Colorectal cancer screening in Canada: 2021/2022
Response to COVID-19
The COVID-19 pandemic has had a profound impact on health services across the country, including the reduction or pausing of cancer screening. Jurisdictions have been impacted in different ways, and many have developed innovative tools and processes to adapt to the impact of COVID-19.
The rollout of a new screening program had to be adjusted to avoid in-person gatherings. Community meal events that had been planned as part of the program launch were replaced with radio and newspaper ads.
The program currently does not offer organized colorectal cancer screening. As a result of opportunistic colorectal cancer screening, delays may have been experienced during COVID-19 due to decreased availability of clinical appointments (non-emergent), staffing shortages and development to support pandemic efforts.
The program has worked with healthcare providers and other partners to support and maintain its colorectal cancer screening activities. Activities have included:
- Revisions to the post-polypectomy surveillance guidelines to optimize the use of colonoscopies.
- Design and implementation of the Alberta Health Service Connect Care System to enable timely and accurate fecal immunochemical test (FIT) and colonoscopy-related data collection in the province.
- A CIHR-funded project to assess screening rates and outcomes among First Nations in Alberta.
- Guidance documents for healthcare providers and facilities, including case prioritization protocols.
- An integrated cancer screening initiative, led by nurse practitioners, to provide cervical and colorectal cancer screening using Screen Test mobile screening mammography units in rural and remote communities.
In spring 2020, the Ontario Ministry of Health paused all non-essential health services (e.g., cancer screening). This resulted in a pause in FIT kit mailing and some colorectal screening correspondence letters. A gradual approach was taken to resuming healthcare services (FIT kit mailing resumed in summer 2020 and colorectal correspondence campaigns in winter 2020). Ontario Health (Cancer Care Ontario) continues to monitor screening trends and provide supports to Regional Cancer Programs (RCPs) as needed.
Tools that have been developed include:
- Tip sheets for primary care and endoscopy providers providing evidence-based recommendations on prioritizing colorectal cancer screening during COVID-19.
- A COVID-19 regional monitoring and planning tool that is shared with RCPs on a monthly basis to help monitor and improve COVID-19 recovery metrics (e.g., fecal test volumes, colonoscopy volumes, wait times for colonoscopy for people with an abnormal fecal test, regional endoscopy backlog).
The program also developed a media kit with materials (e.g., key messages, robo-call scripts, program fact sheet) to support regional public awareness campaigns.
The program implemented a new funding system for endoscopy units to improve volume and reduce wait times. This funding system now includes an additional amount for colonoscopy overproduction to reduce the waiting lists that have increased during COVID-19.
The program also aims to establish the pairing of health institutions according to their proximity, their wait times for colonoscopies and their capacity. As soon as the balance between supply and demand in colonoscopy is reached in a health institution, the pairing and the management of colonoscopy cases from the partner institution is mandatory. The program supports an ongoing project to explore the relevance of prioritizing patients according to quantitative FIT results.