Systemic Treatment Program
Implementation Plan 2019–2023
A companion report to the Ontario Cancer Plan
The Systemic Treatment Program Implementation Plan 2019 to 2023 outlines targeted initiatives to improve the quality, safety and accessibility of systemic treatment across Ontario through a person-centred approach. The plan guides our work[*] over 4 years and requires a collective effort on the part of all partners, including regional and provincial stakeholders, healthcare providers, patients and their caregivers. Together we will continue to address gaps in care for patients receiving systemic treatment and ensure that clinical evidence drives our efforts.
“This implementation plan is our contribution to a higher quality cancer system through the commitments in OCP 2019 to 2023. Together with our regions we will work towards a better experience for all in the cancer system.”
“Following my diagnosis, I didn't know that several of my systemic treatments had options for different routes of administration. I would have wanted to know this sooner and have assistance with understanding the treatment options available. Moving towards a standardized approach to care for all patients including consistent guidelines and transparent patient-provider communication, will address these needs and lead to a more patient-centred health system.”
Strategic Objectives and Initiatives
Systemic Treatment in Ontario
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 2: REGIONAL MODEL FOR QUALITY SYSTEMIC TREATMENT
THE DEMAND FOR SYSTEMIC TREATMENT IS INCREASING[*]
THE AVAILABILITY OF ORAL SYSTEMIC TREATMENT HAS GROWN IN RECENT YEARS[*]
For more information
Evaluating our Progress
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:
About This Plan
The Systemic Treatment Program Implementation Plan was developed in 2019. This iterative process included:
- evaluating the Systemic Treatment Provincial Plan 2014–2019 to identify successes and areas for improvement
- aligning with the goals and strategic objectives of the Ontario Cancer Plan 2019–2023
- planning, data gathering and analysis in consultation with clinicians and administrators
- ongoing consultation with stakeholders throughout the province as the plan was refined, including patient and family advisors, regional cancer centres and other internal program areas
Thank you to the partners at the regional cancer programs, including the systemic treatment committees, communities of practice and working groups, for their invaluable support. Their commitment and support is critical to this program’s success in improving care for patients .
Many system partners also support the initiatives outlined in our plan. External partners include provincial agencies, healthcare organizations, healthcare professionals, and their regulatory bodies and associations.
Thank you to the patient and family advisors who participated in the development of the plan and other systemic treatment initiatives. Their experiences and advice helped create a plan that better addresses the needs and values of patients receiving systemic treatment in Ontario.
Executive Sponsors, CCO
Robin McLeod, Vice President, Clinical Programs & Quality Initiatives
Garth Matheson, Vice President, Planning & Regional Programs, Analytics & Informatics
Clinical Programs & Quality Initiatives, Planning & Regional Programs, CCO
Leta Forbes, Provincial Head, Systemic Treatment Program
Elaine Meertens, Director, Diagnosis and Treatment Programs
Vicky Simanovski, Director, Regional Program Development & Funding Unit
Erin Redwood, Interim Director, Regional Program Development
Daniela Gallo-Hershberg, Group Manager, Systemic Treatment Program
Anita Rombough , Group Manager, Oncology Nursing & Transitions in Care
Aliya Pardhan, Team Lead, Systemic Treatment Program
Annie Cheung, Senior Pharmacist, Systemic Treatment Program
Andrea Crespo, Senior Pharmacist, Systemic Treatment Program
Jane Yao, Senior Specialist, Systemic Treatment Program
Jessica Ng, Pharmacist, Systemic Treatment Program
Sarah Salama, Pharmacist, Systemic Treatment Program
Rosemary Ku, Specialist, Systemic Treatment Program
Sivanuja Paras, Coordinator, Systemic Treatment Program
Clinical Leads, CCO
Kathy Vu, Safety Lead, Systemic Treatment Program
Katherine Enright, Quality Care and Access Lead, Systemic Treatment Program
Vishal Kukreti, Clinical Lead, Health Technology and Information Management, Clinical Programs & Quality Initiatives
Lorraine Martelli, Provincial Head, Oncology Nursing Program
Patient and Family Advisors
We thank the following Patient and Family Advisors for their participation in the development of the plan or in other systemic treatment initatives.