Professional Documents
Culture Documents
Final Report
March 2005
Northern Cancer Control Strategy Final Report
Table of Contents
1. Executive Summary ........................................................................................................ 2
1.1. Approach to Planning ............................................................................................ 2
1.2. Data and Inventory Assessment ............................................................................ 2
1.3. Building a Northern Cancer Program --Recommendations................................... 5
1.4. Summary and Next Steps ...................................................................................... 8
2. The Northern Cancer Control Project ............................................................................. 9
2.1. Overview ............................................................................................................... 9
2.2. Project Participants and Roles ............................................................................... 9
2.3. Project Timelines................................................................................................. 10
3. Principles underlying cancer control in B.C. ................................................................ 11
3.1. The Organization of Cancer Control in B.C........................................................ 11
3.2. Delivering this Population Based Cancer Control Program ................................ 11
3.3. BCCA Strategic Plan 2004-2010......................................................................... 11
4. The Findings…Health and Cancer in the North ........................................................... 12
4.1. The Data .............................................................................................................. 12
4.2. Prevention and Promotion Findings .................................................................... 19
4.3. Screening Findings .............................................................................................. 21
4.4. Detection, Treatment, and Care Findings ............................................................ 24
5. Analysis & Recommendations for Enhanced Cancer Control in the North.................. 31
5.1. Decision Criteria.................................................................................................. 31
5.2. Develop a Northern Cancer Program .................................................................. 31
5.3. Prevention, Promotion and Screening Priorities.................................................. 32
5.4. Detection and Diagnosis Priorities ...................................................................... 33
5.5. Treatment and Care Priorities.............................................................................. 33
5.6. Additional Considerations and Enablers of the Strategy ..................................... 36
6. Appendices.................................................................................................................... 39
6.1. Data...................................................................................................................... 39
6.2. Prevention and Promotion ................................................................................... 53
6.3. Screening ............................................................................................................. 55
6.4. Detection, Treatment and Care ............................................................................ 56
6.5. Implementing the Priorities ................................................................................. 63
1
Northern Cancer Control Strategy Final Report
1. EXECUTIVE SUMMARY
1.1. Approach to Planning
The Northern Cancer Strategy Project is a joint initiative between the British
Columbia Cancer Agency (BCCA) and Northern Health (NH). The mandate is to
create a plan to address the cancer control needs of Northerners into the
foreseeable future in a way that responds to the epidemiology of cancer in the North
and the demographic and service delivery challenges that are unique to Northern
BC.
The mandate of the Project is to plan for a continuum of cancer related services
from Prevention and Health Promotion, to Screening, Detection, Treatment,
Rehabilitation, and Research. A framework is used to match the issues surfaced in
the Preliminary Findings Document with priorities for action around three main
categories of outcome:
Incidence of cancer,
Survival from cancer, and
Quality of life and Access to services for Northerners.
The information and ideas contained in this report rely primarily on the knowledge
and experience of Northern physicians, nurses, pharmacists and program staff from
the Northeast, Northern Interior and Northwest Health Service Delivery Areas
(HSDA’s) and the clinical leaders and medical specialists from the BC Cancer
Agency. Through the invitation of the Northern Medical Advisory Committee, 15
medical staff members from communities across the North contributed to the
identification of weaknesses in current services and offered many ideas for
improvements. Similarly, nurses, pharmacists, palliative care workers, diagnostic
technologists and public health professionals contributed their knowledge of
limitations in current clinic activities and prevention programs, including access and
communication issues as identified by patients. Together, they made many
suggestions to strengthen and better link cancer services. Northern Health’s recent
public consultation process also contributed perspectives from many communities
that more needs to be done to prevent illness and foster better health as well as to
improve access to services. Representatives from the Canadian Cancer Society
contributed insights into areas where patients and the public had voiced a desire for
improved services. Through contributions of staff of the BC Cancer Agency, all of
this information was considered within the context of a province wide program of
cancer control.
The primary focus of this strategy is to improve outcomes. Actions and projects
proposed will be monitored and measured to ensure the changes are improving
cancer control in the North.
2
Northern Cancer Control Strategy Final Report
3
Northern Cancer Control Strategy Final Report
the continuum of care e.g. psychosocial support, nutrition counseling for cancer
patients etc. Palliative and hospice care is offered across NH but it is fragmented.
The use of telehealth for cancer control is also limited in NH.
Some of the issues that have emerged from the data and inventory review include:
Significantly higher Standardized Mortality ratios for all cancers combined
and specifically Lung Cancer.
Poorer 5 year survival rates for breast, prostate, colorectal, and lung cancer
as compared to residents of other Health Authorities in B.C.
Surgical and chemotherapy treatment services and a range of prevention
and screening services have been developed over time in the North, but
are not well linked to ensure the best coordination of service to the
client/patient or to ensure optimal results.
While systemic therapy (chemotherapy) is offered in a number of
communities, resources are limited, demand is increasing and no
supporting structure exists to assist the communities with implementing
quality improvements or guidelines, or provide relief nurse staffing and
training, etc.
Diagnostic testing is offered across the three HSDA’s, however consistent
organization is limited and quality assurance occurs outside of an overall
regional Health Authority framework. Reference group clinicians identified a
need to establish clear clinical guidelines and decrease the time required of
patients for investigation in circumstances where multiple studies were
required to reach a diagnosis.
More family practitioners in oncology are needed to improve patient access
to care within the Northeast, Northern Interior and Northwest Health Service
Delivery Areas.
Patients referred for radiation therapy must travel outside of the region to
BC Cancer Agency sites or Alberta, which presents social and financial
challenges.
Variability exists across the 3 HSDA’s in the use of radiation therapy for
both the initial treatment of cancer and palliative treatment for late stage
cancer. Overall, Northerners have similar rates of curative treatment to
other British Columbians, but rates of radiotherapy for palliative treatment
are lower for Northerners than for residents of the southern mainland.
Supportive care and palliative care services tend to be fragmented and
differ by community.
Some important unanswered questions remain relating to gaps in the data:
What specific cancer services are being provided in Alberta to people in the
Northeast… Do Northerners present with more advanced cancer than their
provincial counterparts?
4
Northern Cancer Control Strategy Final Report
Chemo Review
Short Term Priorities Women’s Health Program
Telehealth
Research & Best
Practices to Improve Navigation, Primary Care/Diagnostic Coordination and Transportation
NH Health Status
Surgical
Oncology
5
Northern Cancer Control Strategy Final Report
6
Northern Cancer Control Strategy Final Report
7
Northern Cancer Control Strategy Final Report
8
Northern Cancer Control Strategy Final Report
Project Vision: To strengthen the capacity to prevent, detect, and treat cancer and
support patients in the North.
Project Goal: Develop a shared vision of short and long-term priorities for cancer
control in the North that are patient focused, evidence and data driven.
This phase of the strategy is focused on opportunity definition. The team
investigated existing programs and services, analyzed data and made
recommendations for change. Subsequent initiatives will focus on detailed
implementation planning for needed changes.
9
Northern Cancer Control Strategy Final Report
10
Northern Cancer Control Strategy Final Report
11
Northern Cancer Control Strategy Final Report
Total
HA Name Year Gender 0 -19 20-54 55+ 65+ 75+ Pop-
ulation
Northern 2005 All 86631 156660 56155 25957 10092 299446
% 28.9 52.3 18.8 8.7 3.4 100.0
Northern 2015 All 77203 163582 82856 40331 14345 323641
% 23.9 50.5 25.6 12.5 4.4 100.
Source: BC Stats, Population Projections, PEOPLE 29, acquired through the Health Data Warehouse-
Dec 22, 2004.
12
Northern Cancer Control Strategy Final Report
Aboriginal, First Nations and Métis peoples comprise a very significant and
important part of the Northern population. According to the most recent Census,
there are between 35,000 and 45,000 Aboriginal First Nations and Métis persons
residing in the area served by Northern Health.
12000
10000
People Living with Cancer
8000
6000
4000
2000
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
13
Northern Cancer Control Strategy Final Report
The graph below shows that the age standardized rate of death for all cancers
combined in Northern Health is 18.11 per 10,000 vs. the provincial rate of 16.05
BC
Northern
Van. Island
Van.Coastal
Fraser
Interior
10 12 14 16 18 20
Age Standardized Mortality Rate per 10,000
Source: Data to support graphic obtained from BC Vital Stats, acquired through the Health
Data Warehouse.
The data that describes the Incidence of cancer in the North appears to show a
great deal of variability between the 3 HSDA’s for example, an age standardized
rate of 58/100,000 in the Northwest for colorectal cancer compared to rates of
44/100,000 in the Northern Interior and a BC rate of 46.6/100,000. (See the
following 3 tables)
400
350
300 Breast
250 Colorectal
200
150 Lung
100 Other
50 Prostate
0
All Cancers
Northwest Northern Northeast BC Total
Interior
14
Northern Cancer Control Strategy Final Report
400
350
300 Breast
250 Colorectal
200
150 Lung
100 Other
50 Prostate
0
All Cancers
Northwest Northern Northeast BC Total
Interior
All
Males Breast Colorectal Lung Other Prostate Cancers
Northwest 0 58.3 48.6 167.5 105.2 379.5
Northern Interior 0 46 60.9 146.2 120.2 373.4
Northeast 0 52.6 64.1 132.8 121 370.5
BC Total 0 48.8 52.5 154.5 115 370.8
15
Northern Cancer Control Strategy Final Report
400
350
300 Breast
250 Colorectal
200
Lung
150
100 Other
50 Prostate
0
All Cancers
Northwest Northern Northeast BC Total
Interior
All
All Breast Colorectal Lung Other Prostate Cancers
Northwest 0 58 49 150.4 0 370.7
Northern Interior 0 44.1 58.4 151.8 0 363.3
Northeast 0 49.8 53.7 124 0 331.4
BC Total 0 46.6 49.7 153.9 0 360.1
While the statistical tests do not generally indicate that the variability between the
3HSDA’s and the BC incidence rates are statistically significant, the incidence data
should be interpreted with caution given that the numbers of cases in the North are
relatively small. The rates are highly dependent on the population denominators
that are used, which are based on projections from Census counts which may be
higher than the “truth” due to the slowing of the economy in most of the North.
16
Northern Cancer Control Strategy Final Report
The data that describes the 5-year survival rates also show a great deal of
variability between HSDA’s in the North. For example, the 5 year survival for lung
cancer ranges from 16.4% in the Northwest to 11.7% in the Northern Interior to
8.3% in the Northeast.
1
0.9
0.8 Breast
0.7 Colorectal
0.6
0.5 Lung
0.4 Other
0.3
0.2 Prostate
0.1 All Cancers
0
Northwest Northern Northeast BC Total Weighted
Interior
All
Breast Colorectal Lung Other Prostate Cancers Weighted
Northwest 0.841 0.537 0.164 0.561 0.929 0.608 0.603
Northern Interior 0.794 0.592 0.117 0.493 0.803 0.543 0.548
Northeast 0.811 0.604 0.083 0.527 0.875 0.58 0.573
BC Total 0.846 0.569 0.148 0.497 0.871 0.574 0.569
We can be confident in the “tombstone” data that indicate that the mortality rates of
lung cancers and all cancers combined are significantly elevated in Northern
Health. More work will need to be done to ensure the reliability of our cancer
incidence rates.
While 5-year survival rates are slightly lower than the BC rate when considered
across all of Northern Health, there is a great deal of apparent variability between
HSDA’s. Defining how cancer incidence and survival interact to produce the
observed mortality rates will be an important task for ongoing consideration as the
proposed cancer strategy goes forward.
17
Northern Cancer Control Strategy Final Report
Data Themes
• The unique geography and demographics create challenges (and opportunities).
The key challenges include:
• Small widely dispersed population with a higher proportion of young people.
• Rapid growth in the number of seniors predicted.
• The highest proportion of Aboriginal people of any BC Health Authority.
• High Standardized Mortality Ratios for All Cancers and Lung Cancer.
• Variable and somewhat poorer overall 5 year survival rates for breast, prostate,
colorectal, and lung cancer.
• Gaps still exist in the data
• What type of cancer service does the Alberta Cancer Board provide to the
residents of the Northeast?
• Do Northerners present with more advanced cancer than their provincial
counterparts, and if they do, what factors contribute to this?
18
Northern Cancer Control Strategy Final Report
19
Northern Cancer Control Strategy Final Report
20
Northern Cancer Control Strategy Final Report
BC
Northeast Screening mammography is an
Northern Interior important strategy for the early
Northwest detection of breast cancer.
N. Vancouver Is.
Central Vancouver Is. Provincially, the screening program
S. Vancouver Is. participation rate is 47.15 %.
North Shore/Cst Garibaldi Participation rates in the North are
Vancouver as follows. Northwest 33.5 %,
Richmond Northern Interior 46.9 % and the
Fraser South Northeast 38.5%.
Fraser North
Fraser East
Though participation is lower than
Thomp Cariboo Shus
the provincial rate, approximately
Okanagan
20,000 women every 2 years
Kootenay Boundary
undergo Breast Cancer screening in
East Kootenay
Northern BC
0 25 47.1
50 75 100
Participation Rate (percent)
21
Northern Cancer Control Strategy Final Report
BC
Northeast Cervical cancer is the most commonly
Northern Interior diagnosed form of reproductive cancer.
Northwest
This is due to the development and
N.Vancouver Is.
Central Vancouver Is.
widespread use of the Pap (smear) test.
S.Vancouver Is.
North Shore/Cst Garibaldi
Each year approximately 21,000 Northern
Vancouver
women undergo cervical screening in the
Richmond area served by Northern Health. This
Fraser South translates to a regional program
Fraser North participation rate of 190.3 / 1000 women
Fraser East
ages 20 – 69, which is lower than the
Thomp Cariboo Shus
Okanagan
Provincial average of 205/1000 women.
Kootenay Boundary One cancer is prevented for every 1500
East Kootenay Pap smears.
0 50 100 150 205
200 250 300
Rate per 1000 women
22
Northern Cancer Control Strategy Final Report
Screening Themes
• Participation rates for breast and cervical screening fall slightly below provincial
averages.
• Geography and road quality prevent mobile mammography units from visiting
some remote communities.
• The First Nations population is known to have a higher incidence of cervical
cancer than the general population; however they have lower rates of
participation in screening programs.
• The lack of coordinated primary care standards and scheduling for screening and
detection in some Northern communities negatively impacts citizen’s access to
screening and detection programs and services.
23
Northern Cancer Control Strategy Final Report
Surgery
Surgery is available in the North from a variety of general and sub-specialist
surgeons e.g. general, orthopedic, urology, oral maxillofacial, plastic, gynecology,
ENT and pediatric ENT, ophthalmology, dental, and endocrine. General and sub-
specialty cancer surgery is offered in many Northern communities but involvement
with the BCCA Surgical Oncology Network is limited and based on the individual
surgeon. This is likely a reflection of the creation of a regional medical staff
structure only within the last year. A general surgeon from Prince George is an
executive member of the BCCA Surgical Oncology Network.
24
Northern Cancer Control Strategy Final Report
Lumpectomies as a Percent
of all Breast Surgery
Breast-conserving surgery (lumpectomy),
followed by radiation treatment, is the
recommended procedure for most women
with early stage breast cancer.
BC Guidelines produced by the Canadian
Northeast
Northern Interior Medical Association and Health Canada
Northwest suggest that four out of five women with
N. Vancouver Is. early breast cancer may be treated
Central Vancouver Is. successfully with breast conserving
S. Vancouver Is. surgery rather than a radical mastectomy.
N. Shore/Cst Garibaldi Lumpectomy is commonly combined with
Vancouver the excision of lymph nodes from the axilla
Richmond (armpit) to determine the potential for
Fraser South spread of the cancer
Fraser North
Fraser East
The graph to the left shows that the rates
Thomp Cariboo Shus
of Breast Conserving Surgery at slightly
Okanagan
above the Provincial average in Northern
Kootenay Boundary
Interior (NI) and Northwest (NW). The
East Kootenay
rates for Northeast (NE) are lower but
0 10 20 30 40 50 60 63.4 70 80 90 further investigation will be necessary to
100
Percent of all Breast Surgeries
determine if it is due to referral patterns to
Source: Morbidity Database, BC Ministry of Health – acquired Alberta.
through the Health Data Warehouse. Breast Conserving
Surgery reflects hospitalization data for fiscal 2000/2001.
25
Northern Cancer Control Strategy Final Report
Radiation Therapy
Radiation therapy or radiotherapy is one of the most important types of non-surgical
treatment prescribed for patients with common cancers. Radiotherapy is given
through repetitive treatments, usually on a daily basis, provided over an extended
time period. The proportion of cancer patients treated by radiotherapy at some time
during their illness has risen steadily to about 50%.
There are no radiation therapy facilities in NH. Therefore, patients referred for
radiation treatment must travel to one of the BCCA sites in Vancouver, Victoria,
Kelowna or Fraser Valley for an extended period of time, which typically ranges
from three to six weeks. This presents travel and social challenges for patients and
their families. In 2003, 357 people from NH were referred to BCCA radiation
facilities. Most of those patients went to the Vancouver Centre (309) while a
substantial minority went to the Southern Interior Cancer Centre in Kelowna (44). A
handful of patients went to the Fraser or Island facilities.
The table following indicates the number of Northeast residents accessing services
of the Alberta Cancer Board. At this time data is not available on the type of
services accessed, but some portion of these numbers would include radiotherapy.
26
Northern Cancer Control Strategy Final Report
The table following indicates that people living in NH are referred for radiation
therapy less often than those living near radiation facilities e.g. Okanagan, Fraser
Valley, Vancouver or Vancouver Island.
Data from at least one year indicates that initial radiation treatment rates in the
North (i.e., cases referred within 12 months of diagnosis) are comparable to the rest
of the province with relatively high rates in the NW, slightly lower rates in the NI,
and low rates in the NE….again, probably due to referrals to Alberta. Overall,
Northerners have similar rates of curative treatment to other British Columbians, but
rates of radiotherapy for palliative treatment are lower for Northerners than for
residents of the southern mainland.
Key: All Cases: Cancer cases in this table include all invasive cancer diagnosis in BC residents
and exclude non-melanoma skin cancers. Health Authority / Health Service Delivery Area:
Includes Health Authority / Health Service Delivery Areas at time of diagnosis. Non-Referred
Cases: Diagnosis Date = 1995-1997 and 2000-2002 Referred Cases: Site Admit Date =
1995-1997 and 2000-2002. Percentage is of total new cases. Radiation Cases: Radiation
Start Date within 6 months of the Site Admit Date (Referred Cases). Percentage is of total
new cases. SOURCE: CAIS (Patient Information) DATE RETRIEVED: 02 November 2004
Systemic Therapy/Chemotherapy
Chemotherapy is one of the most common treatments for cancer. It is the main
treatment for some types of cancer, such as leukemia, Hodgkin's Disease and Non-
Hodgkin's Lymphomas. Cancers of the lung, breast, testes, colon, ovary, and
stomach are also treated with chemotherapy. For some patients, chemotherapy
may be the only treatment they receive.
BCCA operates one Community Cancer Centre in Prince George and five
Community Cancer Services in Dawson Creek, Ft. St. John, Prince Rupert, Terrace
and Smithers. The Community Cancer Centre provides a full range of systemic
27
Northern Cancer Control Strategy Final Report
therapy for cancer patients. Partial funding and training for nurses are provided by
BCCA. Chemotherapy is also administered by nurses or physicians in other smaller
communities that do not have a formal BCCA program e.g. Kitimat, Quesnel, and
Queen Charlotte Islands.
Current Local BCCA Site Admit Year and BCCA Referral Treatment Centre***
Health Area 2002 2003
VCC Pr. Rupert CCSI Terrace Dawson Crk VICC FVCC Total Cases VCC Pr. Rupert CCSI Terrace VICC FVCC Kamloops Total Cases
Burns Lake 6 0 1 1 0 1 0 9 6 0 1 0 0 1 0 8
Fort Nelson 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0
Kitimat 6 0 2 1 0 0 0 9 10 0 0 0 1 0 0 11
Nechako 12 0 0 0 0 0 0 12 7 0 3 0 0 0 0 10
Nisga'a 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1
Peace River North 6 0 5 0 0 1 0 12 10 0 6 0 0 0 0 16
Peace River South 11 0 1 0 1 0 1 14 8 0 1 0 2 1 0 12
Prince George 57 0 10 0 0 1 2 70 59 0 18 0 0 1 1 79
Prince Rupert 11 5 1 0 0 3 2 22 19 5 0 0 2 0 0 26
Queen Charlotte 7 0 0 0 0 0 0 7 4 0 0 0 0 0 0 4
Quesnel 6 0 30 0 0 1 1 38 14 0 10 0 1 2 0 27
Smithers 13 0 0 1 0 0 0 14 11 0 2 2 1 0 0 16
Snow Country 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0
Stikine 3 0 0 0 0 0 0 3 1 0 0 0 0 0 0 1
Telegraph Creek 1 0 1 0 0 0 0 2 3 0 0 0 0 0 0 3
Terrace 27 0 0 6 0 0 0 33 21 0 2 2 1 2 0 28
Upper Skeena 4 0 1 0 0 0 0 5 3 0 0 0 0 0 0 3
Grand Total 174 5 52 9 1 7 6 254 177 5 43 4 8 7 1 245
* BCCA Fully Admit Northern Health Authority Cases:
Cases assessed or treated by a BCCA Oncologist (excludes cases referred for lesser service, eg conference only, special procedure, nutrition only, etc).
Current address postal code is in Northern Health Authority catchment.
** Prescribed Chemotherapy:
Chemotherapy includes IV or oral chemo or hormone therapy. First chemotherapy prescription date on pharmacy database is on or before BCCA site admit date.
*** Referral Treatment Centre:
Patient referred to a BCCA treatment centre or just to a BCCA Communities Oncology Network (CON) clinic.
Chemotherapy may or may not have been administered at the BCCA centre or clinic.
The NH chemotherapy program does not provide high dose intensive therapy for
leukemia and does not participate in clinical trials. There is only one internist with
expertise in medical oncology available for consultation in NH. In general, there is
no formal organization for chemotherapy administration across the North, demand
is increasing, resources are limited and standards and guidelines may not be
uniformly applied across the communities.
28
Northern Cancer Control Strategy Final Report
Support Services
Coping with cancer and its treatment involves a range of issues for patients,
families and caregivers. In order to meet their physical, social, emotional, nutritional,
informational, psychological, sexual, spiritual and practical needs throughout the
spectrum of the cancer experience a number of supportive and rehabilitative
services need to be developed. (Canadian Strategy for Cancer Control, 2002).
Pharmacy, nursing and medical consultation is provided in NH. Psychosocial,
nutritional and emotional support is provided by professionals where available, but it
is fragmented and only two communities offer navigation services. Some areas
have support groups and the chemotherapy nurses provide services whenever
possible.
Telehealth
Telehealth is currently being used in a variety of ways to support cancer control in
the North:
Oncologists involved in provincial tumor groups regularly meet through
video conferencing to discuss and develop individual patient treatment
plans and revise treatment protocols. There are also educational rounds
broadcasted via videoconferencing.
BCCA offers weekly education sessions to oncologists, nurses and other
clinicians practicing within BCCA's cancer centres and communities
involved with cancer care across the province. Clinicians working within
sites that are part of the communities' oncology program, delivering
chemotherapy to patients locally, are a key target audience to access this
specialized education service.
The hereditary cancer program has provided genetic counseling services
linking Vancouver based practitioners with ten clients in Prince George
and will be implementing a similar project servicing Prince George and
Prince Rupert.
The use of telehealth for cancer control is not fully optimized in NH. There are
numerous examples where telehealth has been used in other jurisdictions for
patient consultations, and patient or provider teaching etc. For example, the Victoria
Cancer Centre completed a successful trial of clinical consultation with newly
diagnosed gastrointestinal cancer patients in Nanaimo. There is a plan to
29
Northern Cancer Control Strategy Final Report
reintroduce this service between Victoria and Nanaimo and expand it to Campbell
River. A similar service is being implemented between the Cancer Centre in
Kelowna and clients in Cranbrook and Kamloops.
Other
Complementary and alternative medicine, also referred to as integrative medicine,
encompasses a broad range of healing philosophies, approaches and therapies
e.g. massage therapy, mind body therapy, image enhancement, therapeutic touch
and naturopathic treatments. Some of these services are available in the
communities privately e.g. The Centre for Integrated Healing has expressed interest
in developing a satellite centre in Smithers.
(See Section 6.4 of the Appendices for further treatment and care program
information by HSDA.)
30
Northern Cancer Control Strategy Final Report
31
Northern Cancer Control Strategy Final Report
Chemo Review
Short Term Priorities Women’s Health Program
Telehealth
Research & Best
Practices to Improve Navigation, Primary Care/Diagnostic Coordination and Transportation
NH Health Status
Surgical
Oncology
The following sections outline the short term priorities under the categories:
Prevention, Promotion and Screening;
Detection and Diagnosis; and
Treatment and Care.
32
Northern Cancer Control Strategy Final Report
3. Enforcement
4. Policy Development
5.3.3. Investigate known programs and best practices that reduce the
incidence of cancers amenable to preventive action
Public Health currently works in partnership with a number of other organizations in
the development of health promotion initiatives focused on healthy living. In general,
these initiatives are community or program specific. For example, Northern Health
is involved in Chronic Disease Prevention activities in seven communities involved
in a Chronic Disease Prevention and Management Collaborative Process. This
priority will see NH working with other Health Authorities and BCCA to select and
plan additional effective prevention strategies during next three years.
33
Northern Cancer Control Strategy Final Report
5.5.4. Radiotherapy
Any discussion of radiation oncology services in the North requires an appreciation
of the scope of radiation oncology practice and an understanding of the essential
elements required to provide a quality service. The scope of radiation oncology
practice spans the entire continuum of cancer care from diagnosis, clinical
assessment and treatment decision making to treatment planning treatment and
follow-up. The complex nature of radiation oncology requires the recruitment of
many specialists and the establishment of appropriate infrastructure.
In recognition of the increasingly complex nature of oncology management,
radiation oncology practice has become increasingly sub specialized by anatomical
tumor site. As such, a radiation oncologist’s practice is typically limited to two or
three tumor sites. It is no longer possible for a single radiation oncologist to do
“general practice” radiation oncology and maintain expertise for all cancers. The
complexity of cancer management also recognizes that oncology management is
multidisciplinary in nature and involves close collaboration with both surgical and
medical oncology specialists.
In addition to the medical management requirements, the practice of radiation
oncology has been dramatically altered by improvements in technology, both
hardware and software, which have fully integrated the quality assurance,
dosimetry, treatment planning and simulation with the final treatment delivery
process. The maintenance and operation of this multi-system infrastructure and
process requires highly skilled technical personnel (medical physicists, electronics
technicians, dosimetrists and radiation therapists). In summary, the modern
practice of radiation oncology requires significant concentration of medical and
technical expertise to support and maintain a high quality service. These specialists
are in short supply across Canada.
The increasingly tertiary nature of a radiation oncology consultation and treatment
service is a reality which must be considered in planning any enhancement of
34
Northern Cancer Control Strategy Final Report
services in the North. BCCA guidelines for a radiation service would require the
following:
A population of oncology cases large enough to support and justify a
concentrated resource (BC has typically considered a catchment of
approximately 750,000 to justify a radiotherapy centre. Other jurisdictions
have recommended population estimates of 600,000 to 1,000,000 or a
minimum population to support four linear accelerators and the associated
infrastructure.).
Accessibility through transportation links.
The recruitment of a critical mass of radiation oncologists.
The associated development of a critical mass of surgical and medical
oncologists.
The development of minimum staff numbers for medical physics,
electronics, dosimetry and radiation therapy technologists.
The necessary infrastructure for quality assurance, radiation dosimetry,
treatment planning and simulation.
The necessary treatment capacity (number of linear accelerators) with
sufficient redundancy to accommodate machine downtime on any individual
unit such that patients’ requirements for uninterrupted treatment are not
jeopardized.
Preceding and concurrent with the development of Northern Health’s Cancer
Strategy, there has been considerable public discussion about, and support for, the
establishment of a Prince George based radiation therapy service. When the above
criteria are examined it does not appear that the catchment area for the North is
large enough to support a service at this time. Feedback from Northern physicians
indicates that patients in the Northeast and Northwest are better served by current
arrangements than they would be through a service located centrally in the North
because of the established referral links, full range of specialized care in tertiary
centres, and relative ease of North – South travel. It is also likely that the trend to
refer some of the cancer patients from the Northeast to Alberta will continue. While
the population of NH is close to 300,000, given the referral and travel patterns, a
northern radiation service at this time could respond, at most, to a population of
175,000 or about 25% of the current minimum recommended guideline. A service
of this size would only allow the available sub-specialized radiation oncologists to
treat a portion of the anatomic tumour sites requiring other patients from within this
area to be referred to larger centres.
Population growth, development of other cancer services in the North, adequate
planning for oncology human resource specialists, improvements in East – West
transportation links within the Region, and developments in clinical technology may
combine to improve the feasibility of a Northern service in the future. In particular,
the advancements in digital linkages and the implementation of clinical information
systems may enable new models of service to be feasible. However, some
strategies can be implemented in the short term, which will reduce the demands on
patients and families who face multiple appointments, require information and
support, and face significant travel and accommodations requirements during
investigation, treatment and follow up care.
5.5.5. Navigation
The Northern Cancer Program will provide patient navigation services across the
three HSDA’s through registered nurses knowledgeable in all aspects of cancer
35
Northern Cancer Control Strategy Final Report
care. Patients who receive several types of treatment will be supported to ensure
that the planning and organization of their treatment minimizes travel requirements.
Assistance will be available when patients encounter difficulties in the often
complex series of consultations, examinations and treatments required by their
illness. This “navigation service” requires strong communication links within both
BCCA and NH to address process and scheduling issues.
5.5.7. Telehealth
The well-developed infrastructure in telehealth in both the North and at the BCCA
offers the opportunity to reconsider how patient consultative services to BCCA
tumor site specific specialists in radiation, medical and surgical oncology can be
enhanced. Telehealth linkages could also be of value to primary care physicians to
provide assistance and advice on patient management particularly in relation to
many of the clinical problems faced by patients in the post-treatment phase of their
illness.
Year one of this telehealth strategy will focus on improving NH family physicians
access to BCCA specialists for consultation. Year two will focus on improvements
to patient consultation and staff education.
1
Dr. Alan Bernstein, CIHR President, Newsmaker's Breakfast, Ottawa, January 20,
2004
36
Northern Cancer Control Strategy Final Report
Work in this area will be ongoing. In particular, Northern Health has an opportunity
to build relationships with BCCA, UNBC, UBC and the Northern Medical Program to
work collaboratively to expand research and teaching in the area of cancer control.
Enhancing research and education will improve the ability of NH to recruit and
retain staff, as well as monitor and maintain an up to date level of care based on
evidence. In nursing there is an opportunity to facilitate research into health and
aboriginal health in relation to cancer control. Student practicums can be
developed for both registered nurses and medical students.
The BCCA is engaged in varying degrees of all aspects of research at provincial,
national and international levels. The BCCA undertakes cancer research in
collaboration with organizations representing the North or including the North as a
focus of the research. The BCCA would entertain all opportunities to partner with
Northern Health that fit within the mandate of cancer research and within the
academic setting post-graduate academic associations. As part of the established
ongoing forum, continuing professional health education will be facilitated in
collaboration with Northern Health.
37
Northern Cancer Control Strategy Final Report
38
Northern Cancer Control Strategy Final Report
6. APPENDICES
6.1. Data
Canada’s Socio-Economic Health Regions
Northern Health is often compared with other health regions in British Columbia.
While these comparisons are useful for many purposes they can mask the fact that
the Northern and Rural areas of Canada often face challenges that are unique and
absent from the more urban context. Many of these challenges are anchored in the
socio-economic context.
Socio-economic factors are a fundamental determinant of how healthy citizens will
be, the opportunities they will have to make wise and healthy decisions, and how
their lives will unfold.
Because of the positive association between socio-economic status and health,
comparisons between communities are often more useful if they are made among
those that are socio-economically similar.
39
Northern Cancer Control Strategy Final Report
10,000 + persons
Northern interior
Major urban centers in the North are shown as stars on the above map and include the
communities of Prince Rupert, Kitimat, Terrace, Prince George, Quesnel, Dawson Creek and
Fort St John. Collectively, these urban areas and their immediate communities are home to
approximately 185,000 persons or just under two-thirds of the Northern population.
A significant number of northerners however, live in much more rural and remote circumstances.
Some communities such as Gitga’at (Hartley Bay) and Lax kw’alaams (Port Simpson) are only
accessible by floatplane or boat, weather permitting. Others such as Good Hope Lake, Takla,
Dease Lake and Lhoosk’uz Dene (Kluskus) are accessible by gravel roads that require driving
times of six to twelve hours under optimum conditions.
The vast geography, the small widely distributed population, and the differing needs of each
community present enormous challenges when it comes to promoting good health, preventing
disease and providing sustainable and integrated health services.
40
Northern Cancer Control Strategy Final Report
Northern Demographics
On average the population in the North is considerably younger than the rest of BC.
The average age of people in the north is 34 years whereas the average age of the BC
population is 38 years.
8.0
6.0
shows the relative
contribution of each age
group to the overall
4.0 population for both
Northern BC and British
Columbia.
2.0
Age Groups
0.0
90+
<1
15 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 - 44
45 - 49
50 - 54
55 - 59
60 - 64
65 - 69
70 - 74
75 - 79
80 - 84
85 - 89
1-4
5-9
10 - 14
41
Northern Cancer Control Strategy Final Report
Northern Demographics
BC
Northwest
Northern Interior
Northeast
North Van Is.
Aboriginal, First Nations and Métis peoples
Central Van Is.
comprise a very significant and important part
South Van Is.
of the Northern population. According to the
NorthShore-CG
Vancouver
most recent Census there are between 35,000
Richmond
and 45,000 Aboriginal First Nations and Métis
Fraser South
persons residing in the area served by
Fraser North Northern Health. This is likely an
Fraser East underestimate.
ThompsonCariboo
Okanagan
Kootenay Boundary
East Kootenay
Population
> 15,000 Aboriginal people are on average considerably
10,000 – 14,999 younger than their neighbors. Whereas the
5,000 – 9,999 average age of northerners overall is 34 years
< 5,000 of age, the average age of Aboriginal and First
Nations peoples is 28 years. In fact, almost 45
% of the Aboriginal and First nations
population is between the ages of one to 24
years.
Not only is this population much younger, the
patterns of illness, such as cancer, are
different than those experienced by other
Northerners.
Source: BC Vital Statistics Agency, Regional Analysis of Status Indians in British Columbia 1991 – 2001.
42
Northern Cancer Control Strategy Final Report
Life Expectancy
BC
Northeast
Northern Interior
Northwest
Life Expectancy is an expression of
North Vancouver Island
the age to which a baby born today
Central Vancouver Island
is expected to live given the present
South Vancouver Island
mortality experience of the
North Shore/Coast Garibaldi
population. In British Columbia the
Vancouver
current BC life expectancies are 77.3
Richmond
years for males and 82.47 years for
South Fraser
females.
Simon Fraser
Life expectancies for Northerners are
Fraser Valley
from 3 to 4 years shorter than those
Thompson Cariboo
for BC residents overall.
Okanagan
Kootenay Boundary
East Kootenay
Years of Life
Source: BC Stats, BC Ministry of Management Services
43
Northern Cancer Control Strategy Final Report
Northern Residents
The Leading Causes of Death for residents of
Northern BC were similar to those elsewhere in
Infectious/Parasitic North America: Circulatory and Heart Disease,
Diseases
Other
9%
1% Cancers, Respiratory Diseases and external
events such as motor vehicle crashes, falls,
Cancer workplace injuries, suicides, homicides, etc.
External Causes
13% 28%
Cancers are a significant cause of death amongst
northerners.
Digestive System
Diseases Leading Causes of Death during 1991 - 2001
4%
Circulatory System
Respiratory system 1391 deaths
Diseases
32%
Source: BC Vital Statistics Agency – Regional Analysis of Health Statistics for Status Indians in British Columbia, 1991 – 2001.
44
Northern Cancer Control Strategy Final Report
45
Northern Cancer Control Strategy Final Report
Males Females
80.00
Age Standardized Incidence Rate per 10,000
70.00
60.00
50.00
40.00
30.00
20.00
10.00
.00
Multiple Myeloma
All Other
Non-Hodgkins
Esophagus
Lung
Colorectal
Stomach
Leukemia
Oral
Melanoma, Skin
Pancreas
Cancers
Lymphoma
Males Females
70
Age Standardized Mortality Rate per 10,000
60
50
40
30
20
10
0
All Other
Lung
Multiple Myeloma
Non-Hodgkins
Oral
Stomach
Esophagus
Colorectal
Leukemia
Pancreas
Melanoma, Skin
Cancers
Lymphoma
46
Northern Cancer Control Strategy Final Report
700
600
Number of Persons
499
500
400 378
332
300
181
200
119
100 53 53
12 10
0
0 - 19 20 - 39 40 - 59 60 - 79 80 +
Age Groups
350
322
Deaths 2005 Deaths2015
300
250
Number of Persons
217
200
150
1 27
111
103
100 84
50
9 11
2 3
0
0 - 19 20 - 39 40 - 59 60 - 79 80 +
Age Groups
Data Source: BC Cancer Agency, Projections 2003 - 2017, published April 2003. Data is for the area
served by Northern Health and was prepared by the Surveillance & Outcomes Unit, Population &
Oncology, and BC Cancer Agency. The calculation of projected New Dx and Deaths were undertaken
using BCStats People 27 Methodology.
47
Northern Cancer Control Strategy Final Report
Predicted Percentage Change in New Cancer Cases for selected Cancer types
2005 - 2015
Breast
Prostate
Lung
Colorectal
Cervix
Health Authority
Pancreas Interior
Fraser
Stomach
Van Coastal
Ovary
Van Island
Lymph: N-
Hodgkin North
Leukemia
Melanoma
All Other
All Cancers
-10 10 30 50 70
Percentage Change in Cases
Source: Custom Calculation for Northern Health, provided by the BC Cancer Agency Dec 21, 2004
Between 2005 and 2015 the North can expect to see an increase in the number of new
cancer diagnoses. Most of this increase is due to the fact the population is aging.
Percentages can be somewhat misleading however because when there are a small number
of cases involved, a change in just a few cases can result in large percentage changes. For
example, between 2005 and 2015 we can expect the number of stomach cancers to jump
from 21 cases per year to 30 cases per year - this represents a 43% increase in new cases.
48
Northern Cancer Control Strategy Final Report
30
In 2003, the BC Ministry of Health
conducted a survey of Tobacco use.
20
BC The tobacco survey found that nearly 32 %
of all Northerners were current smokers.
This was by far the highest smoking rate in
the province of BC.
10
The survey also found that nearly 40 % of
persons aged 15 – 24 years, were current
smokers. Again, the highest rate in BC. The
0
Van. Coastal Fraser Interior Van Island Northern
BC average is only 23 %.
Health Authority
49
Northern Cancer Control Strategy Final Report
50
Northern Cancer Control Strategy Final Report
51
Northern Cancer Control Strategy Final Report
0 5 10 15 20 25 30
52
Northern Cancer Control Strategy Final Report
2
Van Netten, C. Preliminary Report of the BC Radon Survey, Phase 2, 1991-1992
University of British Columbia report.
53
Northern Cancer Control Strategy Final Report
54
Northern Cancer Control Strategy Final Report
6.3. Screening
The following table outlines the programs and services available for Northern
Residents.
55
Northern Cancer Control Strategy Final Report
U/S Aspiration
Breast Biopsy
Lab Services
NM Sentinel
Core Biopsy
Localization
Stereotactic
Breast MRI
Bone Scan
Breast CT
Fine Wire
Nodes
NW Prince
Rupert
(serving
QCI)
Terrace,
Kitimat,
(serving
Dease
Lake,
Stewart
and Atlin)
Smithers, mobile
Hazelton
and
Houston
NI Lakes mobile
District
Omineca mobile
Prince
George
56
Northern Cancer Control Strategy Final Report
Mammography
U/S Aspiration
Breast Biopsy
Lab Services
NM Sentinel
Core Biopsy
Localization
Stereotactic
Breast MRI
Bone Scan
Breast CT
Fine Wire
Nodes
Quesnel Future
Plans
Robson mobile
Valley
MacKenzie mobile
NE North
Peace
South
Peace
Radiation Therapy not not not Patients must travel to one of the
available available available BCCA sites such as Vancouver,
Kelowna, Victoria or Fraser Valley for
treatments. Some patients,
particularly in the NE, are referred to
Alberta.
Family Practice limited limited limited The Family Practice Oncology group
care is working with BCCA to improve the
capabilities of family practitioners in
the communities to manage cancer
patients. Several family practitioners
have taken the oncology training
offered by BCCA.
57
Northern Cancer Control Strategy Final Report
Home Care
Pastoral Care is offered at PGRH,
Pastoral Care other communities coordinate with
local ministries.
58
Northern Cancer Control Strategy Final Report
59
Northern Cancer Control Strategy Final Report
PREPARED BY: Sherry Reid, Data Analyst - Surveillance & Outcomes, PPO
DATE PREPARED: 15 November 2004
*These rates are artificially low as they do not include services provided by the Alberta
Cancer Board. See page 26.
5 0 .0 0 %
4 0 .0 0 %
3 0 .0 0 %
2 0 .0 0 %
1 0 .0 0 %
0 .0 0 %
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
In te rio r F ra s e r V a n c o a s ta l V a n Is la n d N o rth e r n
0.001400
0.001200
0.001000
0.000800
0.000600
0.000400
0.000200
0.000000
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
60
Northern Cancer Control Strategy Final Report
61
Northern Cancer Control Strategy Final Report
BCCA
NH
Yukon and
Alberta
NH Regional
Cancer Program
Leader
63
Northern Cancer Control Strategy Final Report
the priorities discussed in the next section e.g. navigation, transportation, telehealth,
information management etc.
64
Northern Cancer Control Strategy Final Report
mandate is to conduct Pap tests and breast exams for women who do not access this
service through medical practitioners. Also included is testing for STIs. This is an ongoing
project that is still in the developmental stages. It involves training public health nurses
and other nurses to provide the service, establishing competencies, and setting up clinics
encouraging women to access the service. The original target was to establish this
service in 6 communities across the North with a special focus on Aboriginal women.
Outcomes expected: Increased percentage of underserved female population will be
screened for cervical cancer and will access mammograms
Who, What and When? Lynda Anderson, Coordinator, Women’s Health Program
65
Northern Cancer Control Strategy Final Report
Columbia. These rates reflect the risk of the population to develop cancer and do not
evaluate the efficacy of the medical system in diagnosing and treating cancer. The
potential effectiveness of medical care is more appropriately reflected by cancer survival
rates which measure the likelihood that an individual diagnosed with a particular cancer
will live for a pre-specified time. Examination of cancer survival rates, for the five health
authority regions, shows Northern rates to be a little below the provincial average.
These differences are not dissimilar to those observed between different provinces of
Canada. Because of the relatively small magnitude of the differences it is unlikely due to
large differences in diagnosis or treatment, however in order to investigate this further it
will be necessary to adopt a multi-phasic approach.
Outcomes expected: The outcome of the retrospective study will provide a better
understanding of where resources and effort should be focused to improve survival.
Who, What and When? The following steps are suggested:
1. Identify sentinel cancers. It is not practical or statistically wise to try to
investigate all different types of cancer. Two to three major cancers would
be identified as indicators of underlying patterns of diagnosis and treatment.
These cancers would have the following characteristics: 1-2 would be
cancers for which effective screening exists, multi-modality care is indicated
in their management, and differences in survival exist between North and the
rest of BC.
2. Analysis would be conducted within the North on outcomes for these sentinel
cancers. The objective is to determine whether subgroups can be identified
where differences are greater than the average.
3. Using the groups so identified, analysis of existing data would then be
targeted to identify potential causes. It is anticipated that the cause could fall
into two broad classifications: disease is more advanced at diagnosis in the
North than elsewhere or curative treatment is ineffectively applied.
4. Prospective data would then be collectively within the groups to
independently confirm the validity of the conclusions from step 3.
Personnel Involved: BCCA statistical staff, BCCA clinical experts on sentinel cancers, NH
experts on delivery patterns, NH statistical staff.
Time frame: Step 1: month 1, Step 2: month 2, Step 3: months 3-5, and Step 4: months
6-10, Final report: months 11-12
b) Diagnostic Testing
The priority: Currently in the North, patients who present with signs or symptoms may
not always follow the most expedited path to a definitive diagnosis. This not only delays
diagnosis but causes stress for the patient and wastes NH resources. This initiative will
improve primary care linkages to develop a coordinated system from first encounter to
screening, detection, treatment and follow up. Medical staff and diagnostic departments
will need to develop quality improvements in practice to bring practice to standards as set
by BCCA. Scheduling will also be a focus of this priority. Residents of many of the
smaller communities must travel to larger centres to access screening, imaging and lab
services. The lack of coordinated scheduling requires the patients to attend multiple sites
over a longer period of time resulting in delays and travel inconveniences.
Outcomes expected: Patient is supported and informed and is enabled to access
services in a timely way (e.g. through initial consult to follow up). Standard clinical
pathways will be utilized across the North.
66
Northern Cancer Control Strategy Final Report
Who, What and When? BCCA will provide clinical pathways/CPG’s to NH. NH will need
to formalize the use of CPGs related to screening and detection, and then adopt a quality
improvement process with primary care physicians around use of these CPGs.
The NH Medical Director will implement this priority with family practitioners and
diagnostic departments. This work will involve the development of communication
strategies to involve and inform the physicians. The Family Practice Oncology Network
will be a resource in implementation planning. There will need to be an investment in
infrastructure to support implementation, ongoing monitoring and continuous
improvement.
Who, What and When? The Northern HEALTH CONNECTIONS Program (NHCP) will
be a $4m initiative managed by Northern Health for the residents of the North.
Complementary to, but distinct from, the Provincial Travel Assistance Program the NHCP
will enhance access to health care services for people encountering travel and
accommodation barriers.
The NHCP is open to any resident of Northern Health with no restrictions based on age,
income, or disease type. Persons with access to other travel or accommodation
assistance, e.g. WCB, social assistance, employer-paid, band-paid etc., are expected to
access those funding sources first. NHCP not meant to replace other funding sources.
Although the NHCP will not directly reimburse individuals for expenses incurred, the
NHCP will work with transportation and accommodation providers to provide reduced
rates to persons who have to travel out of their home community to access health
services. Services eligible will be all hospital and physician office based programs, e.g.
laboratory, diagnostic imaging, in and out patient services, scheduled physician office
visits, as directed and required by physician referral.
b) Surgical Oncology
The priority: The Surgical Oncology Network's includes all providers of surgical oncology
services. The Network's goal is the integration of quality surgical oncology services into
the formal cancer care system. It does that through: creating communication tools to
enhance surgical decision making; participating in the identification and/or development
of peer-reviewed, evidence-based guidelines based on "best practice" principles;
developing a high quality continuing education program that meets standards of the
Royal College of Physicians and Surgeons; conducting regionally based research and
outcome analyses to provide vital information for Network initiatives.
67
Northern Cancer Control Strategy Final Report
The network council has members for all health regions as does each of its committees
and taskforces. Dr Gil Wankling of Prince George serves on the Executive of the
Network. The network annually has its "annual road show" combining provincial and local
expertise to bring continuing medical education to the surgeons of the region. It is also
provides a venue from surgeons across the health region to meet and discuss common
issues with respect to cancer care. When guidelines are developed it is the input of
surgeons from across all regions that help to ensure that not only are the guidelines
representative of best practice but that the implications on service delivery are known.
The Network is currently undertaking a provincial infrastructure survey so the supports
available to surgeons in the care of cancer patients will be identified by hospital.
As the data shows, for the most part the residents of the north have access to surgical
care for the treatment of their cancer. The guidelines and continuing medical education
supports surgeons to provide the highest quality care. On going monitoring (as is
currently the case for networks current rectal cancer outcome project) provides quality
assurance that residents are indeed getting access to quality care.
Outcomes expected: The Network's goal is the integration of quality surgical oncology
services into the formal cancer care system.
Who, What and When?
BCCA to conduct a provincial infrastructure survey so the supports available to
surgeons in the care of cancer patients will be identified by hospital
BCCA to continue and enhance communication with Northern surgeons
68
Northern Cancer Control Strategy Final Report
Telehealth
Mobile service
Who, What and When? The Terms of Reference of the External Review would include
familiarization with the current model for the provision and delivery of chemotherapy
services to Northern residents, BCCA documentation regarding standards for delivery of
chemotherapy, PHSA and Northern Health Information Systems (including health
records). The review team would make site visits to communities that house the three
models of care (e.g. Regional Cancer Centre, Community Cancer Centre/Clinic and
Community Cancer Services Nurses). A written report would be presented to NH/BCCA
Steering Committee or designates.
The reviewers will be a team with BCCA Systemic Therapy working knowledge,
Information Systems\Health Records, Rural knowledge and Administration experience. It
is suggested that one member be a BCCA General Practice Oncologists with experience
working with Northern patients and the BCCA, Family Practice Oncology Network. As
Manitoba has established strong community outreach programs for the delivery of
chemotherapy care, a member of the team could be chosen from Manitoba. The third
member should have the skills that are not covered by other members of the team and
fulfill those experiences identified in the first sentence.
The review will take 3 months to complete from initialization to report submission
d) Navigation
The priority: A Patient Navigator is someone who helps patient’s access information and
support throughout the cancer journey by linking them to the formal and informal
networks and resources that exist within their region. By co-coordinating efforts so that a
patient receives information, psychosocial supports, and practical assistance in a timely
manner, patients are helped to develop effective coping strategies that maximize healthy
functioning. Helping a patient access the many support networks that exist outside of the
formal health care system increases adjustment and quality of life. In regions that have
fewer support resources, a Navigator may be required to provide information and support
directly to patients, and therefore must have the professional expertise and skills to do
so. A Navigator may also use community development methods to build capacity for
providing support within communities. The ability to network and build collaborative
relationships is essential.
An effective patient Navigator may have a nursing or social work background as
knowledge about the care process, from start to finish, is essential in communicating to
patients. Basic medical knowledge about cancer is needed (e.g. diagnostic procedures,
test results, treatment options, side effects and management) as is knowledge of
information resources that patients can access to gain more detailed understanding of
their disease and treatments. The ability to assess psychosocial needs is also required.
About one third of cancer patients experience high levels of distress: patients suffering
emotional distress have more difficulty making decisions about treatment, seek more
medical consultation, and are less satisfied with the medical care. Therefore a Navigator
must have sensitivity and superb communication skills in order that she/ he can respond
appropriately to the concerns of distressed patients, can provide emotional support when
needed, and refer to expert counseling if necessary. Knowledge of the practical needs of
cancer patients and helpful resources is needed (e.g. transportation, financial). Lastly,
knowledge of local and distant resources and supports, and a willingness to continuously
access and increase those resources, will enhance the efficacy of the Patient Navigator.
NH will need to develop navigation services across NH using pilot projects to expand to
additional communities.
Outcomes expected: Improved access and movement through the continuum of care
via:
69
Northern Cancer Control Strategy Final Report
e) Enhanced Consultation
The priority: The Agency currently provides consultation and follow-up for cancer
patients in the North through the attendance of a radiation oncologist at regularly
scheduled consultative clinics in Prince George, Prince Rupert, Terrace, Dawson Creek
and Whitehorse. While these clinics in some cases eliminate the need for patients to
travel to Vancouver for consultation, they are essentially a triage function whereby the
attending oncologist confirms the patient’s need for treatment and then redirects them to
the appropriate radiation oncologist in Vancouver on a tumor-site specific basis. The
resulting delay in many cases is an additional delay in seeing the appropriate individual at
BCCA which negates the value of this service for many patients.
The well-developed infrastructure in telehealth in both the North and at the BCCA offers
the opportunity to reconsider how consultative services to appropriate tumor site specific
specialists in radiation oncology as well as medical and surgical oncologists could be
developed. Telehealth linkage could also be of value to primary care physicians to
provide assistance and advice on patient management particularly in relation to many of
the clinical problems faced by patients in the post-treatment phase of their illness.
Outcomes expected: The potential contribution of telehealth to improving access to sub
specialists in all the oncology disciplines for both specialists and primary care physicians
in the North has not been formally discussed to date. It is recommended that this occur
in the short term as a means of enhancing access to, and quality of, care for patients with
cancer in the Northern Health Region.
Who, What and When? Review effectiveness of existing Consultation Clinics in NH.
Develop and panel of experts with formal slots available for access by NH family
physicians.
NH: Integrate with Transportation and Navigation Strategies
BCCA: to expedite access
f) Telehealth
The priority: Enhance the capability and use of telehealth and information technology to
improve cancer control (e.g. web-based guidelines/standards, telepathology, sub-
specialty consultation, patient and professional education, navigation etc.). Telehealth
offers practical alternatives for the delivery of health care services. Effective use of
telehealth should integrate and support existing structures in rural and remote
communities. It can improve access to specialized high quality cancer care, education,
training and supervision, while decreasing the resource impact on the provider and
recipient. The use of this technology should be outcome-focused and evidence-based,
leading to the development of a model for use internationally.
70
Northern Cancer Control Strategy Final Report
g) Palliative Care
The priority: Develop a coordinated comprehensive Palliative Care Program that has
linkages with Home Care, the BCCA Provincial Palliative Care Network and other similar
rural sites. Northern Health developed a Palliative Care Strategy in 2004. The purpose of
the Palliative Care Strategy is threefold:
To improve access to Palliative Care services.
To increase the quality of Palliative Care services
To improve the integration and coordination of Palliative Care services
throughout the North
The Palliative Care Strategy identifies four broad strategic areas for action. They include:
Position Palliative Care services within the organization structure of Northern
Health and establish a system of leadership.
Establish a coordinated network of Palliative Care Services supported by policies
and procedures, protocols, and clinical practice guidelines.
Build the capacity of Palliative Care service providers.
Quality management – develop program performance measures that will be used
to facilitate improvement in the delivery of services.
71
Northern Cancer Control Strategy Final Report
72
Northern Cancer Control Strategy Final Report
• Tobacco Control:
• Transfer of Pilot Program from HC to NH $350,000
• Program Expansion to full region $350,000
• Best Practices Review - Prevention $25,000
Detection and Diagnosis:
• Application of BCCA diagnostic protocols and HSDA $30,000 $5,000
investigation & process redesign
• Mammography screening & Reproductive Health $30,000
Treatment:
Palliative Care:
Total
73