About
224
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Introduction
Clinician (Radiation Oncologist) Scientist (Epidemiologist) who focuses predominantly on Cancer Care Delivery Research, Patient Reported Outcomes (PROs), and clinical trials of precision radiotherapy for oligometastatic disease.
Current institution
Additional affiliations
August 2010 - November 2016
Position
- Associate Professor, Radiation Oncology Department Head - Centre for the North
September 2005 - present
October 2010 - present
Education
June 2019 - September 2020
June 2002 - June 2005
September 1998 - April 2002
Publications
Publications (224)
1523
Background: Understanding a patient's clinical narrative, timeline, and history is critical for accurate treatment decision-making. However, reviewing and summarizing complex records is time-consuming and error-prone. Recent advancements in artificial intelligence (AI), specifically large language models (LLM), offer paths to improve quality a...
CARO-COMP JSM 2023 Abstract
12069
Background: Approximately 20% of women receiving endocrine therapy (ET) for early-stage breast cancer (BrCa) discontinue their regimen due to side effects, including vasomotor symptoms and arthralgias, subjecting them to higher rates of disease recurrence. Exercise is one approach to mitigate ET-related toxicity and potentially improve medica...
Background:
A relationship between the axillary-lateral thoracic vessel juncture (ALTJ) dose and lymphedema rate has been reported in patients with breast cancer. The purpose of this study was to validate this relationship and explore whether incorporation of the ALTJ dose-distribution parameters improves the prediction model's accuracy.
Methods:...
Indigenous peoples represent approximately 5% of the world's population and reside in over 90 countries worldwide. They embody a rich diversity of cultures, traditions, languages and relationships with the land that are shared through many generations and that are distinct from those of the settler societies within which they now live. Many Indigen...
Background and purpose:
Stereotactic ablative radiotherapy (SABR) for oligometastases may improve survival, however concerns about safety remain. To mitigate risk of toxicity, target coverage was sacrificed to prioritize organs-at-risk (OARs) during SABR planning in the population-based SABR-5 trial. This study evaluated the effect of this practic...
Should SABR Be Used for Oligometastatic Disease?The efficacy of stereotactic ablative radiotherapy in the oligometastatic setting has not been shown in phase 3 randomized controlled trials for breast (or many other) cancers. We review the evidence base and propose a trial to address the question, should stereotactic ablative radiotherapy be used fo...
Purpose/Objective(s)
Clinical Audit and feedback (CA&F) is a demonstrated successful knowledge translation (KT) method that positively impacts change in practice in numerous clinical scenarios. However, there has been low implementation of CA&F in oncology, and specifically in radiotherapy (RT) prescribing practices. We sought to identify the impac...
Purpose/Objective(s)
Locally advanced, non-metastatic pT4 well-differentiated thyroid cancer (WDTC) diagnosed at age <55 years is considered to be Stage I disease by the American Joint Committee on Cancer (AJCC) 8th edition staging system implying excellent cause-specific survival (CSS) outcomes of ≥95% at 10 years. There are no published outcomes...
Purpose/Objective(s)
Despite increasing utilization of stereotactic ablative radiotherapy (SABR), there is a lack of large population-based outcomes data. This study was designed to examine, as the primary end point, side effects and quality of life, which were reported elsewhere. This analysis focuses on overall survival as a secondary endpoint....
Purpose/Objective(s)
Health-related quality of life (HRQOL) outcomes are lacking in patients with oligo-metastatic disease (OMD) receiving stereotactic body radiotherapy (SBRT). The aim of this individual patient data meta-analysis was to determine the effect of SBRT on the HRQOL of patients with OMD.
Materials/Methods
As part of a previously desc...
Purpose/Objective(s)
We previously demonstrated a low utilization, but mild increase over time, of advanced radiotherapy (RT) techniques (3D conformal RT [3DCRT], intensity modulated radiotherapy [IMRT] and stereotactic ablative radiotherapy [SABR] from 2009-2016) for bone metastases. Patient reported outcome (PRO) data was not yet available in our...
Purpose/Objective(s)
The recently developed ESTRO/EORTC oligometastatic disease (OMD) classification has not been validated in terms of its prognostic significance. This study stratified patients from the phase II SABR-5 trial based on ESTRO/EORTC criteria, and compared progression-free survival (PFS) and overall survival (OS) to determine the prog...
Purpose/Objective(s)
SABR may improve survival in patients with oligometastases, but for some lesions, safe delivery of SABR may require a reduction in delivered dose or target coverage. This study assessed the association between target coverage compromise and oncologic and survival outcomes through a secondary analysis of the SABR-COMET Phase II...
Purpose/Objective(s)
A subset of patients with oligometastatic cancer experience early widespread cancer dissemination and do not benefit from metastasis-directed therapy such as stereotactic ablative radiotherapy (SABR). This study aimed to identify factors associated with early polymetastatic relapse (PMR).
Materials/Methods
The SABR-5 trial was...
Purpose
The recently developed European Society for Radiotherapy and Oncology (ESTRO)/European Organization for Research and Treatment of Cancer (EORTC) oligometastatic disease (OMD) classification has not been validated in terms of its prognostic significance. This study stratified patients from the phase II SABR-5 trial based on ESTRO/EORTC crite...
Background
Oligometastatic disease (OMD), generally defined by the presence of ≤5 metastatic lesions, represents an intermediate state between localized and widespread metastatic disease. This study aimed to question the conventional definition of OMD and assessed the significance of the total volume and loci of metastases in characterizing OMD usi...
There has been an increasing interest in patient-reported outcome (PRO) measures in both the clinical and research settings to improve the quality of life among patients and to identify when clinical intervention may be needed. The primary purpose of this prospective study was to validate an acute breast skin toxicity PRO measure across a broad sam...
Purpose
A subset of patients with oligometastatic cancer experience early widespread cancer dissemination and do not benefit from metastasis-directed therapy such as stereotactic ablative radiotherapy (SABR). This study aimed to identify factors associated with early polymetastatic relapse (PMR).
Methods and Materials
The XXX trial was a single ar...
Background
A novel device for supine positioning in breast radiotherapy for patients with large or pendulous breasts has been developed and tested in phase II studies. This trial is designed to assess the efficacy of the device to reduce skin toxicity and unwanted normal tissue dose in comparison to the current clinical standard for supine breast s...
Purpose
Despite increasing utilization of stereotactic ablative therapy (SABR) for oligometastatic cancer, prospective outcomes are lacking. The purpose of this study was to determine progression-free survival (PFS), local control (LC) and prognostic factors from the population-based phase II XXX trial.
Methods and materials
The XXX trial was a si...
Introduction
Published health-related quality of life (HRQOL) outcomes are lacking in patients treated for oligo-metastatic disease (OMD). The aim of this systematic review and individual patient data meta-analysis is to determine the effect of stereotactic body radiotherapy (SBRT) on HRQOL outcomes of patients with OMD.
Methods
Studies screened i...
Background: Following palliative radiotherapy for bone metastases from non-small cell lung cancers (NSCLC), up to 30% of patients may derive no symptomatic benefit, and there are no biological predictors for this. The purpose was to investigate if epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genetic rearrangement wer...
Despite the known importance and necessity of the standardized collection and use of patient-reported outcomes (PROs), there remain challenges to successful clinical implementation. Facilitated through a quality improvement initiative spearheaded by the Canadian Partnership for Quality Radiotherapy (CPQR), and now guided by the Canadian Association...
The BC-brain questionnaire was developed by BC Cancer to detect health problems in patients with central nervous system (CNS) tumours in routine clinical care, treated with radiotherapy (RT), as part of the Prospective Outcomes and Support Initiative (POSI). This study aimed to present and validate the BC-brain questionnaire in patients with brain...
We assessed whether advanced RT techniques were associated with differences in patient-reported outcomes (PROs). Patients with bone metastases who completed the brief pain inventory (BPI) before and after RT were identified, and RT technique was categorized as simple (e.g., parallel opposed pair) or advanced (e.g., 3D-conformal RT (3DCRT), intensit...
PurposeThis study compares patient-reported outcomes and treatment-related complications during radiotherapy before (August 2019–January 2020) versus during (March–Sept 2020) the COVID-19 pandemic.Materials and methodsThe MD Anderson Symptom Inventory-head and neck module was used to assess curative intent in H&N cancer patients’ symptoms during ra...
Background:
Individuals with psychiatric disorders (PD) have a high prevalence of tobacco use. Therefore, we assessed the hazard of receiving a tobacco-related (TR) cancer diagnosis among individuals with PD.
Methods:
Several population-based provincial databases were used to identify individuals in BC diagnosed with depression, schizophrenia, b...
Purpose/Objective(s)
The management of oligo-metastatic disease (OMD) is evolving, with increasing data supporting the use of stereotactic body radiotherapy. The aim of this systematic review and meta-analysis is to analyses health related quality of life (HRQOL) outcomes and the side-effects of SBRT in patients with OMD.
Materials/Methods
We sear...
Purpose/Objective(s)
After the publication of the landmark SABR-COMET trial, concerns were raised over toxicity of SABR for oligometastases. This population-based study was designed as a bridge from phase II to phase III trials, while assessing the toxicity profile of SABR in a larger cohort from a provincial cancer program.
Materials/Methods
From...
Purpose/Objective(s)
To evaluate gastrointestinal (GI) patient reported outcomes (PROs) in cervical cancer patients treated with definitive radiotherapy (RT), comparing 3D conformal RT (3DCRT) vs. intensity modulated /volumetric modulated arc therapy (IMRT/VMAT).
Materials/Methods
A retrospective analysis of cervical cancer patients treated with c...
Purpose/Objective(s)
Our published economic analysis of the SABR-COMET randomized trial determined that SABR is cost-effective for patients with 1-5 oligometastases, with incremental cost-effectiveness ratios (ICERs) of $37,157 (2018 CAD$) and $54,564 (2018 USD$) for the Canadian and American health care systems, respectively. Long-term outcomes fr...
Purpose:
To assess the relationship between breast cancer subtypes and patient reported outcomes (PRO) following palliative radiotherapy for bone metastases.
¬
Methods:
Prospectively collected PRO for all breast cancer patients treated with palliative, bone metastasis-directed radiotherapy from 2013 to 2016 in the [state/province] of [blinded] wer...
Purpose
This study compares patient reported outcomes and treatment related complications during radiotherapy before (August 2019 -Feb 2020) versus during (March -October 2020) the COVID-19 pandemic.
Materials and Methods
The MD Anderson Symptom Inventory – Head & Neck Module was used to assess curative intent H&N cancer patients’ symptoms during...
Background:
This study assesses whether 90-day mortality differs between patients living in rural and urban areas, as lower access to supportive care services in rural areas could result in higher mortality.
Methods:
All patients with head and neck cancer (HNC) treated between 1998 and 2014 with radiotherapy in British Columbia were included. Pa...
Purpose
Standard planning target volume (PTV) margins for lung stereotactic ablative radiotherapy (SABR) are 5 mm. High-dose-rate volumetric modulated arc therapy (VMAT) delivered using flattening filter-free (FFF) beams with modern immobilization systems may allow for PTV margin reduction. This study assesses whether PTV margins can be reduced fro...
Objectives:
Head and neck (H&N) cancer patients experience significant acute side effects from treatment. This study evaluates prospectively collected patient-reported outcomes (PROs) in H&N patients undergoing radiotherapy (RT) to assess feasibility of electronically collecting PROs and to objectively document symptom acuity and trajectory during...
Purpose/Objective
The benefit of external beam radiotherapy (EBRT) in locally advanced, well- differentiated thyroid cancer (WDTC) is uncertain. The purpose of this study is to evaluate locoregional recurrence (LRR), progression-free survival (PFS) and cause-specific survival (CSS) of patients with pT4 well-differentiated thyroid carcinoma.
Materi...
Purpose
The phase II randomized study SABR-COMET demonstrated that in patients with controlled primary tumors and 1-5 oligometastatic lesions, stereotactic ablative radiotherapy (SABR) was associated with improved progression free survival (PFS) compared to standard of care (SoC), but with higher costs and treatment-related toxicities. The aim of t...
Bone is a common site of metastases in advanced cancers. The main symptom is pain, which increases morbidity and reduces quality of life. The treatment of bone metastases needs a multidisciplinary approach, with the main aim of relieving pain and improving quality of life. Apart from systemic anticancer therapy (hormonal therapy, chemotherapy or im...
Introduction
The incidence of immunosuppression in patients with oropharynx head & neck squamous cell carcinoma (SCC) is not well studied. This study evaluates disease characteristics and treatment outcomes in oropharynx SCC in patients with and without immunosuppression.
Methods
A retrospective review of all patients treated with radiotherapy for...
Purpose
This study evaluated long-term, population-based breast cancer-specific outcomes in patients treated with radiation therapy (RT) to the breast/chest wall plus regional nodes using hypofractionated (HF) (40-42.5Gy/16 fractions) versus conventionally fractionated (CF) regimens (50-50.4Gy/25-28 fractions).
Methods
A prospective provincial dat...
Background:
Patients receiving chemoradiotherapy for head and neck cancer (HNC) are often malnourished. We assessed the utility of nutritional risk index (NRI) in HNC patients undergoing chemoradiotherapy.
Methods:
A population-based retrospective review of HNC patients treated with curative chemoradiation was performed. Demographics, anthropome...
Background:
Through the British Columbia, Prospective Outcomes and Support Initiative (POSI), registered nurses collect patient-reported outcome (PRO) data during telephone follow-up with palliative oncology patients.
Objective:
The research objective was to describe the usefulness and influence of the nursing care provided through POSI follow-u...
TPS6592
Background: Treatment for HPV positive(+) oropharyngeal squamous cell carcinoma (OSCC) is highly effective but associated with significant short and long term treatment related morbidity. We hypothesize that decreasing the regions of elective nodal irradiation (ENI) in the neck will lead to less toxicity and better quality of life/functiona...
Purpose
To evaluate the predictive value of FDG-PET/CT for detection of residual disease after radical radiotherapy for patients with squamous cell carcinoma (SCC) of the oropharynx, comparing p16 positive (+) versus p16 negative (-) disease.
Methods and Materials
A retrospective analysis of patients with SCC of the oropharynx at our institution t...
Background
Radiation oncology graduates occasionally experience difficulties obtaining employment. The purpose of this study was to explore the perceptions of radiation oncology residents (RORs) and program directors (PDs) about the job market and the potential impact on their well-being.
Methods
RORs and PDs from 13 Canadian training programs were...
Background:
A high cancer burden exists among indigenous populations worldwide. Canada and Greenland have similar geographic features that make health service delivery challenging. We sought to describe geographic access to radiotherapy for indigenous populations in both regions.
Methods:
We used geospatial analyses to calculate distance and tra...
Purpose: Locally advanced, pT4 well differentiated thyroid
carcinoma is a relatively rare entity and the benefit of external
beam radiotherapy (EBRT) is unclear. The purpose of this study is
to evaluate locoregional control (LRC) and cancer specific survival
(CSS) of patients with pT4 well differentiated thyroid carcinoma
in the largest retrospecti...
Introduction:
Brain metastases occur in 15%-20% of lung cancer patients. Recently, studies have suggested that whole-brain radiotherapy (WBRT) may not prolong survival for a subset of patients, and is associated with significant side-effects. Furthermore, it is hypothesized that radiotherapy is often given near the end-of-life when the potential f...
Purpose/Objective(s):
Locally advanced, pT4 well differentiated thyroid carcinoma is a relatively rare entity and the benefit of external beam radiotherapy (EBRT) is unclear. The purpose of this study is to evaluate locoregional control (LRC) and cancer specific survival (CSS) of patients with pT4 well differentiated thyroid carcinoma in the larges...
Background:
There is a lack of consensus regarding the management of T4a larynx cancer. We evaluated the outcomes of organ preservation and laryngectomy for T4a laryngeal cancer.
Methods:
Retrospective analysis of patients with T4a larynx cancer at BC Cancer from 1984 to 2014 was performed. Outcomes in patients treated with surgery alone (Sx) (n...
Background and purpose:
Planning complex radiotherapy treatments can be inefficient, with large variation in plan quality. In this study we evaluated plan quality and planning efficiency using real-time interactive planning (RTIP) for head and neck (HN) volumetric modulated arc therapy (VMAT).
Materials and methods:
RTIP allows manipulation of d...
Background:
The oligometastatic paradigm suggests that some patients with a limited number of metastases might be cured if all lesions are eradicated. Evidence from randomised controlled trials to support this paradigm is scarce. We aimed to assess the effect of stereotactic ablative radiotherapy (SABR) on survival, oncological outcomes, toxicity,...
Introduction:
Stereotactic ablative radiotherapy (sabr) is a relatively new technique for the curative-intent treatment of patients with inoperable early-stage non-small-cell lung cancer (nsclc). Previous studies have demonstrated a prognostic value for positron emission tomography-computed tomography (pet/ct) parameters, including maximal standar...
Introduction:
Clinical trials have shown that radium-223 (Ra223) can prolong survival and improve quality of life in patients with metastatic castration-resistant prostate cancer (mCRPC). The objectives of this study were to evaluate pain responses with Ra223 at a population-based level and to determine if there is an association between pain resp...
Objectives:
Palliative thoracic radiotherapy (RT) can improve quality of life for patients with advanced lung cancer, but treatment can be associated with acute toxicity and symptomatic relief may take several weeks. The optimal fractionation schedule is not known. Delivery of RT near the end of life (EOL) is an emerging indicator of poor quality...
