CURRENT GRANTS AS PRIMARY INVESTIGATOR
Do more and more medical tests lead to more diagnoses of cancer with better prognosis? This project was funded by the Ontario Academic Health Sciences Center (AHSC) AFP Innovation Grant program ($78,000. ) with co-investigator PA Groome. Overdiagnosis leads to over treatment and costs. This project, based on ICES data, is designed to determine if the patients of Family Doctors in Ontario who order more routine medical tests and assessments are diagnosed with more cancers, what kind of cancers and if their prognosis improved.
Overdiagnosis and treatment of thyroid cancer in Ontario. This project is funded by an AHRQ Internal ICES grant ($60,000). The knowledge users are Dr J Irish (CCO) and Mr P Huras (LHIN 10). This is a continuation and update of previous work on the overdiagnosis of thyroid cancer and on patterns of practice in the management of thyroid cancer in Ontario.
What should we be telling patients about the risk of stroke and carotid vascular disease after radiation treatment for head and neck cancer? This project was funded by the Queen’s Department of Oncology Interdisciplinary Cancer Research Grant Competition. The grant is for 1 year ($9,095.) with co-investigator K Zaza. Radiotherapy is known to cause athersclerosis but the incidence of stroke and carotid vascular disease is not well studied. This project is based on ICES data and over 14,000 patients with squamous cell carcinoma between 1990 and 2010 looking at rates of stroke, TIA and carotid endarterectomy.
Towards an effective policy on routine follow-up after curative treatment for head and neck cancer was funded by the Canadian Cancer Society Research Institute in winter 2013 within a Quality of Life competition. This grant is for $153,000 over 3 years and the co-investigators are Feldman-Stewart D, Yoo J, Streiner D and Groome PA. This is a joint project with the Department of Otolaryngology at the University of Western Ontario. Institutionally entrenched patient scheduling policies for routine follow-up are typically non-evidence based on outcome or patient need, and not surprisingly in previous work we have documented a remarkably wide variation in the scheduling of and attitudes towards routine follow-up at the Head and Neck cancer treatment centers across Canada. To redesign routine follow-up, evidence on both surveillance and survivorship is needed. This study is designed to understand the patient side – their needs and preferences at the time of routine follow-up – to ensure that quality of life is a key consideration in new models of follow-up. The concepts and methodology could be used for other more common cancer sites. This is a longitudinal prospective cohort study with sequential patients having had curative cancer treatment for Head and Neck cancer recruited to complete a series of questionnaires at 3 successive end-of-treatment yearly anniversary follow-up appointments. For this project we have designed and tested a comprehensive Patient Needs and Preference Questionnaire based on pre-existing validated work on patient attitudes, expected benefits, fear of recurrence and needs during follow-up. Other questionnaires are incorporated to assess anxiety, depression, optimism and quality of life. These will be used to describe the needs and preferences, describe changes over time in those needs and preferences and identify subgroups of similar patients with more or fewer needs.
View the news coverage of this grant.
PAST GRANTS AS PRIMARY INVESTIGATOR
Is the improvement in survival for HPV associated head and neck cancer due to the addition of chemotherapy to radiotherapy or to a more treatment-sensitive cancer? was funded by CIHR as of July 2011 for $600,000 over 3 years. It was also bridge funded by CIHR ($90,000) as of July 2010. The co-applicants include FF Lui, B O’Sullivan, B Perez-Ordonez, M Gillison and P Groome. It has become apparent that the HPV associated stream of patients with cancer of the oropharynx have an improved prognosis over HPV –ve patients regardless of treatment but it is not known if the addition of chemotherapy has added anything except toxicity. This is a unique population-based study, done in association with the Division of Applied Molecular Oncology at the Ontario Cancer Institute, reviewes all patients with cancer of the oropharynx across Ontario in 1998/9 and 2003/4 and is designed to determine if there is a marker-treatment interaction for patients treated with radiation (1998/9) or with chemoradiation (2003/4) depending on HPV status.
The impact of the Ontario Clinical Practice Guideline #5-6a on physicians, patients and practice was funded by NCIC as of July 2008 for $360,000 over 3 years. The co-applicants areGroome PA, Irish J, O’Sullivan B, Gilbert R, Meyers R and Gregg R. The treatment of head and neck cancer changed abruptly in the early 2000s with the addition of platin-based chemotherapy to radiotherapy. This population-based project, using all patients with cancer of the oropharynx from all centers across Ontario in 2003/4, looks at the uptake of and compliance with of a Cancer Care Ontario CPG in 2001/2. The secondary objectives include the feasibility of treatments and the late toxicities. This study is on-going
Towards improved management of alcohol withdrawal in hospitalized patients was funded by the Medical Research Fund at the Kingston General Hospital for $7,900 over 2 years. The co-applicant is M Schellenberg. The objective of the project is to determine if the current processes or identification and management of AWS are effective by identifying the at-risk group, determining the PPV of the CAGE and to determine if the current pre-printed orders are effective. This study is on-going.
Controversy in differentiated thyroid cancer: can 75% of surgeons be wrong? was funded by CIHR as of July 2007 for $280,000 over 3 years. The co-applicants include J Irish, P Groome, R Walker, D Hurlut, R Holden, S Archibald and A Dreiger. There is no evidence on the extent of surgery for low risk differentiated thyroid cancer and as a result there is wide variation in practice. This population-based study of 3500 randomized patients from across Ontario from 1990 to 2002 looks at patients, tumors, treatments and outcomes by geographic region and extent of disease. Preliminary results have been presented at national and international meetings. This study is on-going.
Tough choices: the treatment of cancer of the hypopharynx in Ontario was funded by CIHR as of July 2003 for $250,000 over 3 years in association with a CIHR New Investigator Award. The co-applicants were P Groome, J Irish and B O’Sullivan. This was a population-based study of all patients with cancer of the hypopharynx across Ontario from 1990 to 2000 looking at the patients, the tumors, the treatments and the outcomes. Cancer of hypopharynx has a poor prognosis and there was no agreement on the best treatment between radiotherapy and surgery. This is the largest published series in the literature. We found a huge between-center variation in treatment across the province and no difference in survival between radiotherapy and surgery. The project lead to 4 international presentations, 3 national presentations, 4 publications (Cancer, Head and Neck, Laryngoscope), an audit and feedback presentation to the Head and Neck Site groups done center-by-center across Ontario and my acceptance into the Triological Society.
Is the increasing incidence of thyroid cancer due to increased imaging? was funded by the Endowment Fund of the Clinical Teachers of Queen’s University for $8,900 over 2 years. The co-applicants were W Kent and H Walker. This study was designed to compare the rising “incidence” of thyroid cancer with the rates of diagnostic imaging across Ontario between 1993 and 2004.The results, as published in the World J of Surgery, demonstrated a clear relationship confirming that the increasing incidence is due to increasing use of diagnostic imaging. Further work is underway.
Treatment variation in Thyroid cancer was funded by the Endowment Fund of the Clinical Teachers of Queen’s University for $9300 over 2 years. The co-applicants were W Kent, R Gorge, R Hollins, R Houlden, P Isatola, W Mackillop and R Walker. This study reviewed the pathology reports of 10% of the over 7000 cases of differentiated thyroid cancer in Ontario from 1990 to 2001 and compared tumor size by year, gender and age. We showed that the increasing “incidence” of thyroid cancer was due to an increasing rate of sub-clinical < 2 cm tumors. We concluded, as published in the CMAJ, that this was increasing detection and could only be accounted for by increasing rates of medical imaging.