Transcript Welcome [www.canceradvocacy.ca]

Welcome
Dr. Pierre Major
Co-Chair, CACC
About the CACC
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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
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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?”
Prevention
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 Columbia
Adjunct Professor, Medicine & Oncology, McGill University
Background
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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
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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
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Breast cancer prevention can work
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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
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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
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Determine the logistics for cancer prevention
awareness:
Who should provide funding
 Who should do the counseling
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Conclusions and Recommendations
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Prevention is the “orphan” of breast cancer care
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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 costeffective health intervention programs in Canada….
How We Can Make a Difference?
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Educate women about lifestyle factors linked to
breast cancer and impact of counseling:
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Consider preventative medical interventions:
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Diet and nutrition (20-60% reduction in new breast cancers)
Exercise (30-40% reduction)
Alcohol (20-30% reduction)
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
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Prevention is the “orphan” of breast cancer care
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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
Clinical Trials
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, MBA
Vice-Chair, CACC
Background
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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
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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”
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Clinical trials conducted throughout Canada are
under an increasing threat
Canada’s participation in international clinical trials
in 2007 decreased 12%
The Barriers
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Barriers to conducting clinical trials are increasing:
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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
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Reduced access to new treatments
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Failure to materialize potential survival gains
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Missed opportunity for improving delivery of
optimal patient care through the discipline of
clinical trials
Recommendations
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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
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Patients with cancer should be offered a
clinical trial as part of a standard treatment
option to improve outcomes for themselves and
for others
Collaborative Care
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
Background
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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
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Expansion of oncology services is essential
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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
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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
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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
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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)
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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
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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
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More provinces need to develop collaborative
agreements
Recommendations
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Amend Pharmacy Acts in each province to allow
Pharmacists to prescribe
Standardize educational and competency
requirements
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Formalize written collaborative practice agreements
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Include ability to order laboratory tests
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Ensure quality assurance and confirm outcomes
Advocacy
Walking the Tightrope: Physician
Advocacy and Institutional Fidelity
Pierre Major, MD
Medical Oncologist, Hamilton, ON
Co-Chair, Board of Directors, CACC
Vice-Chair, 2010-2011 Report Card Committee
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
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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
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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
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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
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Lack of formal advocacy training
Recommendations
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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
Patient Perspective
Living with Cancer - Testicular Cancer,
Ovarian Cancer and CLL
Dr. James Gowing, MD
Hematologist / Oncologist, Cambridge, ON
Immediate Past Co-Chair, Board of Directors, CACC
Living with Cancer
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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
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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
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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
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Questions?
Please visit www.canceradvocacy.ca
to view the full 2010-2011 Report Card on Cancer