Dr. Darren Brenner and Dr. Winson Cheung are studying big data to improve care for cancer patients across Alberta

Dr. Darren Brenner

Dr. Darren Brenner has done the math. He knows the chances of him walking through the Calgary Cancer Centre doors are high. Not as a doctor, but as a patient one day. He wants to make sure when he—or any other Albertan—is treated for cancer, his health-care team has the best possible data at their fingertips to predict the best outcomes.

Brenner, Dr. Winson Cheung and a team of clinicians and data scientists at the University of Calgary have positioned the city as a major hub for health outcomes research and real-world evidence generation. At its simplest, they are trying to improve patient care by understanding the gaps in screening and treatment as well as in the health-care system. To accomplish this, big data research that intersects with healthcare policy and industry becomes important.

“Data are only useful if they are used to answer the right questions and if they are analyzed in the right way. Because of this, we have developed a team of clinicians interested in outcomes research and big data in the province. This level of clinician engagement is unique yet essential to ensure that our data are leveraged to address the most high priority clinical issues.” says Dr. Winson Cheung.

Dr. Winson Cheung

Using data coupled with artificial intelligence and machine learning is important to improving patient outcomes across many types of cancer. For instance, in Brenner’s ACCORD project, they used a risk prediction model to determine who will continue treatment for early stage cancer, which can be used to identify who to focus on in terms follow-up or who to approach about different treatment options. 

The goal of the future Calgary Cancer Centre is to build a learning cancer care system with the proper tools, teams, and systems so that the data being collected can immediately change the treatment for the next person to ensure it’s the right treatment, for the right person, at the right time.

“If you’re collecting the right data, it can be used to make better predictions and improve care,” says Brenner. “It improves treatment and care for the next patient, because the system learns from every patient who came before them.”

The Calgary Cancer Centre campaign is a once-in-a-generation opportunity. To excel at data-driven cancer care, you need good infrastructure, talented staff to ensure data integrity, and the right data to be collected. “To be successful, you need a learning care system like the one we will set up,” says Brenner, adding it can be done in pieces but this would take longer and won’t achieve the same impact. “If we want to think big, we can only do that because of that building going up right now that will allow us to have the right people in the right place.”

Funding, including philanthropic dollars, is key to setting up Alberta as leader in using high quality data to drive outcomes. “A learning health system is visionary and transformational,” says Brenner. “We need philanthropy to make this successful and that requires an investment. For instance, Alberta is a leader in cancer prevention because we have traditionally invested in that area. Investing in health outcomes research in the proper way will let us do it faster and with greater impact.”

Jim Fiorentini’s Story

Jim Fiorentini shares his story of undergoing immunotherapy in a phase 2 clinical trial led by Dr. Jose Monzon.

Throughout 2019, Calgarian Jim Fiorentini underwent a series of operations and tests after finding a lump on his lower back, which turned out to be malignant. While the initial operations were successful, further lesions found in the late summer and early fall pointed towards the spreading of merkel cell carcinoma — a rare and aggressive type of skin cancer.

When exploring treatment options, Dr. Jose Monzon, Fiorentini’s oncologist at the Tom Baker Cancer Centre, found that Fiorentini was a fit for a phase 2 immunotherapy clinical trial Monzon was leading. Fiorentini decided to move forward with the trial, and is currently on 22 of 24 cycles of immunotherapy, which have shrunk the lesions throughout Fiorentini’s body effectively. He shares his story here:

When Dr. Monzon  — and I remember this just like yesterday — asked me if I was interested to know what my prognosis was if I did not receive any treatment, I told him ‘no’ because I intended to fight this thing. I thought, ‘Alright, now I have a challenge in front of me. I’m not going to let the challenge beat me. I’m going to do what I can to fight, and then we’ll see what happens.’

“It was determined that I was a candidate for the immunotherapy program [clinical trial] as the best course of action. So, it was just days before Christmas 2019 when I received my first injection cycle of immunotherapy.

“The epiphany occurred when there was another lump. I asked Dr. Monzon if I should have it removed, and he said, ‘No, we’re going to use that as a gauge to see if the immunotherapy is working or not.’

“For a number of cycles after, I avoided touching that area or even investigating the lump on my own. And lo and behold, when I went to have a check-up with Dr. Monzon, that lump had disappeared, and I hadn’t even realized it.

“There was a progression. These reductions just didn’t happen overnight — it took a number of cycles. But we could see the slow retraction of these lesions, to the point where most of them, if not all of them, were no longer detectable.

“[This clinical trial] means I have more time with my family. It gives me hope that I can live to be a little older than I am now. I can hopefully share my experience and provide some comfort and hope for those who are going to follow. 

“I can only hope that my small contribution will help people who would have to suffer through this in the future. It makes me feel good that I get to be a part of this — to help and be a contributor in some small way. It’s a wonderful feeling.

“I think my wife said it the best – sometimes God puts us on this Earth for a reason and maybe, it’s possible, that this is the reason why He put me on this Earth — to help.”

Originally published in Leap magazine.

Dr. Joe Dort

Dr. Joe Dort knows head and neck cancer inside and out. A University of Calgary educator and surgeon by trade, he’s dedicated his career to saving patients – not just treating them, but improving the care they receive and restoring quality of life for them and their families.

But it’s his work as a researcher, examining and improving processes in the hospital, where Dr. Dort is making his latest career mark. He is passionate about improving the health care system itself – designing and delivering health care that is more efficient and more effective.

Designing better health care

One of the ways he’s doing this is through a head and neck pathway program he developed in 2010 and continues to be used and refined to this day.

“Back in 2009, if you were a head and neck cancer patient and you were having a surgery, you’d end up in the hospital for an average of 22 days. Over three weeks, you’d have about a one in three chance of having pneumonia and high risk of other complications.”

Deciding that wasn’t good enough, Dr. Dort and the team developed a new care pathway. Today, the current length of stay for head and neck surgery patients is on average is nine to ten days and the pneumonia rate is less than four per cent. Dr. Dort says the difference is standardized care, with a precision medicine focus.

“It’s much less variable because all of the members of the team do the same thing. And if we vary from the protocol, we vary because of something the patient needs.”

Not only is this better for the individual patient; it’s saving the health care system time and money.

“It’s been millions of dollars and thousands of complications avoided because of applying the science of clinical effectiveness to this group of patients, and taking it to broader cohorts of surgical patients.”

This is a powerful example of the way University of Calgary research is informing care and improving outcomes for cancer patients – in Southern Alberta and around the world.

Technologies

Another way Dr. Dort is leading the way in improving treatment and outcomes is by harnessing the power of new technologies.

He and his team are developing a virtual reality (VR) program to practice surgery outside of the human body. Students and doctors will be able to put on VR goggles and go into the operating room to practice operations in a simulated environment. This training and opportunity to practice will benefit countless patients – improving expertise and reducing risk for error.

Alberta-led innovations like these contribute to better patient outcomes, bringing research from the lab to the bedside to advance treatment and care.

Changing the culture of how care is delivered

Dr. Dort sees the Calgary Cancer Centre as an opportunity to get it right for patients and families. He says that the path forward is an improved health care system – something that seems simple but is not easy. But if anyone can do it, he says it’s Alberta, which is set up with the one health care system.

The outcomes of this work are real and life-changing.

“What we’re really trying to do is get closer and closer to a world where more cancers are cured, but also detected earlier and treated better, and treated in a way that allow people to get back to whatever level of function they defined as being meaningful and have a life that they define as a life worth living.”

Through the Calgary Cancer Centre, Dr. Dort says we can change the culture of how care is delivered. “We have a historic opportunity to create something that will really be impactful at the centre level, as well as at the individual level.”