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Journal of
Family Practice Oncology
Provincial Health Services Authority Issue Number 40, Spring 2023 | www.fpon.ca
Education B.C.’s 10-year cancer action plan
Update By Dr. Kim Chi, Chief Medical Officer, and
Heather Findlay, Chief Operating Officer,
By Dr. Sian Shuel, BC Cancer
Medical Education Lead, FPON B.C.’s 10-year cancer plan was officially
announced in February at a special event CANCER CARE YOU CAN COUNT ON
The Family Practice Oncology Multi-year policy framework to deliver cancer care in B.C.
Network (FPON), BC Cancer Primary with Premier David Eby, Minister of Health,
Care Program's educational arm, Adrian Dix, leaders from BC Cancer,
continues offering accredited, free- Provincial Health Services Authority and
of-charge, oncology-based education representatives from our clinical teams.
to help meet educational needs and More than a BC Cancer plan, this is an action
requirements, provide resources, plan for the people of British Columbia that
and support the cancer care system. includes investments in people, technology
Here are some recent and upcoming and innovation across our province. It
highlights. details short-term priorities to better
Partnering with UBC Continuing prevent, detect, and treat cancers along with
Professional Development, FPON’s actionable steps to deliver improved care for
first educational offering of the people now while preparing for the growing
year was a webcast for primary care needs of the future.
entitled 'Precancerous Lesions of the patients who must travel for care from rural
The announcement included an initial
Vulva – What you Need to Know.' This communities.
$440-million investment over three years.
webcast, which included identifying This funding will be used to expand cancer- We’re building capacity across our
lesions of the vulva that have a risk care teams and service hours, introduce organization to deliver on these immediate
of malignant transformation and revised pay structures to ensure B.C. is steps and longer-term change. Thanks to
continued on page 2 attractive and competitive for oncologists additions to BC Cancer’s care funding in
and cancer-care professionals, improve 2021-2022 and 2022-2023 totalling $66M
cancer screening programs, continuing to we’ve been able to recruit 400 new clinical
expand the Hereditary Cancer Program, and support roles across our centres. To
and increase Indigenous patient support date, we’ve filled 85% of these roles, adding
positions. Within this investment is a $170 more than 55 new physicians and 283
BEST PRACTICE million grant to the BC Cancer Foundation new nurses, allied health professionals and
CANCER CARE GEMS to support cancer research, genomic testing, support staff.
increase access to clinical trials and support continued on page 2
1 New 10-year cancer action plan for
B.C.
3 Precancerous lesions of the Vulva
5 Treatment of Liver Malignancies
6 Breast Cancer Screening Update
7 Nutrition and Cancer: What's the
Evidence?
7 Febrile Neutropenia Update
8 BC’s 10-year Cancer Action Plan
& Primary Care Connection: HPV
Vaccination
10 Mental Health Medication Choice
and the Impact on Cancer
Treatments
Education Update Understanding Prognosis in our Patients.' opportunity to your area.
continued from page 1 Find details on future conferences at fpon.
Lastly, FPON’s twice-yearly ‘General
answers to common patient questions, is ca. Alternatively, sign up here to be notified
Practitioner in Oncology (GPO) Education
part of the recurring series of webcasts of our upcoming educational opportunities.
Program,' is an educational requirement
for primary care. So far, 2023 has also The BC Cancer Primary Care Lung Cancer involving a 2-week didactic and 6-week
offered 'Psychosocial Perspective on learning session will be available starting clinical rotation for family physicians
Cancer-Related Fatigue - What is it, and April 16 as part of a series of interactive newly hired as GPOs in BC and the
what can we do about it?', 'Lung Cancer online learning sessions to help primary Yukon (both within community cancer
Screening and Suspected Lung Cancer care providers better support their patients clinics and at BC Cancer Centres). In the
in Primary Care' and 'Pancreatic Cancer with cancer. (See the link in the Learning spirit of inclusion and to align with the
.'This webcast series, which runs the Session Update) Developed in partnership BCMQI Clinical Practitioner in Oncology
third Thursday of most months from 8-9 with the UBC Division of Continuing Privileging Dictionary, after consultation
am, includes didactic and interactive Professional Development, this accredited with stakeholders, the name of the 2-week
teaching with polling questions and module will review lung cancer prevention didactic portion attended by GPOs, BC
Q and A. Accreditation application is and screening (including BC Cancer’s Lung Cancer nurse practitioners and palliative
underway for the upcoming 2023/2024 Screening Program details), diagnosis, medicine residents was changed to
year with planned webcasts, chosen by treatment and survivorship care. Point- Clinical Practitioner in Oncology (CPO)
our representative planning committee of-care resources will be embedded Education. Palliative Care Residents
on 'Things you can do in clinic today to throughout the module. To access the continue to have hands-on clinical
prevent ovarian cancer,' 'Management new lung cancer learning session once teaching specific to their education. The
of Treatment-Related Side Effects of available, go to the Continuing Medical 6-week clinical rotation specifically for
Androgen Deprivation Therapy,' 'Female Education tab at fpon.ca. The newly GPs in Oncology remains unchanged, as
Sexual Health & Cancer Survivorship’ and updated Breast Cancer and the Prostate does the 6-week BC Cancer NP clinical
more. Recordings of previous webcasts Cancer and Colorectal Cancer sessions are rotation requirement. As a result of
and registration links for upcoming also found there. ongoing evaluation and improvement
webcasts can be found at fpon.ca implementation, the 2023 spring intake of
On a related note, small group learning
We kicked off this year’s Cancer Awareness the 2-week didactic CPO Education saw
sessions based on the online Breast
Month with our April 1 'Practical Cancer the addition of talks focused on Hodgkin
Cancer learning module have occurred in
Care for Primary Point of Care Providers.' Lymphoma and Hepatocellular Cancer.
the East Kootenays and West Kootenays.
Topics selected by our primary care Each session saw family physicians, a local As we aim to help meet the oncology
conference working group included GPO, and a medical oncologist from the learning needs of primary care
'Practical Hematology for Primary Care,' Regional Cancer Centre meet virtually to practitioners, GPOs and NPs, we
'This Child May have Cancer: What to discuss the module, network and review continuously seek feedback from our
do and what not to do for a child with a issues relevant to the region. Feedback readers and participants. Please email
suspected malignancy,' 'Managing Late has been positive, and plans for additional FPON’s Medical Education Lead at
Effects of Childhood Cancer,' and 'Lung networking sessions are well underway. sian.shuel@bccancer.bc.ca with any
Cancer – Current Management and Please reach out if you want to bring this suggestions.
B.C.’s 10-year cancer action plan Team-based care puts the patient at the questions. Now that we have the framework
continued from page 1 heart of a dedicated, multidisciplinary health for the plan and the initial investment,
care team, improving continuity of care, our priority at this time is to build out our
These significant recruitment efforts support
experience and outcomes. This collaborative engagement plan with our regional health
our ongoing work to implement a new
model of care will also boost the experience authority partners, First Nations Health
model of care throughout our centres.
and satisfaction of staff and physicians by Authority, primary care and others.
enabling them to work to the full scope of
As we move forward with this work, we look
BC Cancer provides specialized cancer their practice.
forward to sharing more information on our
care services to communities across
To date, 51 teams are active across our priorities and next steps. In the meantime,
British Columbia, the territories of many
centres. These teams support tumour group we encourage you to review the full action
distinct First Nations. We are grateful
to all the First Nations who have cared based care and are tailored to each centre’s plan www.bccancer.bc.ca/cancerplan.
for and nurtured this land for all time, staffing capacity and patient needs. Teams
Contact Dr. Kim Chi at kchi@bccancer.bc.ca
including the xʷməθkwəy̓ əm (Musqueam), could include a patient care aide, clerk,
and Heather Findlay at heather.findlay@
Sḵwx̱ wú7mesh Úxwumixw (Squamish), and licensed practical nurse, registered nurse,
bccancer.bc.ca.
̓ ̓ ətaɬ (Tsleil-Waututh) First Nations
səlil w nurse practitioner, GPO and oncologist.
on whose unceded and ancestral Learn more about B.C.’s 10-year cancer
B.C.’s 10-year cancer action plan has been
territory our head office is located. action plan at www.bccancer.bc.ca/
met with enthusiasm, support and many
cancerplan
2 FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023
Precancerous lesions of the vulva: What you need to know
By Dr. Melanie Altas, Obstetrics & Gynaecology, papilloma virus (HPV) subtypes, such as erosion, smooth or with an irregular surface.
University of British Columbia HPV 6 and 11. They are not precancerous A high index of suspicion is necessary,
and therefore do not require treatment to particularly those with risk factors (see Table 2).4
Vulvar squamous cell cancer makes up 5%
prevent progression to malignancy. LSIL
of gynecologic malignancies. High-grade
should be treated as condyloma.2 When to Biopsy
vulvar intraepithelial neoplasias (VIN) are the
precursor lesions to vulvar High grade lesions are divided • Chronic ulcers or erosions
cancer. While the incidence into high grade squamous • Lesion with atypical features (irregular
of cancer remains stable, epithelial lesions (HSIL) and surface, differing pigmentation,
high grade VIN is increasing, differentiated VIN (dVIN). asymmetrical)
particularly amongst younger These lesions develop via • Skin conditions not improving with
women.1 Diagnosing two distinct pathways. HSIL is treatment (dermatoses such as lichen
premalignant lesions can be HPV dependant and caused sclerosus, condyloma).
a challenge for physicians by high-risk subtypes, such as • First episode of “genital warts” over age
as they often present with HPV 16 and 18. On the other forty.
subtle signs and symptoms hand, the etiology of dVIN is
that can be easily overlooked less well understood but is Clinical Behavior
or misdiagnosed. Early known to develop independent
Dr. Melanie Altas HSIL has been found to be linked to 20%
identification is important as of HPV infection.2
of vulvar squamous cell cancers, whereas
treatment of VIN can prevent
Clinical Presentation dVIN is associated with 80%. Therefore,
the progression to cancer.
most vulvar cancers are not caused by HPV.
Approximately 40% of high grade lesions are Patients diagnosed with high grade lesions
Classification & Etiology asymptomatic.3 Lesions may be found during will commonly inquire about the risk of
Precancerous lesions of the vulva were self-examination or during routine pelvic malignancy. The cancer risk is contingent on
first reported in 19222 and have since been examinations. The most common symptom the type of lesion identified.
described using evolving classification is vulvar pruritus, although patients may
continued on page 4
systems. Currently, the International Society experience pain, dysuria and dyspareunia.
for the Study of Vulvovaginal Disease (ISSVD)
Diagnosing HSIL or dVIN during an
employs a system that differentiates lesions
examination can be challenging owing to
based on etiology and malignant potential
their varied appearance. Lesions may exhibit
(see Table 1).2
different colours such as brown, white, red,
Low grade squamous intraepithelial lesions or flesh coloured (Image 1). Additionally,
(LSIL) are associated with low-risk human lesions may present as flat, raised or an
Table 1: Classification of VIN
Year of Publication 1986 ISSVD 2004 ISSVD 2015 ISSVD
Terminology VIN 1 (mild dysplasia) Condyloma LSIL
VIN 2 (moderate dysplasia) Usual type VIN HSIL
VIN 3 (severe dysplasia
or carcinoma in situ)
Differentiated VIN Differentiated VIN Differentiated VIN
Table 2: Risk factors for the development of high-grade vulvar lesions4
HSIL dVIN
HPV infection Poorly controlled vulvar dermatoses
(lichen sclerosus, lichen planus)
Smoking
> 2 sexual partners Image 1: a) Brown HSIL on perineum b)
Immunosuppression White HSIL in left lower labia majora Photos
courtesy of BC Centre for Vulvar Health
FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023 3
Precancerous lesions of the vulva in younger women, as well as a high risk Apr 1;26(2):140-146.
continued from page 3 of recurrence laser ablation is appealing 5. McAlpine JN, Kim SY, Akbari A et
as repeat surgical excision can lead to al. HPV-independent differentiated
HSIL has a lower malignant potential.1,3
unsatisfactory cosmetic and functional vulvar intraepithelial neoplasia (dVIN)
• 10% risk of progression to cancer
results.6 is associated with an aggressive
• 1.2% chance of regression, particularly in
Topical imiquimod 5% is applied by the clinical course. Int J of Gynecol Path.
young women or pregnancy
patient in a thin layer two to three times per 2017;36:507-516
• Longer time to progress to cancer (50-72
week for up to sixteen weeks. For both laser 6. Preti, Mario; Joura, Elmar; Vieira-Baptista,
months)
ablation and imiquimod, invasive disease Pedro; Van Beurden, Marc et al. The
DVIN is less common but has a higher must be ruled out. Current research suggests European Society of Gynaecological
malignant potential.1,5 there is no difference in outcomes between Oncology (ESGO), the International
• Accounts for less than 10% of high-grade surgical excision, laser ablation and topical Society for the Study of Vulvovaginal
lesions imiquimod.8 Disease (ISSVD), the European College for
the Study of Vulval Disease (ECSVD) and
• 33% risk of progression to cancer
Follow-Up the European Federation for Colposcopy
• Shorter time to progress to cancer (13-23
Following treatment, close clinical (EFC) Consensus Statements on Pre-
months)
surveillance is warranted.6 The risk of invasive Vulvar Lesions. Journal of Lower
recurrence is high, up to 25% with a quarter Genital Tract Disease 26(3):p 229-244,
Treatment
of those being late recurrences.9 At the BC July 2022.
The goals of treatment involve preventing 7. Jamieson A, Tse SS, Proctor L, Sadownik
Centre for Vulvar Health, we follow patients
progression to malignancy and symptom LA. A Scoping Review of Treatment
every six months for two years then annually
relief while preserving vulvar anatomy and Outcome Measures for Vulvar
for those who received surgical excision
function. Intraepithelial Neoplasia. J Low Genit
or laser ablation. For patients using topical
Once the diagnosis of a high-grade lesion imiquimod, closer follow-up is warranted Tract Dis. 2022 Oct 1;26(4):328-338.
is made, a referral should be initiated to both during and shortly after the sixteen- 8. Lawrie T, Nordin A, Chakrabarti M, et
a gynecologist comfortable discussing week treatment. Follow-up appointments al. Medical and surgical interventions
treatment options. In British Columbia, include an examination of the entire lower for the treatment of usual-type vulval
referrals can be made to the BC Centre for genital tract, including vulva, perianal area, intraepithelial neoplasia. Cochrane
Vulvar Health where patients have access to vagina and cervix. Risk factors modification Database Syst Rev.2016 Jan 5;(1)
gynecologists, gynecologic oncologists as can also be reviewed, including smoking 9. Satmary W, Holschneider CH, Brunette
well as psychological support. cessation, HPV vaccination or optimizing LL, Natarajan S. Vulvar intraepithelial
Given the risk of invasive disease, patients control of chronic dermatoses. neoplasia: Risk factors for recurrence.
with dVIN should undergo surgical excision Gynecol Oncol. 2018 Jan;148(1):126-131.
References
with wide margins.6
1. Thuijs, NB, van Beurden, M, Bruggink, AH,
For patients with HSIL, various treatment
Steenbergen, RDM, Berkhof, J, Bleeker,
options are available, including surgical
MCG. Vulvar intraepithelial neoplasia:
excision, CO2 laser ablation and topical
Incidence and long-term risk of vulvar
therapy.6,7 The choice of treatment option
squamous cell carcinoma. Int. J. Cancer.
depends on patient and lesion specific
2021; 148: 90– 98.
Educational
factors as well as provider preference. opportunities provided
2. Bornstein J, Bogliatto F, Haefner H,
Currently, there is no high-quality evidence
Stockdale C, Preti M et al. The 2015
by BC Cancer’s Family
to guide management decision making.7
International Society for the Study of Practice Oncology
There is also a lack of literature on quality- Network
Vulvovaginal Disease (ISSVD) Terminology
of-life outcomes.
of Vulvar Squamous Intraepithelial
CO2 laser ablation is commonly performed Lesions. Obstet & Gynecol 2016 127(2):p made possible in part
in a hospital ambulatory clinic setting 264-268 thanks to the support
using local anesthetic. This is preferred for
3. van Seters M, van Beurden M, de Craen of the BC Cancer
multifocal disease, larger lesions as well as
lesions near the clitoris and perianal area.
AJ. Is the assumed natural history of Foundation
vulvar intraepithelial neoplasia III based on
Given that there is rising incidence of HSIL
enough evidence? A systematic review of
3322 published patients. Gynecol Oncol.
2005 May;97(2):645-51.
BC Centre for Vulvar Health
4. Jamieson A, Tse SS, Brar H, Sadownik LA,
referral information can be Proctor L. A Systematic Review of Risk /BCCancerFoundation
@bccancerfdn
Factors for Development, Recurrence,
found at bcvulvarhealth.ca bccancerfoundation.com
and Progression of Vulvar Intraepithelial
Neoplasia. J Low Genit Tract Dis. 2022
4 FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023
Treatment of liver malignancies: An overview of
Yttrium-90 TransArterial RadioEmbolization (TARE)
By Jasper Yoo, Medical Student, the mapping procedure confirms that hepatic Neuroendocrine tumours (NETs)
University of British Columbia arterial anatomy is amenable to safe delivery
Many patients with neuroendocrine tumour
of Y-90 radioembolics to the liver without
Dr. Pedro Lourenço, Dr. Jun Wang, present with multifocal disease and are
non-target embolization or extrahepatic
Dr. Behrang Homayoon, Interventional not surgical candidates.10 Under the GIYTT
radiation toxicity. This procedure is shorter
Radiologists, Surrey Memorial Hospital protocol, Y-90 radioembolization is used for
compared to the mapping procedure
metastatic NETs with liver-dominant disease
and involves targeted delivery of Y-90
and low-volume extrahepatic disease.4 In a
radioembolic particles into the liver.
retrospective population-based cohort study
conducted in British Columbia, TARE was
Applications of TARE
well tolerated in metastatic liver-dominant
NETs, and 86% of patients achieved partial
Early or intermediate-stage hepato-
response or stable disease.11 In unresectable
cellular carcinoma
metastatic NETs, TARE has a lower incidence
In the setting of hepatocellular carcinoma of side effects and a higher disease control
(HCC), Y-90 radioembolization is performed rate than TACE.10
Jasper Yoo Dr. Behrang Homayoon mainly in those who are not candidates for
surgical resection at time of presentation. Cholangiocarcinoma and
Treatment goals include downstaging gallbladder carcinoma
Overview of yttrium-90 transarterial to resection or transplant, bridging to
radioembolization Under the BC Cancer GIBYTT protocol,
transplant, or palliation. TARE is an important
TARE is now indicated for locally advanced
Transarterial radioembolization (TARE) alternative catheter-based treatment
cholangiocarcinoma or gallbladder
is a minimally invasive catheter-directed strategy for patients with contraindications
carcinoma not amenable for surgical
brachytherapy technique performed by to transarterial chemoembolization (TACE),
resection at time of presentation.4 In
interventional radiology to treat primary particularly those with portal venous
comparison to chemotherapy only,
or metastatic liver malignancies. TARE thrombosis.5
TARE has been shown to prolong
involves the selective intraarterial delivery of More recently, there are emerging data survival in cholangiocarcinoma,12 and
microspheres loaded with the radioisotope supporting the use of Y-90 radiation TARE has also been used to downstage
yttrium-90 (90Y or Y-90) through the segmentectomy and radiation lobectomy previously unresectable intrahepatic
hepatic vasculature, directly targeted at in well-selected patients with HCC. Y-90 cholangiocarcinoma (ICC) to resectable
tumours. In BC, under the GIYTT protocol, radiation segmentectomy is a targeted ICC.13 In addition, radiation segmentectomy
TARE is used to treat early to intermediate- form of TARE typically delivered to one and radiation lobectomy techniques have
stage hepatocellular carcinoma (HCC), and or two hepatic segments. It allows high, been safely used in unresectable ICC.14
it is also used as cytoreductive therapy for ablative doses of radiation to be delivered
hepatic metastatic neuroendocrine tumours to tumours while minimizing damage to Conclusion
(NETs).1-3 More recently, in February, the liver parenchyma and has been shown to be
GIBYTT protocol was activated. Under TARE is an important modality in the
equivalent to other curative-intent treatment
this protocol, the eligibility criteria for management of early to intermediate stage
strategies in well-selected patients.6-7
Y-90 radioembolization expanded to HCC, hepatic metastatic NETs, and locally
Ablative TARE has been shown to improve
include patients with locally advanced advanced unresectable ICC and gallbladder
survival when compared to conventional
cholangiocarcinoma or gallbladder carcinoma carcinoma. Access to Y-90 radioembolization
TARE in select patients with HCC and portal
not amenable to surgical resection.4 is available at various sites across British
vein thrombosis.8
Columbia for patients who have undergone
Y-90 radioembolization is typically a two- Radiation lobectomy involves lobar delivery evaluation by an interventional radiologist
stage procedure. The first session is a of Y-90 radioembolic microspheres that after multidisciplinary discussion at a liver
pre-treatment mapping procedure that targets HCC localized to one hepatic lobe, tumour conference.
involves detailed interrogation of hepatic but also results in ipsilateral hepatic lobar
and mesenteric arterial anatomy with atrophy and contralateral lobar hypertrophy. References
angiography. This is followed by injection of Radiation lobectomy candidates often have 1. BC Cancer. Neuroendocrine Tumors
technetium-99m MAA into the liver for both well-preserved liver function and smaller [Internet]. 2022 [cited 2022 May 30].
dosimetric considerations and to assess the tumour burden, and radiation lobectomy Available from: www.bccancer.bc.ca/
potential for extrahepatic toxicity prior to Y-90 is often performed as a bridge to surgical health-professionals/clinical-resources/
radioembolic administration. The second resection. It can also be performed for cancer-management-manual/
session is typically performed two weeks after larger tumours as an alternative to radiation gastrointestinal/neuroendocrine-tumors
the mapping procedure. It is undertaken if segmentectomy.9 continued on page 6
FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023 5
BC Cancer Breast Screening update
As evidence evolves, BC Cancer Breast services to facilitate breast cancer as part of the BC Cancer Breast Screening
Screening has revised its policy for breast surveillance for individuals at increased risk, Program facilitates annual mammography
cancer risk stratification and is expanding specifically due to a prior tissue diagnosis of: for those with a history of ADH/ALH/LCIS.
• Atypical Ductal Hyperplasia (ADH) The Screening Program retains the patient
in the database and sends annual referrals to
• Atypical Lobular Hyperplasia (ALH)
diagnostic services to schedule this follow-
• Classical Lobular Carcinoma In Situ (LCIS)
up mammogram similar to the screening
BC Cancer Breast Screening now program process for lower risk patients.
recommends surveillance with annual
www.bccancer.bc.ca/screening/
mammography through diagnostic imaging
Documents/Breast-Higher-Risk.pdf
given the typically more complicated history
of biopsy and possibly surgery. The new For those who prefer a visual depiction of
service will facilitate and formalize this the screening referral process, check out
surveillance through: the Breast Screening Algorithm for risk
categorization and consequent screening
• Patient and Provider notifications
regimen within our Program:
• Direct referrals to diagnostic imaging for
annual mammography www.bccancer.bc.ca/screening/Documents/
Breast-Screening-Referral-Algorithm.pdf
For more details check out the BC Cancer
website Health Care Provider fact sheet for This service has been endorsed by BC Family
the Higher Risk Surveillance program. The Doctors, and the provincial Medical Imaging
www.bccancer.bc.ca/screening incorporation of this surveillance extension Advisory Committee.
Treatment of liver malignancies [Internet]. 2022. Available from: www. A systematic review. Eur J Radiol.
continued from page 5 bccancer.bc.ca/books/liver/5-treatment- 2018;100(September 2017):23-29.
modalities-in-hcc doi:10.1016/j.ejrad.2018.01.012
www.bccancer.bc.ca/health-
6. Lewandowski RJ, Gabr A, Abouchaleh 11. Tsang ES, Loree JM, Davies JM, et
professionals/clinical-resources/cancer-
N, Ali R, Al Asadi A, Mora RA, et al. al. Efficacy and prognostic factors
management-manual/gastrointestinal/
Radiation segmentectomy: Potential for Y-90 radioembolization (Y-
neuroendocrine-tumors
curative therapy for early hepatocellular 90) in metastatic neuroendocrine
2. BC Cancer. Treatment Options by Stage carcinoma. Radiology. 2018;287(3):1050–8. tumors with liver metastases. Can J
[Internet]. 2022 [cited 2022 May 30]. Gastroenterol Hepatol. 2020;2020:8-12.
7. Kim E, Sher A, Abboud G, et al. Radiation
Available from: www.bccancer.bc.ca/ doi:10.1155/2020/5104082
segmentectomy for curative intent of
books/liver/6-treatment-options-by-stage
unresectable very early to early stage 12. Gangi A, Shah J, Hat N, et al. Intrahepatic
3. BC Cancer. BC Cancer Protocol hepatocellular carcinoma (RASER): a Cholangiocarcinoma Treated with
Summary of Yttrium-90 for single-centre, single-arm study. Lancet Transarterial Yttrium-90 Glass
Transarterial Radioembolisation Gastroenterol Hepatol. 2022;7(9):843- Microsphere Radioembolization: Results
(TARE) for Hepatocellular Cancer or 850. doi:10.1016/S2468-1253(22)00091-7 of a Single Institution Retrospective
Neuroendocrine Tumours with Hepatic Study. Published online 2018:1101-1108.
8. Cardarelli-Leite L, Chung J, Klass
Disease [Internet]. 2023 [cited 2023 doi:10.1016/j.jvir.2018.04.001.
D, et al. Ablative Transarterial
March 21]. Available from: www.bccancer.
Radioembolization Improves Survival in 13. Edeline J, Touchefeu Y, Guiu B,
bc.ca/chemotherapy-protocols-site/
Patients with HCC and Portal Vein Tumor et al. Radioembolization Plus
Documents/Gastrointestinal/GIYTT_
Thrombus. Cardiovasc Intervent Radiol. Chemotherapy for First-line Treatment
Protocol.pdf
2020;43(3):411-422. doi:10.1007/s00270- of Locally Advanced Intrahepatic
4. BC Cancer. BC Cancer Protocol 019-02404-5 Cholangiocarcinoma: A Phase 2 Clinical
Summary of Yttrium-90 for Transarterial Trial. JAMA Oncol. 2020;6(1):51-59.
9. Malhotra A, Liu DM, Talenfeld AD.
Radioembolisation (TARE) for Locally doi:10.1001/jamaoncol.2019.3702
Radiation Segmentectomy and Radiation
Advanced Cholangiocarcinoma or
Lobectomy: A Practical Review of 14. Kumar P, Mhaskar R, Kim R, et
Gallbladder Carcinoma Not Amenable
Techniques. Tech Vasc Interv Radiol al. Unresectable Intrahepatic
for Surgical Resection [Internet]. 2023
[Internet]. 2019;22(2):49–57. Available Cholangiocarcinoma Treated with
[cited 2023 March 21]. Available from:
from: https://doi.org/10.1053/j. Radiation Segmentectomy/Lobectomy
www.bccancer.bc.ca/chemotherapy-
tvir.2019.02.003 Using Yttrium 90-labeled Glass
protocols-site/Documents/
10. Jia Z, Wang W. Yttrium-90 Microspheres. J Clin Exp Hepatol.
Gastrointestinal/GIBYTT_Protocol.pdf
radioembolization for unresectable 2022;12(5):1259-1263. doi:10.1016/j.
5. BC Cancer. Treatment Modalities in HCC jceh.2022.03.008
metastatic neuroendocrine liver tumor:
6 FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023
Nutrition and cancer: what’s the evidence?
www.bccancer.bc.ca/prevent/nutrition-exercise
About one-third of most cancers can be prevented through a healthy
diet, being physically active and maintaining a healthy weight.
Check out the FPON website for the recording
of the October 20, 2022 Webcast: “Nutrition
and Cancer: What’s the evidence?” presented by
Terry Lok, RD of the BC Cancer Nutrition Services
Department.
https://media.phsa.ca/home/iframe?url=BCCA/
bccahealth%5cFPON_Oct_Webcast_20221108
For more information, check out the following sites
that were recommended during this webcast:
World Cancer Research Fund:
https://www.wcrf.org/diet-activity-and-cancer
Cancer Risk Matrix:
https://www.wcrf.org/diet-activity-and-can-
cer-risk-matrix
Febrile neutropenia assessment and treatment update
The BC Cancer guidance document and lymphoma has been updated. This – updated duration of antimicrobial
for febrile neutropenia assessment and reference is available on the BC Cancer therapy
treatment for adults with solid tumour website in the Supportive Care section of the – updated vancomycin trough target
Cancer Management Manual, under Febrile levels
Neutropenia.
• Updated low risk treatment
Febrile neutropenia assessment
Key updates: recommendations:
and treatment guidance updated
• Consolidated assessment and treatment – consider omitting ciprofloxacin if
December 2022 recommendations of febrile neutropenia no previous infection history with
Febrile neutropenia occurs when a • Updated high risk treatment pseudomonas aeruginosa
patient has a fever and a significant recommendations: – updated treatment alternatives for beta-
reduction in their white blood cells – updated treatment alternatives for beta- lactam allergy
(neutropenia) that are needed to fight lactam allergy – updated treatment alternative for
infections. low risk patients who do not meet all
– clarified indications for antimicrobial
selection outpatient criteria
www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-manual/supportive-care/febrile-neutropenia
FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023 7
BC’s 10-year Cancer Action Plan and some implications
for Primary Care
By Dr. Catherine Clelland Within the details of these areas of focus commercial tobacco products and other
Medical Director, Primary Care, BC Cancer and targets are several priorities that have related lifestyle behaviour.
strong linkage to community primary care.
Disease prevention, screening, diagnosis and HPV, or the human papillomavirus, is the
In particular, the actions indicated under
management, along with longitudinal follow- most common sexually transmitted infection
prevention and early detection that include
up, are core tenants of primary healthcare. in the world today and can affect any man
enhancement of prevention strategies with
Well-established evidence internationally or woman who is sexually active. Using
emphasis on at risk populations
of better patient outcomes condoms may reduce the chances of getting
focused on:
and more cost-effective care HPV, but it is highly contagious, and condoms
when Primary Care is well a. Implementation of health do not provide full protection. Infection
integrated into and involved promotion activities with a can occur with skin-to-skin or oral contact
cross the healthcare care specific focus on lung cancer with the genital area, and without having
continuum. This has formed moving B.C. towards a lower intercourse. While cervical cancer is the most
the basis for the BC Ministry smoking rate, in alignment with common HPV related cancer, the reality is
of Health Primary Care Policy the Government of Canada’s the risk is much broader. Mouth and throat
papers that underpin the Tobacco Strategy. cancer, anal cancer, vaginal and vulvar cancer
shift to the “team-based” b. Increasing the uptake of and penile cancer are also on the list. More
Patient Medical Home and HPV vaccine achieving the recently, there is some early data indicating
development of Primary Care National Advisory Committee HPV related airways cancer, particularly in
Dr. Cathy Clelland
Networks. The cancer care on Immunization (NACI) health care providers providing care for HPV
system is no exception, and target of 90% HPV vaccination related cancer services such as colposcopy.
on February 24, 2023, the Minister of Health coverage (two or more doses) of
Human papillomavirus vaccines are
announced the release of “BC’s 10-year adolescents by 17 years of age, moving to
immunizations that prevent infection by
Cancer Action Plan”, outlining the 10-year the elimination of cervical cancer in B.C.
certain types of human papillomavirus.
goals to:
Smoking cessation has long been part of Available HPV vaccines protect against either
1. Reduce the incidence of cancer in BC; primary care practice and while BC has the two, four, or nine types of HPV. All HPV
2. Improve cancer survival, cure rates and lowest commercial tobacco smoking rates in vaccines protect against at least HPV types
quality of life; and Canada, more can be done to reduce the risk 16 and 18, which cause the greatest risk of
3. Ensure a strong system delivering of cancer, cardiovascular and other smoking cervical cancer. Details of HPV immunization
modern, evidence-based province-wide related conditions. While it is still the leading recommendations and coverage in BC can
cancer care cause of lung cancer, nearly 30% of patients be found on the Immunize BC website
diagnosed with lung cancer today are non- https://immunizebc.ca/hpv In BC, children
To achieve these goals, 3-year targets have
smokers. The risks of vaping, particularly up to the age of 18 are eligible for funded
been set within 4 areas of focus:
of nicotine containing products are only vaccination. Those who get the vaccine
1. Prevent cancer and find cancer earlier; starting to become known, and more data is in grade 6 need 2 doses at least 6 months
2. Ensure timely access to cancer treatments; needed to see the impact on cancer risk. A apart, while those who start the HPV vaccine
3. Optimize care through collaboration and new approach that includes input from youth series on or after their 15th birthday need
partnership; and and others in the target population to design 3 doses over 6 months. Immunize BC has
effective strategies to increase awareness developed a patient/parent handout to
4. Revitalize our cancer care system through
and ultimately reduce risk from the use of help dispel some of the misinformation
essential enablers.
that has been circulating and that can be
downloaded from their website.
According to Immunize BC, in addition to
all children up to the age of 18, the HPV9
vaccine is also recommended and free for:
• HIV-positive people up to 26 years of age
• Transgender people up to 26 years of age
FPON Communications & • Cisgender* males up to 26 years of age who:
Journal of Family Practice Oncology – have sex with other men
have gone Digital – are not yet sexually active but are
To stay up to date with what’s happening, questioning their sexual orientation
sign up through this QR code! – are street-involved
continued on page 11
8 FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023
Protect your child from cancer
with the HPV vaccine.
Four things you need to know about the HPV vaccine:
1. The HPV vaccine is cancer prevention.
The vaccine protects against HPV infections that can cause:
• Mouth and throat cancer
• Cervical cancer
• Anal cancer
• Vaginal and vulvar cancer It also protects against infections
• Penile cancer that cause genital warts.
2. Age matters. Don’t wait to vaccinate.
It is recommended that children get the HPV vaccine in grade 6. Here’s why:
The vaccine works best when given at a young age because preteens produce more antibodies
after HPV vaccination than older teens.
For the vaccine to work best, people need to be vaccinated before they are sexually active and
exposed to HPV.
When you vaccinate your child on time, you give them the best protection from HPV cancers later
in life.
3. The HPV vaccine is safe.
200,000,000
HPV Vaccine Doses Safely Given
Over 15 years of vaccine safety monitoring has shown that
the HPV vaccine is safe. More than 200 million doses of the
vaccine have been safely given worldwide.
4. HPV vaccination works!
Studies in Canada and other countries with HPV vaccine programs have shown a
big decrease in HPV infections, cervical pre-cancers, and genital warts since the
HPV vaccine has been used.
What is HPV? • About 3 out of 4 unvaccinated sexually active people
will get HPV at some point in their lives.
• HPV stands for human papillomavirus. • There are many different types of HPV. Most HPV
• It is the most common sexually infections are harmless and go away on their own. But
transmitted infection. some infections can lead to cancer or genital warts.
07/22
For translations and more
information, scan the QR code or
visit immunizebc.ca/hpv
FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023 9
Managing psychiatric medications in patients with cancer
By Dr. Alan Bates, MD, PhD, FRCPC due to their minimal 2D6 inhibition. An Another setting where prescribing an SSRI
Provincial Lead for Psychiatry and Acting added bonus, that often makes these may seem foolhardy is in the context of
Program Medical Director for Supportive medications more attractive to patients neuroendocrine tumor with risk of carcinoid
Care at BC Cancer reluctant to take a psychiatric medication, is syndrome, but recent reviews suggest they
that both venlafaxine and mirtazapine can are relatively safe.5-6
Given the overall prevalence of anxiety
help with tamoxifen-induced hot flashes
and depression, it’s not surprising that In patients where gabapentin or pregabalin
at night. Escitalopram and citalopram are
mental health comorbidities are common are not working adequately for neuropathic
also relatively low risk. If a
in people with cancer. pain, it’s worth remembering that SNRIs like
patient is unable to achieve
Substance use disorders are duloxetine and tricyclic antidepressants like
adequate results from weak
a good example of mental nortriptyline also have evidence for helping
2D6-inhibitors, it might
health syndromes that can with neuropathic pain.
be reasonable for them to
increase risk of cancer.
choose, in the context of Small doses of as needed lorazepam can
The increased prevalence
education about this issue, help certain patients get through some
of depression in head and
to continue a strong inhibitor investigations and procedures. In addition
neck cancer, compared to
as some evidence suggests to its effects on anxiety, lorazepam can
most other forms of cancer,
the clinical significance of also help with anticipatory nausea. In
is likely partially explained
this interaction is overblown.2 addition to all the other well-known risks
by premorbid depression
However, there are studies of benzodiazepines, the risk of respiratory
associated with risk-elevating
Dr. Alan Bates that report clinically significant depression is present to a much greater
substance use. Cancer
effects.3 degree in patients taking opioids.
treatments can also precipitate
psychiatric symptoms. Steroid-induced In addition to being helpful for hot flashes, Stimulants from both the methylphenidate
mood disturbances, for example, are a mirtazapine has other secondary effects and dextroamphetamine families can
common challenge. Compared to the that tend to be beneficial in this population. sometimes be helpful for brain fog or mental
general population, the rate of diagnosis of Promotion of sleep (at lower doses), fatigue. However, reduction in appetite
psychiatric syndromes begins to increase increased appetite, and reduction of nausea caused by stimulants is often unwanted in this
10 months before cancer diagnosis, peaks all tend to be welcome side effects. Similarly, setting. There is also anecdotal concern about
sharply around time of diagnosis, and olanzapine is often used by oncologists seizure risk being increased by stimulants in
then remains elevated for up to 10 years.1 for treatment-resistant nausea, even in the patients with brain tumors, but the limited
Therefore, primary care providers are absence of any psychiatric symptoms. evidence available does not support that
frequently managing psychiatric medications risk.7 Bupropion is another alternative for
In a setting where methadone, which
in the context of cancer. patients with depression characterized
can have a large effect on QT interval,
by lack of motivation and mental energy,
The best-known cancer- and mental health- is commonly used for pain control, it’s
but it is known to increase risk of seizure,
related medication interaction is likely worth being more vigilant about the risk
particularly in the context of malnutrition and
the risk of reducing the effectiveness of of psychiatric medications prolonging QT.
electrolyte abnormalities. Antipsychotics as a
tamoxifen through strong cytochrome p450 Among SSRIs, escitalopram and citalopram
class also lower seizure threshold.
2D6 (CYP2D6)-inhibiting antidepressants are the only two that show a convincing
such as paroxetine, fluoxetine or bupropion. dose-response effect on QT.4 With a few Steroids such as prednisone and
To mitigate that risk, venlafaxine and possible exceptions, antipsychotics also have dexamethasone given as part of chemotherapy
mirtazapine are antidepressants of choice risk for contributing to QT prolongation. regimens can cause or exacerbate a wide
variety of psychiatric symptoms. Patients with
a history of bipolar disorder are particularly
at risk for destabilization. Olanzapine can be
Key Points used to address steroid-induced irritability,
1. Antidepressants that are strong cytochrome p450 2D6 (CYP2D6) inhibitors hypomania, mania, or psychosis and can be
(e.g. paroxetine, fluoxetine or bupropion) may decrease the effectiveness of given prophylactically in patients with a high
some cancer medications such as Tamoxifen. level of risk. Olanzapine or other antipsychotics
2. Be vigilant about the risk of psychiatric medications prolonging QT, particularly if (depending on the patient and scenario) can
a patient is on methadone for pain management as it can also contribute to this. also be helpful in minimizing immunotherapy-
induced psychotic symptoms and might
3. Steroids (e.g. prednisone and dexamethasone) given as part of chemotherapy
allow a patient to continue a regimen that
regimens can cause or exacerbate a wide variety of psychiatric symptoms.
might otherwise have to be discontinued.
4. Patients with severe and persistent mental illness may need dose reductions of
longstanding medications in the context of acute medical illness and/or acute Patients with severe and persistent mental
medical settings. illness such as schizophrenia or bipolar
continued on page 11
10 FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023Expansion of FPON-UBC CPD self-directed online courses:
Lung Cancer available April 14, 2023
With the increasing prevalence of lung cancer, the BC Cancer Primary Care
Learning Sessions: Lung Cancer eLearning course offers valuable resources and
knowledge to support health professionals in their work. This online course is
designed to provide primary care providers with up-to-date information on the
diagnosis, treatment and management of lung cancer in primary care settings.
Explore the BC Cancer Primary Care Learning Sessions: Lung Cancer today
using the following link:
https://ubccpd.ca/learn/learning-activities/course?eventtemplate=477-bc-cancer-primary-care-learning-sessions-lung-cancer
Links to all modules in the BC Cancer Primary Care Learning Sessions are also available on our website FPON.ca
www.bccancer.bc.ca/health-professionals/networks/family-practice-oncology-network/continuing-medical-education#Primary--Care--
Learning--Sessions
Managing psychiatric medications 2. Haque R, Shi J, Schottinger JE, Ahmed SA, 5. Isenberg-Grzeda E, MacGregor M, Bergel
continued from page 10 Cheetham TC, Chung J, et al. Tamoxifen A, Eagle S, Espi Forcen F, Mehta R, et al.
and Antidepressant Drug Interaction Antidepressants appear safe in patients
disorder may need dose reductions of in a Cohort of 16 887 Breast Cancer with carcinoid tumor: Results of a
longstanding medications in the context of Survivors. J Natl Cancer Inst. 2016 retrospective review. Eur J Surg Oncol J
acute medical illness and/or acute medical Mar;108(3):djv337. Eur Soc Surg Oncol Br Assoc Surg Oncol.
settings. A classic example of the latter is 2018 Jun;44(6):744–9.
3. Kelly CM, Juurlink DN, Gomes T, Duong-
the need to consider reducing olanzapine or
Hua M, Pritchard KI, Austin PC, et al. 6. Isenberg-Grzeda E, MacGregor M,
clozapine in environments where patients
Selective serotonin reuptake inhibitors Matsoukas K, Chow N, Reidy-Lagunes D,
can’t smoke as smoking induces CYP1A2 and
and breast cancer mortality in women Alici Y. Must antidepressants be avoided
speeds up metabolism of those medications.
receiving tamoxifen: a population based in patients with neuroendocrine tumors?
This short article cannot account for all the cohort study. BMJ. 2010 Feb 8;340:c693. Results of a systematic review. Palliat
individual differences between patients, 4. Castro VM, Clements CC, Murphy SN, Support Care. 2020 Oct;18(5):602–8.
settings, and scenarios, and the content Gainer VS, Fava M, Weilburg JB, et al. 7. Meyers CA, Weitzner MA, Valentine
should be used along with other resources QT interval and antidepressant use: a AD, Levin VA. Methylphenidate therapy
and does not replace clinical judgment. Using cross sectional study of electronic health improves cognition, mood, and function
interaction-checking software and being records. BMJ. 2013 Jan 29;346(jan29 of brain tumor patients. J Clin Oncol Off J
aware of kidney and liver dysfunction that 3):f288–f288. Am Soc Clin Oncol. 1998 Jul;16(7):2522–7.
may affect metabolism and serum protein
and medication levels are always prudent
practices. Relatively rare syndromes such as
serotonin syndrome also become less rare BC’s Cancer Action Plan and some implications primary care and our partners will need to
with so many possible variables contributing. for Primary Care continued from page 8 take a much broader approach to ensure
When in doubt, consult with a physician or awareness that HPV related cancers are not
• Cisgender males in youth custody services
pharmacist colleague. The RACE line www. just about cervical cancer prevention. We
centres or in the care of the Ministry of
raceconnect.ca can also be an excellent need to shift the dialogue to counter the
Children and Family Development (MCFD)
resource. When done judiciously, active misinformation that creates stigma around
management of psychiatric medications • Two-Spirit, transgender, and non-binary
HPV, advocate for broader coverage of
in people with cancer can improve quality people up to 26 years of age
immunization and improves prevention of all
of life, reduce side effects, and (through Immunize BC also notes that the HPV9 HPV related cancers in addition to other HPV
improving tolerance of and ability to attend vaccine is recommended, but not provided related conditions. This is action that primary
treatments) lengthen survival. free (unless noted above), for: care, through the Patient Medical Homes
• Females 19 to 45 years of age and Primary Care Networks, in partnership
References with Public Health and BC Cancer can
• Males 19-26 years of age (unless noted
1. Lu D, Andersson TML, Fall K, Hultman CM, collaborate with other partners both at the
above)
Czene K, Valdimarsdóttir U, et al. Clinical local, regional and provincial levels.
Diagnosis of Mental Disorders Immediately • Males 27 years of age and older who have
sex with men We are planning on including pieces on all
Before and After Cancer Diagnosis: A
HPV related cancers in the Fall 2023 Journal,
Nationwide Matched Cohort Study in In our quest for improving care that is
so stay tuned for more information.
Sweden. JAMA Oncol. 2016 Sep 1;2(9):1188. based on equity, diversity and inclusion,
FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023 11Opportunities for clinician input to inform programming
for adolescents and young adults with cancer in BC
Why It Matters
• An AYA is diagnosed with
cancer every 65 minutes in
Canada – more than 20 AYAs
every day.
• Cancer in AYAs is unique from
older adults and pediatric
populations with distinct
medical and psychosocial
needs.
• AYA specific cancer care in
Canada is limited. In the UK and
Australia young adult specific
cancer care is standard practice.
• Only 0.4% of cancer research
funding in Canada is dedicated
to AYAs.
In November at the BC Cancer Summit, the “I want to be able to better support young
Anew Research Collaborative and BC Cancer adults with cancer. I believe we can.”
hosted a session focused on cancer care ~Clinician attending the BC Cancer Summit
needs and programing for AYAs. Attended session focused on AYA care
by nearly 70 AYAs and clinicians, the session
Do you care for adolescent and young reinforced a gap in AYA specific cancer Over the next few months, Dr. Jon Avery,
adult (AYAs) patients (aged 15-39) with care. Building from the Summit, we are now will be interviewing clinicians across BC who
reaching out to clinicians who care for AYAs care for AYAs with cancer and who wish to
cancer? Do you have perspectives and
to understand their experiences, needs and share their insights about AYA specific cancer
ideas on how their diverse needs could be
priorities to improve cancer care for AYAs. care. “This is an opportunity to reflect on the
better met? Read on…
unique needs of AYAs and identify tangible
steps and priorities to improve cancer care
for AYAs in BC,” noted Dr. Cheryl Heykoop,
Anew Research Lead, Program Head of Royal
FAMILY PHYSICIANS & GENERAL PRACTITIONERS Roads University MA Leadership Program
(Health), and patient with lived experience of
Is funding a barrier to you pursuing extra training cancer as an AYA.
in CANCER CARE? Simultaneously, Anew is working on a
research project, funded by CIHR, focused
The Canadian Association of General Practitioners in Oncology (CAGPO) offers on understanding and addressing the cancer
training scholarships of up to one month in duration for FPs/GPs interested in care realities of racialized AYAs. In late spring/
cancer care. Please email info@cagpo.ca for information about the scholarship early summer, we will be hosting
program and application form.
further conversations with clinicians and
Drs. Lori Ann Hayward & Pamela Craigie care providers to reflect on the learnings
Applications must be received by June 15, 2023. from racialized AYAs and identify tangible
Please join us for our annual 2023 CAGPO conference. ways to improve cancer care for racialized
Details at www.cagpo-annual-conference.ca AYAs in BC.
To learn more about any of the above
or to take part in the interviews and/or
conversations, kindly send an expression of
interest to hello@anewresearch.ca
12 FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023Virtual primary care learning session timely as Nelson's
community Oncology clinic transitions to general
practitioner in Oncology (GPO) care model
By Dr. Sian Shuel, medical module, learners came
education lead, primary care together with local experts,
program with Dr. Mike Vance, including their local GPO (Dr.
GPO Nelson, BC Vance), a medical oncologist
from Kelowna and a family
The community of Nelson,
physician champion from
in BC’s Interior, recently
Nelson, to briefly review key
transitioned to a GPO model
learnings from the module.
from cancer care provided
This certified 1.5-hour
by Dr. Phillip Malpass, an
workshop was developed to
internist/geriatrician who
create an opportunity to build
received the Patient Care
connections and discuss
Championship BC Cancer
clinical and community-
Excellence Award in 2019 for
specific questions.
his work.
Feedback from the Learning
With change often comes
Session in Nelson was
opportunity, and earlier this
positive, reporting that
year, BC Cancer Primary Care
the workshop provided an
Program's Virtual Learning chemotherapy nurses, a charge nurse and a
opportunity for an improved understanding
session provided a platform for community clinic clerk.
of the diagnostic, referral and treatment
physicians to connect with one of their new During the one-year transition period from process under the new GPO model.
community GPOs, Dr. Mike Vance, and an internist to GPO care, GPOs from Trail went The module also facilitated an increased
oncologist from their regional BC Cancer above and beyond. Commuting to Nelson, awareness of resources that patients in
Centre in Kelowna on community-specific they covered the outpatient clinic, ensuring Nelson could access through their linkage
questions. patients could continue accessing care in with BC Cancer in Kelowna. The resultant
Dr. Vance is familiar with the area, having Nelson while the three new GPO trainees understanding of, and confidence in, the
completed high school in Nelson. Upon completed their education, including system's process was vital for arming primary
finishing his medical education, he returned rotations at BC Cancer in Kelowna. care practitioners to provide reassurance
to Nelson to practice family and emergency During his clinical rotations, Dr. Vance heard for their patients with a cancer diagnosis.
medicine, followed by hospitalist and about the small group virtual BC Cancer The Learning Session also created an
addictions medicine work. After completing Primary Care Learning Session opportunity opportunity to give feedback to the Regional
his clinical rotations in the spring of 2022, from a medical oncologist who helped Cancer Centre on their ongoing work
he added GPO to his clinical duties. As facilitate a workshop in the east Kootenays. toward equitable access to care and patient
a GPO, Dr. Vance assesses patients for They agreed it would create an excellent resources.
appropriateness of the next round of opportunity to support the local transition to If you're interested in bringing this
chemotherapy after receiving a Community the community's GPO model of cancer care. opportunity to your community,
Oncology Network Referral (CONRef) from
the medical oncologist at the regional centre The virtual Learning Session in Nelson was please get in touch with Dr. Sian Shuel at
and provides surveillance and follow-up based on the online breast cancer module. sian.shuel@bccancer.bc.ca
care. After completing the accredited online
The community oncology clinic in Nelson is
situated inside the Kootenay Lake Hospital. FOR MORE INFORMATION ISSN 2369-4165 (Print)
It helps provide cancer care for patients in ISSN 2369-4173 (Online)
To learn more about the Family Practice
a large geographical area from Kootenay Oncology Network or become involved, Key title:
Lake, 1.5 hours east, to Nakusp, 2 hours please email FPON@bccancer.bc.ca Journal of family practice oncology
northwest. With Nelson being 4 hours east or visit www.fpon.ca Publications Mail Agreement
of Kelowna, the community oncology clinic Number 41172510
The content of articles in this Journal
helps ensure patients can receive care closer represent the views of the named Return all undeliverable Canadian
to home. The cancer care team in Nelson authors and do not necessarily Addresses to
is currently supported by three part-time represent the position of BC Cancer, BC Cancer, 600 West 10th Ave,
GPOs, a dedicated dietician, a social worker, PHSA or any other organization. Vancouver, BC V5Z 4E6
an indigenous patient navigator, three
FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2023 13You can also read
