In the Spotlight: Rapid Expansion of the Simcoe Muskoka Regional Cancer Program

THIS IS AN EXCERPT FROM THE 2017-2018 ANNUAL REPORT.

Wood, glass, stone, regional art work and an open airy reception are what you first see when you enter the Simcoe Muskoka Regional Cancer Centre (SMRCC); part of the Royal Victoria Regional Health Centre in Barrie. The centre officially opened in 2012 and is one of six academic cancer centres partnered with UTDRO. “You can practice really interesting, dynamic, and challenging radiation oncology in a setting like ours,” said Dr. Christiaan Stevens, UTDRO faculty member, and Clinical Director and Head of the Radiation Treatment Program at the SMRCC.

The centre is known for its sub-specialty in gynecologic oncology, but provides almost all forms of cancer treatments, except for paediatrics and head and neck malignancies. The most common cancers in this clinic are the “big four” of breast, prostate, lung and gastrointestinal malignancies; reflective of the aging population in the region. Palliative care is also a significant component of the radiation oncology program.

The SMRCC team consists of three gynecology surgical oncologists, eight radiation oncologists, 11 medical oncologists, four radiation physicists, 32 radiation therapists and four electronic staff. UTDRO faculty members have key positions at the centre. Dr. Matthew Follwell is the Chief of Oncology; other UTDRO faculty members include Drs. Adam Gladwish, Juhu Kamra, Julia Skliarenko, Tiffany Tam, and Fred Yoon.

From L to R: Jessica Conway, Fred Yoon, Tiffany Tam, Oluwabunmi Ogundimu, Juhu Kamra, Matthew Follwell, Adam Gladwish, Christiaan Stevens. Missing: Julia Skliarenko

Through the gynecology oncology program, SMRCC provides external beam radiation, but not brachytherapy. Patients requiring brachytherapy are referred to either the Odette Cancer Centre (OCC) or the Princess Margaret Cancer Centres (PM). Two of the SMRCC gynecology radiation oncologists spend one day a week at the PM practicing brachytherapy. This partnership allows the oncologists to be part of the PM team, while at the same time maintaining their skillset.

Medical Education

The SMRCC is one of the UTDRO teaching sites and usually has one or two UTDRO residents on their community rotation per year. Two recently hired radiation oncologists at SMRCC had completed their community rotation at SMRCC, and were inspired to seek permanent positions. “It has been a very positive experience for ourselves and for UTDRO — giving residents a chance to see a slightly different perspective on how radiation oncology is practiced, and that you can have an academic interest and practice in the community too,” said Christiaan.

Research

Christiaan strongly believes that the potential for collaborative research through UTDRO and its academic hospital partners is outstanding, “When you think of the patient access just beyond Toronto, there are millions of people that if we collaborate in large research studies as a department, we could do things that very few other departments in the world could do.”

Every year, SMRCC participates in the Collaborative Research Seed Grant through UTDRO. So far, they have been awarded two grants, one focused on stereotactic ablative radiotherapy for renal tumors; the other on the implementation of a brachytherapy discharge education program.

SMRCC also participates in Canadian Clinical Trials with the National Cancer Institute of Canada, and the Ontario Cancer Oncology Group, and aspires to become a member of NRG Oncology.

Growth

SMRCC has been growing at an annualized rate of >10% per year. In their first year (2012), there were 1,300 new patient consultations; in 2017−18, there were 2,299 consultations. “The hospital has grown enormously. It has doubled its foot print in five years and we’re in the process of doing a master plan to build even further,” said Christiaan.

Several factors contribute to this rapid growth, including an aging population and lifestyle risk factors. Simcoe Muskoka has one of the highest incidence of chronic diseases in Ontario with 42% of residents suffering from a chronic condition.

New consultations, treated cases, and treatment visits at SMRCC from 2016 to 2018.

Challenges

The geographical region is disparate and patients have to travel long distances to receive radiotherapy. That combined with a significant number of low-income patients who cannot afford time off work or travel add to the challenges of treatment delivery.

There is also the demographics of a predominantly younger staff with young families. The department does not have the mix of veteran radiation oncologists with mid- and early- career oncologists.

Future Plans

There are two satellite chemotherapy sites, one in Huntsville and one in Orillia supervised by SMRCC. The centre would like to have the same capability in another smaller town, such as Collingwood.

The department will soon install a fourth linear accelerator that is fully stereotactic enabled with a Hexapod couch. The Hexapod couch should improve the precision in radiation therapy delivery for tumours located close to critical structures, such as the spinal cord. A new physicist plus a number of radiation therapists would need to be hired to support the new accelerator.

Amidst the rapid expansion, Christiaan describes what is most important to the centre and its future, “Inevitably, the goal as a program is to provide exceptional person-centred care and I think we are doing a very good job of that.”

To learn more about SMRCC, visit rvh.on.ca/smrcp.

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