Enhancing Quality

The Canadian Association of Provincial Cancer Agencies (CAPCA) and the Canadian Partnership for Quality Radiotherapy (CPQR) have a shared commitment to improving cancer care for Canadians by supporting high quality, patient-centered and safe radiation treatment across the country.

For over 10 years, CPQR has been a world leader in quality improvement initiatives for radiation treatment. CPQR’s impact demonstrates the value of investing in a partnership model that brings professionals together to improve radiation treatment quality and safety. This collaborative network supports sustainably and drives innovation by addressing common issues, sharing best practices and knowledge across all cancer programs.

CPQR is now a standing committee within CAPCA. This is an important step to sustaining radiation treatment quality improvement advances made over the last decade, improving clinical outcomes through radiation treatment innovation and strengthening system performance.

The CPQR website remains available for partners and the radiation treatment community to access CPQR materials and resources. Visit the programs page for access to guidance documents, guidelines, and self audit tools.

Oral cancer drug therapy allows patients to self-administer cancer treatment at home. While it provides greater convenience for patients, it also introduces new risks. These risks include inadequate or missing guidance to:

• pharmacy staff in hospital and community settings on appropriate handling protocols; and
• patients and caregivers expected to handle and administer these therapies at home.

The oral therapies brought a need for new processes, safeguards and standards to ensure high quality patient care.

In 2015, CAPCA assembled experts to provide guidance on the safe handling of oral cancer therapies for both hospital and community pharmacies. These included:

• experts in medication and patient safety;
• experts in pharmacy practice and health systems design; and
• patient and family representatives.

The resulting task groups developed two guidelines:

1. the evidence-based Oral Cancer Drug Therapy Safe Use and Safe Handling Guideline ( 2015); and
2. the Safe Use and Handling of Oral Anti-Cancer Drugs in Community Pharmacy Guideline (2017).

Experts from 70 Canadian and American organizations helped with the external review of these guidelines. Reviewers had expertise in patient or medication safety, occupational health and safety, transportation of hazardous drugs, and/or pharmacy practice.

Within days of the pandemic being declared in March 2020, CAPCA members met weekly to discuss significant planning and delivery issues and discuss potential common approaches to the quality and safety of the provincial cancer programs. We also started to use a document-sharing platform to ensure relevant information was disseminated and leveraged in a timely manner as the situation was rapidly evolving. The group focused initially on consistent application of public health measures to keep patients and healthcare staff safe and identifying issues in modifying treatment. A pan-Canadian program modelling community of practice has also been initiated to help inform decision making as services resume.  Our collective experience with COVID-19 is a powerful example of the importance of system leaders connecting and sharing information in real-time during a time of national crisis.

Proton Beam Therapy (PBT) is being introduced as an alternative to some traditional radiotherapy and new photon technologies. PBT uses protons to deliver a high dose of radiation to the exact tumour location while carefully sparing surrounding tissue and organs from radiation. The benefit of this, especially for tumours in close proximity to sensitive tissue and organs, coupled with the potential cost-savings due to the ability to treat previously untreatable disease, makes PBT an attractive therapeutic option in select pediatric and adult patients.

To coordinate consistent access to planning and delivery of PBT for Canadian patients either in Canada or out of country, CAPCA, with the support of an expert Proton Beam Therapy Consensus Working Group, conducted a current-state analysis of existing provincial- and national-level clinical guidelines and recommendations in Canadian jurisdictions, Europe and Australia and determined there was a need for pan-Canadian consensus-based recommendations.

The Pan-Canadian Recommendations for Proton Beam Therapy Access in Canada are available in both English and French. These recommendations support application of consistent clinical criteria to inform treatment options, treatment planning and referrals, and serve as a companion to existing provincial and national clinical practice guidelines, legislation, and professional practice standards.  

CAPCA and the Canadian Partnership Against Cancer (CPAC) have collaborated on the development of a standardized lung cancer screening business case to facilitate planning and decision-making at the jurisdictional level for the implementation of provincial/territorial organized lung cancer screening programs.

Jurisdiction-specific cost and resource estimates were generated using CPAC’s OncoSim modelling tool, enabling jurisdictions to identify optimal implementation models to enhance their case for establishing an organized lung cancer screening program.

By 2023, CAPCA and CPAC will have established system readiness to implement organized lung cancer screening programs by:

• leveraging pan-Canadian expertise in lung screening trials
• leveraging implementation experience from the development of previous breast, colorectal, and cervical screening programs.

Early integration of palliative care is an important aspect of quality cancer care delivery. CAPCA is working with the Canadian Partnership Against Cancer’s (CPAC) on the implementation of the Canadian Inter-Professional Palliative Care Competency Framework.

The Framework establishes a minimum national standard for palliative care in Canada and seeks to direct consistent implementation and measurement of palliative care competencies in practice.

 By 2023: A parallel process will be undertaken to identify comprehensive, Peoples-specific and self-determined palliative care competencies to add to the broad competencies addressing care for First Nations, Inuit, and Métis already included in the Framework. Engagement with First Nations, Inuit, and Métis partners, organizations and communities will be conducted to identify gaps and opportunities in service delivery.

The framework will be validated by palliative care specialty organizations, including the Canadian Society of Palliative Care Physicians and the Canadian Nurses Association.

Implementation of the framework will include integrating the competencies into post- graduate education and training, using the competencies to address gaps in hiring practices, embedding the competencies into the accreditation process, and collaborations to operationalize the competencies in home care settings.