New clinic redefines care for young women with locally advanced breast cancer


Canada’s first patient-centred, multi-disciplinary clinic for the management of locally advanced breast cancer and inflammatory breast cancer Ð a stage three breast cancer that is often difficult to treat, associated with poor outcomes and high probability of re-occurrence Ðis redefining cancer research and treatment for young women who are typically affected by this disease. The clinic, located at Toronto Sunnybrook Regional Cancer Centre, the comprehensive cancer program at Sunnybrook & Women’s, now has more than 50 patients enrolled and receives three new referrals per month.

Dr. Mark Clemons, medical oncologist at Toronto Sunnybrook Regional Cancer Centre (TSRCC) and principal investigator for the clinic found that women, particularly young women diagnosed with aggressive forms of breast cancer, face unique psychosocial and treatment challenges requiring specialized therapy and support. He also found that many of the women he treated felt that current breast cancer programs and support groups didn’t suit their needs.

“One of the more unique aspects of the clinic is that it is 100 per cent patient-driven and highly responsive to their specific needs and support issues,” said Clemons. “By focusing on improving treatment, care and support for those women with the hardest cancer to care for, we hope to improve the treatment for all breast cancer patients,” said Clemons.

In addition to the psychosocial issues these women face, the care of this patient group is complex and requires coordination of various disciplines including medical, surgical, radiation oncology as well as nursing and other supportive care disciplines. Dr. Clemons enlisted the help of Barbara Fitzgerald, an advance practice oncology nurse, to run the Locally Advanced Breast Cancer (LABC) Clinic and streamline the treatment process.

“I’m hopeful that the clinical case management model being used at the clinic will improve the quality of care by decreasing the potential for fragmentation of care, duplication of services, promote interdisciplinary collaboration and establish a system to monitor interdisciplinary outcomes,” says Fitzgerald. “We are developing an innovative clinical, research and education driven LABC program that is focusing on coordinated treatment planning among the various disciplines.”

Karen Fergus, psychologist in supervised practice, along with colleague Brian Doan, began the Supportive-Expressive Therapy Group to help these women contend with issues such as premature menopause and enhanced aging; the uncertain likelihood of conceiving a child; interruptions to the establishment of careers and families; the influence of their illness on new and future intimate relationships; disfigurement and its effects on their body image and sense of womanhood.

According to Fergus, “These women feel separate from their peers who have not experienced such a traumatic life disruption, and they also find themselves isolated among the broader cancer population because of their stage of life and relatively young age. We try to provide a safe and supportive environment to help the women express and process their feelings around these painful issues.”

Locally advanced breast cancer accounts for ten to 15 per cent of all new primary breast cancers and while there has been an annual improvement in the prognosis for women with early breast cancer, the prognosis for women with LABC remains poor.

Dr. Clemons and the team are currently working on a number of innovative clinical trials for the treatment of LABC that will assess the efficacy of reversing the order of standard treatment. LABC patients would receive chemotherapy first to reduce the tumour, followed by surgery to remove a more localized cancer and finally a course of radiation therapy.

TSRCC is the highest accruer in Canada to the NCIC-CTG MA22 study which is evaluating tumor response clinically and at the gene array level to a combination of taxotere and epirubicin. Many investigators at TSRCC are involved in the NCIC-CTG MA22 protocol development including Dr. Maureen Trudeau at TSRCC who is the national chair of the NCIC-CTG MA22 study and Dr. Kathy Pritchard who is the co-chair of the NCIC-CTG breast cancer site group. The advantage of this clinic is that multi-disciplinary translational research can take place in a patient-centred format. The benefit is that repeat tumor biopsies can be performed during systemic therapy – these biopsies allow both histological and gene array analysis to be performed in order to better explain the mechanisms of tumor sensitivity and resistance to treatment.