2011-2012 Report card on cancer in canada TM

1. 2011-2012 Report card on cancer in canadaTM Cancer Advocacy Coalition of Canada

2. Welcome Dr. James Gowing Past-Chair Cancer Advocacy Coalition of Canada

3. 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

4. 2011-2012 Report Card

5. Screening Breast Cancer Screening – Reducing Suffering from Breast Cancer Martin J. Yaffe, PhD Imaging Research Program, Sunnybrook Research Institute University of Toronto

6. 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.

7. Mammograms Circa 1980 and 2004

8. Mortality Reduction from Modern Mammography Screening

9. 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

10. 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

11. Smoking 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, MEd Executive DirectorNL Alliance for the Control of Tobacco

12. 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 Background

13. 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

14. 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

15. Smoke-free MUH in Canada

16. 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

17. 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

18. Biomarkers 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

19. 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

20. 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

21. Lung Cancer Lung Cancer and Stigma from the Lay Caregiver Perspective Dr. Michelle Lobchuk, RN, PhD Faculty of Nursing, University of Manitoba

22. 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

23. 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

24. 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

25. Lung Cancer 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

26. 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

27. 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

28. 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

29. 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

30. Questions? Please visit www.canceradvocacy.ca to view the full 2011-2012 Report Cancer on Cancer in CanadaTM