DAY 1: THE VALUE OF EARLY DETECTION ACROSS MULTIPLE TUMOR TYPES
Symposium Day 1 Opening Welcome and introduction to CCRAN Welcome from CCRAN's President Calls to action from October 2022 Symposium Objectives for this year's Early-Age Onset Cancer Symposium	Dr. Monika Slovinec D'Angelo, Ph.D. Health Scientist, VBHC Expert, Chief Research Officer at CCRAN Ms. Filomena Servidio-Italiano, OCT, M.A. President & CEO, CCRAN Mr. Allen Chankowsky Cancer Patient Advocate
Key Learnings from CCRAN's 2021 and 2022 EAOCRC Symposia Authors of publications produced from CCRAN's prior Early Age Onset Cancer symposia will speak to the key messages and outcomes from these scientific events. Updates on action items identified at last year's Symposium will be shared.	Dr. Michael Raphael GI Medical Oncologist, Odette Cancer Center at Sunnybrook Health Sciences Center Dr. Clarence Wong Gastroenterologist, University of Alberta
The Global Trend in Early Onset Cancer Since the 1990s, an increase in the incidence of early-onset cancers has been documented globally. Upward trends in early onset cancer diagnosis are documented across different cancer types, including breast, prostate, thyroid, colon, esophagus, kidney, liver, and pancreas. The most common cancers vary by age group and sex. Lead authors of the publication “Is early- onset cancer an emerging global epidemic? Current evidence and future implications” (Nature Reviews Clinical Oncology, September 2022, 19(10):1-18) will deliver findings from their research and perspectives on the global trends in early-onset cancer from their clinical experience.	Dr. Tomotaka Ugai, M.D., Ph.D. Instructor, Harvard Medical School, Brigham and Women's Hospital/Harvard Medical School; Faculty Member, Cancer Epidemiology Program, Dana-Farber / Harvard Cancer Center
Health Break	AYA CAN Video
System-Level Challenges to Accessing Screening and Timely Diagnosis for Early-Onset Cancers Patients with early-onset cancer face unique challenges throughout the entire cancer care continuum, from investigation and diagnosis, through treatment to survivorship or end-of-life care. Leads from patient advocacy organizations representing individuals affected by lung, breast, cervical, ovarian, colorectal, and pancreatic cancers will speak to key challenges faced by young adult patients with respect to timely screening and diagnosis, including: o Needs of early onset patients o Uptake of screening among those over and under 50 years of age and strategies to promote screening programs. o Screening programs currently available to people under 50 in Canada (i.e., for cervical, breast, lung, colorectal cancers) o Intra- and inter-provincial differences in access to cancer screening for those under 50 years of age o Opportunities to scale successful screening programs (e.g., early detection program for ovarian cancer at Princess Margaret Hospital) and institute new programs where they currently do not exist. Commonalities with respect to system-level access challenges across cancer types and opportunities for collective efforts to address common priorities and ensure early diagnosis will be discussed.	Moderator Ms. Martha Raymond Executive Director, GI Cancers Alliance Inc. (US) Panel Colorectal Cancer: Ms. Filomena Servidio-Italiano, M.A. President & CEO, CCRAN Lung Cancer: Ms. Michele Wright Patient Support Initiatives Coordinator, Lung Cancer Canada Breast Cancer: Ms. MJ DeCoteau Founder & Executive Director, Rethink Breast Cancer Cervical Cancer: Ms. Teresa Norris Founder and President, HPV Global Action Ovarian Cancer: Ms. Elise Gasbarrino Founder + Executive Director Pink Pearl Canada Pancreatic Cancer: Ms. Stefanie Condon-Oldreive President & CEO, Craig's Cause Pancreatic Cancer Society
Lunch Break	Video: Count Me In Project, Mary McGillicuddy, Manager, Advocacy Groups, Count Me In
Identifying and Addressing the Psychosocial Needs of Younger Cancer Patients Across the Continuum of Care Younger patients (under the age 50 years) are at a different stage in life and have unique concerns and challenges related to their cancer journey. In this session, patients afflicted with young-onset cancer will speak to their cancer journeys. This sharing of personal experiences will serve to highlight the unmet needs relevant to younger patients and the importance of a multidisciplinary care approach to adequately support this patient population. Through moderation, the session will provide insights on when and how the unique psychosocial needs of young adult cancer patients can be addressed, including their: General wellbeing and quality of life Stigma associated with a cancer diagnosis at an early age Fears and anxiety surrounding toxic treatment options and long-term side-effects Benefits of some novel treatment modalities in the context of psychological wellbeing Apprehensions around initiating return to work and the fear of resuming a career Worries around survivorship Concerns around intimacy, sexuality, fertility preservation (i.e., sperm/egg banking) concerns, and challenges around raising a young family	Moderator Ms. Marlie Smith Clinical Nurse Specialist, AYA Oncology Program at Princess Margaret Hospital Presentation: Dr. Abha Gupta Medical Director, AYA Oncology Program at Princess Margaret Hospital Panel Colorectal Cancer Journey: Ms. Jessica Dasler Colon cancer patient Breast Cancer Journey: Ms. Alyson Geary Breast cancer survivor and Lead, Impact Partnerships, Support + Community Powered Projects, Rethink Breast Cancer Lung Cancer Journey: Ms. Lindsay Hlushak Lung cancer survivor Cervical Cancer Journey: Ms. Joanna Kirsh Cervical cancer patient Cholangiocarcinoma Journey: Ms. Teresa Holmes Caregiver and Co-Founder, Hepatocellular Cholangiocarcinoma Canada
From Detection to Diagnosis, Treatment and Survivorship: Tailoring Care to the Needs of Young-Onset Cancer Patients Recognition of the unique challenges of young-onset cancer patients point to the importance of tailored care models in effectively addressing those needs. Currently, for adult cancers, disease management and treatment protocols are the same regardless of patient age. The unique supportive care needs of young adult patients are not included in pediatric or adult care models. Anxiety around accessing not only therapeutics, but also diagnostics, such as imaging, in a timely manner to help diagnose cancer in young patients is a critically important unmet need and psychosocial issue for young cancer patients. It is pertinent to consider how clinical care can be optimized for the young-onset cancer population to attain better outcomes, enhance quality of life, and improve system efficiencies. Clinical experts will provide perspectives and recommendations on how cancer care can be tailored to meet the specific needs of young adult patients. For example, through integrated models that enable care delivery at critical points in the cancer care trajectory. Issues, such as the long-term physical consequences of cancer treatment on this patient population, the tendency to overtreat in some young onset cancers, implications on general wellbeing, and opportunities for innovative therapeutic approaches will be discussed.	Moderator Dr. Petra Wildgoose Family Physician and Lead, Young Adult Colorectal Cancer Program at Odette Cancer Centre, Sunnybrook Health Sciences Centre Medical oncologists: Colorectal Cancer Dr. Safiya Karim Medical Oncologist and Clinical Assistant Professor, Tom Baker Cancer Centre, University of Calgary; Medical Director, Integrative Oncology Clinic Lung Cancer Dr. Shaqil Kassam Medical Oncologist, Southlake Stronach Regional Cancer Centre Breast Cancer Dr. Nancy Nixon Medical Oncologist, Tom Baker Cancer Centre, Calgary, AB Gynecologic Cancers Dr. Sarah Hamilton Radiation Oncologist, BC Cancer Agency Pancreatic Cancers Dr. Ravi Ramjeesingh Medical Oncologist, Nova Scotia Cancer Centre & Dalhousie University Radiology Perspective: Dr. Ania Kielar President, Canadian Association of Radiologists
Health Break	VIDEO: Dr. Brandon Sheffield, Molecular Pathologist
How Do We Achieve Timely Diagnostic Testing? What is the Role Of Real-World Evidence? Earlier diagnoses can be key to improving cancer outcomes, including survival, for some cancers, such as melanoma, colorectal and cervical cancers. As such, cost-effective, population-based approaches to early detection drive value in healthcare for patients, healthcare providers, and systems. There are barriers to achieving equitable access to strategies (e.g., advanced diagnostics) that enable timely diagnoses. Furthermore, policy and regulatory decisions around access to screening and diagnostic testing are driven by robust analyses of costs and benefits, but availability of reliable data is often a limitation. In this session, experts will speak to: The role of advanced diagnostics, including comprehensive genomic profiling (CGP), circulating tumour DNA (ctDNA), and diagnostic imaging, that enable timely management and optimal treatment pathways for early onset cancer. Systemic factors that lead to diagnostic access issues. The role of evidence in decision-making around screening strategies, diagnostic pathways and technology assessments. The value, utility and acceptance of real-world evidence, including patient reported outcomes, in decision-making and promoting access to timely diagnosis.	Moderator Mr. Don Husereau, BSc. Pharm MSc. Health Economist, Faculty of Medicine, University of Ottawa Panel VBHC Expert Dr. Monika Slovinec D'Angelo, Ph.D. Health Scientist, VBHC Expert, Chief Research Officer at CCRAN Medical Oncologist: Dr. Ravi Ramjeesingh Nova Scotia Cancer Centre & Dalhousie University Pathologist: Dr. Aaron Pollett Anatomic Pathologist, Director of Division of Diagnostic Medical Genetics, Mount Sinai Hospital HTA Perspective Ms. Sylvie Bouchard Director, INESSS Health System Perspective Dr. Helen Anderson MBchB, FRACP, MD, FRCPC Provincial Medical Director, Systemic Therapy at BC Cancer, Provincial Health Services Authority
Accessing Clinical Trials for the Management of Advanced Disease Across Multiple Tumor Types Patients want to know how to manage their disease once they exhaust standard of care therapies. Clinical trial experts will discuss opportunities presented to cancer patients through clinical trials as well as the associated benefits to Canadian healthcare. In this session speakers will share information about how patients can navigate the clinical trials landscape, including resources that are available for them to access to help inform thoughtful discussions with their treating oncologists. A cancer patient testimonial will inspire this discussion and a U.S. based foundation will share their work in this space to provide insights on how access to clinical trials is being facilitated in the U.S. landscape.	Moderator Dr. Monika Slovinec D'Angelo Presentations Dr. Dawn Richards, Ph.D. Founder of Five02 Labs Inc. (Clinical Trials Finder in Canada) Director of Patient and Public Engagement at Clinical Trials Ontario Dr. Stephanie Michaud, Ph.D. President BioCanRX Dr. Eric Chen GI Medical Oncologist, Clinical Trials Investigator Princess Margaret Cancer Centre Dr. Stephanie Michaud, Ph.D. Mr. Allen Chankowsky Cancer Patient Advocate Mr. Jim Palma Executive Director, TargetCancer Foundation
Opportunities for research and care delivery models to close the evidence gaps and advance the fight against early-age onset cancers will be addressed with a focus on: Raising awareness of observed trends among professionals and the public Addressing specific supportive care needs (including but not limited to returning to work, mental health, communication with children around cancer and financial stress) across the whole patient journey: at diagnosis, during treatment and as part of survivorship care Run more longitudinal cohort studies in the future where we follow the same cohort of participants over the course of their lives, collecting health data, potentially from electronic health records, and biospecimens at set time points. Collection and utility of real-world data to inform policies aimed at improving timeliness of diagnosis and management of early-onset cancer.	Presentation Dr. Shuji Ogino Harvard T.H. Chan School of Public Health Professor in the Department of Epidemiology, Professor of Pathology, Harvard Medical School, and Brigham and Women's Hospital
Closing Remarks. Glance at Day 2. Thank You.	Ms. Filomena Servidio-Italiano, OCT, M.A. President & CEO, CCRAN

DAY 2: OPTIMIZING EARLY AGE ONSET COLORECTAL CANCER CARE & OUTCOMES
Symposium Day 2 Opening Welcome from CCRAN's President Welcome & Recap of Day 1	Dr. Monika Slovinec D'Angelo, Ph.D. Health Scientist, VBHC Expert, Chief Research Officer at CCRAN Ms. Filomena Servidio-Italiano, OCT, M.A. President & CEO, CCRAN
Understanding the Impact of a Colorectal Cancer Diagnosis: Considering the Patient Journey Across Disease Stages Patients and survivors of colorectal cancer will present salient points from their patient journeys. What supports and information were helpful and at what point in their cancer journey, what experiences were detrimental, what barriers they encountered and how they were or were not able to overcome them. Experiences meaningful to patients (that made a difference to their journey and outcomes) will be elaborated on. The importance of measuring patient-reported symptoms, experiences, and outcomes will be discussed, along with how they can be addressed in routine care.	Moderator Ms. Cassandra Macaulay Senior Manager of Programs & Education, CCRAN Patient Panel: Stage II colon cancer survivor: Ms. Atoosa Rashid Stage III rectal cancer survivor: Ms. Armina Ligaya Stage IV colon cancer patient: Mr. Steve Slack Stage IV rectal cancer patient: Ms. Hayley Painter
Identifying and Addressing the Unique Needs of Younger Colorectal Cancer Patients Younger patients (under the age 50 years) are at a different stage in life and have unique concerns and challenges related to their CRC journey. This session will address the unmet needs relevant to younger patients to highlight the importance of a multidisciplinary care approach required to properly support this patient population. A model of care excellence, namely a clinic dedicated to early age onset colorectal cancer that is operating with great success at Sunnybrook Hospital, will be discussed and opportunities for scaling it across Canada explored. Panelists will address the young adult colorectal cancer patient's: Overall wellbeing and quality of life; Support systems, resources and educational opportunities for patients and their family members; Fears and anxiety surrounding toxic treatment options; Benefits of some novel treatment modalities in the context of patients' psychosocial wellbeing; Intimacy, sexuality, fertility preservation (i.e., sperm/egg banking) concerns, and challenges around raising a young family; Evidence-based programing that patients can access to help them make informed decisions and participate in shared decision-making with their treating oncologist.	Moderator: Dr. Petra Wildgoose Family Physician and Lead, Young Adult Colorectal Cancer Program at Odette Cancer Centre, Sunnybrook Health Sciences Centre Panel: Patient Expert Dr. Marko Yurkovich, MD Primary care physician and stage IV colorectal cancer patient Stage IV colon cancer patient Ms. Suzanne Wood Professional, young mother, metastatic cancer patient Radiation Oncologist Dr. Rob Rutledge, MD, FRCPC Radiation Oncologist at the Nova Scotia Cancer Centre the QE II Health Centre Fertility Expert Dr. David Gurau Obstetrician and Reproductive Endocrinologist, Generation Fertility Patient Support Program Lead Ms. Cassandra Macaulay Senior Manager of Programs & Education, CCRAN
Health Break	VIDEO: Dr. Brandon Sheffield, Molecular Pathologist
Advancements in Colorectal Cancer Diagnostics and Treatments: The Role of Comprehensive Genomic Profiling (CGP) Advancements in colorectal cancer diagnostics (e.g., biomarker testing, genomic profiling, circulating tumor DNA) are pertinent to the selection of precision medicines for the management of young onset colorectal cancer. Clinical experts practicing in different healthcare landscapes (US, Europe and Canada) will share their perspectives on opportunities for: Promoting awareness, education and application of innovations for improving treatment in stage IV cancer patients; Improving patient access to diagnostics and treatments in the metastatic setting; Increasing the uptake and utility of CGP as an eventual standard of care; Highlighting a national initiative for improving biomarker development, quality assurance, and access to high quality testing for precision medicines.	International & Health Policy Presentations Dr. José Perea Colorectal Surgeon, Surgery Department, Jimenez Diaz Foundation University Hospital, Madrid, Spain Dr. Christopher Lieu GI Medical Oncologist, Associate Director Clinical Research, Co-Director, GI Medical Oncology, University of Colorado Dr. Emina Emilia Torlakovic, MD, Ph.D. Head, Division of Hematopathology at SaskHealth Founder and Director, Canadian Biomarker Quality Assurance (CBQA)
Preventing Early Age Onset Colorectal Cancer through Earlier Screening Programs for Hereditary Syndromes While the majority of cases of early-onset cancers appear to be sporadic in nature, access to genetic testing in relevant cases is imperative, as germline mutations can still occur and have wider implications for cancer management and surveillance for the affected patient and their family members. Lead clinician from a hereditary cancer clinic at a centre of excellence will present on the importance of genetic counseling, psychosocial supports and guidance in integrated patient care. The role of hereditary screening clinics will be discussed as well as current barriers for patients accessing this optional screening. The distinction between germline and somatic gene mutations will be made, including their differential impact on treatment and survivorship.	Presentation Dr. Kim Ma Medical Oncologist, Segal Cancer Centre at Jewish General Hospital
Lunch Break	Video: Count Me In Project, Mary McGillicuddy Partnership Manager, Advocacy Groups, Count Me In
Improving the Diagnosis and Management of Hereditary Colorectal Cancer This session will focus on the needs of young cancer patients with a hereditary syndrome, on the ideal care pathway for this patient population, and on the systemic gaps and challenges that preclude care delivery that would lead to best possible health and wellbeing outcomes. Experts will speak to: Diagnostic and management care pathways for colorectal cancer patients with or at increased risk of a hereditary syndrome. Healthcare services and support systems currently available to help improve the diagnosis and management of disease. Unserved needs of this patient population, both for previvors (patients with a newly identified inherited gene mutation) and newly diagnosed colorectal cancer patients who tested positive for a hereditary cancer syndrome. Advantages of specialized early-age onset cancer clinics, with respect to provision of medical care and psychosocial support to help alleviate the fears and anxiety that typically accompany a diagnosis of an inherited form of cancer. Learnings and evidence from implementation of a model for a one-of-a-kind early-age onset cancer clinic in Ontario	Moderator Dr. Petra Wildgoose Family Physician and Lead, Young Adult Colorectal Cancer Program at Odette Cancer Centre, Sunnybrook Health Sciences Centre Panel Hereditary Cancer Patient Expert: Ms. Claudia Martino CMMRD Syndrome Patient Medical Oncologist: Dr. Michael Raphael GI Medical Oncologist, Sunnybrook Health Sciences Centre Surgical Oncologist: Dr. Usmaan Hameed North York General Hospital Genetic Counselor: Ms. Laura Palma, MSc, CCGC, CGC Certified Genetic Counsellor, Medical Genetics Assistant Professor, McGill University
The Treatment of Early-Stage Disease Clinical experts will highlight therapies that are being used to manage early-stage disease. They will discuss considerations pertinent to treatment decision-making, including: Employment of minimally invasive surgical therapies in the management of early-stage disease to ensure patients resume their active and busy lives raising children and demanding careers The potential avoidance of chemoradiation and surgery in the MMR-D setting of an early-stage rectal cancer diagnosis that could instead be substituted with immunotherapy; The use of circulating tumor DNA (ctDNA) in the post-surgical setting to detect minimal residual disease; Additional innovations for improving the cancer treatment journey for early-stage disease in young-age onset colorectal cancer patients.	Moderator Dr. Chris Hiller, Ph.D. Survivor of Stage II Rectal Cancer Panel Patient Expert: Ms. Catherine Mason-Mifsud Stage II Rectal Cancer Survivor Surgical Oncologist: Dr. Usmaan Hameed North York General Hospital Medical Oncologist (US): Dr. Aparna Parikh GI Oncologist, Director, MGH Cancer Center's Global Cancer Care Program, Massachusetts GI Medical Oncologist: Dr. Andrea Cercek GI Oncologist, Memorial Sloan Kettering Cancer Center
The Role of the Microbiome in Gastrointestinal Cancers Altered microbiome composition (oral and intestinal) contributes to tumour development and thereby likely to the rising global trend in early-onset cancer. Of the 14 early-onset cancer types with a rising incidence, eight (those of the colorectum, oesophagus, extrahepatic bile duct, gallbladder, head and neck, liver, pancreas and stomach) relate to the digestive system, indicating the potential pathogenic role of the microbiome in cancer risk. Nutrition (e.g., the Western diet), lifestyle factors and antibiotic use can lead to microbial alterations that increase disease risk and contribute to the development of cancer (as well as other chronic diseases). Obesity, smoking, and alcohol, for example, are all established risk factors for pancreatic cancer and have also been linked with early-onset disease. The microbiome also has a significant pathogenic role in inflammatory bowel disease (IBD), which is an established risk factor for CRC; the incidence of IBD has been increasing in adolescents since the 1980s. Our diet feeds the microorganisms in our gut and directly influences microbiome composition across the lifespan. The early-life microbiome is known to influence the development of the immune system, and research investigating tumour–microbial–immune interactions is emerging. Early life exposures (i.e., perinatal period or childhood) to factors that alter the microbiome are also under investigation. Experts on the role of the microbiome in the development of colorectal cancer will present on current evidence to provide insights on how this risk factor can be addressed effectively in young adult populations.	Moderator Dr. Sharlene Gill GI Medical Oncologist, BC Cancer Agency Panel Dr. Pavlina Spiliopoulou Medical Oncologist, Assistant Professor, University of Glasglow UK Dr. Anna Spreafico Head and Neck Medical Oncologist, Princess Margaret Hospital and Site Lead and Clinician Investigator within the Tumor Immunotherapy Program Mr. Marcelino Dolores Colorectal Cancer Patient Expert
The Treatment of Advanced Stage Disease: Improving Patient Outcomes through Surgical Resection Accessing surgical therapies to help improve the management of metastatic colorectal cancer: Treatments such as liver, lung, and peritoneum-directed therapies are improving the patient's journey and outcomes by way of survival and quality of life. This session will speak to liver and lung directed therapies such as: Hepatic Arterial Infusion Pump Chemotherapy, In Vivo Lung Perfusion, Living Donor Liver Transplant and Hyperthermic Intraperitoneal Chemotherapy to treat metastases that originate from the colorectum.	Presentations Dr. Marcelo Cypel Thoracic Surgical Oncologist, UHN Dr. Gonzalo Sapisochin Hepato-Pancreato-Biliary Surgical Oncologist, Toronto General Hospital Dr. Paul Karanicolas Hepatobiliary Surgical Oncologist, Sunnybrook Health Sciences Centre Dr. Anand Govindarajan Surgical Oncologist, Mount Sinai Hospital
Nutritional Guidelines for Supporting the Patient's Cancer Journey and Symptom Management The specific needs of young cancer patients are not being met, partly because their unique care and treatment needs are not recognized. This session will examine opportunities to optimize nutritional care by focusing on: Nutrition needs during and after treatment Promoting a healthy relationship with food Nutrition support for symptom management Nutritional considerations in the setting of LARS, partial bowel obstructions, and stomas.	Presentation Ms. Felicia Newell, RD, MSc Registered Dietitian
Closing remarks for Day 2 and Symposium. Thank you.	Ms. Filomena Servidio-Italiano, OCT, M.A. President & CEO, CCRAN

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