New report provides snapshot of Canada's cancer system

Care improving for colorectal and other cancer patients - but still room for improvement

A comprehensive report released today by the Canadian Partnership Against Cancer provides a snapshot of how Canada's cancer system is performing in key areas from prevention through to patient experience and outcomes.  Produced in collaboration with cancer programs in each province and territory, the 2012 Cancer System Performance Report is intended to inform cancer control planning and delivery across the country by enabling the identification of best practices and areas for improvement. For example, while the report shows that Canada has shown steady improvements in screening people for colorectal cancer and treating people with the disease, it also suggests where health system planners and clinicians might focus their efforts to make further advances.

"Having high-quality data on the performance of the cancer system and using it to plan and make decisions is critical to reducing the impact of cancer on Canadians," said the Honourable Leona Aglukkaq, federal Minister of Health. "This report and the actions that will be taken as a result of it highlight the value of our government's investment in the Canadian Partnership Against Cancer as part of a coordinated approach to overcoming this complex set of diseases."

Rates for colorectal cancer screening up, yet variations in treatment remain
The report shows that the percentage of average risk Canadians who are up-to-date with their colorectal cancer screening tests has improved over time in the vast majority of provinces and territories, with the national average rising from 38 per cent in 2009 to 43 per cent in 2011. While colorectal cancer screening rates are not as high as participation in screening for breast or cervical cancer, which have existed for a longer period of time, the progress made since 2009 so far suggests that recent provincial efforts to develop and implement organized screening programs have been successful.

"As a colorectal cancer survivor who received excellent care, I encourage anyone over 50 to be screened - early detection is important, when the disease is usually easier to treat," said Archie McCulloch , a retired scientist from Fall River, Nova Scotia. "I'm encouraged that more Canadians are now being screened; these programs can literally save lives."

In the area of colorectal cancer treatment, the report shows a steady increase in the percentage of patients with locally advanced rectal cancer receiving radiation prior to surgery: the average rate for this recommended standard of care rose from 40 per cent in 2007 to 49 per cent in 2009. However, analysis suggests that not all patients are being treated according to the recommended guidelines with almost a quarter of patients receiving post-operative radiation instead of the preferred pre-operative radiation. An additional sixth of patients are not seen by a radiation oncologist at all. The report also reveals some differences in treatment rates among provinces, and also between patient age groups, with older patients less likely to be treated according to the recommended guidelines for chemotherapy and radiation therapy.

"Overall, the report points to positive trends in key areas of colorectal cancer screening and treatment, including the fact that many patients are indeed receiving the standard of care, which is important because it can lead to better outcomes," said Dr. Heather Bryant , Vice-President, Cancer Control at the Canadian Partnership Against Cancer. "The opportunity with this report is for people involved in planning and delivering care to identify how to build on successes and improve areas that require attention, and taking the necessary action to optimize patient care."

Trends in emerging cancers: pancreatic and liver
New in this year's report is an overview of cancers that have a significant disease burden or that data suggest are on the rise. Pancreatic cancer, for example, is the 12^th most-diagnosed cancer in Canada, and has overtaken prostate as the fourth-leading cause of cancer death. Despite the huge impact of this disease, there have been no encouraging changes in incidence, mortality, or survival over the past 15 years, in contrast to the advances in breast, colorectal and lung cancers. Liver cancer is also explored in the report, and while incidence is generally low in more developed countries, it has been increasing in Canada and elsewhere.  The increase coincides with higher rates of chronic infection with hepatitis B or hepatitis C, though the extent of correlation is not yet known.

Hospitals most common place of death for cancer patients
More than 75,000 Canadians will die of cancer in 2012, making it the leading cause of death in the country, as well as the leading cause of premature death. While many indicators in the report are intended to drive system-level change that will help to reduce the number of Canadians who die from cancer, the report also provides data on end-of-life care, an emerging area of research and interest that has generally been under-measured. Although results from several surveys suggest that patients who know they are dying of cancer would prefer to die at home or in a home-like setting, data from 2005 to 2009 show that 70 per cent of people who died of cancer in Canada died in a hospital and only 11 per cent were known to have died at home.