Research Projects
Research Project #1 (Fully Funded) - "Duodenopancreatectomy versus Best Supportive Care for Pancreatic Adenocarcinoma."
Many surgeons and physicians have been considering that the Whipple procedure is only a palliative therapy. In their opinion, the results are not good enough to suggest that the Whipple procedure should be offered to patients. Although they realize that without undergoing surgery, the mean survival is only 6 months, these doctors say that most of the patients with pancreatic cancer are quite advanced in their age and therefore they should not be operated on.
No previous research has focussed attention to the patients' perspective. As physicians, we recommend some treatments because they are the only available potential way to cure. Despite the fact that the Whipple fails for the majority of our patients, we are able to cure a few of them. Is that sufficient to support surgery for everyone? We don't know.
My interest is to find out. The Probability-Trade-Off (PTO) interview will provide us with an understanding as to what patients with pancreatic cancer, would decide if fully informed about their condition and the options available to them.
PTO is a formal, structured interview that makes patients go through a clinical situation. After being fully informed about the nature of the disease, the probabilities of success and failure, the patients are asked to choose between two or more treatments. Then, the probabilities of success and failures are changed in a progressive way so that one treatment becomes more appealing over the others. The difference between the starting probability and the probability when the patient changes her/his mind is called Minimal Probability Trade Off that the individual is willing to accept to undergo a therapy that is more invasive but that can potentially provide a better long term outcome.
This research technique is quite new and has not been used before for pancreatic cancer.
Click on the following link to read the Protocal and to review the budget.
Research Project 2 (Funding in Progress)- Pancreatic Cancer Registry: Framework for Genetic, Epidemiological and Clinical Outcomes Studies of Sporadic and Familiar Tumours
Background: Pancreatic cancer (PC) is a highly lethal malignancy representing 10% of
all gastrointestinal tumors with the majority of patients dying shortly after diagnosis. The
only potential cure for PC is surgical resection that is carried out only in 10-20% of all
patients because the tumor has already spread or medical co-morbidities make the risk
of perioperative mortality prohibitive. Even when surgery is performed, the median
survival is 14-16 months as recurrent disease is common and PC is poorly responsive to
chemotherapy or radiation.
Rationale of the study: Recent studies have shown that up to 10% of PCs are
diagnosed in families where more than one member has suffered from the same tumor.
Several inherited genetic mutations might explain this phenomenon and are currently the
focus of gene profiling. The clinical application of these findings may change the
management of high-risk individuals as it occurred for other genetically transmitted
tumors (e.g. colorectal, breast, thyroid cancers).
Current Limitations: The incidence and prevalence of familial PC in Atlantic Canada is
currently unknown and advances in epidemiological research in this field are needed.
The current lack of knowledge might significantly impact the chances of early diagnosis
and survival in high risk individuals for PC in this part of the Country.
Hypothesis: That the incidence of familial PC in Atlantic Canada is comparable to the
rates reported in the literature and that a genetic defect is responsible for the
transmission of this condition. Screening for PC in high-risk individuals might improve
the outcomes of this tumor by early diagnosis and therapy.
Primary aim of this study: A) to study the incidence of familiar PC and variables
influencing survival for patients affected by sporadic PC in Atlantic Canada. B) To
assess the impact of screening program for PC in high risk individuals.
Secondary aims of this study: To obtain tumor tissue samples (when available), and
peripheral blood bank from all patients diagnosed with PC in Atlantic Canada. To obtain
peripheral blood samples from healthy individuals of identified high risk families to study
the genetic profile of familiar PC and patterns of transmission.
Feasibility: The management of patients affected by PC is complex and needs
advanced expertise in many disciplines and the majority of PC patients are referred to
tertiary medical centers. Contrary to other areas in North America and Europe, in Atlantic
Canada there are only three University Medical Centers where the majority of these
patients are referred to: Victoria General Hospital in Halifax (NS), Moncton General
Hospital (NB) and Memorial University Hospital in St. Johns’ (NFL). The advantage of
centralized patient referral and the fact that the mobility of the population in Atlantic
Canada is significantly less than in other parts of the Country, make our Institution an
ideal center for epidemiological studies on familiar conditions.
Importance of this study: PC has poor prognosis. Familiar transmission of PC may
occur in up to 10% of cases and early diagnosis by screening modalities may have a
significant impact on year-life saved. Therefore, the creation of a familiar PC registry in
Atlantic Canada would contribute to the advancement of genetic research and direct
education and screening to high risk families where tumor related deaths may be
prevented.
Click on the following link to read the Protocal and to review the budget.