close

Join our Mailing List

Receive the latest news, event invites, funding opportunities and more from the Ontario Institute for Cancer Research.

Data from 10,000 Ontario Health Study participants studied for vaccine effectiveness

Ontario Health Study (OHS) investigators merited a $500,000 CIHR operating grant to relate COVID-19 antibody levels to vaccine effectiveness by looking at COVID-19 infection levels, hospitalization rates and deaths in vaccinated OHS participants.

They will also assess how immune response to vaccination varies by:

  • Type of vaccine (AstraZeneca, Pfizer or Moderna) including mixed doses
  • Number of doses received
  • Time since last dose
  • Time between those doses
  • Factors such as the participants’ age, sex, genetic makeup, and the impact of certain pre-existing health conditions (including cancer, arthritis, lupus, diabetes, kidney and liver disease)
  • Whether vaccine effectiveness varies by viral variant (including Delta and Omicron)

“By studying how antibody levels change over time, we can assess the efficacy of different vaccines, and provide insights into the need, and timing, for future boosters,” said OHS Scientific Associate Dr. Victoria Kirsh.

“Also knowing more about how people’s genetic traits, age and health status can impact immune response will help policy makers tailor recommendations for who can most benefit from boosters, and when.”

From December 2020 to June 2021, the OHS invited select participants to complete an online questionnaire about vaccination, previous COVID-19 infection, and underlying medical conditions and medications taken. The antibody study included 10,569 participants (age 21 to 93), of whom 62% were women. Participants also used an at-home kit to provide a dried blood spot sample, which was tested for antibodies to SARS-CoV-2 (anti-spike IgG, anti-receptor binding domain of spike (RBD) IgG, and anti-nucleocapsid (N) IgG). Collection of second dried blood spot samples from these participants begins February 2022.

With participants’ prior consent, some of the previously collected blood samples will undergo DNA extraction and genotyping, as will some of the dried blood spot samples. Researchers will then link the questionnaire and genetic data to several administrative health databases to ascertain COVID-19 infections, hospitalizations, ICU admission and death.

Examining how differences in people’s genetic make-up may affect antibody levels is vital to understanding possible sources of vaccine failure, Dr. Kirsh noted. “If there are common genetic variants found to drive a compromised immune response, this would support the idea of more widespread use of booster shots down the road.”

Read more about the OHS COVID-19 Antibody Study. The principal investigators for this project are Dr. Victoria Kirsh, OHS Executive Scientific Director Dr. Philip Awadalla, and CanPath Scientific Coordinator Kimberly Skead. The funding was provided by the Canadian Institute for Health Research.

CanPath’s COVID-19 Antibody Study is funded by the Government of Canada, through Canada’s COVID-19 Immunity Task Force, and by the Canadian Institutes of Health Research.

***

This article was written by the Ontario Health Study and shared with permission. The original article is published at ontariohealthstudy.ca


Radiation or surgery: finding the best treatment for oropharyngeal cancer

Dr. David Palma talks about ORATOR, the first published trial comparing quality of life outcomes between treatment options for cancers of the throat and back of the tongue.

The demographics of oropharyngeal squamous cell carcinoma (OPSCC) have shifted dramatically in recent years, with much younger people commonly diagnosed with these cancers of the throat and back of the tongue.

This has made considerations of long-term quality of life even more important. It has also led to spirited clinical debates about treatment options, says Dr. David Palma, an OICR Clinician Scientist and radiation oncologist at London Health Sciences Centre (LHSC).

Patients with oropharyngeal cancers are usually treated with either radiation or surgery. And while both have very high cure rates, both are associated with potentially lifelong side effects.

So Dr. Palma – a radiation oncologist – and his LHSC colleague Dr. Anthony Nichols – a head and neck surgeon – led a randomized trial to compare both treatments’ long-term impact on quality of life. The ORATOR trial ran for about four years and enrolled a total of 68 patients. Long-term results were recently published in the Journal of Clinical Oncology, and Dr. Palma spoke with OICR News about what he and Dr. Nichols found.

Tell us about how the demographics of oropharyngeal squamous cell carcinoma (OPSCC) have changed recently.

In the past 15 or 20 years, we’ve seen a large increase in cases of cancer of the oropharynx, and it’s due to an epidemic of the human papillomavirus virus (HPV). Traditionally, most patients with OPSCC were around 70 years old and often had major exposure to alcohol or tobacco. Now, many patients are in their 40s, 50s and 60s, and they are often non-smokers. It’s a whole different population.

How has this changed conversations around treatments?

The historical treatment has been radiation, and the good news is these cancers are extremely curable. If you’re a non-smoker with an HPV-related cancer, your chance of cure might be around 90%. But treatment can be very, very difficult on patients. Radiation can give people dry mouth, difficulty with taste, difficulty with swallowing. Sometimes people may need a feeding tube. For this new population of younger patients, they might have to live a long time with these side effects.

How did the ORATOR trial come about?

The biggest development in this area in recent years was the advent of transoral robotic surgery (TORS), which allows a surgeon to remove a tumour more easily than older surgical methods. As TORS became more popular in the U.S., there were studies suggesting that maybe it was a better approach than radiation.

At the same time, radiation was improving so that we could be much more precise and avoid damaging normal tissue like the saliva glands.

So, we had these two possible treatments and we didn’t always know which one was best. And in medicine, you don’t really know which treatment is best until you do a randomized trial.

How was quality of life measured in the trial?

We measured swallowing function through patient surveys. Swallowing is the main thing that can be negatively affected by these treatments, and so besides curing the cancer, our priority with treatment is to maximize a person’s swallowing ability.

What did trial show about radiation versus surgery?

The first finding is that both treatments were very good at treating cancer. Long-term survival was quite good regardless of whether patients had surgery or radiation.

Both groups also reported good swallowing function. Results were a little bit better with radiation, which was actually contrary to what I expected. But the difference didn’t meet the definition of what would be a clinically significant change. Over time, we found that cure rates remained very good and the differences in swallowing function between the two treatments became less prominent.

What are your main takeaways from these results?

Our findings were reassuring that both treatment options are good at curing cancer and provide good outcomes for patients.

They do however have different side effect profiles which can be discussed between physicians and patients. Since this is the only published trial comparing surgery and radiation for these cancers in a randomized fashion, it gives us a lot more information to come to a shared decision with our patients on which treatment is best.

What’s next for this research?

Our next step is to explore what we call de-escalation, which means reducing the intensity of the treatment to try and improve quality of life while preserving the high cure rates.

We recently completed a study called ORATOR 2 to compare surgery and radiation as part of a de-escalation approach. The results have been reported and should be published soon.

Ontario’s support for research will change lives across the province

A major investment in research by the Ontario government will help OICR and other organizations bring health and economic benefits to the people of the province.

In a press release distributed today, Minister of Colleges and Universities Jill Dunlop announced three years of funding for OICR and four other Ontario-based research organizations: Ontario Genomics, Clinical Trials Ontario, The Fields Institute and Compute Ontario.

This investment will allow OICR to implement our new Strategic Plan and continue to conduct and support world-class translational cancer research that leads to life-changing patient outcomes. It will ensure OICR researchers and collaborators across Ontario can continue their innovative studies, and allow us to offer new funding opportunities that support research and translate findings into healthcare and policy solutions.

The government’s investment in OICR will also fuel our work with our strategic partner, FACIT, to ensure the economic benefits of Ontario’s research innovations stay in Ontario, helping lead Ontario out of the pandemic and into the future.

As part of today’s announcement, OICR President and Scientific Director Dr. Laszlo Radvanyi joined Minister Dunlop and representatives from the other four organizations in a video message.

“With this generous support from the Government of Ontario, OICR will develop new knowledge and tools to fight cancer as effectively as possible, help patients live longer, healthier lives and bring economic benefits to the people of Ontario,” Dr. Radvanyi said.

Read more about today’s announcement from the Government of Ontario.

Proactive outreach program helps chemotherapy patients manage side effects

A telephone-based toxicity management program was shown to improve quality of life for chemotherapy patients and reduce the severity of side effects, but did not reduce hospital visits between treatments.

For cancer patients on chemotherapy, time between treatments can be fraught with illness and uncertainty.

Nausea, fatigue, diarrhea and pain are all potential symptoms of toxicity, which occurs as a side effect when chemotherapy drugs damage healthy cells as well as cancer cells. Though common, these side effects can be severe. And it’s hard for patients at home to know when they are serious enough to need medical attention.

“There is a constant question about the severity of toxicity symptoms and how to handle them,” explains Dr. Eva Grunfeld, Professor of Family Medicine at the University of Toronto and Clinician Scientist at the Ontario Institute for Cancer Research (OICR).

Dr. Eva Grunfeld, OICR
Dr. Eva Grunfeld

“Patients and their family caregivers are constantly evaluating: ‘Are these symptoms okay or not okay? Are they serious enough that we need to go to hospital?’”

Many patients receiving chemotherapy will visit the emergency department or be admitted to hospital at least once during their treatment. These trips to hospital can be difficult for patients and put strain on the health system, leading researchers to explore proactive approaches to better support patients and reduce acute care visits.

An OICR-funded study led by Dr. Grunfeld and Dr. Monika Krzyzanowska recently evaluated one potential option: a remote symptom management program where oncology nurses call patients at home at key times during each cycle of their chemotherapy treatment.

“When a patient is at home potentially experiencing symptoms of toxicity, a call from an oncology nurse can help them with their symptom management,” says Dr. Krzyzanowska, a medical oncologist and Professor of Medicine at the University of Toronto. “The theory is that this kind of proactive interaction can help catch symptoms of toxicity earlier.”

The program was trialed with patients in treatment for early stage breast cancer in 20 Ontario cancer centres. The results, recently published in BMJ, suggest that it was associated with less severe toxicity symptoms and better quality of life, but did not impact the number of times patients visited the emergency department or were admitted to hospital.

Dr. Monika Krzyzanowska

Dr. Krzyzanowska says the improvements to patient outcomes, which were measured via questionnaires, are encouraging. They echo findings from the team’s earlier pilot study and other similar studies, which also showed that these kinds of programs are well-received by patients and healthcare providers.

Though it didn’t make in impact on visits to acute care, Dr. Krzyzanowska says that making some tweaks to the program’s target group – or potentially pairing it with another intervention – could help realize its full potential for patients and the health system. She notes that the study has become even more relevant since the COVID-19 pandemic because of Ontario’s increased reliance on remote care delivery.

“I strongly believe that we need some sort of a proactive toxicity monitoring program for patients undergoing cancer chemotherapy,” Dr. Krzyzanowska says. “The question is really about how.”

Beyond the findings, the study makes an important methodological contribution by measuring its primary outcome – the number of acute care visits – using routinely collected administrative health data. This approach is rare for a randomized trial and provides more accurate and comprehensive measurement.

For Dr. Grunfeld, the study offers promising evidence that researchers can build upon to explore province-wide options to manage the side effects of chemotherapy. She has seen many patients struggle with toxicity in her practice, and experienced toxicity intimately when her husband underwent chemotherapy recently. She says a program like this could offer much-needed support and comfort during those difficult days between treatment.

“Toxicity is an enormous thing to have to manage and worry about,” she says. “I can really empathize with how knowing someone will be checking in is really important.”

Dr. Geoffrey Fong appointed Officer of the Order of Canada

An OICR senior investigator has been awarded one of Canada’s top civilian honours for his research on policies to reduce the negative health impact of tobacco products.

Dr. Geoffrey Fong was appointed an Officer of the Order of Canada on Dec. 29, 2021, when the Governor General of Canada announced 135 appointments. The Order of Canada recognizes outstanding achievement and service to the nation.

Dr. Fong is a Professor of Psychology at the University of Waterloo and the Founder and Chief Principal Investigator of the International Tobacco Control Policy Evaluation Project (ITC Project), which evaluates the impact of population-level tobacco control policies. His research has demonstrated the effectiveness of tobacco control measures like plain packaging for cigarettes and bans on menthol cigarettes, and his findings have informed tobacco control efforts in Canada and around the world. 

“I am humbled and honoured to receive this recognition, which is a tribute to our dedicated research team, who have worked together to evaluate and understand the impact of policies throughout the world,” Dr. Fong said.

“I am grateful for the support from OICR and other funding agencies, including the Canadian Institutes of Health Research (CIHR) and U.S. National Cancer Institute, which have allowed us to use our research evidence to strengthen and accelerate population-level action to tackle the number one preventable cause of cancer and non-communicable diseases more generally: tobacco smoking.”