Dr. Pierre MajorCo-Chair, CACC

Welcome

About the CACC

The Cancer Advocacy Coalition of Canada is a registered, non-profit cancer group dedicated to advocacy and education

CACC’s volunteer Board of Directors is comprised of patient advocates, oncologists and health sector executives

CACC operates on unrestricted grants from sponsors based on guidelines that ensure the organization’s autonomy

CACC publishes the annual Report Card on Cancer in Canada™, the only independent evaluation of our cancer systems’ performance

2010-2011 Report Card

Fighting cancer is a tough enough battle …

In this year’s Report Card we ask, “Why are governments making it even harder for cancer patients and their caregivers?”

Cancer Prevention in Canada: The Sooner the Better

Joseph Ragaz, MD, FRCP Board Member, CACC

Medical Oncologist & Clinical Professor,  Faculty of Medicine & School of Population & Public Health, University of

British ColumbiaAdjunct Professor, Medicine & Oncology, McGill University

Prevention

Background

Breast cancer mortality has decreased by 25-30% over the last 20 years due to: Widespread public education leading to earlier

diagnosis Evidence-based therapy

Despite decreasing mortality rates, 23,000 women are still diagnosed each year in Canada, and over 4,000 will die, with absolute numbers increasing

Prevention has the potential to reduce the number of new patients with breast cancer in Canada

What We Know

Breast cancer prevention can work Lifestyle and medical interventions improve

outcomes

Prevention programs are currently aimed at individuals and families with a genetic predisposition to breast cancer (5%)

For the remaining 95% of women at risk for breast cancer, lifestyle and medical interventions could also reduce the risk, but there are no dedicated prevention programs

What We Need to Do

Identify which prevention interventions are evidence based and most cost-effective

Identify women at high-risk: Family history Suspicious breast pathology (atypia, etc.) Survivors of breast cancer

Determine the logistics for cancer prevention awareness: Who should provide funding Who should do the counseling

Conclusions and Recommendations Prevention is the “orphan” of breast cancer

care No medical specialty has a mandate for

practising breast cancer prevention No dedicated breast cancer prevention

programs If prevention is not practiced now,

Canadians will face several thousand additional breast cancers each year

Governments should support the creation of breast cancer prevention programs

Cancer prevention: potential for one of the most cost-effective health intervention programs in Canada….

How We Can Make a Difference? Educate women about lifestyle factors

linked to breast cancer and impact of counseling: Diet and nutrition (20-60% reduction in new breast

cancers) Exercise (30-40% reduction) Alcohol (20-30% reduction)

Consider preventative medical interventions: Anti-estrogens (Tamoxifen / Raloxifen: 40-50%

reduction) Anti-inflammatories (Aspirin: 20-30% reduction)

Result: avoidance of several thousand new breast cancers each year

Conclusions and Recommendations Prevention is the “orphan” of breast cancer

care No medical specialty has a mandate for

practising breast cancer prevention No dedicated breast cancer prevention

programs If prevention is not practiced now,

Canadians will face several thousand additional breast cancers each year

Governments should support the creation of breast cancer prevention programs based on compelling scientific evidence

Cancer prevention: one of the most cost-effective health interventions

Should Clinical Trials Be Considered Part of the “Standard of Care” for Cancer Patients?

Dr. Susan Dent, MD, FRCPC Medical Oncologist, Ottawa Hospital Cancer Centre

Sandi Yurichuk, BS, MBAVice-Chair, CACC

Clinical Trials

Background

Institutions with high participation rates in clinical trials have better patient outcomes

Clinical trials contribute to high quality care Participation in clinical trials allows patients

to access potentially effective new treatments

What We Found

Less than 7% of Canadian adults with cancer are enrolled in clinical trials CCO reports that between 2007-2009 cancer

patient participation in clinical trials in Ontario decreased 28%, citing a “changing environment for supporting clinical trials”

Clinical trials conducted throughout Canada are under an increasing threat

Canada’s participation in international clinical trials in 2007 decreased 12%

The Barriers

Barriers to conducting clinical trials are increasing: Lack of sustainable funding for clinical research Declining ability of hospitals to support clinical trial

infrastructure Increase in ethics and regulatory requirements Increasing timelines for conducting a clinical trial Industry-sponsored trials decreasing due to

increasing international competition

Impact of Declining Trial Participation

Reduced access to new treatments

Failure to materialize potential survival gains

Missed opportunity for improving

delivery of optimal patient care through the discipline of clinical trials

Recommendations

Gain long-term financial commitments from governments to support clinical trials in both academic and community centres

Ensure adequate institutional infrastructure support for conducting clinical trials

Encourage more clinical trial collaboration across Canada and internationally

Improve timeliness of conducting clinical trials to remain competitive internationally

The Answer

Patients with cancer should be offered a clinical trial as part of a standard treatment option to improve outcomes for themselves and for others

The Role of the Nurse Practitioner and Clinical Pharmacist

David Saltman, MD, PhD Board Member, CACC

Chair and Professor of the Discipline of Oncology, Faculty of Medicine, Memorial University, St. John’s, NL

Collaborative Care

Background

Despite decreasing rates of some cancers, the absolute number of new cancer cases is on the rise, as is the number of people living with cancer

Expansion of oncology services is essential

Current and anticipated shortage of cancer specialists

Potential Solutions

Expanding the role of Pharmacists: pharmacology drug toxicities order entry systems patient education drug funding

Expanding the role of Nurse Practitioners: patient assessment psychosocial care procedures patient education ability to prescribe

Collaborative Agreements

Developing a collaborative practice agreement involves: Making changes to provincial Pharmacy

Acts Gaining approval by provincial pharmacy

and medical boards and host institutions Establishing educational and competency

requirements Defining the scope of practice

What We Did

Surveyed cancer centres from each province

Telephone interview or e-mail with follow-up telephone call

Responses collected from one cancer centre in each of the 10 provinces

Survey started November 2010 and completed January 2011

What We Found

Six centres had Nurse Practitioners in collaborative practice, and four centres had Pharmacists

AB, ON, NS and NB had both NPs and Pharmacists in collaborative practices, but only NPs had prescribing privileges

SK and QC did not have NPs in their cancer centres

What We Found (Cont’d)

Six centres reported Nurse Practitioners prescribing one or more types of oncology medications (IV, oral, hormone or supportive care medications)

In only two centres (AB and NS) were NPs prescribing all forms of cancer medications

No centres permitted NPs to prescribe narcotics

What This Means

Nurse Practitioners and Pharmacists are entering into collaborative agreements within cancer centres to improve patient care by: Reducing patient waiting times Enhancing patient safety Freeing up physician time for more new

patients More provinces need to develop

collaborative agreements

Recommendations

Amend Pharmacy Acts in each province to allow Pharmacists to prescribe

Standardize educational and competency requirements

Formalize written collaborative practice agreements

Include ability to order laboratory tests Ensure quality assurance and confirm

outcomes

Walking the Tightrope: Physician Advocacy and Institutional Fidelity

Pierre Major, MDMedical Oncologist, Hamilton, ON

Co-Chair, Board of Directors, CACC Vice-Chair, 2010-2011 Report Card Committee

Advocacy

Physicians as Advocates

“As health advocates, physicians should responsibly use their expertise and influence to advance the health and wellbeing of individual patients, communities and populations.”

- Royal College of Physicians & Surgeons of Canada

May, 2008

General Standards of Accreditation

Health Advocate “5.1 The program must be able to demonstrate that residents are able to understand, respond to and promote the health needs of their patients, their communities and the populations they serve.”

- Royal College of Physicians & Surgeons of Canada- College of Family Physicians of Canada

- Collège des médecins du Québec 2010

Background

Medical educators and professional medical associations publicly endorse physician advocacy

But, physicians infrequently engage in advocacy activities

We are more likely to endorse or celebrate a physician’s scientific or patient care achievements than efforts to change public policy

The Reality

Physicians have always had the responsibility to advocate for individual patients and their families

Community and societal advocacy is now a requirement for completion of undergraduate medical training and many residency programs

But … institutional barriers remain and in some cases are being strengthened

Barriers to Physician Advocacy Formal or informal fidelity agreements

limit advocate’s ability to speak publicly about a number of issues Most oncologists are employees of government

healthcare institutions Concern about job security and career

advancement Advocacy may put physicians in conflict with

employer/institution and government healthcare priorities

Corporate loyalty can override best interests of the patient, community and society

Lack of formal advocacy training

Recommendations

Healthcare leaders and educators need to support and implement physician advocacy activities

Public discourse about healthcare issues, including funding, access to medicines, wait times, etc. should be transparent and not seen as an attempt to undermine institutions or political processes

CACC will ask professional bodies to interact with healthcare authorities and government to remove barriers to physician advocacy

Living with Cancer - Testicular Cancer, Ovarian Cancer and CLL

Patient Perspective

Dr. James Gowing, MDHematologist / Oncologist, Cambridge, ON

Immediate Past Co-Chair, Board of Directors, CACC

Living with Cancer

The authors share their own stories about the unique barriers that they face in their fight for equitable access to cancer innovation across the country

Updates on last year’s articles on the patient experience with rare cancers: multiple myeloma, gastrointestinal stromal tumour, neuroendocrine tumours and chronic myelogenous leukemia

This year’s Report Card provides new patient insights into living with testicular cancer, ovarian cancer and chronic lymphocytic leukemia

Patient Contributors

Thank you to our 2010-2011 Report Card patient contributors: Peter Laneas, The Canadian Testicular Cancer

Association Elisabeth Ross, Ovarian Cancer Canada Derek Caine, CLL Patient Advocacy Group

And to our returning patient contributors : David Josephy, GIST Sarcoma Life Raft Group Canada Cheryl-Anne Simoneau, CML Society of Canada Jim Kormos, CNETS Canada

Please visit www.canceradvocacy.ca to view the full 2010-2011 Report Card on Cancer

Questions?