Module 5: Cancer Care Ontario and The Aboriginal Cancer Strategy

1. Module 5: Cancer Care Ontario and The Aboriginal Cancer Strategy

2. Welcome to Cancer Care Ontario and the Aboriginal Health Strategy. This course takes 30 minutes to complete. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. Select the arrow keys at the bottom of your screen to move forward and move back, or to stop and start the module.

3. Course Learnings By the time you complete this learning module, you will be able to identify: CCO’s vision and Aboriginal Cancer Strategy II (ACS II) ACS II Strategic Priorities Strategic Accomplishments and Future Direction Cancer Care Ontario and the Aboriginal Cancer Strategy

4. Insert Pre-Test Quiz Slide Q: Name two of the Aboriginal Cancer Strategy II’s strategic priorities. A:____________________________________ Move forward to begin Chapter 1

5. Chapter 1: Overview of the Aboriginal Cancer Strategy II

6. Cancer Care Ontario’s Mandate and Vision

7. Cancer Care Ontario (CCO) is an agency of the provincial government of Ontario, responsible across Ontario for: • planning, • coordinating, and • improving cancer services. This mandate includes: • ensuring patients receive better care every step of the way, • through planning, and coordinating cancer services.

8. CCO’s goal is to prevent cancer by: • promoting healthy living, and • catching it early through screening and detection. To make this goal a reality, CCO partners with: • health care professionals, • health organizations, and • groups involved in cancer prevention and care.

9. The 13 Regional Cancer Programs (RCPs) located across the province in the Local Health Integration Network regions are CCO’s most important partners.

10. Each RCP is led by a Cancer Care Ontario Regional Vice President.Pictured: Dr. Mark Hartman, RVP, Regional Cancer Services, Northeast (Sudbury)

11. The Ontario Cancer Plan III CCO aims to provide people with the knowledge they need to make informed decisions about their care. CCO’s Ontario Cancer Plan III (OCP III) is the guide for Ontario’s cancer system. It is the third cancer plan that has been developed since 2005. The OCP III focuses people and patients in prevention, screening, diagnosis, treatment, follow-up and palliative care.

12. Through this plan, CCO will:

13. The OCP III is driven by a commitment to quality and is guided by CCO’s vision of providing Ontarians with the best cancer system in the world. • It is not just about ensuring that clinical practice is evidence-informed. • It also involves ensuring that cancer patients have equitable access to cancer services.

14. Vision To improve the performance of the cancer system with and for FNIM peoples in Ontario in a way that honours the Aboriginal Path of Well-being.

15. The Steps On This Path Are: 1. Health in balance: giving equal importance to all aspects of health 6. Joint and personal responsibility: health and well-being is the duty of the individual, family and community 2. Wellness: both emotional and spiritual 3. Active choice: one’s ownership for health decisions 4. Holistic approach: balance mind, body, and spirit with community and environment 5. Understand root causes: past and present aspects that impact health

16. Insert pop up exercise box • This is a non-scoring exercise • [Add in a pop-up: What are the steps in the Aboriginal Path of Well-being?]

17. Insert pop up exercise box Add in a pop-up answer: The steps on the Aboriginal Path of Well-being include: • Health in balance, Wellness, Active choice, Holistic approach, Understand root causes, Joint and personal responsibility.

18. The Need for a Specific Aboriginal Cancer Strategy The OCP III identified an urgent need to reduce preventable cancers in FNIM populations. Studies have shown that cancer incidence has risen dramatically in each of the First Nations, Inuit and Métis (FNIM) populations over the past few decades.

19. From being nearly unknown a few generations ago: * Source: Mortality of Métis and Registered Indian adults in Canada: An 11-year follow-up study by Michael Tjepkema, Russell Wilkins, Sacha Senécal, Éric Guimond and Christopher Penney, December, 2009

20. About half of all cancer deaths are related to commercial tobacco use, diet and physical inactivity. Smoking rates among FNIM people are much higher than in the remaining Canadian population. Lack of consumption of fruits and vegetables, and physical inactivity are also reported to be higher among FNIM people.

21. Cancer survival is worse for FNIM people than for other Ontarians. Some of the reasons include: • FNIM people are diagnosed with later stage cancers. • Access to screening and treatment is difficult for many FNIM people living in rural and remote communities.

22. Challenges within the health system in Ontario:

23. Challenges at the community level:

24. These factors emphasized the need for a specific cancer control strategy to reverse these trends.

25. A snapshot of FNIM Cancer Profiles

26. First Nations: Cancer Profile Prior to 1991, Ontario’s First Nations had lower rates of cancer and deaths than the general Ontario population. Since 1991, cancer incidence rates have been increasing in Status First Nations for: • colorectal • lung • breast • prostate As with the general population, the incidence of cervical cancer has decreased.

27. First Nations people in Ontario have poorer cancer survival rates than the general population for: • breast • colorectal • prostate • lung

28. A recent study examining reasons for poorer breast cancer survival in First Nations women compared to non-First Nations Ontarians identified: • The two major determinants of survival differences as: • Later stage at diagnosis, and • Greater co-morbidity Source: Sheppard et al. 2010

29. Ranking of Top Cancers for First Nations These top 3 cancers account for >50% of cancer for each gender.

30. Métis: Cancer Profile The most common cancers among the Métis: • prostate • lung • breast • colorectal This is the same as for other Ontarians. Ontario Métis have a 20% lower incidence of cancer compared to the general population. Except for lung cancer in females: The rate may be as much as 40% higher.

31. Lung cancer rates for Canadian Inuit males and females are the highest in the world and rising in Inuit men and women at 3.2 and 5.3 times the Canadian averages, respectively. Inuit have had higher rates of nasopharyngeal, salivary gland and esophageal cancers, but rates are decreasing. Rates of lung, breast, colorectal and cervical cancers have increased sharply across all regions.

32. Insert pop up exercise box • This is a non-scoring exercise • [Add in a pop-up: Provide two strategies that you can implement to help reduce later-stage cancer diagnosis for FNIM patients]

33. Placeholder for: Video / or Message & Photo: Alethea Kewayosh, Director, Aboriginal Cancer Control introducing the Aboriginal Cancer Strategy II Move forward to begin the quiz for this chapter

34. The Aboriginal Cancer Strategy IIThe Aboriginal Cancer Strategy II (ACS II) is a deliverable within OCP III’s Strategic Priority of Risk Reduction: Develop and implement a focused approach to cancer risk reduction to support the need to reduce preventable cancers in FNIM populations. CCO’s Aboriginal Cancer Care Unit (ACCU) leads the ACS II.

35. ACS II’s clear plan for reducing risk and preventing cancer: 2012 -2015

36. The ACS II builds on the foundation established by the Aboriginal Cancer Strategy I that was implemented during 2004–2009. Insert Video Content from Alethea regarding building on the ACS 1 (approx. 20 seconds)

37. It will stay true to the Aboriginal Path of Well-being, outlined earlier in this chapter, by following these principles: Physical, mental, emotional, spiritual and cultural needs of the individual, family and community. Taking a Holistic Approach: To integrate the traditional, holistic approach to health. Being Community Based: Make a difference at the community level and be responsible to the community. ACS II: One Commitment Taking the Aboriginal world view and valuing community knowledge and assets. Ensuring Cultural Competence: Work in harmony within culturally diverse communities. Being Inclusive: To be respectful of people first, and to seek out and listen to FNIM peoples’ voices.

38. First Step: Relationship Building and Engagement Over 18 months: The Aboriginal Cancer Control Unit (ACCU) engaged with provincial FNIM groups to develop the strategy. The collaboration had a clear focus: This direct engagement approach was key to developing and delivering an impactful strategy. • Respecting the FNIM governance structures and relevant protocols. • The strategy was developed using suggestions and guidance from the FNIM health tables and leadership.

39. Second Step: Educate and Build Capacity Ontario’s Regional Cancer Programs (RCPs) are the most important partner for implementing the ACS II strategy. • RCPs will engage their FNIM clients through Aboriginal Health Care networks to implement the strategy. • Ontario’s FNIM people will receive cancer services that address their needs, and • It will set standards in care for rural and remote communities.

40. How this is being accomplished:

41. The goal is to work together (CCO, RCPs, Primary Care and FNIM communities) to build sustainable capacity to address the burden of cancer on FNIM people across Ontario.

42. Placeholder for: Video / or Message & Photo: Michael Sherar, President & CEO CCO discussing part of the strategy Move forward to begin the quiz for this chapter

43. Insert Quiz slide: Quizzes for Chapter 1 There are two short questions for this chapter. Q: What is CCO’s vision for FNIM people and the cancer system? A: __________________________________

44. Insert Quiz slide: Quizzes for Chapter 1 Q: What are two of the challenges FNIM people face with the current cancer system in Ontario? A: __________________________________

45. Chapter 2: Strategic Priorities

46. The ACS II outlines six strategic priorities that align with the overall objectives outlined in the OCP III. The six strategic priorities are used to shape the direction of all regional FNIM cancer plans across the province. Strategic Priorities to 2015 We will review the six strategic priorities in detail including the challenge(s) they are addressing and how each challenge will be addressed.

47. Strategic Priority #1Build productive relationships: Work with FNIM groups to formalize relationships based on trust and mutual respect, including embedding FNIM communication and engagement structures to achieve success. This supports the OCP III Goal: Improve the performance of Ontario’s cancer system.

48. Challenge Historically, there has been a tangible disconnect between the FNIM community, the health care system, and provincial and federal governments. Solving health problems requires respectful engagement with FNIM people based on the original relationship of nation to nation, built on a foundation of trust and shared decision-making. CCO has placed ultimate importanceon engaging FNIM leadership to develop and implement the ACS II. • Objectives • Develop a relationship protocol between CCO and each FNIM group • Establish 10 Aboriginal cancer control networks across Ontario • Establish First Nations, provincial and federal government collaboration for First Nations cancer control issues • Action • Directly engage provincial FNIM advisory committees and leadership • Hire and train ACLs to employ APNs in 10 RCPs • Support First Nations policy development with governments to address First Nations cancer control

49. Insert pop up exercise box • This is a non-scoring exercise • [Add in a pop-up: Historically, there is a disconnect between the FNIM community and the health care system. List some of the FNIM resources you know about in your community that you can connect with to help build a collaborative relationship. If you do not know any, enter in Not applicable. ]

50. Strategic Priority #2Research and Surveillance: This priority will involve building and populating databases to provide accurate information for planning, surveillance and research.This supports the OCP III Goal: Strengthen Ontario’s ability to improve cancer control through research.