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Research Focus: Cancer and precision medicine

May 23, 2019
Guylaine Spencer

Denise Bryant

Photo: Dr. Denise Bryant-Lukosius

Precision medicine is changing the face of cancer treatment through the use of targeted therapies that differ from traditional chemotherapy, says Dr. Denise Bryant-Lukosius, a researcher and associate professor in the McMaster School of Nursing. Although these advancements offer promise, the best ways of delivering care for patients receiving these treatments are not well established.  “We have to prepare patients to be able to manage their care as best they can, because they are receiving care in a system that’s not quite ready for it,” she says.

To address this challenge, Bryant-Lukosius is leading a research study, “Empowering Patients in the Precision Medicine Era of Cancer Care:  An Experience-Based Co-Design Study at the Juravinski Cancer Centre.” Juravinski Cancer Centre is located in Hamilton, Canada. The study is funded by the Ruth and Lewis Sherman Foundation.  

What exactly is precision medicine?

Bryant-Lukosius describes precision medicine as a “rapidly developing field, predominately in cancer but also in other areas, such as diabetes, cardiovascular disease, arthritis, and inflammatory bowel disease. It can involve immunotherapy drugs and other drugs and vaccines that target specific cancer-causing pathways. Ideally, precision medicine is an approach to care where you draw on multiple sources of information about the patient to develop a tailored plan of care that increases that specific patient’s odds of having better outcomes with fewer side effects.”

Many of these new treatments are in clinical trials, but the results have been so positive that the clinical trial period now is quite short and these new drugs are coming on to the market quickly, she notes. “These new treatments are different than chemotherapy. In fact they have almost the reverse affect of chemotherapy by heightening the immune system, and as a result have a different side-effect profile.”

How is the research being conducted?

“In our research, we are using some very innovative approaches to examine how we are currently delivering targeted and immune therapies as standard first-line treatment for patients with lung cancer and melanoma,” says Bryant-Lukosius. “We’re getting patient and provider perspectives around how care is delivered, what are the challenges, what’s going well, and where things could be improved, especially from a patient empowerment lens.”

“Key to the success of this study has been the tremendous instrumental support and engagement of the senior executive team and clinical leaders at the cancer centre. We also have a very strong interdisciplinary research team with expertise relevant to Experience-Based Co-Design methods. For example, our post doctoral fellow is a medical anthropologist with experience in observational methods. The study involves unique strategies to observe public spaces at the cancer centre, patient clinic appointments, and multidisciplinary patient case conferences to learn about the contexts of how care is delivered. The researchers are also conducting interviews, focus groups, and consensus meetings – involving patients and health care providers. The consensus meetings bring patients and providers together to agree on the priorities for improvement,” she explains.

Patient engagement is shaping the research

“One interesting thing about this study is that it actively engages patients,” says Bryant-Lukosius. “We have an advisory committee that includes patient representatives and representatives from the clinical teams and managers. They are giving us advice about how to best implement this study and get the data. For example, I was not going to observe patient clinic appointments or team meetings. We were just going to do interviews and observe the public spaces, but the patients and providers felt that that wasn’t sufficient. If we really wanted to learn about the model of care, they said, we had to be in there. So it significantly changed the design of our study.” Patients and providers have been engaged in both planning and conducting the study. “It’s a different way of doing research,” Bryant-Lukosius notes. “It’s a lot of work but also a lot of fun.”

Next steps?

The data collection should be done by September. The hope is that the information and recommendations gleaned will result in changes that will improve patient care.

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