Forging new paths in cancer treatment

Italian-Canadian Dr. Denny De Petrillo on his work in gynecologic oncology

Dr. Denny De Petrillo is a leading authority on the treatment of cancer, particularly in his area of specialty, gynecologic-oncology. One of the first gynecologic oncologists in Canada, his career has coincided with the development of the specialty. In addition to being at the forefront of instituting integrated care in cancer, writing numerous papers and other works often dealing with the psychosexual rehabilitation of patients, he has headed various gynecologic and surgical oncology departments at leading hospitals and cancer centres in Ontario.
His work has taken him throughout the world as a speaker, consultant and lecturer. Currently Dr. De Petrillo is a professor of Obstetrics, Gynecology and Surgery as well as sub-specialty fellowship program director of the Division of Gynecologic Oncology at the University of Toronto. He is also the Vice President of Medical Affairs for Comprehensive Care International, and sits on many medical boards and committees, including being Chair of the Surgical Oncology Policy Advisory Committee for the Canadian Association of Provincial Cancer Agencies.
The Toronto native was born to Italian parents, his father coming here from Montecasino at the age of 17, his mother from a town on the Mediterranean at age 14. "They actually met in Canada," he says from his office at Princess Margaret Hospital. "My mother became a seamstress. My father, (who) just died at the age of 91, became a barber. After the war he started to call his Italian cousins and colleagues over and got them jobs. So the whole Italian immigration population really came from people like my dad who were instrumental in bringing thousands of Italians over."
De Petrillo received his medical degree from the University of Ottawa in 1966, then did his post-graduate internship at Toronto's St. Joseph Hospital with the intent to specialize in orthopedics, but plans soon changed. During his internship he had the opportunity to explore other specialties. "In those days you had a rotating internship," he explains. "A rotating internship means you take one or two months on each specialty, like pediatrics, internal medicine and general surgery, and obstetrics and gynecology."
De Petrillo particularly liked the last rotation, in part because of the enthusiasm and inspiration of the chief resident he studied under, a doctor from Greece who was very interactive with the patients. "If you look at the history of people who have gone into specialty work, it's usually on a role model experience." He continued his residency at Hamilton's McMaster University then opted to do his six-month general surgery rotation in San Bernardino, California.
"But (San Bernardino) was the home of the Hells Angels, which I didn't realize till I went down there," he recalls. "And so part of, or almost all of my six months was spent in trauma, gunshot wounds, knife wounds, a lot of sick patients."
He returned to Hamilton to complete his pathology. Although he had planned to go into clinical practice in Mississauga with an Italian obstetrician-gynecologist, De Petrillo so enjoyed his surgical work he decided to go back to California, this time to Los Angeles, to do two years' of cancer work, in gynecologic oncology. He then returned to Hamilton, where he was director of the Division of Gynecologic Oncology at McMaster from 1973 to 1984.
At the time this was a new specialty. "The American boards had just recognized it," he explains. In Canada, De Petrillo recalls, there were only two specialists, both of whom had trained in surgery more than in all of the aspects of gynecologic cancer. He and another colleague in Winnipeg were the first to come back to Canada completely trained in the field.
"One of our blessings is that out clinical gynecologists, those that are in community and clinical work in obstetrics-gynecology, have recognized the sub-specialty of gynecologic cancer."
"We were really the first to completely look after the patient," De Petrillo continues. "We would see them, assess them, we would do the surgery. We were trained in chemotherapy, so most of us would give chemotherapy afterwards. The radiation therapy if needed would be given by one of the radiation oncologists. But then we would be involved in pain control; palliative care, psychosocial support, the whole thing for the patient with gynecologic cancer."
This was a new approach to care that was not at first embraced or understood by the entire medical community. "When we presented it, the comments were 'well, what's the big deal?' because they hadn't even thought about it," De Petrillo remembers. As the years progressed, more and more papers and literature appeared supporting the benefits so that today the psychosocial aspect is a huge part of cancer care. He also notes that communication in the cancer world has opened up with the physicians, patients and families, breaking the older paternalistic model.
Not only was gynecologic oncology unique in its comprehensive and holistic approach to cancer, but it also delved for the first time into the special issues facing women afflicted with it. For, as De Petrillo explains, the diagnosis of a gynecologic cancer introduces a sexuality component that doesn't exist with other cancers for women with the exception of breast cancer. "By sexuality I don't mean sexual activity," he notes. "I'm talking about sexuality about how they feel as a person, how the woman feels as a person, how she interacts with her partner and her children." Issues of self-image become crucial.
"When a woman has a cancer of the cervix," he continues, "she initially is worried about the cancer, about the effects of the treatment. But she's also, in the back of her mind, concerned about how she feels, how she will look afterwards and how her husband or partner will respond. Once a treatment's started and finished, the fear of recurrence or death is getting less and less, then the other issues regarding her sexuality come to the forefront and become the most important. So we have introduced a system where the partner's involved from the beginning. Discussions about treatment is done with the partner and patient because he can reinforce things that often they don't even think about or hear when you talk to them about it."
De Petrillo notes that the issues raised in gynecologic cancers mirror those suffered by men with prostate cancer, although it has taken even longer to be brought in the open. "Men have never discussed this, but I can tell you a man with prostate cancer is suffering the same worries that the female does with gynecologic cancer," he says.
McMaster afforded a unique opportunity to forge this new way to work with gynecologic cancer. As it had a very good relationship with the referral centres, they started a referral programme involving all the gynecologists. "We tried to involve them by bringing them on as colleagues and helping them make the right decision," he recalls.
Hamilton also dedicated a ward for the gynecologic cancer patients, a novel idea at the time. People then believed that palliative care patients should be kept away from other patients with gynecologic cancer. At McMaster they found that having all the patients together was supportive to them. "We actually were the first ones in North America really to have an integrated unit of gynecologic cancer involving surgery, chemotherapy, radiation therapy, primary nursing, psychiatry involved," says De Petrillo. "We had a wonderful unit."
Hamilton's strides and successes were noted in Toronto and in 1984 De Petrillo was invited to be Chief of the Department of Obstetrics and Gynecology at the Wellesley Hospital. Then in 1991 Princess Margaret decided to have a department of surgery and asked he him to be the first head of the Department of Surgical Oncology. That unit has now grown to have 36 surgical oncologists.
From 1996 to 2002 De Petrillo was Coordinator of Surgical Oncology for Cancer Care Ontario. Cancer Care Ontario used to have an international arm, now privatized as Comprehensive Care International, of which De Petrillo is Vice President of Medical Affairs. It is called upon to assist the developing world in establishing cancer centres and developing protocols and infrastructure. Beginning first as a casual process where general recommendations were made, it has evolved into a formal consulting business. It has brought De Petrillo to several countries like Brazil, Costa Rica and Trinidad and Tobago, where they are currently developing a national cancer care programme along with the building of a cancer care centre.
De Petrillo sees that in general it is not the quality of the physicians, but technology and infrastructure that is missing in the developing world. He cites Trinidad as an example. "The physicians working in Trinidad are probably the best trained of most people I've seen because they've trained in the United States, England and Canada, or all three and have come back and want to work in Trinidad," he notes. "The ones that come back are the ones that really want to do something in the country. What the country lacks is technology, a mission to do this. The professional component of the medical system is as good as ours, the technical component is what's lacking."
With his ongoing work both in Toronto and internationally, De Petrillo continues to raise the quality of cancer care worldwide.

Publication Date: 2003-06-22
Story Location: http://tandemnews.com/viewstory.php?storyid=2861