Every cancer diagnosis comes as something of a shock. But when Dr. Murray Mickleborough received his, in 2010, it came with an added layer of surprise: Mickleborough, a long-time maxillofacial surgeon, had cancer in his throat, one of the very same areas in which he specialized. Suddenly, the doctor had become the patient.
“We got to thinking: if we could generate this cartilage without having to access these other sites, we’d really be helping our patients get back
to normal much quicker,” says Dr. Martin Osswald.
As Mickleborough’s cancer spread to his mandible, he decided he wanted to give back to one of the institutions that had been instrumental in treating him. But even executives at the Institute for Reconstructive Sciences in Medicine (iRSM) in Edmonton were staggered by what Mickleborough had in mind: a $1-million donation that would help find ways to improve quality-of-life outcomes for patients battling head and neck cancer.
“He was enamoured with the work they were doing [at iRSM],” says Ross Porter, Mickleborough’s son-in-law, “and he felt that some additional resources could take things to the next level.” That next level became even more reachable thanks to a matching $1-million donation from the Alberta Cancer Foundation, and an additional $500,000 gift from the Caritas Hospital Foundation. In all, some $3 million was gathered to fulfill the goal that Mickleborough (who passed away in June of 2011) had envisioned.
The question remained, however: what was the best way to go forward? Originally, the plan was to create a dedicated research chair position, in Mickleborough’s name, at the faculty of engineering at the University of Alberta, which would then work in tandem with iRSM. But, Porter says, recruiting for such a position takes time, and when the hiring committee wasn’t able to find a suitable candidate in their initial search, they decided to change course.
Instead, what they decided on was a project-based collaboration. Researchers from across the U of A were invited to submit proposals that had the potential to “substantially impact” treatment for patients with defects of the head and neck, as a result of cancer, in any of five different areas. A special emphasis was placed on improving patients’ overall quality of life.
Now, the first two projects to be funded by the Dr. Murray E. Mickleborough Interfacial Biomechanics Research Program have been announced. Each will receive a total of $150,000 for a two-year period of research. The first, led by Dr. Martin Osswald, is a ground-breaking bench study that will help scientists generate a specific type of nasal cartilage that frequently needs to be removed following cancer treatment.
In order to reconstruct a nose, “the cartilage must be harvested from elsewhere in the body of that patient,” says Osswald, a maxillofacial prosthodontist and assistant
professor in the U of A’s department of surgery. “That’s an extra surgical procedure. You basically have to remove tissue from another part of the body, risking many associated complications,” he says. “We got to thinking: if we could generate this cartilage without having to access these other sites, we’d really be helping our patients get back to normal much quicker.”
“[Mickleborough’s] passion has always been about how to make people function better and feel better. Talking to him before he passed away, I think this is exactly what he wanted the money to be used for,” says Dr. Hadi Seikaly.
Osswald and his team (including co-investigators Dr. Adetola Adesida and Dr. Kal Ansari, and their collaborator Dr. Nils Petersen) hope to instead grow this cartilage in the lab, using the patient’s existing stem cells as well as special scaffolding that has been 3D printed for the occasion. In addition to saving patients another surgery, Osswald says that this way, the tissue can be precisely customized ahead of time according to the individual patient’s needs. That’s especially important when dealing with an area as sensitive – and as visible to the public – as a person’s nose. “They’re particularly vulnerable, these patients,” Osswald says. “Cancers of the head and neck are very obvious. You can’t hide them.”
The ultimate goal with the Mickleborough funding will be to determine whether this process can be done on a mass scale – in other words, whether every head and neck cancer patient in Alberta can one day have a replacement custom made without having to go back under the knife.
Another faculty member at the U of A’s departments of surgery and oncology, Dr. Hadi Seikaly, has heard similar concerns about quality of life from his patients who struggle with head and neck cancer. While the focus is always initially on survival, eventually, he says, “Patients start asking, ‘Well, what am I going to look like? How am I going to function? Am I going to be able to go out for dinner with my family?’ Function has become extremely important in these situations.”
The problem, says Seikaly, who is a professor of surgery and the divisional director and zone section head for otolaryngology head and neck surgery, is a lack of data from which to make reliable predictions about a patient’s outcome after treatment. That’s why, in 2008, he helped found the Head and Neck Research Network (HNRN), an international collaboration between three centres: the iRSM in Edmonton, where the network is headquartered, the Beth Israel Medical Centre in New York City and Finland’s University of Turku. Together, these centres created a shared database that allows doctors to better track the outcomes from various methods of treatment, which in turn gives patients the ability to choose between them with more certainty.
After several years of important research, however, funding for the network ran out – until, that is, the Mickleborough research program came along. “It’s given us a new lease on life,” Seikaly says. “The funding will help us establish and solidify an international network for functional outcomes, and an international resource for information, both for patients and doctors.”
One recently completed study, for instance, looked at functional outcomes for patients who have had parts of their tongues removed as part of treatment for cancer. Another, which is ongoing, looks at the overall costs for different types of treatment. And a third is designed to improve the way that physicians measure outcomes in the first place. Taken together, the HNRN has the potential to make significant improvements for doctors and patients alike.
Despite the international stature of the network, Seikaly is quick to add that the funding it receives from the Mickleborough program will largely remain in Alberta. HNRN plans to hire its new coordinator position here, and because the research network is based out of Edmonton and iRSM, that’s where all funding decisions will be made. “Edmonton has been, historically, very strong in functional outcomes,” Seikaly says. “We have a strong research base.”
Credentials aside, Seikaly has an added personal connection to the Mickleborough program: he knew him briefly, when Seikaly was a resident years ago, and he later became Mickleborough’s surgeon when he was receiving treatment for his cancer. “Mickleborough’s passion has always been about how to make people function better and feel better,” Seikaly says. “Talking to him before he passed away, I think this is exactly what he wanted the money to be used for.” In the interest of full disclosure, Porter points out that the committee that chose the successful research projects only learned that Seikaly and Mickleborough knew one another after the adjudication process was complete.
For Porter and the rest of the Mickleborough family, any progress is good news. After nearly four years of uncertainty about whether (and how) the money would be invested, they’re thrilled about the possibilities of what this first round of research turns up – both for the scientific benefits, and for fulfilling the memory and spirit of Porter’s father-in-law. “Murray was about making things happen, in his professional life and his personal life,” says Porter. “We’re really excited that stuff is happening, and that there’s an opportunity to make an impact in patients’ lives through the research that Drs. Seikaly and Osswald will be undertaking.”
As for the future of the Mickleborough research program, it remains secure, thanks to that $3-million endowment. Its exact shape, however, is still to be determined. Depending on what happens over the next two years, Porter says the committee may decide to put out another call for research proposals, or they may reconsider a permanent chair position.
Either way, the goal remains to honour Mickleborough’s vision. “[Murray] had a strong bias for action, he was innovative and creative, and I think he would celebrate doing something that is not typical,” Porter says. In the end, “it’s all about trying to accelerate results, and make things happen, and figuring out the best way to do that.”