Annual Report - Legislative Assembly of Ontario · OCP III, which officiallytook effecton April 1, 2011, charts our course from 2011-2015with a focuson prevention, screening,diagnosis,treatment,follow-up,and

Annual Report 10 11

Rapport annuel10 11

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ACTION CANCERONTARIO

Rapport annuel

1 LETTRE DU PRÉSIDENT ET PRÉSIDENT DU CONSEIL D’ACTION CANCER ONTARIO

2À PROPOS D’ACTION CANCER ONTARIO

3LE PLAN DE LUTTE CONTRE LE CANCER DE L’ONTARIO

4RECHERCHE SUR LES CANCERS PROFESSIONNELS

SERVICES DE CANCÉROLOGIE

Prévention et contrôle du cancer

•Dépistageintégréducancer•Surveillance•Recherche•Recherchesurlescancersprofessionnels•ContrôleducancerchezlesAutochtones•Soinsprimaires

Diagnostic

•Projetsurlestempsd’attentepourlediagnostic•Déterminationdustade/pathologie

Traitement

•Gestiondescheminementspathologiques•Modèlesdeprestationdessoins•Conférencesmultidisciplinairessurlecancer•Améliorationdel’expériencevécueparlespatients•Chirurgiecontrelecancer•Radiothérapieavecmodulationd’intensité•Radiothérapeutesspécialistescliniques•Programmedetraitementgénéralrégional•Imageriecontrelecancer•Oncologiemoléculaire•Leprogrammedefinancementdesnouveauxmédicaments•Programmeontariendetraitementcollaboratifdessymptômesducancer•Soinsauxsurvivantsetsoinsdesurvie

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CANCER CARE ONTARIOAnnual Report

1 LETTER FROM THE PRESIDENT AND THE CHAIRMAN OF CANCER CARE ONTARIO

2 ABOUT CANCER CARE ONTARIO

3 THE ONTARIO CANCER PLAN

4 2010/11 - HIGHLIGHTS AND ACHIEVEMENTS

CANCER SERVICES

Prevention and Cancer Control

• IntegratedCancerScreening• Surveillance• Research• OccupationalResearch• AboriginalCancerControl• PrimaryCare

Diagnosis

• DiagnosticAssessmentPrograms• Stage/Path

Treatment

• DiseasePathwayManagement• ModelsofCare• Multi-DisciplinaryCancerConferences• ImprovingthePatientExperience• CancerSurgery• IntensityModulatedRadiationTreatment• ClinicalSpecialistRadiationTherapist• RegionalSystemicTreatment• CancerImaging• MolecularOncology• NewDrugFundingProgram• OntarioCancerSymposiumManagementCollaborative• SurvivorshipandFollow-upCare

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Infrastructure

• Capitalprojects• CyberKnifeRoboticRadiosurgery• ProgramTrainingConsultationCentre

ACCESS TO CARE

• AlternateLevelofCareInformation• EmergencyRoomInformation• SurgeryandDiagnosticImagingWaitTimes• SurgicalEfficiencyTargetsProgram

ONTARIO RENAL NETWORK

• ProvincialProgramManagement• RegionalProgramManagement• PerformanceMeasurementandManagement• InformationTechnology• CommunicationsandStakeholderRelations

5 HUMAN RESOURCES

6 FINANCIAL REPORTS

7 APPENDICES

BoardofDirectorsExecutiveLeadershipClinicalLeadershipProvincialLeadershipOntarioRenalNetworkLeadership

ItisimportanttoCancerCareOntario(CCO)thatallOntarianswithdisabilitiescanaccesstheservicesandinformationweprovide.

Toreceivethisinformationinanotherformat,contactCCOCommunicationsDepartment:P:(416)971-9800TTY:1(800)855-0511E:[email protected]

CCOANNUALREPORT 10-114

LETTER FROM THE PRESIDENT AND THE CHAIRMAN OF CANCER CARE ONTARIOWearepleasedtosubmitCancerCareOntario’s2010/11AnnualReport.

Fiscal2010/11wasayearofchangeforCancerCareOntario.Aftermorethansixyears,TerrySullivansteppeddownasPresidentandChiefExecutiveOfficer.UnderTerry’sleadership,CCOhasdeepeneditsworkwithpartnerstoimprovethecancersysteminOntario,solidifiedourroleinprovidingsupportthroughourAccesstoCareProgramfortheOntariogovernment’sWaitTimesStrategy,andestablishedtheOntarioRenalNetworktobeginapplyingtochronickidneydiseasethemodelforsystemimprovementthatwedevelopedthroughcancerandwaittimes.

InthisexpandedmandatewehopetoprovidemorevaluetotheprovincebyleveragingassetsandexpertiseatCCOthatcanbehelpfulinguiding–inpartnershipwithothers–broaderhealth-systemimprovement.

Asfinancialpressuresontheprovinceincrease,CCOandthehealthsystemingeneralwillfaceanevergreaterrequirementtodelivervalue. Ourgoalistodemonstratethatthecoordinatedapplicationofchangeleverscanresultinsignificantandrapidhealthsystemimprovement.Theseleversincludeasolidprovincialplandevelopedthroughwideengagement,apatientand publicservicefocus, acultureofclinicalleadershipandaccountability,thesettingofqualityguidelinesandstandards,excellenceinthedeploymentofmodernelectronictoolstoprovidedataandprogramoperationalsupport,andthelinkingoffundingtoaccountabilityforqualityimprovementatthelocalandregionallevel. Inthisreportonourachievementsintheindividualareasofourmandatewealsoprovideapictureoftheseimprovementleversinaction.Cancer

ThispastyearwecompletedthesecondofourOntarioCancerPlans(OCPs),ourmasterroadmapsforimprovementsincancerservices.Inthepastsixyears,theactionswehavetakenundertwosuccessivecancerplanshaveenabledCCOtobuildasolidrecordofprogressandachievementinthebattleagainstcancer.

Thatstartedin2005withOCPI,whichfocusedonbuildingcapacityforthesystem–thenutsandboltsofhowpeople,information,andtechnologyintersecttoprovidehigherqualitycancercare.

ItcontinuedwithOCPII,whichcoveredtheyears2008-2011.OCPII,whichconcludedonMarch31st,2011,focusedonreducingwaittimes,increasingcancerscreening

participation,andimprovingthequalityofcarebysettingstandards,transformingscreening,diagnosisandtreatmentacrossthecarecontinuum,andbybuildingcapacity.

Together,theseplanshaveguidedouractionsanddrivenouraccomplishments.Highlightsinclude:

• Increasingtheuseofevidencetodevelopstandardsandguidelinestoinfluencepractice,investmentandperformancemanagement

• Establishing13RegionalCancerProgramseachledbyaRegionalVice-President

• WorkingwiththegovernmenttodevelopandlaunchtheSmoke-FreeOntarioStrategyandlaunchtheHumanPapillomavirus(HPV)vaccinationprogram

• LaunchingColonCancerCheck,thefirstpopulation-basedcolorectalscreeningprograminCanada,inpartnershipwiththeMinistryofHealthandLong-TermCare(MOHLTC)

• Introducingprimaryandpalliativecarecancerimagingandpathologyleadsforcancerservicesineveryregion

• Renewingourresearchstrategyfocusedonthetranslationofresearchtobenefitpatients,includinglaunchingtheCCOResearchChairsProgram

• Markingthe20thanniversaryoftheOntarioBreastScreeningProgram(OBSP).Sinceitwasfoundedin1990,theOBSPhasscreenedmorethanonemillionOntariowomenaged50-69,anddetectedmorethan19,000cancers.Mostofthesewereintheearlystages–aclearindicationthattheprogramisworking,andworkingwell

• Significantlyimprovingwaittimesforcancersurgeryandradiationandmakingimportantstridesinimprovingwaittimesforchemotherapy

• Continuingourinvestmentincancerinfrastructurethroughthedevelopmentandexpansionofmajorcancertreatmentfacilitiesacrosstheprovince

• ReleasingthefirstinaseriesofCancerinOntarioreportswhichfoundthatthenumberofnewcasesofcancerisincreasing–primarilybecauseofpopulationgrowthandaging–butthatmortalityratesaredecliningandsurvivalratesformostcommoncancersareimproving

OurprogressunderthesetwocancerplansisreflectedinOntario’shighrankinginaninternationalstudypublishedinTheLancetinDecember2010.ThatstudyshowsthatOntarioisoneofthetopperformersincancersurvivalratesamong12jurisdictionsacrosssixcountries.TheInternationalCancerBenchmarkingPartnership(ICBP)studyconfirmsthatthecancercontrolstrategiesOntariohasputinplaceforearlyscreening,timelydiagnosis,andimprovedaccesstocareareresultinginimprovedsurvivalratesforthemostcommontypesofcancer.

CCOANNUALREPORT 10-11 5

CountriesinthestudyincludedCanada,Australia,Denmark,Norway,SwedenandtheUnitedKingdom–allofwhichhavesimilarwealth,accesstouniversalhealthcare,andlongstanding,high-quality,population-basedcancerregistries.

InCanada,threeotherprovincesinadditiontoOntario–Alberta,BritishColumbiaandManitoba–areparticipatinginthestudy.Ontariorankedfirstamongthem–andthirdamongall12healthjurisdictions–forcolorectalcancersurvival.Inlungandovariancancers,Ontariorankedsecondoverall.

Asthisandotherstudiesshow,ifyouliveinOntarioandgetcancer,youhaveabetterchanceofsurvivingthanalmostanywhereelseintheworld.

Butdespitethesesuccesses,muchmoreneedstobedone.OCPIII,whichofficiallytookeffectonApril1,2011,chartsourcoursefrom2011-2015withafocusonprevention,screening,diagnosis,treatment,follow-up,andpalliativecare,andaddressestheneedtokeepmovingforwardinordertocontinueourprogressandouraccomplishmentsaswestrivetocreatethebestcancersystemintheworld.ThroughOCPIII,wewillcontinuetoimproveonaccessandqualitybutwewillfocusparticularlyonimplementingourIntegratedCancerScreeningStrategy(ICS),improvingthepatientexperience,andredesigninghowcarecanbedeliveredinamoreeffectiveandefficientmanner.

Access to Care

In2004,Canada’sFirstMinistersmadeanationalcommitmenttoreducewaittimesforkeyhealth-careservices.InOntario,thiscommitmentresultedintheMinistryofHealthandLong-TermCare’s(MOHLTC’s)WaitTimeStrategyanditssubsequentEmergencyRoom/AlternateLevelofCare(ER/ALC)Strategy.

Thesuccessoftheseinitiativesrestedonaninformationstrategywiththeabilitytocollectandreportaccurate,reliableandtimelywaittimedata.CCOwasassignedtodevelopanddeploytheWaitTimeInformationSystem(WTIS)tocaptureandreportthisdatainnearreal-timeandsubsequentlywastaskedwithimplementingkeypartsoftheER/ALCInformationStrategy.

AccesstoCare(ATC),whichishousedatCCO,isaservicedeliveryagentfortheWaitTimesStrategyandER/ALCInformationStrategy.

TheoverarchingobjectiveofATCistoenableimprovementsintheaccess,qualityandefficiencyofhealth-careservices.WedothatthroughthestrategicimplementationanduseofInformationManagement/InformationTechnology(IM/IT)solutionsandthetrackingofpatientsastheymoveacrossthecontinuumofcare.BothareessentialinsupportoftheWaitTimeStrategyandtheER/ALCStrategy.

Whilechallengesremaininaccesstocare,75percentofpatientsinOntarioarenowreceivingtreatmentwithin

governmentbenchmarksforallprocedures.Thispastyear,aspartofAccesstoCare,CCO:

• IdentifiedbarrierstothemovementofALCpatientswithverylongwaits,whichledtostrategiesthatwereimplementedbyOntario’sLocalHealthIntegrationNetworks(LHINs)

• StreamlinedERdatasubmissionandenabledlinkagestootherdatasets

• Developedaclinicalengagementprogramstrategythatfocusedondataqualityimprovement

• Expandedpublicreportingofwaittimestoincludeallsurgicalareas

• InitiatedpublicreportingoftheSurgicalSafetyChecklist

Ontario Renal Network

ThethirdandmostrecentareaofresponsibilityforCancerCareOntarioistheOntarioRenalNetwork(ORN),whichCCOestablishedin2009.ORNisimplementingaworld-classsystemfordeliveringcaretoOntarianslivingwithchronickidneydisease(CKD).ORN’s2010/11highlightsinclude:

• Creatingandimplementingaprovincialdialysiscapacityplan

• Puttinginplacetheregionalaccountabilityrequiredtobeginimprovingchronickidneydiseasecareacrosstheprovince.Thisincludestherecruitmentof14RegionalDirectorsand14regionalmedicalleadsineachLHINtodrivetheimplementationofaregionalCKDprogramthatisalignedwithORNprioritiesandobjectives

Lookingahead,theORNwilldevelopandreleaseitsfirstmulti-yearplanforchronickidneydiseaseservicesin2011/12.

Inadditiontoourworkincancer,accesstocare,andCKD,CancerCareOntariohascontinuedtostrengthenouradministrativecapacityacrosstheorganizationtoensureaccountability,transparency,andvalue-for-money.Wecontinuetostrengthenourbusinessprocessesinfinance,procurement,humanresources,andinternalaudittoenableCCOtoachievemoreinhealth-systemimprovement.

SignatureofNeilStuart,BoardChair

SignatureofMichaelSherar,PhD,PresidentandCEO


ABOUT CANCER CARE ONTARIO

CancerCareOntario–anOntariogovernmentagency–drivesqualityandcontinuousimprovementindiseasepreventionandscreening,thedeliveryofcareandthepatientexperience,forcancer,chronickidneydisease,aswellasaccesstocareforkeyhealthservices.

Knownforitsinnovationandresults-drivenapproaches,CCOleadsmulti-yearsystemplanning,contractsforserviceswithhospitalsandproviders,developsanddeploysinformationsystems,establishesguidelinesandstandards,andtracksperformancetargetstoensuresystem-wideimprovementsincancer,chronickidneydisease–throughtheOntarioRenalNetwork–andaccesstocare.

CCObeganlifeinApril1943astheOntarioCancerTreatmentandResearchFoundation.Morethanahalfcenturylater,in1997,itwasformallylaunchedandfundedasanOntariogovernmentagency.CCOisgovernedbyTheCancerActandisaccountabletotheMOHLTC.DetailsofthisrelationshipwiththeministryarelaidoutinaformalMemorandumofUnderstanding(MOU)signedinDecember2009.

Asthegovernment’scanceradvisor,CCO:

• Directsandoverseesmorethan$800millioninfundingforhospitalsandothercancer-careproviders,enablingthemtodeliverhigh-quality,timelycancerservicesandimprovedaccesstocare

• Implementsprovincialcancerpreventionandscreeningprograms

• Workswithcancer-careprofessionalsandorganizationstodevelopandimplementqualityimprovementsandstandards

• Useselectronicinformationandtechnologytosupporthealthprofessionalsandpatientself-care,andtocontinuallyimprovethesafety,quality,efficiency,accessibilityandaccountabilityofOntario’scancerservices

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• Planscancerservicestomeetcurrentandfuturepatientneeds

• Conductsandrapidlytransfersitsownandexternalnewresearchintoimprovementsandinnovationsinclinicalpracticeandcancerservicedelivery

WhileCCO’spublicidentityistieddirectlytothefightagainstcancer,theorganizationalsoestablishedandnowhousesthenewOntarioRenalNetworkandtheOntariogovernment’sAccesstoCareprogram,whichsupportstheOntariogovernmentWaitTimesStrategy.

ThroughtheOntarioRenalNetwork,CCOorganizesandmanageschronickidneydiseaseservicesthroughouttheprovince.AccesstoCareworkstoensurethatOntariansreceivethehealthcaretheyneed,whenandwheretheyneedit.

Inaddition,CCOmanagesspecialaccessprograms,suchasPositronEmissionTomographyforuninsuredindications.ActivitiessuchasthesearemandatedthroughseparateaccountabilityagreementsbetweenCCOandtheMOHLTC.


THE ONTARIO CANCER PLAN

Since2005,CCOhascreatedmulti-yearOntarioCancerPlansfortheprovince.Thesearecancercareroadmapsthatchartthewaysinwhichhealthprofessionalsandorganizations,cancerexpertsandthegovernmentwillworkwithCCOtofightcancer,whileimprovingthequalityofcareforcurrentandfuturepatients.

ThefirstOCPcoveredtheyears2005-2008andfocusedonbuildingsystemcapacity.Thesecondcoveredtheyears2008-2011andconcentratedonreducingwaittimes,improvingthequalityofcare,transformingscreening,diagnosisandtreatment,andfurtherbuildingcapacity.CCObeganexecutingthethirdOntarioCancerPlan,coveringtheyears2011-2015,inApril2011.

OCPIIIcontinuesthetransformationofcancerservicesacrossOntario,includingthedevelopmentofnew,patient-centredmodelsofcaredelivery.OCPIIIwasbuiltonconsultationwithandlisteningtopatients.ThepatientexperienceiscentraltoOCPIIIandrecognizesthatpatientsneed:

• Morecontrolovertheirowncaretoimprovesatisfactionandoutcomes

• Accesstotoolsthatenablethemtoassessandcommunicatetheirsymptomseffectivelysothattheirsymptomscanbebettermanagedbyhealth-careproviders

• Accesstoresourcesandinformationthatmeetalloftheirphysical,emotionalandeducationalneedsthroughoutthecancerjourney

OCPIIIisdrivenbyacommitmenttoqualityinprevention,screening,diagnosis,treatment,follow-up,andpalliativecare.Itwillpayoffindeliveringvalueformoney,managinglong-termcostgrowth,improvingoutcomesandincreasingpatientsatisfaction.


ACCESS TO CARE

CCO’sAccesstoCareprogramistheservicedeliveryagentfortheMOHLTC’sWaitTimesStrategyandER/AlternateLevelofCareInformationStrategy.ATCusesclinicianleadershipandengagement,alongwithstate-of-the-artprojectmanagementmethodologies,todevelopinformationsolutionsanddeploythemtoOntariohealth-careorganizationstohelpreducewaittimesandimprovepatients’accesstohealth-careservices.

TheATCprogramoverseesfourbusinessstreams:

• AlternateLevelofCare(ALC),whichinnear-realtimemeasuresandreportsonthelengthoftimepatientsmustwaitforALC

• EmergencyRoomInformation,whichmeasuresandreportsontheEmergencyRoomlengthofstay

• SurgicalEfficiency,whichmeasuresandreportsonoperatingroomutilizations,safetyandefficiencymetrics

• SurgeryandDiagnosticImaging,whichinnear-realtimemeasuresandreportsonthetimebetweenthedecisiontotreatanddateofthesurgicalordiagnosticImagingprocedure

InATC,CCOworksto:

• Improveaccesstopatientservicesandpromoteaqualitypatientexperiencebyleveraginghealthinformationinsurgicalanddiagnosticimagingwaittimes,surgicalefficiencytargets,emergencyroomwaittimes,andalternatelevelsofcare

• MeettheinformationneedsofOntario’spatients,providers,andfundersbyengagingclinicianexpertstodevelopandimplementprovincialinformationtechnologysolutions

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• Improve–inconjunctionwiththeMOHLTC–theperformanceofhealth-careorganizationsand,moreimportantly,improveOntarians’accesstohealth-careservicesbymanagingthecollectionanduseoftimely,accurateinformationtomeasure,manage,andtrackpatients.Thisinformationalsosupportstransparentreportingandmonitoringtoensureaccountability

• EnsureOntarianshavethebestavailableinformationtomakedecisionsregardingthecaretheyreceivebyprovidingtimelywaittimedatafortheministry’spublicwebsite


ONTARIO RENAL NETWORK

CCOestablishedtheOntarioRenalNetworkin2009toleadaprovince-wideefforttobetterorganizeandmanagethedeliveryofrenalservicesforpatientslivingwithchronickidneydisease.TheORNishousedatCancerCareOntarioandworkstoimprovethequalityofkidneycareacrosstheprovince.

Initsshorthistory,ORNhasactivelyengagedwithkidneydiseasestakeholders,establishedaprovincialandregionalinfrastructurewith26regionalchronickidneydiseaseprograms,andsetperformanceindicators.Itscurrentfocusisonestablishingandensuringtheuptakeofstandardsandguidelinesinthedeliveryofqualityrenalcare,developinginformationsystemsandperformancemeasures,andassessingneedsandplanningcapacity.


2010/11 – HIGHLIGHTS AND ACHIEVEMENTS

CANCER SERVICES

PREVENTION AND CANCER CONTROL

PreventionandCancerControlreferstoworktoeasetheburdenofcancerbyreducingthenumberofpeoplewhodevelopthediseaseandtheimpact onthosewhodothrougheffectivescreeningandearlierdetection.Inaddition,PCCworkstoreduceinequitiesacrossthecancerjourneyforAboriginalpeopleandotherhigh-riskpopulations.

InOctober2010Dr.LindaRabeneckwasappointedasVicePresidentofPreventionandCancerControl(PCC).ThisappointmenteffectivelyconsolidatedCCO’spreventiveoncologyeffortsbycombiningPopulationStudiesandSurveillance(PSS),andPreventionandScreening.

Tosupportitspriorityof helpingOntariansreducetheirriskofdevelopingcancer,CCOinitiatespreventionstrategiesandactionsthatarebasedonstrongevidenceaboutanumberofbehaviours,suchassmoking,physicalactivity,andhealthyeating,orexposuresthatincreaseordecreasetheriskofdevelopingcancer.

CancerCareOntarioplaysakeyleadershiproleintobaccocontrol.Lookingahead,CCOwillcontinueworkingwithitspartnersandotherpublic-healthorganizationstodevelop,implement,andcoordinatetobaccocontrolcapacitybuildingandknowledgeexchangeprogramsandservicesinsupportoftheSmokeFreeOntarioStrategy.

AreasoffocusforPreventionandCancerControlare:

• IntegratedCancerScreening

• Surveillance

• Research

• OccupationalCancerResearch

• AboriginalCancerControl

• PrimaryCare

1) INTEGRATED CANCER SCREENING

Cancerscreeningtoimproveearlydetectionsaveslives.In2007,theprovincialgovernmentmadeacommitmenttoincreaseearlydetectionandfacilitatetheeffectivetreatmentofcancerwithafocusonimprovingscreeningratesforcolorectal,breast,andcervicalcancers.Toaccomplishthis,CCOhassetouttheoverarchinggoalofimplementinganintegratedscreeningstrategy.TheIntegratedCancerScreening(ICS)strategy,developedbyCCOinpartnershipwithMOHLTC,isfocusedon:

• Increasingpatientparticipationinscreening

• Improvingprimary-careproviderperformanceinscreening

• Establishingahigh-qualityintegratedscreeningsystemandinformation managementandtechnologyinfrastructure

BreastcanceristhemostfrequentlydiagnosedcancerinOntariowomen;80percentofbreastcancersarefoundinwomenaged50andolder.

In2010:• Approximately8,900Ontariowomenwere

diagnosedwithbreastcancerand2,100womendiedfromthedisease.

• Approximately490Ontariowomenwerediagnosedwithcervicalcancerand140womendiedfromthedisease.AmongOntariowomen20-49,cervicalcanceristhesecondmostcommontypeofcancer.

• Approximately8,300Ontarianswerediagnosedwithcolorectalcancerand3,400diedfromthedisease.ItisthethirdmostcommoncancerdiagnosedinOntarioanditsincidenceriseswithage,morerapidlyaftertheageof50.

Itisestimatedthatin2011:

• 3.7millionmenandwomenaged50to74,willbeinthetargetagegroupforcolorectalcancerscreening,althoughallmaynotbeeligible

• 1.6millionwomenaged50-69willbeeligibleforbreastscreening

• 4.5millionwomenaged20-69willbeeligibleforcervicalscreening

Overthenextfewyears,thesenumberswillincreaseduetopopulationgrowth.Itisexpectedthatfrom2011-2015therewillbe:


• 50,000morewomeneligibleforbreastscreeningannually

• 62,000morewomeneligibleforcervicalscreeningannually

• 119,000menandwomeneligibleforcolorectalcancerscreening

ThenewlydevelopedIntegratedCancerScreeningprogramlinksbreast,colorectal,andcervicalcancerscreeningattheregionalandservice-deliverylevelthroughprimarycare,clinician,andregionalstakeholderengagement.Theaimofthisintegrationistosupportpatients,providers,andhealth-systemplannersinimprovingthequalityanduptakeofscreeningandthefollow-upofabnormalscreens,toreducemortalityfromthesecancers.

2010/11 HighlightsIn2010/11,CCOandtheMOHLTCfocusedondesigninganddevelopingtheICSprogramandincreasingparticipation,buildingregionalcapacity,andengagingprimarycareresources.Duringthepastyear,we:

• StrengthenedgovernancestructuresthroughworkinggroupstosupportICS

• Createdanexpertclinicaladvisorypaneltosupporttheredevelopmentofthecervicalcancerscreeningprogram

• DevelopedcervicalscreeningandFecalImmunochemicalTest(FIT)guidelinesthroughthePrograminEvidence-BasedCare

• EstablishedkeyperformancemeasuresandreportingforICS

• Engagedprovidersintheplanning,delivery,andevaluationofscreeningprograms

• Providedperformancemeasurementandcustomizedscreeningactivityreportstoprimarycareproviders

• Providedfundingfor:

• Twomobilecoachestosupport under/neverscreenedinitiativesin ThunderBayandHamilton

•• Theexpansionofexisting,andthe

developmentofnew,IM/ITsystems andframeworkstosupportcancer screeningandreporting

•• ExpandedandenhancedIM/ITsystems

includingInScreen™tointegratebreast,colorectal,andcervicalcancerscreeningandaddnewcapabilitytoimprovepopulationsegmentation,participantoutreach,andreporting

• FinalizedthekeyperformancemeasuresforIntegratedCancerScreening

• FinalizedtheIntegratedCancerScreeningprojectgovernanceandprojectcharter

COLON CANCER CHECK

Colorectal(CRC),orcoloncanceristhethirdmostcommoncancerinOntario.Thereisa90percentchanceCRCcanbetreatedandcuredifitisdetectedintime.

ColonCancerCheckisanorganized,population-basedscreeningprogramestablishedin2008byCCOandtheMOHLTCtoreducecolorectalcancermortality.

2010/11 HighlightsIn2010/11,CCOandtheMOHLTCfocusedoncorrespondingwithindividualstoincreaseparticipationinscreeningandonengagingprovidersandthepublicincolorectalcancerscreening.Duringtheyear,we:

• Invitednewlyeligibleparticipants,notifiedparticipantsoftheirscreeningresults,andsentoutscreeningrecallsandremindersOntario-wide.Intotal,CCOsentoutmorethan1,024,395letterstoparticipants

• DeliveredanOntarioCollegeofFamilyPhysicians(OCFP)accreditedprovidereducationprogram

• Enteredintocontractswith64hospitalsandallocatedfundingformorethan30,000additionalcolonoscopies

• Spearheadedpublicawarenesscampaigns,suchastheGetCheckedFromBehindprogramadoptedbyseveralOntarioHockeyLeagueteams

• OntarioisthefirstProvincetolaunchthe RegisteredNurse FlexibleSigmoidoscopyProject.TheprojectiscurrentlyfundedbytheNursingSecretariatoftheMOHLTC.Provenevidenceshowsnodifferenceinoutcomesfromnursesvsphysiciansperformingthisscreening.Todate,thepilothasdemonstratedthatRNFlexibleSigmoidoscopyincreasescapacityforcolorectalcancerscreeningforaverageriskindividuals.Currently11hospitals,40nursesand32physiciansareparticipating.


Funded colonoscopy volumes:

2009/10=11,8302010/11=14,008

ONTARIO BREAST CANCER SCREENING PROGRAM

BreastcanceristhemostfrequentlydiagnosedcancerinOntariowomenandissecondonlytolungcancerasacauseofcancerdeaths.Earlydetectionthroughorganizedbreastcancerscreeningcombinedwitheffectivetreatmentremainsthebestcurrentlyavailabletooltoreducethenumberofdeaths.

TheOntarioBreastCancerScreeningProgram(OBSP)wasintroducedbytheMOHLTCin1990andisoperatedbyCancerCareOntario.

Itsgoalistoreducemortalityfrombreastcancerthroughthedeliveryofhigh-qualityscreening.Regularbreastscreeningfindscancerswhentheyaresmallandlesslikelytohavespread.AlthoughthebreastcancerincidencerateinOntariowasstablefrom1990to2007,mortalitydeclinedacrossthisperiodby35percentforwomenaged50–69.Thisdecreaseinbreastcancermortalityisattributedbothtoimprovedbreastcancertreatmentsandtoincreasedparticipationinbreastcancerscreening.

Thepercentageofwomenscreenedforbreastcancerisapproachingtheprovincialtargetof70percentby2011.WhileparticipationrateshavebeenincreasingintheOBSP,overallbreastscreeningrateshaveremainedstableoverthepastcoupleofyears.

CCOanditsregionalpartnerscontinuetolookatnewandinnovativeapproachesforrecruitingwomenthroughcommunityoutreachactivities,includingusingtheNorthWestMobileCoachinNorthernOntarioandoutreachtoChinesecommunitiesandAboriginalwomen.

ThereremainsaneedtoimprovescreeninginitiativesforallOntariowomenandmakespecialeffortstoreachwomenwholiveinlow-incomecommunities,wherecancerscreeningratesarethelowest.

2010/11 HighlightsThispastyear,CCOfocusedonfundingbreastscreeningandfollow-uptesting,aswellasbuildingparticipation.In2010/11,we:

• Funded501,376breastscreeningtestsat153OBSPsites–thisrepresenteda7percentincreaseover2009/10

• Funded16,218follow-uptestsforwomenwithanabnormalscreeningresult,through54OBSPmulti‐disciplinarybreastassessmentcentres–thisrepresenteda6percentincreaseover2009/10

• Leveragedtheopportunityofferedbythe20thAnniversaryofOBSPtorolloutapublicawarenesscampaign

• Updatedbreastscreeningclinicaltoolsandbrochuresforprimarycareprovidersandnewpatienteducationalmaterialsforthepublictosupportappropriatescreeningandincreaseparticipation

• BroughttheOBSPtoruralcommunitiesthroughtheNorthWestMobileCoachproject,whichvisitsnearly30communitiesthroughoutNorthwesternOntario,fromtheManitobabordereasttoChapleau,andallowseligiblewomenintheregiontocallatollfreenumbertobookanappointmentinanearbycommunity

• PlannedfortheintroductionofwomenathighriskforbreastcancerintotheOBSPprogram

OBSP Screens Delivered

2009/10 468,4862010/11 497,066Increase 6.1 percent (screens funded through OBSP)

Looking AheadImplementationofIntegratedCancerScreeningwillcontinuein2011/12andwillbegintoencompassallcolorectal,cervical,andbreastcancerscreening.ThiswillalsoincludetheannouncedfundingandexpansionoftheOBSPtoscreenwomenathighriskforbreastcancer.Thiswillimprovethequalityofcareforwomenaged30to69athighriskandwillpromotetheearlydetectionandtreatmentofbreastcancer.

PlanningandimplementationofICSwillbecomeasharedCCOprovincialoffice/regionalcancerprogramandMOHLTCinitiativein2011/12asregionalprogramofficesareestablished.ThenumbersofparticipatingsitesandofscreeningparticipantsareexpectedtoclimbasICSbecomesthesinglesourceofqualityassuredscreeninginbreast,colorectal,andcervicalcancers.

Providerengagementandperformancemeasurementwillbeenhancedattheprovincialandregionallevelthroughthestrengtheningofclinicalandscientificleadershipinallthreeareasofscreening.


2) SURVEILLANCE

TheSurveillanceUnitmonitorsprogressincancerandcancercontrol,preparesevidence-basedinformationproductsaboutcancerandcancerriskfactors,andpreparesanddisseminatesrelevantinformationtointernalandexternalstakeholders.Itdoesthisby:

• Regularlycarryingoutriskfactorandcancersurveillanceanalyses,bothpopulation-wideandinspecialsubgroups

• Developingspecialsurveillancestrategiestomonitorcancerorriskfactorsinspecificpopulationgroups(e.g.,occupationalcancers,Aboriginalpopulations,inequalities)

• Providingsurveillanceinformation,consultationandadvicetootherCCOUnitsandoutsidestakeholders

• Developinganddisseminatingknowledge-exchangeproductsandstrategies

• Conductingrelatedresearch

2010/11 HighlightsTheSurveillanceUnitreleasedCancerinOntario:Overview,astatisticalreportaboutcancerincidence,mortality,survivalandprevalenceinOntario.CancerinOntario:Overviewisthefirstdetailedreportondataandtrendsforthemostcommontypesofcancer,andprovidesaclearpictureoftheprogresswearemakingagainstthedisease.

Looking aheadFutureinitiativeswillincludeenhancedsurveillanceofspecificpopulationsandenvironments,afocusonincreasedproductionanddisseminationofsurveillanceinformationandproducts,andprogramevaluationforIntegratedCancerScreening.Knowingwhogetswhatkindofcancerbyagegroup,whatsurvivallookslike,whethermortalityisrisingorfalling,andwhethertherearemorepeoplelivingwithcancerallassistOntarioandCCOinplanning,funding,andevaluatingourcancerservices.

3) RESEARCH

CancerCareOntario’sresearchprogramisorganizedaroundanewlyestablishedscientistnetworkthatlinksresearchersacrossOntarioandsupportstheireffortstotranslateresearchfindingsintoclinicalpractice,includingclinicaltrials.Theresearchnetworksfocusonfourimportantareas:cancerimaging,healthservices,populationstudies,andexperimentaltherapeutics.Inadditiontoourfocusonthefourresearchnetworks,

CancerCareOntariocontinuestosupportanumberofProvincialResearchPrograms.

Partnership with the Ontario Institute for Cancer Research

CancerCareOntarioalsoworksinclosepartnershipwiththeOntarioInstituteforCancerResearch,throughwhichtheOntariogovernmenthasmadeasignificantnewinvestmentincancerresearch.TheInstitute’sroleinvolvesamajorfocusondiscoverywhileCancerCareOntariofocusesonsupportingstudiesofthecauses,preventionandearlydetectionofcancer,andofthecancercaredeliverysystem.Bothorganizationssupporttranslationofresearchfindingsintoclinicalpracticethroughclinicaltrials.

Research Chairs ProgramTheCancerCareOntarioResearchChairsProgramfocusesonattractingleadingnewscientiststoOntarioandsupportingoutstandingscientistsalreadyworkingintheprovince.Therefourkeyareastotheprogram:cancerimaging,healthservicesresearch,populationstudiesandexperimentaltherapeutics.Overthepastthreeyears,19researchchairshavebeenselectedtoworkintheseareas,andfourresearchnetworksnowareinplace.

TheResearchChairsProgramlinksresearchersacrossOntarioandsupportsscientificeffortstotranslateresearchfindingsintoclinicalpractice,includingclinicaltrials.Ontario Health StudyTheOntarioHealthStudy(OHS)isa20-yearstudythatwillrecruit150,000Ontarioresidentsbetweentheagesof35and69toexaminehowgenetics,lifestyle,behaviour,andtheenvironmentcontributetothedevelopmentofcancerandotherchronicdiseases.

Thestudyispayingspecialattentiontothecomplexinterplayoffactorsthatunderliethedevelopmentofmanyofthemostcommondiseases.Findingsfromthestudyareexpectedtohelpresearchersfindnewwaystopreventandtreatdisease.

TheOHSisfundedbytheOntarioInstituteforCancerResearch,theCanadianPartnershipAgainstCancerandPublicHealthOntario,withsupportfromCancerCareOntario.Inaddition,theOntariodivisionoftheCanadianCancerSocietyrecognizestheimportanceofthestudyandendorsesitsobjectives.

Followingapilotphase,datacollectionmovedtoanonlinebaselinesurveyofallOntarioadults(age18orolder)andtheoperationsofthestudywererelocatedfromCCOtotheOntarioInstituteforCancerResearch.


Lookingahead,CCOwillcontinuetoprovidescientificexpertisetothestudy.

Applied Cancer Research UnitsIn2010/11,CCOcreatedtheAppliedCancerResearchUnitprogram.Thisprogramprovidesinfrastructurefundingtogroupsofinvestigatorsworkinginoneormoreresearchareas.TheprogramisanimportantcomponentofCCO’sstrategyforqualityandaccessimprovementandfocusesonthetranslationofcancerresearchandinnovationintopracticeinOntario.Selectionofthesuccessfulunitsbyaninternationalpaneloccurredinearly2011,withawardsmadetothefollowingsixAppliedCancerResearchUnits.

• Princess Margaret Hospital ConsortiumFocus: clinicaltrialsofinvestigationalcancermedicines

• Division of Cancer Care & Epidemiology Focus:researchaimedatevaluatingaccesstocare,qualityofcare,systemefficienciesandgovernancetoimprovecanceroutcomes

• On-PROST: Ontario Patient Reported Outcomes of Symptoms and ToxicityFocus:developingandimplementingPatientReportedOutcomeMeasures(PROMS)tosetupsystemstocollectinformationfrompatientselectronicallyaspartofroutinecare

• SCREEN-NET ONTARIO: The Ontario Cancer Screening Research NetworkFocus:developinginfrastructureandinitiatingpilotstudiesofcancerscreeningwiththeaimofincreasingthenumberofresearchproposalsinthisarea

• Personalized medicine with targeted and genome-wide sequencing Focus: creatingastate-of-the-artjointGenomicsResearchUnit(GRU)attheUniversityHealthNetwork-PrincessMargaretHospital(UHN-PMH)andtheOntarioInstituteforCancerResearch

• System Prototyping in Image-Guided Robotic Percutaneous Interventions Focus: developingacomputersoftwareinfrastructure(SPARKit)thatwillfacilitatereal-timeimagestoguidediagnostic(suchasbiopsies)andtherapeutic(suchasradiotherapy)interventions

Looking AheadFutureinitiativeswillincluderesearchtoincreaseunderstandingofpreventableriskfactorsandtheirdeterminants;population-basedinterventionsinpreventionandscreening;investigationoftheroleofevidenceandpublicengagementinhealth-policydecisions,andstrengtheningtheprovincial/nationalnetworkofcollaboratingresearchers.

4) OCCUPATIONAL CANCER RESEARCH

Occupationalcancercanbedefinedascancercausedwhollyorinpartbyexposuretoacarcinogenintheworkplace.TheOccupationalCancerResearchCentre(OCRC)wasestablishedtofillthegapsintheknowledgeofoccupation-relatedcancersandtotranslatethesefindingsintopreventiveprogramstocontrolworkplacecarcinogenicexposuresandimprovethehealthofworkers.

TheOCRCisjointlyfundedbyCancerCareOntario,theWorkplaceSafetyandInsuranceBoardandtheCanadianCancerSociety,OntarioDivisionandwasdevelopedincollaborationwiththeUnitedSteelworkersUnion.TheOCRCismanagedandaccountablethroughCCO.ItcomprisesacoreteamlocatedatCancerCareOntario,whichincludestheCentreDirector,scientists,andresearchandadministrativestaff.Inaddition,thereisaprovince-widenetworkofcollaborators,includingscientistsandresearchersfromotherorganizations,traineessuchasdoctoralstudents;interns,aswellasvisitingandadjunctscientists.

2010/11 HighlightsDr.PaulDemerswasappointedasthepermanentDirectoroftheOCRC.Dr.DemersisaformerDirectoroftheUniversityofBritishColumbia’sSchoolofEnvironmentalHealthandScientificDirectorofCAREXCanada,amultidisciplinaryteamofresearchersbasedattheSchoolofEnvironmentalHealth,UniversityofBritishColumbia.

Inaddition,therewere17neworongoingprojectsinallareasoftheOCRC’sresearchagenda(surveillance,causes,interventions).TwelveoftheseareongoingprojectsusingtheCentre’scorefunding,andfivearenewprojectsthatwerefundedthroughgrants.

Twolargepubliceventswerealsoheld:theCentre’sannualsignatureevent,whichthisyearfocusedonassessingtheburdenofworkplacecancer,andasymposiumonthehealthimpactsofshiftworkco-sponsoredwiththeInstituteforWorkandHealth.


Looking AheadIn2011/12theOCRCwillcontinuetoexpanditsresearchprogram,buildoccupationalcancerresearchcapacity,anddeliverandexchangeknowledgewithadiversestakeholdercommunity.Newinitiativesthisyearwillinclude:

• AssessingthehumanandeconomiccostsofoccupationalcancerinOntarioandtherestofCanada

• Surveillanceofoccupationalcancerbylinking1991Censusdatawithnationaltumourregistrydata

• Severalpublicevents,includingaworkshopontheclassificationofcarcinogensandasymposiumoninterventionstomitigatetheadverseeffectsofshiftwork

• CollaborativeresearchprojectswithscientistsfromacrossCanada,theU.S.,theU.K.,France,andFinland

Besidesincreasingourunderstandingofthecausesofworkplacecancer,theresultsofthesestudieswillprovidedataneededtomakeevidence-baseddecisionsfortheregulationofworkplacecarcinogens,aswellastosupportvoluntaryeffortsbyemployerstoreduceoreliminateexposure.

5) ABORIGINAL CANCER CONTROL

CancerratesamongFirstNation,InuitandMétis(FNIM)peoplesareincreasingdisproportionatelyincomparisontooverallCanadiancancerrates.FNIMpeoplehavehighermortalityratesfrompreventablecancersandtendtopresentwithlater-stagecancersatthetimeofdiagnosis.ThesefactsunderscoretheneedforimprovingAboriginalscreeningandpreventionstrategies.

Aspartof theAboriginalCancerStrategythatwaslaunchedin2004,CCOhasworkedhardtostrengthenitsrelationshipwithOntario’sFNIMpopulationthroughengagementandcommunicationnetworkswithallFNIMgroups(includingoff-reserveAboriginalorganizations).ThesenetworksaredesignedtoensureacollaborativeapproachandhelpCCOtoeffectivelysupportthesegroupsintheircurrentscreeningandpreventionefforts.

2010/11 HighlightsToeffectivelyleverageexistingcapacityandincreasecancerscreeningawareness,CCOmusthaveagoodunderstandingofFNIMgovernance,programming

infrastructures,andinternalsub-networks.Tothatend,inthepastyearCCOhasbuiltdirectengagementrelationshipswithOntario’sFNIMgroups,settingthefoundationfortheimplementationofscreeningandothercancercontrolinitiatives.

TheAboriginalCancerPreventionTeamprovidedtrain-the-trainereducationworkshops,calledLet’stakeastandagainst…ColorectalCancer,in37locations,includingseveralFirstNationcommunities.Morethan100health-serviceprovidersparticipatedintheworkshops.Inaddition,theteamassistedtheFirstNationcommunitiesofGardenRiver,SixNationsandBeausoleiltohosttheGiantColonexhibitattheirrespectiveHealthFairs.

TheAboriginalTobaccoProgramtooktheexistingPlay,Live,BeTobacco-FreeToolkitandadapteditforaFirstNationaudience,withthegoalofencouragingFirstNationsportandrecreationteams/organizationstobecomeTobacco-Wise.

Looking AheadOneofthekeyinitiativesplannedistostrengthenCCO’srelationshipwithFNIM,andtoencouragethemtoparticipateincancercontrolandscreeningthroughtherenewalandimplementationoftheAboriginalCancerStrategy.

Thisstrategywillfocusonthefollowingstrategicpriorities:

• BuildproductiverelationshipswithinandbetweenCCO,theregionsandFNIMpeople/communities

• EncourageFNIMtobetobacco-wise,whichincludestobaccocessation,prevention,andprotection

• Co-developsharedapproachestoorganizedICSforFNIMpopulationsthatRegionalCancerCentresandotherpartnerswillhelpimplementacrossOntario

• SupporttheprovincialPalliativeCareStrategytoaddressFNIMneeds

• ContinueresearchandsurveillanceworkonFNIMcancerincidenceandscreeningneedstoaddresstherisingburdenofcancerinFNIMpopulations

• EncourageknowledgetransferandexchangetoincreaseFNIMcancereducationandawareness,andinformprogrammingdecisions.Cancerisnotcurrentlyontheradar


ofissuesthatneedtobeaddressedinFNIMcommunities,andthereisstillagreatdealoffearassociatedwiththedisease.Thus,thereisaneedtobotheducateandcreateawarenessofcancerwithintheFNIM

Duringtheyear,CCOaligneditsprogramswithgovernmentpriorities,focusingonraisingscreeningratesinnever-screenedandunder-screenedaboriginalpopulationsandsupportingtheprovince’sSmokeFreeOntarioActthroughitsAboriginalTobaccoProgram.Theprogramwascreated,withinputfromAboriginalyouthandguidancefromcommunityElders,tocreatetobacco-wisemediamessageswithandforAboriginalyouth.

6) PRIMARY CARE

ThePrimaryCareandCancerEngagementStrategy,whichwasproposedinOntarioCancerPlanII(2008-2011),isdesignedtoimprovecancercarebyengagingandintegratingprimarycareprovidersthroughoutthewholecancerjourney.CancerCareOntario’sProvincialPrimaryCareandCancerNetwork(PPCCN)isaninnovativeanduniquenetworkofprimarycareleadersengagedtolinkprimarycareproviderswiththecancersystemacrosstheprovince.

Thenetworkconsistsofoneprovincialand13regionalfamilyphysicianleaderswhoactasresourcestoprimary-careprovidersintheirregionstobringthevoiceofprimarycaretothecancersystemandthevoiceofcancertoprimarycare.Itinitiallyfocusedonimprovingscreeningforcolorectalcancer.

2010/11 HighlightsOverthepastyear,thePrimaryCareprogramworkingwiththePPCCNachievedthefollowing:

• Continuedtoengage familyphysiciansandotherprimarycareproviderstoimproveFecalOccultBloodTest(FOBT)screeningratesthroughouttheprovincebydelivering122providereducationpresentationsthatreachedanaudienceof4,642,comprisedof3,549familydoctors(with87MainproCcreditsand430MainproM1creditsdistributed),444medicalstudents,331registerednurses,198nursepractitioners,and120otherprimarycareproviders

• Ledthedevelopmentofprimarycarereferralguidelinesforsuspicionofcolorectalandlungcancer

Looking AheadThePrimaryCareengagementstrategyispartofthePrimaryCareProgramdesignedtostrengthentheconnectionbetweenfamilymedicineandthecancersystem.

ThePrimary CareengagementstrategyisaclearactionplanthatinitiallyfocusedonimprovingscreeninganddetectionrateswithintheColonCancerCheckprogramandiscurrentlybeingexpandedtobreastandcervicalscreening.Infuture,CCOwillexpandthePrimaryCareandCancerEngagementStrategytoimproveallaspectsofcancercareinOntario,includingprevention,screening,earlydiagnosis,treatment,andcarefollowingcancer.


DIAGNOSIS

Thetimebetweentheonsetofsymptomsandanactualcancerdiagnosisisacriticalphaseofthecancerjourney.Thereareconsiderablegainspossibleinthisphasethatoffertheopportunitytosignificantlyimprovethepatientexperienceandclinicaloutcomes.TheinitialthrustoftheOntarioWaitTimesStrategyfocusedonimprovingaccesstotreatmentafterdiagnosis.CancerCareOntarionowisfocusingonthepatient’spointofentryintothesystemtoensurecancerdiagnosesaremadeasquicklyandaccuratelyaspossible.

DIAGNOSTIC ASSESSMENT PROGRAMS

Thetimefromsuspiciontodiagnosisischaracterizedbytheneedformanytestsandconsultationsandoftencreatestremendousanxietyandstressforpatientsandtheirfamilies.

Toimprovethediagnosticphaseofthecancerjourney,CancerCareOntariohassupportedthedevelopmentandimplementationofDiagnosticAssessmentPrograms(DAPs)throughoutOntario.

Theseprogramsprovidesinglepointsofaccessfordiagnosticservices.Theyconcentrateandcoordinatediagnosticservices,provideinformationandsupporttopatientsthroughouttheprocess,givingthemaccesstomulti-disciplinaryexpertise,informationresourcesandpsychosocialsupports.DAPsalsohelpfamilydoctorsaccessdiagnostictestsfortheirpatients,getpatienttestresultsandinformation,andimproveworkflowefficienciesamongPrimaryCareProvidersandSpecialists.ThroughDAPs,CancerCareOntarioishelpingtoimprovethecoordinationofcare,decreasewaittimes,improvethepatientexperience,and,wherepossible,minimizediseaseprogression.

AkeycomponentofDAPsistheDiagnosticAssessmentProgram-ElectronicPathwaySolution(DAP-EPS),developedbyCCOwithsupportfrom–andinpartnershipwith–theCanadianCancerSociety.DAP-EPSisapatient-focusedinteractivewebsitedesignedtoimprovethediagnostichealth-careexperiencebyprovidingpatientswithaccesstoimportantinformationandsupportastheyprogressthroughtheirdiagnosticjourney,thuseasinguncertaintyatadifficultandstressfultime.

2010/11 HighlightsIn2010/11,CCOsuccessfullyestablishedDAPswithinthe14RegionalCancerPrograms.Presently,lungDAPsexistin11regionsandcolorectalDAPshavebeenestablishedinsevenregionsandNurseNavigatorshavebeenestablishedintheDAPstosupportpatientsthroughthisphaseofthejourney.BuildingonthesuccessoftheseDAPs,CCOisalsoestablishingprostateDAPs.

OnMay30,2011theDiagnosticAssessmentProgram-ElectronicPathwaySolution(DAP-EPS)officiallywent‘live’withafive-monthpilotwithinthelungandcolorectalDAPsatWaterlooWellingtonRegionalCancerProgram(GrandRiverHospital)andRegionalCancerCareNorthwest(ThunderBayHealthSciencesCentre).

Diagnostic Wait Times Project TheDiagnosticWaitTimesProjectfocusesonmeasuringdiagnosticefficiencybydefiningkeypointsandintervalsalongthediagnosticcontinuumofcare.

2010/11 HighlightsInthepastyear,theprojectbuiltonbestpracticesandlessonslearned,exploringinternationaltrendsindiagnosticwait-timemeasurements.Morethan50individualswithclinical,managementandresearchexpertisejoinedanexpertpanelandparticipatedinaconsensusbuildingprocesstohelpdefinekeypointsonthepatientdiagnosticjourney.

Looking AheadCancerCareOntariohasworkedtodevelopprovincialstandardsthatdefinetheorganizationalandpractice-settingfeaturesexpectedofadiagnosticassessmentprogram(DAP).Thesestandardsrepresentoneofaseriesofstrategiestoachievetheoverallgoalofimprovedrapidaccesstodiagnosis.

Thesetwowaittimeintervals–ReferraltoDiagnosisandDiagnosistoTreatment–willbeusedtomonitortheperformanceofDiagnosticAssessmentProgramsthroughoutOntario.

Tofacilitatethecollectionofwaittimedata,theDAPswillbeginbenchmarkingcurrentdiagnosticwaittimesinOntarioandsettingtargetsformoretimelydiagnosisorrulingoutofcancerinpatients.Thestandardizedcollectionofdiagnosticwaittimedataisduetobegininthecomingfiscalyear.


STAGE CAPTURE/PATHOLOGY

TheStageCaptureandPathologyReportingprojectisamulti-yearprovincialinitiativetoimprovethequalityandcompletenessofcancerstageandpathologyreportingdatabyimplementingnationallyendorseddataandreportingstandards.Thisinitiativesupportscancersystemimprovementandenhancedqualityofpatientcarebyprovidingnewinformationtocancersystemproviders,researchers,andotherdecision-makersoncancerstageandpathologyforallOntariocancerpatients.

Stage Capture Project

Stagingistheclassificationofcancercasesaccordingtotheextenttowhichthediseasehasspread.Thestageofacancerisanimportantpredictorofsurvival,andcancertreatmentisprimarilydeterminedbystaging.ThegoaloftheStageCaptureProjectistodevelopdatacollectionprocessesandtoolsthatenabletimelyaccesstoaccurate,completeandcomparablecancerstagedataforallOntarioadultcancerpatients.Ontario’smodelofdatacollectionisleveragingnewtechnologiestoimprovedatacapture.

2010/11 HighlightsThispastyear,CCOimplementedaninformationtechnologysolutiontoautomatestagedatacapturefromelectronicsynoptic(standardized)cancerpathologyreports.Asaresultofthisandotherprojectcomponents,population-basedstagedataarenowavailableforallbreast,colorectal,lungandprostatecancersdiagnosedsince2007.

Looking AheadIn2011/12,CCOwillcompletetheStageCaptureProject.Beginningwiththe2010diagnosisyear,dataforthefourmostcommoncancers(breast,colorectal,lung,andprostate)willallbestagedusingthenewmethodology. Datacollectionwillalsobeginexpandingtoallotherdiseasesiteswiththe2011diagnosisyear.

Pathology Reporting ProjectPathologyreportingisacriticalelementinthediagnosisandtreatmentofcancer.Itisusedtodeterminetheappropriatetreatmentorcombinationoftreatmentsrequiredforapatient.ThePathologyReportingProjectaimstomakecancerpathologyreportsmorecompleteandconsistentbyhelpinghospitalschangetoastandardizedelectronicformatcalled“synopticcancerpathologyreportsindiscretedatafieldformat.”ThegoalistohaveallhospitalsthatelectronicallysubmitreportstoCancerCareOntariousethisnewformat.

2010/11 HighlightsInitialimplementationofthePathologyReportingProjectwascompletedlastyear.NinetyOntariohospitalsnowelectronicallysubmitcancerpathologyreportstotheOntarioCancerRegistryatCCOinsynopticformatusingdiscretedatafields.Pathologyreportingindiscretedatafieldformathasincreasedfrom60to90percentforbreast,lung,colorectal,prostate,andendometrialresections.

Looking AheadIn2011/12,CCOwillcompletethePathologyReportingProjectbyshiftingthefocus fromimplementingsynoptictoolstoexpandingsynopticreportingbeyondforthefivemostcommoncancerresectionsto63typesofcancersurgeryandbiopsiesinallelectronicallyreportingpathologyhospitalsinOntario.


TREATMENT

DISEASE PATHWAY MANAGEMENT

DiseasePathwayManagement(DPM)isanewapproachtoimprovingqualityofcare,processesandpatientexperienceforspecificcancersbymappingandexaminingtheentirecancerjourneyfromstarttofinish.DPMusesadisease-specificapproach,focusingononetypeofcanceratatime,becausethepatientexperiencediffersfromonecancertoanother.

DPMappliesaframeworkforexaminingtheperformanceoftheentiresystemacrossthecancerjourney–frompreventiontorecoveryandend-of-lifecare–andidentifiesanygapsandbottlenecksalongthewaybydevelopingpathwaymapsandusingamultidisciplinaryapproach.Thegoalistoidentifyareasforimprovementinthequalityofcare,processesandthepatientexperienceandtosupportimprovementinthoseareas.DPMservesasacatalystforqualityimprovementbyidentifyingissues,sharingdataandfacilitatingregionalmultidisciplinarydiscussionsaboutthoseissues.Inaddition,DPMprovidespathwaymapsthatdepictrecommendedcareanddevelopsindicatorstomeasuretheimpactofeffortsagainsttheidentifiedissues.

2010/11 HighlightsDiseasePathwayManagementunderwentaprogrammaticreviewbytheCancerQualityCouncilofOntario(CQCO)inearlysummer2010.TheoutcomeofthereviewwasasetofrecommendationsonhowtostrengthentheDPMapproachinthefollowingareas:acceleratedproductionofpathwaymaps,workwiththeregionstofindlocalareasforimprovement,increasedmeasurementfocusonpatientoutcomes,andqualityofcare.

Otherachievementsin2010/11include:• Continueddevelopmentofdisease-specific

pathwaymaps,coveringcolorectal,lung,prostateandselectedgynecologicalcancers

• DyspneaManagementPilotProjectsinsixsites,resultinginpositiveimpactsonsymptommanagementandpatientsatisfaction

• LaunchingProstateCancerDiseasePathwayManagementwiththeassemblyofa53-memberteam,including10patientrepresentatives,undertheleadershipoftwoclinicalco-chairs

• Regionalengagementsessionsforcolorectalcancerandlungcancerqualityimprovement

Looking AheadIn2011,CancerCareOntariowill:

• PubliclyreleasethefirstclinicalpathwaymapsviatheCCOwebsite

• IdentifyprostatecancerPrioritiesforAction

• Makerecommendationsregardingimprovingguidelineconcordanceforlungcancer


MODELS OF CARE

Demandforcancerservicesisexpectedtocontinuerisinginthecomingyears,asaresultofincreasingcancerincidenceandtheprevalenceandcomplexityofcancertreatments.Inaddition,healthsystemresourcesremainconstrained.Takentogether,thesefactorswillmakeitincreasinglydifficulttosustaincurrentmodelsofcaredelivery.

Asaresult,CCOhaslaunchedthemulti-yearModelsofCareInitiativetochangehowOntariowillprovideandpayforcare,engagepatients,andpredictablyandreliablyplanforhealthhumanresourceneedsintothefuture.

Atitscore,ModelsofCareisinformedbytheneedtoimplementnewandinnovative,best-practice,patient-centred,multi-disciplinarymodelsofcancercare.

2010/11 HighlightsIn its first year, the priorities for the Models of CareInitiativewereevidence-informedplanningofactivitiesand determining priorities and scope. Early successesinclude:

• Engagingstakeholdersincomprehensivediscussionsaboutplanning,implementationandevaluationofnewmodelsofcaredelivery

• Developingaprincipleanddata-drivenapproachforthedeterminationofnewhumanresourceneedsaswellastheirallocationthroughouttheprovincetomeetprioritycareneeds.Throughapplicationofthisapproach,wesucceededinsecuringsupportfor11newradiationoncologistsand12medicaloncologists

• Facilitatingcollaborationbyclinicalleadsandoncologybusinessleadsonproposalsforchangestopaymentmodelswhichemphasizecollaborativedecision-making,informationsharing,andaccountabilityforaccessandqualityinsupportofthenewmodelsofcare

Looking AheadCancerCareOntariowill:

• Initiatethestagedimplementationofbestpracticemodelsofcare.Thefirstareaoffocuswillbestreamliningandimprovingthecareofcolorectalcancerpatientswhohavecompletedactivetreatment

• Continuetorefineprocessestotrackhealthhumanresourceneedsandalignhumanresourcesplanningwithoverallsystemplanning

• Workwithpartnerstostreamlineandharmonizealternatefundingplansforoncologistswithaviewtostrengtheningqualityaccountability

MULTI-DISCIPLINARY CANCER CONFERENCES

MultidisciplinaryCancerConferences(MCCs)bringclinicianswithvariousareasofexpertisetogetherinregularlyscheduledmeetingstodiscussdiagnosisandtreatmentofindividualcancerpatients.Participantsrepresentmedicaloncology,radiationoncology,surgicaloncology,pathology,diagnosticradiologyandnursing.Otherhealthcareprovidersinvolvedinapatient’scare--suchasdieticians,rehabilitationspecialistsandpharmacists--mayalsoattend.

EvidencesuggeststhatcasesreviewedatMCCsaremorelikelytoresultinpatientsreceivingevidence-basedcare,havingalltheirtreatmentoptionsconsidered,andenjoyingbetteroutcomes.MCCsarealsoamechanismforpeerreviewandqualityassurance.Theyfosterthedevelopmentofamultidisciplinarycultureacrossdisciplines,andencouragehospitalsacrossregionstoworktogether.

CCOprovidestoolstohelphospitalstaffstartuporimproveMCCsattheircentres.

MCCsensurethatallappropriatediagnostictests,allsuitabletreatmentoptions,andthemostappropriatetreatmentrecommendationsaregeneratedforeachcancerpatientdiscussed.

2010/11 HighlightsInthepastyear,morethan20,000patientswerethefocusofmultidisciplinarydiscussions.Ontarioregionalcentreswerecompliantwith78percentoftheminimumMCCqualitycriteria,upfrom72percenttheyearbefore.

Thispastyear,anupdatedMCCweb-basedresourcewaslaunched,andanextensiveevaluationoftheimpactofincreasingthecoverageandqualityofMCCsisunderway.

Looking AheadOverthenextthreeyears,regionswillbeaccountabletomorestringentqualityandaccesscriteria–theprojecthassetaverychallenging2015goalunderwhichallhospitalstreatingmorethan35uniquepatientswithagivencancerwillensureappropriatepatientshaveaccesstohighqualityMCCdiscussion.


IMPROVING THE PATIENT EXPERIENCE

CancerCareOntariohasmadegreatstridesintreatingthephysicalaspectsofcancer,butrecognizesthatthereismuchworktobedoneindealingwiththeimpactscancercanhaveonapatient’semotionalandpsychosocialhealth.

2010/11 HighlightsKeyaccomplishmentsof2010/11include:

• Conductedapatientsatisfactionsurvey,usingtheAmbulatoryOncologyPatientSatisfactionSurvey(AOPSS),ofmorethan8,000patients.Thesurveyassesseskeypatientexperiencedimensions:EmotionalSupport,Coordination/ContinuityofCare,RespectforPatientPreferences,PhysicalComfort,InformationCommunicationandEducation,andAccesstoCare

• Establishedaprovincialpatientadvisorycouncil(fundedbyagrantthroughtheCanadianHealthServicesResearchFoundation)

Looking AheadOneofthestrategiesintheOntarioCancerPlan2011-2015istocontinuetoassessandimprovethepatientexperience.

Theprioritiesfornextyearinclude:• Continuingtoengageandworkwiththe

PatientandFamilyAdvisoryCounciltoactasexpertadvisorsinoureffortstoimprovethepatientexperience

• ContinuingtomeasureandreportonpatientexperienceusingtheAOPSStool

• Developingacomprehensivestrategytoenhancemeasurementofpatientexperience

• Developingandimplementingasetofpatient-reportedoutcomemeasuresspecifictocancer


CANCER SURGERY

CancerCareOntario’sSurgicalOncologyProgramworkstocontinuallyimprovethequalityandaccessibilityofcancersurgeryacrossOntario.CCOmanagestheCancerSurgeryAgreementtoenhancesystemaccountability,meetshort-termsurgeryvolumerequirements,andsetthestageforlonger-termimprovementsinthequalityofcancersurgeryandintegrationofthecancersystem.

Thoracic Cancer Surgery Standards

Thoraciccancersurgeryisahighcomplexityoperation.Theliteraturedemonstratesaconsistentrelationshipbetweenthoracicsurgeriesperformedinadesignatedthoraciccancersurgerycentreandimprovedpatientoutcomes.Thereare15suchcentresinOntario.

2010/11 HighlightsIn2010/11,CCOcompletedtheimplementationofprovincialstandardstoconsolidatethoraciccancersurgeryindesignatedcentresinordertooptimizepatientoutcomes.AsofDecember2010,allnon-designatedcentreshavestoppedperformingthoracicsurgeryandhaveimplementedplanstopartnerwithadesignatedcentreforthecareoftheirthoraciccancersurgerypatients.

Looking Ahead Itisexpectedthattheprovincewillsoonsuccessfullymeetitstargetof90percentofthoracicsurgeriesperformedwithinathoracicdesignatedcentre.Thisisanimportantmilestone,assuccessfuloutcomessuchaslowermortalityanddecreasedcomplicationsareclearlylinkedtothenumberofsurgeriesperformed(minimumvolumes),andtotheavailabilityofspecializedsurgicaltrainingandhospitalresources.

Hepato-pancreatic-biliary Cancer Surgery Standards

Publishedevidenceindicatesthathospitalsthatperformhighvolumesofpancreaticsurgeryhavebetterpatientoutcomesthanthosewhoperformfewersurgeries.CCOreleasedtheHepato-pancreatic-biliary(HPB)CancerSurgeryStandardsin2006,withninecentresdesignatedtoperformHPBsurgery.CCOunderstandsthataccesstocareclosetohomeisimportantforpatients,butthismustbebalancedbytheneedforhigh-qualityandexpertcare.

2010/11 HighlightAsofMarch2010,fivehospitalsmetthevolumerequirements–onemorethanlastyear–andtwomoreareveryclosetomeetingtherequirementstobecomedesignatedHPBcentres.ThepercentageofpancreaticcancersurgeriesperformedindesignatedHPBcentreshasincreasedfrom79percentin2008to89percentin2010,whilethepercentageoflivercancersurgeriesperformedinadesignatedHPBcentrehasbeenrelativelyconsistentatapproximately87percent.

Looking AheadOntariowillsoonmeetitstargetof90percentofHPBsurgeriesintheprovinceperformedinspeciallydesignatedcentres.

Cancer Surgery Wait Times Surgicalwaittimesaremeasuredbytrackingthetimebetweenwhenadecisionismadetooperateandwhenthesurgerytakesplace.TheOntariogovernment’sWaitTimeStrategyhassettargetsfordifferenttypesofsurgeries.

AsapartnerintheWaitTimeStrategy,CCOisresponsiblefordirectingandmanagingfundingforcancersurgeries.Eachpatientcaseisprioritizedbythesurgeonanddependsonmanyfactorssuchasthetypeofcancer,patientcomplexityandprogressionofthedisease.

2010/11 Highlights In2010,75percentofcancersurgerycaseswerecompletedwithintheirtargettimes,animprovementfrom2009/10.

Variationexistsbetweendiseasesitesandbetweenprioritylevels.Endocrine,prostateandgynecologicalcancershavethelowestperformanceforPriority2cases,with28percent,33percent,and39percent,respectively,completedwithintheirtargets.Breastandsarcoma,ontheotherhand,havethehighestperformanceforPriority2cases,with66percentand82percent,respectively,completedwithintarget.

Looking AheadIn2011/12,CCOwillcontinuetoworkwithRegionalCancerProgramsandhospitalpartnerstoimprovecancersurgerywaittimes.

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RADIATION TREATMENT

Radiationtreatmentistheuseofionizingradiation(x-rays,gammarays,andelectrons)todestroycancercells.Ionizingradiationisalocaltreatment,affectingonlytheareatreated,andisoftenusedincombinationwithsurgeryorchemotherapy.

Improving Treatment Wait Times

CCOreportsonhowmanypatientsarebeingtreatedwithintherecommendedtimeframeortargets,accordingtotwointervals:

1. ReferraltoConsult–thetimebetweenreferralandbeingseenbyaradiationoncologist

2. ReadytoTreattoStartofTreatment–thetimebetweenbeingreadyfortreatmentandreceivingtreatment

ThetargetwaittimefortheReferraltoConsultintervalis 14days.TargetsfortheReadytoTreattoStartofTreatmentintervalvaryfromsevento14daysdependingonthepatient’scondition.

2010/11 HighlightsWaittimesforcancerradiationtreatmentcontinuedtheirdeclineacrossOntarioin2010/11comparedto2009/10.TheReferraltoConsultintervalimprovedby5percentfrom68.4percentofpatientsbeingseenbyaradiationoncologistwithin14daysin2009/10to71.5percentin2010/11despitea4percentincreaseinpatients.TheReadytoTreattoStartofTreatmentintervalalsoimprovedby8percentfrom75.8percentofpatientsbeingtreatedwithintargets(1,7,14days)in2009/10to81.7percentin2010/11witha4percentincreaseinthenumberofpatientsreceivingtreatment.

TheresultshavebeenachievedinlargepartduetotheinvestmentsmadebytheprovincialgovernmentbasedonadvicefromCCO.Overthepastfiveyears,governmentinvestmentsinradiationinfrastructureandequipmenthaveincreasedtheavailabilityandaccesstocancertreatmentsacrosstheprovinceincludingtheopeningofnewcancercentresinNewmarket(Southlake),andDurhamaswellasfacilitiesexpansionsinOttawaandKingston.TwonewsatellitesinOttawaandSaultSteMariealsocameonstreaminthatperiod.Theseinvestmentshaveresultedinanincreasein15treatmentunitsbetweenJuly1,2007,andMarch31,2011.

Looking AheadNewcancercentresarescheduledtoopeninthenexttwoyearsintheNiagaraRegionandBarrie.Thesecentreswillensurethatpatientscanreceivecareclosertohomeandnothavetotraveltoanothercentrefortreatment.Increasedcapacitymayhelptodecreasewaittimesandimprovetheutilizationofradiationtreatment.

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CCOANNUALREPORT10-11 25


Intensity Modulated Radiation Treatment

IntensityModulatedRadiationTreatment(IMRT)isaprecisemethodofdeliveringhigh-dosesofradiationtoatumourwhilesignificantlyreducingdosestothesurroundinghealthytissues.Thisincreaseslocalcontrol,reducestreatment-relatedmorbidityandincreasespatientqualityoflifeandcurerates.IMRTiscommonlyusedtotreatpatientswithbreast,prostate,headandneckcancer,aswellasbraintumours,sarcomasandpediatriccancers.In2009/10,CCObroadenedpatients’accesstoIMRTthroughthedevelopmentofaprovince-wideapproachtoimplementingIMRT,whichisthecurrentstandardofcareinradiationtreatment.From2008/2009to2010/11,thereweredramaticincreasesinthepercentageofIMRTbeingdeliveredacrosstheprovince,withtheprovincialaverageforallradicalIMRTcourses(excludingbreast)havingincreasedfrom17.7percentto32.2percent,respectively.TheRadiationTreatmentProgramcontinuestoworkontheseimprovementsbyfosteringanenvironmentofknowledgeexchange,qualityassurance,sharingbestpracticesamongthecancercentres,providingtargetedcoachinginitiatives,andimprovingaccesstospecializedcoursesandsymposiums.

2010/11 HighlightsThepastyearsawthedevelopmentofdisease-specificevidence-informedguidelinesforIMRT.TheseguidelineshavestrengthenedCCO’sabilitytomonitorappropriatenessofcareinOntario.

Inaddition,CCOenablededucationalcoursesformorethan215multidisciplinaryhealth-careprofessionals,includingradiationoncologists,radiationtherapistsandmedicalphysicistsfromacrosstheprovince.

Expertcoachingteamsfromwell-establishedprogramsprovidedguidanceforfivecancercentresdevelopingtheirprograms.Thisprovidedhands-ontraining,sharingofbestpracticesandexpeditedIMRTImplementation.

Looking AheadInthecomingyear,CCOisplanningtoholdseveralIMRTImageMatchingeducationalcoursesandworkshopsformulti-disciplinaryteamsfromacrossOntario,inadditiontoprovidingcoachingopportunitiestorequestingcancercentres.

**CCOwillalsopublishdisease-specificIMRTindicationsandcosteffectivenessanalysis.

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Clinical Specialist Radiation Treatment

TheuseofClinicalSpecialistRadiationTherapists(CSRTs)hasbeenshowntoimproveaccesstoservices,reducewaittimes,andleadtodevelopmentandimplementationofprocessimprovements.

ThemainfocusoftheCSRTDDemonstrationProjectistoassesstheaddedvaluetothecancercaresystemofdevelopingnewradiotherapypositionsinlinewiththeMinistry’sprioritiesofdecreasedwaittimes,increasedaccessandimprovedhealthofOntarians.TheprojectisintendedtocreateamodelfordevelopmentandimplementationthatwouldensurestandardizedimplementationofCSRTpositionsacrossOntario.

Projectgoalsincludeensuring:

• Allpatientsacrosstheprovincereceiveappropriateandqualityradiationtreatmentbasedonbestavailableevidenceandexpertconsensus

• Radiationtreatmentisdeliveredinawaythatissafeforpatientsandstaffacrosstheprovince

• Allpatientsaccesstheradiationsystemappropriately,andasquicklyandasefficientlyaspossible

• Patientsreceivecareinacoordinatedwayintherightplaceasclosetohomeaspossible

• Thefosteringofanenvironmentoftechnicalinnovationandparticipationinclinicaltrialsandresearch

2010/11 HighlightsThe eight CSRTs in four cancer centres continued tohelpimprovewaittimesandaccesstocareforpatientsby identifying potential efficiencies and improvingeffectivenessofcarethroughinnovationandenhancedservices.

CSRTsalsocontinuetomakesignificantcontributionsto the knowledge base of not only radiation therapypractice,buttotheoverallpracticeofradiationmedicinewith publications of manuscripts, presentations andparticipatinginresearchstudies.

Looking AheadTheinitiativewillmoveintoathree-yearsustainabilitybuildingphasetopermanentlyintegratetheCSRTroleintoOntario’scancercaresystem,expandthepositiontoallregionalcancerprograms,andworkwiththeCanadianAssociationofMedicalRadiationTechnologiststoformalizetherole.


SYSTEMIC TREATMENT

Systemictreatment–orchemotherapy–usesdrugstosloworstopcancercellsfrommultiplyingorspreadingtootherpartsofthebody.Aswithmostcancertreatments,thesoonerchemotherapyisgiven,thebetterthelikelyoutcomeforthepatient.

Improving Treatment Wait Times

Waittimesforsystemictreatmenthaveimproveddespiteanincreasingincidenceandprevalenceofcancerandgrowingdemandforcancerservices.

CCOpubliclyreportsmonthlycurrent,comprehensiveandspecificSystemicTreatmentWaitTimesinformation.SystemicTreatmentwaittimesarereportedaccordingtotwointervals:

3. WaittimesbytargetforReferraltoConsult–Thetimebetweenareferraltoaspecialisttothetimethatspecialistconsultswiththepatient

4. WaittimesbytargetforConsulttoTreatment–Thetimebetweenaspecialistconsultwiththepatientandthetimethepatientreceiveshisorherfirstchemotherapytreatment

ThetargetforbothConsulttoTreatmentandReferraltoConsultis14days.

Systemicnewcases2009/10 40,5262010/11 47,748Increaseof17.8percentincasesfundedbyCCO

Regional Systemic Treatment Program

TheRegionalSystemicTreatmentPrograminitiativeaimstoensurethehighestqualityofsystemictreatmentisavailabletoOntarians,asclosetohomeaspossible.Theprogramhassetanumberofevidence-basedstandardsforthesafeandeffectivedeliveryofsystemictreatment.Thisisaccomplishedthroughtheestablishmentofregionalprogramsandpartnerships,networkbuilding,bestpracticesharingandimplementationofevidence-basedguidelines.

2010/11 HighlightsAsofOctober2010,84percentofOntariohospitalsprovidingchemotherapyhadupdatedpoliciesandproceduresinplaceforthesafehandlingofcytotoxics(immunosuppressivedrugs). Thisisupfrom77percentin2009.

In2011,CancerCareOntarioinitiatedaPatientandProviderSafetyCollaborativeineachregionthatwillidentifyfurtherareasforimprovementthatoptimizesafedeliveryfromordersthroughpreparationtoadministration.

Systemplanningwasstrengthenedtoaccommodatetheexpectedincreaseindemandfortreatment.CCOworkedcloselywithprovincialstakeholderstoidentifyrequiredhealthhumanresources(e.g.medicaloncologists).

Incrementalfundingforsystemictreatmentwasprovidedtocommunityhospitalstoexpandcapacityanddelivercareclosetohome.

InkeepingwithCCO’semergingworkinprovidingoversightforveryspecializedcancerservices,theStemCellTransplantOversightProgramwasintroducedin2010forplanningandmonitoringofin-provincedeliveryofhighqualitystemcellandbonemarrowtransplantservices.

CCOisdevelopinganapplicationtoenhance,captureandanalyzetheminimumdatasetrequiredtosupporttheStemCellTransplantProgram’sobjectives. CCOiscollectingStemCellTransplant(SCT)relateddatafromSCTFacilitieswithPersonalHealthInformation(PHI). Theprogrambeganwithadefinedminimumdatasetfor2010/11.Additionalelementswillbeaddedin2011/12astheprogramdevelopsfurther.

Looking AheadCCOissettoexpandandimprovetheuseofSystemicTreatmentComputerizedPhysicianOrderEntry(CPOE)inOntario.CPOEisacriticaltoolforpromotingpatientsafetybecauseitminimizeserrorsinguidelines,enhancesunderstandingofcomplexdrugregimens,andlimitsexposureofhealth-careproviderstocytotoxins.TheCPOEexpansionprojectinvolvesexpandingOPIS,CCO’schemotherapymedication-orderingsoftware,toanadditional15hospitalsites.Italsosupportsanumberofotherinitiatives,includingenhancingCCO’sdrugformularyeTool,sharingCPOEbestpracticeguidelines,expandingdatacollectionandimprovingthehospitalelectronicclaimsprocessfortheNewDrugFundingProgram.

TheexpansionisexpectedtobecompletedbyMarch31,2013.

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CANCER IMAGING

TheCancerImagingProgram(CIP)atCancerCareOntariowascreatedin2009inrecognitionoftheimportanceofimaginginallphasesofthecancercarejourney.

2010/11 HighlightsDuringthepastyear,theCIPestablishedregionalleadershiptocreateaclinicalqualityagendaforcancerimagingtoensurethatpatientneedsacrosstheprovincearerepresentedandaddressed.2010wasalsothefirstyearthatCCObecameaccountableforPositronEmissionTomographyimagingintheprovince.PETisanuclearimagingtechniquethatproducesathree-dimensionalimageorpicture.Itcanbeusefulindeterminingtheextentofsomecancersandotherdiseases,whichhelpsdeterminethemostappropriatetreatment.

Overthepastyear,theprogramhascontinuedtobuildevidenceforPETimagingtoensurethatOntariansreceiveimaging,leadingtothebestpossibleoutcomes.InitiativessuchasthePETAccessProgramandthelaunchofanonlinereferralsystemtostreamlinethereferralprocessanddecreasedelayscontinuedtoimproveaccessibilityforOntariopatientsin2010/11.

Looking AheadInthenextthreeyears,CCOislookingtobuildonthefoundationputinplacein2010/11,including:

• Identifyingbest-practicestandardsforimagingthroughoutthepatientjourney,beginningwithlungandcolorectalcancers

• Implementingaknowledgetransferstrategytoimprovephysicianawarenessofappropriatepractice

• Identifyingcontributingfactorstowaittimesforpriorityinterventionalradiologyprocedures

• ContinuingtofocusonensuringallOntariopatientswhomaybenefitfromaPETscanarereferred

• ExpandingaccesstoemergingindicationsforPET

• ContinuingtobetransparentregardingprocessesanddecisionsrelatedtoPETscanning

MOLECULAR ONCOLOGY

Personalizedmedicineisaburgeoningareathatispoisedtofundamentallychangehowcancerisdiagnosedandtreated.Personalizedmedicinetailorsmedicaltreatmentstotheuniquecharacteristicsofeachindividualpatient.Itreliesonanunderstandingofhowaperson’suniquemolecularandgeneticprofilemakeshimorhersusceptibletocertaindiseases,aswellaswhichmedicaltreatmentswouldbethereforesafeandeffectiveandwhichoneswouldnotbe.

Becauseeachpersonisunique,thenatureofdiseases–includingtheironset,theircourse,andhowtheymightrespondtodrugsorotherinterventions–isasindividualaseachperson.Personalizedmedicineisaboutmakingthetreatmentasindividualizedasthepersonandthedisease.

MolecularOncology–anareaofpersonalizedmedicine–usesinformationaboutaperson’sgeneticcompositiontopredictcanceranditsprognosis,andtodiagnose,monitorandselectcancertreatmentsmostlikelytobeofbenefittotheindividualpatient.

2010/11 HighlightsCCOestablishedaprovincialexpertadvisorycommitteetoprovideevidence-basedadvicethatwillinformsystemplanning,newtestdevelopment,accessandqualityassurance.

Looking AheadCCOwillpublishresultsoftheadvisorycommittee’shorizon-scanningandevidence-reviewactivitiesandwillworkwithpartnerstodevelopamechanismtoallowtimelyintroductionofnewmoleculartests,diagnosticprediction,andtargetedtherapeuticsastheyrelatetocancer.

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THE NEW DRUG FUNDING PROGRAM

TheNewDrugFundingProgram(NDFP)fundsnewandexpensivecancerdrugsthataresupportedbyclinicalguidelinesandpharmacoeconomicevidence,andhelpsensurethatOntariocancerpatientshaveequalaccesstohigh-qualityhospital-administeredcancerdrugs,regardlessofwhereinOntariotheylive.TheNDFPisadministeredbyCCOandwasestablishedin1995.ItisnowoneofsevenpublicdrugprogramsfundedbytheMOHLTC.

2010/11 HighlightsIn2010/11,theMOHLTCinvestedapproximately$220millionintotheNDFPtoreimbursemorethan23,000patientcaseswithatotalof27cancerdrugsand61indications.

Alsothispastyear,twonewdrugsandthreenewcancerindicationswereapproved.

Looking aheadCancerCareOntariowillcontinuetoenhancetheNDFPin2011/12by:

• ImplementinganEvidence-BuildingProgramforcancerdrugsthatwillsupportmakingcancerdrugsavailablewhenevidenceisemergingorincomplete

• ImplementingtheCase-By-Case(Compassionate)reviewprogram,whichwillprovidepublicfundingforotherwiseunfundeddrugsinexceptional,life-threateningcircumstances

• WorkingtosupportenhancementstoCCO’sComputerizedPhysicianOrderEntrysystem

• WorkingwiththeMOHLTCtosupportthetransitionfromtheInterimJointOncologyDrugReviewtothenewpan-CanadianOncologyDrugReview

ONTARIO CANCER SYMPTOM MANAGEMENT COLLABORATIVE

TheOntarioCancerSymptomManagementCollaborative(OCSMC)aimstoimprovethepatientexperiencebyenhancingthequalityandconsistencyofthepatient’sphysicalandemotionalsymptommanagement.ThecollaborativeinvolvesalloftheRegionalCancerProgramsinpromotingearlieridentification,documentationandcommunicationofpatients’symptoms.Ideally,thisleadstobettersymptommanagementandcollaborativecareplanningwhichimprovesthepatientexperienceacrossthecancerjourney.

TheOCSMCemployscommonassessmentandcaremanagementtools,includinganelectronictoolcalledInteractiveSymptomAssessmentandCollection(ISAAC),whichputspatientsincontroloftheirsymptomassessment.

2010/11 Highlights Implementationofroutinepatientsymptomassessmentsteadilyimprovedoverthepastyear.AsofMarch2011,34,000assessmentsareoccurringeachmonth.Thisrepresents50percentofallcancerpatientsseenattheRegionalCancerCentres.

AllofCCO’s14RegionalCancerCentresand10partnersystemictreatmenthospitalsnowofferpatientstheabilitytoreporttheirsymptomselectronically.CCOalsosupportedtheintegrationofISAACwithhospitalelectronichealthrecordsatsixcancercentrestoimprovecommunicationandreduceworkload.

Evidence-informedsymptommanagementguides-to-practiceandclinicalalgorithmswerepublishedtohelpcliniciansmanageapatient’ssymptomsandtomakeappropriatereferralswhennecessary.CCOissupportingstrategiestoenabletheuseoftheseguides,includingmakingthemavailableasmobileapplications.

Looking AheadCCOwillcontinuetomeasureandreportonsymptomassessmentandthe2011/12provincialtargetisfor70percentofallcancerpatientsvisitingregionalcancercentrestobescreenedeachmonth.AccesstoISAACwillbeexpandedtoanadditional10partnerhospitalsthisyear.ActivitiesarealsounderwaytoincreaseclinicianuseofsymptommanagementguidesandCCOwillmeasuretheadoptionandsuccessoftheguides.


SURVIVORSHIP AND FOLLOW-UP CARE

Duetoadvancesinearlydetectionandscreening,aswellasimprovedtreatments,peoplearelivinglongerwithcancer. By2017,anestimated400,000Ontarianswillbelivingwiththedisease,representinga40percentincreaseinthespaceof10years. Survivorshipcareisclearlybecomingaseparateandimportantbranchofcancercare,requiringitsownguidelinesandbestpractices.

In2008,CCOstruckanexpertpaneltoprovideuswithadviceonourroleinsurvivorshipcare.Thegrouphasidentifiedtwopriorities:

5. Reducingthevariabilityandstandardizingsurvivorshipcarebystrengtheningtheevidentiarybase

6. Promotinginnovativemodelsofsurvivorshipcare

2010/11 Highlights Highlightsofthepastyearincludethedevelopmentofanevidence-basedguidelineoncolorectalcancerfollow-upcareandthedevelopmentofaguidelineonmodelsofsurvivorshipandfollow-upcare.

Looking AheadCCOwillcontinueworktoidentifyevidence-based,innovativemodelsofsurvivorshipandfollow-upcare,suchasshared-careandgroupvisits,whichwilloptimizetheuseofsystemresources,whilemaintainingorenhancingthepatientexperience.ThefirstareaoffocuswillbeimplementingCCO’snewevidence-basedguidelineoncolorectalcancerfollow-upcare.Theroll-outofthisnewmodelofcarewillbeguidedbydemonstrationprojects,andsupportedbyacomprehensiveknowledgetransferandexchangeprogram.

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INFRASTRUCTURE

CAPITAL PROJECTS

OneofCancerCareOntario’sprimaryresponsibilitiesiscoordinatingcapitalinvestmentstobuildandequipcancerdiagnosisandtreatmentfacilities.ThisincludeseverythingfromthebuildingofnewcancercentrestoimplementingtheRadiationTreatmentandRelatedEquipmentReplacementStrategy,whichisdesignedtoensurethatOntariopatientsbenefitfrominfrastructurethatmeetstheneedsandqualityofcarestandards.

2010/11 HighlightsInthepastyear,CCOfocusedontheseinfrastructurepriorities:

• Ongoingdevelopment/expansionofmajorcancertreatmentfacilities:NorthSimcoeMuskokaRegionalCancerCentreinBarrie,ExpansionofSudburyRegionalHospital-RegionalCancerPrograminSaultSteMarieandongoingconstructionoftheWalkerFamilyCancerCentreattheNiagaraHealthSysteminSt.Catherine’s,anintegratedprogramoftheJuravinskiCancerCentreinHamilton

• Securedanadditionalone-timeallocationforradiationreplacementfundingtotaling$4.5milliontoaugmenttheannual$29.5millionallocation.This$34.0millionwasallocatedto10regionalcancercentrestoupgraderadiationequipmentwithmoreadvancedunits

• Providedtechnicaladviceandco-ordinationfortheconstructionofnewfacilitiesinNiagara,KingstonandBarrie

• IssuedRequestforProposalstoestablishVendorofRecordarrangementsforRadiationTreatmentMachines,RadiationOncologyInformationSystemsandTreatmentPlanningSystems

• ThecancercentreisnowopeninSaultSte.MariewiththecompletionoftheconstructionofthenewSaultAreaHospital

Looking AheadActivitiesplannedfortheyearaheadinclude:

• DevelopmentofaCapitalInvestmentStrategyforRadiationTreatmentServices

• SecuringoffundingforadditionalradiationtreatmentequipmentinDurham,GrandRiverandNewmarket

• MonitoringandassessmentoftheintroductionofnewradiationtreatmentandsimulationtechnologiesastheyrelatetoCyberKnifeunitsinOttawaandHamilton,andMagneticResonanceSimulatorinLondon

• Movingforwardwithcapitalinvestmentsinnewtreatmentfacilitiesin,Barrie,Niagara,andKingston

• RelocationofthePortableRadiationTreatmentFacilityfromOttawatoPeterboroughtoprovidecaretopatientsinthePeterboroughregion.Therelocationofthisfacilitymeansapproximately400patientsayearwillnothavetotraveltoOshawafortreatment

• ManagingtheRadiationReplacementGrantprocesstodistributefundingbasedonprovincialpriorities,andworkingtosecureadditionalfundingtobetter addresstheincreasingamountofagingradiationequipmenteligibleforreplacement


ACCESS TO CAREAccesstoCareworkstoimprovepatients’accesstohealth-careservicesandreducewaittimesinsupportoftheprovincialGovernment’sWaitTimeandER/ALCStrategies.ATCachievesthisthroughitsleadershiproleinadvisinggovernmentontheuseofinformationtoimproveaccesstoservicesacrossOntario’shealth-caresystem,aswellasthroughthedevelopmentanddeploymentofnewinformationsolutions.

ATCprovideshigh-qualityinformationproductsandservicestotheMinistryofHealthandLong-TermCare,LHINs,hospitals,thepublicandotherkeystakeholders.Theseproductsenableperformanceimprovementandensureaccountabilitywithinhealthcareorganizations.TheycontaininformationfromATC’sfourlinesofbusiness:

1. AlternateLevelofCareInformation

2. EmergencyRoomInformation

3. SurgeryandDiagnosticImagingWaitTimes

4. SurgicalEfficiencyTargetsProgram

ALTERNATE LEVEL OF CARE INFORMATIONIn2008/09,itwasdecidedthataspartoftheER/ALCInformationStrategytheWaitTimesInformationSystemwouldbeexpandedtoincludeALCinformationinnearreal-timeinbothacuteandpost-acutecare.The114hospitalsinvolvedinthisprojectrepresentabout95percentofhospitalsbedsinOntario.

2010/11 HighlightsActivitiesundertakenthispastyear,inpartialfulfillmentofCCO’scommitmenttodeliverontheER/ALCInformationStrategy,include:

• DevelopmentoftheWTIS-ALCapplicationanddeploymenttosixhospitals

• IdentificationofbarrierstomovementofALCpatientswithverylongwaits,whichledtostrategiesthatwereimplementedbyLHINs

Looking AheadIn2011/12ALCwillfullydeliverontherecommendationsintheER/ALCInformationStrategyfocusedoncapturingALCinformationincluding:

• DeploymentoftheWTIS-ALCtotheremaining108acuteandpost-acutecarefacilities

• TransitionofperformancereportdatasourcesfromALCInterimUploadTooltotheWTIS-ALC

• Additionofself-reportingfunctionalitythroughiPortTMAccess,forhospitals,LHINS,andtheMOHLTC.iPortisasecure,web-basedanalytictoolthatprovidesplannersandpolicy-makerswithinstantaccesstoclearandaccurateprovincialandLHINlevelcancerinformation

• Aone-yearfollow-uptotheALCLongWaitCasesstudyusinglivedatatodetermineperformanceimprovements

• EnhancementtotheWTIS-ALC,includingadditionaldataelements,basedonrecommendationsfromATCstakeholders

EMERGENCY ROOM INFORMATION

ThemorethatisknownabouttheflowofpatientsthroughtheER,themorethepatientexperiencecanbeimprovedandwaittimesreduced.TheER/ALCStrategyincludesstreamliningERdatasubmissionandenablinglinkagestootherdatasets.

Toaddressthis,ATCpartneredwiththeCanadianInstituteforHealthInformation(CIHI)toleveragetheNationalAmbulatoryCareReportingSystem(NACRS)forthetimelycollectionofERwaittimedata.TheEmergencyRoomNationalAmbulatoryInitiative(ERNI)wasintroducedin2009tohelpmeasureandreporthowlongpatientswerespendingintheER.Ninety-onefacilitiesacrosstheprovincearecollectingandsubmittingERdata,whichisnowpubliclyreported.

2010/11 HighlightsAspartofanexpansionofERNI,inMay2011hospitalsbegancollectingfivenewdataelementsrelatedtoconsultsbyphysicianspecialists.Intotal,clinicianswillbecollecting38dataelementsrelatedtothepatientjourneythroughtheemergencyroom.Thisincludeseverythingfromambulanceoffloadtime,towhenpatientsarefirstseenbyaphysicianandtheneventuallyleavetheemergencydepartment.

Alsoin2010/11,CCOdevelopedaclinicalengagementprogramstrategythatfocusedondataqualityimprovement.ATCworkedwith91clinicalleadstohelpeducateERstaffandchampiontheimportanceofhigh-qualitydata.

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Looking AheadIn2011/12,CCOERInformationstrategicplanningwillfocusonadvancingprogramobjectives.Thiswillinclude:

• ProposingnewdataelementsforadditiontotheERNIdataset

• ContinuingtofocusoncomplianceanddataqualitytoensurethatERinformationismeaningfulto allstakeholders

SURGERY AND DIAGNOSTIC IMAGING WAIT TIMES

TheWaitTimesInformationSystemisaprovince-widesystemthattracks,measures,andreportsonsurgicalanddiagnosticwaittimes.Morethan3,300cliniciansin94waittime-fundedhospitalssubmitinformationon2.3millionadultandpaediatricsurgeriesandMRI/CTscanseachyearinOntario.Publicreportingofthisinformationbeganin2006.Cliniciansuseastandardpatientpriorityratingandtargetsthatweredevelopedbyexpertpanels.

2010/11 HighlightsLastyear,publicreportingofwaittimeswasexpandedtoincludeallsurgicalareas.Seventy-fivepercentofpatientsinOntarioreceivedtreatmentwithingovernmentbenchmarksforallprocedures.Forexample,CTscanswereperformed50dayssooner,whichisa62percentimprovement.

Looking Ahead2011/12willbringsignificantenhancementsandadditionstotheWTISincluding:

• ExpansionoftheWTIStocaptureWait1forsurgery.Wait1isthewaittimefromreferraltoasurgicalspecialisttothefirstconsultation.Thisdatawillassistinunderstandingthetotalwaittimeforsurgeryandinformaccessperformanceimprovementstrategies.Reportingwillbeginin2012/13

• DeploymentoftheWTIStohospitalswithneworadditionalMRI/CTmachines

• DevelopmentandrolloutofanOrthopaedicQualityScorecardforhipandkneereplacementswhichprovideshospitalsandLHINswithatooltosupportqualityimprovement

• EnhancementstotheWTISforbothsurgeryanddiagnosticimagingtoimprovequalityofdatabeingcaptured

SURGICAL EFFICIENCY TARGETS PROGRAM

TheSurgicalEfficiencyTargetsProgram(SETP)usesdataaboutOperatingRoom(OR)performancetoidentifyareaswhereperformanceissuesexistintheperioperative(thedurationofapatient’ssurgicalprocedure,fromadmissiontodischarge)portionofthecontinuumofcare.SETPmeasuresandreportsonsurgicalmanagementKeyPerformanceIndicators,benchmarkstheperformanceofcomparablehospitals,andestablishesprovincialperformancetargetsinsupportofprocessimprovements.ThisprogramhelpstooptimizesurgicalcapacityinOntario,increasesaccesstosurgicalservicesandmaintainshigh-qualitypatientcare.

2010/11 HighlightsOverthepastyear,SETPimplementedstandardizedprocedureservicereporting,enhancedreportingofsurgicaldelaysandcancellations,andinitiatedpublicreportingoftheSurgicalSafetyChecklist.

Sincereportingbegan,complianceamongSETPhospitalshasbeenabove90percent,meaningthatallthreephases(Briefing,TimeoutandDebriefing)ofthechecklisthavebeenconducted.

Looking AheadNextyear,SETPwill:

• Identifyopportunitiestodriveprovincialperioperativeperformanceimprovements

• Implementstandarddefinitionsforpreadmissionscreeningandsurgicalblockswhichwillimprovedataqualityandpromotebetterconsistencyacrosstheprovince

• EstablishprovincialperformancetargetsforthePercentageofPatientsScreenedPriortoSurgeryandPercentageofSubsequentCaseOn-TimeorEarlyIndicators

• Promotesharingofperioperativeleadingpracticesacrosshospitals


ONTARIO RENAL NETWORKProvincial Program Management

CCOisoverseeingthenewlyestablishedOntarioRenalNetworkasitmovesforwardwithestablishingleadership,governance,andaccountabilitystructurestoenabletheimplementationofaworld-classsystemfordeliveringcaretoOntarianslivingwithchronickidneydisease.

Attheprovinciallevel,theORNhasformedajointexecutivecommitteewiththeMOHLTC.TheORN’sworkplan,includingtheprovincialorganizationalstructureandbudget,wasapprovedbytheMOHLTC.AnevaluationframeworkfortheORNconsistingofkeydeliverablesandtargetshasbeendeveloped.

TheORNhasalsoestablishedtheOntarioRenalCouncil,whichhasabroadrangeofstakeholdersbringingdiverseperspectivesandadvicetotheworkoftheORN.

TheORNhasrecruitedastrongprovincialleadershipteamandstruckanumberofimportantcommitteestoleadtheimplementationofitsgoalsandactivities.Thesecommitteesinclude:

• AClinicalAdvisoryCommittee–consistingoftheProvincialMedicalDirector(chair)andsixnephrologistswithregional,academicandcommunityrepresentationacrosstheprovince–whichmeetsregularlytoprovideclinicalguidancetotheworkoftheORN

• TheDataCollectionandAnalysisAdvisoryPanel(DCAAP)– consistingofrepresentationfromtheformerTheRenalDiseaseRegistry(TRDR)AdvisoryCommittee,ORNleadershipandotherstakeholders–whichmeetsregularlytoprovideexpertfeedbackandinputondataandperformancereportingactivities

• AHospitalLiaisonCommittee–consistingofhospitalCEOsandsenioradministratorsfromeachofthe26RegionalCKDprograms,andfivedirectfundedsatellitesacrosstheprovince–whichhasbeenestablishedtoactasacriticalsoundingboardforhospitaladministrationrelatedactivities(e.g.,fundingmodels)

• AProvincialLeadershipForum–comprising

the14ORNRegionalDirectors–whichmeetsmonthlyasaforumtoplanandcoordinatetheprovisionofCKDservicesinOntario

Funding Agreements and Allocation

TheMOHLTChasendorsedanewprocessfortheallocationoffundsforCKD.ThisrequirestheORNtomanagetheprocessofallocatingfundsforincrementalserviceandadviseonbasefundingallocation.Tosupportthisfunction,theORNhasengagedinthefollowingactivities:

• ContractualCKDProgramAgreementsforincrementalfundinghavebeensignedwithCKDserviceproviders(hospitalsanddirectlyfundedsatellites)acrosstheprovince.Theagreementssetincrementalfundingbasedonvolumes,performance,qualityimprovementactivitiesanddatasubmissionrequirements

• The2010/11in-yearincrementalfundingallocationprocesswasledbytheORNandcompletedincollaborationwithCKDRegionalPrograms,LHINsandtheMOHLTC.Thisprocessrequiredextensiveengagementwithhospitalstoreviewfundedandyear-endforecastactivityvolumes,toresolvedatadiscrepancies,andtomakeanynecessaryfundingadjustments

Activity-based Funding Model

InNovember2008,theJointPolicyandPlanningCommittee(JPPC)recommendedacase-basedfundingmodelforCKDthataddressesashortfallinCKDcostsandaccountsforclinicalcomplexity.InresponsetotheMOHLTC’srequesttodevelopanewfundingmodelforCKDby2010/11,aproposedfundingframeworkwasdevelopedandreviewedbytheClinicalAdvisoryCommittee,theProvincialLeadershipForumandaFundingModelReferencePanel.

Thisframeworkiscurrentlybeingdiscussedwiththe14RegionalRenalSteeringCommitteesacrosstheprovinceaswellastheMOHLTC.Inthespringof2011,theMOHLTCmadeaninitialinvestmentinthisenhancedframework.

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Capacity Planning

TheMOHLTChasrequestedthattheORNdevelopaprovincialdialysiscapacityplanthatwillprojectcurrentdialysisserviceutilizationpatternsinOntarioto2013,thusdeterminingwhat,ifany,needexistsforadditionaldialysiscapacity.ThisyeartheORNhas:

• Identifiedthedialysiscapacitysurplus/shortfallforeachLHINusingcurrentpatienttravelpatterns,drivetimeanalysis,dialysisstationutilizationratesandhomedialysisrates,andproposedoptionstomaximizeexistingcapacityineachregionwhereappropriate

• DevelopedaProvincialCapacityPlanwithrecommendationstotheMOHLTC

Regional Program Management

TheORNnowhasaregionalstructuretosupporttheeffectivebusinessoperationsandimplementationofCKDprogramprioritiesacrossthe province.Thisstructureiscarryingoutitsmandatetoimprovethecoordination,managementandqualityofCKDservicesintheprovince.

Therecruitmentof14RegionalDirectorsand14regionalmedicalleadshasbeencompletedineachLHIN.

Performance Measurement and Management

PerformancemeasurementandmanagementisoneofthecoreareasofbusinessfortheORN.TrackingprogressonthesuccessoftheORN’sstrategicinitiativesatbothaprovincialandregionallevelwillhelpinformdiscussionswithregionalCKDprogramsonareasthatrequireadditionalattentionorsupport.Thefollowinginitiativesareunderwayinthisarea:

• Aperformancemeasurementandmanagementcyclehasbeendevelopedtotrackprogressandwillbefullyimplementedin2011/12

• Aregionalreportandscorecardofkeyperformancemetricshasbeendevelopedtosupporttheperformancemanagementprocess

• TheClinicalAdvisoryCommitteehasidentifiedandendorsedasetofqualityindicatorsforCKDthatarealignedwiththegenerallyacceptedguidelinespublishedbytheNationalKidneyFoundationintheUnitedStates

(KidneyDiseaseOutcomesQualityInitiative)andtheCanadianSocietyofNephrology

Information Management/Technology

Untilrecently,datawasavailableforonlyhalfofchronicdialysispatientsintheprovince.TheORNisinvestinginaninformationmanagementsystemthatwillobtaintimelydataonallCKDpatientsintheprovince.Thiswillenablethedevelopmentofabaselinepictureofqualityintheprovince.Thefollowingprogresshasbeenmadetowardsthisbroadergoal:

• AnagreementwassignedwithUniversityHealthNetworktotransferTheRenalDiseaseRegistry(TRDR)includingintellectualproperty,tworenaldiseaseregistrystaff,technicalinfrastructureanddatapreviouslycapturedbytheregistrytotheORN

• Aone-timesurveywasadministeredtoCKDprogramsacrossOntario,representingapproximatelyhalfofprogramsthatdidnothistoricallysubmitdatatoTRDR

• TheORNnowhasaprovincial,minimumdatasetentitledtheOntarioRenalReportingSystem(ORRS),onallchronicdialysispatientsintheprovince

• TheORNhasnowimplementedamonthlydatacaptureandreportingprocessforincidentandprevalentchronicdialysispatientinformation

• AdatasharingagreementbetweenCCOandtheCanadianInstituteforHealthInformationhasbeensigned

• TheORNhascommencedcollectionofCIHI’sCanadianOrganReplacementRegistry(CORR)chronicdialysispatientinformationtostreamlinedatacollectionactivitiesonbehalfofCKDserviceprovidersinOntario

• AsecureportalfortransmissionofpersonalhealthinformationhasbeenestablishedforusebyCKDserviceproviders

• AnORRStechnicalinfrastructurerebuildisunderway

• Thedevelopmentofalong-term,integratedsolutiontoelectronicallycapturedatafromCKDserviceprovidersacrosstheprovinceiscurrentlyunderway

CCOANNUALREPORT10-11

Communications and Stakeholder Relations

Inanefforttoimprovetheorganization’stransparencyanddeveloprelationshipswithstakeholders,thefollowingactivitiesareunderway:

• TheORNhasitsownwebsite,www.renalnetwork.on.caandnewsletter,ORNConnects.SixissuesofORNConnectshavebeenreleasedtostakeholderssinceFebruary2010.Goingforward,thisnewsletterwillbeissuedonaquarterlybasis

• TheORNisdevelopingacommunicationstrategythatwillidentifyengagementopportunitieswithkeystakeholdersandmediaaswellastheorganization’skeymilestones

• TheORNhelditssecondtownhallinJune2010thatwasattendedbyabroadrangeofstakeholdersacrossOntariotoconfirmandfurtherdeveloptheORN’spriorities

• TheORNhelditsinauguralplanningdayinMay2011attendedbyCKDleadersacrossOntario

• AseriesofmoreintimateengagementactivitiesisbeingplannedtofurtherdevelopimportantORNrelationshipswithprimarystakeholderssuchasRenalAdministrativeLeader’sNetworkofOntario,OntarioAssociationofNephrologists,KidneyFoundationofOntarioandotherindustryrepresentatives

• Lookingahead,theORNwilldeveloptheirfirstmulti-yearplanforCKDservicesacrosstheprovince

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HUMAN RESOURCES

Duringthe2010-11fiscalyear,CCO’sstaffcomplementgrewasaresultofanexpansionofourscopeandmandate,inparticularintheareaofAccesstoCare,PositronEmissionTopographyandtheOntarioRenalNetwork.

Forfiscal2010-11,CCO’sFTEtotalwas688.50.


FINANCIALS

40



See accompanying notes to the financial statements. 3

Cancer Care Ontario Statement of financial position (In thousands of dollars) March 31 2011 2010 Assets Current Cash and cash equivalents (Note 3) $ 155,804 $ 106,331 Short-term investments (Note 4) 80,982 30,044 Receivables and prepaids (Note 5) 20,253 36,912 257,039 173,287 Long-term investments (Note 4) - 50,080 Capital assets (Note 6) 103,488 97,542 $ 360,527 $ 320,909 Liabilities Current liabilities Accounts payable and accrued liabilities (Note 7) $ 190,280 $ 135,877 Deferred operating grants (Note 8(a)) 6,546 37,434 196,826 173,311 Deferred contributions related to capital assets (Note 8(b)) 115,930 101,786 Post-retirement benefits other than pension plan (Note 9(b)) 3,314 3,356 316,070 278,453 Fund balances Endowment 2,317 2,317 Internally and externally restricted 10,005 23,822 General – unrestricted 26,669 14,585 Investment in capital assets 5,466 1,732 44,457 42,456 $ 360,527 $ 320,909 Commitments (Note 15) Contingencies (Note 16) Guarantees (Note 18)

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Cancer Care Ontario Statement of operations (In thousands of dollars) Year ended March 31, 2011 Restricted General Total 2011 2010 2011 2010 2011 2010 Revenue Ministry of Health and Long-Term Care $ - $ - $ 777,962 $ 697,165 $ 777,962 $ 697,165 Capital contributions from Ministry of Health and Long-Term Care for Integrated Cancer Programs - - 11,216 16,232 11,216 16,232 Ministry of Health Promotion - - 695 3,066 695 3,066 Net investment income (Note 11) 25 41 2,488 1,090 2,513 1,131 Amortization of deferred contributions related to capital assets (Note 8(b)) - - 30,981 28,303 30,981 28,303 Other (Note 12) 5,914 10,947 7,156 7,780 13,070 18,727 5,939 10,988 830,498 753,636 836,437 764,624 Expenses Integrated Cancer Programs Services 88 2,025 292,398 284,946 292,486 286,971 Drugs - - 218,983 199,094 218,983 199,094 Salaries and benefits 2,954 3,083 59,348 52,212 62,302 55,295 Surgical services – hospitals - - 51,101 49,475 51,101 49,475 Chronic kidney disease services - - 46,073 - 46,073 - Screening services - - 40,498 41,272 40,498 41,272 Amortization of capital assets 51 121 32,351 28,552 32,402 28,673 Purchased services 2,296 5,506 21,715 13,642 24,011 19,148 Capital contributions to Integrated Cancer Programs - - 14,027 16,232 14,027 16,232 Medical services 69 411 13,948 12,764 14,017 13,175 Hospital systemic therapy services - - 13,747 14,958 13,747 14,958 Other operating (Note 13) 703 1,638 10,561 10,104 11,264 11,742 Pension (Note 9(a)) - - 4,686 3,976 4,686 3,976 Consulting services 136 487 4,049 22,093 4,185 22,580 Occupancy costs 61 217 3,531 3,162 3,592 3,379 Professional fees 4 10 401 257 405 267 Loss (gain) on disposal of capital assets 435 - 92 441 527 441 Post-retirement benefits other than pension plan (Note 9(b)) - - 130 222 130 222 6,797 13,498 827,639 753,402 834,436 766,900 Excess (deficiency) of revenue over expenses $ (858) $ (2,510) $ 2,859 $ 234 $ 2,001 $ (2,276)



Cancer Care Ontario Statement of changes in fund balances (In thousands of dollars) Year ended March 31, 2011 Restricted General – Invested in Total Endowment Other Unrestricted capital assets 2011 2010 Fund balances, beginning of year $ 2,317 $ 23,822 $ 14,585 $ 1,732 $ 42,456 $ 44,732 Excess (deficiency) of revenue over expenses - (858) 2,859 - 2,001 (2,276) Net change in investment in capital assets (Note 10) - (69) (3,665) 3,734 - - Interfund transfers (Note 14) - (12,890) 12,890 - - - Fund balances, end of year $ 2,317 $ 10,005 $ 26,669 $ 5,466 $ 44,457 $ 42,456

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Cancer Care Ontario Statement of cash flows (In thousands of dollars) Year ended March 31 2011 2010 Increase (decrease) in cash and cash equivalents Operating Excess (deficiency) of revenue over expenses $ 2,001 $ (2,276) Amortization of capital assets 32,402 28,673 Amortization of deferred contributions related to capital assets (30,981) (28,303) Loss on disposal of capital assets 527 441 Benefit expense related to post-retirement benefits other than pension plan 130 222 Post-retirement benefits other than pension plan paid (172) (192) 3,907 (1,435) Change in non-cash operating working capital Receivables and prepaids 16,659 (21,496) Accounts payable and accrued liabilities 54,403 18,838 Deferred operating grants (30,888) (7,215) 40,174 (9,873) 44,081 (11,308) Investing Proceeds from maturity of investments 50,302 - Purchase of investments (51,160) (50,078) Purchase of capital assets (38,936) (37,329) Proceeds on disposal of capital assets 61 70 (39,733) (87,337) Financing Amounts received related to capital assets 45,125 32,766 Increase (decrease) in cash and cash equivalents 49,473 (65,879) Cash and cash equivalents, beginning of year 106,331 172,210 Cash and cash equivalents, end of year $ 155,804 $ 106,331


7

Cancer Care Ontario Notes to the financial statements (In thousands of dollars) March 31, 2011 Nature of operations The Government of Ontario approved the establishment of Cancer Care Ontario (the “Organization”) on April 29, 1997 to advance services for cancer patients to improve the outcome, quality and efficiency of cancer services. The cancer services encompass prevention, screening, diagnosis, treatment, research, education and palliative care. The Organization was incorporated under the name of The Ontario Cancer Treatment and Research Foundation by an Act of the Legislature of the Province of Ontario in 1943 and the name of the Organization was changed in 1997 to Cancer Care Ontario. The Organization is a registered charity under the Income Tax Act (Canada). Members of the Board of Directors and Board Committees are volunteers who serve without remuneration. The Organization’s mission is to improve the performance of the cancer system in Ontario by driving quality, accountability and innovation in all cancer-related services. The Organization’s mission includes an emphasis on performance management. In accordance with the Cancer Program Integration Agreement (“CPIA”), the Organization funds the Integrated Cancer Programs (“ICP”) at various hospitals in return for agreed upon cancer services. The Organization supports the provincial government’s Ontario Wait Time and Access to Care (“ATC”) Strategies. The ATC program is comprised of information technology and information management initiatives with a strategic focus on improving access, quality and efficiency of patient care and tracking patients as they move across the continuum of care. The mandate of the ATC program is the development and implementation of information strategies and information systems to support improved access to care, ongoing operation of information systems, data analysis and reporting. In June 2009, the Ministry of Health and Long-Term Care (“MOHLTC”) formally transferred to the Organization the provincial oversight and co-ordination of the Chronic Kidney Disease (“CKD”) Program. The mandate of the CKD program is to develop and implement a provincial CKD strategy that will lead to measurable and sustained improvement in CKD care across the province. This includes improved strategies for vascular access and home dialysis, implementation of a patient-based funding model and earlier detection and better disease management.

46


Cancer Care Ontario Notes to the financial statements (In thousands of dollars) March 31, 2011

8

1. Significant accounting policies The Organization’s financial statements are prepared by management using Canadian generally accepted accounting principles. Fund accounting The Endowment Fund reports contributions subject to externally imposed stipulations specifying that the resources contributed be maintained permanently, unless specifically disendowed by the donor. Restricted investment income earned on Endowment Fund resources is recognized as revenue of the Restricted Fund. The Restricted Fund reports all other externally and internally restricted resources. The main use of these resources is for research. These funds include donations and grants which either have specific restrictions placed on their use by the donor, have been received by a particular cancer centre and are restricted for use by that particular cancer centre or have been internally restricted by the Board of Directors. The General Fund accounts for the Organization’s MOHLTC, the Ministry of Health Promotion (“MHP”) and other funded programs. This fund reports unrestricted resources and restricted operating grants. Contributions The Organization follows the deferral method of accounting for restricted contributions related to MOHLTC, MHP and other funded programs which are recognized as revenue of the General Fund in the year which the related expenses are incurred. The Organization follows the restricted fund method for all other restricted contributions which are recognized as revenue of the appropriate Restricted Fund in the year of receipt. Unrestricted contributions are recognized as revenue of the General Fund when the amount is reasonably estimated and collection is probable. Contributions received for the purpose of capital assets are recorded as deferred capital contributions and are amortized on the same basis as the related capital assets. Contributions for endowment are recognized as revenue of the Endowment Fund in the year of receipt. Cash and cash equivalents The Organization considers deposits in banks, certificates of deposit and short-term investments with original maturities of three months or less as cash and cash equivalents. Investments Investments are classified as held for trading and carried at fair value. Investment transactions are accounted for on a settlement date basis and transaction costs are expensed as incurred.



9

1. Significant accounting policies (continued) Capital assets Capital assets are recorded at cost. All capital assets are amortized on a straight-line basis at rates based on the estimated useful lives of the assets. Therapeutic and other technical equipment is amortized over 5 years; office furniture, equipment and software are amortized over periods ranging from 3 years to 5 years; and leasehold improvements are amortized over the 5 year term of the leases. Effective April 1, 2010, the Organization began capitalizing externally acquired and internally developed software. This new accounting policy was applied prospectively as the amounts related to the prior years for externally acquired software are immaterial and the information related to internally developed software is not readily available. The impact of this new accounting policy resulted in $11.4 million in software costs being capitalized in the current year. Land and buildings for four lodges donated by the Canadian Cancer Society – Ontario Division are recorded at nominal value, as current value is not reasonably determinable. Impairment of long-lived assets An impairment charge is recorded for long-lived assets when an event or change in circumstances causes the asset’s carrying values to exceed the total undiscounted cash flows expected from its use and eventual disposition. The impairment loss is calculated as the difference between the fair value of the asset and its carrying value. Pension costs and post retirement benefits other than pension plan (i) Pension costs The Organization accounts for its participation in the Healthcare of Ontario Pension Plan

(“HOOPP”), a multiemployer defined benefit pension plan, as a defined contribution plan, as the Organization has insufficient information to apply defined benefit plan accounting.

(ii) Post-retirement benefits other than pension plan The cost of post-retirement benefits other than pension plan is actuarially determined

using the projected benefit method prorated on employment services and expensed as employment services are rendered.

The transitional obligation arising from the adoption of this accounting policy is being amortized over the expected remaining life of eligible retirees.

Use of estimates The preparation of financial statements requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the year. Actual results could differ from those estimates.

48



10

2. Capital disclosures The capital structure of the Organization consists of fund balances comprised of endowment funds, internally and externally restricted funds, general – unrestricted fund, investment in capital assets, and deferred capital contributions. The Organization’s objective when managing capital is to safeguard its ability to continue as a going concern, so that it can continue to provide the appropriate level of benefits and services to its stakeholders. A portion of the Organization’s capital is restricted in how it is to utilize its externally restricted contributions and deferred capital contributions as described in Note 1. The Organization employs internal control processes to ensure the restrictions are met prior to the utilization of these resources and has been in compliance with these restrictions throughout the year. The Organization sets the amount of fund balances in proportion to risk, manages its capital structure and makes adjustments to it in light of economic conditions and the risk characteristics of the underlying assets. 3. Cash and cash equivalents – restricted Cash and cash equivalents includes $404 (2010 - $402) which is restricted, as it relates to a pension plan that has been dissolved and is being held in escrow in the event that former members put forth a claim. These funds are subject to externally imposed restrictions and are not available for general use. 4. Investments 2011 2010 Guaranteed Investment Certificate, interest at 2.0%, maturing September 4, 2010 $ - $ 30,044 Guaranteed Investment Certificates, interest at 2.1%, maturing March 3, 2012 10,226 10,017 Guaranteed Investment Certificates, interest at 2.26%, maturing March 5, 2012 30,693 - Guaranteed Investment Certificate, interest at 2.05%, maturing March 5, 2012 40,063 40,063 80,982 80,124 Less maturing within one year 80,982 30,044 $ - $ 50,080 5. Receivables and prepaids 2011 2010 Accounts receivable $ 4,225 $ 2,396 Due from MOHLTC 14,818 34,329 Prepaids 1,210 187 $ 20,253 $ 36,912



11

6. Capital assets 2011 2010 Accumulated Net Net Cost Amortization Book Value Book Value Therapeutic and other technical equipment $ 272,034 $ 181,885 $ 90,149 $ 93,838 Office furniture, equipment, software and leasehold improvements 18,549 5,210 13,339 3,704 $ 290,583 $ 187,095 $ 103,488 $ 97,542 The cost of therapeutic equipment includes deposits of $19,674 (2010 - $12,405). Amortization of these amounts will commence when the equipment is available for use. 7. Accounts payable and accrued liabilities 2011 2010 Trade payables $ 63,980 $ 67,762 Accrued liabilities and other 63,955 57,600 Payable to MOHLTC, MHP and other 61,941 10,113 Pension escrow 404 402 $ 190,280 $ 135,877 8. Deferred contributions a) Deferred operating grants Deferred operating grants represent unspent resources related to MOHLTC, MHP and other funded programs. Unspent amounts are held for use in subsequent periods or settlement by the respective ministry. Changes in the deferred operating grant balance are as follows: 2011 2010 Balance, beginning of year $ 37,434 $ 44,649 Amounts received related to subsequent periods 45,697 26,785 Amounts recognized as revenue (3,268) (19,063) Amounts returned to MOHLTC (11,376) (4,824) Amounts reclassified to accounts payable and accrued liabilities (61,941) (10,113) Balance, end of year $ 6,546 $ 37,434

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12

8. Deferred contributions (continued) b) Deferred contributions related to capital assets Deferred contributions related to capital assets represent the unamortized and unspent amount of funds received for the purchase of capital assets. The changes in the deferred contributions related to capital assets balance for the year are as follows: 2011 2010 Balance, beginning of year $ 101,786 $ 97,323 Amounts received related to capital assets 45,125 32,766 Amount recognized as revenue (30,981) (28,303) Balance, end of year $ 115,930 $ 101,786 The balance of deferred capital contributions related to capital assets consists of the following: 2011 2010 Unamortized capital contributions used to purchase capital assets $ 98,022 $ 95,810 Unspent contributions 17,908 5,976 Balance, end of year $ 115,930 $ 101,786 9. Pension costs and post-retirement benefits other than pension plan a) Pension costs Employees of the Organization are members of HOOPP, which is a multiemployer defined benefit pension plan. HOOPP members receive benefits based on length of service and the average annualized earnings during the five consecutive years that provide the highest earnings prior to retirement, termination or death. Contributions to HOOPP made during the year by the Organization on behalf of its employees amounted to $4,686 (2010 - $3,976) and are included in the pension expense in the statement of operations. b) Post-retirement benefits other than pension plan The Organization offered non-pension, post retirement benefits to its retired employees. Effective January 1, 2006, the Organization no longer offers non-pension, post retirement benefits to its active employees. Benefits paid during the year under this unfunded plan were $172 (2010 - $192). During the year, the Organization decreased its accrued benefit obligation by $95 (2010 –decreased by $457) based on the most recent actuarial valuation for the post-retirement benefits other than pension plan dated March 31, 2010. The next valuation will take place as at March 31, 2012.



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9. Pension costs and post-retirement benefits other than pension plan (continued) Information about the Organization’s post-retirement benefits other than pension plan is as follows: 2011 2010 Accrued benefit obligation $ (2,856) $ (2,951) Unamortized actuarial gain (1,114) (1,132) Unamortized net transitional obligation 656 727 Net accrued benefit liability $ (3,314) $ (3,356) The actuarially determined present value of the accrued benefit obligation is measured using management’s best estimates based on assumptions that reflect the most probable set of economic circumstances and planned courses of action as follows: 2011 2010 Discount rate 4.5% 4.5% Hospital and drug cost trend rate 8.5% in 2011 9% in 2010 to 5% in 2018 to 5% in 2018 and after and after Other medical costs trend rate 4% per annum 4% per annum 10. Investment in capital assets 2011 2010 Capital assets $ 103,488 $ 97,542 Amounts financed by deferred capital contributions (98,022) (95,810) $ 5,466 $ 1,732 Change in net assets invested in capital assets is calculated as follows: Purchase of capital assets $ 38,936 $ 37,329 Deferred contributions related to capital assets (33,193) (37,322) Amortization of deferred contributions related to capital assets 30,981 28,303 Amortization of capital assets (32,402) (28,673) Disposal of capital assets (588) (511) $ 3,734 $ (874) 11. Net investment income Net investment income earned on the Endowment Fund resources in the amount of $25 (2010 - $25) is included in the Restricted Fund.

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14

12. Other revenue 2011 2010 General Fund Canadian Partnership Against Cancer $ 2,527 $ 2,572 Ontario Agency for Health Protection and Promotion 2,284 - eHealth Ontario 503 3,557 Salary recovery 392 888 Canada Health Infoway repayment - (1,856) Miscellaneous 1,450 2,619 $ 7,156 $ 7,780 Restricted Fund Grants $ 5,694 $ 10,640 Donations 220 307 $ 5,914 $ 10,947 13. Other operating expenses 2011 2010 Restricted Fund General office $ 394 $ 506 Education and Publications 136 216 Travel 82 249 Equipment 59 531 Other expenses 32 136 $ 703 $ 1,638 General Fund Equipment $ 4,262 $ 4,576 Education and Publications 1,960 1,556 General office 1,903 1,733 Travel 873 778 Patient service 800 800 Other expenses 763 661 $ 10,561 $ 10,104 14. Interfund transfer 2011 2010 Transfer to the General Fund from the Restricted Fund $ 12,890 $ 688 Transfer to the General Fund from the Restricted Fund represent the release of internally restricted reserves approved by the Organization’s Board of Directors.



15

15. Commitments a) The Organization leases space, and computer and office equipment. Under the terms of

the leases, future repayments are estimated as follows for the year ending March 31: 2012 $ 3,939 2013 1,960 2014 152

$ 6,051 b) The Organization has committed $24,101 (2010 - $9,614) for the purchase of equipment,

which is net of deposits disclosed in Note 6. 16. Contingencies The Organization is a member of the Healthcare Insurance Reciprocal of Canada (“HIROC”), which was established by hospitals and other organizations to self-insure. If the aggregate premiums paid are not sufficient to cover claims, the Organization will be required to provide additional funding on a participatory basis. Since the inception, HIROC has accumulated an unappropriated surplus, which is the total of premiums paid by all subscribers plus investment income less the obligation for claims reserves and expenses and operating expenses. Each subscriber which has an excess of premium plus investment income over the obligation for their allocation of claims reserves and expenses and operating expenses may be entitled to receive distributions of their share of the unappropriated surplus at the time such distributions are declared by the Board of Directors of HIROC. There are no distributions declared by HIROC as of March 31, 2011. 17. Financial instruments The carrying amounts of cash and cash equivalents, receivables, and accounts payable and accrued liabilities approximate fair values due to the short-term nature of these instruments. The fair values of investments are disclosed in Note 4. Investments consist of guaranteed investment certificates with a fixed interest rate that in management’s estimation is at market. Credit risk Credit risk arises from cash and cash equivalents and investments held with financial institutions and credit exposures on outstanding receivables. Cash and cash equivalents and term investments are held at major financial institutions minimizing any potential exposure to credit risk. It is management’s opinion that the risk related to receivables is minimal as most of the receivables are from federal and provincial governments and organizations controlled by them.

Interest rate risk Interest rate risk is the risk that the value or future cash flows of financial instruments will fluctuate due to changes in market interest rates. The Organization currently is only exposed to interest rate risk from its investments. The Organization does not expect fluctuations in market interest rates to have a material impact on its financial performance and does not use derivative instruments.

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18. Guarantees a) Director/officer indemnification The Organization’s General By-Laws contain an indemnification of its directors/officers, former directors/officers and other persons who have served on board committees against all costs incurred by them in connection with any action, suit or other proceeding in which they are sued as a result of their service, as well as all other costs sustained in or incurred by them in relation to their service. This indemnity excludes costs that are occasioned by the indemnified party’s own dishonesty, wilful neglect or default. The nature of the indemnification prevents the Organization from making a reasonable estimate of the maximum amount that it could be required to pay to counterparties. To offset any potential future payments, the Organization has purchased from HIROC directors’ and officers’ liability insurance to the maximum available coverage. The Organization has not made any payments under such indemnifications, and no amount has been accrued in the accompanying financial statements with respect to the contingent aspect of these indemnities. b) Other indemnification agreements In the normal course of its operations, the Organization executes agreements that provide for indemnification to third parties. These include, without limitation: indemnification of the Landlords under the Organization’s leases of premises; indemnification of the MOHLTC from claims, actions, suits or other proceedings based upon the actions or omissions of the representative groups of medical, radiation and gynaecology/oncology physicians under certain Alternate Funding Agreements; and indemnification of the ICP host hospitals from claims, actions, costs, damages and expenses brought about as a result of any breach by the Organization of its obligations under the CPIA and the related documentation. While the terms of these indemnities vary based upon the underlying contract, they normally extend for the term of the contract. In most cases, the contract does not provide a limit on the maximum potential amount of indemnification, which prevents the Organization from making a reasonable estimate of its maximum potential exposure. The Organization has not made any payments under such indemnifications, and no amount has been accrued in the accompanying financial statements with respect to the contingent aspect of these indemnities. 19. Comparative figures Certain comparative figures have been reclassified to conform to the financial statement presentation adopted in the current year.

CCOANNUALREPORT10-11

APPENDICES

BOARD OF DIRECTORS

Neil Stuart, Chair(Jun.1,2010–May31,2013)

Ratan Ralliaram, Vice Chair(Nov.15,2006–Nov.14,2012)InterimChair(Dec.13,2009-May31,2010)

Peter Crossgrove(ChairmanEmeritus)

Kevin Conley(Jun.27,2007–Jun.26,2014)

Michael Cooper(Aug.12,2009–Aug.11,2012)

Malcolm H. Heins(Feb.25,2009–Feb.24,2012)

Darren Johnson(Jun.20,2007–Jun.19,2010)

Shoba Khetrapal(Dec.21,2006–Dec.20,2012)

Marilyn Knox(Mar.23,2011–Mar.22,2014)

Patricia Lang(Jun.20,2007–Jun.19,2014)

Dr. Andreas Laupacis(Mar.23,2011–Mar.22,2014)

Dr. Wendy Levinson(Feb.13,2008–Feb.12,2014)

Roland Montpellier(Dec.1,2004–Nov.30,2010)

Stephen Roche(Sept.20,2006–Jun.30,2012)

Dr. Walter Rosser(Jun.27,2007–Jun.26,2014)

Dianne Salt(April7,2010–April6,2013)

Dr. Mamdouh Shoukri(Sept.24,2008–Sept.23,2011)

Betty-Lou Souter(Jun.20,2007–Jun.19,2013)

EXECUTIVE LEADERSHIP

Terrence Sullivan, PhDPresidentandCEO(fromApril2010toJanuary2011)

Michael Sherar, PhDPresidentandCEO(sinceJanuary2011)

Helen Angus,VicePresident,OntarioRenalNetwork,CCO

Judy Burns,VicePresident(A),Planning&RegionalPrograms(sinceJan.2011)

John McLaughlin, PhDVicePresident,PopulationStudiesandSurveillance(untilOctober1,2010)

Rick Skinner,VicePresident,ChiefInformationOfficer

Dr. Joe Pater,VicePresident,ClinicalandTranslationalResearch(untilMarch2011)

Dr. Linda Rabeneck,VicePresident,PreventionandCancerControl(sinceOctober4,2010)

Elham Roushani,VicePresident,FinanceandHumanResources,ChiefFinancialOfficer(CFO)

Pamela Spencer,VicePresident,CorporateServices,GeneralCounsel,ChiefPrivacyOfficer

Dr. Carol Sawka,VicePresident,ClinicalProgramsandQualityInitiatives

Michael Sherar, PhDVicePresident,Planning&RegionalPrograms(April2010toJan2011)

Mitchell Toker,VicePresident,PublicAffairs(untilSeptember2011)

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CLINICAL LEADERSHIP

Dr. Julian Dobranowski,ProgramHead,CancerImagingProgram

Audrey Friedman,ProvincialHead,PatientEducation

Esther Green,ProvincialHead,NursingandPsychosocialOncologyPrograms

Dr. Jonathan Irish,ProvincialHead,SurgicalOncologyProgram

Dr. Leonard Kaizer,ProvincialHead,SystemicTreatmentProgram

Dr. José PereiraProvincialHead,PalliativeCareProgram

Dr. John Srigley,ProvincialHead,PathologyandLaboratoryMedicineProgram

Dr. Padraig Warde,ProvincialHead,RadiationTreatmentProgram

PROVINCIAL LEADERSHIP

Dr. Louis Balogh,RegionalVicePresident,Central

Claudia den Boer Grima,RegionalVicePresident,ErieSt.Clair

Brenda Carter,RegionalVicePresident,SouthEast

Dr. Peter Dixon,RegionalVicePresident,CentralEast(untilJuly2011)

Paula Doering,RegionalVicePresident,Champlain

Dr. Bill Evans,RegionalVicePresident,HamiltonNiagaraHaldimandBrant

Dr. Sheldon Fine,RegionalVicePresident,PeelRegionalCancerCentre,CentralWestandMississaugaHalton

Dr. Mary Gospodarowicz,RegionalVicePresident,TorontoCentral

Mark Hartman,InterimRegionalVicePresident,NorthEast

Garth Matheson,RegionalVicePresident,NorthSimcoeMuskoka

Dr. Craig McFadyen,RegionalVicePresident,WaterlooWellington

Brian Orr,RegionalVicePresident,SouthWest

Michael Power,RegionalVicePresident,NorthWest

Dr. Linda RabeneckRegionalVicePresident,TorontoCentral(2005–2010)

Dr. Andy Smith,InterimRegionalVicePresident,TorontoCentral(October1,2010–March17,2011RegionalVicePresident,TorontoCentral(sinceMarch17,2011)

ORN LEADERSHIP

Helen AngusVicePresident,OntarioRenalNetwork

Treva McCumber,ExecutiveLead,CKDPrograms,OntarioRenalNetwork(untilAugust2011)

Dr. David Mendelssohn,ClinicalChampion,ResearchandInnovation

Dr. Judith Miller,ProvincialMedicalDirector,OntarioRenalNetworkClinicalChampion,EarlyIdentificationandPrevention

Dr. Louise Moist,ClinicalChampion,VascularAccess

Dr. Andreas Pierratos,ClinicalChampion,IndependentDialysis


ORN PROVINCIAL LEADERSHIP

Rick Badzioch,RegionalDirector,HamiltonNiagaraHaldimandBrant

Jill Campbell,RegionalDirector,TorontoCentral

Lise Corriveau,RegionalDirector,NorthEast

Patricia Dwyer,RegionalDirector,ErieSt.Clair

Ken Fast,RegionalDirector,CentralWest(untilAugust2011)

Elaine Chemeris,RegionalDirector,CentralWest(sinceAugust2011)

Julie A. Gordon,RegionalDirector,SouthEast

Melanie Tremblay,RegionalDirector,Central

Julia Salomon,RegionalDirector,NorthWest

Carol Rhiger,RegionalDirector(A),SouthWest(sinceJuly2011)

Connie Twolan,RegionalDirector,Champlain

Marni Van Kessel,RegionalDirector,NorthSimcoeMuskoka

Peter Varga,RegionalDirector,WaterlooWellington

Nancy Webster,RegionalDirector,MississaugaHalton

Jay Wilson,RegionalDirector,CentralEast

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Documents

Annual Report - Legislative Assembly of Ontario · OCP III, which officiallytook effecton April 1, 2011, charts our course from 2011-2015with a focuson prevention, screening,diagnosis,treatment,follow-up,and