In 2014/15, we collaborated with partners to lead change across the system and improve cancer control in Canada.
Progress in Action
Strategy in Action
Click on an icon to discover how the cancer strategy is advancing.
- Diagnosis & Clinical Care
Click on an icon to learn about the priority area’s highlights for the year.
- Diagnosis & Clinical Care
- Person-Centred Perspective
- First Nations, Inuit and Métis
- System Performance
- Knowledge Management
- Public Engagement & Outreach
Coordinated approach to cancer screening
It took 50 years to establish cervical screening programs across Canada. And 10 years to implement breast screening. Colorectal screening happened in three.
That’s the power of collaboration.
Colorectal cancer is the second leading cause of cancer deaths in this country. In 2015 alone, more than 25,000 Canadians will be diagnosed with colorectal cancer and an estimated 9,300 will die from it.
The good news is that screening can help prevent colorectal cancer or catch it early when it is highly treatable. Screening requires a simple stool (fecal) test followed by a colonoscopy if microscopic blood is detected in the stool.
However, implementing a population-based screening program is complex and given the nature of Canada’s health system, programs often vary across the country. In 2007, only three provinces had plans to establish colorectal screening programs.
To facilitate expanded development and program evaluation, the Partnership created the National Colorectal Cancer Screening Network—a collaboration that brought together cancer experts; provincial, territorial and national partners; and patients and families. Its role was to review the evidence, understand the reasons for gaps in screening across the country and determine how to incorporate best practices in the design and delivery of new and existing programs.
This coordinated approach paid off. Rather than duplicating time-intensive work, provinces and territories were able to incorporate the Network’s findings quickly. By 2010, programs were planned or in place in 10 provinces and one territory.
An added benefit of the joint approach was better harmonization of data collection, which allows the effectiveness of provincial screening programs to be tracked and compared. And through their participation in the Network, programs continue to learn from each other. Screening program approaches are fine-tuned, best practices identified and the latest research findings incorporated. It’s a successful model that is now being applied to other areas of screening; the Partnership has also convened experts from across the country to consider new evidence on lung cancer screening in high-risk populations.
But the true success of the collaborative approach is reflected in the numbers. A report from the Partnership shows that in 2012, 44 per cent of Canadians aged 50-74 reported they were up-to-date with their colorectal screening. That’s a substantial jump from 32 per cent only four years earlier.
And while the ultimate impact of these improved rates of screening can only be measured over time, this much we know: fewer Canadians will develop colorectal cancer and fewer will die from it.
“Working with peers coast-to-coast provided opportunities to collectively analyze screening options, share lessons learned about program rollout and accelerate the process in places still in the earliest phases of implementing population-based colorectal screening. That saves time and valuable health care resources.”
Dr. Winson Cheung, Chair, Colorectal Cancer Screening, Monitoring & Evaluation
2015 marks the first year of a new Partnership initiative that brings together the tobacco control and cancer control communities to better integrate their efforts and resources to help cancer patients quit smoking. Smoking is the number one cause of cancer and recent research shows that tobacco use by cancer patients reduces the effectiveness of their treatment and their likelihood of survival.
The Prevention Policies Directory has published more than 2,200 policies in Canada’s only searchable database of policies and laws related to all of the modifiable risk factors for cancer and chronic disease. The Directory is a valuable resource for public health professionals, policy-makers and academics working to create healthier communities through evidence-informed policies.
In just two years, the Partnership’s CLASP (Coalitions Linking Action and Science for Prevention ) Initiative has influenced 1,722 practice changes and 60 policy changes focused on cancer prevention. Examples include creating a “prevention practitioner” position in primary care offices to work one-on-one with patients to help them adopt lifestyle changes and regular cancer screening, and adopting policy changes to support healthy built environments that encourage walking and cycling.
The Partnership’s newly released Lung Cancer Screening Framework for Canada provides guidance to provinces and territories that are considering the advisability and feasibility of early detection programs for populations at high risk for lung cancer. A total of 48 partners and experts from all 10 provinces and three territories contributed to the framework.
Colorectal cancer is the second leading cause of cancer death in Canada. But screening can help prevent colorectal cancer or catch it early when it is highly treatable. With support from the Partnership’s National Colorectal Cancer Screening Network, 10 provinces and one territory now have screening programs planned or in place. Colorectal Cancer Screening in Canada: Monitoring & Evaluation of Quality Indicators—Results Report, January 2011–December 2012 provides an update on how well these screening programs are performing against national targets in areas such as participation rates and wait times for follow-up colonoscopies.
In their own words: Margaret Tompson
Margaret Tompson’s first awareness of the value of clinical trials was as a young occupational therapist testing hand function.
It was a double-blind study on Levodopa, a drug used to treat Parkinson’s disease, and she saw some incredible results. Her next encounter with a clinical trial was as a newly diagnosed patient with breast cancer.
“I was in shock from the diagnosis,” she remembers. She didn’t know what to ask or where to go for answers. But as her mind settled, her researcher instincts took over. She scoured the public and medical libraries, educating herself about treatment options and guidelines.
When she first saw her surgeon, she told him she wanted a lumpectomy. However, on receiving the pathology results, she told him she wanted the more aggressive treatment option, a bilateral mastectomy.
“He made me argue and prove that it was medically correct,” she laughs. He had arrived at the same conclusion given her family history, but was curious to hear her rationale. “We had a real partnership and it was wonderful.”
During her treatment, Margaret was offered the chance to join a clinical trial to test “TAC,” a combination of chemotherapy drugs used to treat breast cancer after surgery.
Joining the trial was a “no-brainer,” Margaret says, since it was a chance to try out a new drug at Phase III, when it had already cleared the hurdle of proving both safety (Phase I) and proper dosage (Phase II). Phase III trials seek to firmly establish efficacy and monitor for side effects.
“I was really pleased to be in a trial,” she says. “I had a feeling I got better care because of the longer period of close monitoring. Now I encourage patients to see if they’re eligible for a clinical trial and to explore this option because of its benefits.”
Unfortunately, not everyone sees clinical trials in such a positive light. Adult clinical trial participation rates in Canada are low at less than five per cent of cancer patients.
In contrast, the United Kingdom has the highest rate of cancer clinical trial participation worldwide at more than 12 per cent, the result of a concerted national effort to raise clinical trial participation by supporting trial centres.
Several population-based studies show that patients who were treated in cancer centres with active clinical trial programs had health outcome advantages such as improved survival. This is likely due to better processes and delivery of care, including treatment guideline concordance.
Margaret Tompson is a retired occupational therapist living in Saskatoon, Saskatchewan. She participated as a patient advisor with the Partnership’s Breast Cancer Screening “Wait Time” workshop.
Choosing Wisely Canada is a campaign by the Canadian Medical Association to help physicians and patients engage in conversations about potentially unnecessary tests, treatments and procedures. This year the campaign released its list of 10 commonly used practices in cancer diagnosis and care that are low value, unnecessary or harmful. Developed by a task force of experts convened by the Partnership, the list will help physicians and patients make wise choices that lead to better care.
A project with centres in Alberta, Manitoba, Ontario and Nova Scotia demonstrated that using a standardized electronic template to collect surgical information saves time and improves patient care. In the Partnership’s Synoptic Surgery Reporting Initiative Benefits Evaluation: Final Report , 65 per cent of participating surgeons reported that the standardized capture of information improved clinical decision-making. Discharge summaries were also faster and more comprehensive. Work continues to expand electronic synoptic reporting across the country.
Over the next year, more than 1,000 paramedics in Nova Scotia and Prince Edward Island will be trained in palliative pain and symptom management in order to help palliative cancer patients avoid unnecessary trips to emergency departments. The project is one of 15 Partnership-funded projects across the country that are focused on improving the patient experience.
With the support of the Partnership’s Patient Experience and Patient-Reported Outcomes Initiative , eight provinces have implemented a standardized tool that screens cancer patients for distress. The tool gathers information on symptoms such as fatigue, pain, depression and anxiety that can affect a person’s ability to cope. Screening for distress allows patients and clinicians to develop a personalized care plan to address individual needs and improve quality of life.
The Canadian Partnership for Tomorrow Project (CPTP) has now opened its data to researchers around the world. 300,000 Canadians aged 35-69 have volunteered to share information about their health, lifestyle and behaviour with CPTP making it Canada’s largest population health platform. It’s also one of a handful of globally significant cohorts that will help researchers solve the question—why do some people develop cancer and chronic diseases and others don’t?
The Partnership is one of eight funding partners behind the Canadian Cancer Clinical Trials Network. The Network plans to double participation in cancer clinical trials in Canada to more than 10 per cent of all cancer patients.
The Partnership has released three reports that highlight the cancer journey of First Nations, Inuit and Métis peoples and provide the first-ever baseline against which progress can be measured. The most recent report, Métis Cancer Control in Canada Baseline Report , examines issues such as accessing cancer care in rural and remote communities, financial burden and lack of trust and confidence in the cancer care system.
In their own words: Bill Blackwater
Bill Blackwater considers himself one of the lucky ones, despite a diagnosis of renal carcinoma in 2002.
When family and friends learned of his illness, Bill found an endless supply of support. He knows many others living around his Kispiox community in the Gitxsan region of northern British Columbia are not always so fortunate.
In fact, when a friend received his own cancer diagnosis, Bill began noticing a curious thing: people seemed to shy away from the man. They went silent when he talked about his treatments. It was almost as though people were ashamed or embarrassed for him.
“They were scared,” he says. So for three months Bill lobbied the local public health nurse to start a cancer awareness program, with the aim of taking the taboo out of a diagnosis.
Since then, Bill, who worked in a salmon hatchery for 30 years, has become a committed advocate for better cancer care.
Although he has deep links with the cancer community, helping to shape the cancer control strategy for northern B.C., he has only recently become involved with the Partnership’s work in First Nations, Inuit and Métis communities, attending a symposium and then signing up to volunteer as a patient advisor.
His vision for the future of cancer care for First Peoples is to see better relationships develop between patients and physicians. His own experience of living with symptoms for more than 10 months taught him that sometimes clinicians are prone to wait rather than investigate.
With First Peoples, he notes, the patient-physician relationship must extend beyond the individual, encompassing their families too. That’s something some physicians have been slow to recognize and accommodate.
The province is already making positive strides, he says, introducing an Aboriginal liaison to help individuals navigate through the cancer care system.
But Bill also envisions a future where traditional and Western medicine work better together to offer a patient comfort and reprieve.
“We’d like to let the mainstream medical society know that we do want to do what you say, but we’d also like you to take a look at what we have,” he says.
First Peoples are often told to forgo traditional treatments in favour of Western drugs, with physicians raising concerns of negative interactions between the two. But advice should be guided by evidence, Bill says. Any potential for interference in the effectiveness of treatments should be studied and understood.
At the very least, traditional ways should be considered.
“Sometimes that’s as simple as bringing in a cedar bough, which is special to the Gitxsan people,” he says. “That’s enough for some people.”
Bill Blackwater was instrumental in the development of a cancer strategy for northern British Columbia.
Thanks to the investment and efforts of the Partnership and Canada’s cancer agencies, nine provinces are collecting stage data for over 90 per cent of breast, colorectal, lung and prostate cancer cases (the most common cancers). The data provides clinicians and patients with powerful information to help plan care and predict outcomes. Policy-makers gain a new tool to help them determine where to invest for positive impact—screening and early detection or better access to improved treatment. The Partnership released the first analysis of the pan-Canadian data in Cancer Stage in Performance Measurement: A First Look.
The 2015 Cancer System Performance Report included 17 “dashboard” indicators that provide information on how well we are doing across the country in key areas of cancer control from prevention, screening, diagnosis and treatment through to survivorship and end-of-life care. Targets have been assigned to many of the indicators and provinces have been comparing their results to identify opportunities for system improvements.
The Partnership’s 1in3 cancerview digest published eight issues of evidence-based information on topics ranging from cancer in adolescents and young adults to smoking cessation to radon gas exposure in homes and workplaces. The digest summarizes the latest evidence and provides resources to help health professionals connect evidence and practice in novel ways.
Analytically Yours is a new online interactive space launched by the Partnership to support collaboration and the exchange of knowledge among cancer data analysts in Canada. Analysts can download resources and training tools, connect with peers, ask questions of experts and find information on conferences and career postings.
In their own words: Rhonel Biddy
Rhonel Biddy came to Canada with her sister’s children, intending to stay just long enough for her nieces to get settled with their mom. Then her sister, only 30 at the time, was diagnosed with breast cancer.
“That sort of changed the entire course of my life – and theirs as well,” she says. After four years living with the disease, her sister passed away.
Rhonel remembers how little information they had, and how little they knew about where to find the right information. That ultimately drove her to seek out a career working as a health records specialist.
“For a long time I wanted to get involved and do something to give back to the health care system and to maybe help others who were in the same position that we found ourselves. I could never really find anything that I wanted to do that felt enough for me,” she says.
Then, Rhonel saw an opportunity to become a patient and family advisor with the Canadian Partnership Against Cancer and jumped at the chance.
At the Partnership, Rhonel volunteers with the steering committee for the Coordinated Data Development Initiative. The initiative is designed to build capacity across the country to analyze, use and report data effectively. Cancer control data is crucial for planning, management, policy development and research, something Rhonel knows from first-hand experience.
“It is important because in order for you to know how you’re doing, where you are, what you might need to improve, you need to measure. And in order to measure, you need to have that data.”
Rhonel’s voice on the committee is one that reminds all members that patients have a stake in their information too.
Having pan-Canadian statistics on cancer treatment is necessary for system planning, but patients and families need the information presented in a way that makes it easily understood and useful for the decisions they’ll be making, she says.
“Sometimes what’s lost is that individual patient,” she says. “The person can get lost in the numbers. It’s difficult to see, sometimes even myself, trying to think of it from a professional standpoint. You have to pull yourself back and ask, ‘This is important to the patient, how can we use this information?’
“I firmly believe understanding the lived experiences of patients and families are vital to creating a system that puts the patient first,” she says.
Rhonel Biddy is a health records specialist in Toronto, Ontario who acts as a patient and family advisor to the Partnership’s Canadian Data Development Steering Committee.
In celebration of World Cancer Day 2015 , the Partnership hosted federal Health Minister Rona Ambrose and experts from across Canada in an exploration of innovations across the cancer continuum. The Partnership also released results from its recent national public poll. Top result: 94 per cent of respondents support a national strategy to reduce the burden of cancer.
In their own words: Bob Aldridge
In late 2011, Bob Aldridge went to his Winnipeg family doctor complaining of a sore throat. He went back after he began struggling to eat certain foods, like bagels, having developed a difficulty with swallowing. After a late February 2012 consultation with an ear, nose and throat specialist who made a referral to CancerCare Manitoba, Bob went back to his family physician again, worried that the time between appointments was stretching too long.
This time his doctor noticed an alarming change in his voice.
Tests revealed a sizeable growth. Within 10 days, Bob and his wife, Cathy, had their first meeting with a surgical oncologist at CancerCare Manitoba. About a month later, they were meeting with a team of health care professionals – a medical oncologist, radiation oncologist, dentist, research specialist, speech therapist and dietitian – all focused on the invasive squamous cell carcinoma at the base of his tongue.
Surgery was not an option. Instead, Bob underwent eight weeks of chemotherapy and 35 sessions of radiation. “Other than the normal side effects, I tolerated the treatments quite well. It was after treatment ended that my life got much more difficult,” he says.
By then, Bob was already eating most of his meals through a PEG (stomach) tube; he’d developed ulcers in his mouth that were so painful he could barely tolerate even water. These problems paled by comparison when he began waking up in the night feeling like he couldn’t breathe. It was discovered his airway had closed to only 10 per cent of its usual capacity. He was sent home with a tracheal tube, which needed rigorous care and maintenance.
“It made life kind of difficult,” he says with understatement. “I was mostly housebound.” He would venture out for walks, but feeding through the tube took hours. The tracheal tube was in place for more than three months.
From the outset, Bob and Cathy – whose unwavering support was key to his journey – adopted the attitude that although Bob’s treatment options were limited, they had to believe that chemotherapy and radiation would be successful. They demonstrated their confidence by booking a cruise to Alaska for one year later – a trip the entire family made with Bob still moving slowly but back to gingerly swallowing soft foods.
The trip symbolically marked the start of a “new normal.”
“I’ll never be back to the way I used to be, but I am living a fairly normal life,” he says. He’s still very careful about what he eats and, more importantly, how he eats it to avoid aspiration.
“Normally you don’t have to think about these things. Now it is important that I do,” he says.
Although he’s had no signs of cancer for nearly three years, Bob is still actively involved in the cancer system, offering to support newly diagnosed patients and eagerly advising on Manitoba’s “In Sixty” initiative, which aims to move individuals from tests to treatment within 60 days. “Some of us know too well the agony of having to wait for answers,” he says.
Bob Aldridge is a communications volunteer with the Partnership. He and his wife, Cathy, live in Winnipeg, Manitoba where he is also a volunteer with Manitoba’s “In Sixty” initiative.
Improved data collection
When dealing with cancer, better data mean better decisions—and better care.
For clinicians, the information provided by surgery and pathology results is critical to providing high quality care. In particular, knowing the stage or extent of the cancer helps clinicians identify the best treatments for their patients and predict the likely course of the disease.
Stage data is equally valuable when captured at a system level, and accessing it is now much easier thanks to the efforts of cancer agencies across Canada and a $20 million investment by the Partnership. Today, nine provinces are collecting stage data in a consistent electronic format for over 90 per cent of breast, colorectal, lung and prostate cancer cases (the country’s most common cancers).
This achievement allows comparative analysis of stage data across the country, providing the foundation for better policy and resource allocation decisions at a system level. For example, decision-makers will be able to determine whether increased investments in screening and early detection programs are resulting in more people being diagnosed at an earlier stage and lower overall mortality rates.
The Partnership is also playing a leading role in supporting the transition to standardized reporting, known as synoptic reporting, to further advance the use of data in clinical and system decision-making.
Traditionally, surgery and pathology (tissue sample) reports have been narrative in format. Too often, this has resulted in missing information, misinterpretation and treatment delays. Synoptic reporting provides a data field and standardized format for each type of information, resulting in more accurate, complete reports that can be transmitted electronically—and much faster.
The benefits of the shift to synoptic reporting across the country are already evident for patients, clinicians and the health care system. A recent evaluation co-funded by the Partnership showed that surgical reports were generated faster when clinicians used electronic synoptic reporting: 75 per cent of reports were posted to patient charts within 24 hours compared to 15 per cent when traditional narrative reporting was used. And at a system level, data can be extracted and analyzed in a way not possible before. As a result, important conversations about best practices, effectiveness and quality improvement are taking place across organizations and jurisdictions as gaps in quality of care are identified.
The path forward is clear. Improving the collection, reporting and analysis of data will improve the quality of cancer care for all Canadians.
“Standardizing surgical data collection makes it easier to assess the quality of the care we are providing and see what needs improvement. An electronic checklist, or synoptic report, can also act as a reminder to follow agreed best practices.”
Dr. Jason Park, a surgical oncologist at Winnipeg’s St. Boniface General Hospital and CancerCare Manitoba whose clinical focus is surgery for complex colon and rectal cancers
Canada’s largest population health research platform
Canada stepped onto the international stage this year as this country’s largest population health research platform opened its data to researchers around the world.
Thanks to its size and comprehensive data, the Canadian Partnership for Tomorrow Project (CPTP) is one of a handful of population cohorts with global significance and a powerful resource for researchers as they search for new ways to detect and treat disease.
Three hundred thousand Canadians aged 35-69 have volunteered to provide information about their health, lifestyle, environment and behaviour. In addition, significant subsets of participants have provided physical measures (e.g., height, weight, waist circumference and blood pressure measurements) and biological samples (e.g., blood samples, toenail clippings, urine samples and saliva). The result is a rich research tool—one that positions Canada as a leader in longitudinal and chronic disease research and greatly strengthens this country’s research competitiveness.
The Partnership connected scientific leaders from across Canada to create the CPTP, and it represents the Partnership’s single largest investment. The project brings together five regional population cohorts: BC Generations Project, Alberta’s Tomorrow Project, the Ontario Health Study, Quebec’s CARTaGENE project and the Atlantic PATH.
The benefits of this joint effort are many. The sheer size of the CPTP cohort could save researchers a decade of time spent recruiting subjects, and the longitudinal data will allow them to gain a better understanding of diseases like cancer that take many years to develop. Through CPTP, researchers will have the opportunity to explore links between factors such as an individual’s health, lifestyle history, exposure to environmental toxins, and genetic makeup with the risk of onset of cancer and chronic diseases. The data could also help shed new light on the factors that contribute to regional disparities in cancer and chronic disease rates. And because participant data can be linked to administrative health records, researchers will also be able to study the effectiveness of policies and practices intended to improve disease prevention and management.
As the data grows, the value of the research platform will continue to increase. Researchers will be able to obtain information on how the health of participants changes over time. And there is the possibility of gathering information in additional areas (for example, mental and cognitive health or occupational and residential history).
With such potential, CPTP provides hope of new discoveries that will improve the health of all Canadians—now and into the future. Let the research begin.
“Really, the value of the cohort increases over time. The longer you wait, in fact, the value increases. In 10 years this is going to be extremely valuable, in 20 years, this is going to be a gold mine. So while it’s difficult to judge the value now to research, in the future it’s going to be a tremendous resource.”
Dr. John Spinelli, Principal Investigator, B.C. Generations Project
A vision becomes reality
In our first five years, 2007-2012, the Partnership enabled cancer control efforts across the country by bringing together cancer survivors, patients and families, as well as clinical experts and government representatives. Knowledge translation was central to our work – helping to move what is known about cancer control into action across the country and helping to fill key knowledge gaps.
Canada’s Cancer Control Strategy
The Partnership evolved from the Canadian Strategy for Cancer Control – a volunteer-driven coalition of cancer experts, patients and survivors that drafted Canada’s first national cancer control plan and advocated successfully for its funding.
The coalition’s vision for a coordinated, pan-Canadian strategy led the federal government to announce the creation of the Canadian Partnership Against Cancer, which began operations in April 2007. The federal government created the Partnership with an initial five-year mandate to implement this national cancer control strategy, as well as to assess whether this model was an effective model for improving cancer control in Canada.
Details about each of the initiatives in the first mandate are available through each annual report.
View the progress and annual reports from 2007-2012