Addressing the urgent needs of people with cancer during the COVID-19 pandemic requires supportive leadership and innovative approaches. In November 2020, the Partnership announced a commitment of $24.5M to support innovation in Canadian cancer services that will both address challenges arising from the pandemic and continue the work of the Partnership with partners across Canada to innovate cancer care, with a focus on improving access to world class cancer screening services for underserviced populations.
The Partnership is working with partners across Canada to accelerate and introduce programs that will:
- Restore and sustain cancer care in the wake of a pandemic
- Drive faster innovation to improve access to world-class screening
- Address inequities in care for underserviced populations
- Advance the priorities and actions of the Canadian Strategy for Cancer Control 2019-2029 (the Strategy)
Innovating Against Cancer
The COVID-19 pandemic has changed the face of health care in Canada. It has created challenges for cancer agencies and programs and many unknowns for people living with cancer. Many people were unable to see their doctor in person, others were told cancer screening appointments were cancelled and some were told they would have to wait longer for cancer surgery.
Innovating Against Cancer is a suite of initiatives that will help restore and sustain cancer screening and clinical care, drive faster innovation in how cancer services are delivered, and implement system-level changes that address inequities in cancer care for First Nations, Inuit and Métis people, and underserviced populations.
The leadership and support of the Partnership gives provincial cancer programs the ability to work together to improve the cancer care system for all Canadians.
We are grateful for the funding support recently received from the Partnership which enabled British Columbia to be the first in Canada to announce a population-based provincial lung cancer screening program.
We are stronger when we work together, and together, we are changing the outcomes and making a difference in the lives of all Canadians touched by cancer.
-Dr. Kim Nguyen Chi, Chief Medical Officer, BC Cancer
Innovating Against Cancer – The initiatives
Eliminating cervical cancer through innovative practices
The World Health Organization has set the goal to eliminate cervical cancer worldwide this century and Canada’s Minister of Health committed the country to achieving this. A key step to achieve this in Canada is the Action Plan for the Elimination of Cervical Cancer in Canada 2020-2030, now available. The Partnership and partners across Canada are using this plan to guide action on priorities toward the elimination of cervical cancer in Canada by 2040. These priorities include HPV vaccination of boys and girls, a shift to primary HPV screening in cervical screening programs and ensuring all people receive appropriate follow-up when abnormalities are identified. First Nations, Inuit and Métis-specific priorities and actions are also presented in the Action Plan. The Partnership has provided $1.6 million in funding to immunization partners Urban Public Health Network, Rural Remote and Northern Public Health Network, and the Public Health Physicians of Canada, and is working with The Society of Gynecologic Oncology of Canada on clinical guidance for follow-up and management of patients after abnormal HPV testing.
Supporting partners to further lung cancer screening programs across Canada
The Partnership is working with all provinces to, for the first time, implement organized lung cancer screening for people at high risk. Initial work in Ontario and other jurisdictions is furthering these efforts. Recently, British Columbia announced its plans for a screening program expected to be running by the spring of 2022. The Partnership is committing $5.0 million to this work over the next 1.5 years to accelerate planning and implementation across Canada. The evidence is clear that screening people at high risk of getting lung cancer can save lives because this type of cancer, when caught early, has better treatment outcomes. This initiative will place a special focus on working with First Nations, Inuit, and Métis to develop Peoples-specific approaches to increase the accessibility of lung cancer screening programs for First Nations, Inuit, and Métis communities. The Partnership has released a report on Lung Cancer and Equity that focuses on income and geography and its effect on lung cancer diagnosis and outcomes.
Supporting advancement of world-class cancer screening systems from coast-to-coast-to-coast
The first wave of the pandemic saw cancer screening programs stop or drastically modify their approach to finding cancer early, out of a fear of patient exposure to COVID-19 along with a lack of access to diagnostic and lab time. The Strategy sets out new approaches to screening that require fewer in-person interactions with the health-care system and more accessible, highly reliable home-based screening options. The Partnership is providing funding of $3.4 million to support early adoption of these innovative approaches to screening programs. Additionally, the Partnership has brought together experts from across the country to rethink how cancer screening services can optimally resume in ways that are responsive and ensure access during successive waves of COVID-19. This guidance document Management of Cancer Screening Services During the COVID-19 Pandemic and Building Resilient, Safer and Equitable Screening Services provides evidence-based recommendations to ensure all provinces and territories can increase the resiliency of screening services during further outbreaks or service disruptions.
Improving cancer surgery
The Strategy identified the need for faster, clearer, and more effective pathways from diagnosis to treatment, including access to high-quality surgery for cancer patients. In September 2020, on behalf of 11 Canadian surgical associations, the Partnership released the pan-Canadian Action Plan for Cancer Surgery. The Action Plan presents a unified approach, identifying key partners and providing guidance on coordinated efforts needed to deliver high-quality, efficient, and coordinated surgical cancer care. The pandemic has created new challenges for the delivery of surgical care. The Action Plan comes at an important time and will aim to drive innovation and a shift towards new models of care to safeguard the delivery of cancer surgery in Canada as health resources are stretched.
Reducing false positive screening results for breast cancer and unnecessary follow-ups
Abnormal call rates (ACRs) in breast cancer screening (mammograms showing a possible tumour) have been rising across Canada since 2014 with no significant change in cancer detection rates. This means more women are receiving false positive screening results, which can lead to unnecessary stress and worry, in addition to avoidable follow-up tests that in themselves carry risk of harm. Through the Partnership’s funding and support of our network of experts, Canada’s breast cancer screening community recently released a Framework outlining six evidence-based approaches to guide pan-Canadian and jurisdictional efforts to reduce ACRs. If implemented, these approaches will see a reduction in ACRs in the coming years, which will, in turn, result in fewer false positives, fewer follow-up appointments and fewer interactions with the healthcare system during the pandemic and beyond.
Colorectal cancer screening for underserviced communities
The Strategy’s call to improve the reach of organized colorectal screening – and a reduction in colorectal cancer rates – is now being expedited with expanding the use direct-mail at-home screening tests, which will reduce the need for any health-care system interaction. The Partnership is also investing $1.5 million in a multi-year initiative to help provinces and territories better identify populations who are under-screened for colorectal cancer and to work with local communities to remove barriers that prevent them from accessing these screening programs. As a first step, the Partnership provided jurisdictions with training on the use of geo-mapping to identify communities where colorectal screening rates are particularly low and the Partnership will be releasing a toolkit that provides evidence-based approaches for improving screening participation that can be adapted to suit specific populations and local contexts.
Other funding and support for innovative initiatives
In addition to these major areas of innovation to cancer care already funded and underway, the Partnership will be funding:
- $5.5 million to expand the Paramedics and Palliative Care program – a collaborative program from the Partnership and the amalgamated organization Canadian Foundation for Healthcare Improvement/Canadian Patient Safety Institute; these funds expand paramedic palliative care services in the home
- $6.3 million to replace several traditional supports to cancer patients with virtual or alternate models of care
- Improved symptom monitoring for patients with virtual Patient-Reported Outcomes tools when in-person visits are not possible
- $1.3 million to support for virtual tobacco cessation counselling and at-home or other cost-effective and convenient dispensing of nicotine replacement therapies