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.
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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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