Keith Stewart
As of June 1, Dr. Keith Stewart is the new Vice President, Cancer and Director of the Princess Margaret Cancer Program, UHN, and Regional Vice-President, Toronto Central South Regional Cancer Program, Ontario Health. Dr. Stewart is coming from the Mayo Clinic but was a distinguished clinician and researcher at UHN for 13 years before that. (Photo: Courtesy Keith Stewart)

UHN and the Princess Margaret Cancer Centre (PM) welcome back renowned multiple myeloma clinician and researcher, Dr. Keith Stewart, from the Mayo Clinic.

Effective June 1, Dr. Stewart is the Vice President, Cancer and Director of the Princess Margaret Cancer Program, UHN, and Regional Vice-President, Toronto Central South Regional Cancer Program, Ontario Health. 

Dr. Mary Gospodarowicz, former Medical Director, will continue to play an active role in Princess Margaret's Global Cancer and Smart Cancer Care Programs, along with mentoring the next generation of clinical leaders.

Marnie Escaf, former Senior Vice President and Executive Lead, will work with Dr. Stewart for several weeks to ensure a smooth transition. Marnie will then take on a new leadership within UHN as Vice President, Clinical.

Dr. Stewart began practicing at Toronto General Hospital (TGH) in 1992, subsequently moving his clinical practice to the Princess Margaret in 1999. While at UHN, he became the first research director at TGH, began the University of Toronto McLaughlin Centre for Molecular Medicine, and conducted the first viral gene therapy clinical trials in Canada.

UHN prepared him well for the move to the Mayo Clinic in 2005, where he was the Director of the Mayo Clinic Center for Individualized Medicine. This center focuses on genome-based research and clinical implementation, customizing care to a patient's unique genetic makeup.

He was also the Vasek and Anna Maria Polak Professor of Cancer Research at the Mayo. As a scientist, Dr. Stewart has more than 25 years of sustained national funding for a laboratory research program in genomics and biology of multiple myeloma, and has led many clinical trials of new drugs for this blood cancer.  

Integrating cancer operations across UHN

Dr. Stewart notes that in many ways the Princess Margaret and Mayo are alike: they have a strong patient-centred culture, a team-based approach to solving challenges, and a voracious appetite to boldly try new and creative approaches to transform patient care.

"The one key thing that I learned at the Mayo is that everyone lives and breathes its primary value: 'The Needs of the Patient Come First,'" he says. "You see it everywhere. It's team-based medicine, it's how appointments are clustered for the patients' convenience, it's how they create a welcoming and soothing patient environment, and it's how the clinic focuses on efficient, reproducible, system-wide processes.

"The patient does not have to struggle or push to get exceptional service. They get everything wrapped up quickly, and communicate results to the patient in an unhurried, compassionate manner. It's the Mayo gold standard instantly recognized around the world."

Much of that already exists at PM and UHN, says Dr. Stewart, adding that he would like to build on integrating cancer operations across UHN even further, with an emphasis on creating and sharing information through digital platforms, such as the Smart Cancer Care Program.

Developed at the Princess Margaret, and spurred on by COVID-19, Smart Cancer Care has reduced in-person visits to the cancer centre by 500 to 700 appointments a day, shifting them to virtual ones.

Dr. Stewart also stresses that cancer care for generations to come will require a "fearless vision:" detecting cancer early while it is still curable; developing high-definition, precision treatments to replace outmoded treatments with debilitating side effects; using Artificial Intelligence to discover unexpected links and patterns within cancer for better detection; and creating "comfort and joy" for both staff and patients.   

He hopes that he can help streamline cumbersome administrative practices that bog down clinicians and support staff who could better spend their time with patients, reflecting on their next projects, building strong, diverse teams and practicing wellness with a UHN BRITE practice, such as pausing and taking a deep, nourishing breath, to build resilience "On the Go."

'What if we could prevent these cancers in the first place'

Personalized, or precision medicine tailored to a patient's genetic make-up is one area that Dr. Stewart knows well from his work at the Mayo's Clinic Center for Individualized Medicine.

One of his proudest accomplishments there was to launch the next-generation DNA whole exome sequencing of 200,000 patients to discover those at high inherited risk for cancer, high cholesterol, and other rare diseases. Next-generation sequencing has substantially sped up the process of sequencing or decoding all of a person's DNA, the unique blueprint of a person's whole body.

What used to take years can now be done in as little as days or weeks.

He explains that this new DNA screening technology finds an increased risk of cancer, due to genetic mutations inherited from a parent, in 10 per cent to 15 per cent of cancer patients. Current, history-based screening methods miss up to half of these families.

"What if we could prevent these cancers in the first place by identifying those at highest risk much more efficiently with intense screening?" he asks, adding that a simple blood test using DNA sequencing technology can now detect a cancer before it becomes symptomatic, and is still curable.

"If we were the first to offer such a blood test on a large scale, that would set us apart from most other cancer centres in North America," Dr. Stewart says.

He notes that DNA sequencing can also identify patients who are at risk of adverse drug reactions, and that the Mayo Clinic has used this technology, called pharmacogenomics, successfully in patients as part of its supportive care.

Cancer care requires skill set of empathy and strong technical skills

The Princess Margaret, he adds, is already a world leader in studying advanced cancer to identify the specific features of a tumour that can make one drug more effective over another one. 

Despite the intense research, administrative and fundraising demands of multiple roles at the Mayo Clinic, Dr. Stewart continued his clinical practice with patients with multiple myeloma, a treatable but incurable cancer of white blood cells that is mainly treated with chemotherapy and stem cell therapies.

Cancer can be a devastating and deeply frightening diagnosis for patients, he says gently, adding that for that reason, it requires a skill set combining both empathy and strong technical skills.

He recounts that after finishing medical school in Aberdeen, Scotland, he began working in a newly opened bone marrow transplant ward at the Glasgow Royal Infirmary in 1985.

"Many of those leukemia patients were in their 20s, the same age as I was," he recalls, "They required aggressive chemotherapy and a bone marrow transplant, treatments demanding high level levels of technical competence.

"They were so desperately sick, and I had great empathy for these patients. I wanted to help them.

"And that's when I decided that this is what I wanted to do as my life's work."    

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