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Clinical Standards to improve Patient Outcomes - 2014 Update

2014 was a busy year in the world of clinical standard development at CCNS. Clinical experts, administrators, cancer patients and survivors from across Nova Scotia continued their work in many areas. New working groups were also established in lung cancer and oral systemic therapy. Below is a report of our progress in each of these areas.

Rectal Cancer Clinical Treatment Standards
With the rectal cancer clinical treatment standards finalized, a process was established to understand the gaps between current clinical practice and the new standard. This information must be gathered, synthesized and included with the standards document when it is sent to the Department of Health and Wellness for review and hopefully approval, as it will inform the implementation plan and any associated costs. The impact assessment, in the form of a survey, was sent to appropriate district leaders in early Feburary. The plan is to submit the standards, with supporting documents, by late Spring.

Diagnosis and Referral of Patients Clinically suspicious for Colorectal Cancer
The external review of the draft recommendations for the Diagnosis and Referral of Patients Clinically Suspicious for Colorectal Cancer was completed by health professionals in March 2014 and by patients in September 2014. Working group members are now incorporating feedback from both health professionals and patients. It should be ready for submission to Department of Health and Wellness for review and approval by early in 2015. While an important companion document to the Rectal Cancer Clinical Treatment Standard, these receommendations are intended primarily as a stand-alone resource for family physicians and other primary care providers to ensure patients who may have symptoms of colorectal cancer receive timely diagnostic care to ensure best possible outcomes.

Psychosocial Health Services
Standards for addressing psychosocial health services for patients affected by cancer were sent to district health authorities for an impact assessment early in 2014. The analysis is complete and CCNS plans to submit it to DHW for approval this spring.

Lung Cancer
In June 2014, a new Working Group was established to address concerns about long delays in the diagnosis and start of treatment for patients who have symptoms of lung cancer.

Anecdotal evidence from Cancer Patient Navigators, the results of a chart review of lung cancer surgical patients in Capital Health, and results from a patient and family focus group and an online survey, are helping to inform the process. Nova Scotia is also learning from similar projects and experiences occurring in other provinces.
The goal is to have draft recommendations and the external review by health professionals and cancer patients and families finalized early this year.

Oral Systemic Therapy
The use of oral systemic therapy (chemotherapy taken in pill form) for cancer is increasing rapidly. In the past three years, two-thirds of all new cancer drugs approved for funding in Canada were oral agents. At first glance, oral agents appear safer and easier for patients. However, this is not necessarily the case: 

  Oral chemotherapy is just as toxic as IV chemotherapy 

  Unlike IV chemo, which is given in cancer centres by specialists, oral chemo is   dispensed from community pharmacies and taken by patients at home without the same safety measures

 There is almost no verification of oral prescriptions before they leave the hospital setting

CCNS has drafted standards for ordering, verifying and dispensing oral systemic therapy. In fall 2014, an impact assessment was conducted against these draft standards in Nova Scotia hospitals. The draft standards, impact assessment summary and proposal to address the identified needs will be submitted to DHW soon. CCNS has developed tools and other resources have been developed and are available on the CCNS website to support community pharmacists and other non-oncology health professionals who work with patients who are taking oral systemic therapy.

Will standards, once implemented, improve patient outcomes?
Monitoring the impact of the standards, when approved and implemented, will be key to our success. This will require identification of appropriate quality indicators. A working group with representatives from across the province, including Department of Health and Wellness, cancer survivors and CCNS staff has been established to guide the selection, definition and reporting of quality indicators. This work continues.

In the meantime, if anyone with questions about our work in clinical standard development may contact Chris Collier, Interim Chief Operating Officer, CCNS by phone at 902-473-4638 or by email at