Article by Kyla Trkulja

Graphic design by Amy Assabgui

Male cancers, specifically prostate and testicular cancer, pose a serious threat to men’s health–both physically and psychologically. While the outcomes of these cancers are more favourable relative to others,¹ patients and survivors face a variety of challenges including mental health struggles and lessened quality of life.² 

Dr. Robert Hamilton, a surgeon-investigator at the Princess Margaret Cancer Centre, is working to improve the quality of life for these men through both his clinical practice and research. His training included a medical degree (MD) and Urology Residency from University of Toronto, a Master’s Degree from University of North Carolina at Chapel Hill, and a Research Fellowship at Duke University. “I knew I wanted to have my career be more than just sitting in the office seeing the next patient and doing the next surgery,” he said, describing the curiosity that led him to pursue research. “When you’re the one asking the research questions, you quickly realize that you can affect more than just that one patient that’s in front of you.”

Dr. Hamilton came to Princess Margaret Cancer Centre in 2012 after completing his Oncology Fellowship in New York City. “I was always interested in cancer, the biology, as well as the psychological or psychosocial functional aspects of what the cancer did to people,” Dr. Hamilton explained. His interest in urology stemmed both from the favourable outcomes, which allows him to positively affect the patients, and from the deep personal interactions with patients due to the intrinsic nature of urological organs. “It’s incredibly rewarding that you can help [patients] in [the psychological] domain as well as conquer the cancer biology.”

Dr. Hamilton has seized the unique opportunity to improve the quality of life of cancer patients and survivors both in and out of the clinic. He is currently the only physician in Canada to utilize minimally invasive robotic surgery for testicular cancer, which decreases the length of hospital stay compared to traditional surgery.³ The nerve-sparing small incisions promote a quicker recovery time and cause fewer post-operative complications, making this an innovative technique to improve the quality of life of testicular cancer patients and survivors. 

To tackle the mental health challenges of survivorship, Dr. Hamilton teamed up with Dr. Anika Petrella who was completing her PhD in health behaviour under the supervision of Drs. Catherine Sabiston and Andrew Matthew. Dr. Petrella started ‘The Ball’s in Your Court program’ in collaboration with the University of Toronto after noticing that the mental health burden on young men diagnosed with testicular cancer was a huge challenge. “These [15 to 35-year-old] men who get told they have testes cancer go from thinking they’re going to live forever to wondering if there’s a chance they could die relatively soon. It’s a fundamental uppercut to the ego, and that has profound implications.” In fact, Dr. Hamilton described this mental shock and denial as the biggest challenge impacting these patients.

The unique life experiences and young age of the population meant that these patients could not be effectively integrated into existing survivorship programs. Thanks to Dr. Petrella’s research, a physician- and counsellor-led program was created to engage testicular cancer survivors with physical and group wellness sessions outside of the hospital, allowing them to make meaningful connections and become more resilient. “You don’t think of yourself as a patient when you’re there,” Dr. Hamilton said. 

Dr. Hamilton’s translational research covers topics ranging from basic science to population health sciences. In prostate cancer, he focuses on chemoprevention, with an emphasis on statin medications to lower cholesterol and improve outcomes after diagnosis. For testicular cancer, his main focus is on survivorship and identifying biomarkers associated with cancer susceptibility and patient prognosis.

Before the COVID-19 pandemic, Dr. Hamilton was one of the leaders in utilizing virtual care for his patients to improve their quality of life. In-person follow-up appointments usually require patients taking time off of work and travelling long distances for a brief appointment telling them that everything is normal. In Dr. Hamilton’s model, after an initial meeting with early-stage cancer patients to discuss diagnosis, staging, and expectations, the remainder of the patient’s visits were virtual unless there was something of concern. Importantly, the virtual care was asynchronous, allowing patients to view their results or ask questions at any time. Dr. Hamilton was also able to interpret test results and answer questions. The ultimate goal was to enhance the quality of life for patients, as well as their adherence to follow-up appointments. The phase one trial for this virtual care system showed promising results. Patient compliance and quality of life improved while clinic burden was reduced. Princess Margaret Cancer Centre was also able to expand its services to more patients in remote areas across Ontario. Even with virtual care becoming more popular as a result of COVID-19, Dr. Hamilton’s asynchronous and patient-centered approach remains unique, and he hopes that his methods will be used to shape the future of virtual healthcare. 

The multiple roles that Dr. Hamilton plays in research and as a physician have allowed him to make a tremendous impact on male cancer patients and survivors. Balancing it all can be a challenge but being able to positively affect people’s lives both in and out of the clinic is described by Dr. Hamilton as an honour and a privilege. “That’s the excitement of it, which I love. I wouldn’t do anything else.”

References:

1. Filippou, P., Ferguson, J. E., 3rd, & Nielsen, M. E. (2016). Epidemiology of Prostate and Testicular Cancer. Seminars in interventional radiology, 33(3), 182–185. https://doi.org/10.1055/s-0036-1586146
2. Schepisi, G., De Padova, S., De Lisi, D., et al. (2019). Psychosocial Issues in Long-Term Survivors of Testicular Cancer. Frontiers in endocrinology, 10, 113. https://doi.org/10.3389/fendo.2019.00113
3. Ray, S., Pierorazio, P. M., & Allaf, M. E. (2020). Primary and post-chemotherapy robotic retroperitoneal lymph node dissection for testicular cancer: a review. Translational andrology and urology, 9(2), 949–958. https://doi.org/10.21037/tau.2020.02.09