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Knowledge Creation and Translation at the Odette Cancer Centre

Frances Wright with Catriona, Brian and Declan

Frances Wright's practice of surgical oncology is focused on breast cancer and malignant melanoma. She is particularly interested in locally advanced breast cancer - those that are greater than five centimetres at presentation, invade the chest wall, or have fixed palpable axillary lymph nodes. She has recently finished a study to determine whether lumpectomy is feasible for these tumours following their shrinkage by chemotherapy. Restaging by MRI reveals that up to 20% become treatable by lumpectomy, rather than the standard modified radical mastectomy. This clinical study was spearheaded by Frances at Sunnybrook Health Sciences Centre and funded by the Canadian Breast Cancer Foundation, Ontario Chapter.

In contrast, tumours less than two centimetres in size at presentation are treated by lumpectomy and whole breast radiation. Brachytherapy - or partial breast irradiation - is only being offered as part of a clinical trial at the present time.

She is opening a trial in her busy melanoma practice wherein patients with positive sentinel lymph node biopsies will be randomized to node dissection versus follow-up by clinical examination and ultrasound every four months. Since only 20% of sentinel node positive patients will have further disease in their lymph nodes, the morbidity of node dissection might be delayed or avoided if those who will not progress can be spared this treatment. Radiation is added after node dissection if the resected nodes are large. There is a 5-10% incidence of complications such as lymphedema or numbness in patients following axillary dissections. These complications are more frequent in those who undergo groin dissection.

In addition to the clinical trials, Frances' research includes the study of knowledge translation, a significant focus of scholarship within the Odette Cancer Centre surgical oncology group at Sunnybrook - Andy Smith, Calvin Law, Anna Gagliardi, Natalie Coburn, and May Lynn Quan. Frances recently published a study demonstrating the effectiveness of opinion leaders in changing clinical practice. The impact of clear and persuasive communication of the need to sample twelve or more lymph nodes for accurate staging at the time of colectomy was foreshadowed in an article in the Winter 2006-07 edition of the Spotlight. With Marcus Siminovitch in Hamilton, Frances has studied the practice of low and high volume surgeons performing pancreatectomy for cancer. Her qualitative interviews with surgeons were frank, revealing and constructive. Frances works with Cancer Care Ontario on the effect of multidisciplinary conferences on cancer management across the province. This work, under the direction of John Irish and Robin McLeod, supports the effectiveness of team care and the value of multidisciplinary planning at the outset of cancer treatment.

Frances was encouraged to pursue surgical oncology during her general surgery residency by Ross Walker at Queens. She received excellent guidance and training in qualitative research during her Masters degree program at OISE under Linda Muzzin. In her surgical oncology fellowship, she was supported and guided by Andy Smith and her current partners Calvin Law, May Lynn Quan and Peter Chu. She describes the oncology group as a highly collegial, supportive group that makes challenging work fun. Frances' husband is high school geography and science teacher Brian Roche. They have two children, 9-year-old Catriona and 5-year-old Declan.

M.M.





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