2011-2012 REPORT CARD ON CANCER IN CANADATM

Cancer Advocacy Coalition of Canada

Dr. James GowingPast-Chair

Cancer Advocacy Coalition of Canada

Welcome

About the CACC

• The Cancer Advocacy Coalition of Canada is a registered, non-profit cancer group dedicated to advocacy and education

• CACC’s volunteer Board of Directors is comprised of patient advocates, health professionals and health sector executives

• CACC operates on unrestricted grants from sponsors based on guidelines that ensure the organization’s autonomy

• CACC publishes the annual Report Card on Cancer in Canada™, the only independent evaluation of our cancer systems’ performance

2011-2012 Report Card

Breast Cancer Screening – Reducing Suffering from Breast

Cancer

Martin J. Yaffe, PhDImaging Research Program,

Sunnybrook Research InstituteUniversity of Toronto

Screening

Background

•About 40 per cent of the deaths and 56 per cent of the years of women’s lives lost come from cancers that emerge between the years 40 and 59

•The Canadian Task Force on Preventive Health Care (CTFPHC) doesn’t appear to clearly understand all of the issues around screening and includes some erroneous information in its report

•The CTFPHC estimated incorrectly that it would be necessary to screen 2,108 women in their 40s for 10 years to save one life; whereas the actual number needed to screen is about 750

•In the U.S., the Secretary of Health and Human Services - and Congress - asked insurance companies not to deny coverage of mammography screening for women in their 40s.

Mammograms Circa 1980 and 2004

Mortality Reduction from Modern Mammography Screening

Location Reference Period Ages RR Netherlands van Schoor et al. 2010 1975-1990 40-49 0.5

Sweden Tabar et al. 2001 1988-1996 40-69 0.52

Finland Antilla et al. 2002 1986-1997 50-59 0.81

Finland Parvinen et al. 2006 1987-1997 55-69 0.64

Denmark Olsen et al. 2005 1991-2001 50-69 0.63

Sweden SOSSEG 2006 1980-2001 40-69 0.61

Italy Paci et al. 2008 1995-2001 50-69 0.64

Iceland Gabe et al. 2007 1987-2002 50-64 0.65

Canada Coldman et al. 2007 1988-2003 40-79 0.76

Finland Sarkeala et al. 2008 1992-2003 60-69 0.72

UK Allgood et al. 2008 1995-2004 50-69 0.52

Australia Roder et al. 2008 1994-2005 45-80 0.7

Norway Kalager et al. 2010 1996-2005 50-69 0.9

Netherlands Paap et al. 2010 1989-2006 50-75 0.24

Woman-Years Lost Due to Breast Cancer Diagnosed at Different Ages –

from SEER Data

More woman-years are potentially saved by screening in the 40s and early 50s than for older women

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

40-44years

45-49years

50-54years

55-59years

60-64years

65-69years

70-74years

75-79years

80-84years

85+years

P-Y Lost (no screening)

P-Y Lost (screening)

P-Y Saved/Y

Key Findings

• Digital mammography has been demonstrated to provide a marked improvement in the detectability of cancers in women with dense breasts and those under 50

• Earlier detection can allow reduction in the morbidity associated with treatment

• Overall, screening women in Canada in their 40s would prevent about 200 premature deaths due to breast cancer each year, and save about 6,000 woman-years of life

• In formulating its recommendations on screening, the CTFPHC grossly over-weighted the negatives and downplayed the saving of life

• The Federal Government in Canada should request a re-evaluation of the data

Smoke-Free Multiunit Housing in Canada

Dr. David Saltman, MD, PhDChair and Professor of the Discipline of Oncology, Faculty of

Medicine, Memorial University, St. John’s NL

Kevin Coady, MEdExecutive Director

NL Alliance for the Control of Tobacco

Smoking

Background

• Secondhand smoke is now controlled at work and in public, but is still a problem in multiunit dwellings

• Cigarette smoke coming from within a single unit of a multiunit housing complex exposes non-smoking residents in other units to the risks of environmental tobacco smoke (ETS)

• Publicly funded housing lags behind the private sector in smoke-free housing• It is the poor, seniors and disabled who are forced to

use public housing and are the most vulnerable, yet they are more likely to be exposed to secondhand smoke

Multiunit Housing in Canada

•Private or publicly owned multiunit housing (MUH) •Apartments•Condominiums•Attached housing

•11 million people live in MUH in Canada

•4.5 million people in Ontario live in MUH

•32% of Ontario residents rent

•49% of Torontonians rent

The Health Hazards of Environmental Tobacco Smoke

•Cancer•Acute and chronic respiratory disorders

•Middle ear infections

•Cardiovascular disease

•Sudden infant death syndrome

•Poor cognitive function in kids

•Neurobehavioral disorders

Smoke-free MUH in Canada

Jurisdictions Public MUH Private MUH

BC Yes Yes

AB Yes Yes

SK None Yes

MB Yes Yes

ON Yes Yes

QC None Yes

NB None Yes

NS Yes Yes

PE Yes Yes

NL Yes Yes

YK Yes None

NT None None

NU None None

Is Ventilation an Option?

• Secondhand smoke cannot be controlled using ventilation or air-cleaning systems

• Up to 50% of the air in MUH may be re-circulated throughout an entire building

Key Findings

•The only effective way to completely eliminate ETS exposure in multiunit dwellings is to establish 100 per cent smoke-free buildings

•SK, NB, QC, NT and NU still do not offer any smoke-free public housing

•Provincial and municipal governments need to do more• Educate tenants and landlords about how to implement and maintain smoke-free policies • Focus on health benefits and the potential positive economic outcomes

Implementing Molecularly Targeted Treatments for

Lung Cancer Patients

Dr. Peter Ellis, MBBS, MMed, PhD, FRACP, FRCPC

Associate Professor, Dept. of Oncology, McMaster University and Staff Medical Oncologist, Juravinski

Cancer Centre, Hamilton ON

Biomarkers

Background•Lung cancer represents a major burden of disease for the Canadian population

•Increased understanding of non small cell lung cancer (NSCLC) has led to the development of therapies targeting specific molecular pathways

•Oncologists have treatment options that can extend life and improve outcomes for NSCLC

•Mutations of the epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genes are reported to be associated with a high likelihood of response to therapy

•Approximately 10-15 per cent of Canadian patients with NSCLC have such a mutation•Knowledge of gene mutation status appears crucial in determining which patients should receive first-line therapy with EGFR and ALK inhibitors

Key Findings

•There is no mechanism in place to provide testing to identify which patients might benefit from molecularly targeted treatments

•To approve a drug for public funding and not fund a mechanism to identify which patients might benefit from that drug is short sighted

•These advances highlight the need to develop a pan-Canadian strategy to:

•adopt molecular testing•simultaneously fund the patient selection test and the targeted therapy

Lung Cancer and Stigma from the Lay Caregiver

Perspective

Dr. Michelle Lobchuk, RN, PhD

Faculty of Nursing, University of Manitoba

Lung Cancer

Background

•Most studies on lung cancer stigma have tended to focus on public and patient views without examining the impact on lay caregivers

•Family and friends can harbour negative attitudes toward patients with lung cancer that impact their helping behaviours

•Smokers are made to feel that they are part of a special deviant class. The reality is that 10 to 20 per cent of lung cancer patients never smoked

•Although lung cancer causes 27 per cent of cancer-related deaths, it gets only seven per cent of cancer-specific research funding, and 0.1 per cent of cancer donations

Lung Cancer and Stigma

•Rules are different for lung cancer – the pervasive societal message is – IT’S OKAY TO BLAME •Smokers are sensitized to re-pay society for their bad choices:

• Pre-illness: •high cigarette taxes, stark images, repugnant odour/appearance, public bans, repulsion of second and third hand smoke

•At diagnosis:•Reminded of smoking linkage – dealing with society’s disappointment in weakness in self control – a disease itself

Key Points

•Anger not openly talked about, but acted upon: blatantly (lack of research support) and subtly (avoidance of empathetic understanding)

•Guidelines are still needed to help caregivers (professional and family) and patients deal with stigmatized disease

Exploring Possibilities for Treating Tobacco Dependence

Dr. Annette SH Schultz, PhD, RN

Associate Professor in the Faculty of Nursing, University of Manitoba Principal Investigator, St. Boniface

Hospital Research Centre

Lung Cancer

Background•Tobacco use and smoke exposure

•The most preventable causes of disease, disability and death

•Health professionals have played a key role in transforming opinions about tobacco use

•Benefits have been reported when patients stop using tobacco after initial diagnosis

•Stigmatized people are less likely to seek health care

•When a person living with lung cancer is stigmatized within their family, health care decisions are often less collaborative and tend not to reflect the patient’s needs

•It is imperative to treat tobacco dependence among all patients with cancer

Tobacco Dependence Treatment

•Two million Canadian smokers made an attempt to quit in the last year

•These Canadian would benefit from receiving tobacco dependence treatment

•Treat dependence as part of the full spectrum of care for lung cancer patients

•Enhance response to cancer treatment•Reduce risk of complication and secondary disease•Alleviate isolation associated with stigma

•Treatment options include•Sustain an ongoing dialogue

•We need to talk about tobacco use and dependence•Manage withdrawal symptoms with effective pharmacotherapy regime•Advise and assist cessation efforts•Referral to support abstinence and/or cessation

Health Care Providers

•Important for health care providers to initiate tobacco dependence treatment because patients are unlikely to raise the topic

•What is your current practice standard?•Compassion and frustration with smokers•What is your perception of smoking?

•Habit versus addiction?

•How able are you to offer withdrawal symptom and cessation treatment options?

•Educate yourself on effective symptom management•Awareness of referral options in your community

•Keep the conversation open and ongoing with patients and their families

Systemic Strategies

•Since patients must leave hospital property to smoke, there is an organizational responsibility to adopt programs to treat tobacco dependence

•Consider a potential role for Accreditation Canada in influencing how tobacco dependence is managed and treated in hospitals and other health care institutions

Please visit www.canceradvocacy.ca

to view the full

2011-2012 Report Cancer on Cancer in CanadaTM

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