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Systemic Treatment Program
Implementation Plan 2019–2023

Cancer Care Ontario logo.

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.

Dr. Leta Forbes

Dr. Leta Forbes

Provincial Head, Systemic Treatment, Cancer Care Ontario

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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.”

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

Melissa G.

Patient and Family Advisor, Cancer Care Ontario

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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.”

Melissa G.
Patient and Family Advisor, Cancer Care Ontario

Strategic Objectives and Initiatives

Person-Centred

Person-centred Icon

Person-centred
These initiatives align with the “Person-centred” goal in the Ontario Cancer Plan 2019 to 2023

Ontario Cancer Plan Strategic Objective Our Initiative
Promote early conversations relating to advance care planning, prognosis and goals of care, and share identified goals with the care team
  • Develop a framework and educational strategy to facilitate ongoing discussions between healthcare professionals, and patients and caregivers on goals of care
Improve health literacy competencies among healthcare professionals, patients and caregivers to improve communication, self-management and quality of life
  • Continue to collaborate with the Patient Education Program to optimize the health literacy of the Drug Formulary documents.
Improve access to cancer information for patients and caregivers
  • Provide and support broad communication of current, evidence-based knowledge, including maintaining and updating the Drug Formulary
  • Identify and address gaps in patient-facing tools related to systemic treatment

Safe

Safe Icon

Safe
These initiatives align with the “Safe” goal in the Ontario Cancer Plan 2019 to 2023

Ontario Cancer Plan Strategic Objective Our Initiative
Implement a model of care to provide comprehensive symptom and side-effect management
  • Support multi-program quality improvement initiatives, including work related to toxicity management
  • Collaborate with community care providers to support patients who receive systemic treatment in the community
Develop and implement clinical standards and practices to improve treatment quality and safety
  • Implement quality priorities through funding and performance management, including:
    • Systemic Treatment - Quality-Based Procedures (ST-QBP) funding model refresh
    • Systemic Treatment - Quality Improvement (ST-QI) initiatives
  • Facilitate the implementation of best practices for take-home cancer drugs
  • Provide guidance to facilities on hepatitis screening and vaccinations for patients receiving systemic treatment
  • Develop knowledge transfer and exchange strategies, and assess alignment with clinical guidance documents
  • Develop guidance on outpatient management of febrile neutropenia
Strengthen the culture and system-level oversight for safety
  • Provide forums to strengthen connections and interdisciplinary collaboration on systemic treatment safety issues. For example, Regional Quality and Safety Network, Systemic Treatment Incident Learning Committee
  • Collaborate with the Ontario College of Pharmacists on the reporting of oncology-related medication incidents
  • Support facilities on how to implement reporting requirements for the Protecting Canadians from Unsafe Drugs Act (also known as Vanessa's Law), and explore options for obtaining safety information for analysis and sharing
  • Respond to identified systemic treatment safety issues, and facilitate the sharing and exchange of information and best practices
  • Support facilities to implement and assess alignment with the following standards and guidelines:
    • Regional Systemic Treatment Program Standards
    • Take-home cancer drugs best practice guidelines
    • Clinical practice guideline for the prevention and management of cancer medication related infusion reactions
    • Antiemetic Recommendations for Chemotherapy-Induced Nausea and Vomiting: A Clinical Practice Guideline
  • Develop and implement a provincial strategy on monitoring and analyzing cancer medication-related infusion reactions

Equitable

Equitable Icon

Equitable
These initiatives align with the “Equitable” goal in the Ontario Cancer Plan 2019 to 2023

Ontario Cancer Plan Strategic Objective Our Initiative
Plan and allocate funding, capital equipment and infrastructure, and health human resources to support equitable care across the province
  • Explore opportunities to look at rates of systemic treatment use and plan for access

Efficient

Efficient Icon

Efficient
These initiatives align with the “Efficient” goal in the Ontario Cancer Plan 2019 to 2023

Ontario Cancer Plan Strategic Objective Our Initiative
Develop approaches to address healthcare professional burnout
  • Support the development of approaches to address healthcare professional burnout
Facilitate the adoption of biosimilar drugs
  • Provide support to facilitate the adoption of biosimilar drugs

Effective

Effective Icon

Effective
These initiatives align with the “Effective” goal in the Ontario Cancer Plan 2019 to 2023

Ontario Cancer Plan Strategic Objective Our Initiative
Expand measurement of clinical outcomes and compare outcomes against other jurisdictions
  • Establish performance and quality indicators specific to the delivery of systemic treatment to:
    • monitor and measure system performance,
    • analyze trends,
    • compare performance to targets and benchmarks
Develop strategies to support evaluation and implementation of innovative technologies and interventions
  • Support facilities with the implementation of Systemic Treatment Computerized Prescriber Order Entry best practices, including the transition from the Oncology Patient Information System
  • Provide advice on health technology as it relates to systemic treatment, including:
    • e-prescribing
    • provincial guidance on robotics or pharmacy compounding software
    • Health Technology Community of Practice

Timely

Timely Icon

Timely
These initiatives align with the “Timely” goal in the Ontario Cancer Plan 2019 to 2023

Ontario Cancer Plan Strategic Objective Our Initiative
Improve timeliness of diagnostic and treatment services by advancing wait time monitoring and performance management strategies
  • Monitor the barriers and access to providers and resources through wait time indicators (i.e., access to systemic treatment chairs)
  • Explore new opportunities for integrated wait time indicators

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

Systemic Treatment Facilities Ontario Map

FIGURE 2: REGIONAL MODEL FOR QUALITY SYSTEMIC TREATMENT

Regional Model for Quality Systemic Treatment Diagram

THE DEMAND FOR SYSTEMIC TREATMENT IS INCREASING

THE AVAILABILITY OF ORAL SYSTEMIC TREATMENT HAS GROWN IN RECENT YEARS

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

Methodology

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

Partners

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.

Acknowledgements

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.

Melissa G.

Irma K

Subi B.

Dorothy B.

Jane L.

Laurel W.

Joanne M.