Ontario Cancer Plan 4 (2015-2019)

Pre-reading for regional engagement

September, 2013

Table of contents • Background/refresh

• OCP III overview

• Rationale for OCP 4

• Lessons learned from OCP III

• Updated approach & timeline

•Current state assessment

• Cancer related statistics/data (CSQI & Canadian Cancer Statistics, 2013)

• Cancer System Quality Index results (CQCO)

•Environmental scan

• Cancer system stakeholders’ areas of focus

• Areas of focus of Canadian and international cancer plans

• Findings from a systematic review of European national cancer plans

• Emerging trends/ opportunities related to CCO’s program areas

•Questions related to SWOT

2

OCP III OVERVIEW &

OCP 4 APPROACH

Background/Refresh

OCP III – 2011-2015

4

OCP III: 6 strategic priorities and 30 initiatives

1: Develop and implement a

focused approach to cancer risk

reduction

Cancer prevention performance measurement

framework

Online cancer risk assessment tool

Cancer risk reduction initiative in each RCC

Renewed Smoke-Free Ontario Strategy & the Provincial Training & Consultation Centre

Second Aboriginal Cancer Strategy

2: Implement integrated cancer

screening

ICS strategy for breast, cervical & colorectal

cancers.

Expand InScreen

ICS support services at RCCs & accountability

for screening

Centralized administration support for all cancer screening

Integrated screening reports for primary

care providers

3: Continue to improve patient

outcomes through accessible, safe, high quality care

Disease pathway maps, quality improvement

targets

Provincial plans for delivery of surgery,

radiation treatment & palliative care

Strengthen quality assurance & best

practice at provider level

Develop measures & manage performance on patient outcomes

Recommendations on new technology that

improves patient outcomes

Oversight of stem cell transplant,

neuroendocrine tumours & sarcoma

4: Continue to assess and improve

the patient experience

Access to information, coordination of care &

Electronic Pathway Solution (diagnostic)

Improved survey instruments to measure

patient experience during treatment

ISAAC adoption & use increased use of tale-

ISAAC

Better response to elevated symptom

scores using notification alerts

Measure patient-reported outcomes

(post-treatment)

RCP accountability for improving the patient

experience

Expand regional psychosocial oncology

& patient education programs

5: Develop and implement

innovative models of care delivery

Develop new models of care delivery

Implement models & address necessary

changes

Evaluation, modification &

improvement of models

6: Expand our efforts in

personalized medicine

Process to integrate new knowledge into

clinical practice

Implement recommendations of

CCO’s Molecular Oncology Task Force

Mechanism to evaluate &integrate new

knowledge for doctors & patients

(effectiveness & cost-effectiveness of

targeted therapies)

Access to & quality of clinical & laboratory

services

Using different tools and processes to improve

the cancer system performance

6

Cancer Care Ontario (CCO) Regional Cancer Programs

Regional Cancer Programs Regional Cancer Programs Regional Cancer Programs

Regional Cancer Programs

Work collaboratively to implement OCP, improve system performance & reach goals

CSQI informs

OCP progress reporting Internal

performance management tool – overall progress

against OCP

Regional performance

management tool - areas requiring

improvement

Quarterly Regional

Performance Scorecard

guides

Shared priorities /initiatives

7

Updates/Evolutions

Since OCP III

CCO Corporate Strategy 2012-2018

Why OCP 4?

8

OCP III ends in 2015. Progress has been made in the past few years. Need to evaluate goals and strategic priorities.

Cancer system and health system changing and progressing and we have learned more about the cancer journey.

Organizational changes – new Corporate Strategy (vision, mission, areas of focus)

Previous OCPs have been successfully accepted, adopted and used. A well articulated plan has facilitated change and progress in the cancer system .

OCP III – Lessons learned

9

- Overall approach

- Comprehensive and consultative

- Expected outcomes more clearly articulated (compared to OCP II)

- More time for plan development

- PLC & CC – more oversight and accountability for plan development

- More patient engagement

- More regional engagement

- Engage additional key stakeholders

- Embed measures of success expected by end of strategy

- Earlier engagement with communications

- Build on previous plans; core work will continue to support goals

What worked well? Future approach

Ph

ase

0

Phase I:

Conduct Environment

al Scan, Current state assessment & develop

OCP framework.

Phase II:

Identify strategic

priorities, desired

outcomes, and options

for initiatives.

Phase III:

Validate strategic

priorities & prioritize

initiatives.

Phase IV:

Finalize strategic

priorities, initiatives

and develop implementation roadmap

(inc. funding).

Phase V:

Develop launch plan. Write plan, translate,

develop final product.

Obtain final sign-off. Launch.

Alignment with other CCO activities

10

Stakeholder Consultation & Engagement; Ongoing Environmental Scanning

CCO business planning 2015/16

Systemic Treatment Provincial Planning

DAP strategic planning

OC

P 4

C

on

curr

ent

acti

viti

es

Board Retreat

Exec Team, PLC & CC, Board & SPPRM, PFAC, CQCO

Joint CEO, RVP, PLC

Spring Planning Day

Joint CEO, RVP, PLC

Feb-Apr 2013

May-Sep 2013 Feb-May 2014 Jun-Aug 2014 Sep2014-Jan 2015 Oct-Jan 2014

Board Input

Release - January 2015

CCO organizational PM framework

CCO business planning 2015/16

Phase VI:

Develop detailed

implementation plan, and launch measurem

ent of progress

(scorecard)

Aboriginal Cancer Strategy III – June 2015 release

TBC-CIO Strategic Planning

ET Retreat (Tentative)

Feb 2015 onwards

Board sign-off

Board Input & international

validation Board Input

Spring Planning Day

CANCER RELATED STATISTICS/DATA

(CSQI & CCS)

Current state

Report date: February 2013

Data source: Ontario Cancer Registry, Collaborative Staging Database

Prepared by: Cancer Care Ontario, Informatics Centre of Excllence

Population-based distribution of cancer stage, breast cancer, Ontario, 2007-2011

Reporting of Cancer Stage

Year

2007

2008

2009

2010

2011

Pe

rce

nta

ge

(%

)

0

10

20

30

40

50

60

70

80

90

100

Stage I

Stage II

Stage III

Stage IV

CSQI 2013

Report date: February, 2013

Data source: Ontario Cancer Registry, Collaborative Staging Database

Prepared by: Cancer Care Ontario, Informatics Centre of Excellence

Population-based stage distribution of cancer stage, colorectal cancer,patients diagnosed from 2007-2011, Ontario

Reporting of Cancer Stage

Year20

07

2008

2009

2010

2011

Pe

rce

nta

ge

(%

)

0

10

20

30

40

50

60

70

80

90

100

Stage I

Stage II

Stage III

Stage IV

CSQI 2013

Report date: February, 2013

Data source: Ontario Cancer Registry, Collaborative Staging Database

Prepared by: Cancer Care Ontario, Informatics Centre of Excellence

Population-based stage distribution of cancer stage, lung cancer,patients diagnosed from 2007-2011, Ontario

Reporting of Cancer Stage

Year

2007

2008

2009

2010

2011

Pe

rce

nta

ge

(%

)

0

10

20

30

40

50

60

70

80

90

100

Stage I

Stage II

Stage III

Stage IV

CSQI 2013

Report date: February, 2013

Data source: Ontario Cancer Registry, Collaborative Staging Database

Prepared by: Cancer Care Ontario, Informatics Centre of Excellence

Population-based stage distribution of cancer stage, cervical cancer,patients diagnosed from 2007-2011, Ontario

Reporting of Cancer Stage

Year

2007

2008

2009

2010

2011

Pe

rce

nta

ge

(%

)

0

10

20

30

40

50

60

70

80

90

100

Stage I

Stage II

Stage III

Stage IV

CSQI 2013

CANCER SYSTEM QUALITY INDEX

RESULTS

Current state

CSQI 2012 & 2013

*

*

*

*

*New or updated areas or indicators

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

CQCO 2012 & 2013 summary Good news (* as well in 2012) Areas for improvement 2013 (*as well as in 2012)

Safe • HPB surgeries stds; post-surgical death rate declined for pancreatic & liver resection

• CPOE increasing across cancer treatment facilities

• Neutropenia, fever or infection are common & should be considered in overall treatment plan

• Unplanned visits to the hospital after chemotherapy *

Effective • Increase in breast cancer screening • Synoptic pathology reporting* • MCC • Positive Margins after Rectal Surgery • Pts. consultation with Med Onc after surgery • Radiation & IMRT pts. treated according gdles • Reporting cancer staging at diagnosis • More cancer survivors receiving treatment

based on best available evidence

• Treating lung & colon cancer according to gdls * • Follow up of abnormal screening results *cervical

Accessible • WT for cancer • WT for radiation • WT for systemic

• CRC screening * • WT between consult to treatment for

chemotherapy *

Responsive • Pt. experience with DAPs & nurse navigators • Pt. satisfaction in ambulatory care (outpatient)

settings * • Symptom mgmt via ESAS tool & more providers

are using tool

• Emotional support satisfaction remains low compared to other aspects measured

• Pt. satisfaction outpatient by type of cancer • Pts need more info about impact of cancer

(beyond treatment) on their life • More measures to determine patients’ &

survivors’ quality of life • Coordination & continuity *of care

CQCO 2012 & 2013 summary Good news Areas for improvement 2013 (*as well as in 2012)

Equitable • Cancer burden still higher among lower SES * • Some variation exists in the use of gdls for patients 70+ • All screening programs continue to indicate that

individuals with lower SES less likely to be screened than those with higher-SES.

• Improve screening rates among under/never screened • Other socio demographic factors such as age, sex,

geography and ethnicity also have a significant impact on risk factors for cancer, cancer screening rates, as well as treatment.

• More work needs to be done, using a whole-of-society approach to ensure equity.

Integrated • Primary Care & Screening indicator suggest that retention, participation & follow-up rates are higher among individuals enrolled with a physician in a PEM practice

• Wait times from Surgery to Chemotherapy * • No target for Cancer Screening Integrated Participation • Integrated WT from diagnosis to treatment

Efficient • Chemotherapy in last 2 wks of life • Radiation equipment utilization (no

target) • New measures for cost-effectiveness

of IMRT vs non-IMRT

• Start palliative care discussion & referrals sooner, variation across province

• Use of acute care too high * • Death in acute care hospital remains high * • Alternatives need to be initiated so last minute visits to

ER and hospital can be avoided

Overall summary (2012/2013) • As of today, we’re best at treating people once they are in the system.

• Cancer services provided are generally effective and evidence-based; in 2013 strongest dimensions are

effectiveness and accessible

• Ontario is relatively strong, by world standards, in providing effective diagnosis and high-quality

cancer treatment services.

Areas for improvement/focus

• Lung Cancer treatment

• Prevention (risk factors)

• More ‘safety’ measures, across all aspects of cancer treatment and from the patients’ perspective.

• More focus required on the patients’ & survivors’ quality of life and consideration of the whole person

and family during and after active treatment.

• Cancer burden among those with lower socioeconomic status. A whole-of-society approach is required

to ensure equity.

• Better measures to determine value for money for all services, while maintaining good health

outcomes and seamless patient care. Resources and supports at the end-of-life.

• Services across the system need to be coordinated and integrated to support seamless and effective

patient transitions regardless of location or provider.

• Patient-centred integrated wait times show that although individual service-specific waits are

achieving their targets, it’s a long wait from diagnosis to treatment from the patients’ perspective.

The vision for the system is that it will be fully integrated if patient transitions are seamless and

effective regardless of location or provider.

CANCER SYSTEM STAKEHOLDERS’

AREAS OF FOCUS

Environmental Scan

Summary of system stakeholder strategic areas of focus -

National Other points to note

Can Partnership Against Cancer (CPAC) 2012-17

Research – understand cancer & related chronic dis.

Population based prevention

Population based screening

High quality early detection

High quality clinical care

Cancer control for First Nations Inuit Metis

Person-centred perspective (cancer journey)

-Public & pt. engagement & awareness -Perf. Reporting

Canadian Cancer Society (CCS) 2010-15

Research for prevention

Influence public policy for quality cancer care (screening, early detection)

Support programs on needs of pts. & caregivers (supportive care, survivorship, end-of-life care)

Engage more Canadians in the fight against cancer

-Programs are available & accessible -Improve quality of life

Can Assoc of Prov Cancer Agencies (CAPCA) 2009-14

Alignment & role clarity or agency

Safe care - share & promote best practice, tools, processes, knowledge sharing

Enhanced cancer care across the continuum – community setting (identify gaps, shared oncology care, education curriculum for GPOs)

Access to cancer drugs & mitigate costs (utilization mgmt, purchasing)

CIHI (2012-17)

Improve the comprehensiveness, quality & availability of data

Support population health & health system decision-making

Deliver Organizational Excellence

GPOs = General Practitioners of Oncology

Summary of system stakeholder strategic plan areas of

focus - Provincial

Other points to note

MOHLTC – public health 2013 (3-5 yrs)

Optimize healthy human development – early childhood development

Improve the prevention and control of infectious diseases - immunization

Improve health by reducing preventable diseases and injuries – physical activity & healthy eating, tobacco & alcohol

Promote healthy environ – natural & built – focus on built environ(?)

Strengthen the public health sector’s capacity, infrastructure and emergency preparedness – workforce, collaboration, info & knowledge sharing

Note: MOHLTC has separate strategies for seniors & mental health & addictions

Health Quality Ontario (HQO) 2012-?

Focus the system on a common quality agenda (quality plans)

Build evidence & knowledge (health tech assessment)

Broker improvement (training, best practice implementation)

Catalyze speed (process & tools, system recommendations on accreditation, infrastructure)

Evaluate progress (indicators, reporting)

Ontario Institute for Cancer Research (OICR) 2010-15 (Translation priorities)

Adoption of more personalized medicine for cancer

Solutions to clinical issues that could benefit patients in the next 5 yrs. – pancreatic, prostate, breast, colon, children and youth

Digitization and interpretation of cancer data.

Acceleration of patents to products program (commercialization)

Additional innovation & technology program priorities available in plan

AREAS OF FOCUS OF CANADIAN AND

INTERNATIONAL CANCER PLANS

Environmental Scan

Provincial Cancer Plan Priorities/Areas of Focus* (Please note : terminology used in plans related to goals/priorities/activities varied)

AB 2013-30

Prevention-Reduce risk through coordinated & integrated strategies; Increase awareness

Screening – use robust data and appropriate activities

Integrated diagnosis, treatment & support services

Psychosocial, physical, supportive care & palliative care throughout journey for patients & families

Research (primary care, prevention, cancer care, policy)

Develop strong workforce (needs, gaps in data, roles/skills definition, models)

Manage infrastructure (information, equipment, IT, knowledge)

Surveillance-Develop strong monitoring system

Integrated care (evidence, care models)

SK 2011-14

Improve the client, patient & family Experience throughout cancer journey

Improve the coordination & timely access of safe, high quality care for clients, patients and their families

Development of quality measures, accountability and transparency that enhance evaluation

Enhance & maximize the benefits of integrated primary prevention & early detection programs to reduce risk

MB 2012-17

Primary Prevention & health promotion (work with partners)

Early detection through screening &diagnosis – improve access, reduce anxiety

Access to quality patient-focused cancer treatment & care

Follow-up care & survivorship (optimal pathways, symptom management)

Cross Cutting Objectives

Establish vulnerable populations Program

Provide professional education; Share patient communication guidelines

Promoting & supporting cancer research

Implement cancer patient tracking information system …

Consult patients in design of physical space

NL 2010-?

Prevention through promoting a healthy population (collaborate with stakeholders)

Identifying individuals at risk

Coordinating care along cancer continuum (primary health, navigation, best practice)

Supportive & palliative care (increase access)

Clinical practice guidelines & standards

Access and advocacy (social policy, location of service, drug issues)

Surveillance & information systems & technology- comprehensive programs supported by research agenda

Education & training for public and professionals; accountability & measuring success

PEI 2004-15

Prevention-Identify individuals at risk; decrease # preventable cancers

Screening & diagnosis- improve access to timely & accurate diagnosis

Treatment & supportive care (access, symptom management, rehab, palliative care throughout treatment)

Survivorship (enhance quality of life for survivors & families)

Palliative & end of life care (continuity, access in different settings, throughout treatment)

*Publicly available plans included. BC cancer plan is currently under development, and not available publicly. An interview will be set up with BC for input.

Summary of high-level provincial findings

• Many provincial plans highlight areas of focus which align at least in

part with CCO’s ‘Cancer Journey’

• One plan included ‘Cross-cutting Objectives’ as additional areas of

focus, spanning multiple areas, or the entire cancer journey

• Coordination of care, integration, education and training, and health

promotion were each called out separate as areas of focus in multiple

provinces.

• Developing the cancer workforce has been identified as an area of

focus for Alberta

International Cancer Plan Priorities/Areas of Focus (Please note : terminology used in plans related to goals/priorities/activities varied)

New South Wales 2011-15

To reduce the incidence of cancer (through improving modifiable risk factors)

Improving the survival of people with cancer

Improving the quality of life of people with cancer & their caregivers

Cross-Cutting Issues

Monitoring and evaluating cancer control activities

Strategic research investment

Improve cancer outcomes for Aboriginal people

Improve cancer outcomes for rural and remote populations

Improve cancer outcomes for people who are socio-economically disadvantaged

Enhance the role of primary and community care in cancer control

SUI 2011-15

Epidemiology & monitoring (more comprehensive & precise data)

Prevention & Screening (measurement, study risk factors, manage interfaces between primary/secondary/tertiary prevention.

Research (translation, expand outcome research, public KTE)

Therapy (self management/determination, guidelines, quality assurance, training, cost-effectiveness)

Nursing (expand evidence base, innovative models, self management)

Psychosocial Support (info on resources, guidelines, coordination, research)

Psycho-oncology (standards/guidelines, funding, integrate into multidisciplinary care)

Rehabilitation (coordinate inpatient/outpatient, patient pathways, quality, funding, interdisciplinary training)

Palliative Care (capacity, access, communicate benefits, education, research)

FRA 2009-13

Monitoring & evaluation (smoking, physical activity, environ, immunization)

Research (transfer of outcomes for benefit of all patients)

Observation (better understanding of cancer burden)

Prevention & Screening – preventive actions to avoid cancers or seriousness

Patient care – guarantee each patient individualized and effective care management

Life during & after cancer (improve quality of life and fight any form of exclusion)

Cross-cutting Themes

Take more effective account of health inequalities

Encourage analysis & taking account of individual & environmental factors

Strengthen the role of the referring doctor

International Cancer Plan Priorities/Areas of Focus (Please note : terminology used in plans related to goals/priorities/activities varied)

Malta 2011-15

Policies for prevention (preventing preventable cancers)

Policies for early diagnosis

Ensuring quality in the diagnosis & treatment of cancer

Improving the quality of life of persons living with cancer

The patient’s perspective

Human resources

Surveillance and research

Implementation of the plan

UK 2011

Putting patients & public first: information and choice

Improving outcomes for cancer patients: prevention and early diagnosis

Improving outcomes for cancer patients: quality of life and patient experience

Improving outcomes for cancer patients: better treatment

Improving outcomes for cancer patients: reducing inequalities

Autonomy, accountability and democratic legitimacy: commissioning and levers

Wales 2012-2016

Preventing cancer (healthy lifestyle/choices & minimize risk)

Detecting cancer quickly where does occur or recur.

Delivering fast, effective treatment & care so they have best chance of cure

Meeting people’s needs (feel well supported and informed, able to manage the effects of cancer)

Caring at the end of Life (feel well cared for & pain & symptom free)

Cross-cutting Areas

Improving information

Targeting research

Summary of high-level international findings

• Many of the international areas of focus align in part with CCO’s

‘Cancer Journey’

• Cross-cutting issues/themes/areas are evident in a number of

jurisdictions, aimed at multiple phases of the ‘Cancer Journey’

• Quality of life is a recurring area of focus across a number of

countries

• Other areas of interest include: nursing, psychosocial support,

psycho-oncology, human resources, epidemiology/monitoring

FINDINGS FROM A SYSTEMATIC

REVIEW OF EUROPEAN NATIONAL

CANCER PLANS

Environmental Scan

Recommendations from report analyzing national

cancer control plans (NCCPs) in Europe

Critical health system functions

Need to understand the health system context

Intermediate goals

Ultimate goals

Source: Imperial College London. 2009. Analysis of National Cancer Control Programmes in Europe

Key components of a NCCP and

analytical framework used in study–

Areas to consider

Source: Imperial College London. 2009. Analysis of National Cancer Control Programmes in Europe

Additional activities related to service delivery: Health Education Health Promotion Screening Primary health care Inpatient care National Drug Policy Improvement of quality of medical services Care Networks Multidisciplinary Diagnosis Multidisciplinary Care

EMERGING TRENDS/ OPPORTUNITIES

RELATED TO CCO’S PROGRAM

AREAS

Environmental Scan

Emerging trends/ opportunities related to CCO’s

program areas (common themes)

• Quality based procedures/patient based funding

• Resource efficiency - innovative models of care (ex. alignment of clinical & organizational best practices)

• Physician level quality/performance reporting

• Implementation/adoption of new technologies (ex. cancer surgery, oral chemo, protons, minimally invasive)

• Care in the community

• Personalized medicine (science & technology)

• Patient specific pathways (for education, as foundation for EMR)

• Self-care/management enabled by education, information and technology

• Decision-support tools (for clinicians and patients)

• Standardization (ex. process, protocols, and regional level programs)

• ‘Systems thinking’ (ex. impact of implementing one program/guideline on other programs/area both upstream and downstream)

SWOT Questions (Strengths, Weaknesses, Opportunities, Threats)

From an “internal perspective” (i.e. CCO + RCPs)

1. What are the strengths of CCO and the RCPs?

a) What makes each of these a strength/ allowed these strengths to be sustained?

2. What do you feel are areas for improvement, or limitations of CCO and the RCPs?

a) Where are we vulnerable?

From an “external perspective” (i.e. environment external to CCO + RCPs)

3. Please describe any emerging trends in healthcare/cancer care that you feel CCO should take note

of in developing the next OCP.

a) Which of these areas would require innovative solutions that CCO could lead?

4. What do you see as the cancer system’s top 3 to 5 priorities over the next 3-5 years? These can

include either internal or external drivers (e.g. Social/demographic factors, Political factors,

Environmental factors, Technological factors, Legal factors etc.) .

50

SWOT Questions continued

5. What do we know about our external environment that we have not yet addressed?

6. What are the pressure points or points of vulnerability for the current cancer system?

a) What factors in the broader external environment contribute or add to areas of vulnerability?

7. What do you see as the cancer system’s top 3 to 5 challenges over the next 3-5 years. These can

include either internal or external drivers (e.g. Social/demographic factors, Political factors,

Environmental factors, Technological factors, Legal factors etc.)

Additional Questions:

8. If you were a patient requiring care and/or a family member interacting with Ontario’s cancer

system, what would you expect the system to deliver?

9. What would make us the best cancer system in the world?

51