The majority of women with breast cancer are now diagnosed at an early stage and more than 80% will be long-term survivors. Breast cancer survivors usually have follow-up visits after completing treatment. In many centres, it is usual practice for patients to see their family physician for follow-up, which has been shown to be a safe alternative to follow-up with the cancer specialist. However, the follow-up period can be accompanied by feelings of abandonment, uncertainty about who is primarily responsible for follow-up care, and anxiety.
The COR group are currently testing an approach to make the transition to follow-up easier for both the patient and her family physician. The approach involves a brief educational session for the patient, an individualized care plan for the patient, and guidelines for the patient and the family physician. Our aim is provide patients and family physicians with the tools they need for follow-up care. The study will take place in Nova Scotia, Quebec, Ontario and Alberta and the results will be relevant to almost all women diagnosed with breast cancer in Canada today.
Colorectal cancer is the second most prevalent cancer for both men and women in Canada, with about 760 new cases diagnosed in Nova Scotia each year. Because of the high prevalence of colorectal cancer and the fact that researchers have found strong evidence of better outcomes when people receive timely and appropriate access to health services, we are studying the current state of colorectal cancer services in Nova Scotia from positive screening and diagnosis through to follow-up and end-of-life care.
To do this, we have brought together a team of researchers, physicians, and decision/policy-makers with the skills and knowledge to improve cancer services in Nova Scotia (CIHR/CCNS Team: ACCESS). Specifically, we are developing ways to measure access to and quality of colorectal cancer services along the entire cancer care continuum. The information we gain will give us a better understanding of how to improve the entire system, and consequently improve outcomes for people diagnosed with colorectal cancer in our province.
End-of-life care moves away from treatment-based care, and focuses on pain and symptom management, quality of life, and supportive care in the community and at home. In Canada, several key reports have concluded that end-of-life care needs to be measured and monitored to improve the quality of care that we provide. Our work focuses on developing tools (indicators) to measure the quality of end-of-life care provided to cancer patients in Nova Scotia. To explore which aspects of end-of-life care we should measure, we consider what is important to patients, caregivers, physicians, nurses, and other health professionals.
The objectives of our research in end-of-life cancer care are to: 1) develop and test indicators of quality end-of-life care from population based administrative health databases, such as the cancer registry, 2) establish indicators that are acceptable to health care professionals working in end-of-life care, and 3) explore what is important to cancer patients and their family caregivers at end-of-life. Our aims are to build a system that can monitor the quality of end-of-life care in Nova Scotia, identify the areas that need improvement, and provide guidance to develop programs and policies that will ultimately improve the care we provide to patients at the end-of-life.
Taking all types of cancer, two-thirds of individuals diagnosed today will be long-term survivors. After completing treatment, cancer survivors are transferred to follow-up care, with the main purpose being to detect a cancer recurrence or a new cancer. Often, routine follow-up practices place a large burden on the health care system because follow-up care is usually provided by cancer specialists and follow-up care sometimes results in a large duplication of visits and tests. However, research shows that follow-up care by a family physician is a safe and acceptable alternative, and that many tests are performed even when the evidence does not support their use. To ensure that we provide the best quality care for all cancer patients, survivors, and their loved ones, it is important to understand where we are in terms of current practices to identify where we need to move in the future.
We are studying the current patterns of follow-up care provided to cancer survivors in Nova Scotia. The objectives of this research are to gain a better understanding of the patterns of routine follow-up care provided to survivors of breast cancer, colorectal cancer, prostate cancer, and lymphoma in Nova Scotia. For breast and colorectal cancers, this research will allow us to assess whether the current care practices are consistent with evidence-based guidelines and may provide insight into developing ways to help physicians and patients stick to those guidelines. For other cancers where there is little evidence in terms of follow-up care, such as prostate cancer and lymphoma, our studies will provide an important starting point to assess the best ways in which to provide follow-up care to these survivors.