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Colorectal Cancer
Disease Pathway Management:
North East Ontario Context
Amanda Hey MD CCFP FCFP
Regional Primary Care Lead
Northeast Cancer Centre, HSN
Faculty/Presenter Disclosure
Faculty: Amanda Hey, Annelind Wakegijig, Agnes
Kanawase, Roger Boyer II, Jamie White, Michael Loreto,
Kathleen Callaghan, Julie Whitten, Traci Franklin, Sherri
Baker, Silvana Spadafora, Patrick Critchley

Relationships with commercial interests:
•Grants/Research Support: none
•Speakers Bureau/Honoraria: none
•Consulting Fees: none
•Other: none
Disease Pathway Management
Disease Pathway Management

https://www.cancercare.on.ca/ocs/qpi/dispathmgmt/
Disease Pathway Management

https://www.cancercare.on.ca/ocs/qpi/dispathmgmt
Evidence Alone is Never Enough

Evidence
Context

Values

JAMA Users’ Guide to the Medical Literature
American Medical Association

Circumstance
Panel Sequence
• Panel facilitator presents case
• Panelist present their topic sequentially
• Audience Q&A at the END of each panel
Panel 1: Screening-Diagnosis
Panel 2: Treatment
Panel 3: Treatment-Survivorship-Palliative
Regional Aboriginal Cancer Lead
Will provide leadership on FNIM cancer care in the region
by:
• Engaging and collaborating with
primary care providers
• Championing the ACS II strategic
vision in collaboration with RCP staff
• Strategic planning and
program design
• Peer education and training
8
Colorectal Cancer:
A Case for Action
Annelind Wakegijig MD CCFP
Regional Aboriginal Cancer Lead
Northeast Cancer Centre, HSN
Colorectal Cancer Rates 2007

Rate per 100,000

Age Standardized Incidence and Mortality Rates
80
70
60
50
40
30
20
10
0
Male Incidence

Female
Incidence
North East

https://www.cancercare.on.ca/cms/ Accessed October 2013

Male Mortality Female Mortality
Ontario
CRC and Ontario First Nations
Colorectal cancer incidence, Ontario,
1968-2001, ages 15-74
Males

Age-standardized rate/100,000

Females
90

90

80

80

70

70

60

60

50

50

40

40

30

30

20

20

10

10

0

0

19681975

19761983

19841991

1992- 19971996 2001

Year of diagnosis
Rates age-standardized to the 1991 Canadian population
Horizontal bars around First Nations rates indicate 95%
confidence limits

19681975

19761983

19841991

19921996

19972001

Year of diagnosis
First Nations
All Ontario

Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)
Mr. TW: Case History 1
56 yr. First Nation male
• Mother was diagnosed with CRC age 66
• He was at Residential School as a child
• He seeks advice from his social worker
• He attends his community health centre
• His nurse practitioner assess him at
increased risk for CRC
• He is referred for colonoscopy

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Colorectal Cancer Disease Pathway Management, Northeast Ontario Context, Dr. Amanda Hey

  • 1. Colorectal Cancer Disease Pathway Management: North East Ontario Context Amanda Hey MD CCFP FCFP Regional Primary Care Lead Northeast Cancer Centre, HSN
  • 2. Faculty/Presenter Disclosure Faculty: Amanda Hey, Annelind Wakegijig, Agnes Kanawase, Roger Boyer II, Jamie White, Michael Loreto, Kathleen Callaghan, Julie Whitten, Traci Franklin, Sherri Baker, Silvana Spadafora, Patrick Critchley Relationships with commercial interests: •Grants/Research Support: none •Speakers Bureau/Honoraria: none •Consulting Fees: none •Other: none
  • 6. Evidence Alone is Never Enough Evidence Context Values JAMA Users’ Guide to the Medical Literature American Medical Association Circumstance
  • 7. Panel Sequence • Panel facilitator presents case • Panelist present their topic sequentially • Audience Q&A at the END of each panel Panel 1: Screening-Diagnosis Panel 2: Treatment Panel 3: Treatment-Survivorship-Palliative
  • 8. Regional Aboriginal Cancer Lead Will provide leadership on FNIM cancer care in the region by: • Engaging and collaborating with primary care providers • Championing the ACS II strategic vision in collaboration with RCP staff • Strategic planning and program design • Peer education and training 8
  • 9. Colorectal Cancer: A Case for Action Annelind Wakegijig MD CCFP Regional Aboriginal Cancer Lead Northeast Cancer Centre, HSN
  • 10. Colorectal Cancer Rates 2007 Rate per 100,000 Age Standardized Incidence and Mortality Rates 80 70 60 50 40 30 20 10 0 Male Incidence Female Incidence North East https://www.cancercare.on.ca/cms/ Accessed October 2013 Male Mortality Female Mortality Ontario
  • 11. CRC and Ontario First Nations Colorectal cancer incidence, Ontario, 1968-2001, ages 15-74 Males Age-standardized rate/100,000 Females 90 90 80 80 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 19681975 19761983 19841991 1992- 19971996 2001 Year of diagnosis Rates age-standardized to the 1991 Canadian population Horizontal bars around First Nations rates indicate 95% confidence limits 19681975 19761983 19841991 19921996 19972001 Year of diagnosis First Nations All Ontario Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)
  • 12. Mr. TW: Case History 1 56 yr. First Nation male • Mother was diagnosed with CRC age 66 • He was at Residential School as a child • He seeks advice from his social worker • He attends his community health centre • His nurse practitioner assess him at increased risk for CRC • He is referred for colonoscopy