To what extent can cancer patients be in charge of their own destiny? That’s the big question that tugs at Dr. Nigel Brockton, a research scientist in cancer epidemiology in the Population Health Research department of Alberta Health Services – Cancer Care.
Brockton is heading up studies that are trying to identify what patients can do to increase their chances of survival after a cancer diagnosis. In particular, he’s interested in whether reducing inflammation in the body through lifestyle and medication can prevent cancer from spreading.
“It’s metastasis that kills the vast majority of cancer patients,” says Brockton. “If we could intervene in the spread of cancer, we would have a much better chance of impacting the burden of cancer.”
Inflammation is known to play a role in increasing the risk of getting some types of cancer, particularly colorectal cancer. Studies are also showing that people who take anti-inflammatory drugs like Aspirin and ibuprofen are showing increased rates of survival after a cancer diagnosis.
In fact, eating well, exercising and maintaining a healthy body weight may help cancer prevention in that it keeps the level of inflammation in the body down. Obesity is a low-grade inflammatory state.
“We know that inflammatory syndromes of all sorts increase the risk of cancer,” says Brockton. He adds that understanding the role of inflammation in cancer could increase the understanding of “all of the big chronic diseases.”
“I’m interested in things that patients can do that are not part of their treatment – exercise, vitamin D, anti-inflammatory drugs, having a healthy body weight – all things that could impact inflammation and might reduce the risk of the spread of cancer,” says Brockton.
Brockton’s boss, Dr. Christine Friedenreich, explains that the research Brockton is conducting is a step beyond what’s been done in the past in both breadth and scope. “He is one of two molecular cancer epidemiologists that we recruited to Alberta in 2007. Since his arrival, he has created large multidisciplinary teams of researchers working collaboratively on breast, colon and head-and-neck cancers,” she says.
Brockton’s interest in cancer research began after a Ewing’s sarcoma (a cancer of the bone that typically strikes children and adolescents) that originally developed when he was a teenager recurred while he was in his third year of university. At that time, he was pursuing his childhood dream of becoming a marine biologist. Interested in finding out more about what was happening to him, Brockton found himself in the university library – this was before the Internet – poring over textbooks.
“Even when I graduated I thought I would do marine biology related to cancer. But that meant collecting marine organisms and mushing them up and pouring them on cells, and that didn’t seem that interesting a life for me,” he says with a laugh.
Instead, Brockton took three years off to, as he puts it, “go skiing.” In fact, he broke the British record for speed skiing twice and won an FIS World Cup Race.
Eventually, Brockton decided to head back to higher learning and undertake his Ph.D. He applied for everything he could find related to cancer research. “I realized I was in the position to contribute,” he says, “and that became important.” But he never gave up skiing. After 17 years of racing, Brockton sat out for three seasons when he moved to Canada in 2007. In March of this year he’ll be back at it, racing for the British team (he’s not a Canadian citizen yet) in the World Cup at Sun Peaks in British Columbia.
Now settled in Calgary, Brockton and two colleagues are conducting two prospective studies, one on breast cancer and one on colorectal cancer. The researchers will follow hundreds of patients in each group in an attempt to discover if there are specific factors that impact whether the cancer spreads.
Brockton is excited about the potential benefits of the research. Discovering what patients can do after they’ve been diagnosed to improve outcomes could save more lives, in the short term, than discovering what they can do to prevent getting cancer in the first place.
“We know how to reduce about 40 per cent of cancers,” he says, citing the usual don’t smoke, drink less alcohol, get active and eat healthfully. “But look around. A lot of people don’t follow those guidelines. Whereas when someone is diagnosed with cancer, they are pretty receptive to what they can do as an individual to increase their chances.”
The prospective studies are long-term. Colorectal cancer patients will be followed for five to six years and breast cancer patients will be followed for seven to eight years.
In the meantime, Brockton is conducting retrospective studies, looking at Albertans who have been diagnosed and treated in the last 10 years.
“We know their outcomes. We’re asking if there are any characteristics of their tumours that might have predicted their outcome. And from those characteristics, we hope to be able to predict the disease course of patients diagnosed now and to work out whether there are any targets that are amenable to any kind of therapeutic intervention.”
Q&A with Dr. Nigel Brockton
Q: What do you like about living in Alberta?
A: Just about everything! But particularly the mountains, the “family-friendliness” and the opportunities for research.
Q: Who inspires you?
A: Many ordinary people doing extraordinary things.
Q: You’re 40 years old now. Why are you getting back into ski racing?
A: Mostly because I can. I’ve been training and I’m in good shape. I wanted to do it again before all the guys I raced with leave the sport.
Q: What’s the last book you read?
A: Something to my children – they’re 2 and 4. Otherwise, all of my reading is scientific.
Q: What’s the best advice you’ve ever received?
A: “Everything in moderation.” This is advice given by Dr. J. Duffus, a toxicology lecturer, but it’s relevant to life in general, I think.
Old Drug, New Tricks
Dr. Nigel Brockton and his colleagues found that some head-and-neck tumours responded well to traditional therapy, others not so much. They went looking for the reason why. They found that the tumours that were related to infection with HPV (about 40 per cent) were the ones that responded well to standard treatment. So they looked for other differences between the two tumour groups.
They found that the non-HPV-related tumours often featured a protein called carbonic anhydrase IX, or CAIX. It keeps the acidity inside a cancer cell at a manageable level by pumping the acid out of the cell. This acidifies the environment outside of the cell, which leads to the membranes dissolving and the tumour spreading.
“We found that if you have a high level of this CAIX, you have a poorer prognosis,” says Brockton. But it turns out there is an old class of drugs, CAIX inhibitors that have been used as diuretics and as treatment for altitude sickness. “They could potentially be used with existing treatments to stop the tumour from spreading.”
Information like this could lead to more targeted treatment regimens depending on the characteristics of the tumour. Ultimately, says Brockton, doctors might be able to tell from the biopsy at diagnosis whether a full neck dissection is necessary or whether just the primary tumour needs to be excised.