Restructuring!Cancer!Services! … Cancer Care Ontario ... Ontario Cancer Plan III 2011-2015 4 . 5...
Transcript of Restructuring!Cancer!Services! … Cancer Care Ontario ... Ontario Cancer Plan III 2011-2015 4 . 5...
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Restructuring!Cancer!Services!for!Survivorship!Care:!The$Ontario$Experience
Dr. Carol Sawka MD, FRCPC VP, Clinical Programs and Quality Initiatives
Cancer Care Ontario Professor of Medicine, University of Toronto
August 30, 2012
UICC World Cancer Congress
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Setting the context for healthcare in Canada Canada:!
• >"33"million"people,"9.9"million"sq."km"• 10"provinces,"3"territories"• Healthcare:"na;onal"strategy,"provincial"plans/
implementa;on"• Cancer"services"uniquely"organized"in"most"
provinces""
"Ontario:!!• >"13"million"people,"1.1"million"sq."km."• Est."72,300"incident"cases"in"2012"• Colorectal,"Lung,"Breast"and"Ovarian""
have"high"rela;ve"rates"of"survival""interna;onally"
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About Cancer Care Ontario
Mandate!• Provincial"government"agency"
responsible"for"con;nually"improving"cancer"services"
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Mission!• Improving"the"performance"of"the"
cancer"system"by"driving"quality,"accountability"and"innova;on"
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In Ontario, cancer incidence is increasing….
4 Ontario Cancer Plan III 2011-2015
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…. as are 5 year Cancer Survival Rate for those living with cancer
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… leading to a 40% increase in the number of Ontarian’s living with cancer
Ontario Cancer Registry 6
406,000"
Ontarians"will"be"living"with"cancer"by"2017.!
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Inconsistency in follow-up visits with Specialists* for Breast Cancer Patients
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Figure!1:!%!Breast!Cancer!Survivors!with!at!least!one!followBup!visit!by!specialists*!in!Regional!Cancer!Centre!!12B24!months!aHer!their!diagnosis!in!2009.!
67"
35"40"
71"79" 80"
59"67"
88"95"
81" 85"93" 93"
0"10"20"30"40"50"60"70"80"90"
100"
A" B" C" D" E" F" G" H" I" J" K" L" M" N"
%"Pa;ents"Followed["Up" """"""Provincial"Average"*"Specialists"include"Medical,"Radia;on"and"Surgical"Oncologists"in"Regional"Cancer"Centres"in"Ontario""""Source:"Ontario"Cancer"Registry,"Ac;vity"Level"Repor;ng,"Discharge"Abstract"Database"and"Na;onal"Ambulatory"Care"Repor;ng"System""
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High-variability in follow-up testing and care FollowBup!PracLce!PaMerns!Cohort!Studies!–!Grunfeld!et$al.1"• Examined"follow[up"prac;ces"for"Breast"Cancer,"Hodgkin’s"Lymphoma,"Endometrial"
Cancer"and"Colorectal"Cancer"pa;ent"cohorts"in"Ontario"
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• Number!of!followBup!visits!within!cohorts!highly!variable!– Some"cohorts">50%"pa;ents"had"more"(or"fewer)"than"guideline"recommended"
visits"– Pa;ents"frequently"seeing"mul;ple"providers"
• FollowBup!imaging!within!cohorts!variable!– Many"pa;ents"had"too"frequent"imaging"
• Screening!for!relevant!secondary!cancers!within!cohorts!variable!– Higher"than"expected"numbers"of"unscreened"pa;ents"in"some"cohorts"
1. Kron et al. Obstetrics and Gynecology (2009), and Grunfeld submitted and unpublished data
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Patients are not Satisfied
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Our Vision for Survivorship
Goals:!1. To"enable"cancer"survivors"to"receive"the"right"care"in"the"right"place.""2. To"ac;vely"empower"cancer"survivors"with"pa;ent[centred"informa;on"and"
tools."3. To"develop"the"evidence"base,"informa;on"and"tools"for"oncologists"and"
primary"care"providers."4. To"enable"improved"coordina;on"and"integra;on"of"survivorship"care"into"
planning"and"prac;ce."10
Survivors!of!cancer!have!access!to!the!right!care!and!informaLon!to!achieve!a!
posiLve!health!status!
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Our Approach • Con;nue"to"build"evidence"base"
."
• Facilitate"and"evaluate"new"models"of"care"that"deliberately"extend"scope"of"prac;ce"of"nursing"and""allied"health"professionals"and""include"strong"primary"care""follow[up"."
• Understand"tools"and"training""requirements"to"drive"change"Improve"pa;ent"experiences"and""ac;vely"empower"cancer"survivors""with"tools,"informa;on"and""support"when"needed"
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Progress to Date
• Maximize"opportuni;es"to"transi;on"care"from"Cancer"Centres"to"Primary"Care"Providers:"• Colorectal"Demonstra;on"projects"–"3"sites"• Breast"Cancer"Models"–"all"Regions"(14"sites)"
To"enable"survivors"to"
receive"the"right"care"in"the"right"
place"
• Literature"review"and"scan"in"progress"
• Plan"to"follow"
To"ac;vely"empower"
survivors"with"pa;ent[centred"informa;on"and"
tools"
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Goals!
AcLviLes!
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Progress to Date
• Evidence[based"guidelines"""""""""""Completed:""Colorectal"Cancer"""""""""""In"progress:""Models"of"Care""
"""""""""""""""""""""Breast"" """""Lung"Cancer""" """""Prostate"Cancer"
""""""""""Planned:""""""Gynecological"Cancer"" """""Head"and"Neck"Cancers"
To"develop"the"evidence"base,"informa;on"and"tools"for"providers"
• Engaging"Primary"Care"to"implement"guidelines"
• Planned"integra;on"of"guidelines""into"electronic"medical"records"
• Iden;fica;on"of"key"performance"indicators"ongoing"
Improved"coordina;on"and"integra;on"of"care"
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Goals!
AcLviLes!
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Survivorship Models of Care for Colorectal and Breast Cancer
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Examples!of!Key!Elements!within!Models:!!• Increased"scope"of"prac;ce""
• i.e."Nurse"Prac;;oner[led"clinics"and"maximizing"use"of"Primary"Care"Providers"
• Crea;on"of"care"plan"with"pa;ents"• Psychosocial"support"and"link"to"community"resources"• Educa;on"sessions"in"group"format"• Tools"for"clinicians"and"pa;ents"• Rapid"re[entry"referral"to"specialists""• Pa;ent"and"provider"experience"measures"
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!!!!Key!Enablers:!• Electronic"Medical"Record"with"embedded"Guidelines"for"cancer"follow[up"• Electronic"Care"Plans"for"providers"and"pa;ents"
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Champlain Regional Cancer Program
15 Colorectal Cancer Follow-Up
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Questions?
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