Cancer Strategy / Strategic priorities / Priority 3

Priority 3: Deliver high-quality care in a sustainable, world-class system

More is not always better when it comes to treating cancer. Care must be based on best evidence and each person’s values and preferences.

Action 1

Set best practices and standards for care delivery and promote their adoption

Implementing multidisciplinary care

Action 2

Eliminate low-benefit practices and adopt high-value practices

Optimizing care at end of life
Optimizing screening and appropriate follow-up

Action 3

Design and implement new models of care

Expanding models of care

Select jurisdiction to see progress:

Implementing multidisciplinary care

Each province and territory has provided their own content and measures this indicator differently. Because of these differences, data cannot be compared across jurisdictions. The data tables and technical appendix are available upon request. References for Canada-wide information are online.

Why we are focusing on multidisciplinary care
patient, caregiver, healthcare professional

People with the same cancer often receive different treatments depending on their healthcare team and where they live. These differences can be reduced by setting standards for high-quality care.¹
Using multidisciplinary teams is an important element of high-quality care.^2,3 A multidisciplinary care team is a diverse group of healthcare professionals with a range of specialties working together to deliver coordinated, person-centred care and support.
Multidisciplinary care is especially important for complex cancers such as rectal cancer in adults^2,4-6 or for any type of cancer in children.^7,8 These patients often have better outcomes when a team of different types of healthcare providers (e.g., surgeon, radiation oncologist, medical oncologist, pathologist, radiologist, nurses, etc.) work together on treatment recommendations.
Multidisciplinary teams are not always available in rural and remote areas. Virtual care can help people access these teams without having to travel to urban centres. Virtual care can also help rural/remote healthcare providers access and participate in the multidisciplinary team.
It is important that multidisciplinary teams provide culturally safe care, in both urban and rural/remote areas.

What we want to achieve

Multidisciplinary teams involved in determining treatment for all people with cancer who could benefit from this approach to care; team involved at the time of diagnosis and throughout a person’s cancer journey, as appropriate
Improved access to multidisciplinary teams for people living outside urban areas by using virtual care. This includes supporting First Nations, Inuit and Métis who live in rural and remote areas to access culturally safe virtual care when possible.

What this would mean for people in Canada

Better cancer care, better patient experience and better outcomes
Successfully adopting standards for high-quality care in one area of the cancer system sets the stage for changes to improve care in other areas

Implementing multidisciplinary care

Where we are today

Proportion of surgeons performing rectal cancer surgery where more than two thirds of their patients are presented at a Multidisciplinary Care Conference (MCC) in 2020
Bar graph

Data source: Provincial cancer agencies and programs
Notes:

27 surgeons, who on average performed ≥5 rectal cancer surgeries per year in 2019 & 2020, were sent the survey (a locally designed survey from the rectal cancer surgical tumour group to collect data on their MDC practices). 18 responded, giving a 67% response rate. However, respondents constituted 90% of the rectal cancer surgery volume in 2019 and 2020 for all surgeons who were sent the survey.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Prioritizing access to multidisciplinary care (MDC), as it is the best way to ensure that people with cancer experience accurate review of their case by all expert providers
Increasing awareness among people with cancer to ensure they know that they can ask for a review by an MDC team

Current situation

People with rectal cancers benefit from MDC because standard treatment usually involves surgery, chemotherapy and radiation. Multiple clinical and tumour factors affect decisions for which of these is given and in what sequence. It is therefore important to have experts from each field involved in the decision-making to make sure the appropriate treatment plan is developed.
Review of pathology and imaging by subspecialists in a conference setting with surgeons, medical oncologists and radiation oncologists improves the treatment plan in up to 25% of people with rectal cancer.

New efforts

This survey (a locally designed survey from the rectal cancer surgical tumour group to collect data on their MDC practices) information will be used to inform healthcare leaders regarding identified obstacles to MCC utilization, and strategies will be implemented to improve access and support surgeons to address barriers to MDC.

Indicator:
Proportion of surgeons performing rectal cancer surgery where more than two thirds of their patients are presented at a Multidisciplinary Care Conference (MCC) in 2020

Implementing multidisciplinary care

Where we are today

Percentage of new patients diagnosed with rectal cancer seen at the Saskatchewan Cancer Agency in a disease site-specific clinic in 2022
66.1% seen in disease site specific clinic. 33.9% not seen in disease site specific clinic.

Data source: Provincial cancer agencies and programs
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Implement a multidisciplinary approach to caring for people with breast, gastrointestinal, genitourinary or lung cancer by establishing disease site-specific group triage rounds, multidisciplinary tumour rounds and clinics.
Target: After being discussed at disease site-specific group triage rounds, majority of patient referrals for breast, gastrointestinal, genitourinary and lung cancers are seen in multidisciplinary disease site specific clinics.

Current situation

Triage and treatment plans for the majority of people with breast, gastrointestinal, genitourinary or lung cancer were previously determined by individual physicians rather than by a group of multidisciplinary care providers. Multidisciplinary care triage and treatment rounds have been established and/or strengthened for all four major disease site groups (breast, gastrointestinal, genitourinary and lung).

New efforts

Strategies are being piloted to increase the participation of providers in group triage rounds to coordinate care for people with breast, gastrointestinal, genitourinary or lung cancer.

Indicator:

Percentage of new patients diagnosed with rectal cancer seen at the Saskatchewan Cancer Agency in a disease site-specific clinic in 2022

Implementing multidisciplinary care for gastrointestinal (GI) cancer patients

Where we are today

Percentage of patients with GI cancer who were discussed by a multidisciplinary care team case conference prior to treatment

57.4% in 2019, 58.3% in 2020, and 64% in 2021.

Data source: Provincial cancer agencies and programs
The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Increase tracking efforts and prioritize the digitization of relevant patient information into ARIA (CCMB's electronic cancer patient record system).
Standardize collection templates for all disease-site group case conferences.
Strengthen collaboration efforts between disease-site group chairs.

Current situation

GI case conferences are attended by medical oncologists, radiation oncologists, oncological surgeons, hepatobiliary surgeons, pathologists, radiologists, psychosocial oncology counsellors and nursing staff.
Individuals with the following diagnoses are preferentially discussed at GI case conferences: rectal cancers (stage II/III and neoadjuvant RT within 120 days before surgery), colorectal cancers (stage IV and surgery within one year of diagnosis), neuroendocrine tumours (stage III/IV), pancreatic cancer (all stages and surgery within one year of diagnosis) and gastric cancer (surgery within one year of diagnosis).

New efforts

CCMB is evaluating the current state of case conferences within its different disease-site groups and using other provinces for benchmarking (by comparing statistics such as meeting frequency, volume of patients and type of clinicians present at meetings). The long-term goal is to build on the findings of the latter and enhance CCMB’s multi-disciplinary care efforts.

Indicator:

Percentage of patients with GI cancer who were discussed by a multidisciplinary care team case conference prior to treatment

Implementing multidisciplinary care for pediatric cancer patients

Where we are today

Percentage of pediatric patients with cancer who were discussed by a multidisciplinary care team case conference prior to treatment

85% in 2019 86.3% in 2020

Our goal

CancerCare Manitoba (CCMB) endeavors to discuss every child or adolescent newly diagnosed with cancer in a multidisciplinary team setting.

Current situation

Pediatric case conferences are attended by pediatric oncologists, surgeons, neurosurgeons, pathologists, hematopathologists, radiologists, physician assistants, geneticists, nursing staff, pharmacists, social workers, and members of the management office.
The standard of care for children and adolescents with cancer is to discuss every case in a case conference setting. Pediatric cases are often discussed in more than one case conference meeting (e.g., Tumour board, BMT rounds, brain tumour rounds, radiology rounds). Pediatric case conference rounds are the gold standard for multidisciplinary care.
A multidisciplinary care program for adolescents and young adults has recently been developed. A designated psychosocial clinician provides ongoing counselling services specifically to this subset of the cancer population.
Radiation treatments are offered at the Western Manitoba Cancer Centre in Brandon which provides cancer treatment closer to home for children and adolescents with cancer living in rural areas in Western Manitoba.

New efforts

CCMB is evaluating the current state of case conferences within its different disease-site groups and using other provinces for benchmarking (by comparing statistics such as meeting frequency, volume of patients and type of clinicians present at meetings). The long-term goal is to build on the findings of the latter and enhance CCMB’s multi-disciplinary care efforts.

Indicator:

Percentage of pediatric patients with cancer who were discussed by a multidisciplinary care team case conference prior to treatment

Implementing multidisciplinary care for rectal cancer patients

Where we are today

Percentage of GI Multidisciplinary Cancer Conferences (MCCs) in ON that were standards concordant, by fiscal year
91.4% in 2019-2020 at the start of pandemic, 94.9% in 2021-22 pandemic era and 93.4% in 2022-23

Our goal

Ontario’s vision is to support and advance high quality multidisciplinary cancer conferences (MCCs).
The provincial target for Ontario’s MCC-related indicator is 80% concordance against the standard.

Current situation

Ontario evaluates the frequency and clinical participation of MCCs for GI cancers.
The percentage of GI Multidisciplinary Cancer Conferences (MCCs) that were standards concordant increased from 91.4% in 2019-2020 to 94.1% in 2021-2022 and 2022-2023 combined.
The Surgical Oncology Program at Ontario Health implements an evidence-informed MCC strategy and collaborates with regional cancer programs to monitor quality of MCCs.

New efforts

The implementation of MCCs has been a success in Ontario as it has become an important part of the patient treatment pathway.
MCCs have become integrated into clinical practice and have continued to take place virtually during the COVID-19 pandemic and have increased during this time.

Indicator:

Percentage of GI Multidisciplinary Cancer Conferences (MCCs) in ON that were standards concordant, by fiscal year

Implementing multidisciplinary care of pediatric cancer patients

Where we are today

Estimated percentage of pediatric patients* with cancer (all cancers combined) in ON who were discussed by a multidisciplinary care team within 1 month of treatment initiation in the past year (2020-2021)
Overall 80%

*Definition of pediatric patients with cancer: Any child or adolescent, aged 0–18 years, diagnosed with cancer or benign CNS tumour, treated in a specialized childhood cancer program in Ontario.
Data source: Provincial cancer agencies and programs
Note: These data are based on the estimated percentages of children with cancer discussed in multidisciplinary tumour boards, based on semi-structured interviews, conducted by POGO, with Tumour Board Leads at the pediatric cancer programs in Ontario.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Multidisciplinary care is a critical component of childhood cancer care in Ontario.

Current situation

Multidisciplinary tumour boards are regularly scheduled meetings of healthcare providers from various disciplines. Participants discuss the diagnosis and treatment options of individual patients with cancer. Multidisciplinary tumour boards are an integral part of a cancer care system.
There are five pediatric cancer programs in Ontario, each with multidisciplinary tumour board discussions attended by clinicians from multiple disciplines.
Interviews with tumour board leads at the five specialized childhood cancer programs demonstrated that the majority of children (90%) diagnosed with cancer in Ontario are discussed at key points in their treatment where a decision is required. Approximately 80% of pediatric cancer patients were discussed at multidisciplinary tumour boards within one month of treatment initiation.
Multidisciplinary tumour boards are an integrated part of pediatric cancer clinical practice in Ontario and have continued virtually during the COVID-19 pandemic.

New efforts

The review of multidisciplinary tumour boards for pediatric cancer patients has demonstrated that efforts are in place in local pediatric cancer programs in Ontario to discuss children with cancer in multidisciplinary tumour boards at key points in their treatment where a decision is required.
Continued efforts for discussion of challenging and/or rare cases in provincial tumour boards will be a priority for Ontario childhood cancer programs.

Indicator:

Estimated percentage of pediatric patients with cancer (all cancers combined) who were discussed by a multidisciplinary care team within 1 month of treatment initiation in the past year (2020-2021)

Implementing multidisciplinary care

Where we are today

Percentage of patients diagnosed with stage II or III rectal cancer who received pre-operative radiation therapy
46.1% in 2017. 50.6% in 2018. 55.6% in 2019. 48.8% in 2020.

Our goal

Improve adoption of best practices in treatment of cancer patients.

Current situation

Pre-operative radiation treatment (along with chemotherapy) has been associated with improvements in local disease control and a reduction in treatment-related toxicity for patients with Stage II and III rectal cancer compared to post-operative radiation therapy.
In NB, the percentage of people with Stage II-III rectal cancer who had pre-operative radiation therapy ranged from 46.1% to 55.6% over a three-year period.

Indicator:

Percentage of patients diagnosed with stage II or III rectal cancer who received pre-operative radiation therapy

Implementing multidisciplinary care for pediatric cancer patients

Where we are today

Percentage of pediatric new oncology cases with documented multidisciplinary tumour board rounds prior to initiation of treatment in 2019-2020

Data source: Provincial cancer agencies and programs
Notes:

Data includes pediatric patients from the Maritime provinces seen at the pediatric tertiary centre (IWK Health Centre).
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Ensure a multidisciplinary approach is used to treat all pediatric patients with cancer.

Current situation

Multidisciplinary tumour board rounds include an oncologist/hematologist and at least three other disciplines, e.g., pediatricians, nurses, allied health professionals and patient navigators.
Multidisciplinary rounds are used in the management of various pediatric cancers. For some cancers, these rounds take place prior to beginning treatment. For other cancers, multidisciplinary rounds are held after surgery takes place (brain cancer) or after treatment has begun (leukemia).
68% of new pediatric oncology cases were documented and discussed in multidisciplinary tumour board rounds in 2019-2020 prior to the initiation of treatment. This includes only documented rounds found in patient charts that contained a list of attendees with 3 or more disciplines documented in attendance. The data may underestimate multidisciplinary participation in these rounds due to the reliance on chart documentation to capture the data.

New efforts

Work is underway to improve documentation of rounds so it reflects all of the participating health disciplines.

Indicator:

Percentage of pediatric new oncology cases seen in Nova Scotia with documented multidisciplinary tumour board rounds prior to initiation of treatment in 2019-2020

Implementing multidisciplinary care for pediatric cancer patients

Where we are today

Percentage of pediatric patients in PE not treated in the adult cancer treatment centre who were discussed at the multidisciplinary discussions
100% in 2019, and 85.7% in 2020.

Our goal

Ensure all pediatric cases are discussed by a multidisciplinary team either at the IWK Health Centre in Halifax or the Queen Elizabeth Hospital in Charlottetown or both.

Current situation

Healthcare providers from the different areas of cancer care (e.g., radiation, chemotherapy, surgery, pathology) work together in “case conferences” for pediatric oncology to ensure each case gets the best possible care.
Complicated pediatric cases are discussed at the IWK Health Centre by multidisciplinary teams. All PEI pediatric cases are discussed in multidisciplinary pediatric rounds at the Queen Elizabeth Hospital.

New efforts

PEI is fortunate to be working with the IWK Health Centre on pediatric cancer cases. Multidisciplinary discussions of cases are done in a comprehensive way.
Pediatric patients have specialized treatments at other facilities across Canada and the United States; multidisciplinary discussions will be needed to continue optimal care.

Indicator:

Percentage of pediatric patients not treated in the adult cancer treatment centre who were discussed at multidisciplinary discussions

Implementing multidisciplinary care for rectal cancer patients

Where we are today

Percentage of adult patients with rectal cancer in PE discussed at multidisciplinary rounds or discussions
33.3% in 2019, and 42.1% in 2020.

Our goal

Ensure a multidisciplinary approach is used to treat all people with rectal cancer.
Create clear treatment pathways for surgery, radiation oncology and medical oncology.
Implement surgical synoptic reporting for rectal cancer.

Current situation

Healthcare providers from the different areas of cancer care (e.g., radiation, chemotherapy, surgery, pathology) work together in “case conferences” to ensure each person with cancer gets the best possible care.
PEI rectal cancer cases are often discussed at Tumour Board Rounds or with specialist doctors.

New efforts

PEI plans to adopt treatment pathways for rectal cancers to improve patient care.

Indicator:

Percentage of adult patients with rectal cancer in PE discussed at multidisciplinary rounds or discussions

Implementing multidisciplinary care

Where we are today

Percentage of patients in NL diagnosed with stages 1 to 3 rectal cancer in 2019 calendar that were discussed at least one time at a Gastrointestinal (GI) tumour board committee
50% in 2019, and 34.1% in 2020.

Our goal

Cancer cases are discussed at tumour board meetings for healthcare providers of various backgrounds to allow them to collaborate on treatment recommendations.

Current situation

Newfoundland and Labrador currently has multidisciplinary tumour boards for:

Gastrointestinal malignancy
Thoracic malignancy
Breast malignancy
Hematologic malignancy
Gynecologic malignancy
Head and neck malignancy
Genitourinary malignancy
Central Nervous System Malignancy

Newfoundland and Labrador currently has a multidisciplinary clinic for:

Gynecologic malignancy
Head and neck malignancy

A pediatric-specific tumour board aims to discuss all cases of pediatric cancer.

Indicator:

Percentage of patients in NL diagnosed with stages 1 to 3 rectal cancer that were discussed at least one time at Gastrointestinal (GI) tumour board committee

Select jurisdiction to see progress:

Optimizing care at end of life

Why we are focusing on the percentage of patients who received treatment for cancer in the last two weeks of life
end of life

Many patients receive tests and treatments near the end of life that provide little benefit and can cause more harm than good.¹
In the last few weeks of life, treatments like chemotherapy are unlikely to improve survival. However, these treatments can make a person feel sicker at a time when quality of life and time with family and friends is most important.
Reducing these treatments improves patient outcomes and patient experience, while generating savings that could pay for new drugs and technologies.¹

What we want to achieve

Patients avoid chemotherapy in their last two weeks of life; focus is on ensuring their physical comfort and providing them with emotional and mental health supports.
People who would benefit from palliative care identified early in their cancer journey
Advance care planning discussions happen early and in culturally safe ways so that people with cancer receive the care they want and need at the end of life

What this would mean for people in Canada

Better quality of life for people approaching the end of their lives
Better use of resources in the system to ensure that all people with cancer receive high-quality care

Optimizing screening and appropriate follow-up

Why we are focusing on optimizing screening participation
woman waiting for cervical cancer screening

Unnecessary tests and treatments can cause more harm than good¹. For example, screening people for cancer too often or screening people who don’t meet the guidelines can increase the number of false positive results. This leads to unnecessary anxiety for individuals and further tests and treatment that could be avoided.
Reducing unnecessary tests and treatments will also save money—money that can be used to improve care.
Provincial/territorial guidelines for cervical screening vary on what age screening begins and how often people should be screened. Identifying shared national participation targets for screening and more closely following screening guidelines can maximize the benefits of screening and reduce unnecessary tests and treatments.
Primary cervical cancer screening (currently a Pap test) is recommended every two to three years for individuals aged 25 to 69 who are at average risk of cervical cancer in most jurisdictions, though guidelines may vary across provinces and territories.²Eight provinces and territories begin screening at age 21, while four begin screening at age 25.
Presently, the Pap test is the most commonly used cervical screening test. Over a three-year interval in Canada, 235,550 (2.8%) Pap tests were performed outside of the guidelines.
Canada is shifting to HPV testing to replace Pap testing as the primary cervical screening tool in Canada.²

What we want to achieve

Cancer screening system works in partnership with First Nations, Inuit, and Métis to co-develop culturally safe resources on screening that meet the needs of communities
Increased access for unscreened and underscreened populations to support participation in screening programs
Successful implementation of HPV testing to replace Pap testing²

What this would mean for people in Canada

Fewer false positive results and the unnecessary stress, anxiety or additional tests or treatments they can cause
Shifting from Pap tests to HPV primary screening could:
- prevent over 3000 women from getting cervical cancer⁵
- avoid 1000 cervical cancer deaths in total by 2050⁵

Optimizing care at end of life

Where we are today

Percentage of adult patients who received IV chemotherapy as an outpatient at a regional cancer centre within 14 days of death

7.3% in 2015, 6.4% in 2016, 6.6% in 2017, 7.2% in 2018, 6.6% in 2019.

Data source: Provincial cancer agencies and programs
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Improve quality of life for people with cancer at the end of life.
Reduce unnecessary system costs associated with expensive and ineffective treatment at end of life.

Current situation

End-of-life and palliative care services provide people with cancer with:
- pain and symptom management
- psychological care
- grief support for family caregivers
- access to specialized medication, supplies and equipment.

New efforts

British Columbia is working to introduce palliative care early, so care and treatment reflects a person’s own wants, needs and preferences.
Work is underway to encourage early and more frequent conversations between the care team and people with cancer and their families about goals of care.
The province will educate health care providers to increase awareness of low-value treatment choices and their impact for individuals with poor prognosis.

Indicator:

Percentage of adult patients who received IV chemotherapy as an outpatient at a regional cancer centre within 14 days of death

Optimizing screening and appropriate follow-up

Where we are today
Percentage of total annual Pap test volume in 2018 that was among people with a cervix aged 18-24
Age group: less than 20 years 0.2% in 2018 and 0.1% in 2022, 20-24 years 2.4% in 2018 and 1.0% in 2022, 18-24 years 2.6% in 2018 and 1.1% in 2022

Data source: Provincial cancer agencies and programs

Note: The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

As we work towards Canada’s elimination of cervical cancer targets, more screen-eligible individuals are up to date with cervical cancer screening.
We are working to reduce screening and follow-up outside of Canadian Taskforce Guidelines.
Screening programs continue to monitor the utilization of screening services across relevant age groups.

Current situation

The Cervix Screening Program screens people aged 25-69 every three years with a Pap test.
Pap tests in people with a cervix under age 25 have been declining since 2016 when the start age for cervix screening changed from 21 to 25.
In the most recent period (2022), the volume of Pap tests done among people with a cervix aged 18-24 represents only 1.1% of the total annual program volume; this is down from 2.6% in 2018. This corresponds to 3,679 Pap tests in this age group relative to the 322,455 total Pap tests provincially in 2022.
British Columbia continues to monitor participation and uptake of screening programs in all age groups.

Indicator:

Percentage of total annual Pap test volume that was among people with a cervix aged 18-24

Optimizing care at end of life

Where we are today

Percentage of patients who died of cancer and received any systemic therapy in the last two weeks of life

2.3% in 2019, and 2.2% in 2020.

Our goal

Ensure an early, community-based and systematic palliative approach to care is available for all people living with advanced cancer.
Minimize the number of patients receiving potentially inappropriate treatments like chemotherapy in the final two weeks of life.

Current situation

Palliative care is integrated into cancer care to increase the likelihood that patients’ symptoms are well-managed.
Palliative and end-of-life curricula are included in education for doctors, nurses and other health professionals.

New efforts

Systems are being put in place so that all people with cancer can receive palliative care at home or as close to home as possible.
Alberta is equipping oncology teams to provide patients with information about where to access quality palliative care in their communities.

Indicator:

Percentage of patients who died of cancer and received any systemic therapy in the last two weeks of life

Optimizing screening and appropriate follow-up

Where we are today

Percentage of eligible individuals aged 25-69 who were up-to-date* for screening during a 42-month period
63.6% in 2017-19, and 59.6% in 2020-22.

Data source: Provincial cancer agencies and programs
Notes:

*Includes individuals who completed at least one Pap test or colposcopy exam.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Cervical cancer screening:

80% of Alberta’s eligible population will be up to date for cervical cancer screening.
The Alberta Cervical Cancer Screening Program aims to:
- Reduce the incidence of cervical cancer in Alberta
- Reduce disparity in participation rates across the population
- Build awareness and integration of cervical cancer prevention and screening
- Engage in continuous quality improvement and assurance across the screening continuum

Current situation

The Alberta Cervical Cancer Screening Program engages individuals in screening, develops partnerships, and participates in research to enhance program quality.
Cervical cancer screening with a Pap test is recommended for people aged 25-69 with a cervix every three years.

New efforts

Alberta is working to improve information and education of Albertans and healthcare providers about screening.

Indicator:

Percentage of eligible individuals aged 25-69 who were up-to-date* for screening during a 42-month period

Optimizing care at end of life

Where we are today

Percentage of patients with cancer who died and received an IV or subcutaneous cancer drug treatment within 14 days of death
5.7% in 2019. 4.1% in 2020. 6% in 2021.

Our goal

Achieve high quality, timely (earlier) conversations with people who are diagnosed with a life-limiting illness and their families to ensure a clear understanding of the disease trajectory and care and treatment options.

Current state

Access to symptom management and palliative care services has been expanded.
Telehealth is used to make high quality palliative care available to patients in rural and remote areas.
Paramedics are being trained to deliver palliative and end-of-life care in patients’ homes, allowing patients to remain at home whenever possible.

New efforts

Developing a Saskatchewan Cancer Agency and provincial Community of Practice to focus on quality and continuity of palliative care services, which will focus on early integrated palliative care and improving quality of life
Serious Illness Conversation training provided for interprofessional teams
Focus educational efforts on initiating Advance Care Planning discussions

Indicator:

Percentage of patients with cancer who died and received an IV or subcutaneous cancer drug treatment within 14 days of death

Optimizing screening and appropriate follow-up

Where we are today

Percentage of people with a cervix in SK aged 18-24 who received a Pap test
Age 18 to 20: 1.1% in 2019, 1.1% in 2020, and 0.8% in 2021. Age 21 to 24: 7.8% in 2019, 8.4% in 2020, and 7.4% in 2021.

Our goal

Maximize screening through Pap tests for people within the recommended age guidelines.

Current situation

Saskatchewan’s Screening Program for Cervical Cancer screens people aged 21-69 every two years with the Pap test until they have three consecutive negative tests. They are then tested every three years.

New efforts

Saskatchewan is implementing updated cervical screening guidelines, including Pap, HPV reflex testing, and healthcare provider and public resources.
Strategic plans and objectives for community engagement are in development.
New screening software will enable the development of a full indicator and performance measurement system for screening. This will help provide unique opportunities to identify quality improvements such as low benefit practices that can be eliminated.
Work is underway to explore primary HPV screening in Saskatchewan, including self-sampling.

Indicators:

Percentage of people with a cervix in SK aged 18-24 who received a Pap test

Optimizing care at end of life

Where we are today

Percentage of cancer patients who received their first systemic therapy treatment (i.e., cycle 1 day 1) within the last 15 days of life and who died of cancer-specific causes in 2018-19, overall and by sex

Overall: 1.2%. Male: 1.2%. Female: 1.2%.

Data source: Provincial cancer agencies and programs
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Minimize the number of patients inappropriately receiving curative treatments like chemotherapy in the final 15 days of life.

Current situation

Clinicians are encouraged to discuss goals of care and advance care planning with all patients living with late-stage cancer. This provides opportunities to review and update treatment plans as needed.

New efforts

A Provincial Systemic Therapy Program was implemented with the aim of improving adherence to provincial standards for systemic treatments, including chemotherapy.

Indicator:

Percentage of cancer patients who received their first systemic therapy treatment (i.e., cycle 1 day 1) within the last 15 days of life and who died of cancer-specific causes

Optimizing screening and appropriate follow-up

Where we are today

Percentage of individuals who received a Pap test who were outside recommended age categories for cervical cancer screening guidelines (18-20 years old or 70 and older)
10.5% in 2014-16, and 7.5% in 2017-19.

Data source: Provincial cancer agencies and programs
Note: >69 years of age may not be inappropriate. Screening should be discontinued at >69 years only if the patient has had 3 negative pap tests in the past 10 years or one negative high-risk HPV test in the last 5 years.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Work towards minimal use of screening outside guidelines by using risk stratification tools.

Current situation

Pap tests are recommended for most women aged 21-69 in Manitoba. Transgender men and non-binary people assigned female at birth may also need regular Pap tests.

New efforts

Cervix Check is working on an HPV self-sampling project which aims to improve accessibility of cervical cancer screening to individuals who don’t have easy access to a healthcare provider. The aim is to increase screening rates among women who are under-screened.

Indicator:

Percentage of individuals who received a Pap test who were outside recommended age categories for cervical cancer screening guidelines (18-20 years old or 70 and older)

Optimizing care at end of life

Where we are today

Percentage of cancer patients who received systemic therapy in the last two weeks of life
6.8% in 2019, 6.6% in 2020, start of pandemic, 6.5% in 2021, pandemic year and 6.5% in 2022

Data source: Provincial cancer agencies and programs
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations.

Our goal

Reduce treatment that occurs at the end of life that can worsen a person’s quality of life while having no positive impact on survival.
Support clinicians to optimize goals of care discussions at the end of life.

Current situation

The percentage of patients with cancer who received systemic treatment (e.g., chemotherapy) in the last two weeks of life remained consistent between 2019 and 2022 (6.5%).

New efforts

Ontario Health (Cancer Care Ontario)’s provincial indicator for systemic treatment administered in the last 30 days of life will continue to be included in the Regional Cancer Program’s Quarterly Performance Review Report for the 2023-24 fiscal year.
Ontario Health (Cancer Care Ontario)’s Systemic Treatment Program completed their 2023-24 Quality Improvement initiative on incorporating consistent practices to encourage Goals of Care conversations in the oncology setting. Increasing the number of Goals of Care conversations is anticipated to lead to more thoughtful and patient-centered decisions to administer systemic treatment that is administered at the end of life.

Indicator:

Percentage of cancer patients who received systemic therapy in the last two weeks of life

Optimizing screening and appropriate follow-up

Where we are today

Percentage of people with a cervix aged 18-24 who received a cytology (Pap) test
Age group Overall 18-24 years: 13.7% in 2017, 13.6% in 2019, 13.3% in 2019, 9.1% in 2020 (start of pandemic) and 9.9% in 2021 (Pandemic era). For Age group 18-20.5 years 3.7% in 2017, 3.4% in 2018, 3.2% in 2019, 2.2% in 2020 (start of pandemic) and 2.0% in 2021 (pandemic era)

Our goal

Continue to encourage cervical screening within the recommended age groups.

Current situation

The Ontario Cervical Screening Program recommends that people with a cervix (women, as well as transmasculine and nonbinary people with a cervix) ages 21-69 who are or ever have been sexually active screen every three years with a cytology test.
In 2020, Ontario Health began encouraging healthcare providers to start cervical screening at age 25 based on moderate quality evidence suggesting that people under age 25 do not benefit from cervical screening¹. The recommended start age for cervical screening will formally increase from age 21 to age 25 when the HPV test is implemented in Ontario as the primary cervical screening test.
Since 2017, the percent of people ages 18 to 24 who have had cervical screening has decreased. Much of the decrease has been driven by the decrease in screening people ages 20.5 to 24, particularly since 2020, which aligns with Ontario Health’s guidance to healthcare providers to delay initiation of screening to age 25.

New efforts

Ontario Health provides tools to healthcare providers and Regional Cancer Programs to support appropriate screening for cervical cancer (i.e., age and interval of screening). Ontario Health:

Helps primary care providers who participate in a patient enrolment model (PEM) practice by providing them with a Screening Activity Report. This report identifies people who are eligible for cervical screening (while this includes people ages 21-69, Ontario Health encourages primary care providers to initiate screening at age 25). Ontario Health also developed Screening Activity Reports for non-PEM physicians serving some rural First Nations communities using geography that aligns with First Nation community boundaries.
Is planning to implement the HPV test as the primary cervical screening test for the Ontario Cervical Screening Program. When HPV testing is implemented in Ontario, the OCSP will formally change the recommended age of initiation for cervical screening to age 25, and this will be supported by changes to program and provincial infrastructure.

1- Canadian Task Force on Preventive Health Care. Recommendations on cervical screening. CMAJ. 2013. 185(10):35-45.

Indicator:

Percentage of people with a cervix aged 18-24 who received a cytology (Pap test) in 2019

Optimizing screening and appropriate follow-up

Where we are today

Percentage of individuals who had at least one pap test in a 42-month time frame (Jan 1, 2020 - Jun 30, 2023) by age group
9.1% in age group 18-20, 55.1% in Age group 21-69 and 4.4% in 70 Plus

Our goal

Eliminate cervical cancer by 2040.

Current situation

The New Brunswick Cervical Cancer Prevention and Screening Program, inclusive of a targeted school based HPV immunization program, has been in place since 2011.
Individuals aged 21 to 69 with an intact cervix who have ever been sexually active are eligible for cervical screening. The cervical program monitors screening activity and proactively sends reminder letters to individuals and to primary health-care providers when screening or follow-up is due.

New efforts

New Brunswick Cancer Network has initiated work on implementation of organized lung cancer screening.
New Brunswick Cancer Network has initiated work on the implementation of HPV primary testing for cervical cancer screening program.
New Brunswick Cancer Network is enhancing media campaigns with refreshed creatives to increase program visibility and improve participation rates/interest in all screening programs.

Indicator:

Percentage of individuals who had at least one pap test in a 42-month time frame (Jan 1 2020 - Jun 30, 2023) by age group

Optimizing care at end of life

Where we are today

Percentage of patients with cancer who received chemotherapy in the last two weeks of life

2016: 8.2% 2017: 10.1% 2018: 12.0%

Data sources: Provincial cancer agencies and programs
Notes:

The denominator includes only cancer patients who had a history of IV Chemotherapy in their last year of life.
Hematological cancers are not included in the data.
Unable to report on oral chemotherapy.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Preserve quality of life for people with cancer.
Reduce use of chemotherapy close to end of life where there is no clear benefit and a patient’s quality of life may be negatively impacted.
Focus on symptom-directed treatments and supportive care.

Current situation

The transition from cancer-directed treatment to symptom management and supportive care is dynamic and complex, requiring frequent re-evaluation and dialogue between care providers, the person with cancer and their family.
Palliative and end-of-life care enhances quality of life for people with cancer and their families by ensuring that their physical and psychosocial symptoms are well managed and that the right supports are in place.

New efforts

Nova Scotia is working to identify people with cancer who would benefit from a palliative care approach earlier by offering specialized training to those working in oncology and primary care settings.
The province is also expanding the use of tools (such as, the Edmonton Symptom Assessment System (ESAS), Palliative Performance Scale (PPS), Eastern Cooperative Oncology Group (ECOG), etc.) to help health care teams identify people with cancer who would benefit from palliative care.
Working towards adapting and implementing national data standards aimed at improving the quality and timeliness of cancer data to enhance cancer data analytics and reporting needed to improve and evaluate cancer care.
A new Oncology Transformation Project (OTP) at Nova Scotia Health will provide real-time oncology information to triage and manage patients’ treatments and symptoms leading to streamlined care, enhanced access to care, reduced wait times, and improved outcomes for patients.

Indicator:

Percentage of cancer patients who received chemotherapy in the last two weeks of life

Optimizing screening and appropriate follow-up

Where we are today

Percentage of people with a cervix in NS aged 18 to 24 who received a Pap smear by calendar year and age group

Age: 18-20: 5.7% in 2018, 4.1% in 2019, 2.1% in 2020, 2.0% in 2021. Age: 21-24: 21.8% in 2018, 15.9% in 2019, 8.0% in 2020, 7.5% in 2021.

Our goal

Minimize screening through Pap tests for people outside of the recommended age guidelines.

Current situation

The cervical cancer screening program screens people aged 25-70 every three years with a Pap test.
Currently unable to differentiate a screening Pap from a Pap performed on a young person with symptoms.
The number of individuals between 18 to 24 years old with a cervix who receive a Pap test has declined between 2018 and 2021.

New efforts

Conducting evaluation of Pap test smears outside of target age groups
Providing feedback to screening practitioners to address potential screening outside of age guidelines
Working towards adapting and implementing national data standards aimed at improving the quality and timeliness of cancer data to enhance cancer data analytics and reporting needed to improve and evaluate cancer care.
A new Oncology Transformation Project (OTP) at Nova Scotia Health will provide real-time oncology information to triage and manage patients’ treatments and symptoms leading to streamlined care, enhanced access to care, reduced wait times, and improved outcomes for patients.

Indicator:

Percentage of people with a cervix in NS aged 18 to 24 who received a Pap smear by calendar year and age group

Optimizing care at end of life

Where we are today

Percentage of patients with cancer who received systemic therapy in the last two weeks of life
7.5% in 2019, and 3.2% in 2022

Data source: Provincial cancer agencies and programs
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations.

Our goal

Avoid chemotherapy for people with advanced cancer who are unlikely to benefit from it.
Eliminate low benefit practices and focus on high value practices such as symptom control and palliative care to improve quality of life for people with cancer.

Current situation

Since 2020, PEI has trained health care professionals in the palliative approach to care to increase their ability to provide care and support to people with cancer and their families. Education opportunities on the PEI palliative care program and philosophies are available online and in-person.
Paramedics are trained to deliver palliative and end-of-life care in patients’ homes, allowing patients to remain at home whenever possible.
Health PEI’s online staff resource centre provides health professionals with tools to increase their knowledge in end-of-life communications, patient assessment and symptom control.

New efforts

PEI values and at every opportunity is incorporating national palliative care competencies into the practice of health care professionals providing palliative care.
The province continues to prioritize and make efforts when possible to provide earlier and better access to palliative care across a wide variety of settings, including primary care and in First Nations communities.
Health care providers are reframing “hope” so that people with cancer and their families are able to better accept the practice of reducing treatments like chemotherapy at the end of life.

Indicator:

Percentage of patients with cancer who received systemic therapy in the last two weeks of life

Optimizing screening and appropriate follow-up

Where we are today

Percentage of people with a cervix aged 18-24 who had a Pap test
Overall: 42.1% in 2017-19, and 10.7% in 2020-22. 18 to 20: 12.1% in 2017-19, and 3.6% in 2020-22. 21 to 24: 63.4% in 2017-19, and 15% in 2020-22.

Data source: Provincial cancer agencies and programs
Note: The COVID-19 pandemic may have affected service provision
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Create a fully organized cervical cancer screening program.
Reduce the number of people screened outside of the PEI Cancer Screening Guidelines, who are unlikely to benefit from it.

Current situation

PEI offers cervical cancer screening but does not have a fully organized cervical cancer screening program.
PEI Screening Guidelines were updated in 2023 to recommend that individuals of average risk between 25-65 years of age are screened for cervical cancer by HPV testing every five years.
Several communications tactics are used to increase awareness of importance of screening.

New efforts

Primary cervical cancer screening using HPV testing was implemented province wide in PEI in May 2023.
PEI will review and update its Cancer Screening Guidelines every two years as per policy practice.

Indicator:

Percentage of people with a cervix aged 18-24 who had a Pap test

Optimizing care at end of life

Where we are today

Percentage of patients diagnosed with invasive cancer and died in 2018 who received chemotherapy in the last two weeks of life

4.1% in 2018, and 4.5% in 2019.

Data source: Provincial cancer agencies and programs
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Provide 75% of staff with high level palliative care training.

Current situation

Currently we have approximately 80% of our provincial staff training in either LEAP (Learning Essential Approaches to Palliative Care) education or serious illness conversation.

New efforts

Newfoundland and Labrador is enhancing palliative care education for health care professionals, and the provincial palliative care resource guide on the cancer care website provides additional resources.
Early Integration of Palliative Care triage process is the automatic referral to pain and symptom management/palliative care services.
Referral processes have been standardized so that patients who need palliative care are identified earlier. This triage pathway has been developed for those who present with advanced disease and a high symptom burden to provide palliative care connections very early.
Work is underway to improve the experience of people with cancer and their families though a person-centered care plan. This includes implementing electronic collection of patient-reported outcomes to assess symptoms so people with cancer can be connected with the support they need. Individuals are able to respond to ESAS and Canadian Problem Checklist questionnaires on their own time using a program called Noona, and completed questionnaires are integrated into the patient’s medical chart.
A video called “Speak up” plays in all clinical areas to encourage patients to talk to staff about advance care planning. Literature and posters are also available.
Paramedics in Eastern Health are being trained to deliver palliative and end-of-life care in people’s homes, allowing patients to remain at home whenever possible. The paramedicine program is highly successful and has recently extended beyond St. John’s to include the Carbonear and surrounding region.

Indicator:

Percentage of patients diagnosed with invasive cancer and died who received chemotherapy in the last two weeks of life

Optimizing screening and appropriate follow-up

Where we are today

Percentage of people with a cervix who had a Pap smear by age group
See table on supplementary data page

Our goal

Minimize screening through Pap tests for people outside of the recommended age guidelines.

Current situation

The cervical cancer screening program screens people aged 21-69 every year with a Pap test until they have three consecutive negative tests. Then they are screened every three years.
Newfoundland and Labrador is considering beginning cervical cancer screening at age 25 to reflect recommendations from the Canadian Task Force on Preventative Health Care.

New efforts

The province’s new information management system includes all screening programs.

Indicators:

Percentage of people with a cervix who had a Pap smear by age group

Select jurisdiction to see progress:

Expanding models of care

Why we are focusing on new models of care
internet, home, hospital, clinic

Innovative models of care delivery are needed to increase equitable access to high-quality, sustainable cancer services.
Innovative approaches can result in more efficient use of existing capacity in the cancer care system to address shortages of healthcare workers and provide more person-centred care.
New models of care offer the potential to better integrate primary care in diagnosis and follow-up care and increase access to nurse practitioners and physician assistants. Increased availability of virtual care and patient navigators could also help improve access to culturally safe care in underserved populations in rural and remote areas, including First Nations, Inuit and Métis.

What we want to achieve

Improved cancer diagnosis, treatment, survivorship and palliative care services
Increased equity through First Nations-, Inuit-, and Métis-led projects aimed at identifying, promoting and implementing innovative and culturally safe models of cancer care

What this would mean for people in Canada

A sustainable cancer system that is more equitable and patient-centred and provides better access and improved outcomes

Expanding models of care

Where we are today

Percentage of new-to-institution patients attending a first consult who completed the patient reported outcomes tools at the time of the consult, by cancer type

All cancers: 77.5% in 2019, and 79.1% in 2020. Breast: 79.4% in 2019, and 80.8% in 2020. Colorectal: 79.3% in 2019, and 81.3% in 2020. Lung: 76.2% in 2019, and 81.5% in 2020. Prostate: 81.3% in 2019, and 72.6% in 2020.

Our goal

Develop a more effective and efficient model of ambulatory cancer care where:
- People with cancer receive the right amount of care, via the right route, by the right provider at the right time
- High quality care is consistently delivered
- All professionals are working to their fullest scope of practice
- Workflow and processes enable smooth care coordination across time and settings
- Digital health strategies are integrated into workflows to improve efficiencies
- All people with cancer are eligible to receive some care virtually
- Patient reported outcomes (PROs) are a key element in determining which patients require additional symptom management and other supports

Current situation

Patient reported outcomes are routinely used in care, but not yet effectively used to determine the amount and type of care and supports a patient needs.

New efforts

Decision support tools are in development that integrate the patient’s capacity (technology, ability) to participate in virtual care events and the complexity of their care needs.
Once the tools are developed, steps will be taken to integrate these decision aids into the provincial electronic medical record (EMR) and patient intake process.
Electronic collection of PROs within the new provincial EMR has been designed and will be launched with go live (anticipated November 2022).

Indicator:

Percentage of new-to-institution patients attending a first consult who completed the patient reported outcomes tools at the time of the consult, by cancer type

Expanding models of care

Where we are today

Percentage of eligible patients seen in a disease site-specific clinic at the Saskatchewan Cancer Agency in 2022
Overall: 31.5%. Breast: 37.2%. Gastrointestinal: 34.7%. Genitourinary: 28.2%. Lung: 24.2%.

Data source: Provincial cancer agencies and programs
Notes:

The COVID-19 pandemic may have affected service provision.
Eligible patient is defined as a patient with cancer in a disease site for which there is a disease site-specific clinic.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Establish disease site-specific clinics and group triage rounds by December 2023.
Ensure 75% of eligible people with cancer are seen at a disease site-specific clinic by December 2023.
Offer virtual care to 100% of eligible people by 2023.

Current situation

People with cancer were previously seen in traditional clinics where a mix of people with different types of cancers are seen. Disease site-specific clinics and group triage rounds have now been established for the four major disease site groups (breast, gastrointestinal, genitourinary or lung cancer). Clinics specific to gastrointestinal cancer began in fall 2021, lung in winter 2022, and breast and genitourinary in summer 2022.
Virtual health appointments are currently offered via telehealth, telephone and videoconferencing. Due to COVID-19, fewer people with cancer are using telehealth appointments, but telephone and videoconferencing appointments have increased.
A single videoconferencing platform has been developed and implemented for the provincial health system.

New efforts

Efforts are now targeted towards increasing percentage of patients seen at disease site-specific clinics. This change will provide people with cancer with same-day appointments with different providers (reducing travel), improve coordination of care, decrease wait times and improve access to clinical trials.
Work is underway to adopt a remote patient monitoring solution for the Saskatchewan Cancer Agency.

Indicator:

Percentage of eligible patients seen in disease site-specific clinic at the Saskatchewan Cancer Agency in 2022

Expanding models of care

Where we are today

Proportion of Pap test specimens tested for high-risk HPV (hrHPV) between 2022-24, overall and by age group

Overall: 2.2%. 30 to 39 years: 2.4%. 40 to 49 years: 2%. 50 to 59 years: 2.7%. 60 to 60 years: 1.8%.

Data source: Provincial cancer agencies and programs
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Reduce unnecessary diagnostic procedures, adopt state-of-the-art methods and evidence-based practices in order to improve and sustain the cancer care system (as outlined by the 2020 Roadmap to Cancer Control for Manitoba).

Current situation

Manitoba is joining the Canada-wide initiative to eliminate cervical cancer with a shift to HPV testing, the leading approach to screening for cervical cancer.
In March 2022, Manitoba introduced HPV triage (reflex) testing* to the cervical cancer screening pathway. All Pap test results that meet certain criteria are now automatically tested for high-risk HPV (hrHPV) and healthcare providers are provided with a combined cytology and HPV result report and recommendation. This approach ensures that the patients who can most benefit from colposcopy are referred faster.

*The purpose of HPV reflex testing is to reduce the number of follow-up Pap tests and/or unnecessary colposcopies. Broadly, reflex testing refers to a procedure that is done only if the results of the initial test meet some predetermined criteria. In the case of HPV, the reflex test would occur if the cytological results of the initial Pap test fell outside the normal parameters or were inconclusive. The reflex test for HPV screens for the presence of DNA from several cancer-causing HPV strains and can be done using the same cervical cell sample collected during the initial Pap test.

New efforts

A new pilot program is sending HPV self-sampling tests to facilitate at-home cervical screening to underscreened women in Manitoba.
The fecal immunochemical test (FIT) replaced the guaiac fecal occult blood test (FOBT) in 2023.

Indicator:

Proportion of Pap specimens tested for hrHPV

Expanding models of care

Where we are today

Percentage of patients admitted twice or more in the last 30 days of their life to acute care hospitals with cancer diagnosis for palliative care or for whom palliative care was initiated any time during the admission
22.9% in 2019. 21.5% in 2020.

Our goal

Develop an evidence-based integrated palliative care model to guide the delivery of palliative care services in New Brunswick.

Current situation

Palliative care improves the quality of life of people diagnosed with life-threatening illnesses and their families through early identification, assessment and support. This can include pain and symptom management and psychological, social or spiritual supports.
The provincial Palliative Care Strategy guides planning and implementation of integrated palliative and end-of-life care services in New Brunswick. Its goal is to support the provision of person and family-centered care across care settings by an interdisciplinary team and in the home.
Information on palliative care services is available on the Social Supports NB website.

New efforts

Work is on-going to develop and implement the following:
- Integrated community-based hospice model.
- Integrated palliative care provider model (for family physicians, nurse practitioners and palliative care physicians) to provide care across settings.
- Standardized assessment and monitoring tools for use across care settings.

Indicator:

Expanding models of care

Where we are today

Indicator data not available at this time.

Our goal

Enable the systematic, electronic monitoring of cancer patients using patient reported outcomes (ePROs) to rapidly identify distress in patients, improve patient-clinician communication, to promote better clinical outcomes, quality of life, patient satisfaction, and overall survival.
Provide cancer care patients with a method to report treatment-related symptoms to their care teams in a standardized, electronic method, from the convenience of their home.
Integrate cancer patient reported outcomes into the clinical record to facilitate review by the multi-disciplinary care teams.
Enable big data analysis that combines ePRO and clinical treatment data.
The Oncology Transformation Project has expanded the use of Noona® across the whole cancer program, targeting all patients of Systemic Therapy, Radiation Oncology, Hematology and Gyne Oncology. Noona® improves communication between cancer patients and their care teams | Nova Scotia Health Authority (nshealth.ca)

Current situation

Cancer care patients can view their oncology appointments and receive appointment reminders or scheduling changes via Noona® on their personal devices.
Noona® is integrated with the provincial oncology information system ARIA®, facilitating workflow between health care team members and enabling data consolidation and analysis within one application.
3,099 patients registered in the first 6 months of Noona’s launch.
The proof-of-concept project demonstrated promising uptake of Noona® with high patient activation rates (82% average), high response rates (80% average) and high patient satisfaction rates (95% satisfied or very satisfied).

New efforts

Expand the e-Patients Come First screening to Systemic Therapy, Hematology, and Gyne Oncology patients.
Patient education is to be delivered to all patients.
Introduce more tumor-specific e-Screening tools to patients.
Introduce more cancer and treatment modality specific education materials sent automatically through Noona®.
Facilitate patient communications utilizing Noona® features like telephone triage and messaging.
Enhance care team collaboration and timely information sharing of ePROs by refining clinic workflows.
Define and build operational and research reporting requirements associated with ePROs and Noona® usage.

Indicator:

Indicator data not available at this time.

Expanding models of care

Where we are today

Percentage of total tobacco users (people who have used tobacco in the last 6 months) who participated in a tobacco cessation service after being screened at a PEI ambulatory cancer treatment centre between April 1, 2022 and March 31, 2023
Overall: 32.2%. Under 65 years: 30.7%. 65 years and over: 33.3%. Male: 33%. Female: 31.3%. Non-lung cancer: 28.1%. Lung cancer: 42%.

Our goal

Reduce tobacco use by people with cancer who are being treated at an ambulatory cancer treatment centre.
Increase tobacco cessation rates of people with cancer. Smoking cessation improves outcomes from surgery, chemotherapy and radiation therapy.

Current situation

All people with cancer who come to the ambulatory cancer treatment centres will be screened for tobacco use.
The screened cancer patients who are identified as tobacco users will automatically have a cessation consultation and be offered the Tobacco Cessation Program.
People who do not want to be enrolled in the cessation program must opt out.
Tobacco cessation products such as nicotine replacement therapy (NRT) patches, lozenges and gum are provided free of charge directly to people with cancer while they are continuing cancer treatment. Referrals to the PEI Provincial Smoking Cessation Program are provided for oral medications such as varenicline and bupropion for people who prefer this treatment.
After a person finishes their cancer treatment, they may be referred to primary care or the PEI Smoking Cessation Program for further support.

New efforts

Ongoing evaluation of this new model of care is providing information on changes to improve the program.

Indicator:

Expanding models of care

Where we are today

Percentage of new patients with cancer who were current smokers and received a referral to the smoking cessation program
Overall: 37.8% in 2020, and 41.8% in 2021. Males: 37% in 2020, and 45.7% in 2021. Females: 38.6% in 2020, and 38.1% in 2021.

Our goal

Increase access to cancer patients to receive smoking cessation support.

Current situation

The Smoking Cessation Program for cancer patients is delivered exclusively by telephone.
The program is accessible in all regions with a team of eight healthcare providers throughout the province.
The team consists of Pharmacists, Nurse Practitioners and General Practitioners who provide clinical smoking cessation counselling and free smoking cessation medications.
Referral uptake and treatment compliance has been improving.

New efforts

The Smoking Cessation Program will be using data visualization software to analyze program's data to create dashboards with the goal to targeting program growth.
Pharmacy students, as a part of their academic training, do assist in delivering the Smoking Cessation Program for cancer patients.
The Health Accord for Newfoundland and Labrador is developing a strategy to increase awareness of and address the social factors that influence health (social determinants of health), as well as balance community-based (primary health care, elder care, social care) and hospital-based services.
As a part of the Health Accord for Newfoundland and Labrador, there is integration of implementing Cancer Care and a Provincial Well-being Approach to the 10-year health transformation.
In 2023 the Cancer Care Program will be participating in a multi-site study to examine the clinical effectiveness and implementation potential of a multidimensional cancer rehabilitation and exercise program for cancer survivors with identified cancer-related impairments.

Indicator:

Percentage of new patients with cancer who were current smokers and received a referral to the smoking cessation program

Our Priorities

Priority 1

Decrease the risk of people getting cancer

Priority 2

Diagnose cancer faster, accurately and at an earlier stage

Priority 3

Deliver high-quality care in a sustainable, world-class system

Priority 4

Eliminate barriers to people getting the care they need

Priority 5

Deliver information and supports for people living with cancer, families and caregivers

Priority 6

Culturally appropriate care closer to home

Priority 7

Peoples-specific, self-determined care

Priority 8

First Nations-, Inuit- and Métis-governed research and data systems

Priority 3: Deliver high-quality care in a sustainable, world-class system

More is not always better when it comes to treating cancer. Care must be based on best evidence and each person’s values and preferences.

Our Priorities

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