Alberta Cancer Foundation

Strengthening Cancer Care Across Alberta

By: Silvia Pikal

Dr. J. Dean Ruether is medical director of community oncology in Alberta. Photo by Bryce Meyer.

Growing up in Calgary, Dr. J. Dean Ruether had a hunch he would follow in his father’s footsteps and work in medicine.

“This just always felt like where I was going to end up,” Ruether says. “From the time I was a little kid, I remember being very aware of how much my father loved what he did. That was a very powerful message for me — do something you love. I’ve been very fortunate to find that.”

After finishing medical school at the University of Alberta, Ruether completed post-graduate training at the University of Calgary in hematology, his father’s specialty. He found it very rewarding to work with patients affected by hematologic malignancies (cancers related to the blood), helping them navigate one of the most difficult and challenging times in their lives. So, he pursued additional training in oncology.

After working in private practice for five years, he joined the Tom Baker Cancer Centre in Calgary as a medical oncologist in 2000.

At the Tom Baker Cancer Centre, Ruether developed an interest in genitourinary (GU) oncology — the research and treatment of cancers that affect the reproductive organs and the urinary system — thanks to the guidance of a former colleague and mentor who was the only oncologist specializing in GU at the Tom Baker Cancer Centre at the time. Ruether was happy to support his work, and when his mentor left for another job, Ruether became the lone oncologist specializing in GU cancers there.

“I became very busy, very quickly,” he says with a laugh.

Throughout his career, he has also developed expertise in endocrine and neuroendocrine malignancies.

“My interest in endocrine malignancies and neuroendocrine tumours grew out of the fact that, at the time, medical oncologists had little to offer these patients and there was a need to develop expertise in this area as new treatments were becoming available to these patients,” Ruether says. “Getting involved in a new area of oncology on the ground floor, from a medical oncology perspective, was an exciting opportunity.”

Reflecting on his 24-year career in clinical practice, Ruether has nothing but good things to say about the job.

“I love what I do,” he says. “I love working with this patient population.

It’s a privilege to be able to care for someone and help them work through the challenges that come with living with a cancer diagnosis.”

In 2015, Ruether was appointed medical director of Community Oncology, CancerControl Alberta. In this role, he is the physician leader for four regional and 11 community cancer centre sites that bring cancer care closer to home for Albertans.

The two main cancer centres in Alberta are the Tom Baker Cancer Centre in Calgary and the Cross Cancer Institute in Edmonton. The four regional community cancer centres, located in Red Deer, Grande Prairie, Lethbridge and Medicine Hat, provide a range of cancer care options to patients in their home communities, including chemotherapy, radiation treatment, and access to supportive care including psychosocial oncology, physiotherapy, nutritional support and social work. Patients see medical oncologists at the tertiary centres in Calgary or Edmonton or one of the four regional community cancer centres and are referred to one of the 11 community cancer centres for systemic treatment if it’s closer to where they live — these are located within hospitals or health centres.

“For a lot of our patients, time is very precious,” Ruether says. “[The goal is to] facilitate people getting care closer to home, or in their own community, and not using up that precious time driving back and forth to the tertiary or regional cancer clinics, which can be three or more hours away. That travel [can be] a huge added burden for patients and their families.”

When he’s not in clinic at the Tom Baker Cancer Centre meeting with patients, Ruether’s medical director role takes him throughout the province for clinical work or for face-to-face meetings with staff at one of the four regional sites in community oncology. He describes meeting with staff in their own environment as essential to being successful in his role. “You can’t replace the value of sitting down with people face to face and hearing from them — what are your challenges? What is working well? What frustrates you? I meet with amazing people who are working in some incredibly challenging circumstances, small environments where resources are precious, and the energy and positivity they bring to work in that set of circumstances is very inspiring.”

Recently, Ruether obtained funding from the Alberta Cancer Foundation to set the infrastructure in place needed to make clinical trials available to patients at the regional cancer centres in Lethbridge, Medicine Hat and Red Deer. That includes supporting a project manager and three research nurses. This past July, the nurses underwent orientation in the clinical trials unit at the Tom Baker Cancer Centre.

“I want to leave the cancer  program a little better off than when I found it.” – Dr. J. Dean Ruether

Ruether says they hope to start offering an expanded list of radiation therapy trials sometime this fall (based, in part, on the success of the ACCEL trial, a clinical trial that took place in three of the regional centres in 2017), and systemic therapy trials for the most prevalent tumour groups (GU, gastrointestinal, lung, breast, hematology) will follow by spring 2019. These trials would include new types of chemotherapy, targeted agents and immunotherapy treatment.

According to Ruether, roughly seven to 11 per cent of patients at the Tom Baker Cancer Centre and Cross Cancer Institute participate in clinical trials, while, in community oncology, less than one per cent of patients participate due to the travel burden of getting to the two main centres.

“I have patients I’m still following now who benefited from participating in clinical trials 10 years ago,” he says. “They’re still here to see those benefits. I’ve seen the difference it can make for people, and that should be available to all Albertans dealing with cancer, not just the ones living in Calgary and Edmonton.”

Not only do clinical trials provide access to new drugs for patients, but Ruether believes the quality of care required to support clinical trials provides an important benchmark for the development of the community oncology program.

“It’s setting the bar at a level where we know we’re doing a really good job of the day-to-day care,” Ruether says. Brenda Hubley, senior program lead, CancerControl North, works in a dyad role with Ruether. She describes him as a great problem-solver and communicator who shows respect to his colleagues by being open to learning, and by supporting others to learn. “

What makes Dean excel as a clinician, leader, and colleague is his authenticity, compassion, dedication and commitment to improving how we care for patients,” Hubley says. “He regularly steps in, and not away, which is a key reason he is highly respected in any forum or situation.”

No matter what role he’s in, Ruether is committed to clinical work and describes it as key to his success. “I never want to step too far away from the bedside — that’s how I maintain the focus, and also how I maintain some credibility with the people I’m working with in community oncology. I’m somebody who will roll up their sleeves and dig into the clinic and help out. That goes a long way when you’re trying to develop programs and sometimes push people to work in ways that are not always comfortable for them. I don’t ask anybody to do something I’m not willing to do.”

Dr. Daniel Heng is a colleague of Ruether’s at the Tom Baker Cancer Centre. He points out that Ruether has strengthened the links between oncologists in the community and larger centres through multidisciplinary tumour board meetings composed of experts in a particular cancer type. At the meetings, the doctors have the opportunity to discuss challenging clinical scenarios and create collaborative patient plans.

“I’ve worked with him for 10 years,” Heng says. “He has shown me time and time again that difficult problems are solved by connecting the right people together who share the same inspiration.”

Ruether is quick to credit his colleagues as contributing to the motivation and passion he has for the job.

“People drawn to work in health care are caregivers, and I’ve been very lucky over 24 years to work with an amazing group of physicians, nurses, people in pharmacy and psychosocial care,” Ruether says. “They’re here because they want to help look after people, and that creates an amazing environment to work in.”

Ruether’s next big goal on the horizon is recruiting more staff for community oncology — an ongoing effort due to competition in major cities in Alberta and across Canada. Despite the challenges that come with building a strong program across 15 different community sites, his work continues to energize him.

“I remember one time talking with my dad about why he enjoyed what he did, and he said, ‘If, at the end of the day, you can feel like you’ve left the world around you a little better than you found it, then that’s the measure of a good day,’” he says. “That has always stuck with me. I want to leave the cancer program a little better off than I found it. That’s what gets me out of bed in the morning — and looking after my patients.”

Dr. J. Dean Ruether Career Highlights

  • Expanded the Annual Community Oncology Update (a yearly two-day meeting that brings together clinicians from the four regional and 11 community sites) to include nurse navigators, managers and colleagues in pharmacy and supportive care, providing crucial educational updates and networking opportunities
  • Improved access to palliative care services by embedding pain and symptom control clinics in two regional care centres
  • Developed a core group of family physicians in all 11 community centres to ensure patients always have access to a doctor
  • Played a crucial role in bringing clinical trials for patients affected by GU and endocrine malignancies to Alberta
  • Built an innovative educational program for prostate cancer patients when they are initially diagnosed. As a result, close to 3,000 men and their family members have gained an under- standing of their diagnosis and the options available to them, making them more confident in their treatment choices
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