the susan leslie clinic for neuroendocrine cancers was started a
few years back by dr law and myself we both had an interest in
neuroendocrine cancer and we soon realized it really wasn't a great place
for patients to go for a center with expertise so we decided
to create a clinic that we envisioned to be
multidisciplinary where patients could go
and receive all the care they needed for neuroendocrine cancers hopefully in one spot
since that time it's really grown quite
a bit we now have expertise with surgical oncology medical
oncology radiation oncology we have endocrinology in our clinic we
have psychiatry and psychosocial oncology in our clinic
as well as nuclear medicine radiology and what we've really added has been a
lot of elements of supported care social work pharmacy dietitian we really
tried to look at all aspects of patient care in the clinic
so when we're making treatment plans for patients the first thing that's really
important is to involve the patient to understand what their priorities are
what they want and what works for them the thing about neuroendocrine cancers
it's a wide variety of diseases it's actually not one type of cancer
so we really want to find out as much about the disease as possible and as i
mentioned about the patient as possible and then with the multidisciplinary team
we often have a consultation to realize what each of us what role each of us can
play and what's in the patient's best
interest moving forward
the last few years have seen a number of new drugs really be developed for
neuroendocrine cancers by far the most common treatment is an
injection that patients will get once a month
from a side effect point of view it's usually well tolerated and sometimes
patients can be on those treatments for even years and it can
without progression of their disease or that means that their disease doesn't
really grow keeps it at bay there are oral
therapies which mean pills that you can take every day
some of them have some side effects but we're quite good at managing them now
and then there's iv treatments that are being developed new chemotherapies and
even old chemotherapies that sometimes work at being able to help control the
disease and sometimes even shrink the disease
new treatments are coming along in terms of what we call systemic radiation which
is where we actually inject radiation into the system to try to target the
cancer cells and that has been showing a lot of
promise lately
there are some side effects from treatment and of course we try to manage
them the most important thing is
communication we need to make sure we have good two-way communication with our
patients so both that we explain to them what side
effects they might experience they can be on the lookout for them
as well as that we make sure that they tell us when they feel side effects
early so we can help manage them
the role of surgery in neuroendocrine tumors can really be focused on two
major things diagnosis and treatment so surgeons are there to help you figure out
what is the problem where is it coming
from where is the primary tumor and give you an overall sense of what
the staging is and that will help you develop the plan
which obviously leads us to the next part
which is treatment surgeons are an integral part of neuroendocrine
treatment not all neuroendocrine tumors can be
treated by surgery but many times whether it's in one spot
or whether it's in many spots the surgeon still has a role
in helping you reduce the amount of neuroendocrine disease or remove it entirely
patients undergoing surgery for
neuroendocrine tumor should have some questions to ask before the surgery
instead of going through a list let me give you some general principles
the first thing is about the surgical choice itself
make sure you understand why you're having surgery
so if you've made a good decision or you know what's happening and you understand
why you're having your surgery then i think that part's really
important the second is make sure you understand
how your family and your loved ones are part of your care
that is when you're timing your surgery you need to understand that they need to
be there for you you know after the surgery in particular
but the important part is that when you set your date of the surgery
that you have a thoughtful process of how you're going to be supported in your
recovery the third general category is
understanding how to prepare before your surgery the answer is never
sit at home and splurge on netflix or whatever
before the surgery the key actually is what do you need to
eat how do you need to get fit what are the exercises you should do
there are actually important things that you should aim for
preparing for your surgery in order for the surgical outcomes to be
as good as they can be finally habits and bad habits in
particular so these are the last things you need to
at least ask yourself about am i smoking too much am i drinking too much
am i eating too much processed foods
those kind of things you need to ask yourself that and if you
need help ask your surgeon or even a dietitian before your surgery to make
sure that you've really made yourself as good as you can be
prior to your surgery
so now you're at a point where you're after surgery and
there are other important questions to ask at this point
obviously give yourself a little bit of time after surgery to recover
but when that time comes to meet with the surgeon after the surgery make sure
you understand the following things the first principle is make sure you
understand what was achieved at surgery
sometimes it is exactly as you understood before
sometimes it's different and it could be a good different or it
could be a different different but the thing is
make sure you understand what happened at surgery and what does it mean for
your care for your outcome and for any other
treatments that you need the second general category is how you
can help yourself recover as quickly and as steadily as possible
so the questions could be when should i
exercise what kind of exercises can i do what foods should i aim for and eat
are there ways of eating that could help me recover
or maybe there's ways that you should modify the way you eat or drink
incompatible with the way the surgery went i think the final thing is
to make sure that you understand things that can happen after surgery
when should you ask for help are there little times where there might be a
warning sign of some things that could be easily treated
but only if you can meet with your team sooner rather than later
again all related to making sure you have optimal recovery after surgery
the final part is to make sure you know where do you go from here
for our neuroendocrine patients we always emphasize to them
that the key to their overall treatment is actually a group
or team approach and it's never just surgery alone
so you've just had surgery the question now is
what should i look forward to what are our next steps
what is the next plan and make sure you understand how that surgery
fits into your overall plan that way everything connects well
and we can optimize your care
for patients with neuroendocrine cancer there are varied
reasons why radiation may be used and it's dependent
on the stage presentation and intentive treatment
and it ranges from being delivered to improve symptoms all the way to being
very aggressive in providing local management
both of a specific site of disease or potentially even
using systemic radiation therapy
generally speaking we would be using
radiation treatment for patients with symptomatic sites of
disease whether it be pain in bones or problems with breathing
where we would use radiation to shrink tumors
another way that we might use radiation is in the
setting of progressive local disease where we're able to deliver high doses
of treatment in that scenario we might be using a
technique called sbrt or stereotactic radiation where we're
attempting to deliver as maximum dose as possible to a tumor
but try to reduce the side effects to
the normal tissue around
the final reason for using radiation
therapy for neuroendocrine patients would be to use systemic treatments the
other name for this is prrt which stands for peptide
receptor radionuclide therapy and this is
a technique where a radioactive isotope is attached to a molecule which is
injected intravenously and in certain patients with recurrent
tumor this may attach to those cells and by doing so can
deliver radiation therapy to all cells in the body that are
expressing this receptor and so dependent on the indication type
of disease radiation therapy has a very large role in management of these patients
so my role is basically to sort of see
patients through their treatment journey and make sure treatments are safe with
respect to the other medications that they're on
and also to manage side effects as they come up
if i was to say to patients there are three things that you need to know from
a pharmacist's perspective i would say every appointment you go to
bring a list of your medications or bring the medications that you take with
you even better because you never know sort
of where each appointment will take you and it's always really good to
revisit if there are any changes and to make sure that we have
an up-to-date list in our records particularly if you're going to start
treatment or change treatments i would say the next thing i
would caution people on but actually encourage
them to enthusiastically involve the nets team with is with
respect to natural products so we you know are constantly exposed to
messaging with respect to alternative therapies or natural supplements
which is fine and you know i think it's great that we explore these things
together and make sure that we're all in the know
of what you're taking whether it be alternative or
through a naturopath so that we can make sure that we keep you safe
on the treatments that you're taking and i think the third thing
i would want to make sure that patients know is to not be afraid
to talk about how you're going to pay for
treatments medications and sort of how to access
the drugs that you need so here at this clinic we have a fantastic drug
reimbursement team as well as amazing social workers and
myself at the pharmacy who make sure a) you have access to all
the treatments that you need and you know we navigate the various access
pathways for you whether it be through your insurance or
through the government health plan