The research conducted by the Supportive Cancer Care Research Unit falls under four main thematic areas

• Supportive cancer care / Coordination of care
• Palliative care
• Information exchange / Shared decision making
• Uptake and evaluation of new cancer treatment technologies

Unit research focuses on identifying the need, developing interventions, and evaluating the effectiveness of these interventions or health services within the cancer system. Examples of research under the different themes are described below.

Supportive Cancer Care/Coordination of Care

The Unit conducted an extensive population based study of cancer patients’ supportive care needs, documenting continued unmet needs particularly for information, emotional and psychological support and symptom and pain management.  We have also studied current community models for supportive care delivery and found them wanting at both an administrative level and at the direct patient care level.  Currently, we are evaluating these models of care which now includes a provincial based randomized trial of a specialist supportive care nursing intervention for cancer patients in the community.  The cost effectiveness of such an approach as compared to alternative strategies will be important to evaluate.

Palliative Care

We are now working independently with other research groups to study palliative care delivery in the province including the systematic evaluation of palliative care of cancer patients in Ontario in their last year of life while at the same time identifying the current palliative care services and programs available and the enablers and barriers of such services that may affect their use.  Dr. Jonathan Sussman is an investigator in a CCO funded study looking at existing patterns of health resource usage in various regions and how this relates to the quality of palliative care. Unit investigators will lead studies of integration and processes of care – e.g. looking at the role of the family physician and enablers to promote their involvement in palliative cancer care.

Information Exchange / Shared Decision Making

Research conducted by the Supportive Cancer Care Unit identified problems with doctor/patient communication especially with regards to treatment decision-making.  We developed a unique visual decision aid used by physician and patients at the time of the cancer consultation to support treatment decision-making.  This aid, called the Decision Board, has been shown to improve patient comprehension, satisfaction and comfort with decision making.  We have now gone on to develop and evaluate computer based versions of this instrument for different cancer disease sites. 

Uptake and Evaluation of New Cancer Treatment Technologies

We studied the use of traztuzumab in metastatic breast cancer as a model for the introduction of new molecular targeted therapies for cancer.  In this line of research we evaluated different methods currently being used in the community for the assessment of HER2 neu status compared to testing in a central lab using IHC and FISH analysis.  We also evaluated the use of traztuzumab for these patients and whether or not they were consistent with current guidelines not only for Ontario but also in comparison to other provinces such as Quebec and British Columbia.  These results suggest that the methods for assessing HER2 in the community are reasonable provided the FISH analysis is used judiciously and that, at least for traztuzumab use, guidelines that are less restrictive and frequently updated will likely lead to appropriate and early use of such therapies.