Download Cancer Strategic Clinical Network - Strategic Plan 2015-2018

Cancer
Strategic Clinical Network
2015-2018
Strategic Plan
October 2015
Dear Colleagues,
Every day in our province someone learns that they, or one of their loved ones, has cancer. And
every day in Alberta miracles happen. Treatment is designed and delivered, patients are cured,
and people get their lives back. Sharing in these miracles is why healthcare workers do their
jobs. However, we know our healthcare system needs to improve so that it can get better and
be sustained for future generations. Helping to make care better is why Strategic Clinical
Networks (SCNs) were created. In the Cancer SCN we are focused on supporting clinical
effectiveness research and enabling teams that want to design and implement innovative care.
This focus spans the entire spectrum of care from prevention to end of life.
The Cancer SCN’s 2015-2018 Strategic Plan is a foundational document that guides our work
by identifying areas of priority for the coming years. The development of the strategic plan
provides an opportunity for us to critically look at what is working well in relation to cancer
prevention and management, as well as to think about what could be improved. It reviews what
we have accomplished since our formation in 2012 and offers the pillars and strategies that will
guide our activities over the next few years. The strategic plan was developed through
consultation with our Core Committee, clinicians, patients and family members, researchers,
community colleagues, and strategic leaders.
Our network assumes leadership in many areas, including the development of clinical care
pathways aimed at improving cancer diagnoses, innovative treatments, and palliative and end of
life care. We are committed to supporting improvements to the health care system through a
critical examination of current practices, learning from research, and identifying groundbreaking
approaches to tackle the most important issues facing cancer control within the foreseeable
future.
We welcome your views and ideas and look forward to working with you along the
transformational journey of the Cancer SCN.
Dr. Joe Dort
Senior Medical Director, Co-Lead
Cancer Strategic Clinical Network
Alberta Health Services
Barbara O’Neill
Senior Provincial Director, Co-Lead
Cancer Strategic Clinical Network
Alberta Health Services
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CANCER STRATEGIC CLINICAL NETWORK
Transformational Roadmap, 2015-2018
Active Years
2015/16
2016/17
Clinical Care Pathways – Development and Implementation
Strategic
Initiatives
 The Alberta Rectal Cancer Initiative and Clinical Care Pathway
 A Clinical Care Pathway to Optimize Major Head and Neck Cancer
Surgery
Palliative and End of Life Care
Collaborative Enhanced Recovery After Surgery (ERAS)
Partnerships
Cancer SCN Seed Grant Funding
Research &
Innovation
Supporting Other Grant Opportunities
Partnerships for Research and Innovation in the Health System (PRIHS;
Alberta Innovates Health Solutions [AIHS])
Collaborative Research and Innovation Opportunities (CRIO; AIHS)
Transformative Program Opportunity (Alberta Cancer Foundation)
Cancer Prevention Research Opportunity (CPRO; AIHS and Alberta Cancer
Prevention Legacy Fund)
Enhanced Care Grant (CancerControl Alberta)
Alberta Thoracic Oncology Program (ATOP)
Transitional
Initiatives
eReferral
Cancer Surgery Five-Year Strategic Plan
On-going
2017/18
Executive Summary
_________________________________________________________________________
The Cancer Strategic Clinical Network (SCN) is committed to saving lives, reducing the burden of cancer,
and transforming the cancer control continuum through its involvement and leadership in efforts aimed at
optimizing cancer prevention, screening, diagnosis and treatment, follow up care, survivorship, and end of
life care. This road map describes the strategies and actions we will undertake across the cancer control
continuum from 2014 through 2017 through our three platforms of work – Strategic Initiatives,
Collaborative Partnerships, and Research and Innovation.
1. Strategic Initiatives
The Cancer SCN’s Strategic Initiatives reflect our intent to reshape cancer prevention and care in Alberta
by improving the patient experience, focusing on evidence-informed quality outcomes, and standardizing
the delivery of care across the province. Our current strategic initiatives involve developing and
implementing provincial clinical care pathways, targeting cancer prevention efforts by encouraging
healthy lifestyles and wellness, developing foundational elements for palliative and end of life care, and
implementing clinical integration models.
2. Collaborative Partnerships
Through a collaborative partnership model, the Cancer SCN aims to facilitate a seamless approach to
working with clinicians and teams from primary care to specialty care, and acute to community care that
will make each patient a priority. Since our formation in 2012, our SCN has strived to bring perspectives
of patients, stakeholders, and clinicians together to develop strategies that have potential to reduce the
burden of cancer in Alberta.
Key partnerships begin through the Cancer SCN’s Core Committee, consisting of clinicians, operation
and strategy leaders, policy makers, researchers, key community leaders, frontline staff, and patient and
family advisors from across the province. Our current partnerships involve supporting implementation of
improvements for palliative and end of care life, bringing key stakeholders together in the area of cancer
prevention, and exploring opportunities to work with CancerControl Alberta, Alberta Health Services’
Zones, Primary Care, other SCNs, and other key stakeholders. The Cancer SCN is also supported by
several departments internal to AHS, and actively collaborates with numerous partners from across
Alberta and Canada.
3. Research & Innovation
The SCNs are mandated to develop a focused provincial health research program in collaboration with
academic partners. Innovation and applied health research by the SCNs is aimed at improving the quality
of care in the six health care quality dimensions (Health Quality Council of Alberta). These dimensions
are often accompanied by major monetary implications to the health system. The results of a focused
stakeholder consultation meeting and an environmental scan of the cancer research landscape in Alberta
together suggest the need for an organized health services research program in cancer. With resources
such as two full-time research staff, access to AHS research services, available seed grant funding, and
opportunities for pan-SCN and zone collaborations, the Cancer SCN is well-positioned to support such an
initiative. Our goals for 2015-2018 include: (1) to create, implement, and disseminate cancer health
services research-generated knowledge; (2) to maximize funding opportunities; and (3) to develop an
academic Cancer Health Services Research Program in Alberta.
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Contents
Executive Summary ................................................................................................................................................4
About the Cancer Strategic Clinical Network .........................................................................................................6
Development of the Strategic Plan ........................................................................................................................6
Patient and Family Engagement .............................................................................................................................7
The Cancer SCN’s Three Platforms .........................................................................................................................8
Platform 1: Strategic Initiatives ..........................................................................................................................8
Platform 2: Collaborative Partnerships ........................................................................................................... 12
Platform 3: Research and Innovation .............................................................................................................. 13
Looking Forward and Next Steps ......................................................................................................................... 17
Glossary ............................................................................................................................................................... 18
Cancer SCN Leadership and Core Committee Members ..................................................................................... 20
References ........................................................................................................................................................... 23
Appendix A: Transitional Initiatives of the Cancer SCN ....................................................................................... 24
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About the Cancer Strategic Clinical Network
Strategic Clinical Networks (SCNs) are provincial teams that bring together the expertise of health care
professionals, researchers, government, communities, patients and their families to improve Alberta’s health
system.
The Cancer SCN is comprised of a variety of cancer stakeholders from across the province to lead and support
evidence-informed improvements and promote innovation throughout the cancer continuum from cancer
prevention, screening, diagnosis and treatment, follow up care, survivorship or end of life care. Through the
design, delivery, and evaluation of strategic initiatives, the fostering of collaborative partnerships, and the use of
research to catalyze meaningful change, our network strives to mobilize stakeholders to reduce the burden of
cancer across Alberta.
As a network, we pursue initiatives to improve the health of Albertans and care they receive. Our initiatives
focus on areas of need or value to Alberta’s health system such as prevention, screening, cancer treatment,
transitions of care, follow-up care, and optimal palliative and end of life care to improve patient outcomes. This
is accomplished by rigourously reviewing best practices, understanding current practice and models of care, and
identifying gaps and variations in care. We are also committed to identifying harmful, outdated, ineffective and
inappropriate processes, procedures, technologies, and treatments without negatively impacting the quality of
patient care.
Cancer SCN Mission:
To contribute to a long term vision for cancer control that enables the best possible health for Albertans,
the Cancer SCN will identify areas that hold greatest promise for bringing about transformational change
to the health care system – working together on important projects and provincial initiatives that:
1. Supports Teams Designing and Implementing Innovative Care
2. Support Clinical Effectiveness Research
Development of the Strategic Plan
The Cancer SCN’s Strategic Plan was developed through consultation with a broad audience of senior leaders,
clinicians, researchers, community colleagues, patients and families to identify important improvement
opportunities throughout the patient journey and across the healthcare continuum. The strategic plan describes
our network’s activities from 2015 through 2018 and represents our intent to take a leadership role in advancing
transformational initiatives in areas such as cancer screening, clinical care pathways, and palliative and end of
life care.
The strategic plan will be reviewed on an on-going basis to ensure our platforms remain relevant and feasible,
and to ensure progress towards fulfilling our network’s mission and goals.
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Patient and Family Engagement
Understanding how patients and families experience
cancer is critical for identifying areas for improvement,
developing strategies and plans that meet patient
needs, and embedding the principles of patient and
family centered care in Alberta’s health system. The Cancer SCN recognizes that every Albertan will have unique
experiences with the cancer system according to their culture, religion, traditions, and geography and we take
responsibility for engaging and collaborating with patients and families to plan, deliver and evaluate every
aspect of our work.
The membership of patient and family advisors on the Cancer SCN Core Committee and within our working
groups helps shift the focus from patients being satisfied (an evaluation of care) to how we can improve the
patient experience (what actually happened and what should happen) through open and honest dialogue. Our
advisors add tremendous value by providing practical and sensitizing input to our priorities and plans, and using
their experiences with the cancer care system to identify areas of improvement. By including patients and
families in our work we will ensure a focus on the patient experience and on obtaining the best outcomes
possible.
“The Cancer SCN is about a group of people - from doctors to health administrators to patients and their families passionate about reducing the instance of cancer and improving the journey for those who must go on it. It is
incredible what can be achieved when people, who are passionate and knowledgeable, whether their experience is
in preventing, diagnosing, treating or experiencing cancer, come together to work toward a common goal.”
Tricia Antonini, Patient and Family Advisor, Cancer SCN
“What I’ve learned from my time with the Cancer SCN is that cancer care is complex but when a group of
passionate health care providers, administrators, and patient & family advisors work together, they create
change. Change that improves the quality of care & life for patients and values every dollar invested to ensure
r. Neil Hagen, Cancer
Senior to
Medical
Director
on the
ATOP
Initiative
from world
the class care. ”
weSCN
can continue
attract the
best health
care
providers
and deliver
Calgary Herald, May 5 2014
Lorelee Marin Patient and Family Advisor, Cancer SCN
r. Neil Hagen, Cancer SCN Senior Medical Director on the ATOP Initiative from the
Calgary Herald, May 5 2014
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The Cancer SCN’s Three Platforms
The Cancer SCN’s three platforms of work represent areas that we believe
have a significant impact across the cancer continuum – from wellness through
to survivorship and end of life care. Building on past successes with the
Alberta Thoracic Oncology Program, eReferral and the Alberta Cancer Surgery
Five-Year Strategic Plan (see Appendix A), our SCN continues to pursue work
within each platform by partnering with CancerControl Alberta, other SCNs,
AHS’ Zones, Primary Care, and Alberta’s academic community to collaborate
on common areas of interest to reduce the burden of cancer.
Platform 1: Strategic Initiatives
The Cancer SCN’s Strategic Initiatives reflect our intent to reshape cancer control in Alberta by improving the
patient experience, focusing on quality outcomes, and addressing variations in care, where it makes sense. The
Cancer SCN plays a leadership role in defining the vision, providing directions, and coordinating support for the
following initiatives:
Strategic Initiative #1: Clinical Care Pathways
The Cancer SCN supports development, implementation and evaluation of integrated, multidisciplinary and
evidence-informed clinical care pathways. Our current pathway projects - the Alberta Rectal Cancer Initiative
and Clinical Care Pathway, a Clinical Care Pathway to Optimize Major Head and Neck Cancer Surgery, and a
Bladder Cancer Clinical Care Pathway – are designed to improve the patient journey, provide better access, and
provide standards of care for quality and access. With these and future pathways, we recognize that success can
be achieved when pathways are owned, implemented and revised (when needed) by clinicians.
The Alberta Rectal Cancer Initiative and Clinical Care Pathway
Rectal cancer accounts for more than 1 of every 10 cancer surgeries in Alberta. It is prevalent, life-threatening,
and complex in scope, requiring interaction between primary care physicians, radiologists, gastroenterologists,
surgeons and oncologists. Surgery is recognized worldwide as a major prognostic factor in rectal cancer
outcomes, as 94% of all patients with rectal cancer will receive surgery. While many patients receive excellent
care from beginning to end, rectal cancer recurrence rates vary across Alberta. Variations exist across the
province in pre-operative staging capabilities, application of best surgical techniques, pathologic grading, and
use of neoadjuvant and adjuvant therapies.
In 2014, the Cancer SCN received funding from Alberta Innovates Health Solutions’ Partnership for Research and
Innovation in the Health System (PRIHS) opportunity to ensure multidisciplinary health care teams deliver the
best possible care to stage II and III rectal cancer patients.
The project team is developing and implementing a rectal cancer clinical care pathway to address appropriate
preoperative staging, consideration of neoadjuvant and adjuvant therapy, and appropriate surgery.
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The pathway is being developed in collaboration with multidisciplinary physician groups (Radiologists, Surgeons,
Oncologists, and Pathologists) as a comprehensive, sequence of interventions tailored for local practice
environments to support:
Use of locoregional staging investigations for all patients undergoing curative surgery.
Consideration of pre-operative neoadjuvant chemoradiation for selected patients.
Application of best surgical techniques, namely Total Mesorectal Excision (TME) for all patients.
Application of pathologic assessment by complete TME evaluation of every rectal cancer specimen
based on best practice methodologies.
Use of adjuvant post-operative chemotherapy.
Implementation of this clinical pathway is underway and includes:
Engagement of multidisciplinary physician groups across the province in understanding local challenges
to implementation of the clinical pathway
Delivery of physician education to reinforce optimal care and highlight pitfalls in practice.
Implementation of structured reporting checklists for consistent and searchable clinical documentation.
in the electronic health record, called electronic synoptic reporting.
Development of a measurement and reporting system to provide physicians managing rectal cancer care
ongoing feedback on individual performance and outcomes.
Creation of tools for establishment of multidisciplinary tumor boards to ensure provision of care plans
according to clinical practice guidelines.
Overall, the Alberta Rectal Cancer Clinical Care Pathway and Alberta Rectal Cancer Initiative provides a standard
reference point for the appropriate care of patients with rectal cancer, while providing physicians with the
resources they need to reduce clinical variations and improve patient outcomes. Specific outcomes of the work
are profiled below:
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A Clinical Care Pathway to Optimize Major Head and Neck Cancer Surgery
The treatment of head and neck cancer (HNC) is complex; it requires significant expertise and involvement from
a range of health professionals because of the vital functions (breathing, chewing, swallowing, and speech)
affected by both the cancer and its treatment. Over 600 new HNC cancers are diagnosed each year in Alberta,
with about 200 of those patients requiring major HNC surgery with free flap reconstruction.
Led by the respective Head and Neck surgical teams in Edmonton and Calgary, with support from the Cancer,
Critical Care, and Surgery SCNs, the development of a provincial clinical care pathway for HNC patients combines
best practices, reduces inappropriate variations, and extracts the greatest value from existing capacity. This
means changes in how perioperative care is currently practiced including a more consistent approach to pre and
post-operative education, and establishment of explicit nutritional and mobilization protocols.
The head and neck cancer clinical care pathway includes:
A High Observation Protocol and standardized order sets to ensure effective critical care immediately
following surgery.
10-day guidelines for inpatient acute care.
Among others, the anticipated outcomes of the head and neck clinical care pathway include <delete the cog in
the diagram below about radiation therapy>:
Strategic Initiatives #2: Palliative and End of Life Care
Palliative and end of life care is one of AHS’ main priorities. The provincial Seniors Health team, the Cancer SCN
and all other SCNs are working together on implementing a provincial framework and strategy that will provide
Albertans with quality care options for palliative and end of life care through improved integration, coordination
and a focus on interdisciplinary care across the health care continuum. The framework is the product of an
extensive literature review and is strategically designed to address symptom control for all patients with
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advanced illness – not just cancer patients.
Patients with advanced stage heart failure, advanced chronic
obstructive pulmonary disease (COPD), and/or advanced stage
cancer, particularly those at end of life, often present to the
emergency department with symptoms of their illnesses and, if
severe enough, are hospitalized and administered treatment in
accordance with protocols. For example, dyspnea (shortness of
breath), which is common to all three illnesses, is often treated with
intubation, medications, and other procedures. Yet, patients at end
of life are unlikely to benefit from such treatment and often die in
hospital against their wishes and those of their families. Patient and
family distress can be significant. This initiative aims to ensure
patients diagnosed with a life-limiting illness (palliative) or patients who are actively dying (end-of-life) will
receive best practice care in an appropriate setting according to their values.
With an initial focus on chronic obstructive pulmonary disease (COPD) and heart failure, this initiative will
identify, prioritize, design and implement foundational elements for optimal PEOLC that will be scalable for
other chronic diseases by March 31st, 2017.
By March 31st, 2016, this initiative will:
Identify and prioritize needs, best practices, gaps and inequities in PEOLC decision supports, selfmanagement supports, and models of care for addressing transitions of PEOLC patients between care
settings.
Develop an implementation strategy, an evaluation framework and resource requirements for
implementation of prioritized supports and interventions in 2016/2017 fiscal year.
By March 31st, 2017, this initiative will:
Develop and implement prioritized decision supports, self-management
strategies/interventions for improving transitions between care settings.
supports
and
Set recommendations for future scale and spread of decision supports, self-management supports and
strategies/interventions for improving transitions between care settings to other chronic diseases.
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Platform 2: Collaborative Partnerships
The Cancer SCN is committed to working in collaboration with key stakeholders,
including patients and their families, other SCNs, Zones and, non-profit and
community organizations, academic communities, and researchers to improve
health and cancer-related outcomes across the province
The issues facing CancerControl Alberta, Zones, Primary Care and the Cancer SCN are complex, dynamic and
often interrelated, necessitating a coordinated approach on the part of multiple stakeholders and interest
groups to address issues that exceed the scope of a single program area or even organization. Through our
collaborative partnerships, the Cancer SCN facilitates seamless approaches to working with clinicians and teams
from across Alberta to design and implement clinical care pathways, improve patient access and transitions of
care, and empower clinicians with evidence-informed best practices.
Enhanced Recovery After Surgery (ERAS)
Each year, more than 230,000 surgeries are performed across Alberta at 59 AHS sites. To ensure that surgical
care can be delivered sooner, safer and smarter across the province, the Surgery and Diabetes, Obesity and
Nutrition SCNs initiated the Enhanced Recovery After Surgery (ERAS) project in 2013.
Drawing from best practices and evidence from around the world, the project improves protocols related to
nutrition, mobility after surgery, and anesthetics and pain control. Applying ERAS inpatient protocols in clinical
settings, patients are more informed and active preoperatively and in their post-operative recovery resulting in
better outcomes and earlier return to previous level of functioning. The initiative aims to improve outcomes,
improve patient experience, and decrease length of stay.
Since 2013, ERAS has been successfully piloted with colorectal patients in two AHS sites. Through funding from
Alberta Innovates Health Solutions and the Partnerships for Research and Innovation in the Health System
(PRIHS) competition, the project will expand across the province to include other surgical areas, including
multiple types of cancer surgery. The Cancer SCN will collaborate and partner with the Surgery SCN and the
International ERAS Society to develop two novel ERAS guidelines: one for Head and Neck Surgery and one for
Breast Reconstruction.
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Platform 3: Research and Innovation
Background
Strategic Clinical Networks (SCNs) are mandated to: develop a
focused provincial health research program in collaboration
with academic partners; create new knowledge; and translate
knowledge into measurable improvements for Albertans. The
mandate involves developing health care research capacity and executing prioritized population-specific health
services, health systems, and health policy research, as well as population and public health research. Where
appropriate and needed, the SCNs may also become engaged in applied clinical and basic research. Further, the
SCNs are expected to access provincial, national, and international research support to execute their ‘for
Alberta’ mandate.
SCN research priorities are based on the health needs of Albertans. As such, the community-at-large, the SCN’s
provincial research network, or the SCN leadership or Core Committee, can recommend research topics and
projects. The impact of research within the SCNs is measured by the outputs from six categories, which include
the Canadian Academy of Health Sciences’ categories of performance indicators: creating new knowledge;
creating research capacity; informing decision-making; providing health benefits; improving health system
effectiveness and efficiency; and broader economic and social benefits.
Research and innovation in the SCNs is prioritized according to five major deliverables:
•
Improving the health of Albertans: preventing diseases and injuries
•
Improving the quality of care (six dimensions of quality; Health Quality Council of Alberta)
•
Decreasing unjustifiable variances in the quality of care
•
Improving value over time
•
Actively translating knowledge of improvements into common practice in Alberta
Validation of evidence-informed, value-added devices, technologies, systems, and services (innovations) can
provide value to Alberta and potential users of the innovation. As such, each SCN has been encouraged to
develop a program around innovation. Internal innovations are high priority; however, the innovations of others
that potentially add value to patients and AHS will also be evaluated and, if appropriate, adopted for use in
Alberta.
Innovation and applied health research by the SCNs is aimed at improving the quality of care in the six health
care quality dimensions. These dimensions can be quantified and are often accompanied by major monetary
implications to the health system. Financial gains realized from savings to the health system can be reinvested in
new research and innovation strategies, or priority quality improvement areas of the SCN, or in the operational
groups that supported the work. In the future, reinvestment will serve as an incentive to stakeholders to support
applied research and to help quantify its benefits.
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Stakeholder Consultation and Environmental Scan
The Cancer SCN hosted a research and innovation strategic planning meeting with its Core Committee members
and several cancer research leaders from across the province on June 18, 2014 in Calgary. The meeting goals
were to characterize the role of research within the Cancer SCN, to delineate the role of research to achieve the
Cancer SCN’s strategic objectives, and to identify a process for prioritizing Cancer SCN research. Following
presentations by several of the Cancer’s SCN’s strategic partners, as well as two panel discussions and a
breakout session, common themes emerged:
•
Transitions of care research: addressing patient and provider research questions around the delivery of
care; supporting patient-oriented and patient-led research; striving to integrate the Canadian Institutes
of Health Research (CIHR) pillars of research (i.e., biomedical, clinical, health services, and population
health); and focusing on access to care, continuity of care, and gaps in transitions of care.
•
Cancer clinical care pathway implementation research: focusing on uptake and sustainability; and
identifying the culture necessary for change.
•
Building cancer research capacity: providing a venue for targeted collaboration in areas of strategic
value; providing access to research resources; and providing access to funding opportunities.
•
Dissemination of new cancer knowledge and information: providing access to opportunities for
knowledge translation; and providing access to SCN-based conferences and meetings.
The cancer research landscape in Alberta is rich with basic scientists, clinical researchers, and population health
researchers. These individuals represent three main bodies: CancerControl Alberta, the Southern Alberta Cancer
Research Institute (SACRI) at the University of Calgary, and the Cancer Research Institute of Northern Alberta
(CRINA) at the University of Alberta. Additional basic research generated out of the University of Lethbridge
further complements the work being done at the CRINA and SACRI. Among the Canadian Institutes of Health
Research (CIHR) four research pillars, health services research in cancer remains the one area that is less
developed in Alberta. There is no organized health services research program for cancer at either of the
universities or within CancerControl Alberta. As such, this represents a niche area that the Cancer SCN is wellpositioned to support by complementing the work being done by our partners. Cancer health services research
is well-reflected in the key messages brought forward through the Core Committee consultation process.
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Research and Innovation Strategic Plan
The goals of the Cancer SCN Research and Innovation Strategic Plan (the ‘Plan’) were developed largely from the
Stakeholder Consultation process and are described below.
Goal #1: Knowledge Creation, Implementation, and Dissemination. The delivery of high quality cancer care
throughout the patient and family journey requires knowledge on the biggest gaps in health services delivery
and transitions of care, from preoperative assessment to palliative/end of life care or survivorship care.
The Cancer SCN will accomplish this goal by providing:
•
Hands-on support and monetary support (seed grants) for the development of competitive research funding
proposals focused on researching innovative ways to close the gaps in health services delivery and
transitions of care.
•
Letters of support for funding applications.
•
Scientific advice on funding applications and non-funded research or quality improvement (QI) initiatives.
•
Logistical support and leadership in meetings between collaborating researchers and stakeholders, including
patients.
•
Access to research resources (i.e., data, statistical support, literature, etc.) for funding applications and nonfunded QI projects.
•
Opportunities for knowledge dissemination; publication of research findings; capturing, transferring, and
translating new knowledge into practice; and incorporating the patient experience throughout the delivery
of new knowledge.
Goal #2: Maximizing Funding Opportunities. The undertaking of cancer health services research will require
that the Cancer SCN capitalize on existing funding opportunities and seek new funding opportunities. We will
work with provincial and national partners to champion the creation of funding opportunities that will allow
grass-roots driven (i.e., clinician- and patient-identified) research questions that address gaps in quality cancer
care throughout the patient and family journey.
The Cancer SCN will accomplish this goal by:
•
Providing a forum for the identification of grass-roots research questions.
•
Creating opportunities for researchers and clinicians and patients to collaborate on grass-roots research
projects.
•
Working with foundation partners, university partners, the government, and non-profit organizations to
develop new funding opportunities aimed at increasing patient quality of care.
Goal #3: Academic Cancer Health Services Research Program. There is no organized health services research
program for cancer at either of the universities or within CancerControl Alberta. Furthermore, the Cancer SCN
Core Committee consultation process identified cancer health services research as an important area of focus.
As such, the Cancer SCN will endeavor to create an academically-affiliated cancer health services research
program. Early work may include establishing a mechanism for integrating clinician- and patient-driven research
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questions into the research agendas of the academic communities. We will aim to create mentorship
opportunities between interested cancer clinician researchers and experienced health services researchers in
order to increase capacity in this area. The expected outcome of this work is a cancer research landscape that is
strong, not only in basic, clinical, and population health research, but equally competitive in health services
research.
For more information:
A more detailed description of the Cancer SCN’s Research and Innovation Strategic Plan can be found on the
main Cancer SCN webpage at: http://www.albertahealthservices.ca/7677.asp.
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Looking Forward and Next Steps
The Cancer SCN’s Strategic Plan outlines the network’s priorities, which are identified by clinicians, patients,
families and communities to foster leading and innovative ideas, and bring about the best possible cancer
control for the benefit of all Albertans. Bringing this document to life requires the Cancer SCN to understand
what currently works well in cancer control, what patients, families, and communities need, and what
opportunities exist for improving cancer prevention, detection, and care within Alberta. Each of our three
platforms reflects our history and chart the course (not sure I understand this statement) for the next three
years to make meaningful improvements alongside Albertan clinicians and patients.
In the future, we look forward to addressing clinical concerns that impact large groups of Albertans across the
province, building upon evidence and successful programs and services that currently exist, and working
together with our partners to meet the challenges and opportunities ahead.
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Glossary
Adjuvant Therapy
Clinical Care Pathway
(Pathway)
Clinical Practice Guidelines
Clinician
eReferral
Knowledge Translation
Palliative and End of Life Care
Treatment that is given in addition to the primary, main or initial
treatment. For cancer, adjuvant therapy is additional treatment
usually given after surgery where all detectable cancer has been
removed, but where there remains a statistical risk of cancer
relapse.
A Clinical Care Pathway is a description of evidence-informed,
clinician recommended interdisciplinary care to help a patient with
a specific health condition or concern move progressively toward
optimal health outcomes.
Source: AHS Clinical Pathways Working Group, October 2013
A systematically developed body of statements that are based on
the most current and best available evidence to assist clinician and
patient decision-making within specific practices of care.
Implementation of clinical practice guidelines are thought to result
in improved patient outcomes though the delivery of effective and
appropriate health care.
Reference: University of Calgary Institute for Public Health
A physician or other health care provider who is involved in the
treatment and observation of patients, as distinguished from one
engaged in research
The eReferral project is Alberta's first paperless referral solution
that offers both receiving and referring providers the ability to track
referrals in real time as they are submitted, received, triaged and
scheduled. eReferral auto-populates demographics contained within
Alberta Netcare and all specialty specific information is searchable
by zone, location, clinic, provider and reason for referral.
Knowledge translation is defined by the Canadian Institutes of
Health Research as a dynamic and iterative process that includes the
synthesis, dissemination, exchange and ethically sound application
of knowledge to improve health, provide more effective health
services and products, and strengthen the health care system.
Palliative and End of Life Care is both a philosophy and an approach
to care that enables all individuals with life-limiting illness to receive
integrated and coordinated care across the continuum. This care
incorporates patient and family values, preferences, and goals of
care, and spans the disease process from early diagnosis to end of
life including bereavement.
Reference: AHS Palliative and End of Life Care Provincial Framework
2013
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Patient
Includes: patients – typically someone receiving care in hospital ;
client – someone receiving a support service; resident – someone
living in a care facility; and older adults who have care needs
Patient Engagement Researcher
Patient engagement researchers (PERs) are people with various
health conditions, trained to design and conduct health research,
using specific adapted methods of qualitative inquiry.
Patient- and family-centered care is an approach to the planning,
delivery, and evaluation of health care that is grounded in mutually
beneficial partnerships among health care providers, patients, and
families. It redefines the relationships in health care. It leads to
better health outcomes and wiser allocation of resources, and
greater patient and family satisfaction.
Patient and Family Centered Care
Reference: Institute for Patient and Family-Centered Care
Represent key strategy areas that the Cancer SCN will be focusing
on, including Strategic Initiatives, Collaborative Partnerships and
Research.
Pillars
These are key enablers that support the SCN in achieving its
strategic work. The Cancer SCN’s pillars are Engagement,
Communication, Measurement and Quality Improvement.
Primary Health Care
Medical care by a physician, or other health-care professional, who
is the patient's first contact with the health-care system and who
may recommend a specialist if necessary.
Strategic Clinical Networks (SCNs) Province wide teams bringing together the experiences and
expertise of health care professionals, researchers, government,
communities and patients and their families to improve our health
care system. SCNs are the mechanism through which AHS
empowers and supports physician and clinical leaders both within
AHS and the community to develop and implement evidenceinformed, clinician-led, team-delivered health improvement
strategies across Alberta.
Synoptic Reporting
A systematized method for structuring health care reports to
include specific data elements that have been demonstrated to
influence health outcomes.
Source: Canadian Partnership Against Cancer
Platforms
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Cancer SCN Leadership and Core Committee Members
LEADERSHIP COMMITTEE
Joseph Dort, Dr.
Senior Medical Director, Cancer SCN
Barbara O'Neill
Senior Provincial Director, Cancer SCN and Critical Care SCN
Gregory Cairncross, Dr.
Scientific Director, Cancer Research
Angela Estey
Executive Director, Cancer SCN
Chris Normandeau
Manager, Cancer SCN
Melissa Shea-Budgell
Assistant Scientific Director, Cancer SCN
Graham Petz
Senior Consultant, Cancer SCN
Adam Elwi
Senior Project Manager, Cancer SCN
Leanne Ross
Senior Researcher, Cancer SCN
CORE COMMITTEE
Charles Butts, Dr.
Physician, Internal Medicine, Medical Oncology
Dean Ruether, Dr.
Medical Director, Community Oncology
Donna Koch
Executive Director - Population, Public and Aboriginal Health, Addiction and
Mental Health, North Zone
Donna Rose
Director, Planning - CancerControl Alberta
Elizabeth Kurien, Dr.
Medical Lead, Provincial Tumour Teams and C-MORE
Frances Cusano
Pharmacy Clinical Practice Leader - Adult Cancer Care
Gail Hufty
Senior Operating Officer, Prov. Integration, CancerControl Alberta
Greg McKinnon, Dr.
Chief, Section of Surgical Oncology, Professor, Dept of Surgery and Oncology
James Silvius, Dr.
Medical Director, Community Senior, Addiction and Mental Health
Janine Giese-Davis, Dr.
Associate Professor of Oncology, Psychosocial Oncology Division, University
of Calgary
Jean Deschenes, Dr.
Provincial AP-Cancer Lead AHS Laboratories
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Ken Stewart, Dr.
Associate Professor, University of Alberta, Thoracic Surgery, Royal Alexandra
Hospital, Co-Lead Alberta Thoracic Oncology Program
Konrad Fassbender
Scientific Director, Covenant Health Palliative Institute
Krista Rawson
Senior Practice Consultant Advanced Nursing Practice
Laura McDougall, Dr.
Medical & Scientific Director, Alberta Cancer Prevention Legacy Fund
Linda Dziuba
Senior Practice Lead for Social Work, Health Professions Strategy & Practice
Lorelee Marin
Patient and Family Advisor; Cancer PAC member
Lorraine Shack
Director, Surveillance &Reporting, CMORE, CancerControl
Marg Semel
Executive Director, C-MORE, CancerControl Alberta
Mark Redmond
Executive Director, iRSM
Marlis Atkins
Director, Adult/ Seniors Strategy & Education Resources, Nutrition and Food
Services
Max Jajszczok
Director, Palliative & End of Life Care Practice and Development, Community,
Seniors, Additions & Mental Health
Micheline Nimmock
Executive Director, Highland Primary Care Network
Mona Udowicz
Director of Quality, Safety and Patient Experience, CancerControl Alberta
Monica Schwann
Director, Screening Programs, Screening Programs / Healthy Living
Myka Osinchuk
Chief Executive Officer, Alberta Cancer Foundation
Paul Grundy, Dr.
Chief Operating Officer & Senior Medical Director, CancerControl Alberta
Sharlene Stayberg
Director, Clinical Innovation and Policy Unit (CLIP), Research and Innovation
Branch, Alberta Health
Sue Young
Executive Director - Adult inpatient Surgical Services, Royal Alexander
Hospital and EZ Trauma Services
Teresa Davidson
Executive Director, Tom Baker Cancer Centre
Teri Myhre
Senior Operating Officer, Acute Care West (South Zone), Acute Care Services
- South West
Theresa Radwell
Vice President, Program Investment, ACF Foundation
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Todd McMullen, Dr.
Division Director - Surgical Oncology, Cross Cancer Institute
Tracy Reberger
Clinical Manager, Red Deer Regional Hospital
Tricia Antonini
Patient and Family Advisor
BUSINESS SUPPORT
Michael Taylor
Senior Analyst, PRIHS Rectal Cancer Clinical Pathway Initiative
Rachel Walkington
Business Relationship Partner, Information Technology
Robin Schlese
Manager, Financial Analytics & Project Support
Tracey Geyer
Senior Health Systems Planner
CORRESPONDING
MEMBERS
Anil Abraham Joy, Dr.
Provincial Breast Tumour Team Leader, Medical Oncologist
Belinda Lau
Senior Financial Analyst - Business Advisory Services
Brenda Hubley
Executive Director of Community Oncology & Provincial Practices
David Dyer
Executive Director, Cross Cancer Institute
Dean Wheeler
Patient and Family Advisor
Kristin Bernhard
Senior Communications Advisor
Mike Ross
Patient and Family Advisor
Paula Germann
Site Director, Cross Cancer Institute
Robin L. Fainsinger, Dr.
Clinical Director, Tertiary Palliative Care, GNH / Edmonton Zone Section
Chief, Palliative Care Program
Sandra Delon, Dr.
Director, Chronic Disease Prevention and Oral Health
Tammy Hofer
Senior Operating Officer, Laboratory Services
Walley Temple, Dr.
Professor/ Departments of Oncology & Surgery, University of Calgary /
Clinical Director, Cancer Surgery Alberta
22
References
Alberta Cancer Prevention Legacy Fund. AlbertaPreventsCancer.ca Edmonton, AB: Alberta Health Services,
2014.
Alberta Health. Changing Our Future: Alberta’s Cancer Plan to 2030 Alberta Cancer Plan. Edmonton, AB: Alberta
Health; 2013.
Alberta Health. Creating Tobacco-free Futures: Alberta’s Strategy to Prevent and Reduce Tobacco Use 20122022. Edmonton, AB: Alberta Health; 2012.
Alberta Screening and Prevention Initiative. ASaP Maneuvers Menu – Reference List. Edmonton, AB: Towards
Optimized Practice, 2014. http://www.topalbertadoctors.org/file/asap-maneuvers-menu-reference-list.pdf
Berman, M., Crane, R., Seiber, E., & Munur, M. (2013). Estimating the cost of a smoking employee. Tobacco
control, 1-6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23733918
Canadian Cancer Society. Canadian Cancer Society youth advocates at TIFF to butt smoking out of movies
(Media Release). Toronto, ON: Canadian Cancer Society – Ontario Division, 2013.
http://www.cancer.ca/en/about-us/for-media/media-releases/ontario/2013/canadian-cancer-society-youthadvocates-at-tiff/?region=on
Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2014. Toronto,
ON: Canadian Cancer Society; 2014.
Cancer Surveillance: 2010 Report on Cancer Statistics in Alberta. Edmonton, AB: Cancer Care, Alberta Health
Services, 2012.
Health Canada / Statistics Canada. Youth Smoking Survey 2010/2011. Ottawa, ON: Health Canada / Statistics
Canada
Statistics Canada, CANSIM, table 105-0501 and Catalogue no. 82-221-X.. Canadian Community Health Survey.
Ottawa, On: Statistics Canada
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Appendix A: Transitional Initiatives of the Cancer SCN
Since our formation in 2012, the Cancer SCN has brought the perspectives of patients and families, stakeholders
and clinicians together to develop strategies and initiatives aimed at reducing the burden of cancer in Alberta.
In 2014, the following two initiatives were successfully transitioned from the Cancer SCN to AHS operations.
The Alberta Thoracic Oncology Program
Across Alberta, an estimated 2,100 new lung cancer cases are expected to be diagnosed in 2014, while an
estimated 1,570 Albertans are expected to die from lung cancer (Canadian
Cancer Society, 2014). The estimated survival of lung cancer patients in
Alberta is 14%, which stresses the importance of early detection, diagnosis and
consultation for one of Alberta’s most prevalent cancers. Since 2010, the
Cancer SCN has worked with thoracic surgeons, nurse practitioners,
pulmonologists and radiologists across Alberta, to develop the Alberta Thoracic
Oncology Program (ATOP) and its two rapid access clinics that expedite
detection, diagnosis, and speciality consultation for patients with suspected
lung cancer. In 2014, the ATOP initiative will be transitioned from a SCN project
to zone operations in both Edmonton and Calgary with service available to all
Albertans with suspected lung cancer.
“ATOP’s Calgary and Edmonton Rapid Access Clinics help us cut
through intermediate steps and in fact save resources. If a radiologist sees
findings suspicious of lung cancer on a patient’s images, he/she can directly
refer that patient to the clinic, rather than wait for the family physician to see
the radiologist’s report and then initiate the process. Within 2 business days
the clinic nurse can then telephone the patient’s family physician saying, ‘Your
patient appears to have lung cancer, is it okay if we see your patient?’”.
Dr. Neil Hagen, Cancer SCN Senior Medical Director on the ATOP
Initiative from the Calgary Herald, May 5 2014
Approximately 13,500 referrals are made to an associate or tertiary cancer centre in Alberta every year.
According to Alberta’s Cancer Plan (2013), by 2030 the projected number of new referrals made annually is
expected to be 27,000 (a 65% increase from 2010). To further enable timely referral into cancer centres, the
Cancer SCN partnered with the Path to Care eReferral team to test how automation of a paper-based system
might optimize the referral process across Tumour Groups. An evaluation of the technology is underway for
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breast and lung cancer referrals as well as hip and knee referrals in collaboration with the Bone and Joint Health
SCN.
eReferral offers patients and referring physicians a referral process that is more predictable, transparent, and
personal. After a patient is referred to an oncologist from a surgeon’s office, the clerk at the office downloads
the patient’s relevant information from Alberta NetCare.
The eReferral platform specifies what needs to be present in the referral, thereby standardizing referral
information and ensuring unnecessary delays in processing. Pending the results from implementation and
availability of funding, this technology will be expanded to the remaining Tumour Groups.
“We have worked hard to get all our triage and referral guidelines up to date and in place across
all our tumour groups, and now getting them into the electronic world [through eReferral] is the
logical next step.”
Dr. Charles Butts, Medical Director of Community Oncology and
Cancer SCN Core Committee Member
The Alberta Cancer Surgery Five-Year Strategic Plan
Cancer surgery remains the primary treatment for most cancers with the surgeon often the first entry point for
cancer patients. Approximately 80% of patients who develop cancer will require surgery, and the quality of
surgical care directly influences clinical outcomes. In 2012, a Five-Year Strategic Plan for Cancer Surgery in
Alberta was developed and endorsed by a group of leading cancer surgery stakeholders from across the
province. Supported by both the Cancer and Surgery SCNs, the plan outlines opportunities for more consistent
and streamlined care for cancer surgery patients, improving their outcomes and leading to more efficient use of
resources. In 2014, the plan was reviewed by a newly established provincial Cancer Surgery Council under the
leadership of CancerControl Alberta and the Departments of Surgery in Calgary and Edmonton.
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