Ontario Cancer Plan 2015 – 2019

Cancer Care Ontario has been creating multi-year cancer plans since 2004. Each plan builds on the progress achieved, incorporates lessons learned as well as work that needs to advance from previous plans.

Our fourth plan, which covered 2015 to 2019, was developed through extensive consultation with stakeholders including patient and family advisors, healthcare professionals, and health system partners across Ontario.

It set 6 goals that cut across the cancer care continuum:

• Quality of life and patient experience – Ensure the delivery of responsive and respectful care, optimizing individuals’ quality of life across the cancer care continuum
• Safety – Ensure the safety of patients and caregivers in all care settings
• Equity – Ensure health equity for all Ontarians across the cancer system
• Integrated care – Ensure the delivery of integrated care across the cancer care continuum
• Sustainability – Ensure a sustainable cancer system for future generations
• Effectiveness – Ensure the provision of effective cancer care based on best evidence

Here are some examples of progress that have been achieved towards each goal of the plan. 

Quality of Life and Patient Experience

• Patients and families have access to 23 symptom management guides to help them manage physical and emotional symptoms and treatment side effects.
• Patients can report their symptoms electronically using the Your Symptoms Matter platform. This information helps healthcare teams provide care that is responsive to patients’ needs.
• Patients and caregivers can report on their experience with the cancer system in real time using Your Voice Matters. These data will help us develop services that better meet their needs. The survey has been used more than 65,400 times to get feedback from patients and caregivers.
• Recommendations for the Delivery of Psychosocial Service in Ontario, along with monitoring referrals and wait times help to improve patients’ access to psychosocial oncology services and quality of life.
• Almost 100 Patient and Family Advisors help make sure our work meets the needs of the populations we serve. Additionally all 14 Regional Cancer Programs actively engage with patient and caregiver advisors.

Safety

• New practice standards for the safe use and handling of oral anti-cancer drugs in community pharmacies will help ensure safe yet accessible use and distribution of take-home cancer drugs.
• An in-depth review of the impact of adopting the National Association of Pharmacy Regulatory Authorities’ Model Standards of Practice for Canadian Pharmacists was conducted to help keep healthcare providers safe.
• The Quality Management Partnership, established in 2013 and led by Cancer Care Ontario and the College of Physicians and Surgeons of Ontario, has been working closely with stakeholders to develop quality management programs for colonoscopy, mammography and pathology. The Partnership’s reports help improve the quality, safety and consistency of care.
• Peer review of treatment plans ensures radiation treatment is appropriate and safe. In the first quarter of 2018/19, 90% of treatment plans in Ontario for radical (curative) radiation treatment were peer reviewed. Regional cancer centres also increased peer reviews of palliative radiation.
• New courses are helping healthcare providers to build their knowledge and skills in cancer. Over 300 healthcare professionals are enrolled or have completed one of the courses we developed in partnership with the de Souza Institute and University of Toronto, on:
  • the safe administration and care in chemotherapy/biotherapy, for community healthcare professionals
  • assessing and educating patients on oral treatments for cancer
  • Essentials of Oncology and Advanced Oncology for pharmacists
• An updated algorithm is providing healthcare professionals with best-practice guidance to help them assess and manage pain in patients with cancer. It also includes new guidance on cannabinoids and opioids.

Equity

• We partnered with First Nations, Inuit and Métis and urban Indigenous communities and Regional Cancer Programs to create and implement the third Aboriginal Cancer Strategy. This strategy promotes a holistic approach to cancer education, prevention, screening and research.
• Path to Prevention: Recommendations for Reducing Chronic Disease in First Nations, Inuit and Métis provided 22 evidence-based recommendations to address modifiable risk factors for chronic disease in these communities. Many organizations are working together make sure all recommendations are underway by 2019.
• Healthcare professionals are learning about cultural competency, conflict resolution, human rights and anti-racism from our 13 Aboriginal Relationship and Cultural Competency courses. Since 2015, there have been more than 24,650 course completions (over 4,200 people).
• The Aboriginal Tobacco Program provides commercial tobacco prevention, cessation and protection support to First Nations, Inuit and Métis and urban Indigenous community members and healthcare providers. The program has supported over 15,000 community members in their journeys to quit (or never start) smoking.
• More patients in need of complex malignant hematology services (patients with acute leukemia and/or requiring stem cell transplant) are able to access timely care. Cancer Care Ontario is working closely with the Regional Cancer Programs to implement the Acute Leukemia Provincial Plan. Hospitals are building additional capacity for future services. Funding is being provided to train 15 acute leukemia and stem cell transplantation fellows, as well as specialized nurses.
• Patients requiring stem cell transplant are provided with local accommodation if they must travel over 100 kilometers for their care. This is to mitigate the substantial out-of-pocket costs associated with the nature of the therapy and the need to be close to a specialist hospital for a lengthy period of time.
• The Ontario Cancer Profiles tool was launched in 2017. Researchers, public health planners and others can get a clearer picture of cancer across Ontario and at the regional level. The tool provides statistics on select cancer burden, risk factors and screening indicators.
• The Cancer Screening Participation Gap Map, also available since 2017, is an interactive online tool that supports identification of at-risk and under never screened neighborhoods. It provides aggregated statistics of people overdue for each of the 3 cancer screening programs (Colon Cancer Check, Ontario Cervical Screening Program, Ontario Breast Screening Program).

Integrated Care

• We are helping cancer survivors transition from oncologists to primary care when appropriate. We identified the essential information that should be included in the patient’s follow-up care plan. This model of care makes best use of healthcare professionals’ roles. A recent study supported by CCO concluded that transitioning care for low-risk breast cancer survivors from oncologists to primary care practitioners was associated with fewer costs and similar or better health outcomes.
• Expert recommendations are promoting the effective integration of clinical nurse specialists and nurse practitioners in the delivery of adult cancer services in Ontario.
• As a lead partner in the Ontario Palliative Care Network, which was launched in 2016, CCO is working with regional partners to identify and ensure services to patients who would benefit from a palliative approach to care, along with their families and caregivers. Through a program offered by the Ontario College of Family Physicians, more than 100 healthcare providers are being mentored to provide palliative and end-of-life care, increasing the system capacity for these services.
• The Childhood Cancer Care Plan: A Roadmap for Ontario 2018–2023 is helping survivors of childhood cancer transition to adult care. We supported the creation of the plan, which was led by the Pediatric Oncology Group of Ontario.
• Diagnostic Assessment Programs ensure that testing for a definitive diagnosis or rule out of cancer is done in a timely, coordinated way. As of 2018, there were 19 lung, 16 colorectal and 10 prostate Diagnostic Assessment Programs across the province.

Sustainability

• We are working with our partners to prevent chronic disease by decreasing the number of people with modifiable risk factors. We focused on implementing Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario, which we developed with Public Health Ontario.
• Several published reports are contributing to a deeper understanding of cancer risk factors and other chronic diseases at the regional levels. These include Cancer Risk Factors Atlas of Ontario and the Prevention System Quality Index.
• More Ontarians are learning what steps they can take to reduce their cancer risk. As of March 2019, over 1,195,994 sessions of MyCancerIQ were started and over 482,020 risk assessments were completed.
• More cancer patients are being screened at regional cancer centres for tobacco use and are accepting referral for smoking cessation counselling. Health outcomes are better when people with cancer quit smoking.
• Eligible women across Ontario are experiencing the full benefits of an organized, high-quality breast screening program at more than 200 Ontario Breast Screening Program sites.
• We developed the fifth Radiation Treatment Capital Investment Strategy. It provides a 10-year view of the additional machines required to meet the growing need for radiation treatment.
• An additional 118 radiation, gynecology, medical oncology/hematology and complex malignant hematology specialists are offering care to patients across Ontario.
• We developed a draft framework to incorporate real-world evidence into provincial and pan-Canadian cancer drug funding decision-making.

Effectiveness

• Working to deliver the most effective care for patients, healthcare professionals from multiple disciplines reviewed the diagnosis and treatment options for 90% of cancer patients at Multidisciplinary Cancer Conferences (as reported in 2017/18).
• Quality-Based Procedures funding for surgery, systemic treatment and gastrointestinal endoscopy is helping to standardize the delivery of services based on evidence-informed practice. This model uses limited resources more efficiently.
• We advanced the Personalized Medicine Strategy in Ontario by completing a current state assessment report of clinical cancer genetic services in Ontario. We have developed and submitted to the Ministry recommendations for comprehensive hereditary cancer testing in Ontario.
• Since June 2017, people at high risk for lung cancer can receive screening, risk assessment, smoking cessation and other support at 3 pilot sites. In the first year of screening, over 4,300 people were screened, and 92% of eligible current smokers accepted in-hospital smoking cessation services.
• Since 2015, more than 110 guidelines and other evidence-based guidance documents have been completed and published on the Cancer Care Ontario website by the Program in Evidence-Based Care. These documents help clinicians and policy makers to apply the best scientific evidence in practice and policy decisions.
• In 2018, our mandate expanded to include management of all Positron Emission Tomography scanning and formal system planning, including capital planning. We developed a planning framework to provide equitable access to high quality Positron Emission Tomography technology.