Restructuring Skin Cancer Care in Ontario: A Provincial Plan.

John Milkovich,Carolyn Nessim,Teresa M Petrella,Louis Weatherhead,Jonathan C Irish,An-Wen Chan,Christian Murray,Grace Bannerman,Laura Pazzano,Tim Hanna,Claire Holloway,Frances C Wright,Katharina Forster

doi:10.3390/curroncol28020114

Abstract

There is a global rise in skin cancer incidence, resulting in an increase in patient care needs and healthcare costs. To optimize health care planning, costs, and patient care, Ontario Health developed a provincial skin cancer plan to streamline the quality of care. We conducted a systematic review and a grey literature search to evaluate the definitions and management of skin cancer within other jurisdictions, as well as a provincial survey of skin cancer care practices, to identify care gaps. The systematic review did not identify any published comprehensive skin cancer management plans. The grey literature search revealed skin cancer plans in isolated regions of the United Kingdom (U.K.), National Institute for Health and Care Excellence (NICE) guidelines for skin cancer quality indicators and regional skin cancer biopsy clinics, and wait time guidelines in Australia and the U.K. With the input of the Ontario Cancer Advisory Committee (CAC), unique definitions for complex and non-complex skin cancers and the appropriate cancer services were created. A provincial survey of skin cancer care yielded 44 responses and demonstrated gaps in biopsy access. A skin cancer pathway map was created and a recommendation was made for regional skin cancer biopsy clinics. We have created unique definitions for complex and non-complex skin cancer and a skin cancer pathways map, which will allow for the implementation of both process and performance metrics to address identified gaps in care.

Highlights

The systematic literature review identified nine papers, none of which described a regional organization of skin cancer services
We have described the development of a comprehensive health system plan for skin cancer care in Ontario
This work is unique as it defines skin cancers by the complexity of the clinical services required for appropriate treatment and encompasses a pathway for all aspects of skin cancer care

Summary

Introduction

Skin cancer is the most common type of cancer in Canada. In 2019, 7300 new cases of melanoma were reported; there is a paucity of reported data for epidermalcreativecommons.org/licenses/by/ 4.0/). Derived skin cancer (keratinocyte carcinoma (KC)), where cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the predominant types [1]. In 2014, the Canadian Cancer Statistics focused on skin cancers and reported 76,100 new cases of KC [2]. Data from Canada and other countries suggest that skin cancer incidence is increasing [2,3]. Recent estimates show that the annual costs associated with skin cancer in Canada amount to $532 million, and by 2031, it is expected that the annual cost will reach $922 million [4]

Results

Discussion

Conclusion