Cancer Services and Challenges in Alberta: A Companion Document
Published February 2013 978-0-7785-8392-9 (Print) 978-0-7785-8393-6 (Online) You can find this document on the Alberta Health website – www.health.alberta.ca and on the Alberta Health Services website – www.albertahealthservices.ca albertacancerplan.ca
Table of Contents Introduction .......................................................................................................................... 3 The Challenge of Cancer ...................................................................................................... 3 Alberta’s Cancer Services – Transformative Changes........................................................... 8 Alberta’s Cancer Services – Infrastructure..........................................................................10 Alberta’s Cancer Services – Quality Practices.....................................................................13 Prevention...........................................................................................................................15 Screening............................................................................................................................19 Diagnosis and Treatment.....................................................................................................20 Research.............................................................................................................................22 Workforce...........................................................................................................................24 Conclusion..........................................................................................................................25 Performance Measures.......................................................................................................25 Related Strategies and Initiatives........................................................................................32 Key Definitions....................................................................................................................33 Resource List .....................................................................................................................37
Cancer Services and Challenges in Alberta: A Companion Document Alberta Health
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Introduction Introduction Cancer is a devastating illness that dramatically affects the lives of patients and their families. Changing Our Future: Alberta’s Cancer Plan to 2030 was developed to help prevent most cancers, cure more cases of cancer, and reduce the suffering of those affected by it. This companion document provides additional information on the current services provided by Alberta’s cancer care system, and the challenges the system faces. It also describes the elements critical to providing high-quality cancer care – prevention, screening, diagnosis and treatment, research and the workforce. Finally, it outlines the performance measures which will be used to determine whether the system is successfully achieving the strategies and actions identified in Changing Our Future: Alberta’s Cancer Plan to 2030.
Challenge of Cancer The Challenge of Cancer Despite the numerous global resources that have been poured into cancer, a cure has not yet been found. The challenge in finding a cure lies in the nature of cancer as compared to other diseases. Although cancer cells grow and spread abnormally, they still have many similarities to normal cells. Most of the drugs used in treatment affect not only cancer cells, but also normal cells in the body, making it incredibly difficult and in some cases impossible to isolate cancer cells for destruction or elimination. Additionally, cancer differs from most other diseases in that it can develop at any stage in life and in any organ. Each individual cancer may respond to treatment differently, depending on its unique biology. The wide range of cancer treatments and services available reflects the biological diversity of cancer. In recent decades, each cancer discovery has provided a better understanding of how normal cells become tumours and how tumours grow, invade, and metastasize; however, each new discovery creates additional questions. While increased knowledge of risk factors means some cancers can be avoided, the cause of many cancers remains largely unknown.
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The Toll of Cancer Worldwide The International Agency for Research on Cancer indicates the international cancer burden doubled between 1975 and 2000 and is set to double again by 2020 and nearly triple by 2030.1 While low- and medium-resource countries are expected to be hit hardest, jurisdictions with well-resourced health systems will still feel a significant impact.
Cancer in Canada and Alberta Two out of 5 Canadians are expected to develop cancer during their lifetimes, and 1 out of every 4 Canadians is expected to die from cancer.2 For 2012 alone, estimates indicate that there were 186,400 new cases of cancer (excluding 81,300 non-melanoma skin cancers) and 75,700 deaths from cancer.3 This is 8,600 more new cases and 700 more deaths than in 2009. Four groups of cancers – lung, colorectal, breast and prostate – account for 53 per cent of all cancers diagnosed in Canada: ›› Lung cancer is the leading cause of cancer death in Canada for both men (27 per cent) and women (26 per cent). In 2012, there were an estimated 25,600 new cases across Canada, with 2,000 new cases in Alberta. ›› Female breast cancer mortality rates have been declining since the mid-1980s. However, breast cancer still ranks second in mortality for women at 14 per cent. An estimated 22,900 women were diagnosed with breast cancer in 2012, with approximately 1,950 cases occurring in Alberta. ›› Prostate cancer is the most common cancer diagnosis in men. There are approximately 4,000 deaths from prostate cancer in Canada each year, ranking it third for cancer mortality. In 2012, estimates indicate there were 26,500 new cases of prostate cancer, with approximately 2,500 of those cases in Alberta. ›› Colorectal cancer contributes to 12 per cent of all cancer deaths in Canada, with 9,200 deaths estimated in 2012. Estimates of incidence indicate there were approximately 23,300 new diagnoses of colorectal cancer in Canada in 2012, with 1,930 cases diagnosed in Alberta.4 ›› Of the 27,000 expected new cancer cases in Alberta by 2030, 3,370 are projected to be colorectal cancer, 3,090 female breast cancer, 2,850 prostate cancer, and 2,800 lung cancer. 1 Canadian Cancer Society. “General cancer statistics at a glance.” http://www.cancer.ca/ 2 Canadian Cancer Society’s Steering Committee. Canadian Cancer Statistics 2012. Toronto, 2012. 3 Ibid. 4 Ibid.
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In Alberta, cancer is by far the leading cause of premature death. Between the ages of 35 and 64, more people die from cancer than heart disease, stroke, other circulatory disorders, infectious diseases and unintentional injuries combined.5 In Alberta in 2010, an estimated 14,900 new cancer cases (excluding non-melanoma skin cancers) were diagnosed and 5,580 people died of cancer.6 In Alberta, a number of key factors are increasing demand for cancer services, including: ›› an annual increase in the number of people living with cancer as new treatments increase survival rates; ›› greater expectations of Albertans to have a health system that provides health promotion, prevention and early detection strategies in addition to timely, state-of-the-art treatments; and ›› most importantly, population growth and aging.7
Dorothea Klein has a form of cancer that cannot be cured. Since the first lump was found under her arm in August 2006, the cancer has spread. Currently, the goal of her treatment is to maintain quality of life and
research can help unlock cancer’s secrets for future generations keep the cancer from spreading further. Klein knows that research can help unlock cancer’s secrets for future generations. She and her husband, Pat, are enrolled in an Alberta Health Services study called The Tomorrow Project, which started in 2000 and will continue for decades. It follows the lives of about 50,000 people – initially without cancer, as was Klein – to find out how lifestyle, the environment and genetics contribute to people’s risk of developing cancer and other chronic diseases. “They need to find out what causes cancer and how we can get rid of it,” she says.
5 Alberta Health Services. Cancer Control: An Action Plan for Alberta: 2010-2030. Unpublished., Alberta, 2011. p.4. 6 Alberta Health Services. Alberta Cancer Registry Annual Report 2010. Alberta, In press. 7 The number of new cancer cases is expected to increase as the population size increases. The incidence rate is stable or decreasing for many cancers, but because of the aging population, more cases are being seen.
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The Challenge of Demographics Age is a key factor for cancer rates in Canada, with 69 per cent of new cases and 62 per cent of cancer deaths occurring among those aged between 50–79 years.8 For both sexes, the median age range is 65–69 years at cancer diagnosis and 70–74 years at death. Cancer is not limited to this age demographic, however; approximately 12 per cent of new cancer cases and 5 per cent of cancer deaths will occur in people under the age of 50 years.9 With a growing and aging population, there will be a higher number of cases even if incidence rates remain stable or decrease. Estimates indicate that the population of Alberta will increase from approximately 3.5 million in 2010 to 4.5 million in 2030,10 and the percentage of the population aged 65 and above will increase from 11 per cent to 19 per cent of the population. Figure 1 illustrates the implications of rising cancer incidence for Alberta. It shows that between 1990 and 2010, the number of new cancer cases in Alberta increased by 112 per cent. The main factors influencing the growth were an aging population (42 per cent increase) and population growth (46 per cent increase), whereas the rate of cancer (i.e., the number of new cancer cases per population in a given time period) accounted for only a 24 per cent increase in the number of new cases.11 By 2030, the projected number of new cases of cancer annually is 27,000, a 65 per cent increase since 2010 and a 240 per cent increase since 1990. The aging population is expected to be the greatest driver behind this increase, while the rate of cancer itself is not expected to change significantly.12 These data, as well as data on global predictions of cancer, are of concern. These trends explain why the province needs to address the incidence and prevalence of cancer in the coming decades.
8 Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2012. 9 Ibid. 10 Numbers are based on the projection period 1984–2008 (Alberta Cancer Registry, May 2011). Population projections from Alberta Health health registration data show these numbers have already been exceeded – the Alberta population in 2010 was 3,690,533 (Alberta Health and Wellness, May 2011). 11 Alberta Health Services, Cancer Surveillance (March 2012). 12 Ibid.
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Figure 1: Increase in New Cases Attributed to Aging, Population Growth, and Cancer Rates, Both Sexes, Alberta, Observations in 1990 – 2010; Projections in 2010 – 2030
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Aging Population (126%)
Change in Rate
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Population Growth
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Population Growth (198%)
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Dr. Doug Strother, a pediatric oncologist and Associate Professor in the Departments of Oncology and Pediatrics at the University of Calgary, visits cancer patient Brynn Lund at Alberta Children’s Hospital in Calgary.
Alberta has one of the highest participation rates Alberta has one of the highest participation rates for pediatric cancer clinical trials in the country, giving kids with cancer access to the latest treatments. About 140 new cases of child cancer are diagnosed in Alberta each year and about one-third are placed on clinical trials.
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Alberta’s Cancer Services – Changes Transformative Changes Changing Our Future: Alberta’s Cancer Plan to 2030 is Alberta’s response to the anticipated increase in the incidence of cancer. The following table lists the transformative changes sought in Alberta’s cancer system. Table 1 – Transformative Changes Future State
Current State
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Focused on cancer care.
A rebalanced cancer continuum emphasizes health promotion and prevention.
Focused on health sector activities.
In recognition of the social determinants of health, stakeholders outside the health system are engaged in the battle against cancer.
Current services are often centred on providers and facilities.
Patients and their families are more informed about cancer and patients are increasingly active partners in their own health. There is a greater emphasis on community services and the provision of care close to home.
Effective and efficient use of the existing cancer workforce.
The cancer workforce is broadened, with primary care practitioners assuming a greater role in providing care and all health providers working to their full scope of practice. Targeted training and supports are available for interdisciplinary teams, primary health care practitioners, and others.
Services are provided by centralized hubs of cancer expertise and some local cancer community clinics within the health system.
The cancer system extends into Primary Care Networks, Family Care Clinics, and other sectors, such as within the education system to support the teaching of healthy living in schools.
Various approaches to cancer care and treatment across the province.
A coordinated provincial approach integrates and manages the diagnosis and treatment of common cancers using standard evidenceinformed processes.
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Future State
Current State Much of the infrastructure planning for cancer is conducted separately from the rest of the health system.
Infrastructure planning for cancer programs, services and activities are aligned with that for the overall health system.
Cancer research increases our understanding of the impact of lifestyle factors and genetic factors on the occurrence of cancer.
Effective knowledge sharing practices shorten the time it takes for new research to move into practice.
Special patient navigation services are helping more Aboriginal Albertans access cancer care. The first Aboriginal navigator in Alberta is located at the Cross Cancer Institute in Edmonton, with plans to expand services to southern Alberta.
The Aboriginal navigator program is one important step forward Aboriginal navigators provide information and services in a manner that considers the cultural differences and needs of Aboriginal patients. They also provide an important link between the health system, patients, their families, and communities. These are important services, as social and cultural differences, as well as challenges specific to Aboriginal communities, can impact Aboriginals’ ability to beat cancer. Aboriginals are more likely to be diagnosed late and to fail to return for treatment and follow-up care. “The Aboriginal navigator program is one important step forward in helping more Aboriginal Albertans access cancer care when needed,” says Angeline Letendre, Provincial Coordinator of Community Oncology.
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Infrastructure Alberta’s Cancer Services – Infrastructure Alberta’s services cover the entire cancer control continuum – from prevention, diagnosis and treatment, to follow-up and survivorship. Alberta is committed to promoting wellness as an effective pathway to improve healthy behaviours and reduce chronic disease. A range of health promotion and prevention initiatives are underway across Alberta, including programs to promote tobacco reduction, obesity prevention, physical activity, healthy eating, mental well-being, and Human Papillomavirus (HPV) immunization. Alberta has evidence-based screening programs in place for breast, cervical and colorectal cancer. Some rural Alberta programs use mobile screening units that travel from community to community and others use established facilities. Once cancer is diagnosed, treatments are provided through Alberta Health Services (AHS) and are usually directed by an oncologist. However, other professionals also play important roles: these include pathologists, diagnostic imaging specialists, primary care physicians, nurse practitioners, and experts in psychosocial care. Figure 2 shows the variety of stakeholders involved in cancer prevention and care.
Figure 2: Key stakeholders and their roles in a comprehensive system
Non-government organizations
Primary care interdisciplinary teams
Patient and family groups
Secondary care teams Tertiary teams
Cancer patients and their families, healthy Albertans
Health innovators Government Employers, employer organizations, industries Community organizations Home Care
Public and population health
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Provincial Advisory Council on Cancer
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Figure 2 continued
Primary care interdisciplinary teams
Health innovators
Ensure early detection, appropriate referral for diagnosis, support for patients during care and post treatment. Educate healthy Albertans about options for prevention and screening.
Accelerate innovation and provide new tools to fight cancer. Includes organizations such as universities, research-oriented industries, academic health centres, strategic clinical networks.
Secondary care teams
Government
Ensure that a diagnosis is made accurately using surgery, laboratory and imaging; and that there is support for treatment.
Help to support and fund the best cancer control possible.
Employers, employer organizations, industries
Tertiary teams Provide specialized treatment, ensuring there is appropriate cancer therapy with evidencebased decisions for treatment. This includes psychosocial oncology and other supportive elements.
Support employees who are dealing with cancer; establish policies to prevent occupational exposure to cancer; help to educate employees about healthy lifestyles.
Public and population health
Promote participation in prevention and screening programs, and best care possible. Help to educate society and to reach vulnerable populations.
Establish population-based screening programs for early detection and treatment.
Non-government organizations
Community organizations
Provincial Advisory Council on Cancer
Provide cancer programs, services and activities; engage in fundraising.
Patient and family groups Provide advice to government and providers on cancer programs, services and activities.
Advocate for action, providing advice to government on cancer programs, services and activities. Champion for the provincial cancer plan.
Specialized treatment offered by tertiary teams (see Figure 3) is provided through a network of cancer care services across the province. The Cross Cancer Institute in Edmonton and the Tom Baker Cancer Centre in Calgary are provincial centres of oncology expertise and are linked, respectively, with the Universities of Alberta and Calgary. These centres provide community services and advanced care to patients, carry out research, develop standards and guidelines for therapy, and lend expertise to other cancer centres in the province.
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The Government of Alberta is investing in key infrastructure at the Tom Baker Cancer Centre and the Cross Cancer Institute, improving services, and adding more beds, more treatment space, and more radiation vaults. In Calgary, cancer services will be gathered on one site, improving the patient experience and expanding services.
ALBERTA ALBERTA ALBERTA
In conjunction with the Edmonton and Calgary sites, four associate cancer centres (located in Grande Prairie, Red Deer, Medicine Hat and Lethbridge) and 11 community cancer centres work together to provide services that span the cancer control continuum, making it possible for many Albertans to receive treatment close to home. Fort McMurray
Radiation therapy is currently available in Edmonton, Calgary and Lethbridge, and is Peace River coming soon to facilities in Red DeerFort (under construction) and Grande Prairie (currently McMurray in the design phase). Once therapy is available in all five cities, the number of people Peace River Fort McMurray Grande Prairie required to travel over 100 kilometres to receive radiation treatment will be reduced from Peace River 28 per cent to eight perGrande cent.Prairie Bonnyville Barrhead Grande Prairie
Barrhead
Bonnyville
Edmonton
Hinton
Lloydminster Camrose
Figure 3: Alberta’s CancerBonnyville Care Centres Barrhead Edmonton
Drayton Valley Lloydminster Camrose
Hinton
Red Deer
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Drayton Edmonton Together, the two tertiary care centres, Valley Hinton Lloydminster four associate cancer centres and Red Deer Drayton Camrose Calgary 11 community cancer Valley centres form Tertiary Red Deer Cancer Centres DrumhellerBow Valley the Alberta Cancer Network. Calgary
Cancer Care Centres Drumheller
Tertiary Community Bow Valley Cancer Centres Cancer Centres Drumheller Calgary
Medicine Hat
Fort McMurray Lethbridge Peace River
High River
Tertiary Cancer Centres
Community Bow Valley Cancer Centres
Community Cancer Centres
Associate Medicine Hat Cancer Centres
Associate Medicine Hat Cancer Centres
High River
Lethbridge
Associate Cancer Centres
High River
Lethbridge Grande Prairie Bonnyville
Barrhead
Edmonton Hinton
Lloydminster Camrose
Drayton Valley
Red Deer Drumheller
Calgary
Tertiary Cancer Centres Community Cancer Centres Associate Cancer Centres
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Bow Valley High River Medicine Hat Lethbridge
Mike Ross, a cancer patient from Lethbridge, is able to get radiation therapy at the local Jack Ady Cancer Centre. The centre opened in 2010 as part of a provincial expansion in radiation treatment services. “I can leave my house at 9:20 in the morning, have my treatment and be home before 11,” says Ross. “I get to sleep in my own bed at night. It’s wonderful.”
I get to sleep in my own bed at night. It’s wonderful. Bringing a radiation treatment centre to Lethbridge was the start of the Alberta Radiation Therapy Corridor. So far the centre has provided radiation therapy for some 600 patients. Red Deer and Grande Prairie will also soon have radiation treatment centres, helping to further reduce the number of Albertans who have to travel far from home for treatment. Alberta’s Radiation Therapy Corridor is a good example of providing cancer care services close to home, a priority of Alberta’s new cancer model.
Alberta’s Cancer Services – Quality Practices Quality Practices AHS is committed to providing the best cancer prevention, treatment and care possible. Examples include: clinical trials providing access to the latest treatments for Albertans with cancer; development of patient navigators to guide cancer patients through their treatment; research into Screening for Distress, The 6th Vital Sign; and the ongoing work of the Provincial Family Physician Initiative. Established in 2005, the Provincial Family Physician Initiative focuses on forging strong relationships between family physicians, oncologists and other specialists, colleges (Alberta College of Family Physicians and the College of Physicians and Surgeons of Alberta) and other partners.
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Much of the strength of Alberta’s cancer system lies in the commitment of the people who deliver care. All specialties include superior oncology training, thanks to strong collaboration with faculties of medicine that are at the forefront of cancer research and treatment. Alberta’s physicians gain experience from treating patients with different types of cancer, and from teaching and undertaking research of all types. Support from the Alberta Cancer Foundation and provincial funding through the Alberta Cancer Prevention Legacy Fund enables the province to recruit internationally renowned physicians, researchers and other health professionals. This commitment goes hand in hand with a strong focus on research and collaboration. Integrating knowledge gained from research is fundamental to a high-quality health system. Alberta’s more than 120 cancer researchers have built strong relationships with Alberta’s interdisciplinary teams and universities, funders of cancer research, industry, government, and the international research community. They regularly have their work published in top international medical journals. (The key stakeholders in the research community are described later in this document.) Furthermore, AHS maintains a system-wide commitment to quality, efficiency, and accountability. AHS uses the six Key Dimensions of Quality13 in the Alberta Quality Matrix as benchmarks to measure quality for all activities throughout the organization. In addition, all AHS services, including cancer services, are accredited through Accreditation Canada, thus ensuring that AHS and its contractors consistently deliver high-quality services. Alberta is committed to establishing and monitoring quality indicators to improve the quality of the province’s cancer screening and treatment programs. In recent years, AHS has used a variety of process improvement techniques to deliver services faster and more efficiently. As one example, through a process known as “LEAN,” AHS identifies and eliminates steps that do not add value to the patient experience or outcome. As a result, AHS has reduced wait times for radiation treatment to meet provincial targets. The creation of CancerControl Alberta will enable cancer patients in Alberta to access more highly integrated care at every stage in the cancer continuum, leading to improved outcomes and higher quality of life. CancerControl Alberta will have a direct impact on cancer diagnosis and treatment services in the province.
13 The Dimensions of Quality include acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety.
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Mike Lang was 25 and an avid outdoorsman when he was diagnosed with Hodgkin’s Lymphoma. He began aggressive chemotherapy almost immediately. “All the young adult cancer survivors I’ve met say isolation is one of the biggest things,” says Lang. “You feel like you’re the only person your age to ever get cancer.”
isolation is one of the biggest things After a retreat sponsored by Young Adult Cancer Canada, Lang had an epiphany. He would gather seven other young adult cancer survivors from across Canada for a journey of a lifetime: an eight-day trip down Oregon’s Owyhee River in what he called “adventure therapy.” “When you meet other people your age who have cancer and who really understand what you’re dealing with, it’s very powerful,” says Lang.
Prevention Prevention The goal of prevention is to reduce the incidence of cancer in Alberta. However, successful prevention strategies must consider the complexity of the behavioural, social and environmental contexts in which we live. The Ottawa Charter for Health Promotion (the Charter) is an important international agreement that recognizes health cannot be achieved by the health sector alone. The Charter promotes actions in the following areas: ›› Develop personal skills – ensure that individuals possess the personal skills to recognize and adopt the life behaviours that prevent cancer. ›› Strengthen community action – ensure that communities are empowered to learn and act on what they can do to help individuals prevent cancer. ›› Create supportive environments – ensure that social and physical environments generate living and working conditions that are safe and cancer preventing. ›› Re-orient health care services – change the focus of the health care system and its professionals to the whole individual and the need for a healthier life within communities, allowing for better prevention of illness and promotion of health. ›› Build healthy public policy – develop public policy that supports and promotes healthy living.
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Multiple well-established risk factors for cancer have been identified, and various prevention strategies address them in each of the areas identified in the Charter: Tobacco Use: Estimates show that one third of all cancer cases can be prevented by avoiding tobacco use and exposure to second-hand smoke. Tobacco use remains the leading cause of preventable disease, disability and premature death in Alberta. Tobacco use in Alberta is higher than the Canadian average, and is especially high in young adults aged 20–24. This demographic has the highest smoking rates in Alberta, at 29 per cent.14 The use of smokeless tobacco, such as chew and spit tobacco, is also problematic in Alberta. Alberta males aged 15–19 and 20–24 have used smokeless tobacco at approximately double the rate of the national average: 17 per cent compared to 9 per cent nationally for those aged 15–19, and 36 per cent compared to 17 per cent nationally for those aged 20–24.15 Additionally, sales of spit tobacco in Alberta make up 39 per cent of Canada’s national sales.16 Diet: Second only to tobacco, diet is considered a leading cause of preventable cancers. Research indicates 14 per cent of all cancer deaths in men, and 20 per cent in women, are accounted for by overweight and obesity.17 For those cancers most associated with excess body fat, maintenance of a healthy body weight can reduce the risk by 19–20 per cent.18 Physical Inactivity: A third of cases of the most common cancers in higher-income countries can be prevented by making healthy food choices, engaging in regular physical activity, and maintaining a healthy body weight.19 In Alberta, nearly half the population is physically inactive and 53 per cent of adults are overweight or obese.20 For some cancers, physical activity may improve survival and decrease mortality after a cancer diagnosis.21, 22 However, many cancer survivors in Canada are overweight and inactive, potentially putting them at risk for chronic health problems. Only 21 per cent of cancer survivors are physically active and 18 per cent have reported being obese.23 14 Statistics Canada. Canadian Community Health Survey - Alberta Share file, 2011. 15 Health Canada. Canadian tobacco use monitoring survey. Ottawa, 2009. 16 Alberta Health Services. Personal communication R. Nugent. Health Canada. July 2010. 17 M Donaldson. “Nutrition and cancer: a review of the evidence for an anti-cancer diet.” Nutrition Journal. 3:19, 2004. p.2. 18 World Cancer Research Fund / American Institute for Cancer Research. Policy and Action for Cancer Prevention. Food, Nutrition, and Physical Activity: a Global Perspective. Washington DC: AICR, 2009. p.18. 19 Ibid. 20 Statistics Canada. Health Profile – Alberta. Statistics Canada Catalogue No. 82-228-XWE. Ottawa. Released June 19, 2012. 21 EM Ibrahim, A Al-Homaidh. “Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies.” Medical Oncology, 2010. p.11. 22 A Vrieling, E Kampman. “The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature.” American Journal of Clinical Nutrition. 92:471-90, 2010. 23 K Courneya, P Katzmarzyk, E Bacon. “Physical activity and obesity in Canadian cancer survivors: population-based estimates from the 2005 Canadian Community Health Survey.” American Cancer Society. 2008.
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Marlene Nelson (left) spends time on a treadmill as part of the Beta Trial study led by Dr. Christine Friedenreich (right) that examines the relationship between exercise
The project is funded by the Alberta Cancer Foundation levels and breast cancer risk. The project is funded by the Alberta Cancer Foundation, which committed $22.6 million in 2011 to support cancer research projects like Dr. Friedenreich’s.
Alcohol consumption: A large prospective cohort study of eight European countries estimated that 10 per cent of cancer incidence in men and 3 per cent of cancer incidence in women was attributed to alcohol consumption.24 Alcohol use has been linked to an increased risk for developing several forms of cancer (head and neck, esophagus, liver and breast cancer) and many other disease conditions. Ultraviolet (UV) exposure: Despite its preventability, the incidence of skin cancer continues to increase, leading to substantial heath-care costs, increased risk of a second primary cancer, and in some instances, mortality. Evidence indicates that each of the three main types of skin cancer – basal cell carcinoma, squamous cell carcinoma, and melanoma – is caused by sun exposure. Skin cancer places a significant burden on patients, their families and the health system. In 2010, approximately one in three Albertans diagnosed with cancer was diagnosed with a type of skin cancer (malignant melanoma or non-melanoma skin cancer).25 Based on current trends, the burden is expected to increase. The use of artificial tanning also increases the risk of skin cancer. Artificial UV radiation has been upgraded to a Group 1 carcinogen (a category that also includes arsenic, mustard gas and tobacco). For individuals who use tanning beds before 35 years of age,
24 Schutze et al., “Alcohol attributable burden of incidence of cancer in eight European countries based on results from a prospective cohort study.” British Medical Journal. 342: d1584, 2001. p.5. 25 Alberta Health Services. Alberta Cancer Registry Annual Report 2010. Alberta, In press.
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there is a 75 per cent increased risk of cutaneous melanoma.26 In Alberta 12 per cent of the population used artificial tanning in 2006, and over 21 per cent of artificial tanning users were between the ages of 18 and 21.27 Viral infections: Approximately 18 per cent of cancers worldwide are caused by infections, with 12 per cent of these being caused by viruses. HPV, Hepatitis B and C, and Human Immunodeficiency Virus (HIV) are among the viruses that can cause cancers. Estimates indicate that 8 per cent of cancers could be prevented by avoiding these cancer-causing infections.28 HPV is a common infection that affects approximately 550,000 Canadians annually and causes 5 per cent of cancers worldwide.29 It is estimated that over 70 per cent of people will have at least one genital HPV infection in their lifetime. There is no cure for HPV infection and it is difficult to prevent transmission of the disease. HPV vaccination has been suggested as the best primary prevention method, and Pap testing as the best secondary prevention method.30 A publicly-funded Alberta HPV Immunization program is currently available for girls in grade five. In addition, girls in grade nine were offered the vaccine in the years 2009–2010 to 2011–2012.
Eric Flores (left) and older brother Esteban took part in the MEND (Mind, Exercise, Nutrition… Do It!) program to reduce obesity and prevent chronic disease, including certain types of cancer. At 9 years old, Eric Flores was at risk of becoming one of the 200,000-plus Alberta youth who are overweight or obese until their family pediatrician suggested MEND. During the 10-week course, Eric’s family learned about nutrition, participated in a grocery store tour and took part in fun game-based physical activity. The course helps kids feel more confident and parents discover how to turn conflict around food into family fun. 26 International Agency for Research on Cancer Working Group on Artificial Ultraviolet (UV) Light and Skin Cancer. “The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review.” International Journal of Cancer. 120(5):1116-22, 2007. 27 National Skin Cancer Prevention Committee. Exposure to and Protection from the Sun in Canada: A Report Based on the 2006 Second National Sun Survey. Canadian Partnership Against Cancer, 2010. 28 Parkin DM. “The global health burden of infection-associated cancers in the year 2002.” International Journal of Cancer. 118:3030-3044. 2006. 29 Society of Obstetricians and Gynaecologists of Canada. “Canadian Consensus Guidelines on Human Papillomavirus.” Journal of Obstetrics and Gynaecology Canada. 196: S1-S56, 2007. p.S3. 30 Ibid.
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Screening Screening Alberta’s screening programs directed at targeted populations ensure those who could benefit from screening are reached, and that resources are not directed towards groups unlikely to benefit. AHS is able to track participation in the target population and reach out to the underserved. It can also track data to support program management, patient follow-up and accountability for outcomes. AHS has three provincial cancer screening programs in place, at different stages of implementation: the Alberta Breast Cancer Screening Program; the Alberta Colorectal Cancer Screening Program, and the Alberta Cervical Cancer Screening Program. The programs aim to reduce mortality of Alberta women from breast cancer by at least 30 per cent; to reduce mortality associated with cervical cancer by 50 per cent; and to reduce mortality from colorectal cancer by 30 per cent, as well as its incidence by 20 per cent after 10 years of full implementation.
More than fifteen years ago, former cardiac nurse Ann Brown was diagnosed with colon cancer and given a 50 per cent chance of survival. “If I hadn’t had the screening, they wouldn’t have caught the cancer and I wouldn’t be here today,” says Brown.
If detected early, it can be cured. Brown had no family history of colon cancer, but one day found blood in her stool and immediately went to her family doctor. “Colorectal cancer is one of the most common causes of cancer-related deaths in Alberta – too many people die from it each year,” says Dr. Catherine Dubé, the Medical Lead for the Alberta Colorectal Cancer Screening Program within AHS. “If detected early, it can be cured.”
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Diagnosis and Treatment Diagnosis Treatment Diagnosis
Through our health care system, it must be determined whether or not a cancer is present; if there is a cancer, what type of cancer it is, and what stage it is at (i.e., how far it has invaded its surroundings, and where it may have spread within the body). It is becoming increasingly important to define certain cellular, molecular and genetic characteristics of individual cancers that provide additional information to guide treatment decisions for individual patients. The diagnostic process typically involves primary care physicians, diagnostic radiologists, pathologists, and often surgeons or other specialists. Timeliness and accuracy within the diagnostic process have a significant impact on patient outcomes and satisfaction. The timeliness and accuracy of diagnosis depend on three attributes: ›› the use of evidence-based clinical pathways for diagnosis of specific cancers; ›› close coordination among professionals and facilities; and ›› skilled and experienced professionals to ensure precise and accurate interpretation of imaging and test results.
Nurse Iffat Iqbal (left) and oncologist Dr. Marc Kerba help cancer patient Shirley Valleau during radiation therapy at Tom Baker Cancer Centre in Calgary.
98 per cent of Alberta patients started their radiation treatment within the four-week benchmark In February 2012, 98 per cent of Alberta patients started their radiation treatment within the four-week benchmark set by the provincial government and AHS.
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Dr. Chris Molnar, left, AHS head of Nuclear Medicine in Calgary, and thyroid cancer patient Ron Visser examine a positron emission tomography/ computed tomography (PET/CT) scanner at Foothills Medical Centre.
the number of scans performed in Calgary is set to triple Thousands more cancer patients like Visser will have access to PET/CT technology, as the number of scans performed in Calgary is set to triple. This powerful technology supports the evaluation and management of several types of cancer.
Treatment There are three main ways to treat cancer: Surgery: Cancer surgery usually takes place in urban hospitals. The primary purpose of cancer surgery is to remove all cancer from the body and a minimal amount of surrounding healthy tissue. If necessary, the surgeon may also remove some lymph nodes in the surrounding area to determine if the cancer has spread. This helps oncologists assess the chances for cure, as well as the need for further treatment. Radiation: Radiation therapy requires specialized equipment such as linear accelerators and occurs at facilities specifically built for this type of treatment, which uses high energy X-rays to destroy cancer cells. Therapy is provided by teams of radiation oncologists, radiation therapists, medical physicists, and nurses. They plan and deliver the treatment and ensure that appropriate care is provided to patients. Systemic therapy: Systemic therapy is the umbrella term for using drugs to kill cancer cells or halt their growth. The most common type of systemic therapy is cytotoxic chemotherapy, which uses drugs that are toxic to some cancer cells and also harmful to some normal cells. Other forms of systemic therapy involve treatment with hormones, drugs that counteract hormones, agents that work through immune mechanisms (immunotherapy) and agents that disrupt cellular pathways that incite cancer cell growth (targeted therapy).
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A Cross Cancer Institute patient attends the Wig Salon for a fitting. The program is staffed by volunteers and is free for patients undergoing treatment.
The program is staffed by volunteers and is free... Wig fittings are just one example of the types of support services available for cancer patients and survivors. The Cross Cancer Institute also offers counselling services, education classes, nutrition consultation, occupational therapy, and spiritual care services. Each of these services is an important component of care within the cancer continuum.
Research Research The Alberta Cancer Prevention Legacy Act, proclaimed in 2006, supported the vision of a cancer-free future and established the Alberta Cancer Prevention Legacy Fund with $500 million. About $25 million of the Alberta Cancer Prevention Legacy Fund is invested each year in research, prevention, and screening activities. Added to this is funding available through Alberta Innovates - Health Solutions (AIHS), the Government of Canada, the Alberta Cancer Foundation, and other philanthropic organizations. Key stakeholders and players in Alberta’s new cancer research community include: ›› AHS – a single provincial health service to serve the health needs of all Albertans. AHS both supports and performs clinical and population-based cancer research. AHS administers the prevention and screening portion (up to $12.5 million) of the Alberta Cancer Prevention Legacy Fund. CancerControl Alberta, a new operating division within AHS, will bring together AHS cancer facilities and programs under one umbrella and fully engage with key stakeholders involved in cancer prevention, treatment and research. ›› AIHS – provides leadership for Alberta’s health research and innovation enterprise by “directing, coordinating, reviewing, funding and supporting research and innovation.” AIHS receives base funding for health research through the Alberta Heritage
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Foundation for Medical Research Endowment Fund. AIHS leverages its base funding through agreements with other stakeholders and strategically invests up to $12.5 million annually from the Alberta Cancer Prevention Legacy Fund into cancer research. ›› Alberta Cancer Foundation – the largest charitable funder of cancer research grants in the province. The Alberta Cancer Foundation supports research, prevention and care for all AHS cancer centres. In 2010–2011, the Alberta Cancer Foundation awarded $15 million in research grants, and has acted as a key partner with AIHS in leveraging funding from the Alberta Cancer Prevention Legacy Fund. ›› Universities of Alberta, Calgary and Lethbridge – these universities develop and promote leadership in teaching and excellence in research; build partnerships for collaborative research and knowledge transfer; and work with AHS to attract and retain the outstanding people required to perform cancer research.
Young adults with a type of brain cancer called oligodendroglioma have the potential to double their life-expectancy thanks to research led by Dr. Gregory Cairncross, who holds the Alberta Cancer Foundation
combining radiation therapy with chemotherapy, the cancer’s growth significantly slowed Chair in Brain Tumor Research and heads the Department of Clinical Neurosciences at the University of Calgary. Radiation therapy is the standard treatment for this type of brain cancer. Dr. Cairncross discovered that by combining radiation therapy with chemotherapy, the cancer’s growth significantly slowed. Now, the life-expectancy with treatment for this type of brain cancer is 15 years – up from seven years.
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Workforce Workforce An aging boomer generation nearing retirement, combined with low birth rates, is reducing labour market growth in Canada. The health sector, like many other sectors, is facing this demographic shift. Projections indicate that by 2015, annual growth of the labour force in Canada will be just 0.7 per cent.31 Alberta industries and employers will need to look at more efficient ways to use the workforce to meet demands, i.e., through improved productivity. The Cancer Workforce Scoping Study: A Report from the Front Lines of Canada’s Cancer Control Workforce: Summary Report32 also identifies this uncertainty surrounding the future of Canada’s workforce. The report notes that over the last 20 years, chronic, recurrent and widespread human resources shortages have occurred in the cancer control workforce’s priority health professions. The report questions who will replace the professionals comprising the cancer control workforce when they retire and how much longer they can keep up with the increasing flow of patients and survivors. The increased complexity of cancer treatments is also fueling more demand for a cancer workforce with specialized skills. In addition to the prevention and detection of new or recurrent cancers, cancer survivors may require treatment for secondary heath problems and side effects like chronic pain, infertility and depression as well as late effects of cancer treatment, some of which may not appear until many years after treatment. In the future, care and services to patients will increasingly be delivered by interdisciplinary teams that include health care providers specializing in oncology, primary care providers, pharmacists, nurses, radiation therapists, and others. Through the use of an interdisciplinary team approach, specialized expertise will be shared and applied across CancerControl Alberta.
Cross Cancer Institute pharmacist Johanna Lo assists a patient in learning how to take medications and understanding the effects. Pharmacists and other health professionals play an essential role in management of cancer and comorbidities and help ensure that patients are active participants in their own health. 31 Human Resources and Skills Development Canada, Looking-Ahead: A 10-Year Outlook for the Canadian Labour Market (2006-2015). 2006. p.37. 32 Canadian Partnership Against Cancer. The Cancer Workforce Scoping Study: A Report from the Front Lines of Canada’s Cancer Control Workforce. Toronto, 2010. p.4.
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Conclusion Conclusion Clearly, the challenge of cancer is unlike any other, both in terms of the complexity of the disease and in its treatment. In Alberta, and many other parts of the world, the challenge is compounded by changing demographics – an aging and growing population means more cases of cancer. The annual incidence of new cases of cancer in Alberta is projected to increase to 27,000 cases in 2030, a 65 per cent increase over 2010. At the same time, members of our workforce are also aging, including cancer care professionals. Many are nearing retirement and are not easily replaced. This companion piece looks at these and other challenges. It also provides an overview of how Alberta effectively responds to cancer today through its high-quality expertise, services, and infrastructure. Alberta is in an excellent position to build on its strengths to reduce the incidence and mortality of cancer in the province, and improve the survival and quality of life for those with cancer. This companion piece sets the stage for Changing Our Future: Alberta’s Cancer Plan to 2030, which identifies the strategies and actions required to address the challenges facing our cancer care system.
Performance Measures Performance Measures Performance measures align with the strategies and actions outlined in Changing Our Future: Alberta’s Cancer Plan to 2030 and will be used to drive quality improvement and accountability. The measures included in the tables below cover major areas of the cancer continuum and are intended to be strategic, long term, knowledge-based, and meaningful measures that are also feasible to implement and useful in comparing the outcomes of Alberta’s cancer strategies with outcomes reported by other provinces and countries.33 New measures of the quality of cancer care may be developed over time, after having undergone a thorough review and approval process.
33 The Canadian Partnership Against Cancer (CPAC) System Performance Initiative contributed to the selection of Alberta’s performance measures. CPAC is an independent organization funded by Health Canada to accelerate action on cancer control for all Canadians.
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Table 2 – Long-Term Performance Measures Age-Standardized Incidence Rates by Sex
Last Actual Results (Baseline)
Summary of National Situation
Age-Standardized Incidence Rates (per 100,000 population): The incidence rate that would have occurred if the age distribution in the population of interest was the same as that of the standard, where incidence rate is defined as the number of cases of cancer (malignant neoplasms) newly diagnosed during a year, per 100,000 population at risk. Canada (2009)35
Alberta (2007–2009)34 All cancers Colorectal Lung Prostate
Males
436.4 55.9 57.6 124.4
All cancers Colorectal Lung Prostate
Canada (2009)36
Alberta (2007–2009)34 All cancers Colorectal Lung Breast
Females
351.6 36.2 44.4 95.5
448.8 59.2 65.1 114.6
All cancers Colorectal Lung Breast
364.2 39.9 47.4 97.6
34 Canadian Partnership Against Cancer. The 2012 Cancer System Performance Report. Toronto, ON: Canadian Partnership Against Cancer, 2012. 35 Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2012. Table 4.1 Estimated Age-Standardized Incidence Rates for Selected Cancers, Males, Canada, 1983–2012. Toronto, ON: Canadian Cancer Society, 2012. 36 Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2012. Table 4.3 Estimated Age-Standardized Incidence Rates for Selected Cancers, Females, Canada, 1983–2012. Toronto, ON: Canadian Cancer Society, 2012.
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Table 2 – Long-Term Performance Measures (continued) Age-Standardized Mortality Rates by Sex
Last Actual Results (Baseline)
Summary of National Situation
Age-Standardized Mortality Rates (per 100,000 population): The mortality rate that would have occurred if the age distribution in the population of interest was the same as that of the standard, where mortality rate is defined as the number of deaths due to cancer (malignant neoplasms) in a year per 100,000 population at risk. Canada (2009)38
Alberta (2007–2009)37 Males
All cancers Colorectal Lung Prostate
180.0 22.7 47.5 22.4
All cancers Colorectal Lung Prostate
Canada (2009)39
Alberta (2007–2009)37 Females
All cancers Colorectal Lung Breast
129.5 12.7 34.3 19.9
193.3 24.3 53.8 19.8
All cancers Colorectal Lung Breast
139.1 15.4 36.5 20.7
37 Canadian Partnership Against Cancer. The 2012 Cancer System Performance Report. Toronto, ON: Canadian Partnership Against Cancer, 2012. 38 Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2012. Table 4.2 Age-Standardized Mortality Rates for Selected Cancers, Males, Canada, 1983–2012. Toronto, ON: Canadian Cancer Society, 2012. 39 Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2012. Table 4.4 Age-Standardized Mortality Rates for Selected Cancers, Females, Canada, 1983–2012. Toronto, ON: Canadian Cancer Society, 2012.
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Table 2 – Long-Term Performance Measures (continued) Five-Year Relative Survival Ratios by Sex
Last Actual Results (Baseline)
Summary of National Situation
Five-Year Relative Survival Ratios: Relative survival is the ratio of the observed survival for a group of cancer patients (malignant neoplasms) to the expected survival for members of the general population who have the same main factors affecting survival (sex, age, place of residence) as the cancer patients (referred to as the comparison population). Alberta (2006–2008)40 All cancers Colorectal Lung Prostate
Males
64% 65% 12% 95%
Alberta (2006–2008)40 All cancers Colorectal Lung Breast
Females
61% 64% 17% 88%
Canada (2004–2006)41 All cancers Colorectal Lung Prostate
62% 63% 13% 96%
Canada (2004–2006)41 All cancers Colorectal Lung Breast
63% 64% 19% 88%
40 Alberta Health Services, Cancer Surveillance, Alberta Cancer Registry. 41 Canadian Cancer Society’s Steering Committee on Cancer Statistics, Canadian Cancer Statistics 2011. Table 7.1 Estimated Five-Year Relative Survival Ratios and 95% Confidence Intervals (CI) for Selected Cancers by Sex, Canada (Excluding Quebec), 2004–2006. Toronto, ON: Canadian Cancer Society, 2011.
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Table 3 – Cancer Control Continuum Measures
Cancer Control Continuum
Performance Measures with Last Actual Results, Alberta and Canada Prevalence of Smoking (daily or occasional): Percentage of the population aged 12 years and older who are current (daily or occasional) smokers. Canada (2011)42 20%
Alberta (2011)42 23%
Overweight or obesity rates: Adults: Percentage of adults aged 18 and older who are overweight or obese. Canada (2011)42 52%
Alberta (2011)42 53%
Diet (fruit and vegetable consumption): Percentage of the population aged 12 years and older reporting consuming fruits and vegetables 5 to 10 times daily or >10 times daily. Prevention Canada (2011)42 44%
Alberta (2011)42 41%
Physical activity: Percentage of the population aged 12 and over who report physical activity (moderately active, active) during leisure time. Canada (2011)42 52%
Alberta (2011)42 56%
HPV Immunization Uptake: Percentage of cohort immunized (females in grade 5 or grade 9 of schools where the provincial HPV vaccination program has been offered) with all three doses of the HPV immunization series. Canada (2008–2009)44 52% to 88%
Alberta (2010–2011)43 60%
42 Statistics Canada. Health Profile – Alberta. Statistics Canada Catalogue No. 82-228-XWE. Ottawa. Released June 19, 2012. 43 Alberta Health Services and Alberta Health, Surveillance and Assessment Branch, November 2011. 44 Canadian Partnership Against Cancer. The 2012 Cancer System Performance Report. Toronto, ON: Canadian Partnership Against Cancer, 2012. Results for provinces other than Alberta and Ontario are the percentage of cohort immunized with the first dose of HPV immunization. Alberta data are for the third dose of HPV immunization.
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Table 3 – Cancer Control Continuum Measures (continued)
Cancer Control Continuum
Performance Measures with Last Actual Results, Alberta and Canada Breast Cancer Screening Participation Rate: Percentage of women between the ages of 50 and 69 years who have had a breast screening mammogram in the last 2 years (biennially). Alberta (2010–2011)45 55%
Canada (2008)46 72%
Colorectal Cancer Screening - Asymptomatic: Percentage of asymptomatic individuals aged 50–74 who reported undergoing a colorectal cancer screening test: Fecal occult blood test within the past 2 years, or flexible sigmoidoscopy within the past 5 years, or colonoscopy within the past 10 years.
Screening
Alberta (2011)47 50%
Canada (2011)47 43%
Cervical Cancer Screening Participation Rate: Percentage of women aged 20–69 who had at least one Pap test in the last three years. Alberta (2009–2011)48 65%
Canada (2008)49 72.5%
45 Alberta Health Services. Alberta Health Services Performance Report Q2 2012/13 (December 2012). 46 Statistics Canada. Canadian Community Health Survey 2008, as reported in The 2012 Cancer System Performance Report. Toronto, ON: Canadian Partnership Against Cancer, 2012. 47 Canadian Partnership Against Cancer. The 2012 Cancer System Performance Report. Toronto, ON: Canadian Partnership Against Cancer, 2012. 48 Alberta Health Services. Alberta Health Services Performance Report Q2 2012/13 (December 2012). 49 Statistics Canada. Canadian Community Health Survey 2008.
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Table 3 – Cancer Control Continuum Measures (continued)
Cancer Control Continuum
Performance Measures with Last Actual Results, Alberta and Canada Capture of Stage Data: Percentage of provincial cancer incident cases, overall and for the top four disease sites (breast, prostate, colorectal, and lung) for which valid stage at diagnosis data are available and collected in the Alberta Cancer Registry. Alberta (2010)50 All invasive cancers Top four cancers
Diagnosis and Treatment
99.9% 99.9%
Other Provinces (2010)50 48.8% to 100% 90.6% to 100%
Radiation Therapy Wait Time: Ready-to-treat to first radiation therapy. 90th percentile elapsed time from ready-to-treat to start of radiation therapy measured in weeks
Alberta (Apr–Sep 2012)51 3.1 weeks
Other Provinces
Percent of radiation therapy cases for which the above wait time was within target
Alberta (Apr–Sep 2011)52 98%
Canada (Apr–Sep 2011)52 97%
Not available.
50 Canadian Partnership Against Cancer. The 2012 Cancer System Performance Report. Toronto, ON: Canadian Partnership Against Cancer, 2012. 51 Alberta Health Services. Alberta Health Services Performance Report Q2 2012/13 (December 2012). 52 Canadian Institute for Health Information. Wait Times in Canada – A Summary, 2012. (March 2012).
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Related Strategies and Initiatives Initiatives Strategies and The following list provides examples of current and ongoing strategies related to Changing Our Future: Alberta’s Cancer Plan to 2030. Many of the strategies listed undergo periodic review and are considered “living” documents. While the list includes strategies as being under the auspices of Government of Alberta and AHS, many of these strategies include partners within universities and/or the private and non-profit sectors. Alberta Health/Alberta Health Services ›› Creating Tobacco-free Futures: Alberta’s Strategy to Prevent and Reduce Tobacco Use (2012–2022) ›› Alberta Sexually Transmitted Infections and Blood Borne Pathogens Strategy and Action Plan (2011–2016) ›› Creating Connections: Alberta’s Addiction and Mental Health Strategy (2011) ›› Creating Connections: Alberta’s Addiction and Mental Health Action Plan (2011–2016) ›› Becoming the Best: Alberta’s 5-Year Health Action Plan (2010–2015) ›› Patient Safety Framework (2010) ›› Alberta Pharmaceutical Strategy (2009) ›› Alberta Continuing Care Strategy: Aging in the Right Place (2008) ›› Alberta Infection Prevention and Control Strategy (2008) ›› Alberta’s Immunization Strategy (2007–2017) ›› Healthy U Initiative (1995) ›› Health System Information Technology 5-Year Plan (2011–2016) ›› Obesity Initiative (2011–2016) ›› Cancer Screening Health Promotion Strategies (2011) ›› Public Health Innovation & Decision Support Strategies (2011) ›› Alberta Health Services’ Strategic Plan for Workplace Health & Safety (2010) ›› Healthy ‘n Green: Towards an Alberta Health Services Environmental Sustainability Strategy (2009) ›› Alberta’s Healthy Aging and Seniors Wellness Strategic Framework (2002–2012) Government of Alberta Cross Ministry Strategies, Policies and Initiatives ›› Active Alberta (2011) ›› Aging Population Policy Framework (2010) ›› Alberta’s Health Research & Innovation Strategy (2010)
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›› Framework for Kindergarten to Grade 12 Wellness Education (2009) ›› CONNECT Alberta’s Action Plan: Bringing Technology to Market (2008) ›› Alberta Alcohol Strategy (2008) ›› Making the Food Health Connection: An Alberta Framework for Innovation (2008) ›› Student Health (ongoing) ›› Alberta Active Living Strategy (1998) ›› Land Use Framework (2008)
Key Definitions Key Definitions Access
The ability of a person to reach or use health services. Barriers to access may be influenced by: (1) a person’s location, income or knowledge of services available; (2) the availability or acceptability of existing services.
Biobanks
Collection[s] of human tissues that can be used for research.
Cancer incidence
The number of new cancer cases diagnosed in a given population during a specific time period.
Cancer incidence rate
Incidence rates are typically reported as the number of new cases for every 100,000 people per year.
Cancer prevention
Activities that prevent or reduce the risk of getting cancer, particularly those related to healthy lifestyles: no smoking, eating a healthy diet and exercising regularly.
Cancer research
Research that ultimately reduces the burden of cancer: i.e., reducing cancer incidence or mortality or improving the quality of life of cancer patients and their families.
Cancer treatment
A series of interventions, including surgery, radiotherapy, chemotherapy, hormone therapy and psychosocial support, that is aimed at curing the disease or prolonging the patient’s life.
Carcinogen
Any substance, radionuclide, or radiation that is an agent directly involved in causing cancer. Group 1 carcinogens include agents or mixtures that are classified as being definitely carcinogenic to humans.
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Chemotherapy
The treatment or control of cancer using anti-cancer drugs.
Cutaneous melanoma
An abnormal growth of tissue on the skin.
End-of-life care
Care when an individual is approaching a period of time closer to death, typified by an intensification of services and assessment.
Evidence-based practice
Treatment decisions based on the best and most up-to-date scientific data available.
Health promotion
The process of enabling people to increase control over their health and its determinants, and thereby improve their health. The primary means of health promotion occur through developing public policy that addresses the prerequisites of health such as income, housing, food security, employment, and quality working conditions.
Integrated care
A coherent set of methods and models on the funding, administrative, organizational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors.
Interdisciplinary teams
A group of health care professionals from diverse fields who work in a coordinated fashion toward a common goal for the patient.
Knowledge exchange
The transfer or exchange of knowledge from one part of the organization to another (or all other) part(s) of the organization. It seeks to capture, organize and distribute knowledge and ensure its availability for future users.
Knowledge transfer A complex system of interactions between researchers and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.53 Molecular characterization
Refers to the chromosome and DNA aberrations that are found in the cells of an individual with cancer.
Morbidity
The incidence of disease within a given population.
53 From Canadian Institutes of Health Research site, March 26, 2012.
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Mortality rate
The number of deaths due to a disease in a given population. Mortality rates are typically reported as the number of deaths for every 100,000 people per year.
Oncologist
A specialist in the treatment of cancer.
Oncology
The branch of medicine concerned with the study and treatment of tumours.
Palliative care
An area of health care that focuses on relieving and preventing the suffering of patients. Palliative medicine uses a multidisciplinary approach to formulating a plan of care to relieve suffering in all areas of a patient’s life. This multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual, and social concerns that arise with advanced illness.
Patient portals
An online point of access (website) that gives patients access to their own health records.
Psychosocial oncology
Psychosocial oncology is concerned with the psychological, social, behavioural, and ethical aspects of cancer. It addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioural and social factors that may influence the disease process.
Population health
Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. In order to achieve these objectives, it looks at and acts upon the broad range of factors and conditions that have a strong influence on our health.
Prevalence
The number of people living with a disease in a given population, either at a point in time or over a period of time. It includes both new and pre-existing cases.
Primary care
Primary health care includes services like health promotion, disease prevention, screening tests and examinations, rehabilitation therapy, nutrition and psychological counselling. It is often a person’s first contact with the health system. While that contact is often with a family physician, a variety of health care professionals can provide primary care, including nurses, pharmacists, dieticians, counsellors, therapists and social workers.
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Public health
The science and art of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention.
Public health services
Services offered to the population as a whole, as opposed to health services offered on an individual basis. Examples include: dissemination of information about communicable diseases and immunization programs.
Screening
Checking or testing for a disease in people who do not show any symptoms of the disease. Examples of cancer screening tests include mammography, colonoscopy and Pap tests.
Secondary care
Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients. Examples include surgeons, radiologists, psychiatrists, physiotherapists, and dieticians.
Stakeholders
Organizations/groups with a direct interest in cancer control.
Staying healthy
Achieving a state of physical, mental and social well-being. People with chronic diseases may also strive to achieve optimal health.
Strategy
A course of action to achieve targets or goals.
Supportive care
Treatment given to prevent, control, or relieve complications and side effects and to improve the patient’s comfort and quality of life.
Surveillance
Treatment that involves closely monitoring a person’s condition with tests and exams given on a regular schedule to reduce their risk of death from a specific cancer. Surveillance also refers to the continuous collection of data for public health decision-making.
Survivorship
Cancer survivorship is the process of living with, through and beyond cancer. It begins when a person is diagnosed and includes people who continue to have treatment to reduce the risk of recurrence or to manage the disease over time. Family, friends and caregivers may also be considered survivors.
Tertiary care
Specialized consultative care refers to care by specialists working in a center that has personnel and facilities for special investigation and treatment.
Whole-person care
Recognizes that health and illness involves the whole person and considers all aspects of a person’s health, including physical, psychological, social, economic, and cultural factors.
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Resource List Resource List The following are resources used by the Steering Committee, the expert working groups, and Alberta Health Services and Alberta Health staff in the preparation of this document: Alberta Health Services. Alberta Cancer Registry Annual Report. Alberta, In press. Alberta Health Services. Alberta Health Services Performance Report Q2 2012/13. December 2012. Alberta Health Services. Cancer Control: An Action Plan for Alberta: 2010-2030. Unpublished. 2011. Alberta Health Services, Cancer Surveillance. March 2012. Alberta Health Services. Cost of Obesity Summary. 2010. Alberta Health Services. Nutrition and Physical Activity Situational Analysis: A Resource to Guide Chronic Disease Prevention in Alberta. 2010. Alberta Health Services. Personal communication of R. Nugent, Health Canada. July 2010. Alberta Policy Coalition for Cancer Prevention. Alcohol-Related Harm in Alberta. Oct. 2010. Australia – Northern Territory Department of Health and Families, Cancer Services Network National Program and Cancer Australia. Cancer Services: Northern Territory Directory. Australia – Queensland Health. Queensland Cancer Control. Strategic Directions 2005-2010. The State of Queensland, 2006. Canada. Ottawa Charter for Health Promotion. November 21, 1986. Canadian Cancer Research Alliance (CCRA). Pan-Canadian Cancer Research Strategy. A Plan for Collaborative Action by Canada’s Cancer Research Funders. Toronto, 2010. Canadian Cancer Research Alliance. Report on the State of Cancer Clinical Trials in Canada. Toronto, 2011. Canadian Cancer Society. The Fight for Life: Nationwide Strategic Plan 2010-15. December 2010. Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2011. Toronto, ON: Canadian Cancer Society; 2011. Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2012. Toronto, ON: Canadian Cancer Society; 2012.
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