QEII Foundation supports improvements in cancer care surgeries for surgeons, patients and the health care system

Dr. Martin Bullock, QEII Division of Anatomical Pathology
Dr. Martin Bullock, QEII Division of Anatomical Pathology

Medical research is conducted with the overarching goal of improving people’s lives. But the value of research isn’t fully realized until research teams translate the science into treatment and care. 

Nobody understands this better than the QEII Health Sciences Centre (QEII) in Halifax, Nova Scotia. 

The QEII Foundation Translating Research Into Care (TRIC) grants fuel direct and positive changes for health care, including better patient outcomes, reduced wait times and improved access to care. 

They provide the opportunity for researchers to collaborate with health system administrators and patients to improve the way health care is delivered in Nova Scotia.

TRIC grants help turn science and theory-based ideas into improved practice and clinical innovation. They are made possible by donors who believe in the power of research to advance health care. 

Dr. Matthew Rigby, Nova Scotia Health researcher and QEII Head and Neck Oncology surgeon, is part of a team working to close that gap between evidence and practice with the help of a 2019 QEII Foundation TRIC grant. 

Along with Dr. Martin Bullock, Division of Anatomical Pathology at the QEII, and Dr. Laurette Geldenhuys, Division Head, Anatomical Pathology at the QEII, Dr. Rigby is conducting a study to assess whether a surgical protocol that proved remarkably successful for head and neck tumors will also improve care for patients with unknown primary tumors. 

For decades, patients who presented with cancer of the head and neck followed a fairly predictable pattern – over 60 years of age, heavy smokers and/or drinkers, with underlying health conditions. 

Non-smokers who developed throat cancer were quite rare. But over the years, oncologists began to notice an alarming rise in throat cancer in younger, otherwise healthy patients.

Around 2007, Nova Scotia was seeing an annual average of 145 new cases of mouth, throat or voice box cancer. The data suggests that by 2028, that number is projected to be as high as 220 cases per year in the province. 

Dr. Rigby observed that trend. “Head and neck cancer rates are pretty stable. But if you look more closely, you’ll find cancers in the front of the mouth, tongue and voice box are going down. But the back of the tongue and tonsil rates are skyrocketing. That’s HPV.”

Human Papillomavirus (HPV) has been around since the 1960s, and we’ve known for years that it can cause cervical cancer in women. We now know that it also causes throat cancer in men and women.

According to Dr. Rigby, “Cancers in the tonsils and tongue base are often in the folds lymphoid tissue where there is a lot of surface area. You can have a cancer growing that you can’t see or feel because it’s so small, but it can quickly spread to a node in your neck.”

That is an unknown primary tumor – where the cancer is detected in a neck node, but the oncologist doesn’t know where it originated.

Back to the study – a few years ago, the same team of researchers conducted a QEII Foundation TRIC-funded study that saw remarkable improvements in the success rate of head and neck tumor surgeries through interoperative assessment. 

Surgeons would remove a tumor with a good margin and send the entire thing to an adjacent pathology lab while the patient remained in the operating room. Pathology results would let them know there and then if they needed to resect more of a margin, or if they could close the patient up. 

Under the old protocol, surgeons would send just a strip of tissue to pathology to be examined and wait, sometimes for weeks, to find out there if was a positive margin – less than ideal for the surgeon, the patient or the health care system. 

Finding an unknown primary can be challenging. Clinically speaking, it’s most likely the tumor is in the tonsil. 

According to Dr. Martin Bullock, Co-PI on this study, “That’s where they’re looking for these tumors in patients who fit the profile of HPV-mediated tonsillar cancers.” Once the surgeon removes the tonsil, Dr. Bullock and his team of pathologists and lab technologists prepare and examine the tissue on the spot, find the tumor and check the margins for cancer cells. 

According to Dr. Laurette Geldenhuys, it’s also a win for the health care system.

As medical co-lead, her main role is to ensure the pathology policies and procedures were fully implemented for the new process; and to monitor the time it took for each procedure to determine if the experimental protocol would have a significant impact on the system. 

“It’s actually had a great outcome. Most importantly, it improves survival rates among patients, and seems to have very little impact on the laboratory side – the increase in human resources that was required was very small.”

This article was originally published in Nova Scotia Health Research and Innovation annual report 2020 (pdf)