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Cancer Care Ontario –Molecular Pathology & Research

Pathology Matters Meeting, Toronto

OCTOBER 6, 2017

Aaron PollettProvincial Head, Pathology and Laboratory Medicine Program Cancer Care Ontario

Outline

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• CCO Research Strategy

• Overview of Cancer Care Ontario / PLMP

• Molecular Pathology • CCO - Personalized Medicine Framework• Transition to Clinical Care

Research Strategy

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Research Motto

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Implement what we Evaluate;Evaluate what we Implement.

Research Goals

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• Expand the types of research we do

• Ensure that we implement evidence more actively

• Increase CCOs research contribution

CCO Research Strategy

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Strategy Roadmap

Research Goals

CCO will use research to improve population health, quality and value of care by building a Learning Health System in Ontario.

Population Health Healthcare Delivery Best EvidenceDetermine Value

Prevention Person Centered Care

Implementation

Efficiency

Integrated Health Delivery

Dissemination

Economic EvaluationsScreening

Expand the kinds of research CCO does

Research Themes

Foundation

OutcomesAnalysisCultureGovernancePartnersInformation

Implement evidence more actively Increase CCO’s research contribution

Uses of Research Results

• Symbolic: use of research to support ideas, positions or actions that have already been taken or decided upon

• Conceptual: use of research to inform policy and program decision makers’ understanding of an issues, but may not lead to direct application in policy and program formulation

• Instrumental: use of research refers to the direct, specific application of research findings in the development of policies and/or programs

symbolic < conceptual < instrumental

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Ontario

Size: Over 1 million square kilometres

Population: 13.6 million people (38% of Canadians)

Health Regions: 14

Distributed cancer system: 14 Regional Cancer Programs and one

central cancer agency: Cancer Care Ontario (CCO)

Pathology: 116 hospitals and 5 commercial laboratories

Pathology reports: 75,0000+ new cancer cases per year

Ontario Cancer Registry

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• > 1,000,000 – pathology reports / year

• 2016 – 76,000 – incident cancers• 91% at least 1 pathology report

• Synoptic Data – 90% of cancer resections• 70 mandated checklists (CAP eCCs)

PLMP Organizational Structure

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PLMP

PLMP Committee

eCC Review Committee

MOTAC

Biomarker Implementation

PMSC

Biomarker Evaluation

Hereditary Cancer Genetics

PLMP Committee: to develop and implement evidence-based pathology standards, guidelines and quality initiatives and support the application of these within the region

Molecular Oncology Testing Advisory Committee (MOTAC):develop evidence based advice to inform system planning, new test development, access and quality assurance

Personalized Medicine Steering Commitee : provide leadership, advice, and input for the implementation of Personalized Medicine within CCO

Personalized Medicine │ The Framework

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Vision:

• Working together to create the best health systems in the world

Mission:

• Together, we will improve the performance of our health systems by driving quality, accountability, innovation and

PLMP Organizational Structure

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PLMP

PLMP Committee

eCC Review Committee

MOTAC

Biomarker Implementation

PMSC

Biomarker Evaluation

Hereditary Cancer Genetics

Personalized Medicine FrameworkG

oal

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Strengthen Quality & Safety

Strengthen & Coordinate Care Models

Strengthen System Planning

1. Develop standards and guidance to reduce practice variation and ensure high quality testing

2. Develop service delivery models for clinical cancer genetic services to increase capacity and improve access to programs and services

3. Increase awareness of best practices through KTE initiatives

4. Strengthen linkages with cancer research to inform system planning and bring discoveries into practice

5. Provide advice and leadership to government and other stakeholders to inform system planning*

6. Advance policies to improve the collection, storage, utilization, and sharing of personalized medicine data

7. Coordinate a process for approvals and funding of molecular tests in oncology

Go

al 2

Go

al 3

Mo

nit

or

and

Eva

luat

e**

8. Develop and foster strong partnerships

* Includes privacy, confidentiality and ethics; ** Health resource utilization, economics, and outcomes

COLLABORATE ALIGN TRANSFORM

Personalized Medicine │ Current Initiatives

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• Complex Malignant Hematology

• Hereditary Cancer Testing

• Biomarkers

Biomarkers

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• Oversight / Funding• HER2 (breast / stomach)• eRAS (KRAS / NRAS) – colorectal adenocarcinoma• ALK / EGFR – Lung• BRAF – melanoma• Sarcoma• Leukemia

• Transition to comprehensive site based testing

Implementation Levers

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• Advice Documents / Recommendations / Guidelines

• Funding

• Quality Metrics (scorecard)• Synoptic Reporting

• Pathway development • (disease site pathways / tissue pathways)

Summary

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• Pathology – driver for cancer care / personalized medicine

• Ontario Cancer Registry (OCR)• Rich information source for pathology

• Increased focus on research / evaluation (research strategy)• Implementation of evidence

Thank You!

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