Regional Models of Care for Systemic Treatment: Standards for the Organization and Delivery of Systemic Treatment

Guideline Objective

This document presents a practical framework and standards to guide the delivery of systemic treatment Ontario-wide, that is, within cancer-centres, and in facilities beyond the confines of regional cancer centres. The primary goal is to provide safe, evidence-based systemic cancer treatment, maximizing the efficient use of resources and employing the principle of person-centered care with an emphasis on providing care as close to home as possible. Service provision, complexity of care, safety, accessibility, and quality care across all levels defined by the patient, organization, and system perspective, as well as appropriateness, transparency, and accountability have been considered. Both education and research are integral due to their important roles in safety and quality improvement. 

Patient Population

All adult patients with cancer who are receiving systemic treatment.

Intended Guideline Users

The standards in this guideline apply to the organization and structure of systemic treatment programs in Ontario. They apply to all institutions and programs delivering ambulatory systemic treatment within the province of Ontario. 

Research Questions

What is the best way to organize the delivery of ambulatory systemic treatment in Ontario? Specifically, what has been published or implemented in other jurisdictions that can inform the following aspects of delivery of systemic treatment:

1. Safe delivery of systemic treatment
   • Staff numbers to safely deliver systemic treatment (double checks, volumes of oncology patients per nurse, volumes of systemic treatment doses/patients prepared per pharmacy technician, volumes of systemic treatment doses/patients verified per oncology pharmacist)
   • Validated teaching tools for oral systemic treatment
2. Requirements of health care providers to be sufficiently skilled and maintain competency (volume of oncology patients per nurse, volume of systemic treatment doses/patients prepared per pharmacy technician, volume of systemic treatment doses/patients verified per pharmacist)
3. Health care providers and their roles
   • The role of oncologists/hematologists, general practitioners in oncology, and nurse practitioners in prescribing systemic treatment