Road to recovery: Cancer in the COVID-19 era

Leveraging the potential of digital technologies

Explore the actions needed for leveraging the potential of digital technologies:

1. Realize the promise of virtual care
2. Maximize use of data to answer key questions
3. Collect race-based and socioeconomic data
4. Support First Nations-, Inuit- and Métis-specific governed research and data systems

1. Realize the promise of virtual care

Replacing clinic visits with virtual care and digital health solutions (such as apps and portals), when appropriate, can make it easier for patients to be involved in managing and monitoring their health, especially for those living in rural/remote communities or people reluctant to travel during the pandemic. Virtual care also slows the spread of secondary infections (such as COVID-19) by keeping cancer patients out of high-risk areas such as waiting rooms. As virtual care is expanded, more work will need to be done to determine which kinds of consultations are best suited for virtual care and how digital technologies can be most effectively incorporated into the clinical workflow. Rules and standards will also be needed to help health-care providers make the most appropriate choices when adopting new digital technologies.

Solutions from across Canada:

• Virtual care as routine: Cancer Care Alberta shifted quickly to virtual care during the first months of the pandemic — and has now made it a routine part of care for all patients with cancer within the organization. The development of a large-scale virtual strategy is currently underway.
• Virtual ED visits: The Children’s Hospital of Eastern Ontario (CHEO) conducted virtual emergency department visits during the early part of the pandemic, ensuring people could access care safely while also allowing staff who had to isolate due to COVID-19 to continue to contribute.
• NEW: Symptom assessments: Radiation oncology centres in Nova Scotia and Saint John, New Brunswick, are using an online tool called Noona to provide patients with an opportunity to electronically report and record cancer-related symptoms, and to highlight information about their wellbeing from the comfort of their home. Symptoms are reviewed by the care team and a follow-up care plan is created with patients when they come into the clinic.
• NEW: Virtual meetings: All oncology nurse navigators (ONNs) in Quebec are now equipped with cameras and headphones to conduct virtual meetings and assessments. This improves access to care and reduces the need for patients to travel to hospitals.
• NEW: Guidance for delivering virtual care: Ontario Health has developed a tip sheet to help oncology providers in surgery, radiation and systemic treatment programs successfully deliver virtual care. The tip sheet includes guidance on technology and equipment requirements, virtual care workflows, symptom management coordination in virtual settings, and other topics.

2. Maximize use of data to answer key questions

By measuring and benchmarking performance, cancer care organizations and jurisdictions can establish a basis for identifying and sharing effective practices. To be most effective, the data used for this benchmarking must be reported and collected at the pan-Canadian level, rather than the jurisdictional level as is currently the case. (That said, jurisdictions also need access to data to predict wait times and improve access to care.) At the same time, new data analytics capabilities allow for highly accurate and novel projections to support more precise planning.

Solutions from across Canada:

• Real-time data dashboards: Alberta is just one of many jurisdictions that has developed data-related monitoring strategies, including a real-time dashboard to assess the impacts of the pandemic. Through this dashboard, the province can monitor cancer case registration levels, flag positive COVID-19 tests for cancer patients, and assess COVID-19’s impact of on survivors and patients in active treatment.

3. Collect race-based and socioeconomic data

The pandemic has hit communities that have been underserved the hardest, but disaggregated data on the specific impacts on their health and well-being, including cancer prevention and care, is scarce. There is an urgent need to collect data on factors that affect health and health care, including race-based and socioeconomic data, which can inform pandemic response and recovery efforts centred around health equity — to ensure help is provided to those who need it the most.

Solutions from across Canada:

• Data collection: The Canadian Institute for Health Information has developed minimum standards for the collection of race-based and Indigenous identity in health care, which will help inform interventions that address health inequities stemming from racism, bias and discrimination.
• Data linkages: The Canadian Partnership Against Cancer and Statistics Canada have developed a new tool for linking data between the Canadian Cancer Registry and the Long-form Census. This will allow for race, ethnicity and socio-economic characteristics to be reported on for cancer patients.

4. Support First Nations-, Inuit- and Métis-specific governed research and data systems

The pandemic has further highlighted the need to improve the completeness, availability and timeliness of data specific to First Nations, Inuit and Métis, including data on the impacts of COVID-19 on their cancer journeys.¹ This will require sustainable funding to support Indigenous data governance capacity and infrastructure, as well as closer partnerships between federal, provincial and territorial governments; data custodians; and First Nations, Inuit and Métis governments, organizations and communities. These efforts will support self-determination and ensure First Nations, Inuit and Métis have the data they need to respond to the pandemic and improve their health and well-being.

Solutions from across Canada:

• Data governance: The First Nations Information Governance Centre (FNIGC) has developed a First Nations data governance strategy that provides recommendations for achieving data sovereignty and aligns with the distinct worldviews of First Nations. Through funding from the federal government, FNIGC is working with First Nations to establish data champion teams at regional and national levels to support the data priority needs of, by and for First Nations.
• Data sharing: The Métis Nation–Saskatchewan (MN–S) and the Saskatchewan Cancer Agency (SCA) signed a data-sharing agreement in 2021 and, together with their partners (University of Saskatchewan and the Canadian Partnership Against Cancer), have developed a Métis-specific cancer surveillance initiative. MN-S citizen information will be linked with patient and client profiles in SCA’s cancer registry and screening programs databases, creating the foundation for ongoing cancer surveillance for Métis populations in Saskatchewan and supporting the development of targeted programming and services.
• Data collection: The Qanuippitaa? National Inuit Health Survey was developed by Inuit from across Inuit Nunangat, with support from Inuit Tapiriit Kanatami, to ensure the data collected is reflective of Inuit life and can be used to inform both short- and long-term changes that will improve the health and well-being of Inuit.