Collaborating for success: Dr. David Palma


“We are creating a tool for patients so they can be better informed when making decisions about their care,” said Dr. David Palma when explaining one of his many research collaborations with the Department of Otolaryngology – Head and Neck Surgery.

Dr. Palma is a Radiation Oncologist and Clinician-Scientist, and is working alongside Drs. Kevin Fung and Alexander Louie, along with graduate and postgraduate trainees to create a web tool that will allow patients who have oropharyngeal (tonsil or base-of-tongue) cancers better determine the treatment option that they feel most comfortable receiving — chemotherapy and radiation or transoral robotic surgery.

Today, the most common treatment for these forms of cancer remains chemotherapy and radiation, Dr. Palma explained. However, there is a growing interest in, and demand for, the robotic procedure.

The robotic procedure, which has become extremely popular south of the border, has yet to be proven as superior. Currently Dr. Palma is working with Dr. Anthony Nichols, as well as colleagues across several sites in Canada and one in Australia, running a randomized trial to compare the effectiveness of chemotherapy and radiation versus robotic surgery.

With the potential of two treatment options before them and the anxiety that accompanies a cancer diagnosis, many patients may be uncertain how best to proceed with their own treatment options. And that’s where the idea for the decision making tool came from. It’s an approach that has proven to be effective with breast and prostate cancer patients for some time.

“We know it’s difficult for patients to make informed decisions about their treatment when they have just heard news of their diagnosis,” said Dr. Palma.

“In order to truly offer patient centred care, and engage our patients in shared decision making, we have to build tools which aid them in deciding how best to move forward. We believe this tool will make a difference.”

The tool is a website, designed by Grace Scott, MSc’15. Together with radiation oncology resident Dr. Jaqueline Lam, Scott implemented the site which provides clear and thorough descriptions of the treatment options, including the side-effects and potential outcomes. Users have the opportunity to learn more about what they can expect from either option while also answering a series of questions helping them to arrive at a decision.

Currently the tool is being piloted with 40 volunteers who log onto the website and are presented with a scenario of a patient with tongue or throat cancer. Once the pilot with volunteers has been completed, the tool will be further tested with patients who have had head and neck cancer and who have completed their treatment. After that phase, the tool will be rolled out to patients actually making treatment decisions. By engaging patients in the development process, Dr. Palma hopes to strengthen the tool further and better understand the needs of patients.

Dr. Palma expects that in the next 18 months to two years, the trial comparing the effectiveness of chemotherapy and radiation versus robotic surgery will be complete. At that time, patients will likely be in a better position to choose between treatment options. With the testing complete, the web tool will be easily incorporated into care environments.

For Dr. Palma, it will become just one more opportunity to engage patients in the decision making about their health and well-being.