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Ontario Cancer Plan 5 2019–2023

Since 2005, multi-year provincial cancer plans have led to improvements in the quality and performance of Ontario’s cancer system. Ontario Cancer Plan 2019–2023 builds on that solid foundation. It provides a road map for how Cancer Care Ontario, the Regional Cancer Programs, health system partners, and, in time, Ontario Health will work together to reduce Ontarians’ risk of developing cancer and improve outcomes for those affected by cancer.

Ontario Health is a single agency that will, in time, take on Cancer Care Ontario’s work as part of Ontario Health’s larger mandate to oversee healthcare delivery in Ontario, improve clinical guidance and support providers to ensure better quality care for patients.

Putting this plan into action will mean creating a cancer system that delivers person-centred, safe and effective services in an efficient, equitable and timely manner.

This plan was made possible through collaboration with Cancer Care Ontario’s clinical leaders. They help translate knowledge and evidence into planning, policy and program design recommendations and decisions across the cancer care continuum.

 

  • Garth Matheson

    This Ontario Cancer Plan builds on past progress while anticipating future challenges and opportunities. With the Regional Cancer Programs and our partners, we are preparing our healthcare system for changing demographics, innovative technologies, and evolutions in care. Together we enable the highest quality cancer services for the people of Ontario.”

    Garth Matheson
    Vice-President, Planning and Regional Programs, Cancer Care Ontario
    Co-Chair, Ontario Cancer Plan 2019-2023

  • Allison H

    I hope the work of this Ontario Cancer Plan will continue to improve communications between patients and their healthcare professionals, and among the various members of the care team. The ongoing priority is helping patients and caregivers move easily through the system, through all stages of care. When you are dealing with cancer, the focus should be on your health, not on trying to figure out the system.”

    Arlene H.
    Patient & Family Advisor, Cancer Care Ontario
    Co-Chair, Ontario Cancer Plan 2019-2023

Goals & Strategic Objectives

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Person-centred

Deliver responsive and respectful person-centred care, optimizing quality of life across the cancer care continuum

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Deliver responsive and respectful person-centred care, optimizing quality of life across the cancer care continuum

Cancer is an intensely personal experience. The patient’s clinical outcome is not the only factor that defines excellence in care. The patient’s views of their experience and quality of life are equally as important.

We will build on the significant progress made towards:

  • symptom management
  • patient-reported outcomes and experience with the cancer system

At the health system level, we will involve diverse patients, caregivers and the public to help improve the cancer system. This will make sure that services and care reflect the needs and preferences of Ontarians.

A person-centred model of care relies on effective communication. This includes communication between patients, caregivers and healthcare professionals. Conversations about goals of care should begin early and continue through all stages of care, using Ontario-based resources. Partnering with the Ontario Palliative Care Network will support work in this area.

Healthcare professionals need the right information and tools to communicate effectively with patients. They need to consider the patient’s health literacy. Patients and caregivers also need information and tools to understand and fully participate in their own care.

Strategic objectives

  • Expand the use of patient-reported outcomes and improve symptom management
  • Expand patient experience measurement and equitable engagement with patients, caregivers and the public
  • Promote early conversations relating to advance care planning, prognosis and goals of care, and share identified goals with the care team
  • Improve health literacy competencies among healthcare professionals, patients and caregivers to improve communication, self-management and quality of life
  • Improve access to cancer information for patients and caregivers

Physically, I received awesome care. But this is an emotional journey as well as a physical one. The system has to take both aspects into account. After I was diagnosed with breast cancer, I did my research and decided, for my peace of mind, I wanted a bilateral mastectomy without reconstructive surgery. I felt that this decision was questioned by doctors who wanted to dictate decisions for me based on best practice protocols and standards of care. I felt like my voice wasn’t heard.”

Kim S. is a social worker specializing in addiction and mental health who was diagnosed and treated for breast cancer in 2017.

 
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Safe

Improve the safety of patients, caregivers and healthcare professionals across care settings

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Improve the safety of patients, caregivers and healthcare professionals across care settings

Patients, caregivers and healthcare professionals expect their health system to deliver safe care. A fundamental principle of healthcare is to “first, do no harm.” There is a need to be proactive in reducing avoidable harm in all care settings.

This work is particularly important as cancer treatment continues to improve. For example, many partners are involved in delivering systemic treatment. There is a need to develop models that will enhance safe and effective care. This will include:

  • prescribing, dispensing and administering cancer drugs
  • monitoring how patients respond to treatment

We will strengthen the delivery of safe care by:

  • standardizing best practices
  • providing better training and education for healthcare professionals
  • providing patients with the necessary tools and education to help them manage the side effects of treatment

We will strengthen the existing culture of safety, governance and accountability. This will include:

  • coordinating the solution and sharing lessons learned when safety incidents occur
  • working with our partners to set standards, and measure and report on quality

Strategic objectives

  • Implement a model of care to provide comprehensive symptom and side-effect management
  • Develop and implement clinical standards and practices to improve treatment quality and safety
  • Strengthen the culture and system-level oversight for safety

Before my surgery and chemotherapy, I was extremely fit and active. I enjoyed marathon running and boating. Now I am in constant pain. My once active sex life is gone, and that has been very distressing. I have had many other side effects too: short-term memory loss, nighttime incontinence, poor spatial awareness and loss of control of my legs in certain positions. A chronic pain management program and a mindfulness program have helped reduce (but not eliminate) some of the pain, which has in turn improved my emotional state.”

Malcolm F. is a retired college professor who was diagnosed with invasive bladder cancer in 2011.

 
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Equitable

Improve health equity across the cancer system such that people are not disadvantaged by who they are, where they live, or what resources they have

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Improve health equity across the cancer system such that people are not disadvantaged by who they are, where they live, or what resources they have

Everyone in Ontario should be their healthiest. People should not be disadvantaged from attaining good health because of who they are, where they live, or what resources they have.

Yet some Ontarians face significant and often many barriers to:

  • reducing their cancer risk factors
  • receiving early diagnosis
  • accessing and using cancer services

A person’s location, culture and financial position may negatively affect their cancer care experience, treatment decisions and outcomes.

A health equity approach recognizes that health is not equal across populations. This approach helps us understand and address the special requirements of people whose health outcomes are influenced by barriers such as:

  • long travel distances
  • out-of-pocket healthcare expenses
  • healthcare professionals’ biases
  • lack of social supports

We will leverage data and work with partners across and beyond healthcare. The aim is to reduce barriers to equitable cancer prevention, screening, care and outcomes for communities identified as most affected by social and health inequities including:

  • patients with rare and less common cancers
  • Indigenous peoples
  • underserved or vulnerable populations

Vulnerable populations are groups and communities at higher risk of disparate healthcare access and outcomes because of barriers to social, economic, political and environmental resources, as well as limitations due to illness or disability. Vulnerable populations may include:

  • economically disadvantaged people
  • racial, ethnic and cultural minorities
  • children
  • elderly people
  • refugees and new immigrants
  • homeless or insecurely housed people
  • people with low education, literacy or language skills
  • uninsured people
  • people living far from services
  • people who identify as LGBTQ+
  • people living with mental health issues, chronic disease or disabilities

Strategic objectives

  • Build capacity to address health equity through expanded use of data, tools and partnerships at provincial and community levels
  • Develop health policy advice and implement strategies for supporting identified underserved and vulnerable populations
  • Implement the fourth First Nations, Inuit, Métis and Urban Indigenous Cancer Strategy with a focus on engagement with local communities
  • Plan and allocate funding, capital equipment and infrastructure, and health human resources to support equitable care across the province

For more information

I felt like everyone in the (healthcare) system had all the knowledge and power, and I was just a number in a box. It was very isolating. We are all people. We all bleed red. But we’re not all straight, white, married with kids, and it shouldn’t be assumed that we are. There are simple, easy things that can be done to build a personal connection and show that you are open to who I am – like asking me how I want to be addressed or even having a poster on the wall that conveys I am in a safe, respectful place.”

Hannah S. is a volunteer coordinator with a community health centre. She (her chosen pronoun) identifies as asexual and was diagnosed with vulvar cancer in 2017.

 
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Efficient

Improve the efficiency and coordination of cancer services

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Improve the efficiency and coordination of cancer services

Ontarians want healthcare resources to be used optimally, with minimal duplication and waste. They want to know that, if they face a suspicion or diagnosis of cancer, they will receive high-quality, well-coordinated care.

For Ontario’s cancer system to be sustainable and available when needed, the growth of new cancer cases needs to slow. At the same time, there is a need to set up processes to make the best use of our human, infrastructure and financial resources. This includes getting the best value from diagnostic services and cancer treatment and reducing inappropriate use of resources.

We will test the real-world effectiveness of interventions in practice. This will help close the gap between best evidence and care provided and improve patient outcomes.

We will work with our partners to optimize and develop solutions to deliver high-quality services that deliver the greatest benefit to patients and the cancer system.

We will do this by:

  • strengthening our prevention and screening efforts
  • reducing variations in care for patients undergoing diagnostic assessment
  • coordinating and integrating cancer service delivery

Strategic objectives

  • Advance the chronic disease prevention strategies
  • Strengthen Ontario’s organized cancer screening programs for breast, colorectal, cervical and lung cancer
  • Reduce variation in the quality of care for patients undergoing diagnostic assessment, from suspicion of cancer to treatment decision
  • Develop approaches to address healthcare professional burnout
  • Increase value of services through funding models, evaluation, policy development and new models of care
  • Assess real-world clinical benefit and value of treatment strategies
  • Facilitate the adoption of biosimilar drugs

For more information

For me, the diagnostic process was really fast. I went to an after-hours walk-in clinic because I had an odd lump at the base of my neck. The doctor immediately sent me for an ultrasound, and he got the results very quickly. He sent me to Emergency for further testing as the results indicated a high chance of malignancy. I was diagnosed with stage 2 Hodgkin’s lymphoma within a week, had further testing, and started chemotherapy a month later. That’s pretty impressive, but I know other people who have waited months for their tests and results.”

Lauren C. was 22 years old when she was diagnosed with cancer in December 2016, just 5 months after graduating with a Bachelor of Technology.

 
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Effective

Provide effective cancer care based on best evidence

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Provide effective cancer care based on best evidence

Effective cancer care means that patients receive services based on the best evidence that contributes to the best possible outcomes for their conditions.

Knowledge and technologies for cancer care and control are evolving. There is a need to continually assess current and new interventions and support the adoption of those that deliver the best outcomes. This includes responding quickly to emerging interventions such as immunotherapies and proton beam therapy.

Personalized medicine tailors the approach to cancer services and care based on the genetic characteristics of an individual, their disease or both. We will promote a consistent and coordinated approach to personalized medicine. This work will also support the unique needs of adolescents and young adults who had or have cancer.

We will expand programs to encourage patients receiving treatment for cancer to quit smoking tobacco. There is strong clinical evidence that shows this improves clinical outcomes.

We will expand our reporting of quality measures to drive evidence-based cancer care beyond hospitals into clinics (including independent health facilities and other non-hospital settings) and private community laboratories.

To help healthcare professionals across care teams make clinical decisions based on the right information at the right time, we will standardize clinical documentation.

Strategic objectives

  • Expand measurement of clinical outcomes and compare outcomes against other jurisdictions
  • Examine the association between patients’ receipt of evidence-based cancer care, and clinical and patient-reported outcomes
  • Develop strategies to support evaluation and implementation of innovative technologies and interventions
  • Implement a framework for using personal and tumour genetics (personalized medicine) to strengthen quality, service delivery and system planning
  • Work with system partners to promote effective and appropriate care for adolescents and young adults
  • Expand tobacco smoking cessation programs
  • Expand quality measurement to include non-hospital settings and reporting at the facility and provider level
  • Advance integrated standardized clinical documentation (synoptic reporting) and enable real-time clinical decision-making and system reporting

I was referred to a radiologist in Toronto to do my kidney biopsy because the radiologist in North Bay did not have as much experience in this specific area. The results showed the position of the tumour on my kidney meant that it could not be treated with ablation. When it came to my surgery, my urologist in North Bay did not have experience in removing kidneys laparoscopically, so he referred me to a specialist who had recently joined the practice, and he planned to sit in on the surgery to build those skills. Although I had to be transferred for both radiology and surgery, I feel confident that I had the best outcome possible because I received the right care from the right people.”

Lauri P. is a retired vice-president of a major bank. She was treated for clear cell ovarian cancer in 2013 and stage 1 kidney cancer in 2017.

 

Timely

Deliver timely care across the cancer care continuum

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Deliver timely care across the cancer care continuum

Many patients say that waiting – for tests and results, for a care plan, for services – is one of the most stressful parts of having or suspecting cancer. Reduced wait times are important for quality of life and decision-making, and can be important for clinical outcomes.

Progress has been made towards meeting wait time targets. We will continue to strengthen approaches to performance management to drive improvements to the timeliness of care.

To support this need, and enhance an integrated approach to care, work will focus on timely transitions:

  • through the different stages of the cancer care continuum
  • between facilities
  • into and out of the cancer system

We will focus on timely access to psychosocial oncology services and palliative care. This will help patients manage the emotional, spiritual, functional, practical, nutritional and rehabilitative challenges associated with cancer. Work in palliative care will support the Ontario Palliative Care Network’s action plan.

Strategic objectives

  • Improve transitions across the cancer care continuum
  • Expand and support timely access to psychosocial oncology services
  • Expand and support timely access to palliative care
  • Improve timeliness of diagnostic and treatment services by advancing wait time monitoring and performance management strategies

For more information

When I was first diagnosed with ovarian cancer, my gynecologist recommended that I have surgery in Toronto (2 hours away). I had a CT scan and MRI in Toronto, which indicated that surgery was not an option, so I was referred for radiation closer to home. Nothing happened for several weeks. The one hospital said they had sent the referral, but the other hospital said they hadn’t received it. I had to personally hunt it down. The delay meant I needed another scan before starting treatment.”

Freida D. is a retiree who splits her time between Kitchener and her native Bermuda. Overall, she says she feels “truly blessed” by the care she received.

 

Cancer in Ontario

Why Ontario needs a cancer plan

Nearly 1 out of every 2 Ontarians will develop cancer in their lifetime.

This stark statistic highlights the importance of a well-organized cancer system for the province.

The Ontario Cancer Plan assures the people of Ontario that there is a system in place dedicated to reducing their risk of developing cancer and providing high-quality care if and when they need it.

New cancer cases are rising

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Figure 1: Projected incidence counts and age-standardized rates for all cancers combined, Ontario, 2011–2018

Our aging population will impact the cancer system

  • More than half of all cancers diagnosed are in people ages 60 to 79.
  • There are now more Ontarians over the age of 65 than under 15. This will have a significant impact on our cancer system as cancer risk increases with age.
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Figure 2: Distribution of newly diagnosed cancer cases by age group, 2013

Cancer is the number 1 cause of death in Ontario

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Figure 3: Leading causes of death, Ontario, 2016

The death rate from cancer is improving

Cancer mortality in Ontario has been declining over the past 3 decades with the rate of decrease accelerating after 2001.

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Figure 4: Age-standardized mortality rates, 1983 to 2013, per 100,000 persons

More people are surviving and living with cancer

As of 2013, the overall 5-year cancer survival rate was 65%, up from about 48% in the mid-1980s, though there was variation in survival across cancer types.

Cancer care does not end at the completion of treatment. As more people survive and live longer with cancer, patients, caregivers and the health system will face new challenges.

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Figure 5: 30-year prevalence for all cancers combined, Ontario

The risk of getting cancer, accessing services and health outcomes are different among Ontarians

The Ontario Cancer Plan provides a road map for the way Cancer Care Ontario, the Regional Cancer Programs, partners in the healthcare system and, in time, Ontario Health will work together to reduce the burden of cancer on individuals and the health system.

Some groups of people in Ontario are at higher risk of some cancers.

The risk of cancer and other chronic diseases is linked to factors such as:

  • age
  • gender
  • income
  • education
  • housing
  • tobacco use
  • alcohol consumption
  • diet (and food security)
  • physical activity
  • body weight
  • environment (e.g., sun exposure, pollution)
  • workplace

These factors may also influence participation in cancer screening, and health outcomes.

  • Women from low-income households or who are recent immigrants are less likely to have Pap tests compared to women who are from high-income households or Canadian born.
  • Survival rates for lung, colorectal, breast and prostate cancer are associated with income. As income rises, so does survival from these cancers.

Our System

Putting the Ontario Cancer Plan into action

The work of Ontario’s 14 Regional Cancer Programs is especially important in helping to meet the goals of the Ontario Cancer Plan and improve the quality and delivery of cancer services.

As part of this effort, the Regional Cancer Programs use the provincial cancer plan to develop their regional cancer plans. These regional plans address local issues and focus on improving cancer services within their communities. Their work helps make sure people across Ontario can access high-quality cancer services as close to home as possible.

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This Ontario Cancer Plan provides a shared vision that Cancer Care Ontario and the Regional Cancer Programs can continue to work towards. The plan is comprehensive and includes important population-based planning to reduce the future burden of cancer in Ontario, as well as strategies that seek to ensure consistent exemplary care for patients with cancer and their families. The recognition that healthcare professionals require systematic support to prevent burnout is a new and important addition.”

Dr. Ralph M. Meyer,
Vice-President, Oncology and Palliative Care, Hamilton Health Sciences.
Regional Vice-President, Cancer Care Ontario

Regional initiatives

Clinical leadership

Clinical Leads, including physicians, nurses and other healthcare professionals, provide leadership and expert advice to help improve the cancer system. Additionally, over a thousand healthcare professionals from across Ontario participate on expert panels and advisory committees, and as reviewers to support our work including the development of clinical program standards and evidence-based guidelines. Their contributions are essential to achieving our goals.

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Our role as Clinical Leaders at Cancer Care Ontario is to partner with patient and family advisors, and healthcare professionals to set goals and plan for change that will be meaningful for all those who experience the cancer system. Together, we have shaped this Ontario Cancer Plan and it will guide our work to achieve a more integrated and responsive system.”

Dr. Leta Forbes,
Provincial Head, Systemic Treatment, Cancer Care Ontario

Partnering with patient and family advisors

Thank you to the patient and family advisors who participated in the development of the Ontario Cancer Plan. Their experiences and advice helped create a cancer plan that better addresses the needs and values of the populations we serve.

Furthermore, as policies, programs and practices are developed to meet the goals of the Ontario Cancer Plan, input from patient and family advisors will help shape decisions that affect patient care and services.

Working with the government

The Ministry of Health and Long-Term Care helps Cancer Care Ontario bring the Ontario Cancer Plan to life.

The ministry reviews and assesses the plan and provides funding for its programs and projects. We advise the ministry about the cancer system performance and regularly report on the results of our work.

System partners

Many system partners help develop programs, policies and projects that support the strategic objectives of the Ontario Cancer Plan. External partners include provincial agencies, healthcare organizations, and healthcare professionals, their colleges and associations.

Measuring Progress

Accountability and measurement

We are accountable to the Ministry of Health and Long-Term Care, our partners and the people of Ontario for meeting the commitments outlined in this plan.

Annual business plans submitted to the ministry and detailed internal operating plans set out how projects and programs will be developed and put in place to support the plan’s goals and strategic objectives.

There are a robust measurement plan and performance indicators to measure progress.

Progress is reported in several ways:

  • Annual report
  • Quarterly and special program reports
  • Quarterly reports on our accountability and funding agreements

Also, the Cancer Quality Council of Ontario monitors and publicly reports on the performance of the cancer system through the Cancer System Quality Index. This index tracks Ontario’s progress towards improving the quality of cancer control, provides international comparisons, and highlights opportunities to improve.

All of this information is used to adjust planning and respond to changes.

Progress to date

CCO has been creating multi-year cancer plans for the province since 2005. Each plan has been built on the achievements of its predecessor.

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  • 2005 to 2008: Our focus was on building system capacity to meet the growing needs of people with cancer in this province.
  • 2008 to 2011: We tackled wait times and quality of care, expanded prevention and screening efforts, strengthened system quality improvement and performance management, and increased our focus on the patient experience.
  • 2012 to 2015: We called for realistic investments in prevention, early detection, care closer to home and research-informed ways to manage growth in costs.
  • 2015 to 2019: We broadened our scope of work to more fully encompass all stages of the cancer care continuum and advance our person-centred approach.

Measuring and reporting on progress helped to identify areas in which work needed to continue to achieve the goals of the plan.

Read more about Cancer Care Ontario’s fourth Ontario Cancer Plan 2015 – 2019.

About this plan

The Ontario Cancer Plan 2019 - 2023 is a road map for the way we will work with the Regional Cancer Programs and health system partners to continue to reduce Ontarians’ risk of developing cancer and improve outcomes for those affected by cancer.

Ontario Health is a single agency that will, in time, take on Cancer Care Ontario’s work as part of Ontario Health’s larger mandate to oversee healthcare delivery in Ontario, improve clinical guidance and support providers to ensure better quality care for patients.

The plan covers the full cancer care continuum including prevention to screening, diagnosis, treatment, recovery, survivorship or end-of-life.

cancer care continuum


The goals and strategic objectives in the plan help to:

  • identify priorities to guide our work at all levels
  • focus our efforts where they are most needed
  • advise the government on major initiatives and funding decisions
  • develop program-level strategic plans
  • bring together many partners within our complex health system

Developing the plan

Cancer Care Ontario began by reviewing the performance of the cancer system and progress made under the previous plan (2015–2019).

We consulted with staff across Cancer Care Ontario, the Regional Cancer Programs and our network of partners, including patient and family advisors. We are grateful for their insights and expertise.

The review and consultations confirmed we are on the right track set by our previous plan. With this current plan, we will continue in the same direction and build on our progress to date. The plan identifies work that needs to advance, new opportunities for improvement and emerging areas within the cancer environment that will require attention in coming years.