Dr. Joseph works to improve outcomes for people diagnosed with cancer, and ensures they have quality of life both during and post-treatment.
By Elizabeth Chorney-Booth
Photographs by John Ulan
Like most healthcare professionals, Dr. Kurian Joseph is passionate about maintaining his patients’ comfort and quality of life. Of course, caring for patients’ well-being is part of the job. But Joseph, a radiation oncologist and researcher at the Cross Cancer Institute (Cross) in Edmonton, has made it his mission to figure out innovative ways to make things better for patients wherever he can.
In addition to treating patients diagnosed with gastrointestinal, skin and breast cancer, Joseph has dedicated his career to a series of research studies designed to improve outcomes and help patients live their best lives possible both during and after treatment. It’s a calling that comes not only from Joseph’s compassionate personality, but also from a friendship in his youth that changed the course of his life. Most recently, it has led him to lead a new research project that could significantly reduce the number of surgeries that patients diagnosed with low rectal cancer (tumours that occur in the lower six centimetres of the rectum) may need to undergo.
When Joseph was at university in India, a close friend was unexpectedly diagnosed with lymphoma and passed away from the disease. Struck by the feeling that a life had ended far too soon, Joseph pursued a career in oncology to honour his friend who also had dreams of becoming a doctor. Although Joseph doesn’t specialize in lymphoma, his friend’s passing inspired him to dedicate his career to advancing cancer care.
“He would have lived if it had happened now,” Joseph says. “At the time, there was no successful treatment. So many things have improved since then.”
Investigating positive outcomes.
Remission and extension of life are always the first goals for patients and oncologists. Researchers like Joseph are concerned about finding effective treatments that not only eradicate a patient’s cancer but also leave them able to enjoy life as fully as possible post-treatment. Joseph has been involved in dozens of research projects since joining the team at the Cross in 2006, often with an emphasis on investigating ways to use existing treatments efficiently and effectively while minimizing negative impacts.
Joseph has published work looking at the effects of providing patients diagnosed with anal cancer breaks in their treatment schedule to reduce the toxicity of the therapy and ultimately improve outcomes, which has since been adopted as a standard of care. His recent research includes a breast cancer study demonstrating how older women with low-risk, early-stage breast cancer can achieve better outcomes with a short course of radiotherapy instead of prolonged endocrine therapy, reducing difficult side effects. These studies may not seem to have much in common, but they showcase Joseph’s curiosity and determination to reduce discomfort for patients while still providing effective results.
“I’m basically interested in outcome research,” Joseph says. “Our research is all done to improve the quality of care of patients.”
A clearer look at rectal cancer.
Joseph applies the same approach in his latest trial, which uses enhanced imaging techniques on patients with low rectal cancer. Currently, all patients with low rectal cancer undergo surgery after receiving radiation therapy and chemotherapy, regardless if any remaining cancer is detected. The practice of routinely prescribing potentially unnecessary invasive surgery to all patients didn’t sit well with Joseph, prompting him to use a unique piece of technology to address the situation.
The issue with using standard imaging equipment such as magnetic resonance imaging (MRI) is the machine is not reliable enough to definitively rule out any remaining cancer. Positron emission tomography (PET) scans detect metabolically active tumours, but Joseph says they can miss up to 30 per cent of low rectal cancers. Alternately, MRI gives good imaging of patients’ rectums but can’t always differentiate between a tumour and scar tissue or swelling caused by radiation or chemotherapy.
The Cross is fortunate enough to have a relatively rare PET-MRI machine, which is a hybrid of the two kinds of scans, allowing doctors to utilize both the imaging power of the MRI and the cancer-detecting skills of the PET simultaneously. Joseph’s new phase two trial follows 40 patients who receive a PET-MRI scan before their radiation and chemotherapy treatments, then scanning again right before surgery. The goal is to compare scan results with surgical pathology findings to assess how accurately the PET-MRI is at ruling out any remaining cancer.
“Meta-analysis shows the PET-MRI will improve the detectability, sensitivity and specificity of the imaging,” Joseph says. If the enhanced imaging results with a PET-MRI show that a patient has had a complete response to radiation and chemotherapy, meaning the cancer has been effectively treated, then those patients would be considered for a “wait and watch” approach without surgery.
The benefits of fewer surgeries.
Joseph predicts as many as 30 per cent of low rectal cancer patients could avoid surgery if the PET-MRI proves to be accurate at identifying patients with no remaining cancer. Not only would this free up operating rooms and surgical schedules, patients would not have to deal with the pain of recovering from surgery. Surgeons often have to remove part or all of a patient’s rectum and occasionally other organs in the adjacent area, such as ovaries or prostate glands. The result is these surgeries can drastically affect a patient’s well-being, leaving them with chronic pain or lasting bowel issues.
“It will significantly affect quality of life for patients,” he says. “If the rectum itself or a portion of the rectum is removed, it will cause a lot of symptoms like abdominal pain and cramps — so many things that wouldn’t happen if we can avoid surgery.”
Joseph says he has seen an increase in rectal cancer diagnoses in recent years, particularly in patients under 50, and these improvements in imaging will have a particular impact on relatively young people who want to preserve their rectal function and quality of life for potentially several decades. He expects his research to be completed by the end of the year, and if the findings are positive, patients diagnosed with low rectal cancer in Edmonton should have access to the PET-MRI machine to either avoid surgery altogether or feel confident that the surgeries they do undergo are absolutely necessary to remove remaining cancer.
“These patients do not want to lose a portion of the rectum,” he says. “Hopefully, we can use the PET-MRI to gather very important information and in the future, avoid surgery for many others.”
Three questions with Dr. Kurian Joseph.
Where do you get your best ideas from?
“From day-to-day life when I meet with patients. Things will come up, and I’ll think, ‘Okay, we should look into that.’”
What job would you have if you weren’t an oncologist?
“My initial plan was to get my masters in chemistry and become a college lecturer. I was planning to teach. When my buddy passed away, I switched my focus as it motivated me to become an oncologist.”
What motivates or inspires you in your day-to-day work?
“I’m passionate about improving the quality of life for patients. I won’t ever delay patients — if I get a referral, I’ll try to see them the same day or next day. That’s the way I work.
