Road to recovery: Cancer in the COVID-19 era

Preparing for the surge in cancer cases

Explore the actions needed for preparing for the surge in cancer cases:

1. Prioritize cancer surgeries and procedures
2. Support strategies led by First Nations, Inuit and Métis
3. Co-design pandemic response and recovery efforts with communities experiencing inequities
4. Enhance the elasticity of the cancer system
5. Support coordination with primary care
6. Leverage cancer care networks
7. Improve oncology services in rural and remote communities

1. Prioritize cancer surgeries and procedures

Given the impacts of delayed treatment on cancer patients, hospitals must continue to prioritize cancer surgeries when determining operating room capacity allocations. As other kinds of elective and less-critical surgeries ramp back up and begin to address their own backlogs, it is essential that the life-and-death nature of cancer not be forgotten. By taking a holistic view of all disciplines, types of surgeries and patient needs/vulnerabilities, and by establishing overarching priority levels for diagnosis and treatment, the use of system resources can be optimized and tuned to where services are needed most urgently to obtain desired outcomes. Allowing for reordering of treatment sequencing, including radiation, ablation or chemotherapy, as temporary measures while patients await surgeries could also be a way of increasing the chances of better outcomes.

Solutions from across Canada:

• Prioritization guidelines: Ontario Health has developed clinical guidance documents and tip sheets to help prioritize patients in its clinical programs, maximizing limited resources by making sure more serious patient cases are addressed first. These documents are flexible to account for each centre’s capacity at the time. Similarly, Quebec has also developed guidelines to help clinicians and decision-makers prioritize surgical patients during the pandemic, based on resource availability and clinical criteria.
• Centralized wait lists: Ontario has invested in the wide-scale adoption of electronic central wait list systems, which will help with hospital, regional and provincial planning of surgical access and load leveling.

2. Support strategies led by First Nations, Inuit and Métis

First Nations, Inuit and Métis communities and organizations have developed strategies and resources to manage the health of their communities and understand their local challenges. By building relationships and partnerships with First Nations, Inuit and Métis, we can listen to how we can create a better way forward that is equitable and culturally safe, co-design more culturally appropriate care that optimizes available community-based supports, and improve communication and coordination of services to make it easier to navigate the cancer system. Having more health-care providers take cultural safety training will also help in this regard.

Solutions from across Canada:

• Travel assistance: The Métis Nation–Saskatchewan Medical Travel Assistance Pilot Program improves outcomes for Métis people with cancer by reducing travel-related barriers that contribute to health inequities.
• Community connections: In the Rural Municipality of St. Laurent, a Community Connector ensures Métis residents have the support they need throughout their cancer journey, enhancing the delivery of equitable care.
• Increased screening: By working in close partnership with community health representatives and local First Nations and Inuit communities, a new colorectal cancer screening program in the Northwest Territories has doubled screening participation rates during the pandemic.

3. Co-design pandemic response and recovery efforts with communities experiencing inequities

Efforts to improve timely access to cancer screening, diagnosis and treatment need to be co-designed, from start to finish, with communities experiencing inequities or organizations that represent them. Having diverse voices with lived experiences of the gaps in care at decision-making tables will ensure pandemic response and recovery efforts are tailored to the needs and priorities of their communities.

4. Enhance the elasticity of the cancer system

Canadian hospitals have been rigorously optimized to run at 100% capacity. When COVID-19 hit, there wasn’t room to accommodate increased demand. Future planning should allow for greater flexibility in staffing and resource allocation, which would help ensure the system’s ability to respond in exceptional circumstances. That might include making formal or informal changes to the scopes of practice for different kinds of health-care workers — including current non-oncology providers — to allow more people throughout the system to contribute to the delivery of person-centred cancer care. Optimizing scopes of practices in this way would help address capacity issues and reduce burnout rates among cancer specialists.

Solutions from across Canada:

• Expanded use of nurse practitioners: Alberta has employed nurse practitioners in community care centres connected to a tertiary cancer centre via telehealth to increase resources at community sites and enhance system capacity. Nurse practitioners in British Columbia have received training in cancer care delivery, enabling them to order diagnostic tests, diagnose cancer, prescribe (most) medications and manage long-term follow-up.

5. Support coordination with primary care

Finding ways to increase the role of primary care teams can help recover and build the capacity of the cancer system. Connected models of care that emphasize coordination between cancer specialists and primary care can improve resource utilization across the entire health-care system. Greater collaboration also reduces wait times and enhances quality of care for patients.

Solutions from across Canada:

• Integrated post-treatment care: Alberta’s Living Well After Cancer initiative supports the integration of cancer and primary care teams to provide seamless post-treatment care and improved navigation of supports within the community.
• NEW: Public awareness campaigns: Ontario Health’s toolkit for primary care providers includes phone scripts, newsletter articles, social media posts, fact sheets and digital posters to increase public awareness of cancer screening. Clinical guidelines have also been developed to support health-care providers, along with data tools to improve the monitoring of screening volumes.

7. Improve oncology services in rural and remote communities

Greater attention needs to be given to models of care that will help bring oncology services to more people across Canada, including those living in rural and remote communities. This should include maintaining funding for companions/escorts who accompany patients from places such as the Northwest Territories as they travel to larger urban centres for care, providing much-needed language, emotional and navigational support. In many cases, pandemic-related lockdowns prevented companions/escorts from travelling with patients.

Solutions from across Canada:

• IV chemotherapy in rural settings: Many provinces across Canada were able to build on the strengths of their community oncology programs during the pandemic. In Manitoba, many patients continued to receive cancer services closer to home, such as systemic therapy in the Community Cancer Programs. Many patients were also able to connect with nurse navigators and psychosocial oncology clinicians across the province.
• Community oncology: In Nova Scotia, a community oncology program is being developed to deliver diagnostic and offers survivorship services in eight community oncology sites, reducing burden on tertiary cancer centres while also delivering care closer to home and reducing barriers to care caused by travel.
• NEW: Cancer care in Nunavut: Nunavut opened its first specialty cancer clinic at the Qikiqtani General Hospital in Iqaluit, in collaboration with The Ottawa Hospital. This clinic allows people with a new diagnosis of cancer and those being followed after treatment to receive care closer to home.