOUR DONATION MATTERS Five ways your donation to the Enbridge Ride to Conquer Cancer has made life better for those facing cancer.

14 FOOD FOCUS Smoothies are an easy and delicious way to incorporate key nutrients into your diet.

16 WORKOUT Practicing the ancient art of Tai Chi can help to improve your strength, balance and overall well-being.

18 EXPERT ADVICE Tips for returning to work following cancer treatment, and preparing your child for the HPV vaccine.

32 CARING Calgarian Elaine Moses helps out-of-town patients undergoing long-term cancer treatment feel much more at home.

46 IMPACT Edmonton-based patient Laura Perram shares the lessons she learned on her personal cancer journey.

47 WHY I DONATE Lifelong philanthropists Beverly and Gerry Berkhold are deeply committed to supporting the cancer community.

49 MY LEAP Having faced cancer in a variety of ways over her lifetime, Kelly Liebe finds inspiration and camaraderie through the annual Enbridge Ride to Conquer Cancer.

50 GAME CHANGER Edmonton-based Booster Juice has been a proud supporter of the World’s Longest Hockey Game fundraising event from the very beginning.

COVER ILLUSTRATION GRAHAM HUTCHINGS/SINELAB

myleapmagazine.ca SUMMER 2018 LEAP 3

MESSAGE

Alberta Advances TRUSTEES

Leigh-Anne Palter (Chair) Rene Aldana Dr. Stanford Blade Dr. Heather Bryant Nancy Guebert Robert (Bob) McGee Andrea McManus Dr. Matthew Parliament Gelaine Pearman Jamie Pytel Rory J. Tyler

NEVER MISS AN ISSUITE! VIS

e.ca/ myleapmagazin e ib cr bs su

4 LEAP SUMMER 2018

I am pleased to have our newly minted board chair, Leigh-Anne Palter, join me in her inaugural Leap magazine message. Leigh-Anne first joined the Alberta Cancer Foundation board of trustees in 2016 and in that short time, has demonstrated a strong commitment to delivering the biggest impact to Albertans and their families facing cancer. Leigh-Anne is the CEO of Chestermere Utilities and has an extensive track record in community leadership at the governance level.

She was nominated as chair earlier this summer.

Our theme for this issue is progress, and experts in the cancer world would say we have seen more advances in the last 10 years, than in previous decades. For instance, you’ll read about our research rockstar (page 38), Dr. Michael Smylie, who leads clinical trials on breakthrough immunotherapy drugs that have changed the way late-stage melanoma patients are treated.

Once considered a dismal cancer to treat, the success rates have improved dramatically in the last few years. In 2007, for example, Dr. Smylie had to tell two patients in their 30s they had exhausted all treatment options, and they likely have six months to live. But the patients had the opportunity to take these new drugs, the cancer went away and they’re still doing well today.

His waiting room, which was once empty because people weren’t living long enough to come back for checkups, is now filled with Albertans and their family members who are flourishing and doing well years later.

We are also seeing progress in our communities across the province, thanks to donor support. Up until recently, if you needed an endoscopy in Bonnyville to examine your digestive tract, for instance, the wait time may have been as long as six months because there wasn’t dedicated space to access it. Our donors worked with partners in the Bonnyville community to help bring an endoscopy suite to the area, making earlier and improved treatment an option (page 22).

In this issue we also feature lifelong philanthropists Gerry and Beverly Berkhold (page 47).

When we talk about progress, the Berkholds are good examples of how we can make that happen. From supporting our patient financial assistance program to investing in new treatment methods such as brachytherapy, the Berkholds show how philanthropy can make a real difference in this province. We are privileged to be part of their story — and that of every other donor we meet.

You will also note on our cover that the Cross Cancer Institute is celebrating an important milestone. For 50 years, Albertans have walked through those doors — 500 are treated there every day — and have received world-class, compassionate care. We are proud to be partners with CancerControl Alberta and Alberta Health Services as they mark this incredible achievement and know they will continue to deliver excellent treatment and care for years to come.

GEORGE ANDREWS,

LEIGH-ANNE PALTER,

PRESIDENT & CEO ALBERTA CANCER FOUNDATION

CHAIR ALBERTA CANCER FOUNDATION

SUMMER 2018

|

VOL. 3

|

NO. 10

ALBERTA CANCER FOUNDATION EDITORS

Phoebe Dey and Christiane Gauthier

EDITORIAL DIRECTOR Jill Foran ART DIRECTOR Kim Larson STAFF PHOTOGRAPHER Jared Sych CONTRIBUTORS Wes Bell, Andrew Benson, Bluefish Studios, Colleen Biondi, Elizabeth Chorney-Booth, Cooper & O’Hara, Caitlin Crawshaw, Jennifer Dorozio, Spencer Flock, Christina Frangou, Jennifer Friesen, Glenn Harvey, Graham Hutchings, Mae Kroeis, Jennifer Madole, Karin Olafson, Aaron Pedersen, Kyle Schneider, Emily Senger, Paul Swanson, Julia Williams PUBLISHED FOR

Alberta Cancer Foundation Calgary office Suite 300, 1620 29 St. N.W. Calgary, Alberta T2N 4L7

PROVINCIAL OFFICE

710, 10123 99 St. N.W. Edmonton, Alberta T5J 3H1 Tel: 780-643-4400 Toll free: 1-866-412-4222 acfonline@albertacancer.ca

PUBLISHED BY

Redpoint Media & Marketing Solutions 100, 1900 11 St. S.E. Calgary, Alberta T2G 3G2 Phone: 403-240-9055 Toll free: 1-877-963-9333 Fax: 403-240-9059 info@redpointmedia.ca PM 40030911 Return undeliverable Canadian addresses to the Edmonton address above.

PRESIDENT & CEO Pete Graves GROUP PUBLISHER Joyce Byrne CLIENT RELATIONS MANAGER Sandra Jenks PRODUCTION MANAGER Mike Matovich AUDIENCE DEVELOPMENT MANAGER Rob Kelly

As the official fundraising partner for the Cross Cancer Institute, Tom Baker Cancer Centre, and 15 regional and community cancer centres across the province, the Alberta Cancer Foundation is making life better for Albertans facing cancer by investing nearly $20 million/year in research, prevention, screening and enhanced care programs.

myleapmagazine.ca SUMMER 2018 LEAP 5

Text CROSS to 41010 to donate

May Greenhouse initiative September Restaurant initiative October 13 Edmonton Eskimos Tackle Cancer November Gala Ask us how you can help

Katie Wiebe katie.wiebe@albertacancer.ca

Last year’s inaugural tournament raised over $300,000 dollars for the Patient Navigator Program. We’re hoping for another successful event in 2018, as we raise funds for the Patient Financial Assistance Program – a program dedicated to easing the financial burdens that come with a cancer diagnosis.

Your support will help Albertans facing cancer with expenses such as medications, transportation, accommodations, and childcare.

August 28th, 2018 at Country Hills Golf Club Shotgun start – 9:30am For more information on how to get involved, please contact Michelle Body by email michelle.body@albertacancer.ca or by phone 403.476.2421

6 LEAP SUMMER 2018

FRONT BRIGHT MINDS | CALGARY CANCER CEN TRE | THE CROSS TURNS 50

BRIGHT MINDS

Dr. Wajid Sayeed is working to improve the outcomes for patients with aggressive brain tumours

D

octors tend to move around a lot early in their careers — it’s typical for young physicians to spend time at different teaching hospitals across the country as they complete their training. A region may see a brilliant, up-and-coming doctor pass through for a research project, only to move on once it’s completed.

This is one of the many reasons why the Alberta cancer care community is so fortunate that, after completing a research fellowship at the Tom Baker Cancer Centre in Calgary, Dr. Wajid Sayeed, a skilled neuro-oncologist, elected to stay in the province.

After studying at universities and hospitals in Ontario and Manitoba, Sayeed, who was born in Calgary but grew up in Ontario, came to Alberta as the inaugural recipient of the Alberta Cancer Foundation’s Lynne Marshall and Wayne Foo Cancer Research Clinical Fellowship >

ONE OF CANADA’S FEW NEURO-ONCOLOGISTS, DR. WAJID SAYEED IS BASED AT THE CROSS CANCER INSTITUTE

PHOTOS BLUEFISH STUDIOS

myleapmagazine.ca SUMMER 2018 LEAP 7

FRONT LINE

IN HIS NEW POSITION, DR. SAYEED’S FOCUS HAS SHIFTED FROM LAB WORK TO PATIENT CARE

in 2015. Shortly after that fellowship wrapped up in July 2017, he accepted a position as a staff neuro-oncologist at the Cross Cancer Institute in Edmonton.

Sayeed spends his days seeing patients with brain cancer, assessing and guiding them through their treatment, and working in conjunction with them to gather data for clinical research projects. While retaining a bright young doctor is always a boon in any community, dedicated neuro-oncologists (i.e. doctors specializing in cancers of the brain and spinal cord, as opposed to more general oncologists who work in consultation with neurologists) are a relative rarity in Canada, making Sayeed’s 8 LEAP SUMMER 2018

presence in the province particularly valuable.

“In Canada, if you count up the number of neurology-trained neuro-oncologists, there are probably between seven and 10 of us, including myself,” Sayeed says. “It just happened that, here in Edmonton, there was a neuro-oncologist who was retiring at the same time I was graduating, so at that point I decided to stay in Alberta.”

A large part of Sayeed’s time in Calgary during his fellowship was spent researching highly aggressive brain tumours called glioblastoma and the benefits of removing those tumours in their entirety, a topic he’s continuing to monitor through his patients at the Cross Cancer Institute. Traditionally, many

neurosurgeons only remove part of a tumour, believing that a full extraction increases the risk of damaging surrounding brain tissue without actually improving the patient’s prognosis.

Sayeed’s research, however, reveals that complete removal can indeed increase life expectancy, so he’s using his position at the Cross Cancer Institute to encourage colleagues to remove as much of each tumour as possible.

“Here in Edmonton, we have a number of surgeons who are more conservative and who choose to preserve patient quality of life by not being too adventurous in their resections, and I’m seeing if I can change some minds with this research,” Sayeed says.

“I’m not a neurosurgeon, so I’m coming at this from the outside, but I see these patients afterwards and have to give them a treatment plan.

The results of their surgery can really shape the entire clinical course of their treatment.”

Dr. Jay Easaw, a medical oncologist now based at the Cross Cancer Institute, worked with Sayeed during his fellowship in Calgary, and the two continue to work together closely in Edmonton.

Easaw says that it has been a joy to watch Sayeed make the transition from student to colleague.

“He’s an outstanding physician. I’ve seen him grow in that he’s now at a point where he commands respect from his group because he’s so knowledgeable,” Easaw says. “He’s understood very quickly that the way to get a team to work well is not to be dictatorial or overly demanding, but to be collaborative.”

Whether it’s collaborating with colleagues or working directly with patients, Sayeed’s focus has shifted from lab work to patient care, making him a better and more sensitive physician. His continued dedication to learning more about what will improve his patients’ quality and longevity of life is part of what makes him such an asset to Alberta’s health-care system.

“My experience has obviously grown, and my appreciation for how to deliver what is ultimately devastating news to a patient has become more nuanced,” Sayeed says. “It’s something that I’m still learning every day, but I’ve learned to read people better. That’s something I’ve definitely added to my medical tool box.” LEAP — ELIZABETH CHORNEY-BOOTH

The Calgary Cancer Centre is Rising Strong The air is full of excitement at the site of the new Calgary Cancer Centre, where work is progressing on schedule since design-builder PCL Construction Management Inc. broke ground in October 2017. Excavation will be fully completed this summer, and the concrete pouring for the lower levels of the parkade is well underway.

Set to open to the public in 2023, and located on the northeast corner of the Foothills Medical Centre site, the Calgary Cancer Centre will be the largest stand-alone comprehensive cancer centre in Canada. Every type of cancer, with the exception of childhood cancer, will be treated there, expanding the reach and breadth of cancer care in southern Alberta and furthering vital research.

From the very start of this project, Alberta Infrastructure, Alberta Health Services and Alberta Health have partnered closely with the PCL/Dialog/Stantec team to create a facility that will support the delivery of leading and comprehensive patient/ family-centred care, a chief aim for the Centre.

Throughout the design process, the project team

has been working with a Patient and Family Advisory Council (PFAC) — assembled to represent the voices of patients and caregivers affected by cancer — to hear and incorporate their feedback. “[We’re] trying as best as possible to [meet the needs] of the types of patients we serve,” says Joanne Aime, project lead for the Calgary Cancer Centre, representing Alberta Health Services.

In addition to exceptional medical care, the Calgary Cancer Centre will provide much-needed space, technology and tools for developing, discovering and carrying out vital cancer research, including clinical studies and trials.

“We need to make sure we have the facilities and the infrastructure to meet the challenges of a growing cancer incidence and increasing cancer care complexity,” says Dr. Sunil Verma, medical lead for the Calgary Cancer Centre and medical director of the Tom Baker Cancer Centre. “[The new Centre] will really help us deliver care, and also help us recruit and retain the staff who are going to be the future of cancer care in southern Alberta.” LEAP

“[The new Centre] will really help us deliver care, and also help us recruit and retain the staff who are going to be the future of cancer care in southern Alberta.”

– Dr. Sunil Verma, medical lead for the Calgary Cancer Centre and medical director of the Tom Baker Cancer Centre

— JENNIFER DOROZIO

CALGARY CANCER CENTRE – NUMBERS TO PONDER

1.3 MILLION TOTAL SQUARE FOOTAGE OF THE FACILITY

450,000

CUBIC METRES OF DIRT THAT WILL BE REMOVED AS PART OF SITE EXCAVATION. THIS IS EQUIVALENT TO 5.2 MILLION WHEELBARROWS FULL.

3,800 APPROXIMATE NUMBER OF DOORS IN THE CENTRE, MEANING A PERSON COULD OPEN A NEW DOOR THERE EVERY DAY FOR 10.4 YEARS.

1,200

APPROXIMATE NUMBER OF HAND HYGIENE SINKS; SOMEONE COULD WASH THEIR HANDS IN A DIFFERENT SINK EACH DAY FOR 3.2 YEARS.

myleapmagazine.ca SUMMER 2018 LEAP 9

FRONT LINE

THE CROSS CANCER INSTITUTE HAS BEEN DELIVERING VITAL CARE FOR 50 YEARS

Golden Milestone The Cross Cancer Institute marks its 50th anniversary this year DARLENE SAMAGALSKI EXPECTED A

“very clinical, sombre place” the first time she visited the Cross Cancer Institute for breast cancer treatment in 1997.

But as soon as she walked through the front doors and saw the bookstore, she breathed a sigh of relief. “I thought, ‘This is my kind of place,’” she says.

With plenty of books to read, and so many friendly volunteers and staff, the Cross Cancer Institute became a hopeful place for Samagalski to receive care, which included many rounds of chemo and radiation.

When the cancer returned 12 years 10 LEAP SUMMER 2018

later, Samagalski wasn’t afraid of the road ahead. “I trusted the Cross because I had such a good experience the first time,” she says. Now stable, she’s one of many former patients choosing to give back to the Cross as a volunteer — naturally, she works in the bookstore.

“I wanted to be part of a place where, when people walk in, there’s a little bit of normalcy.”

Since 1968, the Cross Cancer Institute has treated hundreds of thousands of patients with its trademark blend of compassion and cutting-edge medical science.

“The culture here is one of compassion

and caring, as well as innovation,” says Paula Germann, the Cross Cancer Institute’s site director. Nowadays, the Cross treats about 6,500 adult patients each year, including people hailing from across Alberta, as well as British Columbia, Saskatchewan and elsewhere in Canada.

According to Germann, the Cross is also a place of game-changing cancer research.

“We’re a highly sought-after site for clinical trials,” she says.

This summer marks the Cross Cancer Institute’s 50th anniversary, a milestone that staff recently observed with celebrations that included a barbecue, a games

DARREN BAUMGARDNER HARD AT WORK AT A “SHOW THE LOVE” FUNDRAISING EVENT

Show the Love A special anniversary campaign is asking Edmontonians to show their support for the Cross Cancer Institute

day, the sharing of patient stories, and the opening of a time capsule. “Everyone here [has been] really excited,” says Germann.

“It’s a real honour and I think people are proud of our site and what we do.”

With so many improvements to cancer care over the last five decades, Germann is also excited to see what the next 50 years will bring. “Our patients are experiencing a better quality of life, living longer, and they have more treatments than they once did,” she says. “If past predicts the future, I think we will continue to be successful in all of our care for patients.” LEAP — CAITLIN CRAWSHAW

A couple of years ago, prominent Edmonton businessman Darren Baumgardner found himself in hospital wondering if he had colon cancer.

While he was awaiting his test results, he happened to get a call from a friend on the Cross Cancer Institute golf committee asking him to co-chair the annual golf tournament that raises funds for the Alberta Cancer Foundation.

“I thought, ‘Well now I have to participate,’” he says with a laugh. He continues to co-chair the Cross Cancer Institute Golf Classic, which celebrates its 30th anniversary this year.

Luckily, Baumgardner didn’t have cancer, but his experience was yet another reminder of cancer’s reach in his life and community. The year before, he lost his father-in-law to cancer and before that, his own father received cancer treatment. His friends and colleagues have also had their own run-ins with cancer.

“I think everyone in our community has a story

about how cancer has touched them,” he says.

When Baumgardner and some of his fellow volunteers with the Cross Cancer Institute Golf Classic found out about the Cross Cancer Institute’s 50th anniversary, they saw an opportunity to celebrate the vital role of the hospital. Working with the Alberta Cancer Foundation and local advertising agency DDB, they created a fundraising and education campaign called “Show the Love” to remind Albertans of the Institute’s good work.

“We felt it was necessary to say, ‘Hey, these guys are doing some great work and we need to make them feel special,’” Baumgardner says. “That’s why [we] branded it Show the Love.”

Edmonton businessman Guy Mersereau, who cochairs the campaign with Baumgardner and Peter Wilkes, notes that while the CCI is well-known, “it’s often thought of as a place where people go in and don’t come out.” He’s

hoping the campaign helps to change that perception.

This past April, the campaign launched an official website (showthelovetoday.ca), and a number of events have been planned for the campaign over the coming months, including an October 13 football game (Edmonton Eskimos vs. the Ottawa Redblacks) dedicated to the Cross Cancer Institute. Hospital patients, staff, volunteers, and survivors will be invited to the event, and there will be several fundraising initiatives during the game.

The campaign is also being supported by a number of local greenhouses and restaurateurs who are donating portions of their sales, and by DynaLIFE Medical Labs, which has placed donation boxes at every one of its 35 locations. All of this will help raise needed funds for the hospital, says Mersereau. “[Government funding] can only do so much — there’s never enough for everything that needs to be done.” LEAP — CAITLIN CRAWSHAW

myleapmagazine.ca SUMMER 2018 LEAP 11

FRONT LINE

procedures always carry risks for infection or other complications in a patient, especially if tissue samples need to be gathered more than once.

Not only are liquid biopsies much less invasive, but researchers are finding that these tests could potentially detect some forms of cancer sooner and determine more focused treatment plans for patients.

As studies into the efficacy of liquid biopsies continue, so, too, does the discussion around how these promising tests can work in conjunction with other testing methods to create the best possible cancer screening and treatment processes.

(Read more about two liquid biopsy tests developed in Alberta on page 24.) LEAP — JENNIFER DOROZIO

DID YOU KNOW?

Liquid Benefits Researchers are developing less-invasive ways to test for cancer LIQUID BIOPSIES — a new way of collecting tumour cells from the body — could revolutionize the way cancer is both screened and treated. By examining bodily fluids, such as blood and urine, doctors can detect and study traces of cancer DNA (as well as circulating tumour cells) and potentially gain key insights into which treatments might work for a patient.

Scientists have known for more than a century that tumours shed cancer molecules into the blood and other bodily fluids, but it was only recently determined that studying these DNA molecules

through liquid biopsies could reveal valuable diagnostic and treatment information.

Traditionally, tissue biopsies — which examine tumour cells that are often gathered invasively from the patient — have been the preferred way to determine the presence of cancer.

But tissue biopsies have their barriers. In some cases, for instance, it can be difficult to obtain sufficient tissue to perform all the diagnostic testing that may be required — and there are some tumours that simply cannot be reached via tissue collection at all. In addition, invasive

The Alberta Cancer Foundation supports clinical trials that take place in Alberta, including those focused on early detection.

ILLUSTRATION JENNIFER MADOLE

12 LEAP SUMMER 2018

5 WAYS

Your donation to the Enbridge Ride to Conquer Cancer has made life better for Albertans facing cancer This year, we celebrate the epic 10th annual Enbridge Ride to Conquer Cancer, benefiting the Alberta Cancer Foundation. Here are some real examples of how dollars raised from the Ride have made a difference for Albertans and their families facing cancer.

PATIENT FINANCIAL ASSISTANCE

CLINICAL TRIALS

Alberta has more patients enrolled in clinical trials than the national average, and participation is now more accessible. This means access to lifesaving treatment years before it would otherwise be available.

ADVANCED IMAGING

The first of its kind in western Canada, the PET-MR is an imaging technology that will allow researchers to provide more precise therapy for each patient.

ENHANCING PATIENT CARE

Comfortable treatment chairs, blanket warmers, improved waiting rooms and patient-education resources are made possible through Ride funds.

No patient should have to choose between groceries or treatment options during their cancer journey.

The Ride helps provide patients with access to financial support when they need it most.

BRAIN CANCER BREAKTHROUGHS

Learn more about how you can support the Alberta Cancer Foundation at albertacancer.ca

Ride funds have supported a team of scientists in Alberta who are working to identify new drug combinations for the most common form of brain cancer. As a result, patient life expectancy has been extended.

Since its launch in 2009, the Enbridge Ride to Conquer Cancer has raised more than $60 million for the Alberta Cancer Foundation. myleapmagazine.ca SUMMER 2018 LEAP 13

14 LEAP SUMMER 2018

FOOD FOCUS

Nutrition Boost DO YOU LIKE TO DRINK YOUR FRUITS

and veggies? Freshly pressed juice and thick and delicious smoothies are on trend right now — you can grab a cup of drinkable fresh fruit and veg at your local mall or gym, and even at most airports these days.

The ease of getting all of the vitamins and phytonutrients that come with fruits and vegetables in an easy-to-grab beverage is irresistibly convenient, and these tasty drinks can also encourage us to consume nutrient-rich veggies that we may not otherwise enjoy.

The difference between a juice and a smoothie is fairly straightforward. Juice is liquid that is squeezed out of the fruit or vegetable; the solid part of the food is left behind. Smoothies, on the other hand, involve pulverizing the entire fruit or vegetable (with the possible exception of the peel or seeds) in a blender. From a nutritional point of view, smoothies are usually a better choice, especially when less sugary vegetables are used in the mix, because they incorporate the food’s nutritionally important fibres, are more filling, and represent more of a wholefood option.

Raina Rusconi the operations manager of The Funky Banana, a Calgary-based smoothie and fresh-food bar, says that many of her customers opt for smoothies because the right combination of fruit, vegetables and

add-ins like protein powder or flax seeds can make the less-tasty elements in the mix taste more palatable.

“A lot of people don’t like the taste of kale or spinach and have a difficult time working it into their diet or cooking it,” Rusconi says. “When you blend it up with fruits like bananas or blueberries, you can’t really taste those vegetables, so they become almost like a hidden ingredient.”

For patients undergoing cancer treatment, smoothies are also valuable when solid food becomes hard to manage due to mouth sores, loss of appetite or difficulty chewing.

Jennifer Black, a cancer care dietitian with Alberta Health Services, likes to recommend smoothies to her patients to help them sneak in some veggies and fruit that they may not be up for eating in solid form, but also to incorporate additional ingredients like nut butter or yogurt that can provide a source of protein and fat.

“I tell my patients that they can’t just blend fruits and veggies, they have to add a source of calories and protein,” Black says. “They need more calories and protein than your average person to support them through treatment, especially since they tend to take in less food because of all the side effects. I definitely recommend smoothies often to my patients.” LEAP

Kale Smoothie An easy and convenient way to incorporate key nutrients into your diet.

INGREDIENTS 2 cups fresh or frozen cubed mango 1 cup coarsely chopped kale 1 medium banana, sliced 1 cup apple juice 1 cup plain yogurt DIRECTIONS Place all ingredients in a blender; purée until smooth. Pour into glasses.

Serve immediately. Serves 3.

– Recipe courtesy of ATCO Blue Flame Kitchen

LOADS HY OF HEALET! FIBR

— ELIZABETH CHORNEY-BOOTH

More on Smoothies with Jennifer Black Drinking smoothies can be a nutritionally sound choice for those undergoing cancer treatment, or for anyone else looking to maintain a healthy diet. Alberta Health Services cancer care dietitian Jennifer Black explains how to get the most from liquified fruit and vegetables.

Do you always recommend smoothies over juice?

With juice, you are left with vitamins, minerals and some plant nutrients, but your gut really needs the healthy fibres from the fruits and vegetables because that’s what the good bacteria in your gut feed off of. With juices, you’re really doing yourself a disservice by eliminating those fibres.

Are there some ingredients you recommend over others when making a smoothie?

There is no one better ingredient for smoothies when it comes to choosing what fruit or vegetable to add. It really comes down to what you like. I encourage people to experiment. Avocado is one exception due to its high fat content — use more or less depending on whether you’re watching calories or needing to sneak more in.

What do you recommend people blend in for extra protein and calories?

Any type of nut butter is going to add some flavour and good, healthy fats. A plain Greek-style yogurt or cottage cheese also blends in nicely and reduces sweetness while adding really good protein. If meat is a challenge to incorporate into the diet, protein powder is one of our best sources of protein for patients.

Can people prepare smoothies ahead of time for added convenience?

Yes! You can put together the ingredients for smoothies ahead of time and put them in freezer bags. So, if a patient is trying to conserve their energy, they can just reach into their freezer and get these bags, put them in the blender and add a liquid and then they’re good for a quick snack.

myleapmagazine.ca SUMMER 2018 LEAP 15

WORKOUT

Try Tai Chi Find balance and focus through an age-old martial art practice

by JENNIFER DOROZIO IF YOU’RE LOOKING FOR A LOW-

intensity exercise that can strengthen your body, reduce your stress level and sharpen your mind, it’s time to consider Tai Chi Chuan, more commonly known as Tai Chi. Developed in China centuries ago, Tai Chi is a martial art form consisting of distinct poses performed in succession, and it has long been respected in Chinese culture

for its benefits: extending life, improving health, and connecting mind and body.

“It’s kind of like moving meditation for me, very slow, but very gentle and very focused,” says Danny Lai, a Tai Chi Master who teaches out of his home studio, Dharma-Zen Tai Chi Studio, in Calgary and occasionally leads Tai Chi classes at Mount Royal University.

Characterized by its guiding principle of seeking balance — which comes from the religious tradition of Taoism — Tai Chi requires a person to remain focused and present as each move glides into the next. “[You] need to find a balance for your body, your spirit, your work and for your lifestyle,” says Lai. “From the Tai Chi philosophy, trying to find a balance is the point, I think.”

Lai stresses the importance of mindfulness and balance even in the way he organizes his classes: before each lesson he and his students have tea together, allowing for a moment to pause and connect.

There are five traditional styles of Tai Chi from which most other styles originate: Chen, Yang, Wu Hao, Wu and Sun — named for the families that developed each one. Originally trained in several martial art forms in Taiwan, Lai utilizes a 99-movement Chen-style approach.

As Tai Chi is based on executing an unbroken flow of a set number of movements, much of its mastery comes with diligent, at-home practice and patience, says Lai. The proper way to execute each movement into the next is modelled in class and then left up to the student to perfect as each class adds more poses.

The meditative and intentional approach of Tai Chi has been shown to lower blood pressure, lessen stiffness and pain, improve sleep quality, and even boost self-esteem. Its slow, methodical movements also make the practice an accessible exercise for people recovering from cancer, as well as for those seeking low-intensity workouts while undergoing cancer treatment.

Currently, the effectiveness of Tai Chi in cancer patients is being examined as part of a five-year Mindfulness and Tai Chi for Cancer Health Study (better known as The MATCH Study) at the Tom Baker Cancer Centre in Calgary and the Princess Margaret Cancer Centre in Toronto, with an aim to recruit more than 600 patients from Calgary and Toronto.

Now finishing its second year, the ILLUSTRATIONS ANDREW BENSON

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MATCH Study is gathering feedback from two groups of recovering patients, one group practicing meditation and yoga, the other trying Tai Chi and Qigong (another Chinese martial art connected to Tai Chi and centered on posture, breathing and mental focus). The study will compare how each approach benefits patients, and pinpoint where there might be different outcomes.

“There are few [Tai Chi-focused] studies in cancer care, but broader research shows that Tai Chi can really help people with balance, flexibility and strength, as well as [with] psychological things like stress reduction and decreasing anxiety,” says Dr. Linda Carlson, principal investigator for The MATCH Study and Enbridge Research Chair in Psychosocial Oncology at the Tom Baker Cancer Centre.

Carlson, who has also co-authored a paper on Tai Chi and Qigong’s impact on the quality of life of cancer patients in recovery, says that participants in The MATCH Study are already sharing positive feedback.

One patient who was experiencing peripheral neuropathy (a side-effect of chemotherapy that can cause numbness in the hands) reported that, after practicing Tai Chi and Qigong, “some of the feeling in their hands had been restored,” says Carlson. And another “has found improvement in balance, flexibility and mobility.” LEAP

Get a head start on your Tai Chi practice with these four poses

1

2

3

4

Hsieh Tan Pien

Fan Shen Pien Shen Chui

Tso Pan Shih

Hsia Shih

Diagonal single whip

Turn back; hit with back fist

Bend down with knees crossing

Glide down

Alternative Low-Intensity Workouts Tai Chi is one of many low-intensity, low-impact exercises that can benefit the body and mind when facing cancer and recovery. Here are three more low-impact ways to get the body moving while reducing stress.

YOGA

WALKING

ROWING

Developed from a discipline associated with spirituality and connection to oneself, yoga’s many benefits include increased strength and flexibility, and it has also been shown to help with high blood pressure.

Adding a regular walk to your routine can have enormous payoff when it comes to overall health. Not only is walking gentle on the body and easy to start, but by reducing sedentary time you can shed body fat, boost your mental health and improve stamina.

Whether you’re on a machine or on the water, rowing is a simple movement that engages the whole body and improves cardiovascular health. It’s also extremely trendy these days: instructor-led rowing classes are offered at many gyms in Edmonton and Calgary.

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EXPERT ADVICE

Preparation matters. Meet with your administrator or boss and allow them to see that you’re in good shape and that you’re back on track. Spending a bit of time in your place of work before you return — maybe sitting at your desk — can also allow you to reduce your anxiety when you start on your first day. Realize that going back to work is a challenge, but it’s not as if you don’t know what your work is about, even if you might have been away.

We ask the experts for advice on returning to work after cancer treatment and vaccinating your children against HPV

by JENNIFER DOROZIO

Q: What should a person recovering from cancer consider before they return to work?

DR. GUY PELLETIER

RETURNING TO WORK AFTER CANCER TREATMENT Once cancer treatment is complete, the natural next step for many patients is to consider a return to work. As overwhelming as it can seem, there are ways to help make re-entering the workforce a little easier. Here, Dr. Guy Pelletier, a psychosocial oncologist at the Tom Baker Cancer Centre, shares some tips.

It’s very important to consider a progressive return to work as opposed to returning full-time right off. If you have an insurance plan that provides you with short-term/long-term disability, typically those plans also offer a progressive return to work, in which the insurance company continues to pay you, and your employer pays you for the time you go back to work. It’s easy to neglect the extent of the impact of treatment on the body, and sometimes the psychological impact as well. [It’s] preferable to return when you’re better rested, when you’ve had a chance to get back to exercising and a proper diet.

Q: What practical things can be done to make returning to work less stressful?

Q: What’s a good approach for talking to co-workers who are curious about a person’s cancer treatment?

What I’ve often recommended to people is that they have a good sense of their boundaries and what they want to say.

Asking about a person’s treatment is not just curiosity for many co-workers, it’s also the wish to catch up, to truly understand and, possibly, to care a bit for that person. So, it’s a matter of telling co-workers what you think is best to tell them, in a summary kind of way. Prepare a short, 30-second script, and if people start asking more questions, it becomes optional whether you tell them more.

At the end of the day, you are the one who controls that information.

Q: How can someone returning to work best ask for support?

Knowing what you need and where you can obtain the support you need are important. If you have a better sense of what your problems are, you’ll have a better sense of who to ask. If you have difficulties sorting these things out, [the psychosocial program is] happy to help.

I’ve had many people say to me, “I don’t know what I need,” and that’s perfectly understandable. Support groups can also be helpful; there is quite a wide range of services out there that can help people.

ILLUSTRATIONS JENNIFER MADOLE

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DR. JUDY MACDONALD

cause various different types of cancer, including cervical, vaginal, anal and anogenital cancer.

Giving kids the HPV vaccine in Grade 5* will set them up to get the best protection against HPV infection. The whole idea is to prepare your immune system for exposure to HPV by producing antibodies so that, down the road, when you do get exposed, your body is prepared to fight.

Q: How effective is the HPV vaccine in preventing the contraction of HPV?

HPV VACCINATION AND CHILDREN Human Papillomavirus (HPV) is transferred through skin-to-skin contact and sexual activity, and it can develop into several different cancers.

Because most people will come across the HPV virus in their lifetime, the HPV vaccine was introduced into the Routine Immunization Program in schools across Alberta almost 10 years ago. For most people, the vaccine requires three injections over six months. Here, Dr. Judy MacDonald, medical officer of health in Calgary and the medical officer of health consultant for Alberta Health Services’ province-wide immunization team, discusses the importance of the vaccine.

Q: Why is it recommended that children get the HPV vaccine?

HPV infections are actually some of the most common sexually transmitted infections there are. The vaccine is the best way to protect yourself against an HPV infection that could go on to

It’s actually a super-effective vaccine.

It protects against genital warts and also against a number of the strains or types of HPV that can go on to cause cancer.

We know that it prevents 90 per cent of genital warts. Almost all of cervical cancer is caused by HPV, and we’re getting close to 90 per cent of cervical cancer prevented.

Q: What are the risks associated with getting the vaccine?

This is a vaccine that typically does cause [some of the same reactions] that other vaccines do. For example, some discomfort at the injection site is pretty normal, as well as dizziness and fever, or some muscle aches and pain. Usually what that indicates is that your immune system is kicking in — your body sees this vaccine and is working on producing the antibodies for protection down the road.

Q: How can a parent prepare their child to receive the vaccine?

I would suggest calmly talking to your child about what’s going to happen and

how it will feel. You shouldn’t say things that aren’t true about it, like it’s not going to hurt. Also, make sure your child wears a short-sleeve shirt so that it’s easy to access the arm.

If you know that your child is afraid of needles — or if they’ve ever fainted or felt dizzy or vomited after a needle — you may want to let the school nurse know. The nurse can make arrangements with you about how best to immunize your child in that situation.

Q: If a child is not immunized in Grade 5, are there other opportunities to get the vaccine in school?

If a parent isn’t sure they want their child to get vaccinated in fifth grade and they want to wait a little bit, [the vaccine is also offered at schools] in Grade 9. If the student still doesn’t get vaccinated at that point, they are eligible for free vaccines all the way through Grade 12.

Q: Should an adult who has never been vaccinated for HPV consider being immunized?

Adults may also benefit from the HPV vaccine, but may have to pay for it. The vaccine covers against nine strains of the virus. If you’ve had a pap test that shows HPV infection, it is likely due to one strain of HPV. But you can still benefit from the HPV vaccine, as it can protect you against the other strains. LEAP *Starting in the 2019 school year, the HPV vaccine program will be offered to Grade 6 students instead of Grade 5 students.

Approximately 75 per cent of people who aren’t immunized are likely to get an HPV infection at one point in their life. myleapmagazine.ca SUMMER 2018 LEAP 19

THE PROGRESS ISSUE In recent years, we have seen remarkable progress in cancer research.

Promising advances in screening methods, prevention initiatives and new treatment options are all taking place in Alberta right now, paving the way for improved outcomes and further breakthroughs. Here, we take a closer look at some of the ways scientists and health-care professionals in our province have been making an impact in the stand against cancer.

PREVENTION

RISK ASSESSMENT A new study is exploring the deeper issues underlying cancer-risk behaviour in Indigenous populations

by JULIA WILLIAMS

W

illustration GLENN HARVEY

hen people think of cancer, they don’t typically consider the role psychological trauma can play in the development of the disease.

Cancer risk is often associated with unhealthy behaviours such as smoking, hazardous alcohol use and poor diet. “Persistent engagement in all of these behaviours has been linked to psychological trauma,” says Dr. Cheryl Currie, who is the Alberta Innovates Translational Chair in Aboriginal Health and an associate professor of public health at the University of Lethbridge.

Currie is co-leading a study to examine the impacts of psychological trauma on cancer risk within Indigenous populations. “Through the important work of the Truth and Reconciliation Commission [TRC], Canadians are now becoming conscious of the generations of psychological trauma experienced by Indigenous peoples in residential schools,” says Currie. “The last residential school closed in Canada in 1996. I have students in my classes in their 30s who attended residential school. Yet the role that psychological trauma plays in the development of chronic disease among Indigenous Canadians is often overlooked both in medicine and in the field of health promotion.” >

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Study co-lead Dr. Susan Tallow Christenson, a Blackfoot primary care physician in Kainai Nation in southern Alberta, agrees. Many of her patients are dealing with addictions and mental illness, as well as chronic diseases like cancer, heart disease and diabetes — health outcomes that have been scientifically linked to the physical and mental toll of severe stress in childhood. Christenson says in her community, health-risk behaviour is usually a response to unrelieved stress.

“It’s about trying to get a break from the pain of life and not having any useful tools to help you process what you’re going through,” she says.

Currie and Christenson, along with a team that includes Indigenous Elders and Knowledge Holders, are conducting the study to better understand and address root causes of cancer-risk behaviour among Indigenous adults.

“ The role that psychological trauma plays in the development of chronic disease among Indigenous Canadians is often overlooked both in medicine and in the field of health promotion.”

– Dr. Cheryl Currie

“Typically, interventions to address cancer risk behaviour are focused on educating people that certain behaviours are not good for their health. But that’s short-sighted,” says Currie. “The field of neuroscience tells us that motivations for behaviour go beyond knowing what is good for us.

We have designed a study focused on addressing psychological trauma as a root cause of behaviour, and a door to behaviour change.”

The study will randomize people to four groups — education alone, group talk therapy, trauma-sensitive yoga classes or Indigenous drumming classes. “Trauma lives in the body, not just the mind,” says Currie. “We have designed interventions informed by Indigenous Knowledge Systems about health and healing — Knowledge Systems that recognize the role of healing the body in healing the mind.”

Christenson believes finding healthy stress-management strategies is part of a group of larger solutions for improving health outcomes in Indigenous populations. She says it can be difficult to get people to engage in positive, rejuvenating therapies at first, but it’s worth it.

“People who actually manage to learn to live in a constructive way with what they’ve been through actually become very powerful leaders,” she says. “They start to grow, and then they lead others along.” LEAP 22 LEAP SUMMER 2018

PREVENTION

BETTER CANCER SCREENING IN BONNYVILLE A new endoscopy suite at the Bonnyville Health Centre has cut down wait times

by JULIA WILLIAMS photo BLUEFISH STUDIOS

P

rior to this year, if you were sent for an endoscopy procedure in Bonnyville, Alta., you had to wait until the day surgery suite and operating room were free. They were the only rooms in the Bonnyville Health Centre that met infection control criteria for the procedure. The waiting period was about six months.

That’s why, three years ago, the medical team at the Bonnyville Health Centre identified a dedicated endoscopy suite as a top priority.

Thanks to the generous support of Alberta Cancer Foundation donors, the new suite opened in October 2017, and it’s already cut down endoscopy wait times in Bonnyville significantly. The new suite is also used by the health centre’s obstetrician/ gynecologist to perform colposcopy procedures, which screen for cervical cancer, but it is primarily used to

examine the digestive tract via two types of endoscopy procedures: gastroscopies and colonoscopies.

Colonoscopy is an endoscopic procedure that screens for bowel cancer, and it can be life-saving. Bonnyville family physician Dr. Guy Lamoureux describes it as the ability to put a camera and a light up the “rear end” to look for abnormalities.

Typically, people are sent for this screening when they have a positive stool test, rectal bleeding or significant risk factors for colorectal cancer, which is the second most commonly diagnosed cancer in Canada. Because it’s usually treatable, the survival rate for this type of cancer is about 65 per cent, but it rises to about 90 per cent with early detection. It can also be preventable — it starts as a pre-cancerous polyp, a growth in the colon that can be identified and removed during a colonoscopy. >

DR. GUY LAMOUREUX AND BEV BRACE INSIDE THE NEW ENDOSCOPY SUITE AT THE BONNYVILLE HEALTH CENTRE

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Timely access to endoscopy screening not only stands to improve health outcomes, it also plays a significant psychological role for patients whose medical tests indicate they’re at risk for bowel cancer.

Waiting for a diagnostic test is extremely stressful.

“If you’re sitting there thinking you might have bowel cancer, every little cramp or ache is going to create a lot anxiety,” Lamoureux says.

Bev Brace is the site manager of continuing care at the Bonnyville Community Cancer Centre.

She says that, prior to the arrival of the new endoscopy suite, when colonoscopies were performed in the centre’s day surgery suite, other patients would be present in the waiting and recovery areas, which often exacerbated feelings of anxiety.

“When you’re going

in to any potential bad news situation, you want to maintain as calm an environment as possible,” Brace says. She describes the new suite as calm, self-contained and efficient.

The adjoining dedicated recovery area and patient waiting area provide space where the endoscopist can share preliminary observations about the procedure results in a confidential manner.

The sense of comfort and dignity the new suite provides, combined with shorter wait times, makes it more likely that people flagged for endoscopy screening will go through the procedure — improving their chances of a quick diagnosis and a treatment. “[Colorectal cancer] is such a preventable cancer if people follow the program, but you need to have the facilities to follow up on it,” Lamoureux says. LEAP

Introduction to Endoscopy ENDOSCOPY is a NONSURGICAL way of looking inside the body using a flexible fibre-optic tube equipped with a small light and camera.

The term “endoscope” was first used by French physician and inventor ANTONIN JEAN DESORMEAUX in 1853, but endoscopic techniques have existed in some form since ancient times.

UPPER ENDOSCOPY is performed through the mouth, while LOWER ENDOSCOPY is performed through the anus.

You can have an ENDOSCOPY PROCEDURE while lightly sedated, and while it’s no one’s idea of a good time, it isn’t considered painful.

COLONOSCOPY (endoscopy of the colon) and POLYPECTOMY (removal of pre-cancerous polyps) are the only means of preventing bowel cancers.

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EARLY DETECTION

A LESS INVASIVE ROUTE Alberta scientists have created a blood test that could make a significant impact in the way patients are tested and treated for prostate cancer

by CHRISTINA FRANGOU illustration SPENCER FLOCK

C

atalina Vasquez thinks about an Alberta man whose story she heard earlier this year. He’d undergone a biopsy for prostate cancer. The results came back negative, but he developed a blood infection, followed by sepsis, from the biopsy.

It’s not the first case like this that Vasquez knows of. Up to four per cent of men who undergo a prostate biopsy could develop sepsis, an often-deadly reaction.

That’s why Vasquez, an Edmonton-based microbiologist, has spent the last decade trying to find a test that could spare men from having to undergo invasive biopsies for prostate cancer.

Now, she and colleagues at Nanostics Inc., a University of Alberta spin-off, are close to making this test a reality.

“We have the potential to impact the way prostate cancer is diagnosed and treated around the world,” says Vasquez, chief operating officer of Nanostics.

The company has started clinical trials for Clarity-DX Prostate, a blood biopsy for prostate cancer. Based on results to date, Clarity-DX Prostate is 40 per cent more accurate than the prostate-specific antigen (PSA) test that is typically used in prostate cancer screening.

If clinical trials confirm the accuracy of Clarity-DX Prostate and the test is adopted throughout Alberta, more than 1,000 men a year in this province alone may be able to avoid a prostate biopsy. Currently, more than 4,000 prostate biopsies are done in Alberta annually.

“The goal of implementing this blood biopsy would be to reduce the number of unnecessary [tissue] biopsies, which are invasive, uncomfortable and not completely innocuous,” says Dr. John D. Lewis, the Frank and Carla Sojonky Chair in Prostate Cancer Research at the University of Alberta, and Nanostics’ CEO. The road to this test began a decade ago, when Lewis’ lab discovered that prostate cancer cells shed small particles that migrate into the blood as a primary tumour spreads. Using a micro-flow cytometry machine developed in the United Kingdom to test soldiers’ blood for exposure to biological weapons, Lewis’ research team learned they could detect these particles in the blood. From that knowledge, they developed a blood test to identify these particles, with the support of Alberta Cancer Foundation donors.

But they needed a large biobank, or biorespository, with blood and urine samples from humans to validate their test. So, five years ago, Lewis and his team put together an in-house solution: the Alberta Prostate Cancer Registry and Biorepository. Men across the province are recruited, usually through the province’s urology clinics and cancer centres, to submit blood and urine samples, along with

demographic information and family histories, to the registry. This information helps researchers test new biomarkers that can better diagnose cancer and predict outcomes.

To date, the Alberta Prostate Cancer Registry and Biorepository has collected samples from more than 3,500 men diagnosed with prostate cancer. Using the repository, Lewis and staff have been able to demonstrate that they can detect if a drop of blood comes from a patient with aggressive or non-aggressive cancer.

The next step is to assess the real-world accuracy of Clarity-DX Prostate for men who are also undergoing prostate biopsies in Alberta — clinical trials began this past July. Based on the results, Nanostics could apply to Health Canada and the US Food and Drug Administration to have the test commercially approved next year, says Lewis.

“It’s a made-in-Alberta test. Albertans elected to give their blood and urine to contribute to the result of this test, and obviously we’re very thankful for their participation,” he says.

Ultimately, researchers hope the test will be used in two ways: to help in the diagnosis of prostate cancer and, in men who are already diagnosed with this cancer, to monitor disease progression and help select therapies. LEAP myleapmagazine.ca SUMMER 2018 LEAP 25

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EARLY DETECTION

IMPROVED ACCURACY A Calgary-made blood test has the potential to become a key screening tool for breast cancer

by CHRISTINA FRANGOU

A

bout 1,200 women in Calgary will undergo a blood biopsy this year, along with their regular mammogram to screen for breast cancer.

These women are part of an international clinical trial designed to assess a new breast cancer detection blood test, Breast CancerScout™.

Developed by Syantra, a Calgary-based company, this test has the potential to change breast cancer screening protocols for women.

“One indication where this test may fit in is for patients who now have equivocal findings that might require a biopsy,” says Syantra spokesperson Farhan Farshori. “This is a comprehensive study to see if we can detect breast cancer independently, in order

illustration KYLE SCHNEIDER

to guide the recommendations for the [traditional] biopsy.”

Currently, a screening mammogram is recommended for all women in Alberta between 50 and 74 years of age, while women 40 and older have an option to begin screening.

(Women with known risk factors are advised to begin screening earlier and more frequently.)

But mammography is far from perfect. It has an accuracy rate of about 75 per cent, which means women often need additional mammograms, ultrasounds, magnetic resonance imaging or biopsies to confirm the presence of cancer.

Results from pre-clinical evaluation of Breast CancerScout revealed an accuracy of 87 per cent — higher than the performance of other detection methods, including screening mammography,

mammography combined with a clinical breast examination and ultrasonography.

Clinicians will ultimately have to decide how the test will be used. It could be used as a follow-up to mammography, as a test for younger women who often have higher density breast tissue (which is problematic for mammography) or as part of a regular screening program for women with high risk for cancer.

Dr. Don Morris, head of medical oncology at the University of Calgary and section chief of medical oncology, CancerControl, Alberta Health Services, says the blood test would not replace mammography, but could be useful in combination with it, or as a follow-up test for women whose mammogram results are unclear. It could help

identify which of these women should undergo a biopsy.

“When women have to undergo a biopsy and wait for the pathology, that’s a lot of mental anguish, if you will, as well as resource implication,” says Morris, who was involved with some of the early research for this test.

If a woman’s blood test result were positive, she would be recommended for further testing, which could be a biopsy or further imaging.

The ongoing clinical trials are being carried out in Canada, the United Kingdom and the United States and are currently enrolling participants who fit their eligibility criteria.

Interested candidates in Calgary can contact the Alberta Cancer Research Biobank at acrb.ca before the study wraps up in March 2020. LEAP

The Early Detection Cancer Challenge Clarity-DX Prostate and Breast CancerScout are supported by the Alberta-based Early Detection Cancer Challenge.

Last year, The Alberta Cancer Foundation, Alberta Innovates and DynaLIFE Medical Labs launched the near-$2.5-million

diagnostics challenge to encourage local companies to create new tools for the early diagnosis and detection of cancer.

The goals of the challenge are twofold: to help patients by detecting cancer earlier, and to diversify Alberta’s economy by

encouraging business development in the healthcare sector.

The early detection and diagnosis of cancer, when combined with effective and accessible treatment, reduces cancerrelated mortality. myleapmagazine.ca SUMMER 2018 LEAP 27

TREATMENT/RESEARCH

TWO TESTS IN ONE A new scanner at the Cross Cancer Institute provides doctors with highly detailed 3D images of the body

by EMILY SENGER photography COOPER & O’HARA

A

new scanner at Edmonton’s Cross Cancer Institute is allowing doctors and researchers to see cancers like never before, with the potential to provide the most detailed images to-date of what cancer looks like and how it is working in the body.

Dr. Sandy McEwan, a professor in the Department of Oncology at the Cross, started using the PET-MRI scanner this past May. The scanner blends PET (positron-emission tomography) with MRI (magnetic resonance imaging). According to McEwan, the result is “exquisite pictures of structure” from the MRI, combined with the ability to see and measure actual metabolic processes through PET. “Our ultimate goal is to use this technology to improve patient selection for treatment,” says McEwan. “It’s the idea of precision medicine: treating the right patients, at the right time, with the right dose and the right drug.” >

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DID YOU KNOW? PET-MRI IMAGING CAN BE PERFORMED WITH 50 PER CENT LESS RADIATION EXPOSURE TO PATIENTS THAN TRADITIONAL SCANS.

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Prior to the arrival of the PET-MRI imaging scanner, the Cross Cancer Institute relied on a blended PET-CT scanner, which remains in routine clinical use and continues to be an extremely valuable clinical tool. The CT (computed tomography) scan works well to show a 3D X-ray image, including any abnormalities in structure and blood flow. But MR imaging produces a much more detailed image in most cases.

Typically, for the PET portion of the scan, a radio-labelled glucose marker is injected into the patient. Cancer uses more glucose than normal tissue does, so the injected marker will show the cancer and how aggressive it is, with a more aggressive cancer using more glucose. Researchers can also use different tracers in the PET-MRI when they want to see how another body structure, for example the brain or heart, is working.

When the MR images are combined with the PET, a 20- to 40-minute scan can show doctors both the anatomy and function of a cancer — not only what a tumour looks like, but also what it is doing in the body. Doctors can use this information to predict treatment outcomes, including what kind of drugs might be able to get into a cell, how the tumour might grow and whether there is oxygen in a tumour.

“The absence of oxygen will probably mean that the cancer will not respond to many current [available] treatments,” explains McEwan.

Initially, the PET-MRI will be used for research. “Cancers in the pelvis and the brain will be the ones that will benefit the most and where routine clinical use is most likely,” says McEwan. One project will look at how to create better radiation plans for prostate cancer treatment. A second will look at rare neuroendocrine (gut and pancreatic) cancers and whether they will respond to newly available drugs.

The Cross Cancer Institute PET-MRI is a provincial resource, with patients from all parts of the province involved in research and, eventually, clinical scans. “We think that it will very quickly become a routine tool for some cancers,” says McEwan.

Another exciting application for the PET-MRI is to examine the toxicity effects of chemotherapy. Researchers hope to see why some patients experience side effects like extreme fatigue from chemotherapy treatments, while other patients have much less severe symptoms.

The PET-MRI was provided by the Canada Foundation for Innovation (CFI), and made possible by a partnership between the Alberta Cancer Foundation and the provincial and federal governments.

“This is the outcome of a 19-year collaboration,” McEwan says.

“Nineteen years ago, we made our first CFI application to put in a PET scanner at the Cross. The Alberta Cancer Foundation has supported us through thick and thin in maintaining the PET facility, not only as a clinical program, but also supporting PET clinical research and expanding it through the acquisition of the PET-MRI. This is a long-standing partnership that continues to give back to the people of Alberta and continues to support cancer services in Alberta.” LEAP 30 LEAP SUMMER 2018

TREATMENT/RESEARCH

A NEW APPROACH An Edmonton-based investigator initiated trial offers hope to patients with advanced thyroid cancer

by KARIN OLAFSON photography AARON PEDERSEN

D

r. Todd McMullen, an associate professor in the Department of Surgery at the University of Alberta, is hoping he can contribute to improved outcomes for patients with advanced thyroid cancer.

His research into cancer treatment has instigated an investigator initiated trial (IIT) — a study led by researchers rather than pharmaceutical companies — that is now taking place out of Edmonton’s Cross Cancer Institute. The trial is in its early days, but, if successful, it could change medical practice around the world.

Patients are diagnosed with thyroid cancer when abnormal cells grow on the small, butterfly-shaped gland located in the front of the neck. Typically, individuals with thyroid cancer

are given radioactive iodine, which McMullen explains can sometimes control the spreading of the cancer from the thyroid to the lymph nodes, lungs and bones. However, if a tumour is aggressive and patients are insensitive to radioactive iodine, there are no other active treatments available.

McMullen’s research could offer those patients hope. “I found that a drug called imatinib targets the part of the cancer cell that tells it to be aggressive and turns it off,” says McMullen. “The thyroid cells then become more likely to take up the radioactive iodine. The hope is that imatinib makes a thyroid cell act like a thyroid cell again.”

This research is now in phase I of an IIT, which was launched in June 2018.

McMullen has paired with

PARTNERS IN RESEARCH D R . TO D D M C M U L L E N [ L E F T ] A N D D R . J E N N I F E R S P R AT L I N

Dr. Jennifer Spratlin, a medical oncologist at the Cross Cancer Institute. Spratlin and the phase I team are the only dedicated staff in Edmonton who do early phase I trials for cancer patients, and they are now working with 18 individuals with aggressive thyroid carcinoma

who aren’t responding to any thyroid cancer treatments that are currently available.

“The scientific reason for this trial is to try to find the lowest, safest dosage of imatinib possible that re-sensitizes patients to radioactive iodine,” says Spratlin.

“The bonus would be if,

during the clinical trial, we can also help these patients shrink their tumours, which may or may not result in them living longer.”

The goal is to advance this IIT through to the second and third phases of testing if it proves to be effective, and then to change how

medical practitioners around the world go about treating thyroid cancer patients.

“If this proves to be successful, it would be a whole new aspect of therapy. Previously, nobody knew what molecule specifically was making thyroid cancers aggressive, and

nobody had targeted cancerous thyroid cells [with imatinib] so they would act like a thyroid cell again and take up radioactive iodine,” says McMullen.

“If this works, it could be applied to every thyroid cancer patient around the world.” LEAP

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ELAINE MOSES BRINGS THE COMFORTS OF HOME TO OUT-OF-TOWN PATIENTS UNDERGOING TREATMENT IN CALGARY

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CARING

A Place to Stay ELAINE MOSES provides a home away from home for out-of-town patients needing cancer treatment in Calgary

by ELIZABETH CHORNEY-BOOTH

THERE’S NO PLACE LIKE HOME — ESPECIALLY

when you’re facing illness. But for patients who don’t live in communities close to a major hospital, staying at home during cancer treatment isn’t always an option. Finding a comfortable place to lodge in a strange city with no real expectation of how long treatment may take can be a major source of anxiety for patients and their caregivers.

Enter Elaine Moses, who provides complimentary accommodation to out-of-town patients who need to access treatment in Calgary. After watching the struggles her own father faced when he needed to travel from Drumheller to Calgary for cancer care, Moses decided to invest in a condo near the Foothills Medical Centre and the Alberta Children’s Hospital. She now offers accommodation to people facing long-term treatment.

While Moses does welcome patients being treated for other medical problems, she prefers to house families who need to be in treatment for at least a month and are most affected by the burden of being away from home. As a result, the majority of her guests are cancer patients undergoing bone marrow transplants, a process that involves at least 100 days of treatment.

Over the past 11 years, Moses has housed more than 110 patients and their caregivers from across Canada. In recognition of that generosity, last year Moses was named as the inaugural winner of the Tricia Antonini Award, which is granted to individuals who have made a positive difference for bone marrow transplant patients at the Tom Baker Cancer Centre (all AHS staff members, as well as patients, family members, friends, people in the community, and for-profit and not-for-profit organizations are eligible for the prize). “[Winning that award] was a surreal experience and was definitely a moment of awe that

I will always hold in my heart,” Moses says.

Those staying at Moses’s accommodations live in a self-contained, two-bedroom, two-bathroom unit outfitted with bedding, basic supplies and staple pantry items.

They’re welcome to stay as long as they need to, provided they’re in active treatment. All Moses asks for in return is that they extend some kindness to others when they’re able to.

“We offer it on a pay-it-forward basis, which they can honour in their own way,” Moses says. “It’s intended to be a gift, hoping that they respect the premises and leave it as they found it so that the next family can move in as quickly as possible.”

Moses started recruiting guests by putting up a notice in the Tom Baker Cancer Centre, but now guests are primarily referred to her by social workers or through word of mouth.

Maureen Vadnais and her husband, Frank Sloan, stayed in one of Moses’s condos for more than 150 days when Sloan needed treatment for a form of blood cancer called primary myelofibrosis. The couple farms in the County of St. Paul, which is northeast of Edmonton, and, with no family in Calgary, they had no idea where they’d be able to stay until they connected with Moses.

“It was such a huge stress relief when we found out that we could get into one of Elaine’s condos,” Vadnais says. “Everything we needed was there, and it was such a refuge. Being close to the river, it was nice to be able to go for a walk and clear my head.”

Vadnais has chosen to “pay it forward” by making 100 shirts for other stem cell transplant patients to wear during treatment, customized with snaps to accommodate PICC lines and other equipment. That lovely gesture completes the circle of kindness that Moses envisioned when setting up the accommodations. LEAP

PHOTO JARED SYCH

myleapmagazine.ca SUMMER 2018 LEAP 33

LIVING WELL

DR. NICOLE CULOS-REED

Prescribing Exercise The Alberta Cancer Exercise program adds physical activity into cancer patients’ treatment plans to improve their quality of life and chance of recovery by KARIN OLAFSON IN THE SPRING OF 2017, CANDACE COOK, A

46-year-old Edmontonian living with metastatic breast cancer, was looking for a way to bolster her spirits and her energy. “I was feeling low, weak and tired,” she says.

She decided to give a new program called Alberta Cancer Exercise (ACE) a try, and the results were dramatic. “[By the end of the program] I felt fantastic and optimistic,” Cook says. “After one year of progression on three different lines of treatment, my cancer was stable. And I had found a supportive community, as well.”

For Dr. Margaret McNeely and Dr. Nicole Culos-Reed, co-leads of the ACE study, results like Cook’s are no surprise.

Culos-Reed, a professor in the Faculty of Kinesiology at the University of Calgary, and McNeely, an associate professor in the Department of Physical Therapy, Faculty of Rehabilitation Medicine at the University of Alberta, both believe that a cancer diagnosis shouldn’t just mean a focus on treatment. It should also mean a focus on exercise and wellness. That’s why they are leading the ACE program.

ACE is a free, 12-week community exercise program and five-year study, funded

by Alberta Innovates Health Solutions’ Cancer Prevention Research Opportunity.

It began in January 2017 and was created for cancer survivors and cancer “thrivers” (individuals who are still undergoing treatment). For participants, ACE is about learning how to properly incorporate exercise into a weekly routine after a cancer diagnosis. The co-leads who developed the program, meanwhile, are examining its execution.

PHOTO JARED SYCH

34 LEAP SPRING 2018

ACE-Recommended Exercises ACE incorporates exercises that target different elements of fitness, including cardiovascular endurance, muscular strength, balance and flexibility. Exercises in the 12-week ACE program include: RESISTANCE BAND EXERCISES LIGHT FREE WEIGHTS TREADMILL WALKING STATIONARY CYCLING STRETCHING

DR. MARGARET MCNEELY

“We’re studying how to best implement ACE into clinical care for cancer patients, but we are also studying ACE’s effectiveness,” explains McNeely. “We’re tracking ACE participants to make sure we are actually making a change to their physical fitness and behaviour.”

McNeely and Culos-Reed are hands-on with ACE, doing everything from managing the database of participants’ results, which tracks fitness progress, to supervising the training of new exercise specialists and helping implement the programs.

According to both ACE co-leads, exercise is a healthy way to manage symptoms that accompany cancer treatment, like cancer-related fatigue. Also, exercise slows down the usual decline in fitness and strength that happens during cancer treatment, meaning exercise helps patients recover sooner or more easily. That’s why McNeely and Culos-Reed’s long-term goal is to implement the ACE program across the province on a permanent basis and make exercise a priority in individuals’ post-cancer recovery.

“Patients today are counselled right from the point of diagnosis regarding how their cancer will be treated,” says McNeely. “With ACE, they are also

counselled on the lifestyle changes they can make to improve the overall outcomes of treatment.”

Right now, there is no province-wide exercise program like ACE running anywhere else in Canada. That it’s offered in community health facilities, such as Wellspring and city-run recreation centres, is also unique.

“Instead of delivering the exercise program in cancer centres or in research labs, we wanted to deliver ACE at different community locations so participants then have the skills and the confidence to go into a community exercise class. We want them to become lifelong exercisers,” says Culos-Reed.

Currently, ACE runs out of various community fitness facilities in Edmonton, Calgary, Red Deer and Medicine Hat. ACE will also be offered in Grand Prairie starting this September and in Lethbridge

by January 2019. All exercise specialists working on the program undergo ACE training prepared by Culos-Reed and her partner, Dr. Lauren Capozzi, in order to acquire cancer-specific knowledge.

That training includes a 16-hour online module as well as a practical session with ACE-certified exercise physiologists.

At all sites across the province, the 12-week program is offered three times per year; intake is in September, January and April. Additionally, ACE was designed so that many people can qualify to participate. Regardless of their type of cancer, any adult can register as long as they are currently receiving cancer treatment, are within three years of having completed treatment, or are experiencing ongoing issues related to their cancer.

ACE begins with a baseline fitness assessment. Then, ACE participants join in either circuit training or weight training sessions twice a week with up to 14 others. During the post-program assessment, participants get tested to see how their fitness, balance, flexibility and muscular strength have improved. The co-leads say many participants then choose to register and pay for the ACE maintenance program, which costs an average of $150 for each subsequent 12-week session and allows those individuals to keep up the exercise routine they’ve begun.

Well over 700 participants have enrolled in ACE across Alberta so far. And many of them, including Candace Cook, have already become firm supporters.

Now in the ACE maintenance program, Cook believes ACE is as crucial to her well-being as her medication.

“ACE changed my life,” she says. “It’s given me a healthier, stronger body, but it’s also given me a healthier, stronger mind.” LEAP For more information on the program, visit albertacancerexercise.com.

PHOTO BLUEFISH STUDIOS

myleapmagazine.ca SUMMER 2018 LEAP 35

LIVING WELL

Life After Cancer A province-wide educational event provides much-needed resources and support to those who are finishing treatment and moving on with a cancer-free life by KARIN OLAFSON WHEN LISA DUKE WAS GOING THROUGH

breast cancer treatment at Red Deer’s Central Alberta Cancer Centre, she had an extensive medical support system and was consistently provided with information about her cancer and her treatment.

By the fall of 2017, her treatment was wrapping up and she knew life without cancer was on the horizon — but there was little information available on how this new phase would affect her. She began to look for guidance on what the next chapter of her life would bring.

“You just don’t know what to expect after cancer. Suddenly, you’re done treatment and life needs to go on, but you don’t know what to do,” says Duke.

So, when Duke, who lives in Penhold, Alta., learned about Living Your Best Life — a province-wide educational event designed specifically for those who are finishing or who have finished cancer treatment — she knew she wanted to go.

She attended the half-day Red Deer event, held at the Central Alberta Cancer Centre, last fall. For Duke, the highlights of the day included hearing inspirational survivor stories and trying simple yoga exercises. The event also helped her to realize that she wasn’t alone with her post-cancer questions, confusions and worries.

“I really liked learning about things that doctors often don’t talk about,” says Duke. “For example, doctors don’t always talk about what happens sexually to a person after treatment. At Living Your Best Life, important topics like that were covered, and I learned more about moving on with life after cancer.”

Launched in 2012, Living Your Best Life is an annual event supported by CancerControl Alberta Patient Education and staff across the province. Each year, it takes place at an average of five cancer centres in Alberta, including Edmonton’s Cross Cancer Institute and Calgary’s Tom 36 LEAP SUMMER 2018

THE “LIVING YOUR BEST LIFE” EVENT IS HELD ONCE A YEAR

Baker Cancer Centre. Typically, elements of the Calgary and Edmonton events are also broadcast via live video feed to cancer centres in smaller cities like Medicine Hat. According to Debora Allatt, the lead for patient education and patient engagement at CancerControl Alberta, moving from life with cancer to life post-cancer (or to post-cancer treatment) is a big transition.

Living Your Best Life aims to make that transition easier.

“During treatment, patients focus on their disease and their intense medical schedule. Cancer can disrupt regular day-to-day activities, then, all of a sudden, treatment is over and they have to pick up the rest of their lives again,” says Allatt.

“Living Your Best Life is a visible, tangible support for this time.”

Intended for adults of all ages recovering from all cancer types, the event aims to fill a gap in post-cancer care across the province.

“We discovered that people were finishing cancer treatment, and then there was minimal support for them after treatment.

They were feeling alienated and lost,” says Keira MacKinnon, an Edmonton-based patient education specialist with Cancer-

Control Alberta and one of Living Your Best Life’s lead organizers. The other lead organizer, Krista Marsden, is a Calgary-based patient education specialist with CancerControl Alberta.

MacKinnon and Marsden work together to ensure that Living Your Best Life highlights much-needed resources and provides invaluable support. The agenda varies each year and by location, but typically the half-day event includes the sharing of survivor stories, talks from oncologists and nurses about physical changes post-cancer, and “fireside chats” where speakers cover wellness topics such as managing fatigue, exercise and nutrition, handling stress and living with hope. The event also includes a resource fair where supportive organizations share information on their offerings.

Ultimately, Living Your Best Life supports Albertans who want to learn more about how to best approach life after cancer treatment. And for survivors like Lisa Duke, that’s invaluable. LEAP This year’s Living Your Best Life event is scheduled for October 26. To register, go to bit.ly/book-cancerpatiented.

RESE

38 LEAP SUMMER 2018

by

COLLEEN BIONDI

photos

AARON PEDERSEN

ARCHROCKSTAR DR. MICHAEL SMYLIE is making massive inroads in the treatment of late-stage melanoma

IN

his off hours, Dr. Michael Smylie — a medical oncologist and clinical research veteran at the Cross Cancer Institute in Edmonton — gravitates to activities that will push his physical boundaries, such as long cycling trips or scaling Mount Kilimanjaro (currently the number one item on his bucket list).

Back at the office, he is pushing boundaries related to cancer treatment — and with significant success. Smylie specializes in late-stage melanoma, which has the nasty distinction of being the deadliest of skin cancers, but is finally meeting its match with the introduction of immunotherapies. For the first time, due to promising clinical trial results and research initiatives, he can now offer patients hope for their future. >

myleapmagazine.ca SUMMER 2018 LEAP 39

“Treatment for melanoma has experienced a revolution,” says Smylie, who took his medical training, residency and fellowship at the universities of Leicester, Saskatchewan and Ottawa, respectively.

“Now, there is a relatively good chance we can cure this cancer.”

For more than five decades, treatment for late-stage melanoma involved chemotherapy, the hormone drug tamoxifen and/or interleukin-2/interferon. Cocktails had such devastating side effects that they were nicknamed “toxic placebos.”

“Rarely would you get a patient who did well,” says Smylie, who is 62 years old and a father of five. “It was depressing.” Indeed, median life expectancy for stage 4 melanoma was seven months, and only one patient in 20 lived longer than five years.

Then, in 2007, Smylie attended a National Cancer Institute meeting in the United States where stakeholders — including pharmaceutical companies, biotech firms and melanoma experts — gathered together and committed collectively to finding more effective drug therapies for melanoma. This critical event prompted the exploration and development of immunotherapies (also known as biological therapies), which are treatments designed specifically to help the immune system attack cancer cells.

Normally, our immune systems are efficient and robust, switching on and off as necessary to fight germs or infection. “But cancer cells are master manipulators,” says Smylie. They can create an environment where they engage the “off” switches, called checkpoints, shutting down the immune system’s restorative capacity and giving cancer cells the ability to grow wildly. Immunotherapy agents do not treat cancer directly, Smylie explains. Instead, they release the “brakes,” reactivating the immune system so it can attack the rabid cancer cells.

“Immunotherapy is now one of the pillars of cancer treatment,” he says.

For the last decade, Smylie has been in charge of conducting international immunotherapy clinical trials (spearhead-

ed and funded by global pharmaceutical companies or cancer research groups from the U.S. and Europe) at the Cross Cancer Institute. His duties include assessing a trial’s viability in Alberta, reviewing protocols, getting approval from the ethics committee, overseeing the ordering and delivery of medications, tracking and treating side effects, collecting and reporting measurement data, and discussing results with organizers.

The first major immunotherapy trial for late-stage melanoma took place in 2007 and was designed by an American pharmaceutical group called Medarex. It involved 600 patients and took three years to complete. The treatment group, which included two individuals in their 30s from Alberta, received an intravenous infusion of ipilimumab every three weeks for three months. Data showed that 20 per cent of participants remained alive at the fiveyear mark — the Alberta patients remain cancer-free today — and noted that the immunotherapy was “a potentially curative treatment for metastatic melanoma.”

A subsequent trial, conducted eight years later, added a PD1 inhibitor (PD1 is a cancer protein responsible for putting on those “brakes”) to ipilimumab. That combo treatment resulted in 58 per cent of trial participants being alive after three years.

A more recent trial, which began in the fall of 2017, involves 2,000 patients (20 from northern Alberta, under Smylie’s purview) with stage 3 melanoma. Patients in the trial are receiving treatment — either a single product (ipilimumab or nivolumab) or in combination — for one year. Though preliminary findings won’t be available until the summer of 2019, it is anticipated that the combination treatment will provide something called a “dual blockade,” restoring the immune-system function of participants and stopping cancer cells from being able to turn it off in the first place.

In addition to working on international clinical trials, Smylie is involved in several other research ventures around

immunotherapy. He has recently helped design a protocol in conjunction with Dr. Philip Halloran to examine “inflammatory signatures” of cancer cells (the hypothesis is that cancers with higher inflammation signatures will respond more favourably to immunotherapy treatments). In conjunction with medical colleagues at the University of Alberta, he is conducting biopsies on the melanoma lesions of 35 participants to measure these inflammation rates and track immunotherapy success.

He is also working with another U of A group studying small molecule inhibitors of immune checkpoints.

There are challenges with such research: it takes time to conduct trials, collaborate with stakeholders, create awareness and educate staff. And, in some cases, patients simply do not respond to immunotherapy. But Smylie is proud of the Cross Cancer Institute’s research program for making critical inroads into melanoma treatment, much of which has been supported by Alberta Cancer Foundation donors along the way.

“The amount of knowledge is exploding,” he says. “We are learning more about the science every day.”

And that learning is clearly a team effort. Smylie’s colleague, Dr. John Walker, is appreciative of how Smylie leads and inspires by example. “[He] has helped hundreds of melanoma patients by bringing practice-changing clinical trials to the CCI, but I also credit Mike with helping me develop my own practice style,” says Walker.

“He is an excellent communicator and a true gentleman in clinic. The science of medicine may be learned in a classroom, but the art of practice can only be taught by a gifted practitioner.”

Smylie is grateful for such collegial support, and for the patients who have taken this brave, road-less-travelled with him. “My clinics are populated with people living longer and having a better quality of life,” he says. “It is absolutely stunning.” LEAP

ROCKSTAR TIP Melanoma is largely preventable — cover up when you are in the sun, use sunscreen, and avoid excess exposure and tanning beds.

40 LEAP SUMMER 2018

7

QUESTIONS WITH

DR. SMYLIE 1. Describe what you do in 10 words or less.

Make a difference in cancer patients’ lives.

2. What’s the biggest misperception about what you do?

Some people still think immunotherapy is a form of chemotherapy.

We still have to get over that hump. Immunotherapy, although given intravenously like chemotherapy, is not chemo.

3. Where do you get your best ideas?

From reading. I enjoy science fiction — I loved the Foundation series by Isaac Asimov. I also love history and books about historic figures.

4. What’s the best lesson you’ve learned?

Manipulating the immune system actually works.

5. What motivates you?

Seeing patients do well.

6. What do you do to recharge?

I cycle with two other doctors.

One is very competitive and my goal is to beat him. Sadly, he usually comes out on top.

7. Why does your research matter?

Because we are making such a huge impact on patients’ lives.

myleapmagazine.ca SUMMER 2018 LEAP 41

DR. GILBERT BIGRAS WORKS CLOSELY WITH HIS TEAM IN THE IHC LAB AT THE CROSS CANCER INSTITUTE

42 LEAP SUMMER 2018

TRUE CALLING

WORKING BEHIND THE SCENES Dr. Gilbert Bigras and his team assist in the diagnosis and treatment plans for cancer patients in Alberta and beyond

by EMILY SENGER

WHEN DR. GILBERT BIGRAS TELLS PEOPLE

he is a pathologist, the most common response is, “Oh, so you do autopsies.”

Call it the CSI effect (after the popular television crime drama), but the work of a pathologist is often misunderstood.

Of course, some pathologists do conduct autopsies. But most of them, Bigras included, examine live tissue samples to provide the best possible diagnosis, which is then used by clinicians to create a patient’s treatment plan.

“We have way more work to do with living patients than with the dead,” Bigras says with a chuckle. As the medical lead of the Edmonton Zone Immunohistochemistry (IHC) >

PHOTOS COOPER & O’HARA

myleapmagazine.ca SUMMER 2018 LEAP 43

Laboratory for Alberta Health Services, he examines and diagnoses tissue specimens while also overseeing the largest lab of its kind in Canada.

Though they may never meet him during the course of their cancer treatment, the work of Bigras and his team (and that of his fellow pathologists) aids in the diagnosis and treatment of thousands of patients each year.

“People will say, ‘My doctor told me I don’t have cancer,’” Bigras says. “Well, it’s not their doctor. It’s the doctor behind their doctor. That’s us, providing direction for the patient.”

Here’s what happens behind the scenes: After a patient receives a biopsy or surgery, a whole piece of tissue or smaller sample is fixed in formalin, then encased in a paraffin wax cube. That cube is then sent to a lab to be made into slides. The pathologist will then use his or her microscope to inspect the tissue and determine if there is any anomaly. At this point, the pathologist might need additional information from the tissue, and that’s where the IHC lab comes in.

When needed, additional thin sections from the same wax cube are obtained, baked and sent to the Edmonton Zone IHC lab (currently located in the Cross Cancer Institute). Next, the IHC lab technologist uses specialized machines to perform antigen retrieval, a process that uses heat and buffers to prepare the section for the next step: immunostaining.

During immunostaining, the machine applies highly specific antibodies, which target and link to specific proteins within the patient’s sample. If the proteins are present, they will be revealed by stains linked to the applied antibodies.

This additional information allows the pathologist to reassess the tissue and improves the diagnosis process. It might also predict if the patient would respond to a specific drug. The pathologist then sends his or her diagnosis to the clinician, perhaps an oncologist or a surgeon, who determines treatment.

For Bigras, balancing work as the lone pathologist in the IHC lab, while also administering that lab and finding time for his own research interests, is 44 LEAP SUMMER 2018

no small task. He manages his multiple obligations with a team-first approach. He works closely with Sarah Canil, the IHC laboratory scientist, as well as nine other lab technologists and a lab manager, to troubleshoot issues as they arise.

“I’m a medical resource, on the spot to help for any kind of problems related to immunohistochemistry,” says Bigras.

Lab staff members appreciate his opendoor policy. “He’s so easygoing and so approachable,” says Canil. “He’s not going to tell you, ‘You have to go do this.’ Instead,

he’s going to ask for opinions.”

Bigras’s sense of humour is also widely appreciated among his co-workers. A Francophone who grew up in Quebec, he readily pokes fun at what he sees as his tenuous grasp of English — like the time he thought the idiom “even keel” was “even kill.” In fact, when Bigras was being recruited by DynaLIFE Medical Labs for his first Edmonton pathologist position back in 2004, he initially refused the offer.

“They asked me over the phone if I was interested, and I said, ‘You should find

someone who speaks better English than I.’” After more consideration, however, Bigras, who was working in Geneva, Switzerland, at the time, accepted the job, and he moved to St. Albert with his wife, Nicole, and their twin daughters to begin a new stage in his professional journey.

Bigras’s career path is a winding one.

From the time he was a five-year-old boy, he wanted to be a surgeon, and he got pretty close to that childhood dream in the 1980s during his medical studies at the University of Montreal.

“I started some training in surgery,” Bigras says. “But, after a year, I discovered it was not for me. No regret.”

He had a passion for computer science and image analysis, so he started a master’s degree in biomedical engineering related to computer science. He wasn’t ready to throw out his medical studies, however, and pathology seemed like a perfect fit — it allowed him to combine image analysis with medicine.

From there, Bigras finished his post-graduate studies, earning a PhD in biomedical engineering in France in 1997 before returning to Quebec to work as a pathologist.

“I found my job very tough,” he recalls of those days in Quebec. “We were missing Europe.” So, it was back to Europe for a position as a pathologist in Switzerland.

The need to be closer to family brought Bigras back to Canada in 2004, and he has been the medical lead of the Edmonton Zone IHC lab since 2012.

In his research, Bigras finds ways to combine pathology with his passion for computer science and image analysis.

Recently, he partnered with Nilnanjan Ray, an associate professor in the Department of Computer Science at the University of

Alberta, to explore algorithms related to artificial intelligence. He’s also excited to work with Ray and other U of A computer scientists on projects using convolutional neural networks (CNNs), a hot field of research embraced by companies including Facebook and Amazon. CNNs, which essentially help computers identify and classify IHC images, could someday be used to aid in cancer diagnosis by classifying the samples that pathologists currently view under a microscope.

“ The pathologist will be involved more and more to provide new types of information, beyond the simple diagnosis of cancer.

We will provide information that will drive treatment.”

– Dr. Gilbert Bigras

“It’s very exciting,” Bigras says.

Another exciting and rapidly evolving field for pathologists is testing for biomarkers, which doctors use to predict how well a patient will respond to particular treatments. The IHC lab is working with an Edmonton Zone molecular pathology lab run by Dr. Iyare Izevbaye to become a centre of excellence in this field, especially when it comes to testing for certain lung-cancer biomarkers required for immunotherapy.

“It has been a dream, for decades, that our own body should be able to get rid of a cancer by using our own immune system,” says Bigras. “Like with a cold — we get rid of the virus with our own immune system.”

As he explains, cancer cells usually present a molecular signal to immune cells that say, “Go away, I’m your friend.” But new drug therapies developed in the last few years can inhibit the signal, allowing a patient’s own body to destroy cancer cells.

The administration of the drug can translate to an efficient treatment for some lung-cancer patients who would otherwise have a terminal diagnosis.

“Even though their prognosis was dismal before, some of these patients are probably cured,” says Bigras. “This is spectacular!”

Not all patients respond to treatment, but the field of immunotherapy is still in its infancy. Under Bigras’s leadership, the IHC lab also looks for a lung biomarker called PDL1 in patients throughout Alberta and Saskatchewan. In 2017, the lab performed the lung cancer biomarker test for more than 1,600 patients.

The IHC lab also tests for breast cancer biomarkers, which can be used to determine which treatment is the most appropriate.

While biomarker testing represents only a small fraction of the tests currently conducted in the Edmonton Zone IHC lab, Bigras sees this as an area of medicine that will only be expanded in the near future, as all facets of cancer care strive for a personalized medicine approach.

“Pathology is entering a new world,” says Bigras. “The pathologist will be involved more and more to provide new types of information, beyond the simple diagnosis of cancer. We will provide information that will drive the treatment.” LEAP

PATHOLOGY WORK IN EDMONTON, BY THE NUMBERS

100

Approximate number of anatomic pathologists in Edmonton

1,400

Lab assistants working in labs in the Edmonton area

160,000

Number of IHC tests conducted in the Edmonton Zone IHC lab each year

50

Unstained slides lab technologists can slice off one biopsy cube

4

Main types of breast cancer classified by biomarkers

myleapmagazine.ca SUMMER 2018 LEAP 45

IMPACT

LAURA PERRAM IS GRATEFUL FOR THE CARE SHE RECEIVED AT THE CROSS CANCER INSTITUTE

A Positive Outlook as told to MAE KROEIS

A large tumour on her left lung caused a range of seemingly unrelated symptoms for Laura Perram throughout the summer of 2009, between the time she finished high school and began university. Those symptoms worsened and, soon after her

18th birthday that September, Perram was diagnosed with primary mediastinal large B-cell lymphoma, a rare and fast-growing type of non-Hodgkin lymphoma.

Her treatment at Edmonton’s Cross Cancer Institute consisted of six rounds of chemotherapy over a six-month period, followed by one month of radiation therapy. In January 2010, several months before Perram was scheduled to complete her treatment, her oncologist, Dr. Neil Chua, gave her the good news that she had “no evidence of disease.”

Here, Perram shares the story of her cancer journey.

“My symptoms started when I was doing my Grade 12 diplomas in June of 2009. I had pain in my left shoulder, which we thought was a sports injury or a strain. I also had clicking in my chest when breathing one day, and a stabbing pain in my chest another day, but I didn’t think much of it.

“When I began university that fall, I could barely climb the stairs from the LRT without coughing, but I just assumed I was out of shape.

“I had my 18th birthday in September of that year, and, right after that, I got sick with a cold that wouldn’t go away. Eventually I started coughing up blood and was told I had pneumonia.

“After two X-rays, my doctor called and said he needed to see me right away. For some reason I knew it was going to be cancer — I had that sense. I was told I had a grapefruit-sized tumour on my left lung and then went straight to the Royal Alexandra Hospital for tests. They sent me to the Cross Cancer Institute for the results, and I was told that day it was cancer. I had to start treatment right away. I couldn’t leave or pack or bring anything from home. It happened so fast.

“I had six rounds of chemo and then radiation every day for a month. It was a scary process. I was at the Cross Cancer Institute for a whole week at the beginning of my treatment, and had only just turned 18 the month before, so I was scared. But the nursing staff were amazing. They always checked in on me, encouraged me to bring my friends over and brought me magazines.

“From the very beginning, I wanted to stay positive because I knew it was going to end well. I didn’t want to dwell on any negative things or have people cry in front of me. The fact that the caregivers and nurses were positive, and that they joked with me and didn’t treat me like a sick kid, really helped me with my positivity and my recovery.

“During my treatment I was asked a few times to participate in studies. It was explained that there were really no downsides, that it would just be an extra test here and there and, if anything, it could actually help with detecting anything else because I’d be getting tests not given to your average person. It was an easy yes.

“After I finished treatment, I continued going for checkups, and when I hit the two-year mark, which is remission for my type of cancer, I had a big celebration.

“My experience with cancer 100 per cent made me healthier in the physical sense. When I first got diagnosed, I started working out, and when my treatment was over, I started doing fitness competitions. It was really inspiring to see my body go from its weakest form, where I could barely walk up a flight of stairs, to being on stage.

“I also went back to school and finished my business degree and am now in law school — and I recently got married. I usually like to leave things up to the universe and just kind of take things day by day, but chemo and radiation can affect your fertility, so I can’t wait too long to have kids, which helps me with making a timeline with my life.

“It’s weird to say, but, overall, [my cancer journey] was a very positive experience and I wouldn’t change it for anything. It taught me a lot about myself and brought my family together. You figure out what’s important, what your priorities are and what to let go. Your family matters, your health matters, your happiness matters — nothing else matters.” LEAP PHOTO PAUL SWANSON

46 LEAP SUMMER 2018

WHY I DONATE

Lifelong Philanthropists

by JENNIFER DOROZIO

Beverly and Gerry Berkhold are committed to supporting their community >

PHOTOS WES BELL

myleapmagazine.ca SUMMER 2018 LEAP 47

IN 2014, TO MARK THEIR 50TH WEDDING

anniversary, Beverly and Gerry Berkhold gave $50,000 to five different Albertabased charities: the Calgary Women’s Emergency Shelter, the Field of Crosses Memorial Project, the Matt Banister Memorial Skatepark at Hull Services, Redcliff Scholarships For Advanced Education and the Alberta Cancer Foundation in support of the Margery E. Yuill Cancer Centre.

“We thought it was a nice way to give a boost to some of the charities we were already supporting anyway,” says Beverly.

It was a significant donation, but not entirely out of the ordinary for the generous couple, who, over the years, have gifted more than $1.3 million to various Alberta Cancer Foundation initiatives.

Throughout their many decades together, the Berkholds have made it a priority to give back — both through donations and hands-on volunteerism — to their province and their community.

“We’re able to [give], and it’s just part of being in the community: you give if you have the ability to do it,” says Gerry, who owns Calgary-based Atlas Concrete, a readymix concrete manufacturing business.

In the mid-1990s, Beverly was invited to join the Alberta Cancer Foundation board of trustees, where she eventually proposed the idea of incentivizing fundraising (and honouring local philanthropists) by naming medical centres after their significant donors.

This idea came to fruition in the Berkholds’ own hometown in 2011, when the Medicine Hat Cancer Centre was officially renamed the Margery E. Yuill Cancer Centre following a $3-million donation, via the Alberta Cancer Foundation. The Berkholds themselves contributed $1 million to improve research, treatment and care at their community centre, and their family 48 LEAP SUMMER 2018

THE BERKHOLDS HAVE BEEN PROVIDING SUPPORT TO THE ALBERTA CANCER FOUNDATION FOR MORE THAN 20 YEARS

friend, Willard Yuill, donated $2 million in honour of his mother, Margery, a dedicated nurse and humanitarian who passed away from pancreatic cancer in 1965.

Neither Beverly nor Gerry had personal ties to cancer when they first began volunteering for — and donating to — the Alberta Cancer Foundation more than 20 years ago. They were compelled to get involved and stay involved because of the inspiring people they kept encountering throughout the cancer community.

“They’re pretty special people — the [staff], the other fundraisers and particularly the researchers,” says Gerry. “To provide some support and encouragement to these scientists via public contributions is, I think, very important.”

Through their own organization, the Berkhold Family Foundation, Gerry and

Beverly have also donated to the Alberta Cancer Foundation’s patient financial assistance program, which provides financial help to cancer patients who are struggling to cover the costs of their treatment and everything else that comes with facing a cancer diagnosis.

“If you don’t have a job and you’ve got a family and children and no income, it’s very stressful, so this is part of what we do [to help],” says Beverly.

Today, Beverly and Gerry reside in Calgary. Having raised two boys, and with three grandchildren, a successful business and a lifetime of giving under their belts, there is still no slowing down for the Berkholds: they are now looking to support advancements in brachytherapy through the Alberta Cancer Foundation. LEAP

MY LEAP KELLY AND KELLY LIEBE AT THE 2016 ENBRIDGE RIDE TO CONQUER CANCER

Loving Life Survivor Kelly Liebe is taking on the Enbridge Ride to Conquer Cancer for all those who can’t

by JULIA WILLIAMS

IN 2010, KELLY LIEBE’S 32-YEAR-OLD DAUGHTER, CHRISTINA, WAS

diagnosed with stage 3 breast cancer. Liebe was at the appointment when the doctor outlined a treatment plan, and the experience was surreal — not because Liebe was unfamiliar with the disease (she survived an identical diagnosis in 1998), but because Christina’s treatment plan was so familiar. During her own illness, Liebe had participated in a clinical trial for people whose cancer had spread to their lymph nodes. The evidence gathered from that trial had contributed to the development of a high-dose treatment method, the method the doctor was now describing to Liebe and her daughter.

“You know you do clinical trials for other people, but you don’t know you’re going to be sitting with your own daughter,” Liebe says.

No one would describe cancer as kind or predictable, but for Liebe, it’s been an especially cruel nemesis. Liebe has lost friends to the disease. She herself has been through treatment twice. Her daughter was diagnosed with breast cancer a second time in 2012 and lost her life to the disease later that year. And on Boxing Day 2017, her husband, also named Kelly, noticed a lump on the left side of his neck, which was diagnosed as squamous cell carcinoma of the tongue, a form of oral cancer. In April 2018, he began chemotherapy and radiation treatment.

Through it all, Liebe has never lost her determination to help others. She’s taking part in the 10th annual Enbridge Ride to

Conquer Cancer, a two-day, 200-kilometre bike ride held each August that raises funds for the Alberta Cancer Foundation. Liebe’s husband first signed up for the ride back in 2012, when Christina was battling cancer for the second time.

“He decided that he wanted to do that for her,” Liebe says. “She was in the hospital when the ride was on and she really spurred her dad on.”

After losing Christina, Liebe’s husband kept riding year after year in his daughter’s memory. Inspired by his determination, Liebe decided she would join him for the 2015 event. She knew it would be a difficult ride, but says she’s always been a “pretty tough cookie,” and she was motivated — she believed her participation would honour Christina’s legacy and support those in need of treatment, now and in the future.

Since that first ride, Liebe has continued to participate. She even took part in the event last year, despite being re-diagnosed with breast cancer and undergoing a mastectomy in early 2017. On the first day of that 2017 Ride, Liebe fell off her bike and sliced her leg, but she didn’t consider stopping. She says she felt lifted (even up the ride’s gruelling hills) by her fellow riders and by the event’s extraordinary sense of camaraderie.

“Whenever I think I can’t, I know there are others who really can’t,” Liebe says.

In the months leading up to this year’s Ride, Liebe has trained through spin classes, running and elliptical training. In six years, the team she’s been a part of, “2xkl2015 & Krew,” has expanded from one to seven riders, including family members and friends she and her husband have made during past rides. Collectively, their goal is to raise $17,000 in 2018.

Despite the heartbreaking loss of Christina, Liebe believes her family has received a lot of support in the form of medical expertise, kindness, friendship and community. She says people assume places like the Cross Cancer Institute are sad, but she knows care centres can be full of friendliness and laughter.

“There are so many talented, professional, care-giving people,” she says. “The connections that you make are connections you carry with you.”

Liebe and her husband Kelly are now raising Christina’s children, a 17-year-old granddaughter and a 16-yearold grandson. Liebe says she hopes one day the word “cancer” doesn’t exist, and that families won’t have to go through the pain of it. Until then, she’ll keep riding and keep giving.

“I want to dream big,” she says. “I just love life so much.” LEAP This year’s Enbridge Ride to Conquer Cancer takes place on August 18 and 19. myleapmagazine.ca SUMMER 2018 LEAP 49

GAME CHANGER

“It’s great when we can partner with charitable organizations that also have an active component,” says Karen Smola, national marketing manager with Booster Juice.

“Because we’re not only giving to a great cause, we’re also engaging the community to take part in an event.”

With a commitment of $25,000 this year, the company was the biggest sponsor of the 2018 game.

DALE WISHEWAN (SECOND FROM RIGHT) IS THE CEO OF BOOSTER JUICE

A Boost of Support Edmonton-based Booster Juice played a vital role in the World’s Longest Hockey Game

by JENNIFER FRIESEN

THE SAIKER’S ACRES ICE RINK IN STRATHCONA COUNTY WAS

hopping for 251 hours straight this past February. After 11 days of non-stop hockey, the 2018 World’s Longest Hockey Game fundraiser brought in more than $1.2 million in support of the Alberta Cancer Foundation — while also breaking the previous Guinness World Record for hours played.

Among the thousands of spectators who came out to cheer the players on during the event was Dale Wishewan. In fact, Wishewan hasn’t missed the chance to watch this particular game since the inaugural event launched back in 2003. Despite late hours and temperatures falling below -20˚C, he says there are always crowds of people there to offer support.

“It’s so moving to see how much it means to everyone,” says Wishewan. “When the [players] on the ice see someone holding a sign, or a young boy or girl who has brought their piggy bank in to donate their money, it helps keep them going.”

Wishewan is the CEO of Booster Juice, which has supported the World’s Longest Hockey Game “every year without exception,” he says. The Edmonton-based company supports many different charities each year, but Wishewan says this particular event is close to his heart — and to the hearts of his employees — because cancer affects so many Albertans and the hockey game builds a sense of community while inspiring people to take action.

50 LEAP SUMMER 2018

Booster Juice’s sponsorship amount has grown with each World’s Longest Hockey Game event, and, with a commitment of $25,000 this year, the company was the biggest sponsor of the 2018 game.

“Booster Juice’s contribution created a spark in the community for more people to come on board,” says Carrie Creaser, the Alberta Cancer Foundation’s fund development officer for events. “It was one of those things that was a flicker of the flame that got people really excited and generated more interest.”

This year’s World’s Longest Hockey Game supported the Terry Fox Research Institute’s PROFYLE program, which focuses on gene sequencing in pediatric cancer.

Approximately 150 to 200 children in Alberta are diagnosed with cancer every year, and a considerable number of childhood cancers are incurable. By testing young patients’ DNA, the national PROFYLE program hopes to find out why youth get certain types of cancer while also providing personalized, precision treatment.

“It’s a terrible disease,” says Wishewan. “We’ve all been touched by cancer in so many ways. It’s nice to be able to know from our end that we can help make a difference … if even a few people can be saved by the [PROFYLE program], it’s worth it.”

With Alberta’s economy still suffering from low oil prices, Wishewan says he felt compelled to donate more this year because he expected that a lot of other Albertans wouldn’t be able to chip in as much as usual.

He says Booster Juice has had a number of continuous successful years, and that the company will continue to support the World’s Longest Hockey Game fundraiser in the future.

“The volunteers and players at this event work so hard, and that’s not an easy thing,” he says. “I think it’s phenomenal that they know it’s going to be uncomfortable and difficult, but there they are — they get back out and do the same thing the next time. We look forward to being an even bigger supporter of this event the next time they do it again, too.” LEAP

You’re Invited to a Purple Tie Affair

Benefiting Pancreatic Cancer Research at the Cross Cancer Institute October 20th, 2018 | Art Gallery of Alberta Ticket price of $150 | Doors at 7pm, Entertainment at 8pm

Enjoy an evening filled with dueling pianos, photo booth, silent auction and appetizers!

To buy tickets, please contact tickets@purplewithapurpose.ca | For more information, please visit facebook.com/purplewithapurpose1

You can change lives

one swing at a time.

Join us August 16th in celebrating the 30th Cross Cancer Institute Golf Classic.

Your participation will continue to support the brightest minds in colorectal cancer research to increase survival rates and improve quality of life for cancer patients across the province.

For event details and information about how to get involved, please visit: ccigolfclassic.com/get-involved