St. Paul’s Foundation Enhanced Patient Care grant helps Dr. Jane Lea and residents reach out to patients in need
According to Dr. Jane Lea, an otolaryngologist at St. Paul’s (otolaryngology deals with diseases of the ear, nose and throat) the key to reducing the mortality rate for cancers of the head and neck lies in prevention strategies and early detection.
In a new program that has received grant support from St. Paul’s Foundation’s Enhanced Patient Care Fund, otolaryngology residents under Dr. Lea’s mentorship brought both of these fundamentals to a neighbourhood in need—Vancouver’s Downtown Eastside (DTES).
Following a path many St. Paul’s caregivers take, otolaryngology residents Dr. Evie Landry and Dr. Kimberly Luu opted to go to the patient, not wait for the patient to come to them, by holding a screening clinic at the Drug User Resource Centre in the heart of the DTES.
“St. Paul’s is involved in a lot of international outreach work,” says Dr. Landry, a third year otolaryngology resident and a key force behind the program’s success. “So I wanted to help start something local. And what more fitting population is there than the Downtown Eastside? So deserving. So much need.”
The clinic offered a full head and neck history and physical exam conducted by members of the otolaryngology team. Findings were recorded and appropriate arrangements made for any abnormal findings or pathologies that required follow-up.
“We see a lot of patients from the DTES, especially on-call.” says Dr. Landry. “But we wanted to start an initiative within the community, to find this pathology, and do some preventative work.”
On the clinic’s first day, 48 patients were seen. This was considered a huge turnout for what can be a notoriously hard-to-reach population.
High levels of risk factors
With many otolaryngological diseases being asymptomatic until later stages, finding patients who are at highest risk is crucial and, in the DTES, the risk factors are prevalent. Of patients at the clinic that day, 78% were longtime smokers; 70% were longtime consumers of alcohol; and nearly 80% used drugs.
“Poverty, poor nutrition, poor dental hygiene and lack of access to care are all risk factors for head and neck cancer and we saw them all,” says Dr. Landry. “Ear, Nose and Throat is vast, too: you can have trouble swallowing, you can have pain in your ear, trouble breathing through your nose, problems hearing. So much of it affects the senses, so quality of life is impacted.”
Dr. Landry also encountered new pathologies, citing eardrum perforations as an example. While accustomed to seeing holes in the eardrum as a result of infection, in the DTES that day Dr. Landry and her colleagues saw traumatic perforations—holes in the eardrum caused by punches, kicks and falls.
“While 90% of eardrum perforations from an infection will typically heal,” says Dr. Landry, “we were seeing big, non-healing perforations, a totally different pathology that we are not used to treating.”
Dr. Landry and her colleagues saw one example after another of just how different the DTES can be from the neighbourhoods that surround it.
“When you look at incidence of head and neck cancer in the oral cavity,” says Dr. Landry, “in the general population it’s about one in ten thousand; yet out of 48 people we saw that day, we found five abnormal lesions in the mouth.”
Having identified a need, a future goal for the otolaryngology team is to stage this special screening clinic every two months.
Friends of St. Paul’s are encouraged to support programs like the Enhanced Patient Care Fund, which in turn helps to support the otolaryngological screening clinic and many other innovative programs.