NEW RESOURCES
CCO Aboriginal Cancer Control Unit
Dr. Annelind Wakegijig, Regional Aboriginal Cancer Lead, Northeast Cancer Centre
Cancer Screening Fact Sheets
Cancer Care Ontario’s (CCO) Aboriginal Cancer Control Unit (ACCU) has recently released a new patient resource: First
Nation, Inuit and Métis Cancer Screening Fact Sheets for breast, cervical and colorectal cancer screening (see insert).
The fact sheets were developed in consultation with internal and external stakeholders, and to ensure the information was
culturally relevant and welcoming, three sets of fact sheets for each of the cancer screening programs specifically for First
Nations, Inuit or Métis people (nine fact sheets in total) were created. Plain language principles were used in the design and
the sheets incorporate a variety of visuals, tables, relevant screening statistics, as well as preventative messaging in a clear
and concise format. The fact sheets are currently available in English, with additional versions being produced in Inuktitut,
Oji-Cree and Ojibway within the next year. CCO has disseminated the fact sheets to all Aboriginal Health Access Centres
and regional cancer centres; additionally they will be available on the CCO website (www.cancercare.on.ca) for download
in the coming weeks. Requests for hard copies can be made to the Northeast Cancer Centre (NECC) via the North East
Oncology News mailbox at [email protected]. Any questions or comments on the new fact sheets can be
directed to CCO’s ACCU at [email protected].
Palliative Care Toolkit ‘Tools for the Journey’
Also recently released from CCO’s ACCU is a new palliative care toolkit - a resource developed for both patients and
providers. The kit, entitled ‘Tools for the Journey’, is designed to support the needs of First Nation, Inuit and Métis (FNIM)
patients and caregivers experiencing the palliative stage of the cancer journey. The Palliative Care Toolkit content was
developed and informed through direct engagement with both FNIM community members and health care providers serving
FNIM people in palliative care and features original artwork by an Ojibway artist, created specifically for the project. The
Palliative Care Toolkit contains 6 brochures in a pocket folder, with topics including:
•
•
•
Understanding the Diagnosis for Patients and Caregivers
Taking Care of Your Loved One
Guidelines for Working Together
•
•
•
What to Expect: Making Decisions and Plans
Teachings to Support Grief and Loss (insert)
Who to Talk to for Support
The ACCU has also developed a complementary resource binder for health care
providers. The binder mirrors the brochures, with expanded information on topics
including: avoiding caregiver burnout and how to write a will, among others.
CCO, through various partnerships, is working on hard copy distribution of the toolkits
to Aboriginal Health Access Centres, First Nation Community Health Centres, Métis
Community Councils and regional cancer programs. An Oji-Cree translation of the toolkit
brochures is planned for next year.
The Palliative Care Toolkit will be available for download from the CCO website
(www.cancercare.on.ca) in the coming weeks, however if you are interested in a hard copy
please contact the NECC Aboriginal Navigator Sherri Baker at: [email protected]
or 705-522-6237 ext. 2175. Any questions or comments on the Palliative Care Toolkit
can be directed to CCO’s ACCU at [email protected].
Palliative Care in First Nations, Inuit and Métis Communities
Tools for the Journey
North East Oncology News is produced by the Editorial Advisory Board of the Northeast Cancer Centre
Editor: Mark Hartman
Assistant Editor: Dr. Amanda Hey
Advisory Board Members: Dr. M. Bonin, Dr. A. Caycedo, Dr. P. Critchley, Dr. J. Grynspan, Dr. A. Khomani, Dr. A. Knight, C. Mayer, Ph.D, Dr. E. Roberts,
Dr. S. Shehata, Dr. S. Shulman, Dr. S. Spadafora & Dr. A. Wakegijig
Production Coordinator: Merci Miron-Black
Production Assistant: Kyla Young
Questions or Comments? Want to join our electronic distribution list? Contact us at [email protected]
41 Ramsey Lake Road - Sudbury, ON - P3E 5J1
Phone: 705.522.6237 - Fax: 705.671.5496
printed on 100% recycled paper
visit Cancer Care Ontario on the web at www.cancercare.on.ca
visit Health Sciences North|Horizon Santé-Nord on the web at www.hsnsudbury.ca
Available online at
www.hsnsudbury.ca/NECCprimarycareresources
North
East
Oncology News
S trengthening
C ommunications
As health care knowledge and delivery systems become more complex, it
becomes ever more important to have effective, efficient and integrated
communication methods amongst health care partners. It is also critical that
patients are provided with health care information in a form that is relevant to
them and invites them to seek further care if needed. Inside this newsletter you
will find examples of how clear documentation on a lab sample can reduce rejection rates and
how adoption of a standardized reporting system for mammogram results can clarify clinical
management. You’ll also read about how a Northeast Cancer Centre Multidisciplinary Cancer
Conference in palliative care, delivered through Ontario Telemedicine Network, allows a
community of practice for palliative health care providers to share challenging cases and best
practices. You’ll also read about how Cancer Care Ontario’s Aboriginal Cancer Control Unit,
following extensive community consultation, has launched public communications regarding
cancer screening and palliative care. By continuing to strengthen health care communications,
both health care providers and the population they serve will benefit.
Mark Hartman
Regional Vice President, Northeast Cancer Centre
NEW Regional Surgical Oncology Lead
I am pleased to have been appointed to the role of Regional Surgical Oncology
Lead in North East Ontario, a role that provides leadership to build, foster and
maintain a regional surgical oncology program throughout the North East. This
role involves working across the region with cancer surgeons, other cancer
care providers, hospitals and organizations as well as with the Cancer Care
Ontario’s (CCO) Surgical Oncology Program to implement cancer surgery
initiatives (guidelines, standards, staging, etc.) and to enhance the cohesion and organization
of surgical oncology services across the region. I truly believe that in the North East we have
health care professionals, facilities and programs that provide world class surgical oncology
care to our population, and I look forward to meeting and working with regional health care
colleagues and organizations as we further advance surgical oncology services.
I am originally from Colombia, where I attended medical school and trained in general surgery.
After practicing for 20 months, I came to Canada to retrain and repeated general surgery at
the University of Ottawa and then went to London (Ontario) where I did a clinical fellowship in
colorectal surgery. Currently, I am doing a Masters in Clinical Research through the University
of Liverpool. I have a strong interest in colorectal and minimally invasive surgery, as well as
medical education.
Dr. Antonio Caycedo
Regional Surgical Oncology Lead, Northeast Cancer Centre
Volume 4 Issue 3
Fall 2014
Focus on:
Communications
INSIDE THIS ISSUE:
Strengthening
Communications. ...............1
New Regional Surgical
Oncology Lead ...................1
Improving the Performance
of CCC FOBT Kits...............2
Improving the
Communication of Test
Results................................3
Multidisciplinary Cancer
Conferences: Palliative
Care....................................3
New Resources: Aboriginal
Cancer Control Unit.............4
Inserts:
BI-RADS® Quick Reference
Guide
Palliative Care MCC Poster
Cancer Screening Fact Sheet
Teachings to Support Grief
and Loss
Cancer Screening App
North East Oncology News is a triannual publication from the Northeast Cancer Centre providing evidence based guidance, and clinical and operational updates of
interest with a focus on Primary Care in North East Ontario.
**References used for this issue of North East Oncology News are available upon request from the editor. Articles may be reprinted without permission, provided the
source is acknowledged.**
IMPROVING the Performance of CCC FOBT Kits
IMPROVING the Communication of Test Results
Dr. Amanda Hey
Regional Primary Care Lead, Northeast Cancer Centre
Dr. Evan Roberts
Regional Breast Imaging Lead, Northeast Cancer Centre
The Guaiac Fecal Occult Blood Test (gFOBT) is the colorectal cancer screening test currently recommended for average
risk individuals by ColonCancerCheck (CCC), a joint program of Cancer Care Ontario and the Ministry of Health and
Long Term Care, with colonoscopy being recommended for increased risk individuals.
The following reviews some gFOBT kit use characteristics in the North East LHIN.
North East
Characteristic
Ontario
2010-11
2013-14
2010-11
2013-14
Use of Non-CCC FOBT kit

22%
11%
15%
9%
CCC FOBT kit Rejection Rate

5%
6%
5%
6%
Reason for CCC FOBT kit Rejection (% of rejected kits)
Not labelled

72%
67%
55%
59%
Card expired

3%
15%
2%
11%
Specimen expired

16%
9%
18%
10%
Data Source: Cancer Care Ontario. (2014). ICS CCC Regional Monthly 2014_09 Report [Unpublished]. Toronto, ON: Evaluation and Reporting, Cancer Screening.
CCC FOBT KIT REJECTION RATES
There has been a slight increase in the rate of rejection of kits, representing 1216 kits rejected in the North East in 2013-14!
The following provides some tips for improving CCC FOBT kit use to optimize quality and reduce rejection of kits.
KIT NOT LABELLED, representing 820
kits in the North East in 2013-14. The
CCC FOBT card requires labelling with
the patient’s name and date of birth. Try
‘point of care’ labelling by health care
providers when dispensing the kits AND
a clear message to the patient to follow
the instructions included in the CCC
FOBT kit.
CARD EXPIRED, representing 183 kits
in the North East in 2013-14. Check your
current inventory of CCC FOBT kits to
ensure that they are not expired or about
to expire. Provide at least 3 months to
allow time for the kit to be completed and
returned for testing. Advise the patient
to complete and return the kit at least a
month before it expires AND explain the
kit will not be processed if it does expire.
SPECIMEN EXPIRED, representing
115 kits in the North East in 2013-14.
For lab quality reasons, CCC FOBT
kits require lab processing within 21
days of specimen collection. Advise
your patient to submit the kit by mail or
to a commercial lab drop off box within
10 days of taking the first specimen.
USE OF NON-CCC FOBT Kits
The use of CCC FOBT kits is recommended to realize the full benefits of an organized program for both patients and
primary care providers (PCP). CCC
FOBT kits must be ordered through
Medical Laboratory Web Address
How to Order
an affiliated community laboratory for
Phlebotomy or
dispensing by PCP offices. CCC FOBT
LifeLabs
www.lifelabs.com
Non-phlebotomy Order Form
kits are not available for patients to pick
up at community or hospital laboratory
Gamma Dynacare
www.gamma-dynacare.ca CCC FOBT Order Form
specimen collection centres.
For more information on CCC eligibility please visit:
www.cancercare.on.ca/cms/one.aspx?pageId=9921
American College of Radiology BI-RADS®
The American College of Radiology (ACR) developed a comprehensive guide for standardized breast imaging terminology
and a classification system for mammography, ultrasound and MRI called Breast Imaging Reporting and Data System
or ACR BI-RADS®1. This allows results of breast imaging studies to be communicated to the ordering physician/ nurse
practitioner (PCP) in a clear fashion with a final assessment that indicates a specific course of action.
In North East Ontario, breast imaging radiologists have adopted ACR BI-RADS® for diagnostic mammography and will
include an ACR BI-RADS® category at the end of mammography reports. The ACR-BIRADS® Quick Reference insert in this
issue will assist ordering PCPs in interpreting the ACR BI-RADS® category. Of note, ACR BI-RADS® Category 3 is used
when it is felt that the probability of malignancy is <2% and that a lesion is not expected to change in the suggested interval,
but the radiologist would prefer to establish stability. Categories 4 and 5 should be referred for appropriate interventional
work-up. The next step is usually a breast image-guided core biopsy (IGCB). Many North East (NE) Ontario mammography
sites have arrangements that can facilitate and expedite the pathway to IGCB for the ordering PCP and patient.
The Concordance Report
When a patient undergoes an IGCB it is important that the radiologist reviews the pathology report and communicates to
the ICGB ordering physician whether the results of the imaging exam are explained by the pathology result. This addendum
report is often called a ‘concordance’ report. A concordance report will now be issued by NE Ontario radiologists after the
pathology report of the IGCB specimen has been reviewed by the radiologist. A care path will be advised (e.g. repeat IGCB,
refer for surgical biopsy, return to age appropriate screening). The arrangement for the next steps will depend on the care
pathways that have been developed at each of the NE Ontario facilities performing IGCB.
American College of Radiology BI-RADS® 4th Edition. ACR Breast Imaging Reporting and Data System, Breast Imaging Atlas; BI-RADS. Reston VA. American
College of Radiology, 2003. www.acr.org
1
Multidisciplinary Cancer Conferences: Palliative Care
Dr. Andrew Knight, Regional Palliative Care Lead, Northeast Cancer Centre
Dr. Patrick Critchley, Regional Primary Care Lead - Northern Districts, Northeast Cancer Centre
Multidisciplinary Cancer Conferences (MCCs) were first introduced to the North East about four
years ago. Over this time, they have become a very robust forum bringing together on a regular
basis multiple specialists from multiple communities via Ontario Telemedicine Network (OTN)
to discuss prospectively the optimal management and treatment of newly diagnosed cancer
patients.
Over the years, for those of us that have been involved in providing palliative care education across the North East, we
have been continually challenged in developing a forum that would lend itself for ongoing education. It became obvious
to us that the MCC format could provide a vehicle for Continuing Professional Development in palliative care for medical
staff and other health professionals. MCC participants are invited to present challenging local palliative care cases for
discussion. The format provides participants with an opportunity to review best practices with other primary care providers,
local palliative care consultants and specialists. The goal is to help each other better manage challenging palliative cancer
cases while building and supporting a palliative primary care provider community of practice.
We embarked on our program in February of this year and by June, after three such conferences, had begun to shape
a community of practice with regular attendance from health care providers in North Bay, Sault Ste. Marie, Timmins and
Sudbury.
Resuming in September after our summer break, we now have had our rounds accredited by the College of Family
Physicians of Canada, eligible for Mainpro-M1 credits. Our current plan is to continue on a bi-monthly basis (Jan, Mar, May,
Jun, Sep, Nov). Please refer to the insert for details of how to participate. If you would like to be added to our distribution
list please contact Karen Teddy at [email protected].
Questions or Comments?
Contact us at [email protected]
IMPROVING the Performance of CCC FOBT Kits
IMPROVING the Communication of Test Results
Dr. Amanda Hey
Regional Primary Care Lead, Northeast Cancer Centre
Dr. Evan Roberts
Regional Breast Imaging Lead, Northeast Cancer Centre
The Guaiac Fecal Occult Blood Test (gFOBT) is the colorectal cancer screening test currently recommended for average
risk individuals by ColonCancerCheck (CCC), a joint program of Cancer Care Ontario and the Ministry of Health and
Long Term Care, with colonoscopy being recommended for increased risk individuals.
The following reviews some gFOBT kit use characteristics in the North East LHIN.
North East
Characteristic
Ontario
2010-11
2013-14
2010-11
2013-14
Use of Non-CCC FOBT kit

22%
11%
15%
9%
CCC FOBT kit Rejection Rate

5%
6%
5%
6%
Reason for CCC FOBT kit Rejection (% of rejected kits)
Not labelled

72%
67%
55%
59%
Card expired

3%
15%
2%
11%
Specimen expired

16%
9%
18%
10%
Data Source: Cancer Care Ontario. (2014). ICS CCC Regional Monthly 2014_09 Report [Unpublished]. Toronto, ON: Evaluation and Reporting, Cancer Screening.
CCC FOBT KIT REJECTION RATES
There has been a slight increase in the rate of rejection of kits, representing 1216 kits rejected in the North East in 2013-14!
The following provides some tips for improving CCC FOBT kit use to optimize quality and reduce rejection of kits.
KIT NOT LABELLED, representing 820
kits in the North East in 2013-14. The
CCC FOBT card requires labelling with
the patient’s name and date of birth. Try
‘point of care’ labelling by health care
providers when dispensing the kits AND
a clear message to the patient to follow
the instructions included in the CCC
FOBT kit.
CARD EXPIRED, representing 183 kits
in the North East in 2013-14. Check your
current inventory of CCC FOBT kits to
ensure that they are not expired or about
to expire. Provide at least 3 months to
allow time for the kit to be completed and
returned for testing. Advise the patient
to complete and return the kit at least a
month before it expires AND explain the
kit will not be processed if it does expire.
SPECIMEN EXPIRED, representing
115 kits in the North East in 2013-14.
For lab quality reasons, CCC FOBT
kits require lab processing within 21
days of specimen collection. Advise
your patient to submit the kit by mail or
to a commercial lab drop off box within
10 days of taking the first specimen.
USE OF NON-CCC FOBT Kits
The use of CCC FOBT kits is recommended to realize the full benefits of an organized program for both patients and
primary care providers (PCP). CCC
FOBT kits must be ordered through
Medical Laboratory Web Address
How to Order
an affiliated community laboratory for
Phlebotomy or
dispensing by PCP offices. CCC FOBT
LifeLabs
www.lifelabs.com
Non-phlebotomy Order Form
kits are not available for patients to pick
up at community or hospital laboratory
Gamma Dynacare
www.gamma-dynacare.ca CCC FOBT Order Form
specimen collection centres.
For more information on CCC eligibility please visit:
www.cancercare.on.ca/cms/one.aspx?pageId=9921
American College of Radiology BI-RADS®
The American College of Radiology (ACR) developed a comprehensive guide for standardized breast imaging terminology
and a classification system for mammography, ultrasound and MRI called Breast Imaging Reporting and Data System
or ACR BI-RADS®1. This allows results of breast imaging studies to be communicated to the ordering physician/ nurse
practitioner (PCP) in a clear fashion with a final assessment that indicates a specific course of action.
In North East Ontario, breast imaging radiologists have adopted ACR BI-RADS® for diagnostic mammography and will
include an ACR BI-RADS® category at the end of mammography reports. The ACR-BIRADS® Quick Reference insert in this
issue will assist ordering PCPs in interpreting the ACR BI-RADS® category. Of note, ACR BI-RADS® Category 3 is used
when it is felt that the probability of malignancy is <2% and that a lesion is not expected to change in the suggested interval,
but the radiologist would prefer to establish stability. Categories 4 and 5 should be referred for appropriate interventional
work-up. The next step is usually a breast image-guided core biopsy (IGCB). Many North East (NE) Ontario mammography
sites have arrangements that can facilitate and expedite the pathway to IGCB for the ordering PCP and patient.
The Concordance Report
When a patient undergoes an IGCB it is important that the radiologist reviews the pathology report and communicates to
the ICGB ordering physician whether the results of the imaging exam are explained by the pathology result. This addendum
report is often called a ‘concordance’ report. A concordance report will now be issued by NE Ontario radiologists after the
pathology report of the IGCB specimen has been reviewed by the radiologist. A care path will be advised (e.g. repeat IGCB,
refer for surgical biopsy, return to age appropriate screening). The arrangement for the next steps will depend on the care
pathways that have been developed at each of the NE Ontario facilities performing IGCB.
American College of Radiology BI-RADS® 4th Edition. ACR Breast Imaging Reporting and Data System, Breast Imaging Atlas; BI-RADS. Reston VA. American
College of Radiology, 2003. www.acr.org
1
Multidisciplinary Cancer Conferences: Palliative Care
Dr. Andrew Knight, Regional Palliative Care Lead, Northeast Cancer Centre
Dr. Patrick Critchley, Regional Primary Care Lead - Northern Districts, Northeast Cancer Centre
Multidisciplinary Cancer Conferences (MCCs) were first introduced to the North East about four
years ago. Over this time, they have become a very robust forum bringing together on a regular
basis multiple specialists from multiple communities via Ontario Telemedicine Network (OTN)
to discuss prospectively the optimal management and treatment of newly diagnosed cancer
patients.
Over the years, for those of us that have been involved in providing palliative care education across the North East, we
have been continually challenged in developing a forum that would lend itself for ongoing education. It became obvious
to us that the MCC format could provide a vehicle for Continuing Professional Development in palliative care for medical
staff and other health professionals. MCC participants are invited to present challenging local palliative care cases for
discussion. The format provides participants with an opportunity to review best practices with other primary care providers,
local palliative care consultants and specialists. The goal is to help each other better manage challenging palliative cancer
cases while building and supporting a palliative primary care provider community of practice.
We embarked on our program in February of this year and by June, after three such conferences, had begun to shape
a community of practice with regular attendance from health care providers in North Bay, Sault Ste. Marie, Timmins and
Sudbury.
Resuming in September after our summer break, we now have had our rounds accredited by the College of Family
Physicians of Canada, eligible for Mainpro-M1 credits. Our current plan is to continue on a bi-monthly basis (Jan, Mar, May,
Jun, Sep, Nov). Please refer to the insert for details of how to participate. If you would like to be added to our distribution
list please contact Karen Teddy at [email protected].
Questions or Comments?
Contact us at [email protected]
NEW RESOURCES
CCO Aboriginal Cancer Control Unit
Dr. Annelind Wakegijig, Regional Aboriginal Cancer Lead, Northeast Cancer Centre
Cancer Screening Fact Sheets
Cancer Care Ontario’s (CCO) Aboriginal Cancer Control Unit (ACCU) has recently released a new patient resource: First
Nation, Inuit and Métis Cancer Screening Fact Sheets for breast, cervical and colorectal cancer screening (see insert).
The fact sheets were developed in consultation with internal and external stakeholders, and to ensure the information was
culturally relevant and welcoming, three sets of fact sheets for each of the cancer screening programs specifically for First
Nations, Inuit or Métis people (nine fact sheets in total) were created. Plain language principles were used in the design and
the sheets incorporate a variety of visuals, tables, relevant screening statistics, as well as preventative messaging in a clear
and concise format. The fact sheets are currently available in English, with additional versions being produced in Inuktitut,
Oji-Cree and Ojibway within the next year. CCO has disseminated the fact sheets to all Aboriginal Health Access Centres
and regional cancer centres; additionally they will be available on the CCO website (www.cancercare.on.ca) for download
in the coming weeks. Requests for hard copies can be made to the Northeast Cancer Centre (NECC) via the North East
Oncology News mailbox at [email protected]. Any questions or comments on the new fact sheets can be
directed to CCO’s ACCU at [email protected].
Palliative Care Toolkit ‘Tools for the Journey’
Also recently released from CCO’s ACCU is a new palliative care toolkit - a resource developed for both patients and
providers. The kit, entitled ‘Tools for the Journey’, is designed to support the needs of First Nation, Inuit and Métis (FNIM)
patients and caregivers experiencing the palliative stage of the cancer journey. The Palliative Care Toolkit content was
developed and informed through direct engagement with both FNIM community members and health care providers serving
FNIM people in palliative care and features original artwork by an Ojibway artist, created specifically for the project. The
Palliative Care Toolkit contains 6 brochures in a pocket folder, with topics including:
•
•
•
Understanding the Diagnosis for Patients and Caregivers
Taking Care of Your Loved One
Guidelines for Working Together
•
•
•
What to Expect: Making Decisions and Plans
Teachings to Support Grief and Loss (insert)
Who to Talk to for Support
The ACCU has also developed a complementary resource binder for health care
providers. The binder mirrors the brochures, with expanded information on topics
including: avoiding caregiver burnout and how to write a will, among others.
CCO, through various partnerships, is working on hard copy distribution of the toolkits
to Aboriginal Health Access Centres, First Nation Community Health Centres, Métis
Community Councils and regional cancer programs. An Oji-Cree translation of the toolkit
brochures is planned for next year.
The Palliative Care Toolkit will be available for download from the CCO website
(www.cancercare.on.ca) in the coming weeks, however if you are interested in a hard copy
please contact the NECC Aboriginal Navigator Sherri Baker at: [email protected]
or 705-522-6237 ext. 2175. Any questions or comments on the Palliative Care Toolkit
can be directed to CCO’s ACCU at [email protected].
Palliative Care in First Nations, Inuit and Métis Communities
Tools for the Journey
North East Oncology News is produced by the Editorial Advisory Board of the Northeast Cancer Centre
Editor: Mark Hartman
Assistant Editor: Dr. Amanda Hey
Advisory Board Members: Dr. M. Bonin, Dr. A. Caycedo, Dr. P. Critchley, Dr. J. Grynspan, Dr. A. Khomani, Dr. A. Knight, C. Mayer, Ph.D, Dr. E. Roberts,
Dr. S. Shehata, Dr. S. Shulman, Dr. S. Spadafora & Dr. A. Wakegijig
Production Coordinator: Merci Miron-Black
Production Assistant: Kyla Young
Questions or Comments? Want to join our electronic distribution list? Contact us at [email protected]
41 Ramsey Lake Road - Sudbury, ON - P3E 5J1
Phone: 705.522.6237 - Fax: 705.671.5496
printed on 100% recycled paper
visit Cancer Care Ontario on the web at www.cancercare.on.ca
visit Health Sciences North|Horizon Santé-Nord on the web at www.hsnsudbury.ca
Available online at
www.hsnsudbury.ca/NECCprimarycareresources
North
East
Oncology News
S trengthening
C ommunications
As health care knowledge and delivery systems become more complex, it
becomes ever more important to have effective, efficient and integrated
communication methods amongst health care partners. It is also critical that
patients are provided with health care information in a form that is relevant to
them and invites them to seek further care if needed. Inside this newsletter you
will find examples of how clear documentation on a lab sample can reduce rejection rates and
how adoption of a standardized reporting system for mammogram results can clarify clinical
management. You’ll also read about how a Northeast Cancer Centre Multidisciplinary Cancer
Conference in palliative care, delivered through Ontario Telemedicine Network, allows a
community of practice for palliative health care providers to share challenging cases and best
practices. You’ll also read about how Cancer Care Ontario’s Aboriginal Cancer Control Unit,
following extensive community consultation, has launched public communications regarding
cancer screening and palliative care. By continuing to strengthen health care communications,
both health care providers and the population they serve will benefit.
Mark Hartman
Regional Vice President, Northeast Cancer Centre
NEW Regional Surgical Oncology Lead
I am pleased to have been appointed to the role of Regional Surgical Oncology
Lead in North East Ontario, a role that provides leadership to build, foster and
maintain a regional surgical oncology program throughout the North East. This
role involves working across the region with cancer surgeons, other cancer
care providers, hospitals and organizations as well as with the Cancer Care
Ontario’s (CCO) Surgical Oncology Program to implement cancer surgery
initiatives (guidelines, standards, staging, etc.) and to enhance the cohesion and organization
of surgical oncology services across the region. I truly believe that in the North East we have
health care professionals, facilities and programs that provide world class surgical oncology
care to our population, and I look forward to meeting and working with regional health care
colleagues and organizations as we further advance surgical oncology services.
I am originally from Colombia, where I attended medical school and trained in general surgery.
After practicing for 20 months, I came to Canada to retrain and repeated general surgery at
the University of Ottawa and then went to London (Ontario) where I did a clinical fellowship in
colorectal surgery. Currently, I am doing a Masters in Clinical Research through the University
of Liverpool. I have a strong interest in colorectal and minimally invasive surgery, as well as
medical education.
Dr. Antonio Caycedo
Regional Surgical Oncology Lead, Northeast Cancer Centre
Volume 4 Issue 3
Fall 2014
Focus on:
Communications
INSIDE THIS ISSUE:
Strengthening
Communications. ...............1
New Regional Surgical
Oncology Lead ...................1
Improving the Performance
of CCC FOBT Kits...............2
Improving the
Communication of Test
Results................................2
Multidisciplinary Cancer
Conferences: Palliative
Care....................................3
New Resources: Aboriginal
Cancer Control Unit.............4
Inserts:
BI-RADS® Quick Reference
Guide
Palliative Care MCC Poster
Cancer Screening Fact Sheet
Teachings to Support Grief
and Loss
Cancer Screening App
North East Oncology News is a triannual publication from the Northeast Cancer Centre providing evidence based guidance, and clinical and operational updates of
interest with a focus on Primary Care in North East Ontario.
**References used for this issue of North East Oncology News are available upon request from the editor. Articles may be reprinted without permission, provided the
source is acknowledged.**
PALLIATIVE Medicine Multidisciplinary Cancer Conference Rounds
Frequency: 3rd Tuesday, every 2 months
Upcoming Sessions: January 20, March 17, May 19, and June 16, 2015
Tuesday, January 20, 2015
NECC 4 BOARDROOM / OTN
5:00PM TO 6:00PM
CHAIR
KNIGHT, Andrew
PARTICIPATION
Come to NECC 4 BOARDROOM / OTN for 5:00PM or if outside of the NECC/HSN, please contact your Telehealth
Coordinator for location details.
CASE SUBMISSION
If you would like to present a case at these rounds, please contact Dr. Andrew Knight ([email protected])
DESCRIPTION AND OBJECTIVES
This session will provide participants with an opportunity to review best practices with other primary care providers
and local experts. The goal is to help each other better manage challenging palliative cancer cases in northeastern
Ontario.
AUDIENCE
Family and Palliative Physicians, Nurse Practitioners. Other disciplines may be invited according to the case
presented: Surgeons, Pathologists, Radiologists, Medical and Radiation Oncologists, Nurses and other Allied
Healthcare Practitioners.
HOW TO PARTICIPATE
Please contact Karen Teddy to register your site. Please see the list below of current participating sites for this event.
SUDBURY
Location: NECC 4 BOARDROOM / OTN
Contact: Karen Teddy
Email: [email protected]
NORTH BAY
Contact: Deb Hunt
Email: [email protected]
SAULT STE. MARIE
Contact: Telehealth Coordinators
Email: [email protected]
TIMMINS
Location: System 05
Contact: Diane Veilleux
Email: [email protected]
PCVC (Personal Computer Video Conferencing)
Contact: OTN
Website: http://otn.ca/en/services/pcvc
This program meets the accreditation criteria of The College of Family Physicians of Canada
and has been accredited for up to 1.0 Mainpro‐M1 credits as approved by the Continuing
Education and Professional Development Office at the Northern Ontario School fo Medicine
PALLIATIVE MCCs are an accredited group learning activity as defined by the Maintenance of Certification Program of
The Royal College of Physicians and Surgeons of Canada.
Honouring the
First Nations
Path of Well-being
WHAT IS CANCER SCREENING?
Cancer screening means taking a test that can find cancer before you have any symptoms.
Finding cancer early is one of the best ways we have of beating it. Getting screened regularly leads to healthier and happier lives for you, your family, and your community.
WHAT IS THE COLONCANCERCHECK PROGRAM?
There are different ways to screen for
ColonCancerCheck is a screening program in Ontario colorectal cancer. The screening tests in that encourages men and women aged 50 to 74 to the ColonCancerCheck program are:
test for colorectal cancer. When you are between the ages of 50 and 74, ColonCancerCheck will send you a letter
1. Fecal Occult Blood Test (FOBT)
inviting you to be screened for colorectal cancer and gives
you information on how to get screened.
• This test is recommended for men
and women aged 50 to 74 every 2
What is a Fecal Occult Blood Test (FOBT)?
years if they have no symptoms or
• The FOBT is a simple test that can be done at home.
family history of colorectal cancer.
• The test looks for blood in your stool (poop) that can be
an indication of colorectal cancer.
2. Colonoscopy
• Your health care provider will tell you how to complete
the test.
This test is recommended for people
What happens after I complete my FOBT?
with:
• Both you and your health care provider will receive the
• Symptoms of colorectal cancer
results of the test.
• A family history of colorectal
• If your test is normal (negative)  you will receive a
cancer (parent, sibling, or child
reminder letter from ColonCancerCheck to be screened
who has been diagnosed)
again in two years.
• If your test is abnormal (positive)  your health care
• A positive (abnormal) FOBT
provider will arrange for you to have a colonoscopy.
Most people needing more testing will not have colorectal cancer.
What is a colonoscopy?
• A colonoscopy is procedure where a doctor inserts a long flexible tube into the anus
and is extended along the length of the colon.
• There is a small camera at the end of the tube to help the doctor see and remove
any changes that might be visible.
Colorectal
Cancer
Screening
COMMUNITY LEARNING SERIES
➥ Signs and Symptoms
What happens after my colonoscopy appointment?
• You will be contacted by your primary care provider or
specialist with the results of your colonoscopy.
• Your primary care provider or specialist will let you know when
you need to be screened for colorectal cancer again.
In some regions, flexible sigmoidoscopy performed by a
registered nurse is also a screening option. This test is similar to a
colonoscopy, but the tube is shorter and does not look at your
entire colon. It generally does not involve being put to sleep and
the preparation before the test is simple.
It is important to talk to your health care provider about what
screening test is right for you. If you do not have a health care
provider, you can still get screened! Call Telehealth Ontario at 1-866-828-9213 for more information.
Changes in shape of
your stool from firm to
loose and narrow
Urgent feeling to
empty bowel
Blood in your stool
Changes in bowel
movement – diarrhea
WHAT IS COLORECTAL CANCER? DOES IT AFFECT US?
Colorectal cancer is the second
leading cause of cancer deaths in
Ontario for both men and women.
Colorectal cancer is a type cancer that
develops in the colon and rectum
(also known as the large intestine or
large bowel). Most colorectal cancers
Colon
start as small growths (polyps). We
Anus
know that the number of First Nations Rectum
men and women diagnosed with
colorectal cancer has dramatically increased. However, if
colorectal cancer is found and treated early, there is a 90% chance
it can be cured. Screening is the best thing you can do to find
colorectal cancer early.
ARE YOU AT RISK?
Changes in
bowel movement – constipation
Stomach discomfort
ColonCancerCheck program encourages all men and women
between the ages of 50 to 74 to be screened for colorectal cancer.
Some men and women are at an increased risk of developing
colorectal cancer. For example, people with a parent, sibling or
child who has been diagnosed with colorectal cancer are at an
increased risk. If this applies to you, you should be screened with
a colonoscopy when you turn 50 or 10 years earlier than the age
that your relative was diagnosed, whichever occurs first.
THE PATH TO WELLNESS
Constant tiredness
and weakness
Unexplained
weight loss
If you experience
any of these
symptoms, it is
important to talk
to your health
care provider.
You may not feel
anything if you have
colorectal cancer
A healthy lifestyle may reduce your chance of getting colorectal
cancer, as well as many other diseases. Here are some simple
things you can do:
• Be smoke free
• Maintain a healthy body weight
• Limit alcohol
• Be physically active
• Be sun safe
• Eat a healthy diet
It is easy to get screened! Talk to
your health care provider about
what screening test is right for you,
or call INFOline at 1-866-410-5853.
For more information, please visit:
www.ontario.ca/screen
forlife
Pa l l iat iv e Ca r e in F irst N ations, I n ui t a nd M éti s Com m uni ties
Support
In Your Community
• When we are grieving we might feel that we are to
blame for our loved ones being sick, or that we are
being punished. No-one knows why they became ill;
it is not anyone’s fault
For more information about palliative care, talk to your
health care provider (e.g. doctor, specialist, or nurse) or
community health worker (e.g. home support worker).
• When we are grieving there are people who will help
take care of things and who will be there for us with
compassion and kindness, because grieving is hard
work
• At some point the grieving will get easier, but the
grieving process is a difficult one
• We are all on our own journey; we can depend on
each other and use our spiritual beliefs as tools to
help us
Your health care provider or community health worker
can also provide more resources with information
and support, including information from Cancer Care
Ontario and the Canadian Cancer Society.
Palliative Care in First Nations,
Inuit and Métis Communities
Teachings
to Support
Grief and Loss
Pa l l iat iv e Ca r e in F irs t N ations, Inui t a nd M éti s Com m uni ties
We Are Not Alone
Our Beliefs
Respect
“Palliative care” is not a common term in First Nations,
Inuit and Métis communities. Palliative care is comfort
care. It makes a person as comfortable as possible when
they have an illness that is unlikely to be cured, and it can
also support their family throughout this time.
From a traditional Anishinaabe view, the Elders talk about
how everything is interconnected; one symbol of this is the
medicine wheel. They tell us that we are spiritual beings
who come into this world. Our life begins in the eastern door
and we journey to the west. As a person passes, they will
walk through the western door and return to the spirit world.
Dying is a sacred and natural part of life’s journey; it is the
final stage of our life when our spirit returns to the Creator.
For those who are terminally ill, or for their caregivers, it
may be hard to cope with your feelings. It might help to
know:
For those who have been diagnosed with a terminal illness
it might come as a shock to realize that nothing more
can be done to cure the illness. People often react with
disbelief and do not want to upset their families by telling
them.
Experiencing grief and loss is very painful. Some of our
beliefs and perspectives as First Nations, Inuit and Métis
might be helpful and comforting at this time.
Many of us share a belief in the Creator or God, and we
recognize the Creator in our prayers and ceremonies. We
have a spiritual connection to the Creator and our Elders
remind us that we are connected to the land and related
to all of the living beings around us.
Mushkegowuk people as original inhabitants of the land
traditionally value harmony, and respect and honour the
teachings our Elders and ancestors have shared.
The Haudenosaunee traditionally believe in being of good
mind and honouring the cycles of life represented by the
circle, which is a symbol of unity and strength. When
someone passes, their spirit leaves the body and rises to
the sky world. There is a shared responsibility for comforting
each other in times of loss as well as for celebrating life.
The Inuit have a traditional practice where a newborn child is
given the name of a relative or community member who has
recently passed on, connecting the families. This practice
helps the community healing process and the celebration of
life.
For the Métis, the land sustains the spirits and lives of the
people. Death is seen as a spiritual rite of passage that
respects the beliefs and values of the individual and their
family.
The Christian faith has a strong presence in many First
Nations, Inuit and Métis communities and can be a source
of comfort.
• When someone is terminally ill they often want to spend
their remaining time at home with family close by
• It has been part of our culture as Aboriginal Peoples to
look after our own throughout life, from birth to the time
of dying. This can be done at home with the right support
and equipment, or we can support our loved ones in the
hospital or hospice
• The person who is terminally ill may want to have time with
an Elder, a healer, a priest or a minister, depending on their
beliefs. Any of these people can offer spiritual support and
ceremonies for the person and the family, depending on
their wishes
• For the person who is terminally ill, the love and support
of those around them can help them to find healing and
forgiveness in their life, and share final messages or make
memories to leave behind
• When the time comes for our loved ones to pass, we can
remember that they are more than their physical body;
their spirit will be free
• When we lose someone we need time to let go of our
loved one and to grieve on all levels. There is great
support when we are surrounded by our family, our
community and our beliefs and customs