A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending April 28th, 2021
The following colorectal cancer treatment and research updates extend from March 18th, 2021 to April 28th, 2021, inclusive and are intended for informational purposes only.
This content is not intended to be a substitute for professional medical advice. Always consult your treating physician or guidance of a qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional or delay in seeking it because of something you have read on this website.
CONTENT
1. Phase II LEAP Clinical Trial to Treat mCRC.
2. TRK Fusion Cancer and How to Test For It
3. A Phase II, Open-Label, Multicentre, Study of an Immunotherapeutic Treatment for the MSI High Colorectal Cancer Metastatic Population
4. Phase III Study at the Odette Cancer Centre Comparing Arfolitixorin vs. Leucovorin: Both in Combination with 5FU, Oxaliplatin, and Bevacizumab in Patients with Advanced Colorectal Cancer
5. Canadian Consensus for Biomarker Testing and Treatment of TRK Fusion Cancer in Adults
6. Aspirin Tied to Reduced CRC Risk
7. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
8. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases
9. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer
10. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age
11. Calgary Clinic Emerges as a Research Leader in Canada’s Battle Against Colon Cancer
12. Mayo Study Finds Colon Cancer Driven by Hereditary Gene Mutations in 1 in 6 Patients
13. Stool-based CRC Screening Preferred Over Colonoscopy
14. Young Adult CRC Clinic Available at Sunnybrook Hospital
15. Registration is Now Open For CCRAN’s Early Age Onset CRC Virtual Symposium
16. Determining Priority Access to Comprehensive Genomic Profiling for Canadian Cancer Patients
17. Does Crohn’s Disease Affect Your Cancer Risk?
18. CCRAN’s Spring Newsletter Just Out
19. CRC Survivors Ask: What Can I Do Now?
20. NACI Considering Changes to AstraZeneca Age Recommendations
21. Canada Purchases 8M More Pfizer Doses as Moderna Vaccine Shipment Cut Nearly in Half
22. Results of the Safety and Immune-Efficacy of 1 Versus 2 Doses of COVID-19 Vaccine for Cancer Patients
23. So far, 5,800 fully vaccinated people have caught Covid anyway in US
24. CDC Study Finds Pfizer, Moderna Vaccines are 90% Effective After Two Doses in Real-World Conditions
25. AstraZeneca Safe for Canadians as Young as 30, Vaccine Panel Says
26. The Latest on COVID-19
27. COVID-19 Vaccines Are Still Effective Amid Rising Number of Variants
28. Cancer Patient Advocacy Groups Urge the Prime Minister and Premiers to Help Our Cancer Patients Complete the Vaccine Series within the Clinical Trial Recommended Timeline!
29. Frequently Asked Questions for COVID-19
DRUGS / SYSTEMIC THERAPIES
- Phase II LEAP Clinical Trial For mCRC (Mar.01/20)
The purpose of this study is to determine the safety and efficacy of combination therapy with pembrolizumab (MK-3475) and Levantine (E7080/MK-7902) in patients with triple-negative breast cancer (TNBC), ovarian cancer, gastric cancer, colorectal cancer (CRC), glioblastoma (GBM), or biliary tract cancers (BTC). Participants will be enrolled in initial tumor-specific cohorts, which will be expanded if adequate efficacy is determined. The trial is available at the Odette Cancer Centre and at the Princess Margaret Cancer Centre in Toronto as well as the following Centres throughout Canada: Abbotsford, BC; Winnipeg, MB; CHU de Quebec. For information, visit the link below.
- TRK Fusion Cancer And How to Test For It (Feb.16/21)
https://www.bayer.ca/en/media/news/?dt=TmpBPQ==&st=1
- A Phase 2, Open-label, Multicenter, Study of an Immunotherapeutic Treatment for the MSI High CRC Metastatic Population (Oct.01/20)
The purpose of this study is to look at the effectiveness of the vaccine DPX-Survivac in combination with the drugs cyclophosphamide and the immunotherapy Pembrolizumab in patients with solid cancers who are identified to be MSI-High. All patients will receive combination therapy of DPX-Survivac, cyclophosphamide, and pembrolizumab. Patients participating will know which treatment they are receiving. The trial is currently hosted at the Odette Cancer Centre, and a new site is opening at Mt. Sinai Hospital.
- Phase III Study at the Odette Cancer Centre Comparing Arfolitixorin vs. Leucovorin in Combination with 5FU, Oxaliplatin and Bevacizumab in Patients with Advanced CRC (Oct.01/20)
The purpose of this study is to look at the effectiveness of the drug Arfolitixorin in combination with 5-fluorouracil (5FU), oxaliplatin, and bevacizumab in patients with colorectal cancer (CRC). Patients with advanced/metastatic CRC who meet certain criteria may be able to participate. There will be two groups of patients participating in this study;
- one group will receive Arfolitixorin in combination with 5FU), oxaliplatin, and bevacizumab,
- while the other group will receive the drug Leucovorin in combination with 5FU, oxaliplatin, and bevacizumab (standard of care).
The doctor and study staff will not know which group a patient is in. Patients will be randomized to receive one treatment or the other.
About Arfolitixorin:
Arfolitixorin is Isofol’s proprietary drug candidate being developed to increase the efficacy of standard of care chemotherapy for advanced CRC. The drug candidate is currently being studied in a global Phase 3 clinical trial. As the key active metabolite of the widely used folate-based drugs, arfolitixorin can potentially benefit all patients with advanced CRC, as it does not require complicated metabolic activation to become effective.
Treating cancer patients with arfolitixorin – The goals:
- When treating CRC, for example, arfolitixorin is administered in combination with 5-FU to increase cell mortality in circulating cancer cells and in cancerous tumours.
- Arfolitixorin is administered in conjunction with rescue therapy after high-dose treatment with the cytotoxic agent, methotrexate, in order to suppress the cytotoxic effect in surrounding healthy tissue. The treatment is used for certain types of cancer, such as osteosarcoma, a type of bone cancer. This involves administering arfolitixorin separately, 24 hours after the chemotherapy.
https://sunnybrook.ca/trials/item/?i=293&page=49335 and https://clinicaltrials.gov/ct2/show/NCT03750786
(https://isofolmedical.com/arfolitixorin/ )
- Canadian Consensus for Biomarker Testing and Treatment of TRK Fusion Cancer in Adults (Apr.26/21)
The tyrosine receptor kinase (TRK) inhibitors larotrectinib and entrectinib were recently approved by Health Canada for the treatment of solid tumours harbouring neurotrophic tyrosine receptor kinase (NTRK) gene fusions. These NTRK gene fusions are responsible for both the initiation and maintenance of cancer. They are found in most tumour types at a low frequency (<5%), and at a higher frequency (>80%) in a small number of rare tumours (e.g., secretory carcinoma of the salivary gland and of the breast). Larotrectinib and entrectinib have demonstrated impressive overall response rates and tolerability in Phase I/II trials in patients with TRK fusion cancer with no other effective treatment options. Currently, a major challenge is identifying TRK fusion cancer in a methodologically consistent way that is economically feasible in a public healthcare system.
Ideally, all patients could be tested with a comprehensive next generation sequencing (NGS) panel for all possible actionable cancer alterations at diagnosis. This detects NTRK1, NTRK2, and NTRK3 gene fusions in DNA or RNA. With a plethora of new targets being identified, it is envisioned that in future, the massively parallel analysis of large NGS panels will become routine standard of care for all solid tumours. However, since this is not currently feasible in Canada, strategies for NTRK-positive patient enrichment and NTRK screening must be deployed.
In current circumstances, a pan-TRK immunohistochemistry (IHC) screen, which detects TRKA, TRKB, and TRKC protein, is recommended in patient populations as described who are wildtype for other known oncogenic drivers. Patients whose tumours test positive or are inconclusive by IHC should then receive confirmatory NGS. Researchers recommend a selective TRK inhibitor in all patients with TRK fusion cancer with no other satisfactory treatment options.
This consensus is intended to offer general principles and should be adapted according to the tumour histology and the testing methods/procedures available at each individual Canadian solid tumour biomarker lab, at the discretion of the pathologist and molecular lab director.
https://www.mdpi.com/1718-7729/28/1/53/htm
- Aspirin Tied to Reduced CRC Risk (Apr.26/21)
Regular aspirin use is associated with a reduced risk for developing colorectal cancer (CRC) in older age — but you won’t get the benefit if you start the therapy too late in life, according to a Harvard study published online Jan. 21, 2021, by JAMA Oncology.
Researchers combined the results of two studies involving a total of more than 94,000 people who answered health questionnaires regularly and were followed for three decades. Compared with people who didn’t take aspirin, people ages 70 or older who took either 325 milligrams (mg) or 81 mg of aspirin at least twice per week had a 20% lower risk for developing CRC — but only if they had started the therapy by age 65. Starting aspirin therapy at or after age 70 was not associated with significant protection against CRC. Like any medicine, aspirin isn’t risk-free: regular use increases the risk for gastrointestinal bleeding. If you happen to be taking aspirin regularly for other reasons, this might be an added benefit.
https://www.health.harvard.edu/cancer/harvard-finding-aspirin-tied-to-reduced-colorectal-cancer-risk
SURGICAL THERAPIES
7. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program — Sunnybrook Odette Cancer Centre (July 16/20)
The HAIP program is a first-in-Canada for individuals where colon or rectal cancer (colorectal cancer) has spread to the liver and cannot be removed with surgery. The program involves a coordinated, multidisciplinary team approach to care, with close collaboration across surgical oncology, medical oncology (chemotherapy), interventional radiology, nuclear medicine, and oncology nursing. The Hepatic Artery Infusion Pump (HAIP) is a small, disc-shaped device that is surgically implanted just below the skin of the patient and is connected via a catheter to the hepatic (main) artery of the liver. About 95 percent of the chemotherapy that is directed through this pump stays in the liver, sparing the rest of the body from side effects. Patients receive HAIP-directed chemotherapy in addition to regular intravenous (IV) chemotherapy (systemic chemotherapy), to reduce the number and size of tumours. Drs. Paul Karanicolas and Yooj Ko are the program leads and happy to see patients eligible for the therapy.
Presently at Sunnybrook Odette Cancer Centre, HAIP is being used in patients with colorectal cancer that has spread to the liver that cannot be removed surgically and has not spread to anywhere else in the body. Patients who have few (1-5) and very small tumors in the lungs may be considered if the lung disease is deemed treatable prior to HAIP. If you believe you may benefit from this therapy and/or would like to learn more about the clinical trial, your medical oncologist or surgeon may fax a referral to 416-480-6179. For more information on the HAIP clinical trial, please click on the link provided below.
http://sunnybrook.ca/content/?page=colorectal-colon-bowel-haip-chemotherapy
8. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases (July 12/20)
Approximately half of all colorectal cancer (CRC) patients develop metastases, commonly to the liver and lung. Surgical removal of liver metastases (LM) is the only treatment option, though only 20-40% of patients are candidates for surgical therapy. Surgical therapy adds a significant survival benefit, with 5-year survival after liver resection for LM of 40-50%, compared to 10-20% 5-year survival for chemotherapy alone. Liver transplantation (LT) would remove all evident disease in cases where the colorectal metastases are isolated to the liver but considered unresectable.
Image Source: https://www.slideshare.net/AhmedAdel65/preoperative
While CRC LM is considered a contraindication for LT at most cancer centers, a single center in Oslo, Norway demonstrated a 5-year survival of 56%. A clinical trial sponsored by the University Health Network in Toronto will offer live donor liver transplantation (LDLT) to select patients with unresectable metastases limited to the liver and are non-progressing on standard chemotherapy. Patients will be screened for liver transplant suitability and must also have a healthy living donor come forward for evaluation. Patients who undergo LDLT will be followed for survival, disease-free survival, and quality of life for 5 years and compared to a control group who discontinue the study before transplantation due to reasons other than cancer progression. Despite the trial’s negative outcome, investigation of HIPEC, and other strategies to prevent peritoneal metastasis, should continue, they concluded in Lancet Gastroenterology & Hepatology. “The 21% peritoneal recurrence noted in the overall study population indicates the magnitude of the clinical problem in locally advanced colon cancer, and therapeutic strategies have to be further explored,” they said. “Outcomes of other trials investigating adjuvant HIPEC are eagerly awaited.”
RADIATION THERAPIES/INTERVENTIONAL RADIOLOGY
9. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer (Mar.12/20)
Magnetic resonance-guided focused ultrasound (MRg-FU) is a lessinvasive, outpatient modality being investigated for the thermal treatment of cancer. In MRg-FU, a specially designed transducer is used to focus a beam of low-intensity ultrasound energy into a small volume at a specific target site in the body. MR is used to identify and delineate the tumour, focus the ultrasound beam on the target, and provide a real-time thermal mapping to ensure accurate heating of the designated target with minimal effect to the adjacent healthy tissue. The focused ultrasound beam produces therapeutic hyperthermia (40-42°C) in the target field, causing protein denaturation and cell damage. Currently, there is no prospective clinical data reported on the use of MRg-FU in the setting of recurrent rectal cancer. Recurrent rectal cancer is a vexing clinical problem. Current retreatment protocols have limited efficacy. The addition of hyperthermia to radiation and chemotherapy may enhance the therapeutic response. With recent advances in technology, the investigators hypothesize that MRg-FU is technically feasible and can be safely used in combination with concurrent reirradiation and chemotherapy for the treatment of recurrent rectal cancer without increased side-effects. The study is being offered at the Odette Cancer Centre. Here is the link to the study protocol:
SCREENING
10. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age (Apr.10/21)
With recent evidence for the increasing risk of young-onset colorectal cancer (yCRC), the objective of this population-based longitudinal study was to evaluate the incidence of yCRC in one-year age increments, particularly focusing on the screening age of 50 years. The study was conducted using linked administrative health databases in British Columbia, Canada including a provincial cancer registry, inpatient/outpatient visits, and vital statistics from January 1, 1986 to December 31, 2016. We calculated incidence rates per 100,000 at every age from 20 to 60 years and estimated annual percent change in incidence (APCi) of yCRC using joinpoint regression analysis.
3,614 individuals were identified with yCRC (49.9% women). The incidence of CRC steadily rose from 20 to 60 years, with a marked increase from 49 to 50 years. Furthermore, there was a trend of increased incidence of yCRC among women. Analyses stratified by age yielded APCi’s of 2.49% and 0.12% for women aged 30-39 years and 40-49 years, respectively and 2.97% and 1.86% for men. These findings indicate a steady increase over one-year age increments in the risk of yCRC during the years approaching and beyond screening age. These findings highlight the need to raise awareness as well as continue discussions regarding considerations of lowering the screening age.
11. Calgary Clinic Emerges as a Research Leader in Canada’s Battle Against Colon Cancer (Mar.18/21)
A woman in her ’50s enters a building on the University of Calgary’s Foothills campus, making her way up an elevator and through open doors to the waiting room of the Forzani and MacPhail Colon Cancer Screening Centre. After filling out a short questionnaire on her health and lifestyle, she has joined one of the largest research projects in Canada, designed to improve the early detection and prevention of colorectal cancer (CRC). Researchers at the Arnie Charbonneau Cancer Institute, a joint institute of the Cumming School of Medicine (CSM), Cancer Care Alberta and Alberta Health Services, are gathering data from more than 20,000 participants like her. They are investigating the characteristics that could personalize risk prediction and screening pathways and help develop the next generation of screening tests.
“Our goal is to improve screening for CRC and, ultimately, patient outcomes,” says Dr. Robert Hilsden, MD, PhD’01, MSc’96, the research director of the centre. “First, we want to better understand who is at high risk for CRC and who is not, so we know who needs to be screened and how best to do it. Second, we want to improve the screening experience to maximize participation.” The team is building unique repositories of data that include the collection of biospecimens (blood, urine, normal colon tissue) and detailed information about the participant’s medical history, lifestyle, physical activity and diet.
From this work the researchers intend to develop and advocate for improved policy, practice, and personal change to bend the curve and reduce cancer burden in Canada. Dr. Darren Brenner, PhD, the associate research director of the centre, is leading research to understand why CRC is increasing at a steep rate in young men and women, and to predict the impact of reduced screening during the COVID-19 pandemic. Researchers at the facility also conduct clinical studies focused on improving CRC screening and colonoscopy. The centre’s medical director, Dr. Steven Heitman, MD, MSc, has also led the development of colonoscopy upskilling courses and animal simulation models of polyp removal, driving improvements in colonoscopy quality provincially and nationally.
https://www.ucalgary.ca/news/research-leader-canadas-battle-against-colon-cancer
12. Mayo Study Finds Colon Cancer Driven by Hereditary Gene Mutations in 1 in 6 Patients (Apr.23/21)
In the study, published in Clinical Gastroenterology and Hepatology, researchers within the Mayo Clinic Center for Individualized Medicine found 1 in 6 patients with colorectal cancer (CRC) had an inherited cancer-related gene mutation, which likely predisposed them to the disease. In addition, the researchers discovered that 60% of these cases would not have been detected if relying on a standard guideline-based approach. The patients were tested with a sequencing panel that included more than 80 cancer-causing or predisposing genes. In comparison, standard panels for CRC only include 20 or fewer genes.
“We found that 15.5% of the 361 patients with CRC had an inherited mutation in a gene associated with the development of their cancer,” says Dr. Niloy Jewel Samadder, a Mayo Clinic gastroenterologist and hepatologist, who is the study’s senior author. “We also found that over 1 in 10 of these patients had modifications in their medical or surgical therapy based on the genetic findings.”
In the study, Samadder and his team examined gene variants (mutations) with which the patient was born and that predisposed them to developing cancer. Mutations are abnormal changes in the DNA of a gene. A gene mutation can affect the cell in many ways, including interfering with proteins or causing a gene to be activated. Although many mutations that cause colorectal cancer happen by chance in a single cell — including from environmental factors, diet, smoking and alcohol use — the study confirms many are inherited mutations that set off a cycle of events that can lead to cancer.
“The power of genetics is that we can foresee the cancer that will develop in other family members,” Samadder says. “This can allow us to target cancer screening to those high-risk individuals and hopefully prevent cancer altogether in the next generation of the family.”
13. Stool-based CRC Screening Preferred Over Colonoscopy (Apr.22/21)
“Although several colorectal cancer (CRC) screening methods have been shown to reduce CRC, nearly one-third of eligible adults in the United States have never completed CRC screening and CRC screening continues to be underutilized,” Xuan Zhu, PhD, senior health services analyst at the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and colleagues wrote. “Recommended CRC screening modalities vary with respect to safety, efficacy and cost. Better understanding of the factors that influence patient preference is, therefore, critical for improving population adherence to CRC screening.”
Researchers surveyed 1,062 participants (aged 45-75 years) with an average risk for CRC to investigate preferences among three commonly used CRC screening modalities. The survey informed participants on each screening option, fecal immunochemical test or guaiac-based fecal occult blood test (FIT/gFOBT), multi-target stool DNA test (mt-sDNA) and colonoscopy, and asked participants to choose between two presented options at a time.
When given the choice, 65.4% of respondents chose mt-sDNA over colonoscopy and 61% of respondents chose FIT/gFOBT over colonoscopy; among stool-based screening options, 66.9% of respondents chose mt-sDNA over FIT/gFOBT. According to further study analysis, a larger proportion of younger respondents (aged 45-54 years), Hispanic and non-Hispanic Black respondents and uninsured respondents preferred stool-based testing over colonoscopy. The overall awareness of stool-based testing was lower than colonoscopy awareness (60% vs. 90%) and prior experience was a significant driver for what a respondent chose in the present survey.
“These findings [of patient preference for stool-based tests] underscore the importance of continuing to offer CRC screening options to patients and encourage health care providers to engage their patients in shared decision-making to discuss various available CRC screening options in alignment with patient needs and preferences,” Zhu told Healio.
Image Source: https://synappsehealth.com/en/articles/i/the-faecal-occult-blood-test-fobt-what-is-it-and-how-to-prepare-for-it/
OTHER
14. Young Adult CRC Clinic Available at Sunnybrook (Mar.12/20)
A recent study led by the University of Toronto doctors has observed a rise in colorectal cancer rates in patients under the age of 50. The study mirrors findings from the U.S., Australia and Europe. The growing colorectal cancer rates in young people come after decades of declining rates in people over 50, which have occurred most likely due to increased use of colorectal cancer screening (through population-based screening programs) which can identify and remove precancerous polyps. Patients diagnosed under the age of 50 have a unique set of needs, challenges and worries. They are unlike those diagnosed over the age of 50. Dr. Shady Ashamalla (colorectal cancer surgical oncologist), and his team at the Sunnybrook Health Sciences Centre understand the needs of this patient population.
Dr. Ashamalla belongs to a multidisciplinary team of experts in the Young Adult Colorectal Cancer Clinic who will work with young colorectal cancer patients, regardless of disease stage, to create an individualized treatment plan to support each patient through their cancer journey. Their needs and concerns will be addressed as they relate to:
- Fertility concerns and issues
- Young children at home
- Dating/intimacy issues
- Challenges at work
- Concerns about hereditary cancer
- Relationships with family and friends
- Psychological stress due to any or all of the above
The team of experts consists of:
- Oncologists (medical, surgical, radiation)
- Social workers
- Psychologists
- Geneticists
- Nurse navigator
Should a patient wish to be referred to Sunnybrook, they may have their primary care physician, or their specialist refer them to Sunnybrook via the e-referral form, which can be accessed through the link appearing below. Once the referral is received, the Young Adult Colorectal Cancer Clinic will be notified if the patient is under the age of 50. An appointment will then be issued wherein the patient will meet with various members of the team to address their specific set of concerns.
http://sunnybrook.ca/content/?page=young-adult-colorectal-cancer-clinic
15. Registration is Now Open For CCRAN’s Early Age Onset CRC Virtual Symposium (Apr.27/21)
The incidence of colorectal cancer has been declining in Canadians over 50 years of age, largely due to population-based screening programs. Rates, however, are on the rise in adults younger than 50 years. There is considerable evidence that “the increased incidence of colorectal cancer among younger adults in Canada is not only continuing but possibly accelerating.” In response to the findings and the growing number of young patients seeking support, education, and advocacy for advanced colorectal cancer, CCRAN is hosting its first of three complimentary symposia to be held virtually on June 17, 2021. Over the course of these three symposia, CCRAN will educate on, strategize, and implement a response to the rise in early age onset colorectal cancer (EAOCRC). We encourage all stakeholders, including patients and caregivers, to participate in our symposium on June 17, 2121. Please see graphic appearing below for registration details.
- Determining Priority Access to Comprehensive Genomic Profiling for Canadian Cancer Patients (Apr.28/21)
It has become increasingly apparent that in order to select the best cancer treatment, a comprehensive picture of the tumour at the DNA level is needed. Thus, the idea of using a tumour’s unique genomic fingerprint to match patients to their most effective treatment is the cornerstone of precision (or personalized) medicine. In fact, over 20 cancer therapies linked to over 15 genomic biomarkers have been approved in Canada, with many more quickly emerging.
Currently, the most frequently available molecular tools for cancer patients are single-gene companion diagnostic tests or limited gene panel tests that detect only “hot-spots” for certain genomic alterations. However, with the growing number of therapeutically relevant genomic biomarkers across all tumour types, these tests cannot truly capture a comprehensive view of a tumour’s genomic profile. For instance, when testing of several genomic biomarkers are needed, the sequential nature of single-gene tests presents limitations, which lead to patients being unable to receive testing for all relevant genomic biomarkers and patients missing opportunities for critical, biomarker-matched therapy. “Hotspot” gene panels can avoid some of the limiting factors of single-gene tests; however, they present with other challenges that result in missed opportunities for cancer patients to be treated with their optimal genomic biomarker-matched therapy.
Comprehensive genomic profiling (CGP), can fill the gaps left by single-gene and hot-spot panel testing by taking advantage of next-generation sequencing (NGS) technology which can:
- Accurately sequence a large number of genes simultaneously in a cost-, time-, and tissue-efficient manner.
- Simultaneously identify several different types of genomic alterations, as well as genome-wide changes.
- Easily adapt to include new genomic biomarkers as they become relevant, with minimal increased cost; and
- Potentially eliminate the need for re-sequencing tissue once new biomarker information is available, as initial CGP data can be re-evaluated.
This report provides a list of recommendations to aid decision-makers in this process.
- All patients with advanced or metastatic solid tumours should have access to CGP where deemed necessary or valuable by their clinician.
- Given budgetary constraints, tumour types that currently have five or more genomic biomarkers linked to approved therapies should be prioritized for CGP funding to replace current limited testing modalities.
- Decision-makers must remain cognizant of the many other tumour types which will soon reach the five-biomarker threshold and be able to respond quickly or proactively to provide CGP funding for these patients.
- Any patient with an advanced or metastatic solid tumour who is refractory to standard therapy or is lacking treatment options that could extend survival should be prioritized for CGP.
- Stakeholders should collaborate to establish a new framework for assessing the value of CGP and new genomic biomarker-matched therapies that consider non-traditional methodologies.
- Does Crohn’s Disease Affect Your Cancer Risk? (Apr.08/21)
What is Crohn’s disease?
Crohn’s disease is a chronic inflammatory bowel disorder that can affect the entire gastrointestinal tract. It usually targets the end of the small intestine or the colon. Research suggests that the cause may be related to the balance of good and bad bacteria in the gut microbiome. The most common symptoms of Crohn’s disease are diarrhea, blood in your stool, abdominal pain and weight loss.
How does Crohn’s disease affect colorectal cancer risk?
Crohn’s disease is an autoimmune process that causes the body to attack its own tissue. The resulting long-term injury to the GI tract causes the inflamed areas to be in a constant state of repair and inflammation. “Your body is replenishing the cells that are damaged repeatedly. Sooner or later, with this constant turnover, an error in the replaced cells can result in cancer,” says Anusha Thomas, M.D., a gastroenterologist at MD Anderson West Houston. “The longer this process goes on, the higher the chance that these faulty cells become cancer.” Although Crohn’s can affect all areas of the GI tract and other areas of the body, cancers outside the small intestine, colon, rectum, or anus are rare.
How can you reduce your risk of cancer if you have Crohn’s disease?
While there is no cure for Crohn’s disease, it can be managed with medication. “The goal is to control the inflammation,” says Thomas. “If we can control the inflammation, we worry less about cancer. Once the disease is diagnosed, we follow patients with routine surveillance.” Surveillance includes regular visits with your doctor to manage your medication and regular screening exams. If you have had Crohn’s disease for eight years or more, you should get a colonoscopy every 1 to 2 years. The longer there is inflammation, the higher the risk of cancer.
“With inflammatory bowel disease, the sooner you get a diagnosis, the faster you can get your symptoms under control, reduce inflammation and reduce the risk of cancer,” says Thomas. Crohn’s disease and colon cancer symptoms may overlap. Early detection is also key. The earlier cancer is detected, the better the chances of it being treated successfully.
https://www.mdanderson.org/cancerwise/does-crohns-disease-affect-your-cancer-risk.h00-159460056.html
18. CCRAN’s Spring Newsletter Just Out!
Welcome to the Spring edition of CCRAN’s Newsletter containing rich and exciting updates in CCRAN’s programs and activities. Click on the page below to access the newsletter and important links.
NUTRITION/HEALTHY LIFESTYLE
19. Colorectal Cancer Survivors Ask: What Can I Do Now? (Apr.22/21)
Carol A. Burke, MD, the vice chair of the Department of Gastroenterology, Hepatology and Nutrition at Cleveland Clinic in Cleveland, and the head of the polyposis section in the Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, noted that many common diseases in Western populations, including colorectal cancer (CRC), have links to lifestyle. She added that four healthy behaviors can help prevent CRC and reduce the risk for poor outcomes after diagnosis: maintaining a normal body mass index, avoiding smoking, engaging in recommended levels of aerobic and muscle strengthening exercise, and eating a plant-based diet low in animal fats and processed foods.
Benefits of Exercise
In a meta-analysis of 49,000 survivors of CRC and breast cancer, physical activity had a dose-related effect on survival after CRC diagnosis. Reduction in mortality risk ranged from 15% for 5 metabolic equivalent of task [MET] hours per week of exercise to 38% for 15 MET hours per week. Another type of activity to recommend is resistance training, especially for patients who have lost bone density or muscle function during treatment. Resistance training can improve balance and decrease the risk for falls.
The evidence supporting exercise has been taken up in guidelines from the National Comprehensive Cancer Network (NCCN): 2.5 to 5 hours of moderate-intensity exercise per week (less if exercise is vigorous), or 2 to 3 sessions per week of resistance training. “But recommendations of even light-intensity activity can improve functioning in patients who can’t or won’t do moderate levels of exercise. The big thing is to avoid a sedentary lifestyle,” Dr. Urba said.
Nutrition, Weight Management
The National Surgical and Adjuvant Bowel Project evaluated the association between BMI and outcomes in two randomized trials of adjuvant chemotherapy involving 4,288 CRC patients. Compared with normal-weight people (BMI, 18.5-24.9 kg/m2), very obese patients (BMI =35 kg/m2) had a 38% greater risk for CRC recurrence or a second primary cancer, a 36% increased risk for CRC-related mortality, and a 28% increased risk for death from any cause.
Not only obesity, but diets contributing to it have been linked to outcomes after a diagnosis of CRC. In an adjuvant chemotherapy study involving 1,000 patients with stage II/III CRC, the Cancer and Leukemia Group B trials group queried patients during and six months following adjuvant chemotherapy. Patients in the highest quintile of a Western diet (red meat, fat, refined foods, desserts) versus lowest had double or triple the risk for CRC recurrence and CRC-related death. Patients whose diets reflected a high glycemic index also had worse disease-free survival, recurrence-free survival, and overall survival.
“The NCCN dietary recommendations include high intake of vegetables, fruits, grains, fish and poultry, and a limit on the bad things, including red meat, processed foods and sugars,” Dr. Urba said. These studies are just a small part of a solid foundation of evidence that supports a healthy lifestyle as a means of preventing recurrence of CRC.
Image Source 1: https://www.istockphoto.com/illustrations/home-workout
Image Source 2: https://www.netclipart.com/isee/ioJowi_healthy-food-clipart-eat-well-chart-of-balanced/
COVID-19 UPDATES
- NACI Considering Changes to AstraZeneca Age Recommendations (Apr.16/21)
The National Advisory Committee on Immunization (NACI) is considering whether to change its recommendation that the Oxford-AstraZeneca COVID-19 vaccine not be offered to anyone under the age of 55. Health Canada announced earlier this week the vaccine will remain authorized for all adults in Canada after the country reported its first case of blood clots linked to the shot. The agency says the new and extremely rare blood clotting syndrome may be linked to the vaccine, but they concluded the benefits of the shot still far outweigh any risks.
Dr. Susy Hota with the University Health Network says offering the shot to more people makes sense. “As long as people are aware of what the possibility is and they consent to it, I think it’s an important strategy you need to consider,” Hota said. Dr. Daniel Gregson with the University of Calgary says people do riskier things than get the shot on a daily basis without a second thought. “Surely based on risks, most people are much better off with a vaccine than not a vaccine,” he said.
In late March, NACI recommended a pause on AstraZeneca COVID-19 vaccinations for people under 55 due to safety reasons. Health officials continue to urge Canadians to take whichever vaccine is offered to them. More than 700,000 doses of the vaccine have been administered in Canada and about two million doses have been shipped.
The rollout of the Oxford-AstraZeneca vaccine in Canada has been shrouded with confusion, due to safety concerns and changing guidance over who can receive the shot. Health Canada asked AstraZeneca for a full risk assessment of its vaccine after reports of similar clots in Europe, but the agency says the side effect is extremely rare and the vaccine’s benefits still outweigh its risks.
https://www.680news.com/2021/04/16/naci-considering-changes-to-astrazeneca-age-recommendations/amp/
21. Canada Purchases 8M More Pfizer Doses as Moderna Vaccine Shipment Cut Nearly in Half (Apr.16/21)
Canada has purchased an additional eight million doses of the Pfizer-BioNTech COVID-19 vaccine that will be delivered in May, June and July, Prime Minister Justin Trudeau said Friday. The country will receive four million doses in May, two million in June, and another two million in July. The first shipment of Johnson and Johnson one-shot COVID-19 vaccine will be coming on April 27. The 300,000 doses will be distributed the first week of May. The news came shortly after it was announced that a shipment of Moderna vaccines expected next week has been cut nearly in half from 1.2 million to 650,000 doses. “The supplier has also indicated that 1 to 2 million doses of the 12.3 million doses scheduled for delivery in the second quarter may be delayed until the third quarter,” Minister of Procurement Anita Anand added in a statement Friday. Moderna blames slower than anticipated production capacity for the shortfall.
Image Source: https://www.cidrap.umn.edu/news-perspective/2020/12/fda-documents-show-pfizer-covid-vaccine-protects-after-1-dose
22. Results of the Safety and Immune-Efficacy of 1 Versus 2 Doses of COVID-19 Vaccine for Cancer Patients (Mar.17/21)
This study presents data on the safety and immune efficacy of the BNT162b2 (Pfizer-BioNTech) vaccine in 54 healthy controls and 151 mostly elderly patients with solid and haematological malignancies, respectively, and compares results for patients who were boosted with BNT162b2 at 3 weeks versus those who were not.
Findings show that the vaccine was largely well tolerated. However, in contrast to its very high performance in healthy controls (>90% efficacious), immune efficacy of a single inoculum in solid cancer patients was strikingly low (below 40%) and very low in haematological cancer patients (below 15%). Of note, efficacy in solid cancer patients was greatly and rapidly increased by boosting at 21-days (95% within 2 weeks of boost). Too few haematological cancer patients were boosted for clear conclusions to be drawn.
Researchers concluded that delayed boosting potentially leaves most solid and haematological cancer patients wholly or partially unprotected, with implications for their own health. Prompt boosting of solid cancer patients quickly overcomes the poor efficacy of the primary inoculum in solid cancer patients.
https://www.medrxiv.org/content/10.1101/2021.03.17.21253131v1
23. So far, 5,800 fully vaccinated people have caught Covid anyway in US (Apr.15/21)
About 5,800 people who have been vaccinated against coronavirus have become infected anyway, the US Centers for Disease Control and Prevention tells CNN. According to the CDC, some became seriously ill, and 74 people died. Additionally, 396 (7%) of those who got infected after they were vaccinated required hospitalization.
“To date, no unexpected patterns have been identified in case demographics or vaccine characteristics,” the CDC told CNN via email. Although rare, breakthrough cases are expected. The vaccines are not 100% effective in preventing infections and as tens of millions of people are vaccinated, more and more such cases will be reported.
Pfizer/BioNTech’s vaccine was 95% effective in preventing symptomatic disease in clinical trials, and earlier this month the companies said real-life data in the US shows the vaccine is more than 91% effective against disease with any symptoms for six months. Moderna’s vaccine was 94% effective in preventing symptomatic illness in trials, and 90% effective in real life use. Johnson & Johnson’s vaccine was 66% overall globally in trials, and 72% effective at preventing disease in the US.
Vaccine breakthrough infections make up a small percentage of people who are fully vaccinated. The likelihood of these “very rare” infections depends on how much virus is circulating within a community, Dr. Kawsar Talaat, an infectious disease physician and assistant professor at Johns Hopkins Bloomberg School of Public Health, told CNN. CDC recommends that all eligible people get a COVID-19 vaccine as soon as one is available to them.
https://www.cnn.com/2021/04/14/health/breakthrough-infections-covid-vaccines-cdc/index.html
Image Source: https://medical.mit.edu/covid-19-updates/2021/01/got-vaccine-can-i-toss-my-mask
24. CDC Study Finds Pfizer, Moderna Vaccines are 90% Effective After Two Doses in Real-World Conditions (Mar.29/21)
At full vaccination, the Pfizer and Moderna vaccines were 90% effective at preventing infections, including asymptomatic infections. At least 14 days after first dose but before second dose, they were 80% protective, according to the agency’s Morbidity and Mortality Weekly Report published Monday.
The study assessed how the vaccines protected nearly 4,000 health care workers and first responders. Most of the volunteers of the study (>62%) had received both doses of either a Pfizer or Moderna Covid-19 vaccine. More than 12% had received just a single dose. Among the 2,961 people vaccinated with one or more doses and the 989 unvaccinated participants, a total of 205 had a positive PCR test for Covid-19. 161 infections were identified when participants were unvaccinated, whereas 8 were identified among those partially immunized and 3 were identified among those fully immunized (more than 14 days after their second dose). More than 87% of Covid-19 cases had symptoms. Nearly 23% of the cases sought help from a doctor. There were two hospitalizations, but no deaths.
“This study is tremendously encouraging,” CDC Director Dr. Rochelle Walensky said Monday at the White House Covid-19 briefing. “These findings also underscore the importance of getting both of the recommended doses of the vaccine in order to get the greatest level of protection against Covid-19, especially as our concerns about variants escalate.”
https://www.cnn.com/2021/03/29/health/pfizer-and-moderna-covid-19-vaccines-work-wellness/index.html
- AstraZeneca Safe for Canadians as Young as 30, Vaccine Panel Says (Apr.23/21)
A national advisory panel has recommended Canadians 30 and older can get the Oxford-AstraZeneca vaccine if they don’t want to wait for an alternative, but some provinces say they don’t have enough supply to expand eligibility for the shot. While the committee originally recommended a pause on using AstraZeneca shots for people younger than 55, Health Canada released a safety assessment last week that showed the benefits of the shot outweigh the risks, which the committee said it also evaluated. The committee said the blood clots are rare, and people have an individual choice if they would rather wait to take the Pfizer-BioNTech or Moderna vaccines. The Pfizer-BioNTech and Moderna vaccines use messenger RNA, or mRNA, to trigger an immune response, unlike AstraZeneca, which is a viral-vector vaccine that delivers a safe virus to teach the body to protect against COVID-19.
Although provinces initially suspended giving AstraZeneca shots to younger people based on the committee’s previous advice, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia have since started administering it to people over 40, given the current spread of the virus. Ontario reported its first case on Friday of a rare blood clot in a man in his 60s who received the vaccine, bringing the number of reported cases in Canada to four out of more than 1.1 million doses given, according to the province’s top doctor. Manitoba will also take time to review NACI’s advice, which it said was not a “blanket recommendation” of using this vaccine for all people aged 30 and older, a spokeswoman said in a statement. “Eligibility for AstraZenca will remain at 40 and over until further notice,” the statement said.
Procurement Minister Anita Anand said last week that Canada still expects to receive 4.1 million doses of AstraZeneca from all sources by the end of June. She also said the country can expect to receive around one million doses of Pfizer-BioNTech early next week and 650,000 doses of Moderna by mid-week.
Image Source: https://www.dw.com/en/astrazeneca-germany-other-european-countries-to-resume-use-of-vaccine/a-56922088
26. The Latest on COVID-19 (Apr.15/21)
Pfizer CEO says we may need annual vaccinations for COVID-19
The chief executive officer of Pfizer said Thursday that people may need to get a third COVID-19 vaccination within 12 months of being full vaccinated. Albert Bourla added that annual inoculations may be needed to prevent future spread of the disease. Researchers still haven’t determined how long protection against the disease lasts after someone is vaccinated.
Blood clots rare in Moderna, Pfizer vaccines
A new study reports that the number of blood clot cases is about the same for the Moderna, Pfizer-BioNTech, and AstraZeneca vaccines. The researchers said about 4 in 1 million people who get the Moderna or Pfizer-BioNTech vaccine will develop blood clots. The rate is about 5 in 1 million for the AstraZeneca shot. They note that about 39 in 1 million people who develop COVID-19 get blood clots.
India reports 1-day record in COVID-19 cases
India reported a record 200,000 new cases of COVID-19 today, becoming the second country after the United States to reach this single-day toll, reported The Washington Post. These new cases have pushed India’s total cases to more than 14 million and turned the nation into the pandemic’s global epicenter with little indication the outbreak will slow. To contain the COVID-19 surge, Maharashtra Chief Minister Uddhav Thackeray announced curfew-like restrictions on the movement of people in the state from April 14 to May 1, reported The Indian Express.
- COVID-19 Vaccines Are Still Effective Amid Rising Number of Variants (Apr.23/21)
Recent research from Pfizer looked at 44,000 people around the world — including people in South Africa who were predominantly exposed to the B.1.351 variant — and found that the vaccine remained 100% effective against severe disease and death. Real-world data also shows that the Pfizer vaccine held up against the B.1.1.7 variant, which was first detected in United Kingdom. Even in an area where B.1.1.7 was the dominant strain, the shot was 97% effective against symptomatic COVID-19, hospitalizations, and death. Evidence shows that the same is true with the Moderna, AstraZeneca, and Johnson & Johnson vaccines.
Johnson & Johnson vaccine clinical trials were conducted in South Africa and Brazil — both of which were being pummelled by the B.1.351 variant and P.1 variant, respectively, when the trials were conducted. Though the Johnson & Johnson vaccine was less effective overall against mild and moderate disease in South Africa and Brazil, the one-dose shot still provided strong protection against hospitalization and death.
How the immune system fights variants
The immune system is complex, and antibodies alone won’t determine how protected you are against a pathogen, explains Dr. Joseph Craft, a professor of immunobiology and medicine at Yale School of Medicine. The cell-mediated immune response, which includes B-cells that produce antibodies along with T-cells, also mount a robust response against pathogens, often lasting for years. Our antibodies help prevent an infection from occurring by neutralizing a virus, but the T-cells can recognize parts of the virus on infected cells and clear out the infection before it becomes serious. Research shows that T-cells can identify 52 parts of the coronavirus, so even if there are mutations, the T-cell will still recognize and attack the variants.
How long will T-cell protection last?
According to Craft, once our bodies have been exposed to a virus, we’re typically protected against that virus for a long time. A recent study found people had “strong T-cell responses to variants (including B.1.1.7, B.1.351, P.1, and CAL.20C) equal to the T-cell responses you get from the ancestral strain,” explained Dr. Monica Gandhi, an infectious disease specialist with the University of California, San Francisco. Another study found that T-cell immunity might be our greatest weapon at avoiding severe disease since they’re skilled at rapidly clearing viruses. Scientists will need to continue studying T-cell immunity over time to understand just how protective and durable our cell-mediated response is.
- Cancer Patient Advocacy Groups Urge the Prime Minister and Premiers to Help Our Cancer Patients Complete the Vaccine Series within the Clinical Trial Recommended Timeline! (Apr.28/21)
Cancer Patient Advocacy Groups, including CCRAN, took out a full-page ad in the Globe & Mail, urging the Prime Minister and provincial Premiers to ensure that cancer patients complete their covid vaccine series within the recommended clinical trial data timelines. Evidence to support the recommended timeline appear below.
29. Frequently Asked Questions for COVID-19
Q: What is COVID-19 (or novel Coronavirus Disease – 19)?
A: Coronaviruses are a large family of viruses that can cause illnesses in humans and animals. Coronaviruses can cause illnesses that range in severity from the common cold, to more severe diseases such as Severe Acute Respiratory Syndrome (SARS) and most recently, COVID-19. COVID-19 or novel coronavirus originated from an outbreak in Wuhan, China in December 2019. The most common symptoms associated with COVID-19 can include fever, fatigue, and a dry cough. Though additional symptoms have now been linked with the disease, which may include aches and pains, nasal congestion, runny nose, sore throat, diarrhea, skin rash and vomiting. It is also possible to become infected with COVID-19 and not experience any symptoms or feeling ill. The spread of COVID-19 is mainly through the transmission of droplets from the nose or mouth when a person coughs, exhales or sneezes. These droplets land on surfaces around a nearby person. COVID-19 can be transmitted to that nearby person who may end up touching the surface contaminated with COVID-19 and then end up touching their nose, mouth, or eyes. A person can also contract COVID-19 through inhaling these droplets from someone with COVID-19. Although research is still ongoing, it is important to note that older populations (over the age of 65), those with a compromised immune system and those with pre-existing conditions including heart disease, high blood pressure, lung disease, diabetes or cancer may be at a higher risk of severe illness due to COVID-19.
https://www.who.int/news-room/q-a-detail/q-acoronaviruses)
Q: What can I do to avoid getting Coronavirus?
A: There are various ways in which we can reduce our risk of contracting COVID-19. Below are some measures suggested by the World Health Organization
- Keep at least 2 metres (or 6 feet) between yourself and other people. This will reduce the risk of inhaling droplets from those infected with COVID-19.
- Regularly clean your hands for at least 20 seconds with warm water and soap, or an alcohol-based hand rub. This will kill any viruses on your hands.
- Avoid touching your eyes, nose and mouth. If the virus is on your hands, it can enter the body through these areas.
- Follow good respiratory hygiene by covering your mouth and nose with a tissue or elbow when you cough and sneeze. This prevents the droplets from settling on surfaces or being released into the air around you.
- Stay home as much as possible, especially if you are feeling unwell. If you think you may have the Coronavirus, please see “What should I do if I think I have Coronavirus?” section.
- Please wear a face covering or mask in public when physical distancing is not possible.
https://www.who.int/news-room/q-adetail/q-a-coronaviruses
Q: Are there any treatments available for Coronavirus?
A: People with cancer are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
There are currently no treatments available for COVID-19 but trials are underway to determine how to best treat and manage those afflicted with the virus. Vaccine candidates are being vigorously tested in a number of countries around the world, Canada included. The US government is funding 3 major phase 3 trials on potential COVID-19 vaccines and all 3 trials are being conducted by 3 different pharmaceutical companies looking at different vaccine candidates. The hope is to have a vaccine by the end of the year!
Source: https://www.who.int/news-room/q-a-detail/q-acoronaviruses
Q: Are there special precautions that people with cancer can take?
A: People with cancer (and other chronic ailments such as heart disease, diabetes, high blood pressure and lung disease) are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
Will anything change with regards to my cancer related medical visits? As each patient and treatment plan is unique, it is always best to contact your health care provider for updated information about your treatment plan. In some cases, it is safe to delay cancer treatment until after the pandemic risk has decreased. In other cases, it may be safe to attend a clinic that is separate from where COVID-19 patients are being treated. Oral treatment options could be prescribed by your care provider virtually, without the need to attend the clinic. Finally, some follow-up appointments or discussions could be held virtually (via skype or zoom for example) or over the phone to minimize your risk. As we know, conditions and protocols are changing daily due to the nature of the COVID-19 outbreak, and vary based on location, therefore, the best first step is to reach out to your care provider for guidance.
https://www.cancer.gov/contact/emergencypreparedness/coronavirus
Should you wish to contact your local public health agency, please see below.
Alberta
COVID-19 info for Albertans
Social media: Instagram @albertahealthservices, Facebook @albertahealthservices, Twitter @GoAHealth
Phone number: 811
British Columbia
British Columbia COVID-19
Social media: Facebook @ImmunizeBC, Twitter @CDCofBC
Phone number: 811
Manitoba
Manitoba COVID-19
Social media: Facebook @manitobagovernment, Twitter @mbgov
Phone number: 1-888-315-9257
New Brunswick
New Brunswick Coronavirus
Social media: Facebook @GovNB, Twitter @Gov_NB, Instagram @gnbca
Phone number: 811
Newfoundland and Labrador
Newfoundland and Labrador COVID-19 information
Social media: Facebook @GovNL, Twitter @GovNL, Instagram @govnlsocial
Phone number: 811 or 1-888-709-2929
Northwest Territories
Northwest Territories coronavirus disease (COVID-19)
Social media: Facebook @NTHSSA
Phone number: 811
Nova Scotia
Nova Scotia novel coronavirus (COVID-19)
Social media: Facebook @NovaScotiaHealthAuthority , Twitter @healthns, Instagram @novascotiahealthauthority
Phone number: 811
Nunavut
Nunavut COVID-19 (novel coronavirus)
Social media: Facebook @GovofNunavut , Twitter @GovofNunavut, Instagram @governmentofnunavut
Phone number: 1-888-975-8601
Ontario
Ontario: The 2019 Novel Coronavirus (COVID-19)
Social media: Facebook @ONThealth, Twitter @ONThealth , Instagram @ongov
Phone number: 1-866-797-0000
Prince Edward Island
Prince Edward Island COVID-19
Social media: Facebook @GovPe, Twitter @InfoPEI,
Quebec
Coronavirus disease (COVID-19) in Québec
Social media: Facebook @GouvQc, Twitter @sante_qc
Phone number: 1-877-644-4545
Saskatchewan
Saskatchewan COVID-19
Social media: Facebook @SKGov, Twitter @SKGov
Phone number: 811
Yukon
Yukon: Find information about coronavirus (COVID-19)
Social media: Facebook @yukonhss, Twitter @hssyukon
Phone number: 811
English 
French