Canada

Cancer care in Canada

Two in every five Canadians are expected to develop some type of cancer during their lifetime, with one in four expected to die from their disease.¹

The economic burden of cancer care on all payers in Canada is substantial. The cost of cancer care in Canada has risen steadily from $2.9 billion in 2005 to $7.5 billion in 2012, mostly owing to the increase in costs of hospital-based care.² With the growing burden of cancer, and the resultant financial pressures on our healthcare systems, there is an urgent need to improve efficiencies and reduce waste in cancer care in Canada. Improving efficiency is not a question of linear cost-cutting, but of finding ways to allocate resources more efficiently to achieve better health outcomes for patients.

Although some areas of healthcare in Canada are publicly funded in whole or in part, cancer patients – particularly those in rural areas and/or with limited access to financial resources – often experience high out-of-pocket health costs due to travel, missed work, and uninsured or underinsured drug expenditures. Alternatively, they forgo necessary treatments because they cannot afford them, with dire health consequences.

All.Can Canada initiative

In April 2018, Save Your Skin Foundation (SYSF), a national patient-led not-for-profit group dedicated to leading the fight against non-melanoma skin cancers, melanoma and ocular melanoma, was established as All.Can Canada’s Secretariat to lead the initiative in Canada. SYSF convened a Working Group to discuss how to bring All.Can into the Canadian healthcare space. The Working Group completed a year one discovery phase that involved an informal literature review of nation-wide and province-specific health care reports to identify the top reported areas of waste and inefficiency in cancer care in Canada. These findings were then prioritized through anonymous surveys with cancer care stakeholder groups, including patient group representatives, health care professionals, provincial policy makers, health technology assessment bodies, and pharmaceutical industry representatives. This information was also reviewed in light of responses from over 300 Canadian cancer patients who took part in the All.Can International Patient Survey.

This information was used to produce a Consolidated Report of Waste and Inefficiency in Canadian Cancer Care: Multi-Stakeholder Insights and Recommendations. This report highlights the common themes across stakeholder groups of areas of greatest waste and inefficiency in Canadian cancer care systems.

All.Can Canada, through SYSF and its working group, organized a first multi-stakeholder roundtable in late 2019 to develop consensus on a focus area to begin its work. The consensus statement developed for All.Can Canada is to focus on optimizing patient entry into Canadian cancer care systems, ensuring swift, accurate and appropriately delivered diagnosis and that patients experience coordinated, effective support throughout their treatment experience. The preliminary focus will be on ensuring swift, accurate and appropriately delivered diagnosis as the entry point into the cancer care system.

To direct All.Can Canada’s activities, a multi-stakeholder, patient-led Interim Steering Committee was established to direct an environmental scan to evaluate the capacity of the current cancer care systems in Canada to achieve the consensus statement and provide the basis of the future objectives and action plan for All.Can Canada; to organize a second, multi-stakeholder roundtable to assess the results of the environmental scan; and to determine the objectives and action plan. The final report from this research, Optimizing Diagnosis in Canadian Cancer Care has been published and was used to direct conversations at the second roundtable meeting in November 2021.

Activities and milestones

• Gathered real world data and patient-reported areas of inefficiency and waste through a national patient survey with 300+ respondents and a scan of literature on nation-wide and province specific health care reports
• Validated and prioritized data through consultation with pharmaceutical industry partners, patient representative groups, health care professionals, health technology assessment bodies and policy makers
• Hosted an inaugural roundtable meeting of all key oncology stakeholder sectors to find consensus on the top areas of inefficiency and waste in Canadian cancer care and identify the area of focus for All.Can Canada in 2020 and beyond
• Distributed Roundtable Report and final Consolidated report on waste and inefficiency in Canadian cancer care with consensus statement to attendees and stakeholders
• Assembled All.Can Canada interim steering committee with representation from all stakeholder groups to support, guide and oversee the progress of a multi-year research project that was derived from the roundtable
• Conducted a rigorous environmental scan, including literature review, patient interviews, and provider survey, to assess the current state of cancer diagnosis within Canadian cancer care systems, gather nominated practices, provide insights for a preliminary quality framework, and offer recommendations for change
• Launched COVID-19 Cancer Patient Support Hub, bringing together Canadian oncology patient groups, mental health expertise and health care providers to respond to immediate, emotional and practical needs of Canadian oncology patients during the COVID-19 pandemic
• Hosted a 2nd roundtable meeting of all key oncology stakeholder sectors to review ‘Optimizing Diagnosis in Canadian Cancer Care’ Report to identify opportunities to advance the recommendations of the report and begin to move towards an improved future state in cancer diagnosis using the results of All.Can Canada’s research
• Distributed 2nd Roundtable Report to attendees and stakeholders
• Published Optimizing Diagnosis in Canadian Cancer Care (French version: Optimizer le diagnostic du cancer au Canada)

References

1. Canadian Cancer Society Available here: http://www.cancer.ca/en/cancer-information/cancer-101/cancer-statistics-at-a-glance/?region=bc#ixzz5RZs2GjPG [accessed: September 2018]
2. Claire de Oliveira, MA, PhD*, Sharada Weir, MA, DPhil et al. The economic burden of cancer care in Canada: a population-based cost study. CMAJ Available here: http://cmajopen.ca/content/6/1/E1.full [accessed: September 2018]