Cancer Strategy / Strategic priorities / Priority 4

Priority 4: Eliminate barriers to people getting the care they need

Not everyone in Canada has the same access to high-quality care and support.

Action 1

Provide better services and care adapted to the specific needs of underserved groups

Increasing access to culturally safe care
Increasing support to help patients navigate the system

Action 2

Ensure rural and remote communities have the resources required to better serve their people

Increasing access to virtual care
Increasing access to supportive care services

Action 3

Ensure care can be delivered between provinces, territories and federal jurisdictions when needed

Improving access to timely care for people who need to travel between jurisdictions
Improving access to transportation and general support for those needing to travel between jurisdictions

Select jurisdiction to see progress:

Increasing access to culturally safe care

Each province and territory has provided their own content and measures this indicator differently. Because of these differences, data cannot be compared across jurisdictions. The data tables and technical appendix are available upon request. References for Canada-wide information are online.

Why we are focusing on care that is respectful of a cancer patient’s values, culture, language preference and gender identity
culturally safe care

Although cancer is a disease that affects people across Canada, many people and groups face barriers that lead to inequities in care and access.¹
Institutional racism, prejudice and other barriers are experienced by many individuals and communities, including First Nations, Inuit, Métis, new immigrants, people of colour, LGBTQ2S+ people and those experiencing other inequitable socio-economic factors, such as homelessness. This can have a significant impact on receiving cancer care and survivorship care.¹
For First Nations, Inuit and Métis, inequities in care and access must be understood within the context of colonialism and its impact, past and present. Racism, together with the lack of culturally safe care and other barriers to accessing screening and healthcare services, can result in late-stage diagnosis and has led to poorer cancer outcomes for First Nations, Inuit and Métis communities. To address this, the cancer system must recognize and eliminate the impacts of practices, behaviours and policies that exacerbate systemic racism and colonization within the health system.^2-6
Cultural safety is about making spaces, services and organizations safer and more equitable for people of diverse backgrounds by considering current and historical determinants of health (such as colonization or experiences of lower socioeconomic status) and seeking to eliminate structural racism and discrimination from the healthcare system.⁷
Ensuring the provision of culturally safe care that respects the values, culture, language preferences and gender identity of a person with cancer will result in better health outcomes for that person.⁸
Training health-care providers with the necessary knowledge and skills for providing culturally safe care, as well as designing future policies with cultural safety in mind, will be important steps in improving the quality of care for all people accessing services across the cancer continuum.

What we want to achieve

All healthcare providers have received education and training in providing culturally safe care that respects the values of their patients, and are held accountable for providing that care
A person-centered care model to support individuals that are more likely to experience inequitable cancer outcomes, such as First Nations, Inuit and Métis, new immigrants, people of colour and LGBTQ2S+ people

What this would mean for people in Canada

People experience culturally safe care and feel safer accessing care that acknowledges and addresses their diverse needs
Individuals and their families feel confident the healthcare system is listening and responding to their needs, concerns and feedback
Achieving culturally safe care will help work towards dismantling systematic barriers and help address health inequities

Increasing support to help patients navigate the system

Why we are focusing on patient navigation services or similar programs/services
long travel to hospital

The cancer system is large and complex. Coordinating treatment visits, testing and follow-up appointments can be overwhelming for people with cancer. This is especially true for people living in rural or remote areas, who often experience inequitable access to services compared to people in urban areas.¹
Patient navigators, or similar services, play an important role in providing person-centred care. They provide a variety of services and support to people with cancer as they move in and through the cancer system and ensure that individual needs are considered in care. They identify what support people require and connect them with services during and after treatment to meet those needs (e.g., psychologists, social workers, cultural or religious leaders).^1,11
First Nations, Inuit and Métis community-based navigation services support people by coordinating access to screening, diagnosis, treatment and referrals, and by helping people when they are discharged from hospital. They may also provide interpretive services and connect people with cancer with traditional healing programs/services to further address their cultural or spiritual needs.^12,13

What we want to achieve

Patient navigators and navigation supports available where needed to support person-centered care
Increased patient navigation services for First Nations, Inuit, Métis and underserved groups, including people of colour, LGBTQ2S+ people, and people experiencing other inequitable socio-economic factors such as homelessness.
First Nations, Inuit and Métis community-based navigators available to support people with cancer, no matter where they live (whether in urban, rural or remote areas), to have a culturally safe experience in their cancer care journey.

What this would mean for people in Canada

Cancer care focuses on the needs of patients and families, regardless of where they live
Underserved groups (including, people of colour, LGBTQ2S+ people, and people experiencing other inequitable socio-economic factors such as homelessness) feel safe and supported when engaging and navigating the healthcare system and experience better health outcomes as a result

Increasing access to culturally safe care

Where we are today

Percentage of people that responded positively (“Yes – somewhat”, “Yes – completely”) to the survey question: “Did your care providers treat you with dignity and respect?”

99.5% in 2019 and 99.3% in 2022

Data source: AOPPS patient survey and provincial cancer agencies and programs

Notes:
The 2019 data was collected through the AOPPS patient survey.
In 2022/23, BC Cancer launched its own patient experience surveys within the regional cancer centres through project efforts to implement team-based care
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Improve access to cancer care for populations experiencing health inequities by addressing and reducing system barriers.

Current situation

Recent surveys suggest more than 99% of patients who completed patient experience surveys responded positively with respect to this survey question.
Indigenous Patient Navigator positions at each of the six regional cancer centres, with two centres (Vancouver and Kelowna) having two IPN’s to support increased patient load.
Indigenous cultural safety training is mandatory across BC Cancer for all non-contract staff, which includes the online Sa’nyas training, and the Anti-Indigenous Racism Response Training (AIRRT)
Development or adaptation of Indigenous specific resources that focus on common questions patients face at various stages of their cancer journey.
Although these results above are positive, it is important to note that survey respondents include a very small number of Indigenous patients. As such, further work to measure patient experience for Indigenous patients is underway (see below).

New efforts

Establishing innovative methods of engaging people with cancer experiencing health and social inequities to better understand the cancer care needs of these populations.
Piloting new processes to give adolescents and young adults with cancer early access to Patient and Family Counselling services.
Indigenous specific engagement sessions to discuss patient experience as linked to Indigenous Patient Navigator involvement through a 2-year funded CPAC Models of Care project.
Indigenous specific patient journey mapping activities through a 2-year funded CPAC Models of Care project.

Indicator:

Percentage of people that responded positively (“Yes – somewhat”, “Yes – completely”) to the survey question: “Did your care providers treat you with dignity and respect?”

Increasing access to culturally safe care

Where we are today

Percentage of patients reporting that they were treated with dignity and respect during their cancer treatment

99.7% in 2020, and 99.7% in 2022.

Data source: Ambulatory Oncology Patient Satisfaction Survey (AOPSS)
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Implement culturally appropriate strategies to reach vulnerable populations that experience health disparities and limited access to health care.
Recruit candidates from at-risk populations into nursing and other health programs.
Help these graduates to establish practices in urban and rural at-risk communities.

Current situation

Within Cancer Care, work is underway in collaboration with Indigenous communities and organizations and other portfolios in Alberta Health Services (AHS) to develop an Action Plan to Strengthen Indigenous Cancer Care in Alberta. The Action Plan will address several themes that have arisen through engagement with stakeholders, including:
- Access and jurisdiction
- Knowledge-sharing and collaboration
- First Nations, Inuit and Métis systems of knowledge
- Holistic care
- Support

All work is done in an ethical space and under the umbrella of Alberta Health Services Indigenous Health Strategy, the Alberta Cancer Plan to 2030, OCAP™ and the Principles of Métis Research. The Action Plan will be available at the end of 2023.

Although current efforts are predominantly directed to the Action Plan, other initiatives are also underway, including:
- Hiring additional Indigenous Cancer Patient Navigators
- Collaborating with specific communities to facilitate an improvement that they prioritize. This includes community information, care closer to home and connections with the cancer system.
- Holding a monthly staff lunch and learn on Indigenous reality, culture, history, etc.
- Adding welcoming signage at our sites
- Encouraging the use of land acknowledgements
- Engaging with First Nations, Métis Nation of Alberta Region 3, and Friendship Centres in southern Alberta regarding the new Calgary Cancer Centre

New efforts

The newest initiative is working with key AHS stakeholders to examine what is required from the system to change culture and attitudes to create a positive environment for ceremony and other aspects of Indigenous Traditional Healing.

Indicator:

Percentage of patients reporting that they were treated with dignity and respect during their cancer treatment

Increasing support to help patients navigate the system

Where we are today

Percentage of patients with cancer living in rural/remote areas in AB who utilized the nurse navigator service
23.5% in 2019, and 24% in 2020.

Data source: Provincial cancer agencies and programs

Notes:

The COVID-19 pandemic may have affected service provision.
The data presented reflects only the nurse navigator support in rural/remote geographies. Indigenous and AYA Nurse Navigators for patients residing in non-rural/non-remote are not included. Cancer patient navigation support is assigned based on the needs of the patient.
Not all patients require direct care provided by a patient navigator. Navigation support at the two tertiary centres (Tom Baker Cancer Centre and Cross Cancer Institute) is provided by tumour triage coordinators and other health care providers and is not captured in these data.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Working towards establishing a goal as part of our provincial navigation evaluation

Current situation

Indigenous Cancer Patient Navigators are located in Grande Prairie Community Cancer Centre (Grande Prairie), Cross Cancer Institute (Edmonton) and Tom Baker Cancer Centre (Calgary) to support the specialized care coordination needs of people with cancer located anywhere in Alberta.
Adolescent and Young Adults (AYA) Navigators and Young Adult Cancer Patient Navigators are located at Tom Baker Cancer Centre and Cross Cancer Institute and support AYAs with cancer across the province.
Community Cancer Patient Navigators are available at four regional cancer centres and 10 community cancer centres, providing care coordination for rural/remote patients.

New efforts

Since 2022, the MyAHS Connect (patient portal) service has provided new opportunities for people with cancer to navigate the system more effectively on their own.
Continued investment in cancer patient navigators will support the complex needs of people from specific underserved populations in Alberta including rural, AYA and Indigenous groups.
Work is underway to further integrate navigation with primary care and diagnostic services in communities.

Indicator:
Percentage of patients with cancer living in rural/remote areas who utilized the nurse navigator service

Increasing access to culturally safe care

Where we are today

Percentage of patients who felt their care providers treated them with dignity and respect
Overall 91%.

Data source: AOPSS Survey (2016)
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Establish a strategy to integrate cultural responsiveness throughout the work of the Saskatchewan Cancer Agency (SCA), building on relationships to promote culturally safe care.

Current situation

Saskatchewan Cancer Agency is working to develop, embed and integrate a Culturally Responsive Organisational Strategy, with guidance from First Nations and Métis community partners and Knowledge Keepers.
The Saskatchewan Cancer Agency will be conducting the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) in 2023.  AOPSS is a standardized instrument to assess the overall cancer patient experience.  Aggregated results will be used to inform program evaluation and planning.

New efforts

Saskatchewan Cancer Agency will integrate and embed cultural responsiveness training for staff and leadership.
SCA will develop guidelines for working with First Nations and Métis patients, families and communities.
SCA will focus efforts to recruit and retain more First Nations and Métis employees.
These initiatives are a first step in positioning the SCA to respond to the health-related Calls to Action of the Truth and Reconciliation Commission of Canada.

Indicator:

Percentage of patients who felt their care providers treated them with dignity and respect

Increasing support to help patients navigate the system

Where are we today

Percentage of new cancer patients who were referred to new patient navigator services
86.1% in 2019, and 83.4% in 2021.

Data source: Provincial cancer agencies and programs
Notes:

Due to various access points and timelines related to varying levels of urgency, not all patients are appropriate for New Patient Navigation services (i.e. those diagnosed in hospital or urgent/emergent new patient consultations.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Current situation

Nurse navigators provide support and education for clients with an abnormal breast or colorectal screening result by coordinating, assessing and preparing clients for follow up tests and appointments.
All new cancer patients have access to navigation services. New Patient Navigators attempt to reach all patients prior to their first appointment at the cancer centre to help support and prepare them for their new patient appointment.

Indicator:

Percentage of new cancer patients who were referred to new patient navigator services

Increasing access to culturally safe care

Where we are today

Percentage of respondents to the Ambulatory Oncology Patient Satisfaction Survey who reported a positive response to the question, “Did your care providers treat you with dignity and respect?”

99.3% in 2021, and 99.5% in 2022.

Data source: Ambulatory Oncology Patient Satisfaction Survey
Note:

The COVID-19 pandemic may have affected service provision.
Positive responses were identified as “Yes, completely” or “Yes, somewhat”

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Work to increase availability of culturally-responsive and equitable cancer care as outlined in the 2020 Roadmap to Cancer Control for Manitoba:
- Ensure equitable access to cancer services and care for all Manitobans of every culture, language, age and geographic location.
- Improve service delivery for underserved groups by targeting key gaps in health status and reducing health disparities.

Current situation

CancerCare Manitoba (CCMB):

CCMB promotes and pays for its staff to take the Manitoba Indigenous Cultural Safety Training which addresses the history and perspectives of Indigenous populations in Manitoba.
CCMB provides a patient guide specific to the First Nations population which provides information regarding cancer and health care services available specifically to First Nation populations.
The Quit Smoking Program (QSP) has done outreach work at the Kivalliq Inuit Centre which is a housing agency for Inuit people who travel to Winnipeg for cancer treatment. QSP staff undertake commercial tobacco cessation training to ensure culturally appropriate teaching when working with Indigenous populations.
Navigation Services are freely available to all cancer patients and their families in Manitoba. Patients and their family members can contact Navigation Services directly or be referred by any health care professional. Navigation teams consist of nurse navigators, psychosocial oncology clinician counsellors, and community engagement liaisons and are available within each regional cancer program. Navigation Services seeks to address and mitigate the individual challenges patients face, including those related to diverse socio-economic and cultural backgrounds and diverse identities.
The Underserved Populations Program (UPP) aims to improve service delivery by targeting gaps in health status and reducing health disparities. A key focus of its work is to ensure equitable access to cancer service and care for all Manitobans of every culture, language, age, sexual orientation, gender identity, and geographic location. UPP strives to support patients and families who may face additional challenges, build relationships in underserved communities, educate and support health care providers in providing equitable care to patients and address system issues that cause barriers or delays.
UPP employs an Education and Liaison Nurse for Health Equity who helps the clinical team, patients and their family members understand and access available/recommended cancer care when the clinical team/patient is unable to find resources or solutions. CCMB is working together with the Métis Federation and the Southern Chiefs Organization (the latter representing 32 First Nation communities) to identify priorities/needs, provide training opportunities where applicable and work together to achieve better cancer control and outcomes within these particular communities.
CCMB has reached out to Indigenous organizations to share the 2020 Roadmap to Cancer Control for Manitoba and to work together in identifying realistic and culturally responsive action items to enhance First Nations, Métis, and Inuit cancer control and outcomes. CCMB has also reached out to providers caring for patients in remote communities to assess gaps in cancer care services and work together to address these gaps.
CCMB is represented at the Shared Health table on discussions to address/dismantle racism within the health care system. CCMB is committed to the implementation of a Health Equity Framework as part of the overarching Equity, Diversity and Inclusion priority.

Manitoba:

The Winnipeg Regional Health Authority (WRHA) encourages the use of inclusive language that promotes equity, dignity, and demonstrates respect.

New efforts

As of 2022, CCMB has changed the frequency of the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) from once every 3-4 years to twice per year.
Guided by a First Nations led planning committee, CCMB hosted a series of webinars titled “Patient Support Webinars from a First Nations Perspective” in Fall 2021. In support of people-specific and self-determined care, CCMB is planning patient support webinars from a Métis and Inuit perspective working with Métis and Inuit led planning committees, respectively.
The 2020 Roadmap to Cancer Control for Manitoba includes the following priority populations: geographically isolated populations; First Nations, Métis, Inuit; newcomers; and the elderly.
CCMB is currently engaging with stakeholders and health care partners to evaluate the efficacy of services and works in partnership with Shared Health to adapt services to diverse populations. CCMB’s UPP is providing ongoing and future education initiatives regarding 2SLGBTQ+ populations to all CCMB staff and physicians.
CCMB has recently launched an Indigenous Community Profiles website, a public website with information on resources available in Indigenous communities, to assist clinicians in developing safer and more realistic care plans for patients returning to their home communities. This work is being done with funds from the Canadian Partnership Against Cancer.
Indigenous Community Connectors have been identified by community and trained by CCMB on programs and services available to patients and families. They are trusted members of community who connect patients to CCMB resources as needed. This initiative was funded by the Canadian Partnership Against Cancer.
CCMB has translated the General Cancer Pathway resource into Ininímowin/Swampy Cree, Anishinaabemowin/Ojibwe, Anisininemowin/Ojibwe-Cree, Dakota, Dene, Michif Cree, Michif French and Inuktitut. This work was accomplished with funds from the Canadian Partnership Against Cancer.

Indicator:

Percentage of respondents to the Ambulatory Oncology Patient Satisfaction Survey who reported a positive response to the question, “Did your care providers treat you with dignity and respect?"

Increasing support to help patients navigate the system

Where we are today

Percentage of rural/remote Manitobans living with cancer who accessed CancerCare Manitoba’s Navigation Services, by fiscal year

39.4% in 2019-20, 34.2% in 2020-21, and 40.4% in 2021-22.

Data source: Provincial cancer agencies and programs
Notes:

For this indicator, rural/remote is defined as Regional Health Authorities outside of the Winnipeg Regional Health Authority (RHA). This includes Interlake Eastern (RHA), Northern RHA, Prairie Mountain Health, and Southern Health – Santé Sud.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Continue to work towards the 2020 Roadmap to Cancer Control.

Current situation

CancerCare Manitoba (CCMB) Navigation Services are freely available to all individuals with cancer and their families in Manitoba.
Individuals with cancer and their family members can contact Navigation Services directly or be referred by any healthcare professional.
Navigation teams consist of nurse navigators, psychosocial oncology clinicians and community engagement liaisons and are available within each regional cancer program.
CCMB provides a patient guide specific to First Nations, which provides info regarding cancer and healthcare services available specifically to First Nations.
CCMB is committed to the implementation of a Health Equity Framework as part of the overarching Ethnicity, Diversity and Inclusion Priority.
Indigenous Community Connectors have been identified by community and trained by CCMB on programs and services available to patients and families. They are trusted members of community who connect patients to CCMB resources as needed. This initiative was funded by CPAC.

New efforts

Both the previous and upcoming five-year Roadmap to Cancer Control for Manitoba include the following as priority populations: geographically isolated populations; First Nations, Métis and Inuit; newcomers; and the elderly.
CCMB is currently engaging with stakeholders and healthcare partners to identify cancer-service priorities for diverse and underserved populations.
CCMB has established focused discussion groups with key First Nations organizations to share the Roadmap to Cancer Control for Manitoba to seek out priorities as well as identify any gaps in service for people living in rural or remote areas.
The Western Manitoba Cancer Center is in the process of implementing medical oncology services, which provide additional research opportunities and enhance cancer-care services for people with cancer living in Western Manitoba.
CCMB is focused on bringing optimal health/cancer outcomes and improved patient experience to those that continue to have worse outcomes than the overall population of Manitoba, acknowledges the challenges with racism and cultural safety and plans services with health care equity in mind.
As guided by our Indigenous partners, CCMB has identified the need for an Indigenous Nurse Navigator.
Indigenous community profiles are being developed to allow for safer and more realistic care plans for patients.

Indicator:

Percentage of rural/remote Manitobans living with cancer who accessed CancerCare Manitoba’s Navigation Services

Increasing support to help patients navigate the system

Where we are today

Indicator data not available at this time.

Our goal

Implement the Cancer Patient Navigation Program.

Current situation

The New Brunswick Cancer Network and Regional Health Authorities have collaborated to implement the provincial, community-oriented Cancer Patient Navigation (CPN) Program.

New efforts

Under the new program, operational since spring 2022 cancer patient navigators work with people with cancer of all ages and their families, the interdisciplinary cancer care team and community support agencies to provide assistance and support throughout the cancer continuum, especially in the pre-diagnostic and post-treatment transition to cancer survivorship periods. The goals of the Program are to:
- facilitate coordination of services and continuity of care
- provide information, education and support
- match needs with available resources and services within the healthcare system and the community
The new network of cancer patient navigators includes two pediatric oncology navigators in place since 2011.

Indicator:

Indicator data not available at this time.

Increasing access to culturally safe care

Where we are today

Percentage of individuals who indicated “Agreed” or “Strongly Agreed” in response to the 5-point Likert scale questions in 2020
NS P4 Action 1

Data source: The Nova Scotia Health Cancer Care Program 2020 Patient Satisfaction Survey
Notes:

The survey was provided only in English and therefore people whose primary language is not English may be underrepresented in the survey. This may have impacted the results of some of the questions.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Engage with underserved groups to better understand the barriers they face in accessing care

Current situation

Engagement to date has included work with Mi’kmaw Nation Cancer Care Strategy, Nova Scotia Brotherhood Initiative, Nova Scotia Sisterhood, Health Association of African Canadians and Immigrant Services Association of Nova Scotia.
A co-design model will be utilized to work with historically underserved populations moving forward. This was a key learning from the large-scale engagement work for the Lung Screening Program project, but can be used across the system.

New efforts

Nova Scotia is advancing this work through a variety of strategies:

Engaging with underserved groups in developing a Lung Cancer Screening Program for those at high risk for the disease
Developing new Models of Care in the province based on unique needs across the province.
Engaging with equity deserving groups to inform Psychosocial Oncology Awareness and Access project
Formalizing a partnership with First Nations communities to help implement a Mi’kmaw Nation Cancer Care Strategy
Participating as a member of Nova Scotia Health’s Central Zone Diversity and Inclusion Steering Committee
Participating in provincial work with Nova Scotia Health (NSH) and Department of Health and Wellness (DHW) on the development of a Health Equity Framework. This will inform indicators and accountabilities in health equity. To be published in July 2023.
Early talks to develop an Engagement Framework to inform a sustainable and organized approach to respectful partnerships with historically underserved populations.
Partnering with researchers to identify Nova Scotia communities experiencing excess cancer and who may be unable to mitigate risk without assistance, due to the compromised material, social and environmental conditions in which they live.

Indicator:

Percentage of individuals who “Agreed” or “Strongly Agreed” that the care they received was respectful of their values, culture, language preference, gender identity, ethnicity, and/or physical/mental abilities

Increasing support to help patients navigate the system

Where we are today

Percent of patients who had at least one visit with a cancer patient navigator within one year of a new consult with a cancer centre specialist

2019: 52.1% 2020: 48.5% 2021: 48.3%

Data source: Provincial cancer agencies and programs
Notes:

Navigation data from the Central Health Zone of Nova Scotia is not available prior to 2023.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Make patient navigation services available to all people with cancer in Nova Scotia regardless of where they live.
Focus on transitioning patients through the stages of the cancer journey, such as diagnosis, treatment and survivorship, palliative and end of life care.
Work with First Nations partners to better understand barriers for accessing navigation services.
Ensure people with cancer have access to navigation services sooner to facilitate earlier psychosocial supports and access to care.

Current situation

Eight community-based cancer patient navigators (oncology nurses) serve the Western, Northern and Eastern Health zones. Other psychosocial resources are also available.
People with cancer in the Central Health Zone receive navigation-like services from other providers such as the psychosocial oncology team and drug access navigators (Pharmacy Practice Assistants), and have access to other disease-specific resources.
Cancer patient navigators coordinate appointments and travel for people with cancer; provide practical, financial and emotional support; provide symptom management; and act as a liaison between the person with cancer and the cancer system.

New efforts

Engagement is underway with First Nations to better understand their needs and to explore the possibility of establishing a First Nations navigation role.
The role description for cancer patient navigators has been revised to ensure that it is consistent across the province.
An interdisciplinary navigation model is being explored to strengthen navigation support and ensure patient navigators are working to their full scope of practice.
Most cancer patients will have access to drug access navigators by the end of 2023.
The Central Health Zone will have dedicated patient navigators commencing in 2023.

Indicator:

Percent of patients who had at least one visit with a cancer patient navigator within one year of their referral to a cancer centre specialist

Increasing access to culturally safe care

Where we are today

Percentage of patients who feel they were treated with courtesy and respect
98.9% in 2020, and 99.4% in 2022.

Data source: PEI Ambulatory Care Patient Satisfaction Survey
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

All people receiving treatment at the PEI Cancer Treatment Centre (PEICTC) are engaged in developing a treatment plan that addresses their own goals and needs.
People with cancer are able to choose treatment options acceptable to them. Treatment options are culturally acceptable and should reflect a person’s beliefs, values and wishes.
People with cancer and their families are treated with empathy and respect.

Current situation

A collaborative effort has been initiated with Indigenous Partners, Health PEI and Department of Health and Wellness to continue to advance cancer control and care priorities of the First Nations Communities of PEI and the shared actions of the PEI Cancer Action Plan.

New efforts

Opportunities to engage PEICTC staff in learning about Indigenous and diverse populations in PEI are promoted and ongoing, with additional efforts to coordinate specific learning opportunities starting in 2024. Learning will be both self-driven, encouraged by team leaders, and required for new staff hires.

Indicator:

Percentage of patients who feel they were treated with courtesy and respect

Increasing support to help patients navigate the system

Where we are today

Indicator data not available at this time.

Our goal

Ensure coordinated and timely access to information, services and care for people with cancer and their families on the cancer journey.
Ensure all people with an abnormal fecal test for colorectal cancer have access to a timely and well-informed process to receive a follow-up colonoscopy.

Current situation

PEI has one cancer navigator in the Cancer Patient Navigation Program and one Health PEI Patient Navigator.

New efforts

Planning is underway for implementation of a colorectal diagnostic navigation program to guide people with an abnormal screening fecal test to follow-up care.
The province’s Cancer Patient Navigation Program and the role of the cancer navigator are being reviewed to better meet needs of people with cancer and their families from suspicion to survivorship.

Indicator:

Indicator data not available at this time.

Increasing access to culturally safe care

Where we are today

Percentage of patients who reported that they were treated with respect, compassion and treatment was explained in an understandable way
Treated with respect: 95.9%. Treated with compassion: 95%. Treatment explained in an understandable way: 91.4%.

Data source: Provincial cancer agencies and programs
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Cancer Care delivery practices will continually adapt to the needs of underserved groups to reduce any barriers in receiving equal access to high-quality care.

Current situation

Clinical and non-clinical Cancer Care staff have the opportunity to participate in an Indigenous Culture and Health education module. The purpose of this cultural safety module is to promote the provision of culturally appropriate and safe care through education and knowledge sharing. Presently over 50 staff have completed this module.
The Cancer Care Program has an active Patient and Family Advisor Council (PFAC). This serves to formalize roles and identify potential opportunities for patients and families to participate in improving the patient and family experience.
PFAC members have completed an Indigenous Culture and Health education module.

New efforts

The PFAC is continually making every attempt to achieve provincial representation, as well as individual diversity including cancer diagnosis, demographics (age, gender) and background (cultural and spiritual beliefs).
Eastern Health launch its first Client- and Family-Centred Care (CFCC) Year in Review Impact Report which outlines the role of client/patient and family advisors, the value they bring to the delivery of healthcare services and the advancements in the CFCC approach to care.
Since June 2022, completion of the Indigenous Culture and Health education module is a mandatory part of the Cancer Care Program’s orientation for new staff.
In the fall of 2022, two new Indigenous Patient Navigators (IPNs) were hired. The IPNs are primarily responsible to provide support between Indigenous patients and their respective healthcare professionals in Central Newfoundland (Conne River) and Northern Labrador (Nain).

Indicator:

Percentage of patients who reported that they were treated with respect, compassion and treatment was explained in an understandable way

Increasing support to help patients navigate the system

Where we are today

Indicator data not available at this time.

Our goal

Not available at this time.

Current situation

Newfoundland and Labrador has a cancer patient navigation system that provides a specially trained oncology nurse to guide people through the cancer care system.
There are currently eight cancer patient navigators across Newfoundland and Labrador.
Cancer Patient Navigators (CPNs) collaborate with Indigenous patient navigators, mental health and addictions systems navigators, social workers and bilingual services to ensure that patients receive culturally safe care.
Appointments are in-person or via telephone.
In spring 2021, Eastern Health hired two screening nurse navigators to help people with cancer navigate the system when there is a suspicion of breast cancer, lung cancer or colon cancer.

New efforts

Cancer Patient Navigators (CPNs) are part of the early integration into palliative care program and can refer people with cancer to palliative care, if they are eligible.
Efforts are being made to expand patients/families’ utilization of Noona, an on-line app, across Newfoundland Cancer Care centres.
- The goal is to increase the functionality of this app to not only include electronic collection of patient-reported outcomes, but to incorporate cancer appointment scheduling, and education tools. It aims to expand access to clinical tools, tests and information.

Indicator:

Indicator data not available at this time.

Select jurisdiction to see progress:

Increasing access to virtual care

Why we are focusing on use of virtual care in rural/remote communities^1-3
Access to virtual Care icon

People with cancer in rural and remote communities often need to travel great distances to urban areas to receive care, leading to inequitable access.
Travelling outside of a community is sometimes not possible due to geographic location or weather conditions. The need for travel may also affect a person’s decisions about treatment if, for example, more follow-up visits are required.
Virtual care offers opportunities to reduce travel for people with cancer and provides them with the option to receive care in their home community where they can be supported by family or interpreters in a familiar setting to them.
Improving virtual care can support accessible, culturally safe and timely cancer care for First Nations, Inuit and Métis living in rural and remote communities. Culturally safe virtual care includes ensuring services are designed, led and delivered by and with First Nations, Inuit and Métis and allowing patients to be supported by their family, community and healthcare providers in a familiar setting.
Virtual care has become much more common during the COVID-19 pandemic. However, more work is needed to better integrate virtual care into models of cancer care, especially community-based models of care, over the long term.

What we want to achieve

An evaluation of the quality of virtual care provided to people with cancer during the pandemic and an assessment of what is needed to deliver high-quality, person-centered virtual care for the future
Community-based solutions and capacity building that integrate virtual care into cancer care in rural and remote areas⁴

What this would mean for people in Canada

High-quality and timely cancer care closer to home
Less travel time for people living in rural and remote areas

Increasing access to supportive care services

Why we are focusing on availability of supportive care services^5,6

Cancer can be overwhelming. People with cancer, survivors and their families need support to find their way through the many emotional, psychological, spiritual and practical issues they may face.
People seeking cancer care during the COVID-19 pandemic experience greater challenges due to restrictions on family visits and other bedside supports.
Person-centred care puts the needs of the person with cancer first and provides care and services that addresses these needs. These services can include pain and symptom management, psychosocial support and palliative and end-of-life care.
All people with cancer need access to this support, but people living in rural and remote areas face additional inequities and often must travel to urban centres to access the supportive care services they need, leaving behind the care and support of family and community.
For First Nations, Inuit and Métis, supportive care must include holistic supports that consider the mental, spiritual and emotional health of individuals.

What we want to achieve

Improved access to palliative care and other supports for pain and symptom management, better patient and caregiver satisfaction
Culturally safe supportive care services available in urban, rural and remote areas that are inclusive to the needs of diverse peoples, including First Nations, Inuit and Métis
First Nations, Inuit and Métis communities supported to design and deliver self-determined supportive care programs and services

What this would mean for people in Canada

All people with cancer receive care that addresses the whole person, including pain and symptom management and supports for mental and spiritual health and well-being
High-quality care closer to home that provides people with better access to supportive care services in their community
Better patient and family experience and increased access to community and traditional supports to foster an equitable cancer system that is culturally inclusive for people with cancer and their families

Increasing access to virtual care

Where we are today

Percentage of patients with cancer from rural/remote communities using virtual health appointments, by fiscal year

60.5% in 2020/21. 58.6% in 2021/22.

Our goal

Leverage virtual health solutions to advance patient and provider experience, improve access to care (including for rural communities), and deliver high quality, appropriate, cost-effective and timely healthcare services in British Columbia.

Current situation

During the COVID-19 pandemic, British Columbia expanded the use of virtual care.

New efforts

Monitoring for the use of virtual care is now included in BC Cancer’s information systems, including the new Cerner electronic medical record.

Indicator:

Percentage of patients with cancer from rural/remote communities using virtual health appointments, by fiscal year

Increasing access to virtual care

Where we are today

Indicator data not available at this time.

Our goal

Integrate virtual care into the continuum of care as an important route to deliver care.
Use innovation and technology to connect providers to patients and/or providers to one another for care delivery at a distance, when appropriate.
Provide clinically appropriate, effective virtual care across the cancer care continuum —improving access and reducing barriers to patient care across Alberta.
Co-design service delivery models that integrate virtual care solutions within clinical workflows.

Current situation

Virtual care allows people with cancer who live in rural and remote areas to access both primary and specialty care. 30-40% of care has been occurring virtually since COVID-19.
Digital health strategies are being designed as part of Alberta’s new clinical information system (Connect Care).
The majority of virtual care in Continuing Care Access since COVID-19 has been delivered via telephone.

New efforts

Continuing Care Access is currently working on the development of a virtual care strategy.

Indicator:

Indicator data not available at this time.

Increasing access to supportive care services

Where we are today
Availability of supportive care services (i.e. psychosocial) in rural/remote areas, by fiscal year

78% in 2020-21, and 84.3% in 2021-22.

Our goal
Provide high-quality, multidisciplinary supportive care (psychosocial and rehabilitation oncology) services that are centred on people with cancer and their families who live in rural/remote areas.

icon increasing access to supportive care servicesSupportive Icon

Current situation

Virtual visits for access to psychological and psychiatric support for people with cancer were implemented in Jan 2020.
75% of psychosocial oncology services are delivered through virtual care.
40% of speech language pathology and 15% of physiotherapy/occupational therapy services are delivered through virtual care.
People with cancer reported high satisfaction with virtual care as a modality to receive their supportive services; people who live in rural areas reported higher satisfaction than those living in urban areas.

New efforts

Virtual supportive care strategies are being established in alignment with Alberta Health Services and Cancer Care Alberta.
Benchmarks for supportive care services are being determined as data becomes available and optimal care provision is evaluated.

Indicator:

Availability of supportive care services (i.e. psychosocial) in rural/remote areas, by fiscal year

Increasing access to virtual care

Where we are today

Percentage of cancer patients from rural/remote communities using virtual health appointments for physician-led appointments
22.8% in 2019, and 86.3% in 2020, and 86.8% in 2021

Data source: Provincial cancer agencies and programs
Notes:

Note that appointment modality is not mutually exclusive. Patients may access more than one virtual service at a time.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Offer virtual care to 100% of eligible patients by 2023.

Current situation

Virtual health appointments are currently offered via telehealth, telephone and videoconferencing. Due to COVID-19, fewer people with cancer are using telehealth appointments, but telephone and videoconferencing appointments have increased.
A single videoconferencing platform has been developed and implemented for the provincial health system.

New efforts

Work is underway to adopt a remote patient monitoring solution for the Saskatchewan Cancer Agency.

Indicator:

Percentage of cancer patients from rural/remote communities using virtual health appointments for physician-led appointments

Increasing access to supportive care services

Where we are today

Percentage of patients in SK seen at the Saskatchewan Cancer Agency (SCA) accessing supportive care services
29.2% in 2019, 32.3% in 2020, and 36.8% in 2021.

Our goal

Promote earlier integration of palliative care services to address care priorities of people in rural and remote areas.

Current situation

High quality palliative care is available to patients in rural and remote areas virtually.
Saskatchewan is promoting the availability of supportive services (e.g., home care, palliative care) through partnerships with other jurisdictions.

New efforts

Promoting education of healthcare providers on the benefits of earlier integration of palliative care
Developing a Palliative Care Community of Practice by integrating local palliative care providers into virtual clinic appointments for Saskatchewan Cancer Agency’s Symptom Management and Palliative Outpatient Clinic
Promoting increased use of multidisciplinary virtual appointments for the Symptom Management and Palliative Outpatient Clinic
Enhanced virtual care practices supporting remote access to programs historically provided solely in-person .

Indicator:

Percentage of patients seen at the Saskatchewan Cancer Agency accessing supportive care services

Increasing access to virtual care

Where we are today

Percentage of Manitobans newly diagnosed with cancer and living in rural/remote Regional Health Authorities who attended virtual physician visit appointments, by patient and appointment level

Patient Level was 28.4% in 2019 and 73.3% in 2020 Appointment Level was 15.8% in 2019 and 48.2% in 2020

Data source: Provincial cancer agencies and programs
Note:

Patient-level refers to the proportion of patients who had at least one virtual appointment within a given timeframe. Appointment-level reflects the proportion of all physician visits that were virtual within a given timeframe. Virtual health was defined as the use of TeleHealth, phone, or video for a physician visit.
For this indicator, rural/remote is defined as Regional Health Authorities outside of the Winnipeg Regional Health Authority (RHA). This includes Interlake Eastern (RHA), Northern RHA, Prairie Mountain Health, and Southern Health – Santé Sud. Winnipeg RHA data are not included for this indicator.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Leverage virtual care to increase the accessibility and efficiency of health care services, improve access to health information for people with cancer and their families and support timely and efficient communication with healthcare professionals (as outlined by the 2020 Roadmap to Cancer Control for Manitoba).

Current situation

Due to the COVID-19 pandemic, the proportion of physician visits done virtually at CancerCare Manitoba (CCMB) has significantly increased since March 2020.

New efforts

As a result of the COVID-19 pandemic, the use of virtual care has increased across the health care system. CCMB began tracking the number of virtual care visits to ensure technological capacity needs were met. This work continues as we shift into a new normal of flexible in-person and virtual appointment options.

Indicator:

Percentage of Manitobans newly diagnosed with cancer and living in rural/remote Regional Health Authorities who attended virtual physician visit appointments, by patient and appointment level

Increasing access to supportive palliative care services

Where we are today

Indicator data not available at this time

Our goal

Increase engagement of primary care providers and navigators in the delivery of palliative care services and improve collaboration across regional jurisdictions providing palliative care (outlined by the 2020 Roadmap to Cancer Control for Manitoba).

Current situation

CancerCare Manitoba (CCMB):

CCMB has a palliative care referral process in place for people with cancer and their family/friends/caregivers.
For patients with advanced cancer:
- The Changing Focus-Living with Advanced Cancer initiative at CCMB has a four-part follow-up care plan specifically tailored to individuals living with advanced cancer. This plan is made available during transitional appointments and through the CCMB website. The care plan discusses a variety of topics, including symptom management, emotional and practical aspects of care, and available supports for both the patient and their family/caregivers.
- Patient and Family Support Services provide monthly patient and family education sessions about living with advanced cancer.
- CCMB clinicians are encouraged to discuss goals of care and advance care planning with patients with late-stage cancer, which provides opportunities to review and update ongoing treatment plans. The latter is recorded via the electronic cancer record system (ARIA).

Manitoba:

Palliative care is administered separately within each regional health authority.
The Palliative Care Drug Access Program is provided by Manitoba Health and covers the cost of eligible prescription drugs for individuals registered in a palliative care program within their regional health authority.
Palliative Manitoba (PM) is a registered charity with a focus on bereavement support. PM maintains contact with region-specific palliative care programs on a continuing basis and shares outreach and education opportunities.
Medical Assistance in Dying (MAiD) is available to patients with grievous and irremediable medical conditions which meet specific criteria.

New efforts

CancerCare Manitoba (CCMB):

CCMB’s Pain and Symptom Management Team is working to implement improved palliative care within rural/remote areas of Manitoba.

Manitoba:

While Winnipeg has good palliative care services, there is significant inequity in other areas of Manitoba (mostly due to geography). To address this, Manitoba’s Clinical and Preventive Services Plan outlines initiatives to improve provincial standards/oversight and coordination/centralization of resources to ensure reliable and consistent access to health care for all Manitobans.
The Interlake-Eastern Regional Health Authority (IERHA) is involved in the Paramedics Providing Palliative Care at Home Program (launched in October 2020). The program trains paramedics to deliver palliative and end-of-life care in patients’ homes, allowing patients to remain at home whenever possible. Since October 2020, approximately 90% of the paramedics working in the IERHA have received palliative care-specific training.

Indicator:

Indicator data not available at this time.

Increasing access to supportive psychosocial care services

Where we are today

Percentage of rural and remote cancer patients who were diagnosed with any invasive cancer and indicated willingness to access psychosocial support, by fiscal year

7.1% in 2019-20, 3.2% in 2020-21, and 12.8% in 2021-22.

Data source: Provincial cancer agencies and programs
Notes:

The COVID-19 pandemic may have affected service provision.
For this indicator, rural/remote is defined as Regional Health Authorities outside of the Winnipeg Regional Health Authority (RHA). This includes Interlake Eastern (RHA), Northern RHA, Prairie Mountain Health, and Southern Health – Santé Sud. Winnipeg RHA data are not included for this indicator.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Continue work towards the 2020 Roadmap to Cancer Control for Manitoba.

Current situation

Psychosocial Oncology is part of Patient and Family Support Services at CancerCare Manitoba (CCMB). Individual, couple and family counselling, as well as support groups, are offered at no cost to all CCMB patients and their families.
Psychosocial Oncology Clinician counsellors are available throughout the province with visits provided in-person or virtually.
Rural and Winnipeg psychosocial oncology staff have created a community of practice where they can discuss cases, ask questions, and support each other in continuous learning.
The position of a Provincial Clinical Lead - Psychosocial Oncology is key to onboarding, supporting, mentoring, and responding to clinical questions and problem solving in this area.

New efforts

Planning and providing support services through a health care equity lens is a priority at CCMB.
Through research, CCMB is actively involved in better serving frail elderly individuals living with cancer, who are at higher risk of being over/under treated, including psychosocial services. CCMB is developing standard screening tools for frail elderly individuals living with cancer that address co-morbidities and screen for physical, mental, cognitive and emotional well-being.
Guided by a First Nations led planning committee, CCMB hosted a series of webinars titled “Patient Support Webinars from a First Nations Perspective” in Fall 2021. In support of people-specific and self-determined care, CCMB is planning patient support webinars from a Métis and Inuit perspective working with Métis and Inuit led planning committees, respectively.

Indicator:

Percentage of rural and remote cancer patients who were diagnosed with any invasive cancer and indicated willingness to access psychosocial support

Increasing access to virtual care

Where are we today

Percentage of cancer patients and visits from rural/remote communities using virtual health appointments
2019: 12% of visits, and 19.3% of patients. 2020 (start of pandemic): 47.3% of visits, and 72.3% of patients. 2021 (Pandemic era): 54.7% of visits, and 76.1% of patients. 2022: 48.9% of visits, and 69.7% of patients

Our goal

Enable access to high quality, appropriate, person-centred virtual cancer care.
Reduce barriers to virtual cancer care, particularly where there are concerns about equitable access (e.g., in rural/remote communities).

Current situation

Although the percentage of cancer patients and volume of virtual care visits in rural and remote communities increased significantly since the start of the COVID-19 pandemic, there was a drop from 2021 to 2022 that coincided with an increase in in-person appointments. There is a balance between in-person and virtual care appointments and this reduction in virtual visits would be consistent with achieving that balance. Our Person-Centered Care group has created guidelines that describe when in-person appointments might be considered over a virtual appointment. The remuneration of virtual care visits was also reduced to recognize this balance between virtual care and in-person visits.
In 2022, 69.7% of people with cancer in rural/remote communities had a virtual health care appointment.
- Virtual visits occurred for 61.9% of patients receiving systemic treatment, 69.8% of patients who have undergone radiation treatment, and 82.2% of patients receiving psychosocial oncology care.
- Approximately half of non-treatment appointments for people with cancer in rural/remote communities were virtual (48.9%).

New efforts

The Ambulatory Systemic Treatment Models of Care Recommendations Report, which was published in July 2023, included recommendations on the adoption of virtual care for cancer patients receiving systemic treatment.

Indicator:

Percentage of cancer patients from rural/remote communities using virtual health appointments

Increasing access to supportive care services

Where we are today

Percentage of patients with cancer in ON in rural/remote areas who received palliative care or psychosocial oncology services

In 2019: Palliative at 24.7% and Psychosocial at 11.4%. In 2020 (start of pandemic): Palliative at 26.2% and Psychosocial at 12.5%.

Data source: Provincial cancer agencies and programs
Note:

Palliative care and psychosocial service utilization in rural/remote areas was comparable to that of urban areas.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Our goal

Establish provincial targets for availability of supportive services to people in rural and remote areas.
Improve access to high quality supportive care services to people living in rural, remote and urban areas.
Improve health equity so that people are not disadvantaged by who they are, where they live, or what resources they have.
Develop health policy advice and implement strategies to support underserved people.

Current situation

For patients with cancer residing in rural/remote communities, both palliative care and psychosocial oncology visits increased from 2019 to 2020; 6.1% and 9.6%, respectively.
The percentage of cancer patients receiving these services is similar in rural/remote and urban areas of Ontario.
A plan has been developed to improve access to palliative and psychosocial oncology services regardless of where a person lives, their age or health condition.
The Ontario Palliative Care Network’s provincial program at Ontario Health is working in partnership with the Ontario Health Regions and other provincial stakeholders to implement the Ontario Provincial Framework for Palliative Care, which outlines the government’s commitment to develop a more integrated and equitable system for the delivery of palliative care in the province.

New efforts

Ontario is developing and implementing new models of care to enhance the quality of and access to integrated psychosocial oncology services in hospitals and the community, leveraging virtual and community-based supports.
Indicators are being developed to measure access to psychosocial oncology services, starting with speech-language pathology and dietitian access for head and neck cancer patients.
The Ontario Palliative Care Network has developed the Palliative Care Health Services Delivery Framework which includes recommendations on a model of care to improve access to high-quality palliative care for adults residing in the community and in long term care homes. Model of care recommendations for adults in hospital settings and pediatric populations across all care settings are currently being developed.
The Ontario Palliative Care Network provincial program has received funding from the Ministry of Health to work with Ontario Health Regions over the next three years to implement the model of care in community settings, in collaboration with local health care organizations, including Ontario Health Teams. This model of care for community settings will contribute to sustainable, equitable and coordinated palliative care for Ontarians experiencing serious illnesses and their family or caregivers.
The Ontario Palliative Care Network’s provincial program is developing a measurement plan that includes new indicators to assess, monitor, and evaluate implementation of the model of care for community settings.

Indicator:

Percentage of patients with cancer in rural/remote areas who received palliative care or psychosocial oncology services

Increasing access to supportive care services

Where we are today

Indicator data not available at this time.

Our goal

Increase access to supportive services in the community.

Current situation

Work is on-going to implement integrated palliative and end-of-life care services in New Brunswick. The goal is to support the provision of person and family-centered care across care settings by an interdisciplinary team and in the home.
The provincial, community-oriented Cancer Patient Navigation Program is operational since spring 2022. The Program provides assistance provides assistance and support to people with cancer of all ages and their families, especially in the pre-diagnostic and post-treatment transition to cancer survivorship periods. The goals of the Program are to facilitate coordination and access to available resources and services within the healthcare system and the community.
Information on palliative care services is available on the Social Supports NB website.

Indicator:

Indicator data not available at this time.

Increasing access to virtual care

Where we are today

Percentage of cancer patients using virtual health appointments, by number of patients and number of appointments

Patient level: 1.5% in 2019, 59.2% in 2020, 63.4% in 2021 and 64.1% in 2022 Appointment level: 0.7% in 2019, 31.5% in 2020, 36.7% in 2021 and 37.2% in 2022

Our goal

Maximize use of virtual technology at community oncology sites where appropriate and safe to do so.
Ensure all community oncology sites have access to, or dedicated, virtual care equipment.
Connect with First Nations community partners to explore opportunities for use of virtual care.

Current situation

Telehealth has been a long-standing component of Nova Scotia Health’s care delivery model. Dedicated equipment is available to the Cancer Care Program in selected sites. Technology is available at all sites, and telehealth must be coordinated with other services that can impact accessibility.
In 2019 telehealth was the only virtual option for patients. Attendance at a telehealth appointment requires the patient to travel to a local hospital to attend telehealth appointments with oncologists/NP at other sites.
In 2020, phone and zoom appointments were added to facilitate care during the pandemic.
During the pandemic, multiple resource documents and education materials were developed to support the growth of virtual care.
Nova Scotia has limited coverage of broadband internet in many regions of the province reducing accessibility for at home video appointments.
Socioeconomic status (SES) may limit access to technology required for at home video appointments.

New efforts

Virtual care will be a priority within the Models of Care project. The goal will be to expand on existing use of virtual care, for example, by incorporating the General Practitioner in Oncology (GPO) into visits with other cancer specialists.
Post-pandemic, Nova Scotia will work to establish guidelines that support appropriate use of virtual care platforms and standardize this model of care delivery.
A new Oncology Transformation Project (OTP) at Nova Scotia Health will provide real-time oncology information to triage and manage patients’ treatments and symptoms leading to streamlined care, enhanced access to care, reduced wait times, and improved outcomes for patients.

Indicator:

Percentage of cancer patients using virtual health appointments, by number of patients and number of appointments

Increasing access to supportive psychosocial care services

Where we are today

Percentage of individuals who indicated they received supportive help of those who indicated they needed supportive services in 2020

Data source: Nova Scotia Health Cancer Care Program 2020 Patient Satisfaction Survey
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Ensure people with cancer who live in rural and remote areas have access to the information and resources they need at the appropriate time.
Ensure cancer programs have the appropriate psychosocial oncology resources to support people with cancer who live in rural and remote areas.

Current situation

Cancer patient navigators are available in rural and remote communities.
Psychosocial oncology specialists provide limited care in some rural and remote communities.
People with cancer who live in rural and remote communities have access to limited support services from the two cancer centres in Halifax and Sydney.
Across the province, people with cancer have access to virtual patient education sessions including patient orientation, living beyond cancer and symptom management.

New efforts

Work is underway to increase provision of virtual care both individually and in group format.
Ongoing advocacy for increased psychosocial oncology resources has resulted in new positions in some rural and remote communities across the province. Most cancer patients will have access to social workers and drug access navigators by the end of 2023.
A provincial psychosocial oncology community of practice has recently been established.
Work is underway to establish regular reporting to clinical teams on standards of care in psychosocial oncology, i.e., distress screening.
A framework is being developed for new and innovative psychosocial oncology services across the province.
A new real-time oncology information system will include a patient portal giving patients the ability to report their symptoms directly to their care teams via electronic distress screening and other patient reported measures.

Indicator:

Percentage of individuals indicating they received supportive help among those indicating they needed supportive services

Increasing access to supportive palliative care services

Where we are today

Proportion of Nova Scotians (18 yrs and older) who died of cancer-related causes and were referred to specialist palliative care services, by geography

Overall: 80.8% in 2019, 82.0% in 2020. Rural: 81.4% in 2019, 85.0% in 2020. Urban: 80.4% in 2019,79.2.0% in 2020.

Data source: Provincial cancer agencies and provincial palliative care program
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Ensure that every person who needs palliative care support can access it at the right time, in the right place by the right people.
The goal for pediatric and young adults treated at the pediatric tertiary centre (IWK Health) is a consult to palliative care at the time of diagnosis.

Current situation

Palliative care enhances quality of life for people with cancer and their families by ensuring that their physical and psychosocial symptoms are well managed and that the right supports are in place.

New efforts

Nova Scotia is working to identify people with cancer who would benefit from a palliative care approach earlier by offering specialized training to those working in oncology and primary care settings.
The province is also expanding the use of tools (such as, the Edmonton Symptom Assessment System (ESAS), Palliative Performance Scale (PPS), Eastern Cooperative Oncology Group (ECOG), etc.) to help healthcare teams identify and support people with cancer who would benefit from palliative care.

Indicator:

Proportion of the population who died in 2019 of cancer-related causes and were referred to specialist palliative care services

Increasing access to virtual care

Where we are today

Percentage of patients with cancer who had any out of province virtual appointments
2019: 0.6%, 2020: 0.2%.

Our goal

Ensure timely access to information, services and care for people with cancer and their families.
Increase the number of virtual appointments among people with cancer to facilitate timely access to treatment or consultations to improve patient outcomes and prognoses.
Reduce the burden of travel time, costs and impact on wellness for people with cancer, families and caregivers through expanded use of virtual care.

Current situation

PEI has a limited number of specialists, and people with cancer often have to travel for appointments, including outside the province.
A small number of people are currently served by virtual appointments, but many more could be. All healthcare providers in the cancer care team are equipped with the basic tools/technology to offer some virtual care to people with cancer across PEI.
Unaffiliated patients who are on the patient registry have access to Maple free of cost for primary care needs. Maple is a healthcare platform that allows people to access doctors and healthcare providers using instant messaging, audio or video chats.
Funding from the Canadian Partnership Against Cancer is advancing virtual care through increased availability of equipment and technology for oncology care providers and people with cancer.

New efforts

Focus will be placed on learning from other virtual programs and enhancing virtual care options for people with cancer living in rural areas through collaboration with primary care and chronic disease, home care and community hospitals.

Indicator:

Percentage of patients with cancer who had any virtual appointments

Increasing access to supportive services

Where we are today

Indicator data not available at this time.

Our goal

Ensure timely access to information, services and care for people with cancer and their families.

Current situation

PEI’s Rural Cancer Care Plan was developed in 2019 and has four areas of focus:
- Review and enhance the Cancer Patient Navigation Program
- Increase supports available to those who must travel to the PEI Cancer Treatment Centre (PEICTC) for treatment
- Expand cancer services into rural community settings
- Leverage telehealth technologies to allow rural patients to connect with their oncology team closer to home
Funding from the Canadian Partnership Against Cancer (CPAC) is advancing virtual care through increased availability of equipment and technology for oncology care providers and people with cancer.

New efforts

Initial planning is underway in the Cancer Patient Navigation Program to further engage at the community level.

Indicator:

Indicator data not available at this time.

Increasing access to virtual care

Where we are today

Percentage of patients with cancer from rural/remote communities using virtual health appointments
Patient level: 67.9% in 2019-2020, and 86% in 2020-2021. Appointment level: 37% in 2019-2020, and 60.7% in 2020-2021.

Data source: Provincial cancer agencies and programs
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Enhance and expand the use of virtual care in each regional health authority.

Current situation

Newfoundland and Labrador is currently expanding the use of virtual care in healthcare facilities and at home using the Cisco and Zoom for healthcare platforms.
During COVID-19, the province established a new fee code for clinicians to facilitate virtual communication with patients by telephone or using telemedicine.
The province is using video conferencing solutions, eStethoscopes and digital examination cameras to enhance virtual care appointments.

New efforts

New efforts in virtual care include the following:
- Virtual ERs
- Primary care clinics
- NICU – all birthing sites with virtual technologies and the peripheral devices
- Virtual pre-admission
- Home-based video appointments for cancer care

Indicator:

Percentage of patients with cancer from rural/remote communities using virtual health appointments

Increasing access to supportive care services

Where we are today

Percentage of patients diagnosed with cancer in 2022 who reside outside of the St. John's census metropolitan area and accessed Social Work and/or Nutrition Services
Overall 58.2%

Data source: Provincial cancer agencies and programs
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Provide high-quality, multidisciplinary supportive care services that are centred on people with cancer and their families who live in rural/remote areas.

Current situation

Patients can be referred by any member of the health-care team or patients can self-refer to access Social Work and/or Nutrition Services.
If applicable, patients can be referred to Social Work and/or Nutrition Services outside of the NL Cancer Care program.

New efforts

Patients have the option of in-person or virtual appointments regardless of where they reside in Newfoundland and Labrador.

Indicator:

Percentage of patients diagnosed with cancer in 2022 who reside outside of the St. John's census metropolitan area and accessed Social Work and/or Nutrition Services

Select jurisdiction to see progress:

Improving access to timely care for people who need to travel between jurisdictions

Why we are focusing on care away from home

travel to get care

Accessing care close to home is the preferred choice for a person experiencing cancer. However many people, including First Nations, Inuit and Métis, must travel outside their province or territory for cancer treatment because services are not available close to home.
In very remote areas, people often have to travel by plane to receive treatment, leaving family, friends and work for long periods of time. For example, many people with cancer in the Northwest Territories must travel to Alberta for much of their cancer care¹. Yukon residents regularly travel to British Columbia. Residents from Nunavut frequently travel to Yellowknife, Ottawa, Winnipeg or Edmonton for access to treatment.
Other patients may be able to get care closer to home by crossing the border to a hospital in another province or territory. For example, British Columbia residents who live close to the Alberta border may get care and treatment in Alberta, and people living in the Maritimes may move between provinces for care.
Travelling between provinces and territories creates additional barriers for people with cancer. There may be costs related to travel. Sometimes there are treatment delays due to issues transferring patient-related information from one jurisdiction to the other. And when treatment is complete, the transition home and to follow-up care can be a challenge.
Lack of culturally safe care, lack of support from family or community and isolation during treatment can complicate accessing timely care away from home. People traveling for cancer treatment may need to travel on their own and be away from family (or other supports) for an extended period while treatment is ongoing. They may face further inequities due to challenges with language and lack of inclusive cultural supports such as traditional foods.

What we want to achieve

People who need to travel to other provinces or territories to access cancer care supported by travel policies that allow them to easily access treatment in those provinces²
Inter-provincial agreements on patient care and treatment coverage in place
Information-sharing agreements in place so patient information is easily shared between healthcare teams in different provinces or territories, facilitating follow up care in the home province
Improved and streamlined appointment times to minimize travel time away from family

What this would mean for people in Canada

A cancer care system unified around the needs of people with cancer, no matter where they live
Equitable, high-quality, seamless patient experience
Increased quality and timeliness of cancer care for those needing to travel outside of their home province or territory
First Nations, Inuit and Métis who live in rural/remote areas are supported to travel to other provinces/territories or to urban areas to receive cancer care
First Nations, Inuit and Métis children receiving treatment in different jurisdictions do not experience delays to care because of disputes on whether the provincial or federal government should cover the cost of treatment (Jordan’s Principle)³

Improving access to transportation and general support for those needing to travel between jurisdictions

Why we are focusing on access to transportation programs and other supports^4,5
travel and support

People in rural and remote communities, including First Nations, Inuit and Métis, often have to travel long distances to urban areas to receive cancer care. Sometimes they must leave their communities for long periods of time.
The need to travel for cancer care creates additional worries about work and family. It often involves significant costs for travel (transportation, accommodations and meals).
Provinces and territories have programs in place that cover the cost of travel, but they vary. In some programs, travel costs are fully covered. In others, people have to pay a percentage of costs. Sometimes, patients have to pay up-front and are reimbursed after they have received care. The federal Non-Insured Health Benefits program covers some medical transport costs for First Nations and Inuit, but it is not always easy to access or navigate, and Métis and First Nations without Registered Indian status do not have access to the program.⁶
The travel costs of a family caregiver are rarely covered.
People with cancer who are seeking care have faced challenges in travelling and transportation due to the COVID-19 pandemic. Funding and travel-related supports can help address the emerging difficulties associated with COVID-19.

What we want to achieve

People with cancer and their caregivers have access to transportation programs and other supports that provide financial relief when they need it, ideally without having to pay for travel costs up-front (transportation, accommodations and meals)
Enhanced travel policies for First Nations, Inuit, Métis to support access to family caregivers, as well as funding for travel regardless of status or access to non-insured health benefits

What this would mean for people in Canada

People with cancer will not have to worry about the financial burden of travelling to receive the care they need
Costs will not limit a person’s ability to able to travel with their caregiver
First Nations, Inuit and Métis people with cancer and their families are supported in accessing comprehensive transportation programs, and the programs are accessible for all First Nations, Inuit and Métis, regardless of status

Improving access to timely care for people who need to travel between jurisdictions

Where we are today

Average wait time (in days) for patients with cancer who require cancer treatment outside of their home jurisdiction
Median: 40 days in 2019, 26 days in 2020, and 19 days in 2021. 90th percentile: 179 days in 2019, 157 days in 2020, and 78 days in 2021.

Data source: Provincial cancer agencies and programs
Notes:

If the patient was approved for multiple treatments, the wait time was based on approval to first treatment.
Wait times for patients requiring procedure or treatment outside the province may require measurement of the timelines at different levels. These may include from request of procedure or treatment to approval from SCA, time of approval by the ministry, appointment for procedure or treatment by the facility outside the province. These may have to be taken in account when considering treatment or procedure which could be done within the province.
The COVID-19 pandemic may have affected service provision.

Click here to see all data and data limitations, including any additional stratifications.

Current situation

People with cancer may require treatment outside of Saskatchewan or outside of Canada. For funding, the approval must be obtained from Saskatchewan Ministry of Health, prior to starting treatment.
The Saskatchewan Cancer Agency process of review of out of province and out of Canada requests, and providing recommendation is streamlined to avoid delays.

Indicator:

Average wait time (in days) for patients with cancer who require cancer treatment outside of their home jurisdiction

Improving access to timely care for people who need to travel between jurisdictions

Where we are today

Indicator data not available at this time.

Our goal

Continue to support patients navigating the cancer system and work towards the delivery of timely access to quality cancer care for all people living with cancer (outlined in the 2020 Roadmap to Cancer Control for Manitoba).

Current situation

CancerCare Manitoba (CCMB):

CCMB cancer patients rarely require treatment outside of Manitoba, but if they do the most common indication for out-of-province treatment is for CAR-T therapy (chimeric antigen receptor T-cell therapy). Recently, Manitoba has began to fund CAR-T therapy that is delivered locally.
CCMB’s patient representatives facilitate logistics associated with transportation in the event that care is required outside of a patient’s jurisdiction (outside of Manitoba or Canada).
CCMB provides various cancer-care services to out-of-province patients:
- Radiation therapy for patients from parts of Northwestern Ontario, Saskatchewan, the Northwest Territories and Nunavut
- Bone marrow transplants for patients from Northwest Territories and Saskatchewan. In particular, pediatric patients living in Saskatchewan who need bone marrow transplants are cared for in Manitoba.
- E-beam therapy for patients from Alberta and Saskatchewan (Winnipeg is the only site east of the Rockies that offers this service).

Manitoba:

Manitoba Health assists with costs associated with Manitobans receiving medical care in another province or country. The latter must be a) for a treatment unavailable in Manitoba and b) deemed necessary by a medical specialist. Expenses covered include doctor & hospital bills and transportation.
The Non-Insured Health Benefits (NIHB) for First Nations and Inuit covers fees for transportation to medical services unavailable in their community.
The Northern Patient Transportation Program (NPTP) is available to all eligible Manitoba residents living north of the 53rd parallel from the Manitoba Saskatchewan Border to Lake Winnipeg. The NPTP coordinates transportation for elective and emergency transfers and liaises with First Nations and Inuit Health to coordinate intercity transport and boarding on behalf of the patients

New efforts

In 2023, Manitoba started to deliver CAR-T therapy that is delivered locally.

Indicator

Indicator data not available at this time.

Improving access to timely care for people who need to travel between jurisdictions

Where are we today

Number of patients who received funding approval under the Ontario Health Insurance Plan for cancer treatment outside of Canada, by fiscal year

Fiscal year 2019-2020 (start of pandemic): 69 patients. Fiscal year 2020-2021 (start of pandemic): 27 patients. Fiscal year 2021-2022 (pandemic era): 24 patients. Fiscal year 2022-23: 24 patients

Data source: Ontario Ministry of Health
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Support the Ministry of Health’s Out-of-Country Prior Approval Program which ensures access to funding for medically necessary health services when they are either not performed in Ontario or there is a delay that would result in death or medically significant irreversible tissue damage.
Strive for operational excellence and timely reviews to minimize delays to patient care.

Current situation

Ontario Health (Cancer Care Ontario) reviews applications for Out-of-Country cancer services submitted by Ontario physicians and provides a funding recommendation to the Ministry of Health based on evidence and input from clinical expert reviewers.
The majority of approved Out-of-Country cancer services in FY 2019-2020 was for chimeric antigen receptor (CAR) T-cell therapy which became available in Ontario in late 2019. In subsequent FYs (2020-2021, 2021-2022 and 2022-2023), the majority of approved services was for proton beam therapy.
The decrease in the number of Ontario patients receiving funding approval in FY 2020-2021 can be attributed to a decrease in Out-of-Country applications due to the COVID-19 pandemic and increased capacity to deliver CAR T-cell therapy in Ontario.

Caveats/limitations: The COVID-19 pandemic continues to affect service provision in FY 2022-2023.

New efforts

Ontario Health (Cancer Care Ontario) will support the Ministry of Health in reviewing applications for out-of-country cancer-related services, monitor trends in applications and support the repatriation of services to Ontario where needed.

Indicator:

Number of Ontario patients who received funding approval under the Ontario Health Insurance Plan for cancer treatment outside of Canada, by fiscal year

Improving access to timely care for people who need to travel between jurisdictions

Where we are today

Wait time (in days) for patients with cancer who require cancer treatment outside of their home jurisdiction
Median: 34 days in 2019. 36 days in 2019/2020. 90th percentile: No data for 2019. 124 days in 2019/2020.

– Data not available
Data source: Provincial cancer agencies and programs
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Decrease the average wait time for people with cancer who require treatment (radiation, medical oncology, surgery) outside of their home jurisdiction.

Current situation

PEI has a limited number of specialists, and people with cancer often have to travel for appointments and treatment, including outside the province.
A longer wait time could worsen the cancer stage, the patient’s general health and their overall prognosis.

New efforts

Efforts are underway to keep a full complement of specialists and to supplement with virtual care in PEI to decrease the need for travel out of province for people with cancer.

Indicator:

Wait time (in days) for patients with cancer who require cancer treatment outside of their home jurisdiction

Improving access to transportation and general support for those needing to travel between jurisdictions

Where we are today

Percentage of all patients with cancer and with out of province appointments who were awarded transportation support in bus tickets, bridge or ferry passes, and plane tickets
Hope Air in 2019 was 29.5%, and in 2020 was 30.4%. Maritime Bus in 2019: 1.8%, and in 2020 there was no data.

*Suppressed owing to small numbers
Data source: Provincial cancer agencies and programs
Note: The COVID-19 pandemic may have affected service provision.
Click here to see all data and data limitations, including any additional stratifications.

Our goal

Ensure barrier-free access to care/treatment for people with cancer.
Expand access to transportation services that better meet the needs of people with cancer by reducing the burden of cost and time.
Increase partnerships with community and non-governmental organizations to help more people with cancer and their families afford a fast and comfortable means of transportation (e.g., plane tickets) to ensure timely treatment.
Ensure more people who need to travel out of province for cancer care are provided timely information and support (practical, financial and informational).

Current situation

Some people with cancer need to travel outside the province for treatment due to a shortage of cancer specialists and resources in PEI. Those with low income qualify for governmental support.
Hope Air (an organization that shares 50 per cent of the government’s cost for transportation services) supports patients who need the service with multiple transportation routes (bridge and ferry passes, flight tickets).
A review of the Cancer Patient Navigation Program is underway to ensure people with cancer are supported in accessing government and community services.

New efforts

The current effort to to keep a full complement of specialists and to supplement with virtual care in PEI will help to decrease the need for transportation services, particularly for those with low income.

Indicator:

Percentage of all cancer patients with out of province appointments who were awarded transportation support in bus tickets, bridge or ferry passes, and plane tickets

Improving access to timely care for people who need to travel between jurisdictions

Where we are today

Average wait time (in days) for patients with cancer required Allogeneic Stem Cell Transplant (ASCT) treatment outside of their home jurisdiction
Mean: 177 days in 2019, and 194 days in 2020. Median: 167 days in 2019, and 123 days in 2020.

Our goal

Continue to collaborate with internal and external partners to improve access to patient care and to actively coordinate to minimize treatment delays and strive for timely patient care.

Current situation

The Medical Transportation Assistance Program provides financial assistance for substantial travel costs if residents have to travel to receive cancer care.
For patients who live in Labrador, Air Daffodil provides up to three return flights per year to patients who must travel to receive treatment.

New efforts

The Medical Transportation Assistance Program policy is under review. The organization is looking into ways to provide fair and reasonable compensation for those who have to travel for medical services that are not available within their residential area or within the province.

Indicator:

Average wait time for cancer patients who require cancer treatment outside of their home jurisdiction

Our Priorities

Priority 1

Decrease the risk of people getting cancer

Priority 2

Diagnose cancer faster, accurately and at an earlier stage

Priority 3

Deliver high-quality care in a sustainable, world-class system

Priority 4

Eliminate barriers to people getting the care they need

Priority 5

Deliver information and supports for people living with cancer, families and caregivers

Priority 6

Culturally appropriate care closer to home

Priority 7

Peoples-specific, self-determined care

Priority 8

First Nations-, Inuit- and Métis-governed research and data systems

Priority 4: Eliminate barriers to people getting the care they need

Not everyone in Canada has the same access to high-quality care and support.

Our Priorities

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