Patient access to new oncology drugs in Canada is only possible after navigating multiple sequential systemic checkpoints for national regulatory approval, health technology assessment (HTA) and collective government price negotiation. These steps delay access and prevent health care providers from being able to prescribe optimal therapy. Eighteen Canadian oncology clinicians from the medicine, nursing and pharmacy professions met to develop consensus recommendations for defining reasonable government performance standards around process and timeliness to improve Canadian cancer patients’ access to best care. A modified Delphi methodology was used to identify consensus on 30 questions involving five themes: accountability, disparities, endpoints, timeliness, and cost-effectiveness. It was agreed that greater transparency is required across regulatory and HTA processes. Health professionals in oncology are frustrated for their patients because they are unable to deliver the modern guideline-supported therapies they want to provide due to delays in approval or funding. Canadian health care providers request improvements in timely access to life-saving therapeutics in line with other comparator countries. Clinicians expect urgent improvements in Canadian health systems to give our patients their best chance of survival.

Nonmelanoma skin cancer is the most common cancer in the world, and lung cancer is the leading cause of death from cancer. Histologically, squamous cell carcinoma (SCC) is the second most prevalent type of both skin and lung cancers. We report the case of a 38-year-old female with metastatic, poorly differentiated lung SCC detected on chest X-ray after she presented to the hospital with cough and dyspnea. She had had a 7.5 cm moderately differentiated well-circumscribed posterior scalp SCC completely excised eight years earlier. CT scan showed a large right lung mass, nodular filling defect in the left atrium (LA), and metastases to the adrenal glands and the first rib. Her pulmonary tumor extends to the LA via the right superior pulmonary vein, which is rarely reported in the literature. Ultrasound-guided biopsy of the rib mass showed poorly differentiated SCC. The patient received urgent radiotherapy, given superior vena cava and mainstem bronchus compression. Head CT showed no brain metastasis. A biopsy of the left adrenal initially reported an undifferentiated pleomorphic sarcoma; however, a second pathologist reported it as a poorly differentiated carcinoma of lung origin. At least three pathologists verified the specimen, and it had a PD-L1 test with a 1-49% score. An initial echocardiogram confirmed the LA mass. The patient received a Paclitaxel-Carboplatin-Pembrolizumab regimen as the first-line treatment for metastatic SCC. A repeat echocardiogram after cycle 1 showed a decrease in the size of the tumor in the LA. Almost five months after her initial visit, this young woman’s symptoms and performance status have improved post-palliative radiotherapy and chemo-immunotherapy. Follow-up CT showed smaller lung, nodal, adrenal, and costochondral masses, and evidence of necrosis. This case is clinically relevant because it represents a common problem presenting uncommonly. Moreover, it highlights that ultrasound-guided interventions and medical imaging are essential in directing metastatic cancer diagnosis, treatment, and follow-up, especially when pathology cannot confirm but only presume a specific diagnosis.

Immunotherapy-induced endocrinopathies remain an adverse risk factor for patients undergoing PD-1/PD-L1 and CTLA-4 target immunotherapy treatment. Immunotherapy works by boosting the immune system to target, bind and block tumor receptors that would otherwise allow the cells to camouflage. This paper focuses on thyroid dysfunction, adrenal insufficiency, diabetes mellitus, and hypophysitis, and specifically the clinical presentation, diagnostic approaches, and management of each. All four endocrinopathies often present with generalized symptoms and, therefore, are commonly misdiagnosed. Healthcare professionals must closely monitor symptoms through laboratory testing and, when necessary, diagnostic imaging to appropriately diagnose and treat endocrinopathies. Thyroid dysfunction and adrenal insufficiency are often debated on immunotherapy hold/discontinuation. However, treatment of grade 3–4 diabetes mellitus and hypophysitis results in holding treatment until immune function prognosis decreases or returns to normal. Overall, ongoing research and clinical trials are needed to understand the varying effects of immunotherapy-induced endocrinopathies. Healthcare professionals should always consider patient symptoms, laboratory results and diagnostic imaging to ensure endocrinopathies are not missed and patients receive optimal care.

It is well-known that immune checkpoint inhibitors (ICIs) can lead to uncommon but potentially life-threatening immune-related adverse events (irAEs) such as checkpoint-inhibitor pneumonitis (CIP). Early recognition, identification, and treatment are crucial with regard to decreasing toxicity from ICIs. However, there is a discrepancy in the incidence rates between the clinical trials and postmarketing studies. Several postmarketing studies have developed early detection methods and identified new risk factors in developing CIP. Thus, in this narrative review, we aim to review these incidence rates, early detection methods, and clinical risk factors for CIP in NSCLC patients, which could help to improve CIP diagnosis and management for enhanced NSCLC care. Major clinical trials and postmarketing studies of CIP incidence, early detection methods, and risk factors in NSCLC were reviewed. A wide array of potential risk factors has been implicated in the development of CIP in NSCLC, such as having preexisting interstitial lung disease, receiving PD-1 inhibitors, receiving combination ICI therapy instead of ICI monotherapy, lower pretreatment hemoglobin and albumin levels, increased baseline plasma IL-8 levels, and impaired baseline pulmonary function.

The Northern Constellations 2026 Internal Medicine Scientific Session brings together a diverse collection of scholarly work reflecting the breadth, innovation, and evolving priorities of internal medicine practice in Northwestern Ontario and beyond

Patient access to new oncology drugs in Canada is only possible after navigating multiple sequential systemic checkpoints for national regulatory approval, health technology assessment (HTA) and collective government price negotiation. These steps delay access and prevent health care providers from being able to prescribe optimal therapy. Eighteen Canadian oncology clinicians from the medicine, nursing and pharmacy professions met to develop consensus recommendations for defining reasonable government performance standards around process and timeliness to improve Canadian cancer patients’ access to best care. A modified Delphi methodology was used to confirm strong consensus on 30 questions involving five themes: accountability, disparities, endpoints, timeliness, and cost-effectiveness. It was agreed that greater transparency is required across regulatory and HTA processes. Health professionals in oncology are frustrated for their patients because they are unable to deliver the modern guideline-supported therapies they want to provide due to delays in approval or funding. Canadian patients and their health care providers request improvements in timely access to life-saving therapeutics in line with other countries. Clinicians expect urgent improvements in our health systems to give our patients their best chance of survival.