Man with a Mission
For a man with two full-time jobs, Dr. Armen Aprikian looks remarkably relaxed. In fact, there is little in his demeanor — and no sign on the door of his modest office — to betray the fact that Aprikian, Chief of Urology at the McGill University Health Centre (MUHC), has recently been named Interim Director of the MUHC’s new Cancer Care Mission.
“I ’ve only been at this for a few months and I think I’m still in the honeymoon phase,” Aprikian says with a smile when asked about his apparent serenity. “Everyone is very enthusiastic about what the new mission will mean for cancer care at the MUHC, and this atmosphere of optimism and excitement has made the challenges of setting up a new administrative unit seem fairly minor.”
As a practised urological surgeon who has dedicated much of his career to finding innovative treatments for prostate cancer, Aprikian knows a thing or two about cancer care. Nevertheless, it came as a complete surprise when the MUHC’s Executive Director, Dr. Arthur Porter, asked if he would be willing to oversee the consolidation of all cancer-related services into a new Department of Oncology, which would also become one of the hospital’s priority missions. “Frankly, I was shocked,” says Aprikian, “but I said yes immediately because I know how important this is to the MUHC and I wanted to be a part of it.”
Until May of this year, oncology at the MUHC was not a discrete entity but operated as a division of the departments of medicine and surgery. As Aprikian explains, this has historically been the norm for cancer care, reflecting the many different surgical and medical disciplines with which oncology overlaps and the fact that, particulary in the case of surgeons, practitioners may see non-cancer patients as well. “People seem surprised that the MUHC is only now designating oncology as its own mission and department, as if we are somehow behind the times,” he says. “The opposite is true. Our new Cancer Care Mission puts us on par with North America’s most forward-looking health care institutions. The health care landscape is changing, with cancer care now taking up on average 30 percent of a hospital’s resources. This will certainly increase, especially in Quebec where the population is aging rapidly. The MUHC recognizes this and is working to put cancer care front and centre as we move into the future.”
As a seventh MUHC mission, following the six existing missions of medicine, surgery, women’s health, pediatrics, mental health and neurosciences, oncology is now a pillar of the hospital’s services and a priority in future developments. More concretely, oncology will have the authority to manage its own recruitment and to apportion its own budget. According to Aprikian, “We will now be given our own pie rather than having to negotiate for pieces of other pies. We can hire exactly the cancer specialists we need and budget our resources in the best possible fashion.” Aprikian is quick to acknowledge the support of the chiefs of the departments of medicine and surgery, Dr. David Eidelman and Dr. Mostafa Elhilali, who fully encouraged the move despite its implications for their own departments.
Most importantly, the creation of the Cancer Care Mission and Department of Oncology will allow the doctors, nurses, professionals and staff involved in cancer care to regroup under one umbrella in preparation for the creation of the Comprehensive Cancer Centre, which will be situated on the Glen campus of the redeveloped MUHC. “Having all our cancer specialists working together under one roof is really the best possible scenario,” Aprikian says. “We’ll have the chance to work together seamlessly, without physical and bureaucratic barriers. And patients will be able to see their oncologist, surgeon, clinical nurse specialist or anyone else involved in their care without onerous travel. From a research perspective, we’ll collaborate more easily, sharing ideas and working on multidisciplinary projects without the complications of different departments and sites.”
"Our new Cancer Care Mission puts us on par with North America’s most forward-looking health care institutions."
At the new Comprehensive Cancer Centre, patients and their families will benefit from the contiguous arrangement of units that are closely related to cancer care, such as the oncology day centre, radiotherapy, radiology, surgery, sections of women’s health and the Research Institute. Cancer care is frequently complex, involving multiple specialists, a range of diagnostic procedures and oversight from several divisions. At the centre, a patient will be able to see their oncologist for a follow-up, have an ultrasound and receive radiotherapy in the same building, and, in the best-case scenario, on the same day. For caregivers, this arrangement will allow for easier communication and follow-up when dealing with shared patients. “Cancer patients are under tremendous stress,” says Aprikian. “Having to travel long distances between appointments only exacerbates their anxiety and fatigue and makes it more difficult for them to communicate clearly with us.”
In anticipation of the move to the new Comprehensive Cancer Centre, Aprikian has already created the executive committee that will govern the Cancer Care Mission and subgroups organized according to areas of specialization such as breast cancer, colorectal cancer and the tumour registry. “Because of their unique contribution to Cancer Care at the MUHC, we have given the Cedars Cancer Institute a permanent seat on this committee,” Aprikian notes. Over the next few months he will ask each subgroup to submit a list of needs that will inform the executive’s allocation of resources. These lists will be compiled and sent to the MUHC as an overall assessment of oncology services. “We’re working hard to make sure that moving forward we have structures in place that will ensure the best possible organization, the most efficient communication and the fairest decision-making,” Aprikian says. “By the new year we should have a much clearer picture of exactly where cancer care stands and what is needed to achieve our goals. While waiting for the completion of the Cancer Centre at the Glen, we will focus on regrouping and consolidating so that our move is as easy and seamless as possible.”
For Aprikian one of these goals is to enhance cancer research, and in particular to increase the capacity of the MUHC’s oncology researchers to conduct clinical trials. “Right now the MUHC is one of the busiest cancer centres in the city. Both in terms of quantity and quality, I think we’re doing an excellent job in caring for the population. As an academic health care centre, though, I think we have a responsibility to ensure that even more of our patients are enrolled in clinical trials.” As Aprikian explains, the MUHC’s cancer specialists have been responsible for some incredible advances in the last decade, from the discovery of key genes responsible for breast cancer to pioneering work in new minimally invasive and noninvasive treatments for prostate cancer. “With expanded space for clinical trials our world-class researchers will be able to test their discoveries and move them further along the pipeline. At the same time, we’ll become an even more attractive destination for new research talent.”
Oncology researchers will have access to the Research Institute of the MUHC’s Centre for Innovative Medicine at the Glen, which includes extensive spaces and equipment and facilities for everything from basic scientific research to animal trials to large-scale human testing. In addition, the new Cancer Centre itself will include a clinical research unit where staff will manage the data collected from patients participating in research projects, as well as space for the MUHC’s tumour banks, a valuable resource which allows researchers access to thousands of tumour samples on which to base their research. “With all of these advantages, as well as with greater collaboration with McGill University’s Department of Oncology and its scientists, I predict that oncology research at the MUHC will really blossom over the next five to ten years,” Aprikian says.
What do those five to ten years hold for Aprikian himself? “I honestly don’t know,” he laughs. “Although my role as Interim Director is to put the structures of the Cancer Care Mission in place and prepare the ground for the recruitment of a permanent director, I might like the job too much to want to give it up. They might find my application in the pile when the time comes. We’ll just have to wait and see.” In the meantime, Aprikian will have plenty to keep him busy and, despite the absence of a prominent sign on his office door, he will have the satisfaction of knowing that he played an integral role in creating what promises to be one of Canada’s premier comprehensive oncology centres.
