A Beacon of Hope in the Fight against Pancreatic Cancer

The statistics for pancreatic cancer are sobering. According to the Canadian Cancer Society approximately 7,000 Canadians will be diagnosed with this form of cancer every year and of those, 5,700 will die. While pancreatic cancer is relatively rare compared to more common forms of cancer such as breast and colorectal cancer, it is difficult to detect in early stages and tends to be highly aggressive, spreading quickly to nearby organs and tissues. Furthermore, Atlantic Canada and in particular, Nova Scotia has some of the highest incidence of deaths from pancreatic cancer in Canada.

The beacon of hope in the quest to unravel the mysteries of this deadly disease is cancer research.  Dr. Ravi Ramjeesingh, a medical oncologist, a researcher at Dalhousie University and a member of the Beatrice Hunter Cancer Research Institute, is at the forefront in the effort to change the odds for pancreatic cancer patients.  Dr. Ramjeesingh is highly respected for his clinical and research expertise in the area of hepatobiliary cancers (which comprise a spectrum of invasive carcinomas in the liver, bile ducts, pancreas and gall bladder) and for his research in the field of health service delivery. 

In his role, Dr. Ramjeesingh sees the bulk of pancreatic cancer patients at the QEII Health Sciences Centre in Halifax. Knowing first-hand the struggles of patients and their families, he is determined to do everything he can to improve care and outcomes.

“When I started as a medical oncologist in Nova Scotia in 2015, the province had the worst survival outcome when compared to Canada despite having the same access to treatment as the rest of Canada. The question of why this was happening was always met with a shrug of the shoulders and an ‘I am not sure’,” he recalls. “At that time there was little research being done in pancreatic cancer with many questions needing to be answered.  While it took some time, we began to identify system issues that were likely impacting care for pancreatic cancer in the province, which led to changes and the eventual development of new provincial guidelines for pancreatic cancer. It took research to determine where the unmet needs and barriers were.”

Dr. Ramjeesingh says that research is leading to breakthroughs in treatments for patients with pancreatic cancer, which is notoriously difficult to treat. “Some things that work for other cancers have no effect on pancreatic cancer – immunotherapy being a great example. We do know that looking at the genomic pattern of a patient’s pancreatic cancer can potentially identify other treatment options for that particular patient and also potentially identify treatments which will not work for them.  This is becoming more a routine part of the patient’s care. However, access to genomic testing is somewhat limited and more advocacy is needed to find funding for these large panels of testing that are being done in some of the other provinces in Canada.”

Research has led to a host of improvements in diagnosing pancreatic cancer, says Dr. Ramjeesingh. “We are beginning to see circulating tumour cells as a potential diagnostic tool which was developed from research. It is very much too new to be used in prime time, but my hope is in the next several years we may have something that could identify early recurrence of the disease, and a simple blood test that could be quicker to do than waiting for imaging which in some cases can take time to be done.”

Another example is liquid biopsies. “They could revolutionize how we diagnose pancreatic cancer. The potential of not having to put someone under the knife to get a piece of tissue and to have a blood test instead would be best for all involved. While this is still under investigation, it is my hope that this will become a standard way of diagnosing our patients.”

In addition to his research and clinical efforts, Dr. Ramjeesingh is active in advocacy work. For example, he works with Craig’s Cause Pancreatic Cancer Society, a national organization dedicated to increasing survival and improving the quality of life for Canadians diagnosed with pancreatic cancer, giving frequent talks about the latest interventions and treatments.

Dr. Ramjeesingh believes that while research to date has yielded promising results, more research is needed. “Pancreatic cancer research has been terribly underfunded for many years, especially in Atlantic Canada. Without research, there is little momentum to move the pendulum forward in improving outcomes from this horrible disease. Granting agencies have limited funds and have historically invested their research dollars in other provinces.  Without the generous donations of the public, the research potential of Atlantic Canada in this area cannot advance.” He adds that research investments also support our next generation of researchers and helps to attract top level researchers to Atlantic Canada.

“I have always had a vision of what we could achieve in cancer care in the province,” he says. “There is no reason why we could not become one of the top centers of excellence in pancreatic cancer treatment in Canada.”

Thanks to dedicated researchers like Dr. Ramjeesingh, we’re getting closer to defeating pancreatic cancer, and research in Atlantic Canada could play a key role in creating this future.