Restructuring!Cancer!Services! for!Survivorship!Care:! The$ - PowerPoint PPT Presentation

! Restructuring!Cancer!Services! for!Survivorship!Care:! The$ Ontario$Experience UICC World Cancer Congress Dr. Carol Sawka MD, FRCPC VP, Clinical Programs and Quality Initiatives Cancer Care Ontario Professor of Medicine, University of Toronto August 30, 2012

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" 2 !

About Cancer Care Ontario Mandate! • Provincial"government"agency" responsible"for"con;nually" improving"cancer"services" " Mission! • Improving"the"performance"of"the" cancer"system"by"driving"quality," accountability"and"innova;on" 3

In Ontario, cancer incidence is increasing…. Ontario Cancer Plan III 2011-2015 4

…. as are 5 year Cancer Survival Rate for those living with cancer 5

… leading to a 40% increase in the number of Ontarian’s living with cancer 406,000 " Ontarians"will"be"living"with" cancer"by"2017. ! 6 Ontario Cancer Registry

Inconsistency in follow-up visits with Specialists* for Breast Cancer Patients Figure!1:!%!Breast!Cancer!Survivors!with!at!least!one!followBup!visit!by!specialists*!in!Regional!Cancer!Centre!! 12B24!months!aHer!their!diagnosis!in!2009.! 95" 100" 93" 93" 88" 85" 90" 81" 80" 79" 80" 71" 67" 67" 70" 59" 60" 50" 40" 35" 40" 30" 20" 10" 0" 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" 7 """Source:"Ontario"Cancer"Registry,"Ac;vity"Level"Repor;ng,"Discharge"Abstract"Database"and"Na;onal"Ambulatory"Care"Repor;ng"System""

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" • 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 " 8 1. Kron et al. Obstetrics and Gynecology (2009), and Grunfeld submitted and unpublished data

Patients are not Satisfied 9

Our Vision for Survivorship Survivors!of!cancer!have!access!to!the! right!care!and!informaLon!to!achieve!a! posiLve!health!status! 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

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" 11

Progress to Date AcLviLes! To"enable" • Maximize"opportuni;es"to"transi;on"care"from" survivors"to" Cancer"Centres"to"Primary"Care"Providers:" receive"the"right" • Colorectal"Demonstra;on"projects"–"3"sites" care"in"the"right" • Breast"Cancer"Models"–"all"Regions"(14"sites)" place" Goals! To"ac;vely" empower" • Literature"review"and"scan" survivors"with" in"progress" pa;ent[centred" • Plan"to"follow" informa;on"and" tools" 12

Progress to Date AcLviLes! • Evidence[based"guidelines"" """""""""Completed:""Colorectal"Cancer"" To"develop"the" """""""""In"progress:""Models"of"Care"" evidence"base," """""""""""""""""""""Breast" informa;on"and" " """""Lung"Cancer"" tools"for"providers " " """""Prostate"Cancer" """"""""""Planned:""""""Gynecological"Cancer" Goals! " """""Head"and"Neck"Cancers" • Engaging"Primary"Care"to"implement" guidelines" Improved" • Planned"integra;on"of"guidelines"" coordina;on"and" into"electronic"medical"records" integra;on"of"care" • Iden;fica;on"of"key"performance" indicators"ongoing" 13

Survivorship Models of Care for Colorectal and Breast Cancer ! 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" • " !!!!Key!Enablers:! Electronic"Medical"Record"with"embedded"Guidelines"for"cancer"follow[up" • Electronic"Care"Plans"for"providers"and"pa;ents" • 14

Champlain Regional Cancer Program Colorectal Cancer Follow-Up 15

Questions? 16