Adressing cancer care in BC: Shared Care-funded projects

The Shared Care Committee is funding a range of projects across BC to help address challenges in cancer care.

Alongside the Provincial Health Services Authority (PHSA), BC Cancer, and the Ministry of Health, the committee launched a Call for Proposals in summer 2024. More than 40 applications were submitted, with 15 Expressions of Interest (EOIs) selected for funding.

Priority areas included pain and symptom management, improving diagnostic pathways, and transitions in care (including unattached patients and Community Oncology Networks).

The projects below, grouped according to these priorities, are currently in the EOI phase, while they develop fully planned and budgeted project proposals.

Pain and Symptom Management

Supporting patients in overcoming cancer is only part of the battle. Comprehensive and innovative pain and symptom-management strategies are crucial for the patient's quality of life during and following successful cancer treatment.

Supporting breast cancer patients on endocrine therapy

Two-thirds of people diagnosed with breast cancer in BC are prescribed endocrine therapy, lasting five years. But side effects like arthralgia, weight gain, sleep disturbances, bone loss and induced menopause mean nearly half the people on this treatment will discontinue it well before the five-year mark.

As a result, these patients often experience higher rates of relapse, many of which are severe and incurable.

Together with InspireHealth, the project team will test the implementation of the BE-FIT program. This research-tested self-management program supports people in managing the side effects of endocrine therapy. The project will improve family physicians' knowledge and referral processes to better support patients struggling with ET side effects and symptom management. 

Improving pediatric chemotherapy options in BC

To reduce hospital time for pediatric patients, an outpatient chemotherapy program intends to improve mental health and social connections, create greater independence and cost savings, and enhance patient recovery. The project also has the potential to support other chemotherapy options in an outpatient setting.

On average, patients with osteosarcoma are admitted for six cycles of methotrexate, which equals 50 inpatient days. In comparison, an outpatient can get the same treatment in six four-hour visits.

The project team will analyze the current state of outpatient chemotherapy treatment at BC Children's Hospital and BC Cancer, and conduct an environmental scan of outpatient clinic care models across Canadian care centres.

Optimizing remote symptom and patient monitoring in Richmond

Richmond Hospital is fine-tuning its Remote Symptom and Patient Monitoring System (RESPONSe) program to help reduce the number of cancer patient visits to the emergency department.

The RESPONSe program is for patients experiencing symptoms in the first three months of their chemotherapy treatment. They can access the online platform remotely and report any symptoms in a Health Check survey. If the symptoms can be self-managed, they'll receive support information. If symptoms are more extensive or need an in-person visit, a nurse will call the patient and provide them with directions on the next steps.

While RESPONSe aims to reduce emergency department visits and admissions, it hasn't seen a drop in ED visits, and data show that admission rates remain the same. 

The hospital hopes to identify why patients with better education and symptom management treatments are still visiting the ED. Current program processes will also be reviewed to determine how changes can be made in 2025.

Symptom management for post-treatment patients with gynecological cancer in Kelowna

Surviving gynecological cancer doesn't necessarily mark the end of the care journey.

Despite potentially life-altering symptoms that can affect patients after treatment, many patients don't want to discuss these. This can lead to patients suffering from sexual and mental health issues in silence.

This Shared Care project provides proactive support and follow-up services to patients with gynecological cancer who have undergone surgery and pelvic radiotherapy.

Through data analysis, process mapping, patient engagement, and assessment of other specialized clinics, the project aims to increase the number of patients receiving treatment for gynecological malignancies at BC Cancer Kelowna by 50%. These patients will also be provided with coordinated, proactive management of their genitourinary, sexual health, and endocrine symptoms.

Improving access to pain management for patients with spine metastases in Vancouver

A new project aims to build capacity in spine Stereotactic Ablative Radiotherapy (SABR) delivery, giving better pain control to cancer patients.

Spine SABR is a precise radiotherapy technique that effectively relieves the pain caused by spinal metastases. Only a small group of radiation oncologists provide spine SABR across BC Cancer sites, which means a high demand at sites that offer the treatment. 

This often results in treatment delays, patient travel time, and suboptimal or delayed pain control. For example, a patient from Prince George had to wait four weeks for their treatment, which they had to travel to Vancouver to receive. During their wait, they experienced increasing pain and developed numbness in their legs from the growing tumour.

The project team aims to provide ongoing education and mentorship for medical staff who deliver spine SABR to increase province-wide availability of spine SABR, and in turn help attract and retain medical staff interested in using more advanced radiotherapy techniques.

Increasing access to evidence-based group psychotherapy for BC Cancer patients

Cognitive Behavioural Therapy (CBT) may be just what the doctor ordered for cancer patients with mild-to-moderate depression and anxiety.

While most people are familiar with common cancer treatments, such as radiotherapy and chemotherapy, the psychological toll on patients dealing with cancer is often overlooked. 

BC Cancer physicians, along with Mind Space, are hoping to illuminate this by expanding access to MSP-funded CBT psychotherapy groups for BC Cancer patients.

The project team hopes to better integrate CBT groups as a first-line treatment for mild-to-moderate depression in patients dealing with cancer.

Improving diagnostic pathways

Clear and up-to-date diagnostic pathways can help physicians confidently support their patients through their cancer journey and improve the overall patient experience.

Reducing time to lung cancer diagnosis in the South Okanagan

A small amount of time can make a significant difference when it comes to the diagnosis of lung cancer, which accounts for roughly 25 per cent of cancer-related deaths.

A Shared Care project aims to reduce this figure with earlier diagnosis by researching the gaps in care and referral pathways used in stage-three lung cancer diagnoses. The research will support developing a centralized referral pathway with a single intake form.

The project is also hoping to find a rationale for providing advanced pulmonary diagnostic procedures at facilities across the South Okanagan region to detect lung cancer at an early stage.

Reducing cardiovascular risk in prostate cancer patients in Victoria

People diagnosed with localized and regional prostate cancer can have a positive survival outlook. But for patients also at high risk of cardiovascular disease, the odds may not be as good.

The CV-Prostate project aims to identify risks and mitigation measures for all prostate cancer patients referred to BC Cancer Victoria who require treatment involving androgen-deprivation therapy for more than six months.

The goal is to reduce cardiac complications. Through research, stakeholder engagement, and the development of a nurse practitioner-led cardiovascular risk-management service, the project aims to find options for cardiac health before symptoms develop, reducing the risk of morbidity and mortality.

Improving communication between radiologists and radiation oncologists for timely referrals in the Interior

Spinal cord compression cases are often complex and can get bogged down by disagreements, uncertainties, and a lack of efficient and effective communication between care team members. This can delay patients' treatment and result in paralysis, sensory loss, and bladder or bowel dysfunction.

The project team hopes to design a care pathway for both attached and unattached patients through case reviews, physician engagement, and assessing education needs to speed up diagnosis and treatment.

Reducing wait times for tissue diagnosis in incidentally detected cancer in Victoria

The Victoria Division of Family Practice, along with BC Cancer, the Patient Voices Network, and others, hope to achieve a more efficient tissue diagnosis process for incidentally detected cancers.

Diagnosis tissue can be cumbersome, from communication delays to the complexity of incidentally detected cancer. This project is an opportunity to assess the process, including reviewing previous cases and integrating an ongoing Physician Quality Improvement initiative project to improve core-biopsy booking times in medical imaging, streamline services, and improve efficiency.

Expediting suspected lung cancer diagnosis in the Fraser region

It can take up to 80 days for the initial signs of lung cancer to lead to a definitive diagnosis and complete staging, but a Shared Care project hopes to reduce that to less than two weeks.

A team of oncologists, surgeons, radiologists, and other health care professionals in the Fraser region is working to develop a clear diagnostic pathway for lung cancer, with the goal of decreasing the time from initial signs to definitive diagnosis and treatment referral to less than 14 days.

The Fraser Health region sees more than 1,100 new lung cancer diagnoses—the most common cause of cancer mortality—annually. Literature suggests that without a centralized, expedited, diagnostic pathway, those 1,100 patients will be waiting on diagnoses for anywhere between 50 to 80 days, a time span that could make all the difference between life and death.

Transitions in Care

Patients receiving cancer care will often have a wide-ranging care team, from family physicians to radiation oncologists and everything in between. To ensure the patient receives the care they need when they need it, it is crucial that the care team communicates and facilitates these transitions, removing any barriers it can.

Equity model of cancer care for the Downtown East Side (DTES)

A Shared Care project is offering hope to cancer patients living in Vancouver's Downtown East Side neighbourhood by bringing equitable cancer care to patients in the DTES.

Through provider equity training, the project team will focus on understanding the barriers to care for BC Cancer patients who are living in the DTES and collect data to develop solutions, including a care pathway for patients coming from the area.

The team and Shared Care hope the project will result in a 40 per cent increase in the treatment completion rate for patients coming to BC Cancer Vancouver from the DTEST< along with recommended pain and symptom management and palliative care.

People living with health and social inequities are significantly more likely to be diagnosed with preventable cancers and late-stage disease for screening-detectable cancers. They are also less likely to receive cancer treatment, more likely to have poor pain and symptom management, and to die from cancers that are generally curable.

Rural cancer care network in East Kootenay region brings treatment closer to home

An East Kootenay cancer care network project is underway to support rural patients who must travel to receive care.

The Cancer Care Network project aims to place a physician with enhanced oncology training in a rural community in the East Kootenay region to support Community Oncology Network (CON) clinics.

Oncology patients currently visit one of two care locations during diagnosis and treatment—either a CON clinic or regional cancer centre. However, the distance a patient must travel for care can directly impact the time it takes for an initial diagnosis and the course of treatment.

This network will support the CON clinic in Cranbrook. The increased support is expected to alleviate some of the CON clinic's current workload, expedite diagnosis, and provide care closer to home.

The project team will survey physicians and patients in Golden, with a similar model, to find challenges and areas of improvement.

Vancouver Island project looks to increase Community Oncology Network capacity through alternative care

Vancouver Island Community Oncology Network (CON) sites are looking at ways to increase capacity while ensuring cancer patients receive the care they need.

CON sites are designed to provide high-quality cancer care to patients close to home. However, some patients who receive low-risk oral treatments don't need frequent physician assessments.

The project team hopes that a Victoria-based remote clinic will provide low-risk patients with services from nurses, pharmacists, and medical oncologists remotely, creating capacity in the traditional CON sites for patients with more complex needs.

Building seamless cancer care transitions in Greater Victoria

The Collaborative Pathways for Seamless Care Transitions project in Greater Victoria aims to provide long-term care planning and support for unattached cancer patients. The project will ensure proper transition protocols are in place for cancer patients discharged from acute care but who don't have follow-up care.

Patients will see improved communication, care coordination, and continuity between hospital clinicians, oncology, and community physicians in Greater Victoria. This will provide unattached patients with a clear follow-up care plan. 

The project team will gather data from patients and physicians across specialties such as oncology, family medicine, emergency care, and palliative care to identify challenges and address improvements.