SUSTAINING ACTION TOWARD A SHARED VISION - 2012–2017 Strategic Plan - Partnership Against Cancer Canada (does not include ovarian/gyn)

Blogger's Note: search of 'ovarian'/'ovary'/'gyn' yields null results

SUSTAINING ACTION TOWARD A SHARED VISION - 2012–2017  Strategic Plan - Canada

CONTENTS
2 MESSAGE FROM THE CHAIR AND CEO
4 EXECUTIVE SUMMARY
1. 2012–2017 Strategic Plan
10 THE GROWING CHALLENGE OF CANCER
16 ADVANCING A SHARED VISION
34 2012–2017 STRATEGIC FRAMEWORK
38 STRATEGIC PRIORITIES
52 CORE ENABLING FUNCTIONS
2. 2012–2017 Business Plan
64 PLANNING FOR RESULTS
70 STRATEGIC PRIORITIES
103 CORE ENABLING FUNCTIONS
3. Moving Forward Together
122 TRANSFORMING CANCER CONTROL

Bill C-38 protest has 13,000 websites going dark across Canada this June | Canada Politics - media (c-38 bill/Canadian healthcare)

Bill C-38 protest has 13,000 websites going dark across Canada this June | Canada Politics

"When it comes to politics, Canadians are generally an apathetic bunch. Often, a controversy will brew and within a week or two we forget about it and move on.

It appears Bill C-38 is one issue we're not willing to let go....

Bill C-38

Jobs, Growth and Long-term Prosperity Act

An Act to implement certain provisions of the budget tabled in Parliament on March 29, 2012 and other measures

 

C-38: What it means for health care (media)

Many US cancer survivors still lost in transition : The Lancet (U.S. / Canada....)

Many US cancer survivors still lost in transition : The Lancet

Loud and Clear: seniors and caregivers speak out about navigating Ontario's healthcare system

Change Foundation engaged Ontario seniors.....

Loud and Clear

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About Loud and Clear

In Loud and Clear: Seniors and caregivers speak out about navigating Ontario’s healthcare system, we explain our rationale for the timing and target of our engagement, describe our methodology, present our findings and how we plan to use them, and share the Foundation’s next steps and how they fit, feed into, and even blaze the way for patient-centred healthcare in Ontario.

Dedication

We dedicate this report to the seniors and their family members and friends across Ontario who shared their experiences and stories with us. They spoke forcefully and thoughtfully, with both emotion and measure, about where the system has failed them and how it could serve them better. They spoke loud and clear.

---

“I don’t know what’s happening next, but where do you go to find the answers? Seems like there are roadblocks set up in the system that make it hard.”
Ontario senior 
 

“Our doctor sent us for an appointment with a specialist. We waited five months and never heard anything, so I called and they had no record of the appointment. It would be a good idea if someone from the doctor’s office called the patient once an appointment is made to confirm.”
Ontario senior 

“I’ve never been asked as a caregiver, 'What’s convenient for you?' Or 'How would this work in your family?' instead it’s 'This is what we’re going to do for you.' There's no discussion of collaboration.”
Ontario caregiver

April 2011 (latest revision) - Alberta, Canada health services recommendations: RISK REDUCTION AND SURVEILLANCE STRATEGIES FOR INDIVIDUALS AT HIGH GENETIC RISK FOR BREAST AND OVARIAN CANCER

RISK REDUCTION AND SURVEILLANCE STRATEGIES FOR INDIVIDUALS AT HIGH GENETIC RISK FOR BREAST AND OVARIAN CANCER Date Developed: December, 2007 Last Revised: April, 2011

National Guideline Clearinghouse | Epithelial ovarian, fallopian tube, and primary peritoneal cancer - Alberta, Canada

Blogger's Note: note the differences in early stage recommendations per cell type

National Guideline Clearinghouse | Epithelial ovarian, fallopian tube, and primary peritoneal cancer.

Guideline Title

Epithelial ovarian, fallopian tube, and primary peritoneal cancer.

Bibliographic Source(s)

 

Alberta Provincial Gynecologic Oncology Tumour Team. Epithelial ovarian, fallopian tube, and primary peritoneal cancer. Edmonton (Alberta): Alberta Health Services, Cancer Care; 2010 Jul. 19 p. (Clinical practice guideline; no. GYNE-005).  [104 references]

Guideline Status

This is the current release of the guideline.

- Scope Methodology Recommendations Evidence Supporting the Recommendations Benefits/Harms of Implementing the Guideline Recommendations

- Qualifying Statements Implementation of the Guideline Institute of Medicine (IOM) National Healthcare Quality Report Categories Identifying Information and Availability Disclaimer

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Scope

Disease/Condition(s)

• Epithelial ovarian cancer
• Fallopian tube cancer
• Primary peritoneal cancer

Guideline Category

Evaluation Management Treatment

Clinical Specialty

Obstetrics and Gynecology Oncology Radiation Oncology Surgery

Intended Users

Physician Assistants Physicians

 

Guideline Objective(s)

To outline management decisions for women with epithelial ovarian, fallopian tube, or primary peritoneal cancer



Key Points

1. Completely staged, early epithelial ovarian, fallopian tube, and primary peritoneal cancers are highly curable. As such, patients should be referred to a gynecologic oncologist for adequate staging, including sampling of para-aortic and pelvic lymph nodes, infracolic omentectomy, possible appendectomy and biopsy of suspicious peritoneal lesions, in addition to a thorough inspection and palpation of all peritoneal surfaces, and peritoneal washings.
2. Advanced epithelial ovarian, fallopian tube, and primary peritoneal cancers are best treated with optimal debulking surgery in conjunction with adjuvant therapy. As such, patients should be referred to a gynecologic oncologist  

paywalled: Journal of Cancer Education: Knowledge of Reproductive System Cancers, Their Treatments and Side Effects (Canada)

Knowledge of Reproductive System Cancers, Their Treatments and Side Effects

 Abstract 

We explored, via an online questionnaire, knowledge of breast and reproductive system cancers in patients and non-patients who access the internet for information on these diseases. We compared that knowledge to the attention the diseases have received in medical research and on the Internet. Data were collected from 690 respondents (37 % male, 63 % female) about their knowledge of prevalence, lethality, treatments and side effects of testicular, prostate, breast, uterine, cervical and ovarian cancers. Most males, but only half of the female participants, were patients themselves. Although participants showed better knowledge of cancers specific to their own sex, both sexes felt familiar with breast cancer and less aware of other cancers. Women were as aware as men of side effects of treatments for male reproductive cancers. Sex differences in awareness appear to reflect different attitudes towards illness, bias toward females as caregivers, and the disproportionate media attention given to breast cancer.

abstract: Curr Oncol. 2012 Apr;19(2):70-7. Accelerating knowledge to action: the pan-Canadian cancer control strategy (including blogger's note)

Blogger's Note/Opinion: this is the medline abstract secondary to the recent posting via Oncology Reports; some points to consider: details of the history past need clarification so as not to presume certain statements; in fact a further ~$250 million was funded by the Canadian government at the 5 year renewal date; note also that the Canadian Partnership Against Cancer existed previously (name change), albeit without the current wider structure

                   ~~~~~~~~~~~~~~~~~~~~~~~~~

Accelerating knowledge to action: the pan-Canadia... [Curr Oncol. 2012] - PubMed - NCBI
 

Abstract

"In 2006, the federal government committed funding of $250 million over 5 years for the Canadian Partnership Against Cancer Corporation to begin implementation of the Canadian Strategy for Cancer Control (cscc)...."

"Evaluation findings support the conclusions that Canada has made progress in achieving immediate outcomes (achievable in <5 years) associated with advancing its cancer control goals and that there is evidence that, with sustained effort, those goals will translate into a long-term (>25 years) impact on cancer."

"With the ongoing funding commitment to support coordinated action within a federated environment of health care delivery, there is opportunity to reduce the impact that cancer may have in the long term in Canada...."

Improving cancer control in Canada through knowledge translation: from in-the-field projects to policy initiatives in a new standing section in Current Oncology

Improving cancer control in Canada through knowledge translation: from in-the-field projects to policy initiatives in a new standing section in Current Oncology

Medscape: Oncologists Are Not Health Economists, Suggests Survey (U.S. & Canadian physician survey)

Oncologists Are Not Health Economists, Suggests Survey
 
 "Interestingly, responses to the clinical scenario did not significantly differ between American and Canadian oncologist."

Drug Formulary - Avastin - Cancer Care Ontario (compared to Australia) - see notes

 Blogger's Notes: 

incidence rates ovarian cancer:
Australia: 1,488 (2015 projection)
Canada:  2,600 (annual estimates)

1. Australia population (census) 22 million
2. Canada population (census) 34 million
3. Ontario population (census) 13 million

 
Drug Formulary - Ontario

 SEARCH - 'avastin' (null results for ovarian cancer)

For Health Professionals					For Patients
	Drug Monographs		Chemotherapy Regimens			Medication Information Sheets		Regimen Information Sheets

To refine your search, use Category Search or Advanced Search

CATEGORY SEARCH

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Document	Description	Document Type	Publish Date	Download
BEVA Gastrointestinal - Colorectal Advanced Regimen category: Standard	Drug(s) used: Bevacizumab (with fluoropyrimidine-based chemotherapy)	Regimen Monograph	2011-12-16
bevacizumab (patient)	Other names: Avastin®	Medication Information Sheet	2011-05-10

1-2 of 2  result(s)


(CCS) Clinical Trials - Canada: ovarian cancer/Avastin

	Recruiting in 1 of 2 locations
A Study of the Addition of Avastin (Bevacizumab) to Carboplatin and Paclitaxel Therapy in Patients With Ovarian Cancer	Recruiting in 2 of 4 locations

media: Canadians OK with higher taxes to fight inequality (preserve social programs/health)

Canadians OK with higher taxes to fight inequality

"This attitude toward paying slightly higher taxes is reflected 

equally in high-income and middle income Canadian households.

 It's only their governments who are offside," the report, the first 

from the newly established think tank, said......

abstract: Harmony in drug regulation, but who's calling the tune? An examination of regulatory harmonization in health Canada [Int J Health Serv. 2012] (eg. safety, influences, industry...)

 Blogger's Note: the current federal (conservative) government is known widely for its lack of transparency (past and present), Health Canada, obviously, falls within federal mandates

Harmony in drug regulation, but who's call... [Int J Health Serv. 2012] - PubMed - NCBI

Int J Health Serv. 2012;42(1):119-36.

Source

School of Health Policy and Management, York University, Toronto, ON, Canada. jlexchin@yorku.ca

Abstract

Harmonizing standards on drug regulation makes sense, but it must protect safety, ensure that only drugs that are truly effective are marketed, and protect a country's ability to act independently. The main driving force behind international harmonization is the International Conference on Harmonization (ICH). When it comes to safety, the ICH has been harmonizing to the lowest common denominator. Examples of harmonization indicate that industry priorities have influenced the direction that Health Canada has taken. Harmonization is also intimately tied in with the policy of smart regulation, changing regulations in a way that enhances the climate for investment. Canada has introduced user fees in concert with other countries, but there are concerns that these may compromise safety standards. When it comes to transparency, Health Canada has chosen to adopt the more restrictive European Union model rather than the more open process used by the United States. Finally, there are a number of areas in which Health Canada has chosen not to harmonize, and in each case the decision is in the direction of lower safety standards. Harmonization could be of benefit to Canada, but the evidence to date suggests that Health Canada been harmonizing down rather than up.

Evidence-based Guideline Recommendations on the use of Positron Emission Tomography Imaging in Colorectal Cancer (Ontario provincial Gastrointestinal Disease Site Group)

 Blogger's Note: updated to 2010

Evidence-based Guideline Recommendations on the use of Positron Emission Tomography Imaging in Colorectal Cancer

Dirty Hospitals - Canada CBC.ca

abstract: The practice of pathology in Canada: decreasing pathologist supply and uncertain outcomes

The practice of pathology in Canada: dec... [Arch Pathol Lab Med. 2012]
Sections of Gynecological and Cytopathology Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.

 Abstract

CONTEXT:

Pathology organizations in the United States are preparing for a new era of health care reform. Trends in the supply of pathologists in Canada's managed care system may provide some useful insights in any analysis and projection of future pathologist needs in the United States.

OBJECTIVE:

In this study, population-based Canadian databases were used to devise a parameter for physician supply, cancer cases per physician. The trend in this supply parameter for pathologists was compared to that for radiation oncologists.

DESIGN:

The number of Canadian pathologists and radiation oncologists and the annual number of new cancer cases in each of 2 years, 1999 and 2009, were extracted from reliable databases. Cancer cases per pathologist and oncologist were calculated, and relative trends in supply of physicians in both specialties were identified.

RESULTS:

The annual number of new cancer cases increased from 129,300 to 171,000 from 1999 to 2009. The absolute numbers of both pathologists and oncologists also increased in this time period. However, while the increase in the number of radiation oncologists led to an 8.2% decrease in cancer cases per radiation oncologist, the modest increase in the number of pathologists led to an increase of 17.1% in cancer cases per pathologist.

CONCLUSIONS:

There is a trend toward a decreasing supply of Canadian pathologists relative to that of cancer demands. This finding confirms an earlier population-based study showing a decreased supply relative to population and number of clinical physicians. It is uncertain whether this decreased supply is a result of appropriate application of new, efficient methods or whether health care has been rationed or adversely impacted. Outcome measures to monitor Canadian pathology practice quality are clearly needed.

Journal of Cancer Survivorship, abstract: Patient perceptions of communications on the threshold of cancer survivorship: implications for provider responses (small study)

Abstract 

 "......confusion, insecurity, vulnerability, loss, and abandonment....."

Introduction  

Although high quality professional–patient communication is recognized as fundamental to effective cancer care, less attention has been paid to developing an evidence basis for communications surrounding the stage of the cancer journey when primary cancer treatment concludes, management responsibilities shift from oncology specialist services into the generalist care domain, and the patient transitions beyond patienthood and into survivorship.

abstract: Survival Duration among Patients with a Noncancer Diagnosis Admitted to a Palliative Care Unit: A Retrospective Study

Abstract 

Background: 

Palliative care unit (PCU) beds are a limited resource in Canada, so PCU admission is restricted to patients with a short prognosis. Anecdotally, PCUs further restrict admission of patients with noncancer diagnoses out of fear that they will "oversurvive" and reduce bed availability. This raises concerns that noncancer patients have unequal access to PCU resources.

Purpose/Methods: 

To clarify survival duration of patients with a noncancer diagnosis, we conducted a retrospective review of all admissions to four PCUs in Toronto, Canada, over a 1-year period. We measured associations between demographic data, prognosis, Palliative Performance Score (PPS), length of stay (LOS), and waiting time.

Results: 

We collected data for 1000 patients, of whom 21% had noncancer diagnoses. Noncancer patients were older, with shorter prognoses and lower PPS scores on admission. Noncancer patients had shorter LOS (14 versus 24, p<0.001) than cancer patients and a similar likelihood of being discharged alive to cancer patients. Noncancer patients had a trend to lower LOS across a broad range of demographic, diagnostic, prognostic, and PPS categories. Multivariable analysis showed that LOS was not associated with the diagnosis of cancer (p=0.36).

Discussion/Conclusion:
Noncancer patients have a shorter LOS than cancer patients and a similar likelihood of being discharged alive from a PCU than cancer patients, and the diagnosis of cancer did not correlate with survival in our study population. Our findings demonstrate that noncancer patients are not "oversurviving," and that referring physicians and PCUs should not reject or restrict noncancer referrals out of concern that these patients are having a detrimental impact on PCU bed availability.

press release: Canada, Australia and New Zealand establish a new research partnership - CIHR

Canada, Australia and New Zealand establish a new research partnership - CIHR

Ottawa (March 20, 2012) – The Canadian Institutes of Health Research (CIHR), the Australian Primary Health Care Research Institute (APHCRI) at the Australian National University and the Health Research Council of New Zealand (HRC NZ) are partnering to fund research on innovative models of Community-based Primary Healthcare (CBPHC). As part of CIHR's Signature Initiative, funded teams will examine how to better prevent and manage chronic disease, as well as improve access to care for vulnerable populations.
Recognizing that innovative research in CBPHC is essential to better health outcomes, improved equity, reduced wait times, and an improved patient experience, the partners have agreed to support cross-jurisdictional Canada-Australia and Canada-New Zealand teams of researchers, patients, decision-makers and clinicians.
"This collaborative research between Canada, Australia, and New Zealand will allow our three countries to test different models of primary healthcare", said Dr. Beaudet, President of CIHR. "The international best practices that emerge will benefit our healthcare systems and, most importantly, contribute to better health outcomes."
...........cont'd

Arch Intern Med -- Abstract: Intensive Care Unit Bed Availability and Outcomes for Hospitalized Patients With Sudden Clinical Deterioration (Calgary, Alberta)

Arch Intern Med -- Abstract: Intensive Care Unit Bed Availability and Outcomes for Hospitalized Patients With Sudden Clinical Deterioration

ONLINE FIRST Intensive Care Unit Bed Availability and Outcomes for Hospitalized Patients With Sudden Clinical Deterioration

Background  Intensive care unit (ICU) beds, a scarce resource, may require prioritization of admissions when demand exceeds supply. We evaluated the effect of ICU bed availability on processes and outcomes of care for hospitalized patients with sudden clinical deterioration.

Methods  We identified consecutive hospitalized adults in Calgary, Alberta, Canada, with sudden clinical deterioration triggering medical emergency team activation between January 1, 2007, and December 31, 2009. We compared ICU admission rates (within 2 hours of medical emergency team activation), patient goals of care (resuscitative, medical, and comfort), and hospital mortality according to the number of ICU beds available (0, 1, 2, or >2), adjusting for patient, physician, and hospital characteristics (using data from clinical and administrative databases).

Results  The cohort consisted of 3494 patients. Reduced ICU bed availability was associated with a decreased likelihood of patient admission within 2 hours of medical emergency team activation (P = .03) and with an increased likelihood of change in patient goals of care (P < .01). Patients with sudden clinical deterioration when zero ICU beds were available were 33.0% (95% CI, –5.1% to 57.3%) less likely to be admitted to the ICU and 89.6% (95% CI, 24.9% to 188.0%) more likely to have their goals of care changed compared with when more than 2 ICU beds were available. Hospital mortality did not vary significantly by ICU bed availability (P = .82).

Conclusion  Among hospitalized patients with sudden clinical deterioration, we noted a significant association between the number of ICU beds available and ICU admission and patient goals of care but not hospital mortality.