ROADMAP TO CANCER CONTROL FOR MANITOBA - 2020 Setting priorities, working together and achieving the best results
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2020
ROADMAP TO
CANCER CONTROL
FOR MANITOBA
Setting priorities, working together
and achieving the best results
Vision A world free of cancer. Mission To reduce and, where possible, eliminate the burden of cancer on the people of Manitoba through exemplary programs of prevention, diagnosis, treatment, rehabilitation, continuing care, research and education. These are the Vision and Mission statements of CancerCare Manitoba, which work towards cancer control for Manitoba. What is Cancer Control? Cancer Control aims to reduce the impact of cancer by reducing the incidence, morbidity and mortality of cancer and to improve the quality of life of cancer patients in a defined population, through the systematic implementation of evidence-based strategies for prevention, screening, early detection, diagnosis, treatment, supportive care, follow-up care, palliation and end-of-life care.1 Pembina Valley, Manitoba
TABLE OF CONTENTS
Vision, Mission, and Definition of Cancer Control 2
The Road to Cancer Control for Manitoba 5
Research and Innovation 7
Patient Perspectives on Clinical Trials 8
The Cancer Landscape 11
Patient- and Community-Centred Care 13
Developing the Roadmap to Cancer Control 14
Roadmap at a Glance - Priorities and Objectives 16
Priority 1: Promote Cancer Prevention and Screening 19
Priority 2: Deliver Timely Access to Quality Cancer Care
Closer to Home 27
Priority 3: Provide Evidence-Based, High-Quality Cancer
Services 33
Priority 4: Improve Patient Experience Throughout the
Cancer Continuum 39
Priority 5: Ensure Sustainability of Cancer Services 45
Priority 6: Improve First Nations, Métis, and Inuit Cancer
Control and Outcomes 51
A Framework for High-Quality Cancer Surgery
for Manitoba 54
Next Steps for the Roadmap to Cancer Control 55
Acknowledgments 56
Abbreviations 57
References 58
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 3
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The Roadmap to Cancer Control for Manitoba
Setting priorities, working together and achieving the best results
Cancer affects us all profoundly; it impacts be challenged to keep up with the demand
us physically, emotionally, socially and for cancer services. Thus, for a cancer control
economically. At times, the disease seems to program to be successful, it needs to also
be unyielding. The number of individuals with address measures for sustainability.
cancer continues to rise globally. A recent
Canadian cancer statistic (2018) reports that The priorities call for innovative solutions to
nearly 1 in 2 Canadians will develop cancer in improve efficiencies and effectiveness in the
their lifetime.2,3 The good news is that more healthcare system which, in turn, will allow
Canadians are surviving their cancer and living us to honour our collective commitment
well with the disease. Despite this good news, and deliver the very best cancer care to our
cancer still takes people’s lives prematurely diverse community.
and places an enormous burden on patients
and their families - individuals and caregivers In Manitoba, with the healthcare transformation
whom we know and love. Cancer leaves no that introduced the Manitoba Clinical and
one untouched. Preventive Services Plan (MCPSP), we are well-
positioned to work together as one healthcare
CancerCare Manitoba is responsible for system to set priorities and provide care to all
planning and leading a provincial cancer Manitobans to achieve the best results. The
control program in Manitoba that includes Roadmap to Cancer Control for Manitoba is
prevention, diagnosis, treatment and presented to the healthcare system and all
supportive care, as well as research and Manitobans at this time of opportunity such
education in cancer and blood disorders. It that it will bring the best results one could
is only through a comprehensive approach aspire to see for cancer control. The Roadmap
that the very best care and support can be will inform the MCPSP related to cancer service
provided. provision in Manitoba.
Successful implementation of a well- Successful implementation of the cancer
planned, robust and comprehensive cancer control priorities is largely dependent on
control program which involves the whole the commitment and collaboration of many:
healthcare system will determine the cancer government, healthcare systems, universities,
outcomes and health of the population in healthcare workers, volunteers and individual
Manitoba. Manitobans. It is our privilege as CancerCare
Manitoba and its Board of Directors to provide
To achieve the goal of cancer control, we are leadership to create the Roadmap to Cancer
honoured to present the Roadmap to Cancer Control for Manitoba. Join us as we work to
Control for Manitoba. Six priorities for cancer achieve a world without cancer.
control have been identified in consultation
with key stakeholders. These priorities are
patient- and community-centred and research-
and innovation-driven. The priorities and
corresponding objectives call for the best
evidence-based, high-quality and equitable
care for all Manitobans; regardless of age,
race, culture, disability, gender, religion, or
location in the province.
Dr. Sri Navaratnam, Mr. Jeoff Chipman, Chair,
There is a growing concern that with the President and CEO, Board of Directors,
CancerCare Manitoba CancerCare Manitoba
increasing number of people living with cancer
Professor, Department
and the availability of advanced treatments of Internal Medicine,
and technologies, our healthcare system will University of Manitoba
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 5
PhD Graduate, Research Institute in Oncology and Hematology, CancerCare Manitoba
Research and Innovation
New knowledge improves cancer control
Embedding research into all aspects of Taking discoveries from bench-to-
cancer control is an essential component of bedside, and back again, is the goal of a
CancerCare Manitoba’s mission to reduce the comprehensive research program that
impact of cancer on our population through directly benefits patients.
prevention, early detection and a personalized
approach to cancer treatment. This integrated research culture attracts
the best clinical and research talent from
Over many decades, CancerCare Manitoba across the world and allows us to ask
has built an integrated research ecosystem in specific questions about the needs of our
partnership with the University of Manitoba, local community. In particular, research and
and healthcare partners across the province. innovation projects at CancerCare Manitoba
This vision is based on the establishment address the needs of Indigenous and
of the Manitoba Institute of Cell Biology in vulnerable populations with new approaches
1969 by Dr. Lyonel Israels. A critical part of to prevention, education and patient
this Institute model was the co-location of navigation.
basic science and translational research with
clinicians and patients. In 2015, this approach The Research Institute takes a comprehensive
culminated in the formation of the Research approach to cancer research by integrating
Institute in Oncology and Hematology, ideas, projects and data from across the
which now includes laboratory and clinical cancer journey. This platform is built on
researchers from across the spectrum of Manitoba’s longstanding leadership in data
cancer and blood disorders. The Research capture and analysis at a population level,
Institute is the only provincial organization as well as rich data resources that provide a
dedicated exclusively to improving cancer real-time window into system performance,
control in Manitoba through research and patient outcomes, psychosocial oncology
innovation. Coordination of cancer research and screening. For this reason, research in
across the province is a priority so that all health services innovation is a major priority
Manitobans will have the opportunity to for building a sustainable, cost-effective and
participate in, and benefit from, research evidence-based approach to cancer care in
discoveries. This is made possible due to the community.
the CancerCare Manitoba Foundation which,
through the support of Manitobans, is able Research is foundational to providing the
to generously fund research carried out at best evidence-based, high-quality cancer
CancerCare Manitoba. care to Manitobans and contributes to
cancer control in the province.
Research is critical to improving patient
care because it identifies new and CancerCare Manitoba is committed to
innovative treatments as well as bringing continuing and strengthening this research.
the advantageous impacts of clinical trials Without local research, there is no cancer
conducted here in Manitoba. Research control.
improves patient care and outcomes.
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 7
Patient Perspectives on Clinical Trials
“I was extremely fortunate to have an oncologist who had his pulse
on the clinical trials offered at CCMB. I owe my extended life to him
and the clinical trials group for offering this immunotherapy.”
- Laura, Clinical Trial Patient
“I feel very fortunate to have been a study patient. I am so blessed to
be okay after all these years and I’m grateful for CCMB’s research and
clinical trials.”
- Peggy, Clinical Trial Patient
“The clinical trial nurses had every answer I needed, leaving me with
no fear of the treatment for this already life-changing experience.”
- Matthew, Clinical Trial Patient
8 PRESENTED BY CANCERCARE MANITOBA
Cancer patient, Matthew, meets with clinical trial nurse, Shauna
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA
The Global Context
1 6 IN
DEATHS
IS DUE TO
CANCER
GLOBALLY4
The National Context
1 2 IN
CANADIANS
WILL DEVELOP
CANCER IN
THEIR LIFETIME2,3
1 4 IN
CANADIANS
WILL DIE OF
CANCER2,3
The Manitoba Context
By 2035 10,000 new cancer cases
will be diagnosed EVERY YEAR in Manitoba5
To learn more about cancer in Manitoba visit https://www.cancercare.mb.ca/export/sites/default/About-
Us/.galleries/files/corporate-publications/System-Performance-Report.pdf or https://tinyurl.com/y4ox3e38
10 PRESENTED BY CANCERCARE MANITOBAThe Cancer Landscape
Cancer is the leading cause of death in Canada
The Global Context
Cancer is a leading cause of death in the healthcare systems, individuals living with
world, with an estimated 9.6 million deaths in cancer, communities and cancer agencies to
2018.4 Around the world, governments and find equitable and sustainable solutions to the
healthcare systems are exploring strategies cancer burden. Nationally, the major strategic
for cancer control as the number of people focuses are on cancer prevention, high-quality
with cancer continues to rise. Consistently, care and equitable care for all.7
the cancer control strategies at the forefront
are prevention and sustainability of cancer The Manitoba Context
services. The World Health Organization’s
(WHO) Report on Cancer 2020 identifies the In Manitoba, the picture is very similar.
“serious health problem” of cancer globally, CancerCare Manitoba’s 2019 Manitoba Cancer
regardless of the wealth or social status of System Performance Report highlights the
a nation or individual. The WHO report also growing number of new cancer cases annually.
presents a positive message of achieving In 2016, a total of 6,481 Manitobans received
cancer control through strategic, high-impact a new cancer diagnosis.5 The number of new
investments along the cancer continuum by cancer cases is expected to continue to rise.
government, healthcare providers, partner By 2035, over 10,000 new cancer cases are
organizations, and individuals working jointly projected to be diagnosed in Manitoba every
towards the goal.4 year (an increase of over 50% from 2016).5
Currently, cancer kills over 2,700 Manitobans
The Cancer Moonshot Task Force, under the every year.5 Despite these numbers,
direction of the US Administration, began Manitobans with cancer are living longer lives
a mission to “end cancer as we know it” in due to the availability of new treatments and
2016.6 The strategies ‘shoot for the moon’ with technologies. The five-year survival rate has
goals of achieving scientific breakthroughs, improved from 53% (1997-1999) to 62% (2014-
leveraging data, and accelerating new 2016).5
therapies. They also focus on the very
important groundwork goals of Prevention and Cancer control in Manitoba is impacted by
Early Diagnosis and Improving Patient Access the demographics of the population as well
and Care. as the remoteness of the north and access to
care in that region. The cancer mortality rate
The National Context for 2014-2016 in the Northern Region was 263
per 100,000 people compared to the Manitoba
Closer to home, cancer remains the leading average of 207 per 100,000 people.5
cause of death, responsible for over 25% of all
deaths in Canada.3 More than 600 Canadians In our province, we have the opportunity
are diagnosed with cancer every single for the healthcare system to work together
day and nearly 230 Canadians will die from to identify cancer control challenges and
cancer each day in 2020.2 The 2019-2029 priorities that are unique to Manitoba.
Canadian Strategy for Cancer Control, led
by the Canadian Partnership Against Cancer Our focuses are on cancer prevention,
(CPAC), recognizes the burden of cancer in equitable and culturally-responsive care for
Canada with the increase in numbers of people all, care closer to home whenever possible,
with cancer due to the growing and aging and sustainability of these services. Indeed,
population. It supports a national strategy for these are in keeping with national and global
cancer control achieved through collaborations strategies.
and networks of all levels of government,
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 11Manitoba’s Diverse Population
POPULATION 5.6%9
NORTHERN
REGION
OF MANITOBA POPULATION
1,372,708
8
26.0%10 RURAL
POPULATION
74.0%10 URBAN
POPULATION
18.0% 17.5% 15.6% 9.4%
11 12 12 13
Indigenous Visible Population over Population
population minorities age 65 living at low
income levelPatient- and Community-Centred Care:
The Best Care for Manitobans
Responding to the unique needs of the patient
Patient- and community-centered care emotional, physical, and social needs of
focuses on delivering care that is responsive the patient must be addressed; caring for
to the unique needs and preferences of the ‘whole’ person.
individual patients and their families, which
are also influenced by the communities they This patient-centred approach can only be
live in or belong to. It is organized around the applied with an understanding of the whole
health needs and expectations of patients person to adequately support their cancer
and the community rather than being disease- journey.
centric.
A patient’s cancer journey can be long;
Manitoba has a population of over 1.3 families and communities become vital
million people (2019) with approximately support systems for them. Individuals can
74% of residents living in Winnipeg and often receive treatment, follow-up care,
other smaller population centres.10 A small support and palliative care services in their
percentage (5.6%) of Manitoba’s residents own communities, thereby allowing them
live in the Northern Region of the province to remain close to home and their support
which comprises 67% of the province’s systems. This dimension of community is
landmass.14 Our province is richly diverse in important in planning cancer services to bring
culture, ethnicity, geography, socioeconomic the best care to the people of Manitoba.
status, age, and gender. Manitoba’s Diverse
Population (page 12) highlights some of the Cancer control aims to reduce the impact
population’s variations important to planning of cancer through strategies focused on the
for cancer services. entire cancer continuum – from prevention,
screening and early detection, diagnosis,
Unless these components are recognized treatment, and through to survivorship or
and factored into health planning, end-of-life care. Robust cancer prevention and
along with the acknowledgement of the early detection programs require intervention
challenges of racism and cultural safety, at the population level, best achieved
one cannot provide equitable care, which through engagement with communities which
is key to bringing optimal health outcomes may be geographic or culturally focused.
and improved patient experience to all Understanding the challenges of communities
Manitobans. and developing strong partnerships with
them will help to advance the health of the
Cancer is a leading cause of death and cancer community and cancer control priorities.
care is a significant part of our healthcare
system. Therefore, incorporating patient- and Patient- and community-centred care is
community-centred care for this disease essential for a successful healthcare system.
has a positive impact on the overall health It brings better outcomes and improved
outcomes of the province. Furthermore, patient experience. Evidence also indicates
receiving a cancer diagnosis can have a it costs less to the healthcare system.4 Given
profound impact on an individual, effectively the demands of cancer on individuals and
influencing every aspect of their lives, making the healthcare system, the patient- and
patient- and community-centred care pivotal community-centred approach to care must be
in providing the best care possible. amplified in the planning and implementation
of cancer control priorities. This will bring the
For cancer treatment to be most effective best cancer outcomes as well as result in the
and for a positive patient experience, the enhanced sustainability of health services.
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 13Developing the Roadmap to Cancer Control
Everyone plays a part - from community leaders, patients, educators
to healthcare providers
Preface Environmental Scan
The Manitoba Cancer Plan 2016-2021 outlined An environmental scan of internal and external
strategic priorities primarily for CancerCare cancer reports was completed as a first step
Manitoba (CCMB) to direct their operations to the development of the Roadmap. The key
and provide services to Manitobans. The reports reviewed were:
Roadmap to Cancer Control for Manitoba
provides a provincial approach to cancer • The CCMB Annual Progress Reports 15
control and will serve to guide all healthcare which provide an update on the progress
leaders in every region regarding cancer of the Manitoba Cancer Plan.
services provision. The Roadmap’s priorities • The 2019 Manitoba Cancer System
and objectives were identified following wide Performance Report 5 which presents
stakeholder engagement and consultation valuable contextual information, outlining
at various levels, under the leadership of measures from across the continuum of
CCMB. These are the cancer control priorities cancer. Outcomes such as incidence,
for Manitoba that will inform the healthcare survival, mortality and patient experience
system as it achieves better cancer outcomes are compared across Manitoba’s regional
for Manitobans. The priorities can only be health authorities.
gained through partnerships with healthcare • The 2019 report, Cancer Surgery Quality
leaders and organizations throughout the in Manitoba 16 which compiles quality
province. Together we can make significant indicators for breast, colorectal, lung,
strides in cancer control for all Manitobans. ovarian and prostate cancer surgeries.
• The 2019-2029 Canadian Strategy for
Why is this Roadmap Unique? Cancer Control 7 and the WHO Report On
Cancer 20204. These reports informed and
With health transformation in Manitoba, shaped the development of the Roadmap.
Shared Health has led the Manitoba Clinical
and Preventive Services Plan (MCPSP) for Based on the provincial, national and global
all diseases including cancer. For this plan data and reports, we were well-positioned to
to be successful, a strong understanding of evaluate the present status, issues and future
the disease and identification of the disease priorities for cancer control in Manitoba.
control priorities is required. Therefore, CCMB,
with provincial and national engagement,
produced the Roadmap, which will be a
foundational piece to inform the MCPSP and
the Annual Strategic and Operational Plans of
each region and service delivery organization “One of the most profound
in relation to cancer services.
moments was hearing the stories
of patients - sharing their truth to
set the tone and remind us why
we were all there.”
- Visioning Session Participant
14 PRESENTED BY CANCERCARE MANITOBARoadmap Development
Environmental The process of creating the Roadmap to Cancer Control for Manitoba began in
Scan early 2019. Following the environmental scan as a preliminary step, stakeholder
engagement was facilitated through information sessions including a Visioning
Session with key stakeholders from across the province.
Staff
Engagement
Visioning Session Priority Framework and
Document Development
Patients, health leaders, government
and the University of Manitoba Using feedback from the Visioning
participated in the Session, as well Session, six main priorities were
as representatives from CPAC, synthesized, each with specific
Visioning
Session
First Nations, Métis and Inuit objectives. The resulting priority
health leaders, Manitoba Regional framework was shared with the
Health Authorities, and cancer CCMB Board and Health Senior
surgery experts. Focus areas for Leadership Council. The Roadmap
presentation and discussion were development process involved
Priority cancer surgery, inpatient oncology content experts, the CCMB Executive
Framework care, and First Nations, Métis and Team, the Patient Advisory Group,
Inuit cancer control. The involvement and approval by the CCMB Board of
of all participants facilitated the Directors.
identification of provincial priorities
for cancer control.
CCMB Board
and HSLC*
Roadmap
Development
CCMB Board and
Patient Advisory
Group
Final Roadmap
Submitted to
MHSAL**
Health and Cancer Leaders at the Visioning Session
*Health Senior Leadership Council
**Manitoba Health, Seniors and Active Living
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 15Roadmap at a Glance
Priorities and Objectives
Priority 1 Priority 2 Priority 3
Promote cancer Deliver timely access Provide evidence-
prevention and to quality cancer care based, high-quality
screening closer to home cancer services
Objectives: Objectives: Objectives:
1. Increase the number 1. Enable early stage 1. Enhance access to
of non-smokers in diagnosis and timely precision medicine
Manitoba diagnosis of cancer
2. Optimize
2. Promote proven 2. Increase engagement multidisciplinary
practices to reduce of primary care care through high-
cancer risk in Manitoba providers and performing cancer
navigators throughout disease site groups
3. Increase uptake of the cancer control
cancer screening by continuum including 3. Increase compliance
Manitobans palliative care with cancer surgical
standards throughout
4. Adopt best practices 3. Develop a coordinated Manitoba
for cancer screening in and integrated
Manitoba provincial model 4. Increase concordance
for inpatient cancer with systemic treatment
services standards throughout
Manitoba
16 PRESENTED BY CANCERCARE MANITOBAPriority 4 Priority 5 Priority 6
Improve patient Ensure sustainability of Improve First Nations,
experience throughout cancer services Métis, and Inuit cancer
the cancer continuum control and outcomes
Objectives: Objectives: Objectives:
1. Provide increased level 1. Implement innovative 1. Ensure culturally-
of emotional support for models of cancer care responsive equitable
patients cancer care
2. Integrate digital
2. Improve patient solutions to improve 2. Provide safe and quality
engagement and information flow among cancer care in their own
access to information healthcare providers communities
3. Support patients in 3. Ensure appropriate 3. Support Peoples-
navigating the cancer workforce and specific, self-determined
system infrastructure planning cancer care
to meet future needs
The colours in this publication reflect the Manitoba provincial flag.
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 17Priority 1
Promote Cancer
Prevention and
Screening
Cancer control includes all activities aimed at When cancer cannot be prevented through
reducing the burden of cancer in a population, risk reduction, it needs to be diagnosed early.
ranging from prevention and screening to Screening programs aim to find cancer before
diagnosis, treatment, survivorship supports, symptoms arise when cancer treatment is
and in some cases, palliation or end-of-life minimized and outcomes are best – including
care. The elements at the front end of the an increased possibility of a cure. Currently,
cancer control continuum, notably prevention Manitobans participate in screening programs
(risk reduction) and screening, are essential where there is strong scientific evidence
for cancer control; they reduce the number supporting the use of a good test that can
of people who develop cancer and, where find cancer reliably in asymptomatic people
prevention is not possible, find cancer early – breast, cervical and colorectal cancers. New
when it is easiest to treat and outcomes are tests and targets (specific cancers) continue
best. to be studied; Manitoba needs to be ready for
implementation of significant advances in early
In the past, cancer prevention and screening detection for appropriate cancer control.
programs were often considered ‘nice to have’
from a healthy population perspective, but it Many risk factors for cancer are also
is now recognized that they also contribute risk factors for other chronic diseases.
to the sustainability of the healthcare system. Therefore, a cancer prevention program in
Specifically, investment in prevention and Manitoba can and should be integrated with
screening strategies contribute to future broader provincial and national programs
decreases in the number and acuity of cancer for the greatest impact.
patients. This is particularly important in
an era where the population is aging and Provincial and federal governments, health
growing, two major drivers of cancer rates. authorities, communities, public health
Risk reduction is the only driver that can be agencies, and occupational health groups, all
modified to limit the projected increase in have important roles in promoting cancer risk
cancer rates. reduction including research, education, policy
development and community outreach.
Research has indicated that at least 40%
of cancers can be prevented by reducing This Cancer Control Priority calls for action to
risks such as eliminating exposure to optimize these efforts throughout communities
carcinogens, promoting a healthy lifestyle in Manitoba.
and getting vaccinated.17
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 19Priority 1 Promote Cancer Prevention and Screening
Objective 1
Increase the number of non-smokers in Manitoba
Smoking accounts for approximately 30%18 In addition to relatively high overall smoking
of cancer deaths in Canada and is linked rates in Manitoba, recent data show that
to cardiovascular and respiratory diseases smoking rates are higher in the Northern
among other health conditions. Efforts to assist Region of the province compared to other
individuals to quit smoking or to never begin health regions in Manitoba.5 Expansion of
smoking are important aspects of disease smoking cessation programs, especially in
prevention for Manitobans. northern and rural Manitoba must be a priority.
All care providers play an important role in
In Manitoba, the percentage of people promoting a non-smoking lifestyle to patients,
who identified themselves as current daily including referral to available programs to
smokers in 2015/16 was nearly 19%. This assist efforts to quit smoking.
was higher than the Canadian average.5,19
Moving forward, provincial and national
Smoking is responsible for approximately stakeholders must continue to work together
85% of new lung cancers in Canada and can to reduce the number of smokers in
cause cancers of the mouth, throat, larynx Canada. This will be achieved by increasing
and esophagus, among others.20 Within five collaborations with public health organizations
years of ceasing to smoke, a person’s risk for and provincial and federal governments to
developing certain types of cancer is reduced increase awareness of the risks of smoking
by half compared to a person who smokes.21 and implement smoking cessation programs.
The effectiveness of many cancer treatments
is improved for patients who quit smoking.
“It was a big comfort knowing that someone cared and worked with me to help
me quit smoking when I wasn’t able to before.”
- Smoking Cessation Program Participant
20 PRESENTED BY CANCERCARE MANITOBAEIGHT WAYS TO
REDUCE CANCER RISK
Maintain a healthy
Live smoke free
body weight
Move more Be sun safe
Eat well Limit alcohol
Get vaccinated
Get screened for HPV
(Human papillomavirus)
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 21Priority 1 Promote Cancer Prevention and Screening
Objective 2
Promote proven practices to reduce cancer risk in Manitoba
By practicing a healthy lifestyle and Manitoba, 24% of homes have higher than
participating in cancer reduction programs, recommended levels of radon, compared to
Manitobans can lower the risk of cancer in 11% throughout Canada.22,23
their lifetime. Recent Canadian research has
shown that approximately 40% of cancers can Fortunately, residences can be tested for
be prevented by changing modifiable lifestyle radon gas and mitigation strategies are
and health behaviours.17 available if amounts are detected which
exceed recommended levels.
Making healthy choices such as quitting
smoking, increasing physical activity, The time is right in Manitoba, as we work
eating a healthy diet, maintaining a together towards broad health-system
healthy weight, consuming safer levels of changes, to also work collectively as a
alcohol and practicing sun safety are all healthcare system towards the prevention
important steps individuals can take to of cancer and chronic diseases. These
reduce not only their risk of cancer, but prevention strategies will inform the MCPSP
many other chronic diseases as well. related to cancer service delivery.
Promoting risk reduction for cancer will also Through extensive consultation with all
help prevent other chronic illnesses such as provincial stakeholders, a comprehensive
cardiovascular disease and diabetes. provincial prevention strategy will be
developed that includes public messaging
Certain environmental factors have also been related to key cancer risk factors and
linked to increased cancer risk. associated recommendations.
Of note is radon, a naturally occurring
radioactive gas which is the leading cause
of lung cancer among non-smokers. In
Northern Health Region Community Cancer Program Staff on World Cancer Day
22 PRESENTED BY CANCERCARE MANITOBAObjective 3
Increase uptake of cancer screening by Manitobans
Significant progress has been made in recent jurisdictions in Canada, is currently falling short
years to improve access to cancer screening of meeting Canadian screening targets set for
for many Manitobans, yet some populations breast, cervical and colorectal cancers.
remain under-screened, for example in
the Northern Region and in new immigrant Strengthening existing screening strategies
populations, where the adoption of screening will reduce the incidence and mortality
practices is lower for various reasons. of cancer and ultimately improve health
outcomes for Manitobans. These strategies
The Mobile Mammography Clinic, a must include education, awareness and
program of CancerCare Manitoba, provides access as all are vital to improving screening
the opportunity for many individuals to rates.
participate in screening, particularly those
residing in northern Manitoba. Future initiatives to improve screening rates
include the implementation of self-sampling
This past winter, the mobile mammography to increase cervical cancer screening access,
clinic travelled on a flatbed truck on ice roads and the distribution of fecal tests centrally
to the communities of Oxford House First within the province for colorectal screening.
Nation and St. Theresa Point First Nation.
Although Manitoba has made significant
strides in cancer screening efforts, more
can be done to optimize the availability of
screening, especially in the Northern Region.
When screening is not performed, cancer
is often detected at a later stage when it is
more difficult to treat. Manitoba, like other
Mobile Mammography Clinic visiting Northern Manitoba
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 23Priority 1 Promote Cancer Prevention and Screening
Objective 4
Adopt best practices for cancer screening in Manitoba
We know that cancer screening plays a critical Lung cancer screening for high-risk individuals
role in finding certain cancers earlier, often is another advancement in screening to be
before symptoms occur, and can save lives. In considered for adoption in the province.
Manitoba, we have strong screening programs Research has shown that low-dose CT
for breast, cervical and colorectal cancers. In scanning for individuals at high risk can reduce
recent years, cancer screening technologies lung cancer deaths by as much as 20% and as
have advanced significantly. We are committed a result, current Canadian recommendations
to adopt and implement the best evidence- are that high-risk individuals should be
based screening methods for Manitobans. screened.24,25
Provincial adoption of Fecal
Immunochemical Test (FIT) and high-risk
HPV primary testing for cervical cancer
screening are two examples of advanced
screening technologies for Manitoba.
Eligible individuals throughout Manitoba are currently mailed a Fecal Occult Blood Test (FOBT) kit
24 PRESENTED BY CANCERCARE MANITOBA“As a mom, I try to teach my kids as much as I can about being safe and caring
for their bodies. By giving them the HPV vaccine now, I am giving them an
added layer of protection and reducing their risk of cancer.”
- Manitoba parent of a Grade 6 student
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 25Dr. Cornie Woelk, family physician in oncology, with clinical staff at Boundary Trails Health Centre, Southern Health-Santé Sud
Priority 2
Deliver Timely Access
to Quality Cancer Care
Closer to Home
Accessing quality care within an appropriate approximately 9,000 hospital discharges per
time frame is essential for optimal cancer year in Manitoba related to cancer care26
treatment and outcomes for Manitobans for diagnosis, treatment, surgery, treatment
with cancer. Cancer services need to be complications and pain management. The
equitable and accessible to all Manitobans in priority to provide timely access to quality
a timely manner regardless of location, race, cancer care applies as well to inpatient care of
background or socioeconomic status. cancer patients.
The healthcare system needs to aspire to This Cancer Control Priority calls for action
provide quality cancer services closer to to deliver timely access to quality cancer
home whenever possible, bringing quality care closer to home in both the outpatient
to patients and patients to quality. and inpatient settings, through increased
engagement of primary care providers and
Cancer patients receive care in an outpatient navigators throughout Manitoba.
setting for diagnosis, multidisciplinary
consultation and assessment, and treatment
including systemic chemotherapy, radiation,
and day surgery. Regardless, there are
“The Community Cancer Program (CCP) has been a blessing for me and my
family and has given us relief from stress and anxiety. The comfort inherent in a
familiar CCP contributes to treatment success that cannot be overstated.”
- Cancer Patient, Selkirk CCP
“CancerCare Manitoba represents a shining example of how a provincial
cancer agency, in a challengingly sparse geography outside of its capital, can
systematically advance quality, performance, and innovation over time with
collaborative models of primary care in remote and rural communities.”
- Dr. Terry Sullivan, National Cancer Leader, CPAC
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 27Priority 2 Deliver Timely Access to Quality Cancer Care Closer to Home
Objective 1
Enable early stage diagnosis and timely diagnosis of cancer
The cancer system in Manitoba seeks Timely diagnosis requires the entire
to diagnose cancer early in its disease provincial healthcare system to work
progression whenever possible and to together as efficiently and seamlessly as
diagnose cancer in a timely manner. Early possible.
stage diagnosis of cancer is one of the most
effective measures for cancer control. Public Provincial partners will continue to work
awareness and accessibility to primary care together to improve access and streamline
providers is an important determinant of communications, procedures and services
cancer diagnosis at an early stage. for timely diagnoses. Identifying and
better understanding the existing gaps
An early cancer diagnosis can be achieved in from the presentation of symptoms to a
two ways: through screening of asymptomatic cancer diagnosis is important in facilitating
patients as presented in Priority 1, and through appropriate care. Rapid Diagnostic Clinics and
effective and efficient processes for timely Virtual Diagnostic Clinics will further facilitate
diagnosis when symptoms appear. timely diagnoses and treatment and assist
in ensuring timely diagnoses throughout the
In most instances, a cancer diagnosis is made province.
once an individual presents with symptoms
to their primary care provider or emergency
department. Some patients may also present
with greater disease complexity leading to a
disjointed diagnostic pathway with possible
lengthy delays. It is critical at these care points
to determine a diagnosis in a timely manner.
Integral to the process is the testing and
procedures carried out by various healthcare
partners for the diagnosis to be made.
28 PRESENTED BY CANCERCARE MANITOBACancer Diagnosis by Stage in Manitoba
The percent of late-stage diagnoses (stage IV) by cancer site, 2016.5
Survival rates are frequently lower for individuals with cancer diagnosed at a later stage. Early
cancer diagnoses may result in better outcomes for many cancers.
Stage I Stage II Stage III Stage IV Unknown
Breast (female only) 6.6%
Lung 47.1%
Colon aa 20.3%
Rectum bb 18.9%
Prostate 17.3%
Non-Hodgkin Lymphoma 41.8%
Corpus uteri 5.8%
Melanoma of the skin 2.5%
Kidney 18.3%
Oral c c 40.8%
Pancreas 45.8%
Bladder 18.0%
Thyroid 10.6%
Stomach 29.6%
Ovary 20.2%
Esophagus 35.3%
Liver 16.1%
d
Sarcoma d 21.6%
Cervix uteri 6.8%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Notes: a excluding rectum; b includes rectosigmoid; c oral cancer (buccal cavity and pharynx; includes: lip, tongue,
salivary gland, mouth, nasopharynx, oropharynx, and other unspecified cases); d soft tissue (including the heart).
Staging data shown for cancer sites with more than 40 cases in 2016. Cancer sites are ordered from the most cases
to least (with the exception of rectum and colon which are included near the top as combined they are the third most
common cancer). For more information regarding data presented in this figure, please refer to the Manitoba Cancer
System Performance Report, 2019.5
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 29Priority 2 Deliver Timely Access to Quality Cancer Care Closer to Home
Objective 2
Increase engagement of primary care providers and
navigators throughout the cancer control continuum including
palliative care
Cancer control aims to reduce the incidence, throughout the cancer journey to ensure
morbidity and mortality of cancer across the efficient and effective coordination of care
continuum of care- from prevention, diagnosis and elimination of gaps. These services can
and treatment to supportive and end-of-life be successfully facilitated by navigators in the
care. Primary care providers are the only system.
healthcare providers engaged in the patient’s
care throughout the cancer continuum. Cancer Navigation Services are available
Therefore, a robust network of primary care in every health region and consist of nurse
providers and navigators is of paramount navigators and psychosocial oncology
importance to facilitate early diagnosis, timely clinicians who provide valuable support to
referral and treatment and to improve patient patients.
experience and outcomes.
Continuous investment and education for
Primary care providers with a focused practice primary care providers and navigators are
in oncology are a vital and expanding part essential for high-quality cancer care.
of cancer care in Canada. Family Physicians
in Oncology (FPOs) and other primary care Access to palliative care in a timely manner
providers have been providing care in and availability of optimal pain and symptom
Manitoba for many years. The Department management for cancer patients is an
of Primary Care Oncology at CancerCare important component to improve the quality
Manitoba and the University of Manitoba of life and achieve better cancer control.
provide oncology education to primary care Provincial stakeholders will continue to work
providers to support and enhance their together in addressing the recommendations
expertise and knowledge to provide care to identified through the MCPSP related to
patients with suspected or confirmed cancer palliative care. As many patients who receive
diagnoses. palliative care have cancer, Palliative Care
Programs, CancerCare Manitoba and Regional
The diagnosis and treatment of cancer often Health Authorities must work together to
involve many specialists; coordination of continue to share information and improve
these specialist services is imperative for safe access to palliative care services throughout
and timely care. Communication between the province.
patients and healthcare providers is integral
“I want to let you know how much I have appreciated your Navigation Team
over the past few weeks. Knowing we had a resource to call in case anything
came up was invaluable. Especially given I do not live in Winnipeg, being able
to check in with your office gave me a lot of peace of mind.”
- Cancer Patient
30 PRESENTED BY CANCERCARE MANITOBAObjective 3
Develop a coordinated and integrated provincial model for
inpatient cancer services
Hospitalized cancer patients receive care by An important focus moving forward will be
a specialized team trained in oncology care. the development of a provincial model for
With the growing number of new and complex inpatient cancer services, to build on and
cancer treatments and unique side-effects, improve the existing model of oncology
the need for specialized oncology care is inpatient care in Manitoba. An inpatient
increasing. Delays in optimal care, fragmented oncology unit will improve efficiencies,
care and longer stays in hospital can result safety and patient experience. Additionally,
when coordinated oncology inpatient services transitions to other programs such as
are not in place. palliative care will occur more efficiently
and effectively. One important aspect of this
In Canada, most provinces have a dedicated provincial inpatient unit will be the presence
oncology inpatient unit as a recognized of a Virtual Cancer Care Unit to provide timely
standard of care. A dedicated inpatient communication and expert advice by oncology
oncology unit for Manitoba would serve the specialists to care providers throughout the
province well in delivering timely access to province.
specialized cancer care.
Working together with provincial partners,
A dedicated oncology inpatient unit an oncology inpatient unit will be carefully
would complement the principles of the planned and implemented to provide better
Manitoba Clinical and Preventive Services cancer control, disease outcome, quality of
Plan: to reduce time to treatment, improve care and sustainability within the Manitoba
outcomes, shorten hospital length of stay, healthcare system.
and reduce costs.
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 31Treatment planning for state-of-the-art radiation therapy at CancerCare Manitoba
Priority 3
Provide Evidence-
Based, High-Quality
Cancer Services
To achieve the best patient outcomes and The multidisciplinary team consisting of
cancer control for the province, cancer specialists from various disciplines is at the
services must be of high quality and evidence- core of bringing the best cancer care to
based. There is a significant investment patients. Therefore, the high performing team
in cancer research provincially, nationally is central to providing evidence-based, high-
and globally that continues to bring new quality care that will bring the best cancer
advances. Research and innovation bring outcomes for Manitoba.
new and emerging treatments and advanced
technology to clinical practice resulting in This Cancer Control Priority calls for action
evidence-based, high-quality cancer care for to incorporate new and emerging treatments
patients. delivered by high performing multidisciplinary
healthcare teams.
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 33Priority 3 Provide Evidence-Based, High-Quality Cancer Services
Objective 1
Enhance access to precision medicine
Precision medicine in the context of cancer Precision medicine is also applied in the use of
refers to the prevention, diagnosis and a patient’s genetic and molecular information
treatment of cancer using highly precise to more accurately prevent, diagnose and
and personalized methodologies. These treat cancers. This tailored approach to cancer
methods are applied predominantly in the care considers the specific molecular makeup
areas of radiation treatment and the use of a of an individual or distinct groups of people
patient’s genetic and molecular information to and their cancer to inform clinical decisions
determine targeted drug treatments. and treatment. These targeted therapies
are patient-specific and therefore are often
Precision medicine is at the core of radiation better tolerated by patients than standard
treatment, which precisely targets cancer chemotherapy. A person’s genetic information
cells and saves healthy normal tissue. With may also be used to detect an increased
innovations and technological improvements, risk for cancer development, for example in
radiation oncology is advancing towards ultra- individuals with Lynch Syndrome.
precision personalized radiation therapies.
These therapies have the potential to kill The use of genetic and molecular testing
cancer cells through very high doses of to inform clinical decisions is the new
radiation with fewer treatments compared to standard of care for many cancers.
conventional therapies.
CancerCare Manitoba is working with
These advancements in radiation provincial and national partners to explore
technology allow for ultra-precision and strategies to support the existing high volume
personalized care, with the ability to target of genetic and molecular testing required and
cancer cells within 1 mm accuracy and the anticipated increase as new therapies
minimize treatment side-effects. become available.
Preparing a patient for radiation treatment, Western Manitoba Cancer Centre, Prairie Mountain
Health Region
34 PRESENTED BY CANCERCARE MANITOBAObjective 2
Optimize multidisciplinary care through high-performing
cancer disease site groups
A multidisciplinary approach to care, where Performance determinants of
specialist teams work together to determine multidisciplinary disease site teams:
the best course of treatment for every cancer
patient, is essential to providing evidence- • Training and continuous education
based, high-quality cancer care. Once the • Incorporating research and innovation
care plan is formulated, if care can be safely into clinical practice
provided within the patient’s community, the • Adherence to best evidence-based
plan and information are provided to the local practice
care team. Specialist teams and local teams • Prompt access to many clinical trials
work together to ensure ongoing, safe and • Continued monitoring of quality metrics
optimal care. and disease outcomes
Integral to multidisciplinary care are disease
site groups (DSGs), comprised of healthcare
professionals from diverse disciplines and
areas of expertise focused on a particular
cancer site. There are disease site groups
for all common cancers, for example, breast
or thoracic, consisting of a total of 16 groups.
High performing disease site groups deliver
high-quality care.
The new Calypso radiation machine targets cancer cells using highly precise technology.
CCMB is the first Canadian cancer centre to have this equipment.
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 35Priority 3 Provide Evidence-Based, High-Quality Cancer Services
Objective 3
Increase compliance with cancer surgical standards
throughout Manitoba
Surgery plays a key role in the diagnosis The implementation of cancer surgery
and treatment of cancer. The most common standards improves cancer outcomes. A
form of curative cancer treatment is surgery. cancer surgery framework and plan developed
Approximately 50% of cancer patients by cancer surgery experts in Manitoba, will
in Manitoba require surgery and more complement the Roadmap to Cancer Control
than 5,000 cancer related operations are for Manitoba and provide further guidance and
performed provincially each year.16,5 Therefore, standards for cancer surgery.
access to high-quality cancer surgery
throughout the province is vital for cancer The collaboration of all provincial partners for
control. the continued improvement and organization
of cancer surgery delivery for all Manitobans is
Due to the large volume of cancer surgeries strengthened through the MCPSP.
performed across the province at various
health centres, variations may occur in surgical
practice patterns and outcomes.
A comprehensive and cohesive approach
is needed to meet the expected increase in
cancer surgery volume while maintaining
high quality and sustainable care.
Dr. Pamela Hebbard (R), surgical oncologist Dr. Elizabeth Thompson, cancer surgery lead,
with Pam (L), oncology nurse at CCMB Southern Health-Santé Sud
36 PRESENTED BY CANCERCARE MANITOBAObjective 4
Increase concordance with systemic treatment standards
throughout Manitoba
Chemotherapy, a type of systemic therapy, is In this environment of many complex
a cornerstone of cancer treatment and can treatment regimens, new pharmacy
be provided in the outpatient and inpatient regulations, and oral chemotherapy drugs,
setting in community sites throughout there is a need for the development of and
Manitoba, guided by CancerCare Manitoba. adherence to provincial standards for systemic
treatment. A Provincial Systemic Therapy
Providing systemic treatment in many Program, currently in development, will
communities is one of the ways in which address this need and will ensure the quality
quality cancer care is brought closer to and safe provision of chemotherapy across
home for patients. Due to the large number the province to meet provincial and national
of community sites providing systemic quality standards. The Provincial Systemic
therapy to cancer patients, care must be Therapy Program for Manitoba will also ensure
accessible, well organized, and connected a more cohesive, coordinated and integrated
with the specialty teams at CancerCare approach to enhance communication and
Manitoba. participation of all provincial regions involved
with the planning and safe delivery of systemic
Chemotherapy treatments continue to therapy for the province.
advance, leading to more complex therapies.
The process of chemotherapy drug mixture
within the province is being impacted by new
pharmacy standards to improve the quality
and safety of drug preparations, set by the
National Association of Pharmacy Regulatory
Authorities (NAPRA).27
New pharmacy standards (NAPRA) improve the quality and safety of drug preparations
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 37“It has been so affirming and uplifting to hear people’s experiences and
strategies for walking my cancer journey.”
- Cancer Support Group Participant
38Priority 4
Improve Patient
Experience
Throughout the
Cancer Continuum
Patient experience is what the process of and stressful time for many patients and
receiving care feels like for the patients their families. This impact places a significant
and their families. It is the accumulation of emotional burden on individuals. Providing
experiences through the interactions that emotional support to patients throughout
patients have with the healthcare system, the cancer journey assists them in managing
including their care from doctors, nurses, the cancer journey more successfully and
healthcare staff and healthcare facilities.28 achieving an overall improved outcome.
Navigating the cancer system can prove
The patient experience includes aspects of challenging and often requires assistance to
healthcare delivery that are highly valued best understand all of the cancer services
by patients including timely appointments, and options available. Also imperative
access to information and good for patients and their families is access to
communication with healthcare providers.28 reliable information to better understand their
diagnosis. Engaging patients in their care and
The patient experience is also influenced by treatment empowers them and improves their
a patient’s expectations of the healthcare experience.
system.28 Effective and compassionate
communication in all interactions with This Cancer Control Priority calls for action
patients is key to providing a positive patient to enhance the support available to patients
experience. to improve their experience throughout the
cancer journey.
A patient’s experience is a key element of
patient-centred care. Priorities and objectives
developed through the lens of patient-
centred care and good patient experience are
foundational for a successful cancer control
program in Manitoba. Patients who have a “I was able to talk, express, laugh and
positive cancer experience often have better cry with others who ‘get it’.”
outcomes, leading to overall improved cancer
control. - Cancer Support Group Participant
Receiving a cancer diagnosis often comes
with little to no warning, resulting in a difficult
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 39Priority 4 Improve Patient Experience Throughout the Cancer Continuum
Objective 1
Provide increased level of emotional support for patients
In addition to facing physical changes with rehabilitation initiatives. Access to support
illness, many emotional challenges may be programming throughout the province is
experienced as a result of a cancer diagnosis. variable.
Providing emotional support for patients and
families is vital throughout the continuum An area of focus moving forward will be to
of care from suspicion and diagnosis to increase the availability of support services
treatment and survivorship or end-of-life care. throughout the province, especially in rural
and remote areas. One of the ways in which
Patients who are provided with emotional this can be done is through the increased use
support can manage the cancer journey of digital tools such as video conferencing
with more success, have an improved platforms. Provincial partners will continue
patient experience and achieve an overall to work together to address the gaps in
improved outcome. emotional support for cancer patients and
their families.
Examples of emotional supports and
programming available for Manitoba cancer
patients and families are individual and family
counselling, support groups and cancer
40 PRESENTED BY CANCERCARE MANITOBAObjective 2
Improve patient engagement and access to information
Patient engagement is a key component of direction to patients on where and how to
the patient experience and the patient- and access the most up-to-date, accurate and
community-centred care the healthcare easy to understand cancer information can
system aims to provide to Manitobans. be of great benefit. Healthcare providers
Throughout the cancer continuum, healthcare and navigators play important roles in
providers need to engage with the patient and assisting patients’ increase in understanding
their families to understand the whole person of available information. Being equipped
and their unique needs. with the right information enhances patient
engagement with the healthcare team and
Patients and their families are empowered further empowers patients to make informed
when they are engaged in their care and decisions.
provided with information; as a result,
they are better equipped to make informed Accurate and accessible information is crucial
decisions about their cancer care. for a positive patient experience during the
cancer journey - from diagnosis to treatment
Through this engagement the patient and, if needed, end-of-life care.
experience and the cancer outcome are
improved.
Access to reliable and accurate information
is critical for patients and their families to
understand their cancer journey. Providing
The Patient and Family Resource Centre at CancerCare Manitoba provides cancer information
to patients
2020 | ROADMAP TO CANCER CONTROL FOR MANITOBA 41You can also read
