A Framework for the Organization and Delivery of Systemic Treatment

T Vandenberg,N Coakley,J Nayler,J.A Mackay,M.E Trudeau,C Degrasse,A Smith,C Mclennan,E Green,L Wilcock

doi:10.3747/co.v16i1.297

Abstract

Increasing systemic treatment and shortages of oncology professionals in Canada require innovative approaches to the safe and effective delivery of intravenous (IV) cancer treatment. We conducted a systematic review of the clinical and scientific literature, and an environmental scan of models in Canada, the United Kingdom, Australia, and New Zealand. We then developed a framework for the organization and delivery of IV systemic treatment. The systematic review covered the medline, embase, cinahl, and HealthStar databases. The environmental scan retrieved published and unpublished sources, coupled with a free key word search using the Google search engine. The Systemic Treatment Working Group reviewed the evidence and developed a draft framework using evidence-based analysis, existing recommendations from various jurisdictions, and expert opinion based on experience and consensus. The draft was assessed by Ontario stakeholders and reviewed and approved by Cancer Care Ontario. The poor quantity and quality of the evidence necessitated a consensus-derived model. That model comprises four levels of care determined by a regional systemic treatment program and three integrated structures (integrated cancer programs, affiliate institutions, and satellite institutions), each with a defined scope of practice and a specific organizational framework. New models of care are urgently required beyond large centres, particularly in geographically remote or rural areas. Despite limited applicable evidence, the development and successful implementation of this framework is intended to create sustainable, accessible, quality care and to measurably improve patient outcomes.

Highlights

In Canada, cancer is a major cause of morbidity and mortality, and the leading cause of potential years of life lost
That model comprises four levels of care determined by a regional systemic treatment program and three integrated structures, each with a defined scope of practice and a specific organizational framework
The November 2005 Canadian Post-MD Education Registry revealed that only 34 medical oncology residents and 8 fellows are in oncology training for the entire country 5

Summary

Introduction

In Canada, cancer is a major cause of morbidity and mortality, and the leading cause of potential years of life lost. Medical oncology consultations are increasing by 10%–20% annually, and systemic treatment has increased at an annual rate of 7%–10%, fuelled by new evidence-based therapies that improve survival and quality of life 2. The November 2005 Canadian Post-MD Education Registry revealed that only 34 medical oncology residents and 8 fellows are in oncology training for the entire country 5. Exacerbating this problem are the numbers of retiring physicians 6 and registered nurses 8 anticipated in Canada. Increasing systemic treatment and shortages of oncology professionals in Canada require innovative approaches to the safe and effective delivery of intravenous (IV) cancer treatment. We developed a framework for the organization and delivery of IV systemic treatment

Objectives

Methods

Results

Discussion

Conclusion