Systemic Treatment Program
Implementation Plan 2019–2023

Cancer patients are offered treatment based on their stage, type of cancer and personal preferences. Systemic treatment is a form of cancer treatment, which uses drugs that circulate through the body to cure or slow down the progression of cancer. These treatments may alter hormone levels, directly interfere with cancer cell reproduction or activate the immune system. Treatments can be given by intravenous injections, subcutaneous injections or infusions (parenteral treatment), or in pill form (oral treatment). Commonly, systemic treatment is given in combinations with multiple drugs in standardized treatment regimens.

Systemic treatment is offered in 73 facilities across Ontario (Figure 1) and organized into regions with hospitals specializing in different levels of care (Figure 2). These regions are organized into a network of facilities that often share patients. They work together to care for the needs of their patients and families.

Increase in patients receiving systemic treatment

In Ontario, we are faced with several challenges in delivering the best quality of systemic treatment. Since 2014, we have seen an increase in the number of patients that are treated (Figure 3). Patients can access more options for treatment and must make complicated decisions about quality of life and side effects. Healthcare providers need resources to support our patients and colleagues as the number of treatment options increase. Our work includes:

• strategies for shared decision-making about goals of care, which are conversations essential to aligning care delivery with patient preferences
• timely, appropriate and consistent communication within the healthcare team to increase collaboration and patient safety
• optimizing scopes of practice for the care team members
• supporting systems-based approaches to healthcare professional burnout

Increase in oral take-home cancer drugs

We continue to see a significant increase in the number of treatments that are oral and taken outside of the cancer centre (Figure 4). Ongoing initiatives for take-home cancer drugs include:

• standardizing prescribing and dispensing practices
• developing individualized, proactive monitoring plans for regular assessment of patient adherence, and preventing and managing toxicities for oral systemic treatment
• increasing the availability of high quality, standardized educational materials for patients and their caregivers
• working with community care providers to provide consistent, safe care for existing systemic treatment services in the home/community

Challenges in monitoring and evaluation

Monitoring and evaluation is a vital component of a high performing health system. Although evidence-based guidance documents and toolkits on standardizing care are available, it is challenging to apply those recommendations, and monitor and evaluate their application across settings. In response, we published a set of priority standards that all cancer centres will need to align with and routinely assess. Ultimately, we hope patients will receive a common standard of care throughout the province.

There is also an opportunity to improve the culture of safety in the cancer system by increasing incident reporting and dissemination of lessons learned. We have directed and focused regional efforts towards documentation, collation and analysis of medication incidents and near misses by establishing the Systemic Treatment Incident Learning Committee. However, we need to work more on dissemination of lessons learned and effective organizational change to improve the health system and reduce the risk of poor quality care.

In partnership with our regional networks and clinical experts, we will continue to develop guidelines and resources to help healthcare providers and policy-makers apply the best scientific evidence and make policy decisions. To strengthen connections and interdisciplinary collaboration, we established several forums, such as the Regional Quality and Safety Network, the Systemic Treatment Program Committee, the Health Technology Community of Practice and the Pharmacy Community of Practice.

We will continue to:

• track and manage performance in the regions to identify areas for improvement
• monitor the impact of changes over time
• prioritize systemic treatment initiatives that are person-centred, safe, equitable, efficient, effective and timely

FIGURE 1: SYSTEMIC TREATMENT FACILITIES IN ONTARIO

Figure descriptionFigure description:Close referenceThere are 73 systemic treatment facilities across 14 regions in Ontario.

FIGURE 2: REGIONAL MODEL FOR QUALITY SYSTEMIC TREATMENT

Figure descriptionFigure description:Close referenceTreatment is organized around 4 levels of care (Levels 1-4). Levels of systemic treatment service range from the ability to provide complex highly specialized systemic treatment (Level 1) to low-risk treatment under the direction of a medical oncologist (Level 4).

THE DEMAND FOR SYSTEMIC TREATMENT IS INCREASING^[*]* Source:Close referenceCancer Care Ontario (2019). Activity Level Reporting

Figure descriptionFigure description:Close referenceThe number of patients receiving systemic treatment has increased over the last 5 fiscal years from 57,989 to 86,512 (49% increase).

THE AVAILABILITY OF ORAL SYSTEMIC TREATMENT HAS GROWN IN RECENT YEARS^[*]* Source:Close referenceCanadian Cancer Action Network (CCAN) & Canadian Agency for Drugs and Technologies in Health (CADTH) (2019). Drug Pipeline Information for Patient Groups. Retrieved from http://www.ccanceraction.ca

Figure descriptionFigure description:Close referenceA drug pipeline is the set of drug candidates that a pharmaceutical company has under discovery or development at any given time. The bar chart shows that out of 328 emergent cancer therapies (oncology medications in the pipeline), 157 (48%) will be oral.

Accountability and measurement

We are accountable to the Ministry of Health, our partners and the people of Ontario for meeting the commitments outlined in this implementation plan. Detailed internal operating plans set out how initiatives will be developed and put in place to support the Ontario Cancer Plan’s goals and objectives. There are also key indicators for managing performance and measuring progress.

Progress to date

The Systemic Treatment Program has been creating multi-year strategic and implementation plans for the province since 2009. Each plan has been built on the achievements of its predecessor. Measuring and reporting on progress helped us identify areas where work needed to continue.

Key achievements from the Systemic Treatment Provincial Plan 2014–2019 evaluation:

• Standardization of oral chemotherapy practice
• Enhancement of symptom management approaches
• Development of rigorous clinical guidance and education materials
• Administration of strategic quality improvement initiatives
• Endorsement of key recommendations

Opportunities for growth identified from the Systemic Treatment Provincial Plan 2014–2019 include:

• Integration of care
• Coordination and communication
• Continuous drive for a more person-centred approach, focusing on evidence and partnership

For more information:

• Systemic Treatment Provincial Plan 2014–2019