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Name of Institution: Ï㽶ÊÓƵ

Location: Ï㽶ÊÓƵ Health Centre

Type of Fellowship: Clinical fellowship (≥ 80%). Candidate is expected to complete one clinical research project.

Number of positions: 1Ìý

Length: 1 yearÌý

Fellowship Program Director Dr. Jordi Perez (Departments Anesthesia and Supportive &Ìý Palliative Care) Ìý

Academic affiliation:Ìý Department of Supportive and Palliative Care, Department of Oncology, Ï㽶ÊÓƵ, Alan Edwards Pain Management UnitÌý

Hospitals involved in training:Ìý

Cedars Cancer Centre (Glen Site)

Royal Victoria Hospital (Glen Site)

Montreal General HospitalÌý

Time spent in each institution Glen 70% - MGH 30%Ìý

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Background

The Cancer Pain Clinic was founded in 2011 in a joint effort between the departments of Supportive and Palliative Care and Anesthesiology. It was created to meet the needs of patients with a cancer diagnosis whose pain has become the prevalent symptom. The Cancer Pain Clinic operates three mornings per week for assessments and follow up consultations. Every year, the Cancer Pain Clinic sees more than 200 new patients and more than 700 follow up patients.Ìý

The clinic offers a unique therapy by combining different interdisciplinary approaches simultaneously. Clinicians at The Cancer Pain Clinic include anaesthesiologists, palliativists, radiation oncologists, interventional radiologists, and clinical nurses who specialize in cancer pain management. The benefits of theÌýclinic's interdisciplinary approach include higher rates of patient satisfaction, streamlining the utilization of health resources, andÌýcost-effectiveness.

The departments of Supportive and Palliative Care and Anesthesiology have prestigious teaching traditions. The Palliative Medicine Residency Program and the Chronic Pain Fellowship are well established post-graduate teaching programs on which this fellowship is based.

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Research Activity

The Cancer Pain Clinic engages in clinical research activities. The fellow will gainÌýexperience in designing and organizing a clinical cancer pain research projectÌýby the end of the year.

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Mission

To provide clinical and research training towards comprehensive academic knowledge of the field of cancer pain management.ÌýTo train physicians in the field of cancer pain medicine including a thorough knowledge of the literature regarding the classification, epidemiology, pathophysiology, and treatment of cancer pain. Through practical experience, it will help develop the ability to apply this knowledge to patients who are having pain as a result of cancer and/or cancer treatments.

The fellow will gain an appreciation of the specific challenges in the treatment of cancer pain including the importance of identifying anatomical as well as psychological causes of pain and to identify the appropriate treatment options including (but not limited to) pharmacotherapy, oncological interventions such as chemotherapy or radiation therapy, the role of psychological support, and interventional procedures.

Fellows will engage in research activity as stated above.

Fellows will participate in the teaching of residents from a didactic and practical point of view. This fellowship will increase the academic activities oriented to study and improve cancer pain assessment.

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Funding

For information about acceptable sources of funding please visit the following link: /pgme/admissions/prospective-fellows

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Faculty

Fellowship Program Director - Dr. Jordi Perez (Dept. Anesthesia and Supportive & Palliative Care)

Palliative Care staff: Dr. Antonio Vigano, Dr. Manuel Borod, Dr. Jordi PerezÌý

Anesthesiology staff: Dr. Yoram Shir

Radio-oncology staff: Dr. Marc David

Interventional Radiology staff: Dr. Louis Boucher, Dr. Ali Bessissow, Dr. Tatiana Cabrera

Suggested rotation schedule (1 block = 4 weeks): Cancer pain Clinic - 8 blocks, Palliative Care In patient/Consult - 1 block, Radiation oncology - 1 block, Medical oncology - 1 block, Alan Edwards Pain Management Unit - 1 block, Elective / research - 1 block, VacationÌý - 1 block

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Academic Facilities

Library access, materials relevant to fellowship training, and multimedia materials are available at the Glen Library and MGH libraries. Fellow will join and participate in all academic activities at the department of Supportive and Palliative Care and The Alan Edwards Pain Management Unit.

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Duties and Responsibilities

No calls are required to cover any service

The fellow will interact with residents during their rotation at the Cancer Pain Clinic but will not supervise them.

Clinic responsibilities will include diagnosis, treatment and management of cancer pain syndromes along with health advocacy, clinical mentorship and participation as a member of the interdisciplinary team.

The fellow will take an active part and full responsibility in the thrice per week Cancer Pain outpatient Clinic (0.6/week) including diagnosis, management and health advocacy. The rest of the time allocated to clinical activities (0.2/week) will correspond to hospital consultations. Other activities like interventional cancer pain procedures done in the procedure room can be offered depending on the fellow’s background and interest.

The fellow will become an expert in the field of cancer pain assessment and management and as such will be responsible of teaching rounds to undergraduate and postgraduate students as well as chairing journal clubs and medical rounds.Ìý

The fellow will also participate in academic activities involving the residents, including: seminars, outcome assessment, morbidity and mortality rounds, etc.

The fellow is expected to be involved in all teaching activities within the departments of Supportive and Palliative Care and Pain Medicine. Those include 1) MUHC’s grand rounds, 2) hemato-oncology rounds (when appropriate), 3) palliative medicine core teaching rounds and 4) The Alan Edwards Pain Management Unit RoundsÌý

The fellowship benefits from the support of two departments, Supportive and Palliative Care and the Alan Edwards Pain Management Unit. Dr.Ìý Perez, the program director, will coordinate and schedule the fellow’s clinical and teaching activities including discussion on the progress of the trainee with the different clinicians involved in the program during all rotations. The Cancer Pain Clinic and Palliative Care hospital consultation services have full time clinical nurses who will be in close contact with the trainee to provide feedback and ensure continuity of care to our patients. For secretarial support, the staff of the two parent departments will be made available for the needs that may arise during the fellowship.

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Proposed meetings to be attended by the fellow

The fellow will be encouraged to attend all educational meetings organized by the parent departments (Palliative Care and Pain Medicine). Special effort will be made to provide financial support for research activities (including publications) expected of the Fellow. The fellow will have 20% of his/her time secured, in order to design and conduct a clinical trial in the field of cancer pain. A presentation at a national or international conference as well as a publication in a peer-review journal will be sought.

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Curriculum

The fellow will attend the Cancer Pain outpatient Clinic that has an average of 2 new assessments and 5 follow up consultations per day. This clinic is held three times a week. The fellow is encouraged to observe and participate (if applicable) in the interventional pain procedures indicated for those patients. The fellow will attend, under appropriate supervision, an estimate of 200 new patients and 700 follow up consultations.

The Cancer Pain Clinic receives consultation mainly from the departments of Haemato-Oncology and Radio-Oncology. Of all cancer pain patients seen, an estimate 80% suffer from direct consequences of the tumour involved and the rest are cancer treatment-related pain. The clinic receives consultations from a large variety of oncology subspecialties including lung, breast, haematology and colorectal oncology.Ìý

The applicant will participate in regular journal clubs as presenter or attendee. Reading material to prepare those and other academic activities will be provided by the program directors.

The fellow will have at least one academic activity scheduled that corresponds to the weekly Alan Edwards Pain Management Rounds. Other activities organized by the Palliative Care department will be integrated in the fellow’s weekly schedule.