Saturday, September 12, 2015

Gastric Cancer Consensus Conference (a.k.a. My First Conference)

In debating whether the medical conference I attended this weekend warrants its own blog post I realized that it's actually the first conference I've ever attended (which tells you how successfully my research went in med school) -- so I suppose I can justify posting about it, if only to look back on later!

As us second-year residents got left behind this week when the rest of our program took off for the national radiation oncology conference, we were invited instead to attend the annual Western Canada GI Cancer Conference, which just so happened to be held in Edmonton this year. The focus was gastric cancer, which I've only ever seen a couple of cases of (it's relatively rare -- but aggressive).

The conference was held over Friday and Saturday at the Fairmont Hotel Macdonald.
fairmont hotel macdonald edmonton
it's one of the beautiful old railway hotels -- basically a castle (photo from Wikipedia)
After rounding on my assigned gyne inpatients at an even more ridiculous hour than usual, I handed over at 7 am (shortest surgery day ever!) to head over for registration and breakfast. The conference opened with a talk by a stage-IV gastric cancer survivor, Debbie Zelman, who travelled up from Florida to tell us about Debbie's Dream Foundation: Curing Stomach Cancer. She founded this organization in 2009 to raise awareness and funds for gastric cancer. One particularly neat thing Debbie's Dream does is connect gastric cancer patients with patients who are newly diagnosed, for mentorship and support.

The foundation has recently extended to Canada (Ontario and BC) and the two gastric cancer survivors who head up these branches were also in attendance, to share their experiences. Perhaps I'm very naive, but I was honestly taken aback by how well they all looked. At the cancer centre, I think our population is skewed towards poorer outcomes because it's those sicker patients who keep coming back for treatments and follow-ups; as our aim is to discharge patients from oncologic follow-up as early as possible, we miss seeing how the good ones do. For that reason I thought it was especially interesting and inspiring to hear these peoples' stories and perspectives on the disease.
edmonton river valley fall
Next was break time -- I checked out the view (this hotel = amazing).
edmonton river valley fall
It was gorgeous and 28 degrees out!
The morning proceeded with talks to provide gastroenterological, surgical, medical, and radiation oncologic outlooks on selected controversial gastric cancer topics. I learned so much from both the talks and audience discussion that followed!
fairmont hotel macdonald conference
my stealthy picture doesn't do this room justice -- it's the hotel ballroom and is so so beautiful!
After lunch we broke into BC, Alberta, Saskatchewan, and Manitoba groups to answer several controversial questions (e.g. How should we surveil gastric cancer patients after curative resection? -- spoiler: Surveillance is not recommended, as there is no evidence for its benefit (metachronous gastric cancers are very rare in our North American population).).
canada passport office renewal
We finished early and had a break before dinner so I ran across the street to get my passport renewed. #efficiency
sabor restaurant edmonton
We reconvened for dinner at Sabor Restaurant. It was fancy and delicious.
There were some interesting discussions at our table of medical oncologists and one of the gastric cancer survivors.
When we returned this morning, the answers solicited yesterday from each province were presented, and discussion ensued to draft up new answers upon which all four provinces agreed, to be published as new consensus guidelines. Though I obviously had nothing useful to contribute to the discussion, it was interesting to listen to, and enlightening to see how consensus guidelines are actually arrived at!

Overall, I really enjoyed the two days. I learned a ton, met some nice and clever people from the GI cancer world (a couple of whom I even recognized from our videoconferenced med school lectures four years ago), ate a lot of good food, and got to catch up with the other rad onc resident in my year (we were the only two non-staff (i.e. useless ones) at the consensus conference).
catering fairmont hotel macdonald
they kept us well-fed
I think that the most practical thing I can pass on to people in medicine is that H. pylori is as big a risk factor for gastric cancer as smoking is for lung cancer (isn't that crazy?!). So, if a patient has dyspepsia, don't just give them a PPI and write it off as GERD -- test for H. pylori!! The best way to do so is the urea breath test (EGD biopsies may yield false negatives, because the bacteria are non-confluent on the gastric mucosa). If a patient tests positive for H. pylori, they MUST be treated. In terms of treatment, I learned that our 2015 treatment guidelines (specific to the antibiotic resistance patterns in our region) no longer recommend the classic Hp-PAC triple therapy; instead, first-line treatment with PPI + amoxicillin + clarithromycin + metronidazole is recommended, for 14 days. The importance of completing the entire 14-day treatment course (to avoid increasing bacterial resistance) must be impressed upon patients and, to make it easier for them to take the pills properly, having the pharmacy blister-pack the four medications is a good idea. Of course, treatment guidelines may vary by region -- so be sure to check what regimen is recommended where you're practicing. Bottom line: remember Hp eradication -- I for one will be a lot more cognizant of it!

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