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

CircumstanceValues

Context

JAMA Users’ Guide to the Medical LiteratureAmerican Medical Association

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

Male Incidence Female Incidence Male Mortality Female Mortality0

10

20

30

40

50

60

70

80

Age Standardized Incidence and Mortality Rates

North East Ontario

Rat

e p

er 1

00,0

00

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

CRC and Ontario First Nations

Colorectal cancer incidence, Ontario,1968-2001, ages 15-74

Rates age-standardized to the 1991 Canadian populationHorizontal bars around First Nations rates indicate 95% confidence limits

0

10

20

30

40

50

60

70

80

90

Females

Year of diagnosis

1968-1975

1984-1991

1992-1996

1997-2001

1976-1983

Males

0

10

20

30

40

50

60

70

80

90

1976-1983

1968-1975

1984-1991

1992-1996

1997-2001

Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)

Year of diagnosis

First NationsAll Ontario

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