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A Fair Shake
September 09, 2019 – Beth Fand Incollingo
Weeding Out Uncertainty
September 10, 2019 – Pippa Wysong
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A Fair Shake

A new national strategy for cancer prevention, diagnosis and care aims to make the provision of services and support more equitable across Canada.
BY Beth Fand Incollingo
PUBLISHED September 09, 2019
You may not be very familiar with the Canadian Partnership Against Cancer (the Partnership), but the non-profit organization is working for you.

The Partnership was created by the federal government in 2007 to be the steward of a plan — created by an alliance of grassroots organizations — to improve cancer prevention, diagnosis and care in the country. It’s largely been accomplishing this by working behind the scenes to help provinces and territories change the way things are done in their individual health systems. Now, with the help of nearly 8,000 Canadians who shared their own priorities and ideas, the organization has created a new version of the plan for the decade ahead, the Canadian Strategy for Cancer Control. The document, released June 4, is devoted to reducing the number of people who get cancer, helping more survive and improving their quality of life.

“We are a federally funded organization that is working with all of the provinces and territories in a true partnership to try to make all aspects of cancer care better and more equitable across the country,” says Dr. Craig Earle, vice president of cancer control at the Partnership and a practising oncologist at Sunnybrook Hospital’s Odette Cancer Centre in Toronto.

In overseeing the original plan, Earle says, the Partnership worked with provinces and territories to identify their challenges in providing cancer care and help them share best practices with each other. As a result, there is now only one Canadian province that doesn’t have a colorectal cancer screening program. The plan also resulted in a more uniform ability for provinces and territories to build cancer registries that reflect details about the stage of each cancer recorded, he says. And under the plan, the Partnership launched a landmark research database that collects health and lifestyle information from more than 300,000 Canadians to understand why some people get cancer and others don’t.

The 2007 plan was updated, Earle says, to reflect the advances in technologies and treatments over the past 12 years. The new plan is also different in that it includes more narrowly defined action items than the original one, which was essentially a list of all the important concerns in the cancer arena.

The Canadian Strategy for Cancer Control is focused on five basic priorities:

Decrease cancer risk.
This will be done through smoking cessation or prevention, as well as other proven practices.

While other organizations such as Health Canada will take the lead on smoking cessation in general, the Partnership will continue to lead one aspect of the effort: encouraging tobacco cessation among patients with cancer. “A few years ago, the Surgeon General in the United States pulled together data to support the importance of this — not for prevention, but for cancer treatment,” Earle says. “It’s all more effective if you’re able to quit smoking. We’ve helped every jurisdiction develop a program, and now some are reaching out beyond cancer centres to hospitals without formal cancer programs to do tobacco cessation programs there.”
Another big goal within this category is the near- elimination of cervical cancer.

“The World Health Organization has made an international call for this to happen, so the time is right. We really could eliminate a cancer” — or at least bring its frequency rate to just a few cases per every 100,000 people, Earle says. That would be done by vaccinating everyone eligible against the human papillomavirus, moving away from pap testing and toward HPV testing to screen for cervical cancer and optimizing the latest treatments for the disease.

Earle noted that, while all jurisdictions have access to the HPV vaccine, “some still give it only to girls in their early teens, others give it to boys and girls, and there are differing policies about people beyond school age getting it.”

Yet another preventive strategy would be to automatically test everyone with colon cancer for Lynch syndrome, a familial predisposition to that cancer and some other types; if patients tested positive, this would allow genetic testing of their family members so that those affected could be preventively screened for cancer. Similarly, the preventive removal of the fallopian tubes in women undergoing hysterectomy could head off some cases of ovarian cancer, and the practice will be promoted by the plan.

Diagnose cancer faster and earlier.
The Partnership will address this by facilitating quicker access to diagnostic appointments for patients when cancer is suspected. It will also work to strengthen screening efforts by establishing lung cancer screening programs throughout Canada and navigating the appropriate patients to them.

“No large jurisdiction has a significant lung screening program, but we have some provinces doing pilots of how it would work,” Earle says. One problem so far has been that doctors are sending ineligible patients — those who have smoked, but not heavily — for screening while those more likely to benefit from the testing are not getting it. Another issue has been the use of higher-dose radiation tests, which is not called for in screening guidelines, he says.

Deliver high-quality care in a world-class system.
This effort will involve establishing best practices and standards and creating new care models.

Eliminate barriers to care.
The Partnership will pave the way toward this goal by focusing on underserved communities and those that are rural and remote, as well as ensuring that care can be delivered between provinces when necessary.

The Partnership is considering the creation of a virtual cancer centre of the North that would capitalize on advances in telemedicine, patient portals, electronic health records and more to reach patients who live in remote northern areas of provinces and territories.

“It’s a huge geographic area, but not such a huge population,” Earle says. “Could we start and focus our efforts there, helping to navigate them through the system and bringing them to a province to have a procedure sometimes? We’d like to at least initially explore how to work with our partners to do these things.”

Provide information and support to patients and their families.
This will include addressing the limited and uneven access to palliative and end-of-life care across the country and supporting children, adolescents and young adults in their cancer journeys.

The plan also places a special focus on priorities of First Nations, Inuit and Métis people, who together compose about 5 per cent of Canada’s population. These priorities include the provision of culturally appropriate care closer to home; peoples-specific, self-determined cancer care; and research and data systems governed by these communities.

“In the initial strategy, there was little mention of indigenous peoples,” Earle says. “In Canada, these are populations that have been (medically) underserviced. (One reason is that) about half live in fairly remote and rural settings. In addition, there’s been an unfortunate history of colonialism; we’ve not treated our indigenous peoples well. So, there’s a strong movement for reconciliation and to improve things for this population.”

In preparing the plan, the Partnership interviewed thousands of Canadians from all provinces and territories.

“The largest chunk was the Choicebook, an online survey anyone could do, and we did a major campaign to publicize this work and encourage people to fill out this questionnaire. We asked people their priorities. In my favourite one, we asked, ‘If you had $100 to spend on cancer, how would you divide it up between prevention, screening, diagnosis, treatment, palliative care and survivorship?’ Prevention of cancer was the number one thing they picked, but in public health, prevention is not where our major spend goes.” That insight helped shift the focus of the plan.

The Partnership also spoke with people at public sessions across the country, some of them targeting specific under-served groups such as LGBTQ people or indigenous peoples. Other meetings included health-care providers, and one brought together the heads of Canada’s cancer agencies.

“Although we couldn’t include everything that was brought up, in the end we came up with a list of priorities and actions that we didn’t hear any disagreement about,” Earle says.

While patients can’t join the Partnership in its behind-the-scenes role working with health-care systems, they can make their wishes known. One way is by asking for the care called for in the plan when visiting their doctors, Earle says. The Partnership also regularly does work with patient and family advisers. It is working to grow this network and encourages any Canadians affected by cancer — patients, families, friends, caregivers — to get involved by e-mailing info@partnershipagainstcancer.ca.

In any case, Earle believes it’s helpful for Canadians to know that the Partnership is working to support them through their cancer journeys — and to prevent more of those journeys from ever starting.

“It’s good to know about your health-care system, and that we are trying to make it as equitable as possible for all Canadians, no matter where you live or who you are,” he said.
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