Current Research
Robotic Nipple-Sparing Mastectomy with Immediate Prosthetic Breast Reconstruction
The vast majority of patients undergoing surgery for breast cancer in Toronto still have conventional Breast Conserving Surgery (BCS) or mastectomy as their primary oncologic operation. The Princess Margaret Cancer Center and the Women’s College Hospital in Toronto
represent a unique environment with respect to its large volume of breast cancer patients. In addition, these hospitals have begun to offer OPBS procedures as part of standard breast cancer care, making them among the firsts hospitals to do so in the province. Currently, there is very limited data on the outcomes of oncoplastic procedures in Toronto and Canada.
The primary objective of our study is to assess the clinical and patient reported outcomes with OPBS when compared to conventional BCS or mastectomy.
ABODE Study: At-home Breast Oncology care Delivered with E-Health solutions
The COVID-19 pandemic has significantly impacted healthcare service delivery, highlighting the need for high quality virtual patient care. We have developed a multi-dimensional remote patient eHealth solution for newly diagnosed breast cancer patients and their practitioners to use during the diagnostic and surgical follow-up period. We have developed the Breast Cancer Treatment Application (BCTA) that can facilitate virtual consultations, deliver patient education material, and collect patient reported outcome measures. Using a randomized controlled trial design, we will evaluate a variety of outcomes for breast cancer patients who will use the BCTA through their diagnosis and treatment. Our study will compare changes in patient activation over 1 year among newly diagnosed breast cancer patients between those using the BCTA and those receiving standard care. We will also evaluate anxiety, psychosocial well-being and quality of life between the two groups. To further understand the impact of the BCTA, we will assess the health services utilization and patient satisfaction outcomes. Our innovation will provide a solution to improve communication between patients and their healthcare providers
TICTOC Study: The Impact of COVID-19 on Treatment Outcomes in Breast Cancer
There have been significant delays in breast cancer (BC) treatment during the COVID-19 pandemic yet the experience and perspective of breast surgeons on the diagnosis and treatment of BC is yet to be explored. This study will support the identification of research priorities and development of mitigating strategies for future pandemics.
One-on-one qualitative semi-structured interviews were conducted with breast surgeons in Ontario, exploring the impact of the pandemic on BC treatment, psychosocial well-being, and the future state of BC care. Audio-recorded interviews were transcribed verbatim and coded thematically. Transcripts were iteratively coded using a grounded theory approach to guide identification of significant themes.
Thematic analysis revealed 5 major themes: inter/intradisciplinary collaboration, surgical innovation and creativity, location and surgeon role-based variability in experiences, significant psychosocial impacts on practitioners and patients, and inequities across patient groups for cancer screening and care. For future impacts, surgeons discussed significant ongoing delays, adopting a hybrid model of virtual care, and continuing use of medical interventions that were adopted during the pandemic due to restrictions and resources allocation.
Breast surgeons’ perceived opportunities and concern for worsening disparities adds to the growing literature on cancer care and the COVID-19 pandemic.
Wellness & Burnout Among General Surgery Residents in the Time of COVID-19
The COVID-19 pandemic has placed additional demands on General Surgery residents, who are already at high risk of burnout. This study examines the pandemic’s impact on burnout and wellness among Canadian General Surgery residents at a large training program.
This three-phase project aims to understand, address and mitigate the impact of burnout in surgical trainees. In phase one, a survey study was conducted to understand the prevalence of burnout and issues regarding wellness among residents. In phase two, data from the survey will be used to develop and assess effective solutions through focused workshops. The final phase will evaluate the intervention to create a sustainable program that is reflective of the local environment.
THE EMPRESS TRIAL: the Effect of Mental Practice and Rehearsal on Emotion, Stress & Surgery
The traditional apprenticeship model of training surgical residents places strong emphasis on acquiring skills through procedural exposure and repetition. This has become less feasible in the current medical environment, especially during the COVID-19 era, with operating room resources becoming increasingly scarce and residency work hour restrictions.
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Mental practice is defined as the conscious action of mental and repeated rehearsal of a task without physically seeing or performing it. It has been used extensively for decades in professional sports and music, two fields which are frequently compared to surgery for their complicated fine-motor movements, stressful conditions and goal-oriented tasks.
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The objective is to conduct a pilot study using a randomized-controlled trial design to evaluate the impact of mental practice on stress and intra-operative technical performance of surgical residents. Participants in the control group will be provided with standard learning materials for a laparoscopic cholecystectomy including readings and video instruction. Participants in the experimental group will be taught how to perform verbally guided mental practice by a sport psychologist in addition to the standard learning materials. All participants will be assessed at three time points within a two-month period during surgeries set early, in the middle, and near the end of a rotation. The outcomes for analysis include the ability to perform mental practice, stress/anxiety levels, cardiac and respiratory parameters, and an objective assessment of technical skills.
Using this data, we will model and compare changes in stress/anxiety and improvement in surgical performance over time between the two groups. Our hypothesis is that mental practice will result in decreased stress and improved technical performance among surgical trainees.
ABODE NAC: At-home Breast Oncology care Delivered with E-Health solutions – The ABODE Study for Patients Undergoing Neoadjuvant Chemotherapy
In this project, we will expand the capacity of the app previously developed in the ABODE study to create a virtual prehabilitation care pathway for breast cancer patients who are undergoing neoadjuvant chemotherapy. We will initiate a pilot randomized controlled study to assess the feasibility of a larger future RCT. In addition, we will evaluate a variety of outcomes for breast cancer patients who will use the app throughout their treatment journey. Our innovation will provide an essential virtual platform and resource to cater to patients' requirements as they progress through the stages of neoadjuvant chemotherapy, pre-habilitation, surgical treatment, adjuvant radiation, and ultimately, survivorship​
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