GOSH Podcast

Episode 2: Our Bold Vision

November 23, 2020 Gynecologic Cancer Initiative
GOSH Podcast
Episode 2: Our Bold Vision
Show Notes Transcript

The Gynecologic Cancer Initiative has a bold vision of reducing the incidence, mortality and suffering from gynecologic cancers by 50% by 2034. Learn more about the inspiration and vision of the Gynecologic Cancer Initiative from Dr. Gavin Stuart, our strategic lead!

For more information on the Gynecologic Cancer Initiative, please visit https://gynecancerinitiative.ca/ or email us at [email protected]

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Gavin

By removing those barriers between disciplines and institutions and, and so on, you get a wonderfully rich discussion that is much more likely to produce something that's going to actually help people.

Introduction

Thanks for listening to the GOSH podcast. Gosh stands for the gynecologic oncology sharing hub, an open space for real and evidence-based discussions on gynecologic cancers. We'll share the stories of gyne cancer patients and survivors and hear from researchers and clinicians who are working behind the scenes to improve treatment outcomes. 

Our podcast is produced and recorded on the traditional, unceded territories of the xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and səl̓ilwətaɁɬ / sel̓íl̓witulh (Tsleil-Waututh) nations. It is produced by the Gynecologic Cancer Initiative, a province wide initiative in British Columbia with the mission to accelerate transformative research and translational practice on the prevention, detection, treatment and survivorship of gynecologic cancers.

Nicole

Hi, I am Nicole Keay.

Stephanie

And I'm Stephanie Lam,  

Nicole

and you're listening to the gosh podcast. This is a really exciting episode, not only are we going to dive into more detail about the GCI and why it was formed, but we get to speak with one of the accomplished medical professionals who leads it. In a way I get to flip the table and interview the expert about his motivations, experience and future goals. something I'd never thought I would be doing as a past patient. Usually you're the one who's getting intimate about your life and now the roles are reversed. We're hoping he'll share his insights on the GCI’s vision and goals for the next year. Stephanie, tell us more about today's guest.

Stephanie

For sure, so I'm really excited to introduce today Dr. Gavin Stewart, the founder and the strategic leader of the Gynecologic Cancer Initiative in British Columbia. He is also a professor in the Department of Obstetrics and Gynecology, and he is an active clinician and researcher at based at Vancouver General Hospital and the BC Cancer Agency. He focuses his research on methodology and the conduct of clinical trials within the domain of prevention and treatment of gynecologic cancer. So thank you so much for joining us on the podcast today, Gavin.

Gavin 

Happy to do so.

Stephanie

So we'll just jump right into the first question. I think when Nicole and I were brainstorming for today's episode, we really wanted to get a sense of what the inspiration was behind the Gynecologic Cancer Initiative and why you were inspired to create such an organization.

Gavin

So thanks very much, Stephanie. And I think it's always been clear in my head, perhaps not everybody else, but in my head, the inspiration behind the kind of cancer initiative has been patients. I, myself have spent the better part of four decades now being given the privilege of participating in the care of women with gynecologic cancers or who are affected by gynecologic cancers, and trying to help them in some small way and help their families. And I think right from the beginning, this overwhelming sense that we can do better. And that sense is only increased, I think not just for myself, but for a lot of us over the course of the last however many years. The Gynecologic Cancer Initiative is a reflection of that sense that we can do a lot better and what would that look like. So that's certainly the overwhelming driver. 

A second major piece has been the proliferation of new knowledge. I think all of us realize no matter what field we work in, that there's new knowledge, new science coming at us every day. And sometimes it's a challenge to try and tease that out: Which is the piece that's going to help this person? Which are the pieces interesting? And which are the pieces probably not relevant? And trying to sift through that all the time, I think really requires a group activity to be able to identify those nuggets that one can then take and put into practice and try and help that person that's sitting in front of you. So the knowledge driver is the secondary to the women affected by this disease, but it's still a major piece. 

And then the third driver behind the GCI vision is, I suppose teamwork in its in its broadest sense. I've seen over the years and I've had some administrative roles that have allowed me the privilege of working with stellar colleagues and observing their successes and so on. And it has just struck me very directly, that the initiatives that are most successful in producing new knowledge and helping people, the people that we try to serve, are those that are almost agnostic of institutional boundaries, jurisdictions. And are the sorts of groups that always say, if you're asked to share something, their first answer is always “Yes, how do we do that?” And I been incredibly impressed here in British Columbia, in the domain of gynecologic cancer, that we've got some incredible groups of talents or individually talented persons that we are aware of. And I couldn't help but think that if we were able to create a scaffolding or a framework where all of those persons could work together with a common vision, it would be incredibly powerful. And I think I'll say directly, we look at the HIV/AIDS movement and British Columbia has been a leader because, early on, those persons that were the leaders in that regard, decided that this wasn't about institutional boundaries, this is about patients with a problem. And so they were more than willing to share the knowledge they had, more than willing to work together, more than willing to establish new relationships that perhaps they hadn't even thought of. And it's the same with Gynecologic Cancer Initiative. I think if we can bring the stellar teams together in that common vision. I know we can do a lot better than we're doing now.

Stephanie

Yeah, I think one thing that I've always noted that you've always mentioned when we talk about the Gynecologic Cancer Initiative is how much stronger we are when we come together as the sum of all the different parts. And I think I've noticed how seamlessly some of these groups are working together, we bring together clinicians, statisticians and basic science researchers. And I think everyone's working towards such a common goal that it really makes sense whenever you say: “we're stronger when we come together, as the sum of all our parts”. I think that's what you say, at least…

Gavin

“The whole is greater than the sum of the parts”. Your point has been very well taken. It’s been very gratifying over the last couple of years to see people - physicists, working with clinicians and saying, “Oh, I never really thought that this would be relevant to what you're doing.” We have computer scientists working with pathologists, and the pathologist saying, “Oh, I hadn't stopped to think about that.” We have people in arts and humanities that are directly affecting the delivery of patient care in the clinics. And by removing those barriers between disciplines and institutions, you get a wonderfully rich discussion that is much more likely to produce something that's going to actually help people.

Stephanie

Yeah, I'm also like, incredibly reminded when we have like a patient partner joining us on the podcast today and how, as institutions move towards supporting patient-oriented research, how we're also bringing together patients with lived experiences, family members, and others to support this entire initiative and make sure that things work seamlessly together. I remember, just last week, when one of the patient partners brought up an amazing point while reviewing one of the grants submitted, she was like, “what happened to this survivorship program, if the peer navigators end up recurring from their disease?” And it was something, I noticed how none of the other people on that committee really thought about that point until the patient partner brought it up. And I think that's also another valuable part that the Gynecologic Cancer Initiative has been able to bring forward, is this patient perspective.

Gavin

Absolutely.

Nicole

I think that piece that you just mentioned, Stephanie, is really what allows us to grow and strengthen at probably a quicker rate than if we all continued to work within our own bubbles, right? That creativity and that blending of knowledge is what really propels us forward. So, it's really great to see that this is really at the bones of what the GCI is. Gavin, I'm wondering if you could tell us a little bit about how the GCI came together? Was that more of an organic thing or, how did these groups all decide to come together and create this wonderful organization? 

Gavin 

Well, essentially, UBC, about three-four years ago, recognized that those successful academic institutions were those that were dismantling barriers and encouraging team science, just whatever that might look like. And you look at some of the leading universities in the world or those that perhaps have shot up the rankings, like the University of Edinburgh. They removed all departments and faculties, they went to four colleges, and there's no more departments or faculties. And their research contribution to the world has skyrocketed. And I think a lot of universities have seen that. 

So UBC initiated a competition to say that they were willing to put in some modest resources to groups that were willing to come together and do something different. Based upon my sort of previous observations, I looked at colleagues working in the domain of women's health and gynecologic cancers. And I couldn't help but think that if we could have the people that are delivering care in Surrey, Abbotsford, Kelowna, coming together with the scientists that are working at WHRI, coming together with the teams that works to the BC Cancer Research Center, come together with the folks at the University of Victoria, SFU and UBC working in basic sciences, come together with patients and family groups, that, gosh, that would just be such a powerful group. 

So I spend a lot of time talking to people, I can usually do that okay, and kind of tease them with a “what if” scenario: “What would you think if we brought so and so and so and so into the next meeting?” and most of the responses were perhaps muted…“interesting”. But it only took one or two meetings with different people in the rooms that there was a real spark that started and said, “Oh, well, in actual fact, we're putting in a grant. And if you could be the patient partner on this grant team, this would be great”. “And by the way, this is something we can work with the team at SFU, because you're doing something very different. And we'd like to tie that in with that be okay?” 

And so I said, well, can we come together to put in an application to UBC and so we did and we were successful. I was very pleased that that the productivity of the group went up, and UBC has funded us again in a renewal. I think the trajectory that has now taken with the team is such that it's going to continue as a team effort, because I think we've broken down some of those barriers. I think the other thing I should say is that I think our knowledge culture is changing, particularly in science. The model 10 years ago or more, was that you had to know everything. If you're a PhD, a marine biologist, if there was something under the water, you had to know about it. If you were a cardiologist, if it was related to the heart, you had to know it. I think people have now realized that, in actual fact, we don't know everything. Patients and partners come to the table with key viewpoints and information, like that computer scientists bring something to the table, the pathologist does, the social scientist. And so people are a lot more comfortable recognizing they don't know at all. But if you bring everybody into the room and you get the right mix, there's a risk, we might actually find out something. And that's been a shift in our knowledge culture that's been very, very positive.

Nicole

The next question that we had was around the goals and strategic priorities of the GCI, and one that we wanted to point out was this vision of “reducing the incidence, death and suffering from gynecologic cancers by 50% by 2034”. So very specific vision here, I’m just curious how you landed on those numbers and by that date.

Gavin

So one of the key things in the Gynecologic Cancer Initiative is that this isn't just about better treatment, or it isn't just about better prevention. It isn't about focusing on cancers that start in the ovary or just focusing on cancers started in the vagina. This is taking a broad-based approach. So we recognize that to have an impact on cancer it's going to have to consider aspects of prevention, early diagnosis, treatment and supportive care. And if you miss any of those pieces, you're missing an opportunity to have a great greater impact. Similarly, we've come to recognize that there are some scientists and clinicians who might focus on women affected by cancer in the ovary, but we've come to realize that some of the modeling that's being done on cancers of the vulva or the cervix can actually help inform our thinking related to cancer of the ovary that we hadn't really thought of it that way, but the same pathways might be involved. And how do we start to think about that? 

So what we started to do is have conversations in the context of what we call a cancer control model. What are we doing in the area of prevention? What are we doing in the area of diagnosis, treatment and supportive care? We quickly realize that there's some pretty good examples here in British Columbia. And the work that's being done in terms of prevention of cancer of the ovary by the removal of fallopian tubes, I think I can say is not only been groundbreaking, but internationally recognized as a made in BC solution. And it doesn't take much. And we've been working with our mathematician colleagues to do the modeling that if this has the impact that we predicted, well, we can see dramatic reductions in the incidence of ovarian cancer occurring. We started to look at some of the molecular pathology studies that are being done in early lesions with cancer of the endometrium, and how that might actually affect treatment. And again, the BC team has done some marvelous work people like Blake Gilks, David Huntsman, Jessica McAlpine, are internationally recognized for their work and identifying which are the high risk cancers requiring very specific targeted therapy, which are the ones that we know are less aggressive. And that's allowed us to change your treatment and have a much greater impact. And suddenly, we're starting to impact and in the success of treatment, with patients. Similarly with supportive care, trying to understand where that's going. And then as we look at the different cancers, I just commented on the cancers that start from the ovary. Well, well known to this audience, is related to cancer of the cervix, and we used to think that early detection in terms of pap smears was a good way to do that. And BC's been a world leader in that for six, seven decades. But I think the world has moved on from that and we've now realized it's not just about early detection and diagnosis, we could prevent it with vaccines, and what would that look like every grade six, school girl got a HPV vaccine? And we're starting to get early results as to where that comes from.

Perhaps a long winded answer to your question, Nicole. But as we started to look at these pieces, and started to model these, and said: “Well, we could reduce that by 30%. And if we reduce the incidence by 30%, we're going to have a major impact on the death rate. Or if we looked at the ability to prevent that, and we could prevent 90% of that, gosh”. And so as a team, we worked, and it didn't take long before, we had a 10 year projection where we thought that there was a serious risk of progress here. And we extended that to say, let's not be too bold and audacious, let's look at a 15 year goal. So this was in 2019, when we're putting this together, and mathematically felt that we could achieve a target of 50% reduction from the impact of these cancers in British Columbia by 2034. And that's a very, very inspiring sort of vision. It's a very powerful vision. And it's one that we can we can work with, with donors with government, and they sort of say, “really?” and I can say, “Yes, really, let me explain this to you.” And we can run them through that. And by the time they're finished, they're sort of like “oh, you're serious”. And I've had people say that to me, and I said, “Absolutely, we are serious”. And that's led to some significant fundraising opportunities, government contributions, and I'd be very pleased because it does take resources to support these people and make sure that patients and partners are supported and make sure the science is supported and make sure we're doing the right thing. 

So perhaps a little longer explanation than you wanted, but that's where this vision came from. And you asked about the goals and strategic priorities. So, we needed to take that rhetoric and break it down into, “okay, that's nice, but what are you going to do tomorrow”? So we've been able to put together documentation related to 10 strategic priorities. Some of those are related to a specific disease such as cancer, the ovary, and what does that look like, in terms of prevention and new treatments. Some of that is related to something like molecular pathology, where we know that we have to enhance our understanding of the basic molecular structure of these cancers. And we've even come to realize that if we can do that, we can probably better understand which patients are going to benefit from surgery and which patients probably won't benefit from surgery. Rather than just a one size fits all approach. We’re being very careful to ensure that we're able to have a specific strategy around Indigenous populations, and what does that look like making sure that it's a culturally sensitive approach in that regard. And so I won't go through all 10 strategic buckets if you'd like, but that's what we've been able to do to map out action steps and targets within each of those.

Stephanie

Thanks, Gavin for that. Nicole, I'm always curious about what people think of when they hear the GCI’s vision. As a cancer survivor, what comes up when you hear that as a target?

Nicole

It's really exciting and really inspiring to hear. For me, my biggest motivation in you know, wanting to do, say this podcast or get more involved, is to try and support other women who may be faced with a similar situation to what I went through. But, also with the end goal of, you know, working alongside teams that can make sure they don't have to go through that. So for me, it's really encouraging. And I feel very inspired to hear strategies and targets that are aggressive, isn't really the right word, but they're large goals that I think are, are also really achievable. And so to me, I'm really encouraged by that. At the same time, there's always too you know, that if only this had happened to me, 10 years later, could I be in a different position, but here we are, and, and we work with what we have. But I am just really, I'm really proud to also, have a very small piece in this, and I'm very, very excited, encouraged by it

Gavin 

Yeah, there must be a sentiment of where were you when I needed you? 

Nicole 

Yeah, exactly.

Gavin 

And I’m very sensitive to that Nicole, and I appreciate that there's a lot of women that must have that sentiment. But, I sort of take inspiration from, I always talk about Vanderhoof, because I understand it's the geographic center of the province and being able to go to a group of 10-12 year old girls in Vanderhoof and tell them that we've got a plan that will mean that your chances of ever having what your mum had or your auntie had or whatever else will be 50% less, and this is what we can do. And that's the goal. 

Stephanie

Yeah, definitely. Um, speaking of which, so the very last question we have for you, Gavin. Is if you could speak to what excites you the most about the Gynecologic Cancer Initiative? What do you hope to see in this space in the coming years and what are you most excited about?

Gavin

So whenever we go into a GCI meeting or conversation, the things that always excite me I guess. Number one, and not to lose sight of it, it's the the women and families that have had to deal with so much that I think we can help that. I think we can avoid that from happening again, so many of those women, I think we can help so many of them. A lot of the work that people like Lori Brotto and others have been doing in supportive care, I mean, open the conversation and let's help. And, and, and so that I don't want to lose sight of that. That has been and will always be the first priority. And I include families with that as well, because you know, fortunately, most people don't go it alone they have their support team, and that's really critical. 

The second thing that excites me about the GCI is the team and just watching that grow. And we all have colleagues that are very successful and very well established. And seeing them walking into a room and having a discussion with somebody that they never expected to me during the course of their work day, and finding out that there's a common thread there. And “by the way, we can put in a grant submission together, and why don't we include so and so”. That's very exciting. It sort of sounds goofy, but to me, it's like sitting on a whoopee cushion: “Oh, wow. That's wonderful!” And I like seeing that, that spark that suddenly occurs in the team. And that's a great piece. 

And then thirdly, the other piece that excites me are the learners, and talking about this, and the vision and whether they're undergraduate students or graduate students. Really being able to see how what they're doing in the lab, or what they heard in that lecture that day, could actually help people is again, very exciting to them. And just informally and Stephanie, you've been one of the leaders and Nicole in our, in our webinar series that originally targeted graduate students, but I know it's had a lot of others. And I literally had a conversation with a small group of undergraduates this past week, where they were just so inspired that suddenly, this is what I mean, “my goodness, if I actually go into bacteriology, and I'm doing x, y, and z, I could go to grad school, and my goodness, I could actually, I could help somebody”. And so the learners are very exciting to see and I think that's one of the biggest, I hope, sort of impacts or legacies of the Gynecologic Cancer Initiative, is that we'll see a cohort of learners that are excited by what they're doing.

Stephanie

Yeah, definitely. I think something that I've always noted about the Gynecologic Cancer Initiative is how, there's something for everyone, almost, there's, you know. We try to support trainees and their education, we also try to support patients, and we also try to support developing clinical trials. So there's something along that whole spectrum, and it's really the coming together of everyone, no matter how far along you are in your career or in your journey to supporting this, this vision.  

Gavin 

Yep, and the other thing that I will say is that I find that it's exciting for the philanthropic community as well, and donors. Because by and large, most donors don't care whether their funds go to the red lab, or the green lab, or the blue lab or this institution. They just want their gift to have an impact and understand what that looks like. And my goodness, to be able to say to them that we're actually all wearing the same team jersey here. And this is where we're going to have an impact is very reassuring and I'll say exciting. We have a number of donors that have been supporting us. I constantly get asked the question, “why didn't you do this 10 years ago”? And it goes back to what I said about a knowledge culture. I think things have changed so that's what's exciting.

Stephanie

Great. Well, thank you so much, Gavin. I guess that concludes the episode today. Thank you so much for coming on and sharing your wisdom and your inspiration behind the Gynecologic Cancer Initiative and we're excited to see what's to come in the next year and coming years and what other new projects and fun things are coming up soon. 

Gavin 

Sounds Good!  

Outro

Thanks for joining us on the GOSH podcast. To learn more about the Gynecologic Cancer Initiative and our podcast, make sure to check out our website at gynecancerinitiative.ca