Cancer research often focuses on the development of new drugs and technologies to treat the disease. In recent years, however, more oncologists and researchers are starting to consider the way doctors employ currently available treatments. They are examining standard clinical practices, wondering if they really are the best treatment options, and exploring if these practices can be improved for the benefit of the health-care system and patients alike.
Dr. Jason Tay is one such researcher. The University of Calgary hematologist specializes in blood cancers and is the principal investigator on multiple studies that consider how treatments are currently implemented — a line of inquiry that Tay says often starts with patients themselves.
“I think most of us take our ideas based on observations we have in patient care, and also conversations we have with our own patients,” says Tay. “They might ask: ‘Do I really need to come to the hospital, find parking, and wait half an hour for a five-second injection?’”
That very question is what led Tay to one of his current studies — whether or not blood cancer patients can self-administer chemotherapy at home. For example, patients with myeloma, a type of cancer that begins in bone marrow, require a weekly injection of bortezomib, a chemotherapy drug, during their treatment. The drug is administered with a subcutaneous injection, the same way diabetics sometimes self-administer insulin into the layer of tissue between the skin and muscle. Tay sees real benefits in giving patients the option to perform this injection themselves.
“This is important from a health-care perspective in terms of administration time and cost savings,” says Tay. “But it also empowers
the patient to look after themselves if they want to, and I think this is particularly useful.”
Through the pilot study, which began in May in Calgary and begins in Edmonton in the next few months and is funded by the R.K Dixon Family Award established through the generous gift to the Alberta Cancer Foundation from Mr. & Mrs. Dixon’s estate, willing patients are shown how to administer the injection. They are provided with pre-filled syringes from pharmacies at the Tom Baker Cancer Centre and Cross Cancer Institute. Tay stresses that patients who prefer receiving the injection at a cancer centre will always have that option, but that others may prefer this new method.
“The opportunity to have more choices, in my opinion, generally leads to better quality of life and better health outcomes,” says Tay.
Just as choice is important to patients, so it is for doctors and nurses providing treatments. Another of Tay’s ongoing studies looks at how blood cancer patients receiving stem cell transplants are supported with blood transfusions, and if there might be a better way.
The strong chemotherapy and radiation currently used for blood cancer patients kills fast-growing cancer cells, but it also kills the body’s own quickly growing cells such as bone marrow. Patients typically require a stem cell transplant and often have low platelet counts in the blood. Platelets are produced in the bone marrow and are responsible for blood clotting. With the help of Canadian Blood Services, patients, even the ones who may not need it, are given platelet transfusions as a preventative measure to reduce the risk of potentially dangerous bleeding during surgery. But there are drawbacks to this approach.
“If you give platelets to people who don’t [necessarily] need them, someone else who might need them would have less of an opportunity to [access them],” says Tay. “The question then becomes, is there an alternative way of providing platelets or not providing platelets while ensuring patients undergoing stem cell transplantation will be safe?”
Tay and his colleagues from across Canada are attempting to definitively confirm findings from previous studies that show that a medicine called tranexamic acid can be an equally effective way to prevent bleeding in transplant patients. The researchers plan to enroll over 600 patients in the pan-Canadian study over the next five years. If tranexamic acid is proven equally as effective as platelet transfusions, doctors across the country will have a new tool in their arsenal that doesn’t rely on blood donors.
“We wanted to provide a patient-centred, safe, reasonable, cost-effective alternative,” says Tay.