CAGPO Clinical Training Scholarships in Cancer Care and Control
2015-2016
 
Common Interventional Radiology Procedures Used in the Care of Cancer Patients
 
Over the past year, I had the opportunity to spend one-week observing the Interventional Radiology team at Grand River Hospital, under the supervision of Dr. Darren Knibutat, Chief and Medical Director of Imaging at Grand River Hospital.  My educational objectives during this week were:
 
  • To gain a better understanding of the interventions that the radiologists can provide to our cancer patient population
  • To learn the indications and contraindications for each intervention
  • To learn about the risks and benefits associated with each intervention
  • To observe how the procedure is done
  • To learn appropriate pre- and post-procedural care
  • To learn about the limitations of each intervention
 
During the five days I spent at Grand River Hospital, I observed Dr. Knibutat performing insertions of percutaneous trans-hepatic biliary drainage catheters, percutaneous gastrostomy and gastrojejunostomy tubes, nephrostomy tubes, port-a-caths, and peritoneal catheters.  I also observed drainage of an intra-abdominal abscess and a kidney biopsy.  The cases were of varying complexity in both cancer and non-cancer in-patients and out-patients.  I was able to learn more about the whole patient experience, as I followed a cancer patient receiving a port-a-cath from their arrival at the hospital, meeting with the nurse and Dr. Knibutat to explain the procedure and obtain informed consent, observed the insertion of the port-a-cath, to post-procedural care and discharge home the same day.  I also learned what drugs are used during which procedures to ensure the patient is comfortable.  Another benefit from this experience was reviewing computed tomography and ultrasound images with Dr. Knibutat to determine his plan of action for the various cases.  For each of the procedures, I gained a better understanding of the required pre-procedural bloodwork, length of time to hold anticoagulants prior to the procedure, absolute and relative contraindications, necessary antibiotics, NPO restrictions, possible post-procedural complications, and on-going maintenance of the catheters/drains/tubes.    
 
By completing the above-described educational program, I can bring this information back to my GPO and nurse colleagues.  While in clinic or covering our in-patients, I will now have a better understanding of which patients might benefit from seeing the interventional radiologists for a procedure and refer them in a timely manner.  I will also be more prepared to answer questions from family doctors and community nurses regarding ongoing care of their patients who have catheters, drains or tubes.
 
I would like to thank CAGPO and Dr. Knibutat for providing me with this educational opportunity.  
 
Dr Sara C Hahn,
Kitchener, ON
 
 
     
 


CAGPO Scholarship
2014-2015

I had the privilege of being accepted as a candidate for the 2014-15 scholarship. I was predominantly interested in enhancing my skills and knowledge in After Care, Late effects and Long Term Follow Up of pediatric oncology patients. My intention was to hone my proficiency in order to have improved confidence in starting a Long Term Follow up Clinic in Sudbury, Ontario that is currently a satellite site for POGO. At this time, many of the childhood survivors are still required to attend late effects and long term follow up clinics in either Toronto or Ottawa. As these children grow up, the attendance to these follow up appointments significantly reduces. Unfortunately, due to lack of follow up these children often enter into adulthood with no follow up and often experience sequelae of their cancer treatments. Many reside in Northern Ontario with no family physician.
 
During my two week CAGPO scholarship elective, I chose to learn from the pediatric oncologists at CHEO. I had previously worked as a resident for them during an elective in my Palliative Care residency. I was able to attend the After Care and Late Effects clinics for children as well as the Long Term Care clinics for adult cancer survivors. I also met with their multidisciplinary team and gained better insight into the patient’s experience from the time that they are diagnosed to the time they become discharged to the adult clinic and beyond.
 
Specifically, I reviewed the Handbook of Supportive care in Pediatric Oncology as well as the 2014 COG guidelines for Long Term Care Follow Up of Cancer Survivors. I utilized these references to provide me with the knowledge required to manage patients.
 
Specifically, I also acquired better insight into the neurocognitive delays and deficits of patients whom are followed by the SAVTI team as well as management and education to provide to patients at risk of infertility who attend the Ottawa Fertility Clinic. I also was able to appreciate the manifestations of cardiomyopathy and the appropriate follow up guidelines recommended by the Ottawa Cardiac Institute.
 
Of particular importance, I had many educational moments but the most notable patient I met experienced Bleomycin toxicity as a child and I reviewed it’s clinical presentation and late effects guidelines. I also met many patients who were placed on high dose alkylating agents and antimetabolites with many complications as adults. Nonetheless, I also appreciated that many of the adults I met were unaware of their treatment and subsequently were unaware of the follow up required. I’d like to strive to improve this by providing my future patients with education and support early on in their transition to the Long Term Follow up Clinic to become advocates for their own health and become informed of their previous treatment and follow up requirements.
 
Overall, I feel very privileged to have been accepted to pursue this additional education experience. Not only did I enhance my skills and knowledge, I feel improved confidence to take on the Long Term Follow Up Clinic at the POGO satellite site in Sudbury, Ontario. My preceptors in Ottawa were beyond supportive and allowed me to ask many questions and shared much of their knowledge and experiences.

Dr Candice Walton
Sudbury, ON
 

 
     
 


CAGPO Scholarship
2014-2015

I am writing to thank the CAGPO Scholarship Committee and Board for awarding me a two-week scholarship to support my further training as a GP Oncologist.
 
I completed the two weeks of clinical attachments as proposed in my scholarship application and enclose the schedules for the time that I spent, first in August with the oncologists in Sydney NS whose Cape Breton Cancer Centre Program I represent here in Antigonish and then with the oncology and palliative care teams at the Bliss Cancer Centre in St John’s NL, in the week following the CAGPO conference there in October.
 
Both weeks were excellent learning and networking opportunities as I had the opportunity to spend time with medical / radiation oncologists, GPOs and palliative care physicians. I sat in on many outpatient clinics, attended grand rounds and also saw some oncology inpatients.
 
As mentioned in my presentation to the CAGPO conference, I feel that while I have benefitted personally and professionally from this broad experience, I will now be able to pass on this knowledge to the other members of my oncology and palliative care teams.
 
Thank you once again for your generous support.
 
Looking forward to seeing you all again next year in Lac Lemay!

Dr Phillip Cooper
Antigonish, NS
 

 
   
   

Report by Dr. Tatiana Golu (submitted November 3, 2013)

Final report : CAGPO Clinical Training Scholarships in Cancer Care and Control 2013-14

Thank you again  for granting me this scholarship for my GPO clinical training. I am proud to acknowledge that I have achieved my learning goals, as outlined below.

I completed  a total of just over  4 weeks of clinical training as follows:

1. Oncology/Chemotherapy Clinic at Guelph General Hospital:
    July 2-12, 2013 and Sep. 18-23, 2013 – under the supervision of Dr. Deborah Robinson.

2. Oncology Clinics at Grand River Regional Cancer Centre, Kitchener-Waterloo:
    Sep. 9- 17, 2013 – under the supervision of Dr. Gregory Knight.

Outline of achieved educational objectives and impact of training in my practice:

– My  GPO training included daily clinical exposure to various scenarios involving specific disease sites (mainly breast, lung, GI, GU, gynecologic, but also
   melanoma, lymphoma, neuroendocrine tumours)
– Through my clinical rotations in the oncology and chemotherapy clinics, I learned how the chemotherapy and other cancer drugs are prescribed, and then
    how to administer them.
– I learned the most common chemotherapeutic regimens and protocols , and standard OPIS orders
– I improved my assessment of patient’s condition to ensure  patient is clinically well   prior to receiving the chemotherapeutic agents
– I learned to assess and adjust dose of chemotherapy drugs based on renal function as well as patient’s response to prior treatments
– I practiced management of chemotherapy side effects  and dealing with chemotherapy complications
– I continued to perfect my previous knowledge of Pain and Symptom management
– I started  case-based learning format with my clinical mentor, Dr. Deb Robinson, to enhance my theoretical basis . This is an ongoing weekly/biweekly  
   process, through a small learning group at Guelph General Hospital , possibly in collaboration with Dr. Mary DiCarolis in the future.
– I had the opportunity to acquire information about evidenced-based resources that I can use in my daily GPO practice.

This training has prepared me for working in the Oncology clinic, although the learning process continues.

Dr. Tatiana Golu, CCFP
Hospital Medicine, Guelph General Hospital
 

 
     
 


Report by Dr. Mary DeCarolis
 (submitted 2013)

I am writing to inform CAGPO that I have completed my scholarship in compassion fatigue and burnout in oncology physicians.

I feel very privileged to have had the opportunity to dedicate three weeks of my time to research this very important topic.

With my supervisor, Francoise Mathieu,  I have researched and discussed the literature available to date.  I have recently given oncology rounds at Grand River Regional Cancer Centre (July 18, 2013).  The rounds were extremely well attended (the catered Indian Food and  ice cream sandwiches for dessert may have had something to do with it!) and the feedback to date has been very positive.  I have offered to speak to other groups, if so desired.  I truly hope that this Centre (and others) will actively address the aspects of burnout and compassion fatigue that are within their control.

I also look forward to speaking at the upcoming CAGPO conference.  Since Francoise has spoken on self-care previously, my emphasis will be to provide more of an overview of burnout, and what the physician, community and administration can do to intervene.

Sincerely,
Mary DeCarolis
 

 
     
 


Report by Dr. Lucie Blouin 
(submitted 10/27/11)

There were two parts to the CAGPO Scholarship that I was awarded in 2010.  The first part consisted of familiarizing myself with the more common Hematologic Malignancies and their management including performing bone marrow aspirations and biopsies and familiarizing myself with the chemotherapy protocols and their adverse effects.

The second part consisted of developing counseling and psychotherapy skills for helping cancer clinic patients cope with the emotional issues associated with their illnesses. I was awarded a scholarship for two weeks instead of the proposed four weeks.  Nevertheless, I did try to meet these objectives to some degree, albeit not fully.

Hematological Malignancies

I spent several sessions with one of the Peterborough Cancer Clinic’s medical oncologists learning how to perform bone marrow aspiration and biopsies.  I then began to perform these and received referrals from the hematological oncologists including Dr. Anthony Woods and Dr. Koushie Parasmothy.

However, the need for my services was short lived when a new hematologist arrived in Peterborough to take over the practice of the retired community hematologist. He assumed responsibility for this diagnostic procedure and appears to be meeting the demand for this service.  However, it may be that he might require my assistance in the future if his workload becomes too onerous.

I was also able to spend a short session with one of the hospital’s pathologist looking at bone marrow slides.  I would like to have a few more sessions with her or another pathologist as I think it would help me understand the malignancies better.

I attended the Princess Margaret Hospital Cancer Conference last fall for one day, mostly attending sessions on the hematologic malignancies  which included topics such as: New Agents and Approaches in Lymphomas, Evolving Therapy for Hematologic Malignancies including Myelodysplastic Syndrome, Myeloma and Leukemia and The Importance of Thrombosis in Cancer.

I did a lot of reading on the hematologic malignancies  – this included information available on the National Cancer Institute website as well as patient materials.

I spent two days in Ottawa – the first with a General Practitioner in Oncology who cares for patients in hospital who are undergoing autologous as well as donor stem cell transplants. The second day was spent with another GPO in the outpatient clinic seeing patients either before or after they had undergone their transplants.  This experience was very much appreciated as it gave me insight into the myriad of complications that patients undergoing this intervention face. Stem cell transplant has become a large part of managing a number of hematologic malignancies including multiple myeloma.

Lastly I have shadowed one of the hematologists on a couple of days in his oncology outpatient clinic to gain a practical understanding of the care of this population of patients, including use of transfusions and chemotherapy.  I would still benefit from a couple of more days of this kind of experience and have spoken to our new hematologist about shadowing him, as he is now the clinician caring for the bulk of these patients in our community.

This would allow me the opportunity to familiarize myself with his style of practice.
I have already been able to put my new knowledge and skills to use, covering for the hematologists in their absence due to conference leave, illness or vacation.  Our new community hematologist will soon be dropping a day in the Peterborough clinic to run a clinic at another   nearby community hospital and I anticipate that my services will be further required to cover for him when he is less available in our clinic.

Counseling / Psychotherapy Skill Development

I was less successful in meeting the objectives I set out in this part of my scholarship proposal.  I think that I did make some headway but the means by which I acquired some counselling skills had to be adjusted due to the fact that the courses I had hoped to take were not offered this past year by the GP Psychotherapy Association. These courses have been suspended indefinitely.

I therefore looked elsewhere and decided instead to enroll in the Foundations and Tools course offered in Medical Cognitive Behaviour Therapy by Dr. Greg Dubord (Canada CBT).

This course was developed by Dr. Dubord specifically with busy medical practitioners in mind.  It helps us to develop skills that we can easily incorporate into a typical patient encounter that will enable us to help our patients deal with maladaptive behaviours. These include behaviors that might be interfering with a patient embarking on treatment that would be beneficial to them.  I found the course to be very practical and very helpful in day to day patient encounters.

It was not what I envisioned when I made the scholarship proposal. I envisioned learning skills that I could use during an appointment dedicated to helping patients address their emotional issues.  Instead this course provided “tools” that could be used during a regular clinic appointment.  The “medical cognitive behavior therapy” could then be followed up in subsequent appointments, either set aside for this purpose or as part of a regular follow-up appointment for cancer or chemotherapy. I did feel that the course was worthwhile and plan to take another course offered by Dr. Dubord specifically addressing Anxiety and Depression.

These courses are combined with the opportunity to vacation and in my case I had the added benefit of spending time on the beautiful “Garden Hawaiian Island of Kauai.

I want to very much thank CAGPO for giving me the opportunity to embark on these learning opportunities. The scholarship made it possible for me to develop these new skills that I think will benefit my patients and community.