Understanding Early Age Onset Cancer Patient Priorities and Barriers to Detection and Diagnosis: Survey Findings

CCRAN, in collaboration with multiple other advocacy organizations representing different cancer types, launched a survey to capture patients' priorities and healthcare experiences regarding an early age onset cancer diagnosis. As this is a national survey, information will be reported by province and cancer type.

This session will provide an overview of the survey results, including:

• Early age onset patients' reported priorities regarding information, resources, support, and care needs during the detection and diagnostic phases

• Information about their reported healthcare experiences during these phases of their cancer journey, including patients' experiences related to receipt of medical information and advice

• Access to and barriers impacting timely, appropriate care.

Presentations

Dr. Monika Slovinec D'Angelo, Ph.D.

Health Scientist, VBHC Expert, Chief Research Officer, CCRAN

Cassandra Macaulay, B.Sc., MHS, RTNM

Deputy Chief Research Officer, CCRAN

Filomena Servidio-Italiano, Hon B.Sc., B.Ed., M.A.

President & CEO, CCRAN

Understanding the Increased Prevalence and Underlying Factors of Early Age Onset Cancers

Cancers previously diagnosed in older adults are being increasingly diagnosed in people under 50, researchers are working to tease apart the reasons why. Furthermore, progeny of early age onset cancers (EAOC) is at a higher risk of developing EAOC's. This session will address key questions about the increased incidence of early age onset cancers, including questions related to environmental and lifestyle factors associated with the rising rates.

Experts will speak to:

• Global trends and known risk factors

• Evidence-based risk factors pertinent for different types of cancers

• Preventive measures for reducing the risk of disease at a young age across cancer types, including population health surveillance and health promotion strategies

Moderator

Christopher Mammoliti, BComm (Hons)

EAOC Patient Expert; Thyroid Cancer Survivor & Stage 4 Colon Cancer Survivor

Patient

Jason Abramovitch

Early Age Onset Metastatic Colorectal Cancer Survivor Under Surveillance

Panelists

Dr. Darren Brenner, Ph.D.

Armstrong Investigator in Molecular Epidemiology; Associate Professor, Departments of Oncology and Community Health Sciences; Division Head – Preventive Oncology; Director of Research – Forzani & MacPhail Colon Cancer Screening Centre; Director – Cancer Screening, Detection and Risk Reduction Program, University of Calgary

Dr. Meg Sears, Ph.D.

Chair, Prevent Cancer Now; Sr. Research Associate, Ottawa Hospital Research Institute

Dr. Tomotaka Ugai, MD, Ph.D.

Faculty Member, Cancer Epidemiology Program, Dana-Farber / Harvard Cancer Center; Chair of International Cancer Spect

m Consortium; Principal Investigator in Early-Onset Cancer (EOC) Program; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School; Department of Epidemiology, Harvard T.H.

Chan School of Public Health

Recommendations for Early Age Onset Cancer Screening Programs: Opportunities for Collaborative Advocacy Efforts

After significant advocacy efforts, the breast cancer screening eligibility has been reduced to 40 in Canada, though variability in access remains controversial. Decisions around earlier screening for lung and colorectal cancer are lagging, and timely screening in general for many other cancers is almost non-existent, particularly among younger individuals.

Experts from patient advocacy organizations will elaborate on critical issues related to current screening processes for different types of cancer and will identify advocacy priorities for population-based screening programs, including overarching themes across cancer populations. Opportunities for collaborative advocacy efforts will be explored, including how progress made in breast cancer screening could be leveraged to benefit other cancer populations.

Patient advocacy experts will address:

• How advocacy efforts impact policy, highlighting opportunities for lowering the screening age and improving diagnostic care pathways across cancer types

• Inter-provincial disparities in screening practices and policies, within the context of variable recommendations across jurisdictions.

• Ideal processes for population-based screening programs to reach both those who are higher risk and those who are asymptomatic and/or at average risk of disease

• Opportunities to build on existing advocacy initiatives and collaborative efforts

Moderator

Jenn Gordon

Lead, Strategic Operations and Engagement, Rethink Breast Cancer

Panelists

Teresa Tiano

Chair and Co-Founder, My Gut Feeling; Stomach Cancer Survivor and a 9-Time Cancer Survivor

Cassandra Macaulay, B.Sc., MHS, RTNM

Deputy Chief Research Officer, CCRAN

Michele Wright

Coordinator, Patient Care Initiatives, Lung Cancer Canada

Ken Noel

Executive Director, The Walnut Foundation; Black Prostate Cancer Survivor

Kathleen Barnard

Founder and President, Save Your Skin Foundation (SYSF)

Brenda Clayton, MN

President & Founder, Cholangio-Hepatocellular Carcinoma Canada; Caregiver of Daughter who succumbed to Early Age Onset Cholangiocarcinoma

Prioritizing Timely and Equal Access to Diagnostic Testing in Cancer Care: Examining Policy Options

Timely access to diagnostic testing has been an ongoing issue for Canadians for years. With a shortage of medical imaging equipment and a lack of sufficient health human resources, patients face excessively long wait times for lifesaving procedures.

Experts will discuss system-level issues that contribute to the diagnostic backlog in cancer care across provinces, with an emphasis on factors that could be bolstered to improve the timeliness of diagnosis among younger adults. Policy priorities for optimizing diagnostic pathways for adults under the age of 50 years will be discussed. Speakers will address:

• The importance of timely diagnostic services in cancer care pathways, with a focus on early age onset cancers

• Current state of cancer diagnostics across regions in Canada and health human resource and equipment gaps that contribute to diagnostic delays

• Policy options for improving timely diagnosis of early age onset cancers, including application of AI to streamline diagnostic referral processes

Moderator

Dr. Monika Slovinec D'Angelo, Ph.D.

Health Scientist, VBHC Expert, Chief Research Officer, CCRAN

Patient

Sam Karikas

Invasive Ductal Cell Carcinoma Patient

Panelists

Dr. Darren Larsen, MD, CCFP, MPL

Chair, Cancer Quality Council of Ontario; Board Chair Elect, Canadian Partnership Against Cancer; Senior fellow, Women's College Hospital Institute for Health System Solutions and Virtual Care; Lecturer, Department of Family and Community Medicine and Institute for Health Policy, Management and Evaluation, University of Toronto

Dr. Ania Kielar, MD, FRCPC, FCAR

President, Canadian Association of Radiologists

Michelle Hoad

CEO, Medical Laboratory Professionals' Association of Ontario (MLPAO)

Dr. Jason Karamchandani, MD

Associate Professor, Departments of Pathology, Neurology and Neurosurgery, McGill University; President, Canadian Association of Pathologists

Using Technology to Expand Cancer Screening

To boost colorectal cancer screening rates in her practice, Dr. Gorfinkel developed an automated cancer screening tool. Implementation of this tool through Electronic Medical Record (EMR) in her family medicine practice has increased screening rates significantly without contributing to physician burden. The application of this digital tool facilitates broader screening of patients by removing barriers such as the need for in-person visits and lack of physician time. Opportunities for expanding this tool to younger patient populations and cancer type

will be discussed.

Presentation

Dr. Iris Gorfinkel, MD, CM

Principal Investigator and Founder, PrimeHealth Clinical Research

Advocating for Prompt Detection and Diagnosis of Early Age Onset Cancer

Early age onset cancers tend to exhibit more aggressive characteristics, making prompt recognition and management of symptoms crucial for improving outcomes. These cancers often grow more quickly and may be diagnosed at a later stage, leading to poorer prognoses.

Patient advocates with lived cancer experience from different tumour types will share their personal and expert perspectives on cancer screening and diagnostic pathways in Canada. They will reflect on how the timing of their cancer detection impacted their disease trajectory, the factors that impeded a swift diagnosis, and their resulting healthcare experiences and quality of life. A clinical diagnostic expert with experience in both urban and rural environments will address the barriers that lead to diagnostic delays and discuss approaches for enhancing the timeliness of cancer diagnoses. This will include an examination of systemic issues and factors related to healthcare delivery, and effective cancer screening models.

The discussion will highlight challenges with the cancer diagnostic experience from a patient and healthcare provider point of view and opportunities for improving timely and equitable diagnosis of early age onset cancer in Canada, including the role of patient advocacy and scalability of existing screening and diagnostic models and processes across cancer types and geographic regions.

Moderator

Laura Greer

Senior Vice President and National Health Sector Lead, Health and Wellness, Hill & Knowlton; Breast Cancer Advocate

Panelists

Christopher Mammoliti, BComm (Hons)

EAOC Patient Expert; Thyroid Cancer Survivor & Stage 4 Colon Cancer Survivor

Joanne Nagy

Stage 2 Invasive Ductal Carcinoma Patient, Triple Positive

Katie Hulan

Lung Health Advocate; Early Age Onset Stage 4 ALK Positive Lung Cancer Patient

Thomas Flannery, B.Sc., MBA

Stage 4 Prostate Cancer Patient; Prostate Cancer Foundation Canada

Elise Gasbarrino

Founder & Executive Director, Pink Pearl Canada; Early Age Onset Ovarian Cancer

Dr. Neety Panu, MD, FRCPC, CRCP(C)

Lead Radiologist, Sioux Lookout Meno Ya Win Health Centre

Closing Remarks. Glance at Day 2. Thank You.

Filomena Servidio-Italiano, Hon B.Sc., B.Ed., M.A.

President & CEO, CCRAN

The Role of Psychosocial Support for Young Adults Living with Cancer and Their Families

Patients diagnosed with cancer at an earlier stage in adulthood face unique emotional and psychological challenges related to disruptions in their family life, personal goals, education, career, social relationships, financial status, and future planning. Moreover, young adults often lead complex lives as they are building their careers and families, and may lack the resources (time and financial) to help alleviate the burden of a cancer diagnosis, navigating healthcare, and paying for diagnostic and therapeutic interventions that are not covered publicly. This combination of factors contributes to heightened emotional distress in this patient population.

This session was designed to highlight the unique existential and psychosocial experiences of early age onset cancer patients, particularly those diagnosed with metastatic disease, and the psychosocial supports they seek, are able to access, and find helpful at different phases of their disease trajectory. The impact of a late- stage diagnosis on an individual's clinical and mental health outcomes, as well as a person's social and family environment will be considered in the context of support needs.

Experts in clinical and psychosocial care will speak to the support needs they are encountering with young onset cancer patients in their practice and research, how these needs vary depending on disease stage, and how psychosocial interventions can be effectively and optimally incorporated into cancer care at the healthcare provider and organizational level. They will also speak to the profiles of individuals who seek out psychosocial supports and the importance of raising awareness around the psychosocial needs of this patient population and the role of supports.

Moderator

Dr. Petra Wildgoose, MD, CCFP, MPH

Primary Care Physician and Lead, Young Adult Colorectal Cancer Clinic, Odette Cancer Center, Sunnybrook Health Sciences Centre

Panelists

Julia Girmenia

Key Collaborator, Rethink Breast Cancer; Stage 4 Early Age Onset Inflammatory Breast Cancer Patient

Kathryn Hum

Patient Advocate; Early Age Onset De Novo Metastatic Breast Cancer Patient

Anwar Knight

Award-Winning Broadcaster, Producer & Environmentalist; Hodgkin's Lymphoma Survivor

Psychosocial Support Experts

Dr. Mary Jane Esplen, Ph.D.

Professor, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto

Dr. Sasha Mallya, Ph.D., R.Psych

Clinical Psychologist, Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary

Rachelle Kosokowsky, BA, BSW, MSW, RSW 

Clinical Oncology Social Worker, Saskatchewan Cancer Agency

Dr. Karine Bilodeau, RN, Ph.D.

Associate Professor, Faculty of Nursing, University of Montreal; Researcher, Maisonneuve-Rosemont Hospital Research Centre

The Role of the Gut Microbiome in Cancer Treatment

A medical oncologist and clinician scientist with an expertise in immunotherapy and the microbiome. Dr. Elkrief will provide an overview of the gut microbiome role in cancer treatment. The audience will learn about factors that impact and alter the gut microbiome, and its function, in terms of the role in plays in influencing the effectiveness of cancer therapies, specifically immunotherapies. The following topics will be addressed:

• General information about the gut microbiome, factors that influence & modify the microbiome

• The role of the gut microbiome in cancer treatment, specifically immunotherapy, and its relation to melanoma and lung cancer

• Active clinical trials investigating the role of the microbiome

in lung cancer and melanoma.

Presentation

Dr. Arielle Elkrief, MD

Assistant Professor, Dept. of Hemato-Oncology, The University of Montreal Hospital Research Centre; Co-Director, CHUM Microbiome Centre

What's New in the Management of Metastatic Cancer?

Cancer diagnosed in younger persons is typically more aggressive and more likely to be metastatic, requiring more aggressive treatments. Given their potential to live many more years, younger patients may have a higher risk tolerance and be open to experimental or cutting-edge treatments that can improve their longevity and quality of life. The prospect of novel therapies that promise fewer side effects and better management of their disease, even offering a cure or significant improvement in survival, is a powerful motivator for this patient population.

Targeted therapies that minimize damage to surrounding healthy tissue and reduce the risk of short- and long-term side effects may be of particular interest.

In this session, clinical experts in various cancer types will discuss novel therapies in the management of metastatic cancer that are especially appropriate among patients under the age of 50 years.

Experts will speak to:

• Therapies effective in the management of metastatic cancers

• Key therapeutic advancements that are improving treatment outcomes among young cancer patients in their practice

• The role of comprehensive genomic profiling (CGP) and ctDNA in the application of cutting-edge therapies to significantly improve the patient care trajectory

Moderator

Dr. Joseph C. Del Paggio

Medical Oncologist and Chief of the Department of Oncology, Thunder Bay Regional Health Sciences Centre - Regional Cancer Centre

Clinician Roundtable

Dr. Christine Brezden-Masley, MD, Ph.D., FRCPC 

Medical Oncologist & Assistant Professor, Chair of the HPB Cancer Disease Site Group Halifax, Division of Medical Oncology and Department of Community Health and Epidemiology, Nova Scotia Cancer Centre & Dalhousie University

Dr. Ravi Ramjeesingh, MD, Ph.D., FRCPC

Medical Oncologist & Assistant Professor, Chair of the HPB Cancer Disease Site Group Halifax, Division of Medical Oncology and Department of Community Health and Epidemiology, Nova Scotia Cancer Centre & Dalhousie University

Dr. Helen MacKay, MBChB, B.Sc., MRCP, MD 

Medical Oncologist, Odette Cancer Center, Sunnybrook Health Sciences Centre; Head, Division of Medical Oncology & Malignant Hematology, Odette Cancer Center, Sunnybrook Health Sciences Centre; Senior Scientist, Sunnybrook Research Institute; Professor, Temerty Faculty of Medicine, University of Toronto

Dr. Ronald Burkes, MD, FRCPC

Professor of Medicine, University of Toronto; Medical Oncologist, Mount Sinai Hospital/ Princess Margaret Cancer Centre/ University Health Network

Dr. Pashtoon M. Kasi, MD, MS

Medical Director, GI Medical Oncology; Associate

Clinical Professor, Department of Medical Oncology & Therapeutics Research, City of Hope, Orange County, California

Dr. Jose Perea, MD, Ph.D.

Chief, Department of Surgery, Vithas Arturo Soria University Hospital; Professor of Surgery, European University of Madrid; Principal Investigator, Institute of Biomedical Research of Salamanca

Streamlining Younger Cancer Patients' Clinical Care pathways: The Value of Advanced Biomarker Testing

A cancer diagnosis for adults under 50 carries unique challenges due to their various life demands. Streamlining cancer care trajectories improves patients' care experiences and quality of life, reduces the societal burden of disease, and reduces healthcare costs. Precision diagnostics and treatment, enabled by advanced biomarker testing such as comprehensive genomic profiling (CGP), offers the potential to streamline care by enhancing treatment decisions. Access to CGP in Canada is limited, however, and not yet accepted as standard care. This session highlights the systemic barriers hindering streamlined cancer care in the Canadian healthcare landscape from the clinical, patient, and systems perspective, and examines the value of advanced biomarker testing in optimizing cancer care pathways for early age onset cancer patients.

Speakers will elaborate on the following topics:

• Benefits of advanced molecular testing in optimizing diagnostic and treatment pathways and its implementation in Canadian healthcare

• Timeliness of access to appropriate cancer treatment and the role of companion diagnostics

• Value of advanced molecular testing for early age onset cancer patients and for systems

• Use of real-world evidence to inform the implementation of CGP in cancer care pathways

Moderator

Dr. Cathy Eng, MD, FACP, FASCO

Vanderbilt-Ingram Cancer Center, Nashville, TN; David H. Johnson Chair in Surgical and Medical Oncology; Professor of Medicine, Hematology and Oncology; Director for Strategic Relations; Co- Director, GI Oncology; Co-Leader, Gastrointestinal Cancer Research Program; Director, Young Adult Cancers Program; Co-Chair, NCI Gastrointestinal Steering Committee

Patient

Suzanne Wood

Early Age Onset Stage 4 Colon Cancer Patient

Panelists

Dr. Shaqil Kassam, MD, M.Sc., FRCPC 

Medical Oncologist, Stronach Regional Cancer Centre

Dr. Shantanu Banerji, B.Sc. (Med), MD, FRCPC 

Medical Oncologist, CancerCare Manitoba, MacCharles Site; Senior Scientist, Research Institute in Haematology and Oncology, CancerCare Manitoba; Director, Precision Oncology and Advanced Therapeutics, CancerCare Manitoba; Assistant Professor, Department of Internal Medicine, Section of Haematology/Oncology, University of Manitoba

Dr. Monika Slovinec D'Angelo, Ph.D.

Health Scientist, VBHC Expert, Chief Research Officer, CCRAN

Dr. Robert Grant, MD, Ph.D., FRCPC

Medical Oncologist, Princess Margaret Cancer Centre, University Health Network; Hold'em for Life Professor in Cancer Research, Temerty Faculty of Medicine, University of Toronto; Assistant Professor, Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Associate Member, Institute of Medical Science, School of Graduate Studies, University of Toronto ; Adjunct Scientist, ICES; Associate, Ontario Institute for Cancer Research

Unlocking the Potential of Your Tumour's Biomarkers Status: A Novel Tool to Identify Targeted Treatments and Clinical Trials

Younger patients are often keen to explore innovative precision medicine treatment options and clinical trials. Founded by a cholangiocarcinoma survivor, Genomic Focus is a free online tool which helps patients find personalized treatment options and clinical trials to manage their cancer and highlights the pivotal role of genomics in revolutionizing cancer outcomes.

The following will be addressed:

• How patients can better understand their tumour's biomarkers status

   

• The online tool's ability to identify potential clinical trials and available targeted therapies both within and outside of Canada

Presentation

Matt Reidy

Founder, Genomic Focus; Long-term, Stage 4 Cancer Survivor

The Importance of Information Sharing and the Role of Patient Groups in Promoting Health Equity

Navigating cancer as an early age onset patient can be an incredibly difficult journey. Patients from marginalized groups may face additional challenges and isolation throughout their cancer journey and it is imperative that the landscape continually identifies and implements the resources necessary to improve all outcomes.

The following will be addressed in this session:

• System-level inequities & challenges patients have encountered within their personal cancer care journeys

• How the strategies, tools and efforts of patient groups have served to address systemic barriers to equitable access.

• Explore policy options and advocacy efforts aimed at improving equitable access to timely cancer care, particularly during the detection and diagnostic phases.

Moderator

Michelle Audoin

Patient Advocate and Community Collaborator; All.Can Canada Evidence Working Group; Thyroid Cancer and Metastatic Breast Cancer Patient

Panelists

Dr. Amanda Bolderston, RTT, FCAMRT

Co-founder, Queering Cancer

Anthony Henry, B.A.(Econ.)

President, The Walnut Foundation

Jenn Gordon

Lead, Strategic Operations and Engagement, Rethink Breast Cancer

Bukun Adegbembo, M.Sc.

Director of Operations, Canadian Breast Cancer Network

Frank Pitman

Outreach and Volunteer Coordinator, CCRAN

Michele Wright

Coordinator, Patient Care Initiatives, Lung Cancer Canada

Madison Fullerton

Vice President, Operations & Community

Partnerships, Praxus Health

Closing Remarks for Day 2 and Symposium. Thank you.

Filomena Servidio-Italiano, Hon B.Sc., B.Ed., M.A.

President & CEO, CCRAN