Dr. Meguerditchian’s research program aims at developing tools that ensure quality in the delivery of cancer care across the community. Advances in science have made cancer a treatable disease; yet more than a third of diagnosed patients do not receive recommended care. These deviations from best care occur throughout all aspects of cancer management: screening and diagnosis, post-treatment follow-up and end-of-life care. This impacts recurrence, survival, quality of life and costs. Interventions to manage these deviations are currently challenged by the lack of an integrated cancer care monitoring strategy. Health informatics technology (HIT) represents the ideal tool to address this challenge. The Cancer Care Quality Lab aims to develop informatics tools that integrate currently existing and separately maintained clinical, service, and competency data repositories to monitor quality of care. The Lab’s research specifically targets high-risk situations such as older patients undergoing cancer therapy and preventable adverse events.
Surgical Oncologist, McGill University Health Centre Associate Professor, Departments of Surgery and Oncology, McGill University Program Lead, Cancer Quality & Innovation, Rossy Cancer Network Member, Clinical and Health Informatics Research Group, McGill University
Dr. Meguerditchian completed his medical training at the University of Montreal, where he also received a Master’s degree in Biomedical Sciences. After a General Surgery residency at Laval University, he pursued post-doctoral research and Surgical Oncology fellowships at Roswell Park Cancer Institute (Buffalo, NY), acquiring the skills to deliver evidence-based multidisciplinary cancer care. During this time, he worked on developing community-wide cancer care quality analysis models, and acquired a better understanding of large administrative and clinical data sources. In collaboration with the National Cancer Database, he helped validate linkage algorithms and developed longitudinal breast cancer treatment tracking tools and quality indicator applications for population-wide knowledge translation analysis.
Dr. Meguerditchian is currently a staff surgical oncologist and health services researcher at McGill University.
- Cancer care trajectory
- Compliance to best practice guidelines
- Cancer treatment adherence and challenges
- Post-operative outcomes
- Surgical adverse events and health services use
- HIT and medication reconciliation
- Health professional trainee education and assessment
Predicting Adverse events in Seniors Undergoing Colon Cancer Surgery Using Administrative Data: a Novel Approach to Comprehensive Geriatric Assessment
Older patients undergoing colon cancer surgery (CCS) are at risk for adverse events. Identifying high-risk patients prior to CCS can potentially reduce the burden of post-surgical complications by better tailoring perioperative care. Currently, healthcare providers may apply the risk metrics suitable for the general population; however, these may be inappropriate for older cancer patients. This study evaluates the feasibility of using administrative claims to accurately profile recent health service use as a tool in predicting severe postoperative complications (Clavien-Dindo grades III-V) in older patients undergoing colon cancer surgery.
Preserving Bone Health in Older Breast Cancer Patients Treated with Anti-Estrogen Therapy
Aromatase inhibitors (AI) improve recurrence and survival rates in women ≥ 65 with hormone-receptor positive (HR+) breast cancer (BC). However, AIs are associated with increased bone demineralization in a population already at risk for osteoporosis. Therefore, bone mineral densitometry is recommended at AI initiation to identify patients needing bone preservation treatments. This study assesses compliance to densitometry screening recommendations in older BC survivors treated with an AI and identifies predictors of non-adherence to screening.
Emergency Department Visits Following Breast Cancer Surgery: A Population-Based Study
Emergency department (ED) visits represent unplanned and potentially avoidable use of health services not tailored to cancer patients. They result from the suboptimal management of problems during cancer treatment. Breast cancer surgery (BCS) is the mainstay of treatment for early breast cancer. Despite generally considered a safe procedure with low morbidity compared to other cancer surgeries, BCS may result in significant adverse events, especially in older patients with increased comorbidity. These complications may result in an ED visit, which can significantly alter the cancer care trajectory. This study assesses ED visits in the 45 days following BCS in women aged >65 and identifies risk factors and associated reasons for visiting the ED.
Distress Among Senior Women Diagnosed with Breast Cancer in Quebec: A Study of Psychotropic Drug Use During the Cancer Care Trajectory
Improvements in the diagnosis and treatment of breast cancer have significantly improved survival rates that it may be considered a treatable disease. These gains in survival benefits have largely shifted the focus of cancer care from needs during the acute (or active) phase of the disease to needs arising during survivorship. It is suggested that cancer treatment may lead to psychological morbidity but there are few studies focusing on senior breast cancer patients, an at-risk population with additional comorbidities. This study describes the consumption of psychotropic medications during the cancer care trajectory in a cohort of senior women from Quebec. Specifically, this study will help develop a global understanding of psychosocial distress along various key time points (baseline, active care, and survivorship) in the breast cancer care trajectory.
Adverse Events Following Lymph Node Dissection for Cutaneous Malignant Melanoma: Can We Do Better?
Treatment advances for cutaneous malignant melanoma significantly improved overall survival, estimated at 91% and 89% at 5 and 10 years, respectively. Disease stage remains the most important predictor of outcomes and complete surgical resection offers the best chance of cure. Lymph node dissection (LND) is the current standard of treatment and allows controlling regional involvement in melanoma patients. Several studies have reported varying rates of local and systemic complications associated with LND. However, these studies use a variety of definitions and grading systems, and vary in quality leading to inconsistent results. This study will first, characterize, homogenize, grade and quantify the local and systemic complications associated with LND in cutaneous melanoma patients by conducing a systematic literature review, and second, quantify the incidence of adverse events associated with LND in melanoma patients.
Adjuvant Endocrine Therapy in Breast Therapy in Breast Cancer: A Novel E-Health Approach in Optimizing Treatment for Seniors (OPTIMUM Study)
Adjuvant endocrine therapy (AET) is a low risk, easily administered treatment making it an ideal strategy to reduce the impact of disease in women with hormone receptor positive breast cancer. Despite the considerable survival benefits associated with AET treatment, non-adherence rates of 20% have been reported in trials. This rate may be greater in seniors as older women are often underrepresented in such studies. The integration of e-health tools such as (MOXXI) represents a unique opportunity to address challenges in the delivery of care for older women diagnosed with breast cancer. This study will evaluate the ability of a patient-specific, MOXXI-based, e-health tool (OPTIMUM) that integrates real-time analysis of administrative claims data and provides point- of-care risk assessment to care teams in optimizing breast cancer treatment by increasing AET adherence and persistence in patients aged ≥ 65 years.
Funded by the Canadian Institutes of Health Research
Dr. Heather Gill
Dr. Krista Goulding
Dr. Sinziana Dumitra
Dr. Laura Patakfalvi
Angel M. Rodriguez Rivera