Enhancing cancer control in Canada. The cancer system is evolving. Together, we're leading the change.
Effective, Efficient, Evolving
Strategy in Action
Click on an icon to discover how the cancer strategy is advancing.
- Diagnosis & Clinical Care
- Knowledge Management
Click on an icon to learn about the priority area’s highlights for the year.
- Diagnosis & Clinical Care
- Person-Centred Perspective
- First Nations, Inuit & Métis
- System Performance
- Knowledge Management
- Public Engagement & Outreach
Cancer patients who quit smoking can increase their chances of survival and lower their risk of dying from cancer by 30 to 40 per cent. But smoking cessation programs are rarely offered to patients in cancer care settings, even though research shows many want help to quit. To address this gap, the Partnership is funding seven provinces and two territories to build or expand the cancer system’s ability to provide cancer patients with support to quit smoking—when they need it most.
The athletes’ village built for the 2015 Pan Am/Parapan Am Games in Toronto created a neighbourhood designed to get people walking, biking and taking public transit. That’s good news for cancer prevention, because an active lifestyle can help to reduce the risk of cancer. To design the neighbourhood, planners used a customized tool traditionally used by urban planners to analyze how various community features could support active living. The Partnership helped to fund the assessment through its Healthy Canada by Design program, a Coalitions Linking Action and Science for Prevention (CLASP) project. It’s a model for the future: healthy neighbourhoods make healthy Canadians.
The Lung Cancer Screening Network developed the Lung Cancer Screening Framework for Canada in 2014 in response to emerging evidence and in anticipation of new Canadian guidelines on lung cancer screening. Those guidelines have now been released by the Canadian Task Force on Preventive Health Care. Used together, the framework and guidelines provide provinces and territories with the necessary tools to consider the implementation of lung cancer screening programs. The guidelines recommend low-dose CT scans for adults at high risk of lung cancer, but only in health care settings with expertise in early diagnosis and treatment of lung cancer. They also recommend that additional research be done on issues such as how often screening should take place.
The Partnership hosted a gathering of cancer screening experts, researchers and community groups to take first steps toward a national framework that will improve access to breast, cervical and colorectal screening among underserved populations. Participants recommended that the Partnership focus on enhancing participation among low-income populations, which have significantly lower screening rates than high-income Canadians.
In their own words: Dr. Natasha Leighl
Dr. Natasha Leighl is the President of Lung Cancer Canada.
Smoking cessation in cancer care
Cancer patients who quit smoking can lower their risk of dying from cancer by a startling 30 to 40 per cent. And research shows that most want help to quit. But few are offered smoking cessation programs by their cancer care team. The Partnership is working to change that.
A new initiative by the Partnership is funding seven provinces and two territories to build and expand the cancer system’s ability to support cancer patients who want to quit.
The stakes for patients are high. Many treatments are less effective if a person continues to smoke, and the likelihood of complications and death is higher. As a result, researchers have found that quitting can be just as beneficial as some of the latest cancer therapies.
Tobacco is addictive. Quitting—and holding to it—is tough. And health professionals don’t always know how to communicate the benefits of quitting, or where to refer patients for support.
Partnership funding will help provinces and territories to begin to address these issues. Some provinces will use the funding to evaluate the long-term effectiveness of existing approaches. Others will enhance their systems by finding better ways to identify patients who would like help to quit or by equipping cancer care professionals with the skills to support patients in their efforts.
Still others will develop new approaches to increase access to smoking cessation support. For example the Northwest Territories and Nunavut will focus on ways to provide culturally relevant smoking cessation strategies in remote communities so that patients can access support after they return home from cancer treatment. Nunavut has the highest smoking rate in Canada—62 per cent of residents over the age of 12 smoke—so better options are needed.
This initiative marks the first time that Nunavut is partnering with the Partnership on a funded project and reflects the strength of the Partnership’s collaborative model. It’s a model that promotes collective action to bring about sustainable change. By working together, governments and cancer agencies—in all parts of the country—can learn from and support each other’s efforts to integrate smoking cessation into cancer care.
Most important of all, cancer patients will get support to make a change that can significantly help their recovery.
In their own words: Frankie Best
Frankie Best is the Tobacco Reduction Specialist with the government of Nunavut. The territory’s participation in the Evidence-Based Tobacco Cessation as a Cancer Care Quality Improvement Project is the first collaboration on a funded project between the Partnership and Nunavut.
Finding solutions to system-wide issues
How do we know if our cancer system is working effectively? And if it isn’t, how do we fix it?
Canada’s cancer control system is complex, and a large and varied group of stakeholders share responsibility for its quality and sustainability: provincial and territorial governments, cancer agencies, hospitals and provider organizations, and physicians and health care professionals.
In this context, the Partnership’s system-wide perspective on all aspects of cancer care is not only unique—it’s essential. This bird’s eye view allows the Partnership to look across the entire country, analyze what is working well and work with our partners to find solutions where it isn’t.
Just as important, the Partnership actively facilitates ongoing dialogue and problem solving with stakeholders across the system. Partnership reports are key to these discussions, providing provinces, territories, health care organizations and clinicians with the evidence they need to make improvements at the system level and in day-to-day clinical practice.
For example, a review of high-risk cancer surgery discovered significant variations in surgical care and patient outcomes across the country. The report findings have paved the way for a larger conversation about how and where complex cancer surgeries should take place—including the role of regional centres—and the need to better integrate surgical care within the cancer control system.
Another important discussion is taking place following the release of new Canadian standards for electronic synoptic reporting of cancer surgery. The standards are the result of a multi-year effort by the Partnership, surgeons, and provincial and national partners and will allow surgical data and outcomes to be consistently reported and compared across hospitals and provinces. As work continues to expand synoptic reporting across the country, the standards are leading to the review of best practices and quality improvement at both the system and clinical level. For example, surgeons in four provinces are now comparing their data to determine how well surgical procedures are following established guidelines and to develop a better understanding of complication rates.
Conversations about best practices are also taking place as the result of a new report on quality and sustainability. The report revealed that Canadian cancer patients undergo an estimated 770,000 interventions each year that may be harmful or of little value. The report, which compares clinical practice patterns from across the country with recommendations from Choosing Wisely Canada, provides clinical leaders with important evidence to engage their colleagues in discussions on how to reduce unnecessary tests and procedures.
To be sustainable, the cancer system must continue to evolve. Above all, it must deliver on the promise of better cancer care. By identifying where improvements are needed and engaging each other in finding solutions, the Partnership and its partners will ensure the cancer system does both.
In their own words: Dr. Christian Finley
Dr. Christian Finley, a thoracic surgeon at St. Joseph’s Health Centre in Hamilton, is the lead author of Approaches to High-Risk, Resource Intensive Cancer Surgical Care in Canada. He is also Expert Lead, Clinical Measures at the Partnership.
A study of high-risk cancer surgery released by the Partnership revealed significant variations in surgical care and patient outcomes across the country for esophageal, pancreatic, liver, lung and ovarian cancers. The findings of Approaches to High-Risk, Resource Intensive Cancer Surgical Care in Canada have opened the door to larger conversations on how and where complex cancer surgeries should take place (including the role of regional centres) and the need to better integrate surgical care within the cancer control system.
The accreditation process for Canadian health care organizations now includes radiation treatment standards for cancer treatment, thanks to the work of the Canadian Partnership for Quality Radiotherapy and Accreditation Canada. Health care providers across the county will be held accountable to the new national radiation treatment standards beginning in 2017. The standards will help organizations assess quality at the point of care, bring more consistency to treatment and ensure that all patients receive high quality and safe radiation therapy.
In their own words: Stephen Murray
Stephen Murray is the Electronic Synoptic Pathology Reporting Initiative project manager in Prince Edward Island.
Symptoms like fatigue, pain, anxiety and depression can profoundly affect a person’s cancer experience. The Partnership is supporting the use of Patient Reported Outcomes (PROs)—standardized questionnaires that gather information on various symptoms—to help health care teams create a personalized care plan for each patient. To promote the use of these questionnaires among patients and health-care providers, the Partnership has developed short animated videos for use in hospital and clinic waiting rooms across the country.
In their own words: Janice Howes, System Partner
To provide effective person-centred care, health care practitioners need to know and understand more than a patient’s physical symptoms. A patient’s emotional, psychological and practical needs are just as important.
“If patients let us know how they are doing in these areas, then as clinicians we can provide better service to help meet their needs and concerns,” says Dr. Janice Howes, Psychosocial Oncology Clinical Lead, Cancer Care Nova Scotia, Nova Scotia Health Authority.
That’s why Nova Scotia has been implementing the collection of Patient Reported Outcomes (PROs) across the province. PROs use standardized questionnaires to gather information on a wide variety of symptoms.
“It’s very important for patients to understand that there are clinical services available to help them cope with concerns such as worry, anxiety, sadness, depression, practical and financial issues, fatigue, and pain—and for them to be able to access that help,” Dr. Howes says.
“By measuring Patient Reported Outcomes, we are providing information to better understand the impact and burden of cancer, to help meet individual patient and family needs, and to work toward improving clinical services for all cancer patients.”
Dr. Janice Howes is the project lead for the Atlantic Patient Reported Outcomes (PROs) project. She is Psychosocial Oncology Clinical Lead, Cancer Care Nova Scotia and a psychologist with QEII Health Sciences Centre, Nova Scotia Health Authority in Halifax.
In their own words: Anya Humphrey, Patient and Family Partner
“I almost fell apart,” she remembers. “I couldn’t have told him what it was like. It would have terrified him. It was unacceptable that my husband died the way he did. I realized that if I didn’t speak about it, what would change?”
Since then, Anya has helped shape palliative training for physicians and promotes better understanding among patients about the difference between palliative and end-of-life care. Changing attitudes and perceptions takes time, but she’s committed.
“It can take a long time for system-level change to occur, but I’ve said I’ll keep at it until I start to see a difference.”
Anya Humphrey is an advisor to the Partnership’s Integrate Project, which seeks to improve physician training in palliative care and to help patients receive earlier referrals. She lives in Campden, Ontario.
Linking data to improve care
Each step of a person’s cancer journey creates data—a detailed picture of their diagnosis, treatment and outcomes. When combined with the data of thousands of other Canadians, that information can answer important questions about cancer care in this country. Are treatment guidelines being followed? What treatments are most effective? Are Canadians getting high quality care? What does care cost?
It’s difficult to get a complete picture of cancer care in Canada. Data are collected and stored in various locations across the country: hospitals, cancer centres, community pharmacies, and provincial and national cancer registries. Linking these databases is critical, but it won’t be easy. There are complex technical, analytical, access and privacy issues, and cancer data analysts will need new knowledge and skills to address them.
The Partnership is tackling these challenges by supporting a variety of data linkage projects through its Coordinated Data Development Initiative (CDDI) and by working with cancer agencies across the country to strengthen analytic capacity.
This year, CDDI began funding five projects that are focused on linking treatment data to diagnostic and outcome data. For example, a project led by Statistics Canada will link surgical data gathered by the Canadian Institute for Health Information to diagnostic, staging and survival data captured in the Canadian Cancer Registry. In another project, PEI is partnering with Nova Scotia to link chemotherapy data from community pharmacies to the provincial cancer registry. Nova Scotia, PEI and British Columbia are working to establish links between radiation therapy records and their respective cancer registries.
At the same time, the Partnership continues to grow analytic capacity across the country through its Analytic Capacity Building Initiative. The Initiative helps cancer data analysts enhance their skills through workshops on advanced methodologies and analysis. Analytically Yours, the Partnership’s online learning hub and community of practice, provides further support for learning through free webinars, e-learning modules and standardized resources and tools.
Analytic capacity is also enhanced through the System Performance Initiative, which enables data analysts from the provinces and territories to collaborate on system performance reports that highlight areas for improvement to advance the cancer strategy. Together, they learn about indicator development, gain access to new datasets and learn new methodologies.
These efforts to link Canada’s health databases and build analytic capacity in participating provinces hold great promise. With better access to comprehensive data, clinicians, decision and policy-makers can gain new insights on how to improve diagnosis and treatment. That means better cancer care—and a better cancer experience—for all Canadians.
In their own words: Lorraine Shack
Lorraine Shack is the Director of Surveillance and Reporting at CancerControl Alberta. She is a member of the Analytic Capacity Steering Committee and the Technical Working Group for System Performance.
The Partnership launched its landmark research portal, providing researchers around the globe with access to health and biological data from 300,000 Canadians who have volunteered to share their health information. One of the largest population health research platforms in the world, the Canadian Partnership for Tomorrow project will allow researchers to conduct long-term studies that look at people’s health, lifestyle and health risks. This rich research tool will accelerate new discoveries on how to prevent, detect and treat cancer.
Nearly 1,000 cancer researchers from across the country gathered at the 2015 Canadian Cancer Research Conference in Montreal to share ideas that will shape the future of cancer discovery and care. The biennial event showcases recent innovations in cancer research, features a Community Forum attended by hundreds of patients and is Canada’s only conference devoted to research across the entire cancer care spectrum.
In their own words: Anne-Monique Nuyt, System Partner
This is the question at the heart of research being conducted by Dr. Anne-Monique Nuyt, a pediatrician and neonatologist. Dr. Nuyt is co-Scientific Director at CARTaGENE, one of five regional cohorts that form the Canadian Partnership for Tomorrow Project (CPTP), Canada’s largest population health research platform. She is currently using the data contained in CARTaGENE, and looks forward to digging into CPTP’s sizeable data and biological resources.
“I think the answers for certain questions will be much more solid if we’re able to ask the questions throughout our country and seize the possibility that CPTP is providing us,” she says.
Dr. Nuyt is clear that the potential for discovery within CPTP is enormous, and encourages researchers to maximize its data.
“We have the capacity to provide decision-makers with solid data to make decisions to improve the health of their populations at an optimal cost,” she says. “It’s our responsibility to provide it and it’s their responsibility to use it. We all need to make optimal use of that data.”
Dr. Anne-Monique Nuyt is a pediatrician in the neonatal intensive care unit at CHU Sainte-Justine in Montreal. She is also co-Scientific Director at CARTaGENE, one of five cohorts that form the Canadian Partnership for Tomorrow Project.
Patients, Elders and First Nations, Inuit and Métis cancer control partners gathered for an All Partners Forum in Newfoundland to share information and discuss progress on the Partnership’s initiative to reduce the cancer burden for First Nations, Inuit and Métis individuals and communities. The Partnership is currently funding multi-year projects in 10 provinces and territories focused on improving the cancer journey for Indigenous Peoples.
The Partnership is working with First Nations, Inuit and Métis peoples and organizations to bring together and share promising practices and resources related to Indigenous health supports as a valuable part of cancer control for many Indigenous people. The goal is to help decision-makers across the country learn from successful collaborative models for creating and delivering culturally relevant care. A working group of patients, health care providers and knowledge holders will support this work.
In their own words: Darlene Kitty, System Partner
“For every patient, their journey is unique,” says Dr. Darlene Kitty, Director of the Indigenous Program at the University of Ottawa’s medical school.
“Some patients are more open to cultural resources and traditional ways of healing and others not. We would like to see our First Nations, Inuit or Métis patients have the opportunity to choose traditional resources such as healing ceremonies, traditional medicines, or even just the presence of a healer or other resource persons. It is important to offer that to them.”
As a first step, Dr. Kitty suggests promoting a greater understanding of Indigenous history, cultures and current issues in Canada and how these can affect health through the generations.
“I think once medical teams learn about these, their eyes will be open to more than just statistics about Indigenous people,” says Dr. Kitty. “They will have a deeper understanding of what patients have behind them—the residential school experience—and its impact on patients’ families, on their communities and the social issues. It really plays a big role in how people access health services.”
Dr. Darlene Kitty is the Director of the Indigenous Program of Undergraduate Medical Education and an Assistant Professor in the Department of Family Medicine at the University of Ottawa. She also works as a family physician in Chisasibi, northern Quebec. She is a member of the Partnership’s Indigenous Health Supports Working Group.
Canadian cancer patients undergo an estimated 770,000 interventions each year that may have little value or expose them to unnecessary harm. That’s the conclusion of Quality & Sustainability in Cancer Control: A System Performance Spotlight Report. The report compares current practice with recommendations from Choosing Wisely Canada and identifies areas where eliminating unnecessary tests and procedures would improve patient care and ensure appropriate use of health care resources.
A spotlight report revealed wide variations in the treatment of low-risk prostate cancer across Canada. Prostate Cancer Control in Canada: A System Performance Spotlight Report also found that men in many parts of the country may be choosing treatment that has major side effects without understanding their other options. The report included insights from prostate cancer survivors, who stressed their need for more information about treatment and recovery and better emotional support.
In their own words: Robin Harry, Patient and Family Partner
“Often after a patient has experienced cancer, one of the biggest problems is the psychosocial aspect,” she says. “There’s a lot of uncertainty and fear. That is just as important to deal with as the medical side effects and physical aspects of surviving cancer.”
Robin says this is especially true as patients transition from cancer treatment to follow-up care with a family physician. It’s a perspective she brings to her role as a patient advisor to the Partnership’s Experiences of Cancer Patients in Transition study. The study will survey more than 40,000 cancer survivors across the country.
“I’m hoping the study will show some of the gaps and the needs that cancer survivors have outside the medical aspects of their care,” she says.
“A lot of what cancer survivors have to deal with comes after the ‘all clear’. We still have a lot to go through … survivorship is a lot more than surviving cancer.”
Robin Harry is a patient advisor to the Expert Panel for the Partnership’s Experiences of Cancer Patients in Transition study. She lives in Toronto, Ontario.
In their own words: Kevin Trotman, Patient and Family Partner
When he was diagnosed with prostate cancer just before his 50th birthday, Kevin was surprised to learn that there was a history of prostate cancer in his family. His family’s Caribbean roots may have prevented anyone from saying anything about it.
“You just don’t talk about that,” he says. “Women talk about all of their ailments and maladies, but men don’t speak about it at all. Anything that affects their manhood of any kind, it’s ‘no, not talking about it.’ I’ve actually had a family member who said, ‘I would much rather pass away—I would much rather die—than tell people about this.’”
Kevin is breaking that pattern by speaking on behalf of Prostate Cancer Canada to as many men as will listen. His message is to get screened and discuss treatment options and side effects with your doctor.
“It’s tough, people don’t want to hear about it. They don’t want to think about it. But you’ve got to do it.”
Kevin Trotman is a prostate cancer survivor living in Oakville, Ontario. He participated in a roundtable discussion on prostate cancer in conjunction with the release of Prostate Cancer in Canada: A Cancer System Performance Spotlight Report.
Economic research can help to determine whether investments in health care are delivering high quality care and good value. Unfortunately, very few studies look at the unique elements of the Canadian system. To help address that gap, the Partnership collaborated with the journal Current Oncology on a special supplement of Canadian research papers focused on cost-effectiveness and savings within the cancer care system.
The Coordinated Data Development Initiative is funding five projects across the country to help provinces link data on cancer treatment—radiation, surgery and chemotherapy—with stage, administrative and other data. Linking data provides new opportunities for improving the quality of cancer care. Clinicians, policy-makers and health system managers will be able to see and analyze patterns of care, track whether treatment follows recommended guidelines and identify areas for improvement.
The Partnership celebrated World Cancer Day with 117 countries around the world by joining the international “We can. I can” campaign and hosting an event on how to improve patient engagement in the cancer control community.
Yourcancerstory.ca is the Partnership’s new online initiative to capture the stories of Canadians who have been touched by cancer. Patients, families, caregivers and professionals are encouraged to submit their own video to share their personal experiences. The project will help people support each other and bring a patient perspective to system issues the cancer control community is working to address.
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