Standards of Care

He has traded the stethoscope for a suit and an office, but Paul Grundy is dedicated to excellence in cancer care across Alberta

Paul Grundy spent a chunk of the mid-1980s working with three refrigerators that stored every sample of Wilms tumour that the Cross Cancer Institute had treated. The pediatric oncologist created the bank for researchers who were trying to figure out the nature of the kidney disease and why it almost exclusively threatened children so young they’d just begun to walk. But with only four or five Edmonton patients per year, it would take Grundy’s tumour bank decades to become a reliable source for clinical trials that usually depend on thousands of cases to make breakthrough discoveries. He’s patient, but he knew this wouldn’t work.

Paul Grundy
Photo by Laughing Dog Photography

That’s when he had a breakthrough of his own.

He reckoned that, since the Cross was collecting a few samples a year, so would Calgary’s Tom Baker Cancer Centre, and so would every cancer institute in North America. With the help of the National Wilms Tumor Study (which is a slight misnomer, since the body includes experts from both Canada and the U.S.) he convinced researchers in every state and province to combine their Wilms samples and move the bank to a central location, Columbus, Ohio. “It’s by far the biggest in the world,” he says.

As a result, researchers in Texas can now gain access to the tumour bank as readily as scientists in British
Columbia. They use it for studies and to create clinical trials that steadily improve the standard of care for the disease.

“It’s not about administrative efficiencies,” says Grundy. “It’s about combined power.”

These days, Grundy’s work environment is looking very different. There’s still a refrigerator, but it’s a mini one, better suited to storing his lunch than life’s work. Across from that, there’s a large wooden desk, a bookshelf and an enviable view of Edmonton’s river valley.

Grundy sits comfortably in a low leather chair, the bright Alberta sun beaming through the window. He admits he’s still getting comfortable in the role of senior vice-president of cancer care; it’s the first time someone has held this new Alberta Health Services position.

“My role is to help develop a more provincially-based system,” says Grundy, who also serves as senior medical director at Alberta Health Services. “It’s like trying to steer the Titanic.”

Grundy is guiding the strategic plan of Alberta Health Services’ cancer care, which runs from 2013 to 2030.
It aims to guarantee the same standard of care for all Albertans no matter where they live in the province. It’s no easy task in a region where half the population lives in a few cities and the rest is scattered across 660,000 square kilometres.

“There are challenges for people who live outside of Edmonton and Calgary. We have patients who have to travel 11 hours for an appointment,” says Grundy. “We are expanding our cancer treatment facilities in Grande Prairie, Red Deer and Lethbridge so that 92 per cent of Albertans will be able to get their complete cancer treatment within 100 kilometres of where they live.”

The plan is already in action. Alberta Health Services recently brought two high-level oncologists to the Jack Ady Cancer Centre in Lethbridge, while the newly renamed Margery E. Yuill Cancer Centre in Medicine Hat started offering clinical trials – up to six per year – which allows some 30 new patients to try treatments previously unavailable outside of Edmonton and Calgary.

Technology, too, is expanding to the rest of the province. Red Deer’s centre will get a state-of-the-art radiation therapy facility this year, and so will Grande Prairie in 2017. Although Alberta Health Services gives the plan almost three decades to fully form, Grundy says “it’s never complete.”
And he’s not one to rush into things.

Grundy is the last person you want to be stuck behind in a Starbucks queue. He likes to think the options through, weigh the choices. And, like the brew, any request from subordinates, colleagues and even family

requires “percolating,” he says. “My kids will tell you that if you want to get something done, ask Mom.”
His contemplative, patient personality may aggravate people occasionally, but it has made him an effective researcher. Though the qualities may seem contrary to an executive’s role, they’re quite useful for carving out a thoughtful long-term strategy. And, even though the executive’s suit fits him as well as the lab coat did, he’s still not sure how he ended up wearing it.

Sometime during his fourth year of medical school, he’d become fascinated with the biology of cancer but also recognized that he enjoyed working with children most. “I took a one-month elective on children’s cancer and blood disease and really enjoyed it, and said, ‘This is what I want to do.’ ”

These days, his office refrigerator holds his lunch, not his life’s work

He married his high school sweetheart, Lorie Grundy, who followed a similar path to become a pediatric nurse practitioner. He interned at a children’s hospital in New Zealand and specialized in pediatric cancer at the Children’s Hospital of Philadelphia in 1984 before returning to his hometown, Edmonton, and alma mater, the University of Alberta. But soon he found himself practising less and researching more.

Building on his work at the Wilms tumour bank, Grundy chaired the “National Wilms Tumor Study,” chaired the Kids With Cancer Society and co-founded Canada’s C17 Council, an umbrella organization comprising the 16 Canadian programs that research and treat pediatric hematology, oncology and offer stem cell transplants. “We started this organization with a budget of zero and one or two objectives. Now, 12 years later, it has a budget of $3 million and six staff.”

Along the way, he wove together the necessary skills for his new post as surely as cloth for his suit, until he found himself here, on the 15th floor of an office tower in downtown Edmonton.

He’s also the impetus behind four new councils at Alberta Health Services – for radiation medicine, supportive care, cancer surgery and systemic therapy. Each sees a group of oncologists, pathologists and specialized nurses determining the most important needs in their fields. That way, he says, only the most imperative motions float up to seniors such as Grundy. “The whole idea is to bring the right people together,” he says, “so they have the right forum to identify the biggest needs.”

Susan Fawcett, co-chair of the new radiation medicine council and head of the Alberta School of Radiation Therapy at Alberta Health Services, predicts these councils will be a major leap for cancer care in Alberta.

“His personal vision, and the one he’s trying to engage people with, is to make Alberta, once again, a powerhouse for solutions on the full cancer-control spectrum,” says Dr. Peter Craighead, director of the Tom Baker Cancer Centre. “That’s prevention and screening, all the way through end-of-life care, and underpinning it with

Craighead calls his colleague – who’s been training people not to call him “doctor” for 30 years – a “modest fellow,” and it’s certainly true until you ask him if his vision is just food for the monster we call Bureaucracy.
He shakes his head. “What’s evolved is a vision of what we can accomplish with one integrated health-care system, and it’s not just about administrative efficiencies. It’s about combined power, about having a standard across the province.” As evidence, he points to how they’ve shrunk waiting times for lung cancer surgery in Alberta to two or three months.

It’s also the thinking behind the Government of Alberta’s decision to combine all its regional health boards into what’s become Canada’s largest merger. Now 100,000 employees (or three per cent of the population) don lanyards with a single Alberta Health Services logo. Grundy says the chance to contribute positively to this “unbelievably big event” was very appealing.

Grundy says he’s not sure why he’s become the go-to guy for bringing medical professionals together. The best he can come up with is, “I guess I’m geared to try to improve things around me, creating something bigger.”

Regardless, he’s confident he can do more for cancer treatment from up in the boardroom than down in the lab or at the hospital. “When people ask me, do I miss the clinical work,” he says, “I tell them it’s been so new, so different and challenging in a good way, that I haven’t had time to miss anything.”

But if there’s one catalyst that explains the turn of fate, it’s the one captured in a black and white photograph sitting on his bookshelf. It’s a picture of his mentor, Dr. Giulio D’Angio, bespectacled and grey-haired, holding the first of Grundy’s four daughters.

“He’s the grandfather of the medical specialty of children’s cancer care,” says Grundy. “He was there before there was a specialty in childhood cancer.”

It was D’Angio, who recently retired from the University of Pennsylvania at the age of 90, who first nudged the Albertan toward Wilms cancer and it was under his leadership that Grundy’s first research paper on the disease was published in The Journal of Clinical Oncology. Though they’ve become career-long friends and see each other yearly at industry conferences, D’Angio still remembers the young Grundy’s early start. “He was knowledgeable, meticulous, patients loved him and the team took to him immediately,” says D’Angio. “I really think the world of him. He’s been able to do tremendous good for children.”

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