Julia Peterson, Saskatoon StarPhoenix
As a medical oncologist at the Saskatoon Cancer Centre, Dr. Mita Manna keeps a packed schedule — and a positive outlook.
Throughout all of her in-person and virtual patient appointments in the morning, tumor board rounds over lunch, meeting new patients in the afternoon, reviewing lab results and handling urgent or last-minute treatment concerns into the evening, as well as keeping up with her teaching, research and patient advocacy, Manna finds moments to look forward to.
“There are little ‘wins’ throughout the day,” she says. “Like when you’re talking to a patient about their treatment and everything is going great. Or they’re able to return to work. Or they were trying to get pregnant after treatment, and they tell me they were successful.”
Of course, some days are more difficult, especially for terminal cancer patients and their families. Manna is glad to be able to support them in those moments too.
“If I’m able to alleviate suffering as best as possible, be able to provide any palliative treatment that they’re eligible for, try and maintain their quality of life — that is ultimately my goal,” she says. “I want to ease any suffering, especially for those terminal patients. You want that transition to be smooth, right? You don’t want to make it a moment of crisis for them or for their family. You want to listen to their wishes and provide the best treatment for each individual patient based on their wishes.”
After a short phone call to a breast cancer patient on Feb. 2, Manna was celebrating a very big win indeed. Thanks to a new grant received by Manna and her team, this patient and hundreds of others can finally get the essential genetic testing they had been waiting for.
As Manna explained, some people have a much higher risk of developing breast or ovarian cancer because they have a particular gene mutation, or a cluster of mutations.
Knowing whether a patient has these mutations impacts everything from what surgeries they should get, what medications will best treat their particular cancer, to whether their family members should also be getting additional cancer screenings.
But the process of getting that critical information to the patient and their care team was bogged down in delays.
“We could talk for a long time about the health care crisis — unfortunately, wait times are getting longer,” she says. “The volumes of patients are increasing, and capacity is limited. We do see this on a day-to-day basis, where we’re finding that we are sometimes not able to book patients in as per our regular guidelines because there are not enough human resources, and it’s delaying workup, diagnosis and treatment.
“It’s not just a lack of physicians; we are also running short on nursing staff, on radiology technicians, even on clerical staff.”
Medical geneticists have been in particularly short supply. As of 2023, Manna says, hundreds of breast cancer patients in Saskatchewan were waiting to meet with a medical geneticist so they could get genetic testing. Some had been on the waitlist for more than five years.
Without many more highly-specialized medical geneticists being hired to see patients, it seemed there might be no way to get a handle on this growing problem. But at a breast cancer symposium that year, she heard about a different approach: Mainstream testing.
“There was a plea from our medical geneticist who said that, as a province, we need to establish this program,” Manna recalls. “This is starting to roll out in other countries and other provinces in Canada. We need to do this here.”
With mainstream testing, rather than having to meet with a geneticist before getting tests done, a cancer patient’s surgeon or oncologist can send them for tests right away.
Results come back within a few weeks and, if the patient tests positive for a mutation, that’s when they meet with a geneticist who can explain what the result means.
Genetic counsellor Tara Scriver remembers talking to Manna about the ways mainstreaming would improve patient care in Saskatchewan.
“Because of the resource issues in genetics, at this point I’d say that mainstreaming is necessary to meet the demand,” says Scriver. “Our patients need this information in real time, and it is a process that has been implemented in other provinces. However, it was not gaining traction or attention here.”
When Manna took up the cause, Scriver knew all that was about to change.
“Mita is a champion for genetics,” she says. “We really needed this, because we’re just under-resourced.
“When we look at our wait times here, we’re measuring a lot of those in years. When we think about our patient populations, and cancer in particular, we know that the delay in meeting these patients and offering them testing could mean another cancer diagnosis that we could have been watching for, or taking preventative methods for. And that can translate into their families too.”
In fact, Manna championed the issue all the way to the Royal University Hospital Foundation’s Women Leading Philanthropy (WLP) program, which awarded her $100,000 to launch a pilot mainstream genetic testing program in Saskatchewan.
“Dr. Manna is really putting the patients first and making something better for breast cancer patients,” says Dr. Mary Kinloch, who serves as WLP program chair. “It’s truly remarkable.
“What made Dr. Manna’s program stand out was that it was more about a process change, and what she needed help for was to make that change happen. The results would be sustainable and would offer better care but, in the current publicly-funded system, there was no funding to support that process change.”
The grant money is being spent on staffing and supplies to handle the “initial influx of tests” needed for patients coming off the waitlist, as well as a research project studying the impact of the change.
“If we can demonstrate that this is going to impact patient care and patient outcomes, I think this would be a long-term benefit for our health-care system,” says Manna. “I’m opening up precious resources and time from a geneticist so they can spend time with patients who are identified to have those mutations. They play a huge role in cancer care, which is becoming more complex and precision-based.”
For Manna, getting this grant and starting to make these changes to cancer care in Saskatchewan is just part of what she loves most about her job.
“I’m very fortunate to be in this position to be able to help my patients and get them on the best treatment possible,” she says. “There are so many opportunities and changes that are happening in cancer care right now, and I advocate for my patients.”
