dr. paul wheatley-price: 'my patients inspire me by the way they tackle cancer'
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research is tackling disparities in cancer care, according to dr. paul wheatley-price. getty
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there is no cure for cancer. even if someone goes into complete remission, it’s still possible for their cancer to return. but there are advances in medication and technology that have improved treatment and given people hope. still, in canada, as the population ages, the projections are grim, pointing to a 40 per cent jump in new cancer cases diagnosed between 2015 and 2030.
what might change that picture is research, says dr. paul wheatley-price, associate professor at the university of ottawa and medical oncologist at the ottawa hospital. he’s also the chair of the novartis oncology young canadian investigator awards (noycia), an annual event celebrating its 20th year, that provides funding, support and recognition to 10 cancer researchers who demonstrate excellence in their area of study.
healthing spoke to wheatley-price about his experience treating people living with lung cancer, his ongoing research work, and what he thinks the future could look like in the oncology space.
what attracted you to oncology as a medical student?
dr. w: i was at a well-known cancer hospital in manchester called the christie, and it honestly was like a light-bulb turning on. it had all the components of health care that i enjoy, that i found rewarding, and i knew that was it. you get to know your patients very well in oncology. and you get to know them at a particular time which is a major moment of their life. in many cases, it’s a life-ending illness. you see them quite frequently and intensely, and you have intense conversations, but you have light conversations and you meet their families. it’s a privilege.
another thing about oncology is that it changes rapidly. the field of lung cancer has turned on its head and then turned on its head again just in the last 15 years as things evolve. it’s also a wonderful environment to work in and very multidisciplinary. i work with wonderful nurses, outstanding pharmacists, great social workers. we have a terrific community.
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what’s most rewarding about your work?
dr. w: well, absolutely number 1, i get the most satisfaction from a sense of giving good clinical care. when someone does well with treatment or even if they don’t do well with treatment, you help them come to that understanding. in oncology, we’re trying to help people live longer and improve quality and quantity of life. but cancer can be fatal and being able to help someone through that process too is very rewarding. i’m fortunate in that i have a research program — i also teach a lot and i’ve been involved in advocacy with lung cancer canada. so i’ve had these different elements in my work life that have been very rewarding.
why is cancer so difficult to treat?
dr. w: firstly, it’s not one disease. there are commonalities which define what a cancer is, but there is hugely complex biology at play.
when i moved to canada in 2007, there were broadly two categories of lung cancer. now, we’re looking at 12 to 14 different distinct subtypes of lung cancer that behave differently and have different treatments. the complexity is dizzying.
also, cancer is sneaky in the way that mutations occur in our dna that form cancer and the way that cancers are able to evade our own immune system. when a cell goes wrong, which happens all the time, usually our body has the ability to either fix it or send it to the trash can. cancers escape that, and then they evolve over time as they’re growing in someone. so a drug that works today, and tomorrow it doesn’t work. there’ve been so many advances, but there’s so much complexity.
how has immunotherapy changed cancer treatment outcomes?
dr. w: the modern generation of immunotherapy drugs allows cancer to be visible to our own immune systems. i sometimes use an analogy for people who’ve watched the harry potter movies. harry has this invisibility cloak so he can sneak around hogwarts and doesn’t get caught. that’s essentially like the cancer cells moving around our body, invisible. immunotherapy drugs take the invisibility cloak off, so the immune system can see the cancer, activate and fight the cancer. we first saw these drugs in melanoma maybe a decade ago. immunotherapy is touching so many different cancers now, and what we’re seeing with lung cancer is a majority of people benefit if it controls their cancer for a time. we’re also seeing a significant minority of patients with stage 4 lung cancer — which formerly would’ve been fatal within the year — who are now alive and living normally years later.
dr. paul wheatley-price is an associate professor at the university of ottawa and a medical oncologist at the ottawa hospital. supplied
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what is most exciting about your research?
dr. w: i lead our lung cancer research group, so that is really about bringing clinical trials of new drugs to patients in our cancer centre. we have been involved in some of those immunotherapy trials from a few years ago, which now have moved into standard practice. patients who volunteer for these studies deserve so much credit because they’re taking a risk hoping that this new treatment is going to work.
my own personal research program is in an area called real world evidence. we recognize that with a lot of these new drugs that are run through clinical trials, only about three or four per cent of people with cancer get onto these clinical trials because they meet the strict criteria.
real world evidence looks at the data from everybody and sees what’s actually happening in the clinic when the rubber hits the road. we generate databases with thousands of cases. i’m involved with the leadership of two or three of these canadian initiatives to build national canadian databases in lung cancer. that can help answer research questions, but it can also really help regulatory bodies that need information in order to decide on approvals of new drugs in canada. increasingly, bodies like health canada and others are looking for this real world evidence data.
why are programs like novartis oncology young canadian investigator awards important?
dr. w: the awards are presented every year at asco, the biggest cancer conference in the world. the conference provides a platform to highlight the work that’s going on in canada and brings together canadian oncologists and trainees. for me and my real-world-evidence type research programs and for other trainees, when we do research, one of the central principles is telling people about your results or no one is going to learn. it really is helping to support our next generation of cancer specialists — and when you put all of this together, it’s community-building.
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is there current oncology research that you feel holds a lot of promise?
dr. w: there’s a lot of amazing laboratory research which is now coming into clinical practice. a big step forward that we we’re going to see in the next few years — with a lot of work happening in canada — is around the idea of a liquid biopsy. so instead of having to stick a needle in someone’s body to get a sample of cancer, we know now that cancer releases some of its genetic material into the blood and so quicker and safer detection is possible just from a simple blood test.
also, one of the challenges that we face in canada, but it’s not unique to canada, are issues around equity. there’s some really interesting research looking at how to tackle disparities in access to care. researchers are creating new drugs or new technologies, but then there’s also research into how we make sure that canadians are getting what we can give them now.
is there a message of hope for people who have had a recent diagnosis or are in the midst of treatments?
dr. w: i sometimes say to my patients, ‘i promise, i’ll always be honest with you, good or bad.’ if it’s bad, that’s what they need. usually, i can honestly follow that up with saying, ‘but i have some realistic hope to give you,’ because hope is so important. there is genuine hope because of things like immunotherapy, where we can guide the patient and their oncologist toward a more tailored treatment. we do that because it works. there are more opportunities to help people to live longer and live better.
when anyone gets a cancer diagnosis, it’s a major thing. i’ve seen so many of my patients inspire me by how they tackle getting a cancer diagnosis. they take it as an opportunity to review different elements of their life. for some of them it’s practical things, like getting their affairs straightened out just in case things don’t go well. for other people, it’s engaging their bucket list or spending time with the people they love. there’s a lot of hope in terms of treatments, but there’s also a lot of hope when people refocus on what’s important to them. there are so many people faced with a cancer diagnosis where it just brings out the best in them.
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the winners of the novartis oncology young canadian investigator awards will be announced in the coming weeks. check the winners page for updates.
karen hawthorne is a toronto-based writer.
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