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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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