PL03.06 Improving Outcomes with Immunotherapy: Lessons from Other Diseases

Abstract

The Ottawa Hospital (TOH) in Canada’s capital city is the tertiary cancer care center for the Baffin Island area of Nunavut- a Territory located in Canada’s north accessed by a 3-hour flight. The Inuit of Canada’s north have dramatically higher social and economic inequities compared to mainstream Canada (ITK, 2018). [GB1] [CR2] [CR3] For example, 70% of Nunavut Inuit households experience food insecurities compared to 8% of the remainder of Canada. 63% of adult Inuit smoke compared to 16% of mainstream Canada. Approximately 30% of Inuit living in Nunavut diagnosed with cancer between 2000 and 2010 did not access any cancer services (Asmis, 2016). Building productive relationships is one of the key pillars of our organization’s cancer strategy. This is demonstrated by the efforts that have taken place among key partners including: 1) TOH’s interdisciplinary teams; 2) the Indigenous Cancer Control Unit of Cancer Care Ontario (CCO), a provincial agency responsible for addressing the cancer burden of First Nations, Inuit and Metis (FNIM) peoples; 3) the Qikiqtani General Hospital (QGH) in Nunavut, providing inpatient and ambulatory care in the Baffin Island and 4) Ottawa-based Inuit service provider organizations. The collaborative relationship developed among the multiple partners resulted in the following positive outcomes: The establishment of a ‘Relationship Table’ where Inuit service provider stakeholders in Ottawa and Nunavut meet quarterly to review cancer related issues and to provide advice on service delivery challenges. The Table is grounded in a formalized relationship protocol with the Inuit community and organizational leaders. Significant increase in the number of patients and family members supported by the Indigenous Cancer Program at TOH. Many cases present with very complex physical and psychosocial issues and require extensive and long-term intervention. TOH is involved in several research initiatives related to Inuit and cancer care, with the goals of 1) better understanding barriers to accessing cancer care: 2) developing tools to support the patients’ understanding of their illness and prognosis, and 3) encouraging FNIM involvement in shared decision making. Over the past year, TOH experts in cancer care have delivered introductory education to health care providers in Nunavut. This initial education event led to TOH hosting nine physicians and nurses for a week of onsite training in the Cancer Care environment, thereby solidifying relationships with oncology staff, and enhanced their ability to provide care closer to home for their patients. A significant milestone was achieved in September 2020 when the first dose of trastuzumab was delivered in Nunavut. This was the first cancer-related medication administered in the Territory, and required education of the QGH Team in the areas of HER2 positive breast cancer assessment, clinical monitoring for toxicity, and administration of sc trastuzumab including relevant symptom/self-management strategies and resources. A policy and standard operating procedure for administration, order set, and confirmation of administration documents were finalized and distributed to support the care process. These were a collaboration between nursing and pharmacy (both TOH and in the QGH Medical Day Unit) and were vetted by other key stakeholders in Ottawa (breast disease site lead and medical oncology division head) as well as in Nunavut. The collaborative effort to provide breast cancer therapy in Nunavut was groundbreaking and lays the foundation to provide treatment for other cancers, such as lung cancer. In May 2020, The Ottawa Hospital took the lead in organizing the first ever Oncology conference in Nunavut. It was anticipated that approximately 100 health care providers from across Canada and other international locations would be meeting in Iqaluit, Nunavut to discuss models of care and strategies to improve access to care, health outcomes, and overall patient experience with cancer care. The outcome of this conference was planned to be shared at the WCLC but due to Covid-19, the conference has been postponed.