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Melanie D`Silva took part in research into faster assessmentsof whether cnacer patients are responding to treatments such as chemotherapy.

Doug Nicholson. Not to be printed, broadcast or transmitted without the permission of MediaSource or its representatives.

If all patients were as enthusiastic in their support as Melanie D'Silva, Sunnybrook would be famous across the globe.

"I'd do anything for Sunnybrook," she says with an excitement that belies the difficult challenges she's faced since her diagnosis in January of an aggressive form of breast cancer. From the start, she says, "they've been great. I hate to use the word amazing so much, but that's what this experience has been."

As part of her Sunnybrook experience, Melanie, a corporate human resources professional, participated in research aimed at using non-invasive imaging to determine whether a neoadjuvant (pre-surgical) chemotherapy or radiation treatment is working in patients diagnosed with cancer.

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Dr. Gregory Czarnota, radiation oncologist at Sunnybrook's Odette Cancer Centre and principal investigator in two studies in which Melanie is participating, says the findings are exciting.

"Using low-frequency ultrasound in patients, we've found that we can detect cell death as early as one week into chemo treatment," Dr. Czarnota says.

"This is new research. We wanted to find out if we could measure cell death (apoptosis) in tumours, and at what stage in pre-surgical treatments, using non-invasive imaging methods."

He says the ultrasound and spectroscopy imaging used in the research "has the potential to further reduce toxicity for women while determining at a very early stage whether the chemotherapy being used is working most effectively to reduce the tumour."

Unlike current methods of assessing treatment efficacy (such at PET or CAT scans) that typically take several months to determine results, the ultrasound imaging used in Dr. Czarnota's studies involve no radiation nor injections of a contrasting agent or dye used to see the activity.

In a related study, Dr. Czarnota and his team used a diffuse optical spectroscopy (DOS) system called SoftScan, developed by ART Advanced Research Technologies in Montreal, to measure tumour activity changes throughout chemotherapy treatment.

Melanie participated in both studies and was eager to do so after reading about Dr. Czarnota's research in a magazine while waiting to meet him for her first consult after diagnosis.

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"Yes, it's about giving back, but it's more than that," Melanie says. "Participating in research is exciting and it made me feel involved in my treatment. It was a learning experience, one that kept me engaged."

For Melanie it did mean extra visits and tests. The ultrasound investigation involved scans before and after the first chemotherapy and then at eight weeks, four weeks and one week before surgery.

The DOS imaging study used near risk-free infrared light and was done in six sessions throughout her pre-surgical treatment. She was positioned lying face-down on a scanning table, her breast comfortably placed through an opening in the table and resting in a container filled with warm liquid.

"The research associates were very considerate of potential side-effects from my treatment, and made sure there was little or no discomfort while doing the scans. They also went to great lengths to coincide the scans with other scheduled medical appointments for my convenience," she says.

With findings as promising as the research team has had thus far, there is great potential to inform treatment for other cancers beyond breast, says Dr. Czarnota. This would include esophageal, stomach, pancreatic, and kidney.

"Cancer patients won't have to wait months to find out a chemo treatment isn't killing a tumour," says Dr. Czarnota.

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Oncologists will be able to make changes to the drugs, saving cancer patients precious time and optimizing treatment.

Melanie is now post-treatment following the pre-surgical chemotherapy where she was part of Dr. Czarnota's research study and is now doing physiotherapy rehab at a centre located close to her beloved Sunnybrook.

She says her Sunnybrook team – her general practitioner who is part of the hospital's Family Practice centre, her primary nurse who coordinated all her tests and treatments, the oncologists, technicians and nurses, and the researcher she calls Dr. Greg (Czarnota) – have "restored my faith in our hospital system."

Melanie says she's gratified she was offered the opportunity to help the many other people who have cancer. "There has been so much progress in cancer treatment and how else would we have come this far without these studies.

"It's about giving back, but it's also about being involved."

Going the extra mile

With her warm smile and kind demeanour, it's easy to see that Smitha Casper-Desouza was born to do the work she does. As the patient care manager for one of Sunnybrook's in-patient surgical oncology units, she makes it her mission, along with her staff, to ensure patients have the best experience possible during their stay in the hospital.

A recent hospital-wide initiative launched earlier this year has helped Smitha take her daily mission to a whole new level, and to inspire her staff to do the same.

We Care is an initiative launched throughout Sunnybrook that puts a strong emphasis on customer care. The program's goal is to create 'Sunnybrook Moments,' opportunities where extra effort is put into creating a special experience for patients and their families, visitors, and colleagues. We Care was developed by a committee composed of front-line staff and managers who consulted with patients and their families. It is based on four key components, or tools, to create those special moments. The 4 Cs, as they're called, are: compassion, communication, consideration, and comfort.

It's an initiative that Smitha and her staff have embraced enthusiastically. "These aren't foreign concepts to us," says Smitha, "but this focused approach allows us to set goals together and really make a difference for our patients." For this team, Sunnybrook Moments they've created have covered a broad spectrum. From preparing a space for a family member to sleep overnight near an ailing patient, to taking an extra moment to sit down, hold a hand, and listen to a patient's fears and concerns, Smitha says her team is always trying make a difference, no matter how small.

So far, Smitha says she has already seen an improvement in the unit's patient satisfaction scores, which validates all of the work the C6 Surgical Oncology team has done. She says the 4Cs, which are posted on the unit, are always a reminder for her and the team to review, and to help them go the extra mile. "We get busy. We tend to sometimes do things mechanically. The 4Cs are not about being mechanical. They are about actually sitting down, listening, and focusing on what the patients' and the families' needs are."

She says it's not always easy, and not every patient will have the best experience, but Smitha and her team can always refer to the goals they have set together to create Sunnybrook Moments and to identify how they can make things better for someone else. "It's all about patient care. We might have the best strategic goals, or the best strategic plan and financial plan – but if we have gaps in care, we have failed our patients."

So with We Care as a guide and Smitha Casper-Desouza headlining the charge, the Surgical Oncology Unit is just one team at Sunnybrook that plans on continuing to create special Sunnybrook Moments and making the customer experience that much better, one patient at a time.

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