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Award Recipients 2007


Quality – Individual

Mahmoud A. Khalifa
Quality Improvement of Cancer Pathology Reporting
Toronto Sunnybrook Regional Cancer Centre

Dr. Khalifa is the Pathology lead on the very successful Toronto Sunnybrook Regional Cancer Centre team that has lead Ontario – and indeed the world – in the area of colon cancer staging based on surgical specimens. The team was awarded funding for “Improving Colon Cancer Staging Through a Blended Knowledge Translation Program Aimed at Surgeons and Pathologists” from the Change Foundation (2002-2004) and from the Ontario Cancer Research Network (2003-2005) and has published an important body of work in the peer-reviewed literature. A central finding of this work is that surgeons undertaking resection of colorectal cancers need to remove at least 12 lymph nodes with the cancer specimen, to allow the pathologist to accurately determine whether the cancer has spread beyond the bowel. If fewer lymph nodes are removed – and assessed by the pathologist – there is a significant risk that the cancer will be understaged. The consequence of understaging is that a patient is not offered adjuvant treatment and has a poorer survival. Thus, the fundamental impact of adequate staging of colorectal cancer patients based on an assessment of a minimum of 12 lymph nodes cannot be overstated.

Quality – Team

Coordinated Improvement in Colorectal Cancer Practice and Outcomes
Toronto Sunnybrook Regional Cancer Centre
Team Members: Calvin Law, Frances Wright, Andy Smith, Linda Last, Anna Gagliardi

Since 2000 this team has conducted a series of studies leading to improved lymph node (LN) staging for colorectal cancer (CRC) patients in Ontario. Treatment of CRC involves surgery, during which LNs are removed and examined for the presence of cancer. Patients are classified as Stage III if the LNs contain cancer and require chemotherapy, which cures 15% more of these patients than surgery alone. Several international cancer control agencies recommend examination of a minimum of 12 lymph nodes for accurate staging, otherwise, patients could be mistakenly classified as Stage II and not receive chemotherapy. CRC is the third leading cause of cancer death for men and women in Canada, so the results of this research have implications for a significant number of cancer patients.

The team first found that only 27% of eligible CRC patients in Ontario from 1997 to 2000 had 12 or more LN examined. It was apparent that efforts were needed to improve the practice in this area. However, the literature provided conflicting evidence on the best way to influence practice. Consequently, they first explored the use of an educational intervention at one Ontario hospital. A key aspect of the intervention was the involvement of local opinion leaders (OLs). This led to the launch of a randomized controlled trial (RCT) in 2004 involving 42 Ontario hospitals to more rigorously examine the impact of local OLs on LN staging practice. Preliminary results indicate that the mean proportion of eligible patients in Ontario having 12 or more LNs examined rose to 60% in 2005. At that time, Cancer System Quality Index (CSQI) data suggested that, while overall outcomes had improved, LN staging continued to vary across regions from 32% to 88%, suggesting the need for further improvement efforts. Hence, the group completed an exploratory study to identify factors that influenced LN staging practice.

Innovation – Team

Princess Margaret Hospital Patient Education Program
Team Members: Pamela Catton, Audrey Jusko Friedman, David Wiljer, Robert Luke, Joyce Nyhof-Young, Michelle Arbuckle, Mary Hooey

The unique cancer patient education program at PMH was first established in 1999 and in a few short years has achieved international stature. The goal of the program is to transform the patient experience by creating tailored and individualized information and support networks to meet changing needs throughout the cancer experience. Qualitative surveys have generated positive feedback from hundreds of patients. The program has been acknowledged as a national benchmark by Canadian Council of on Health Services Accreditation in the last two UHN/PMH accreditation cycles in 2003 and 2006. In 2003, Audrey Jusko Friedman, the Director of Patient Education, was awarded the NCI CPEN Gold Star Award for her contributions to the field. The value this program has contributed to the organization is now well established and evidence is mounting that demonstrates its impact on the patient’s cancer experience.

Champlain Regional Cancer Program: Improving Access to Quality Cancer Care
Team Members: Josee Laplante-Care Facilitator, Regional Cancer Program; Jennifer Smylie, Clinical Manager, Regional Cancer Assessment Centre; Eric Simoneau, Administrative Assistant, Regional Cancer Program; Nathalie Langevin, Satellite Co-ordinator.

The Champlain RCP team has been developed and formally integrated within The Ottawa Hospital Regional Cancer Centre (TOHRCC), thereby, creating a legitimate infrastructure to improve access to regional cancer services by identifying priorities and creating a work plan. In addition, opportunities have been taken to maximize resources through soft-funding of initiatives e.g. The Change Foundation, The Ottawa Regional Cancer Foundation, industry support, which in turn, we have been able to leverage to justify permanent resources. In addition, the team developed a regional committee/network structure that includes membership from TOHRCC, a variety of regional partners (including regional hospitals, the Canadian Cancer Society, the Community Care Access Centres, The Ministry of Health, the Canadian Council on Health Services Accreditation), and the Champlain LHIN to ensure a forum for determining a strategic direction/plan. Although the cancer centre has had regional systemic therapy satellites, never has there been the level of commitment and collaboration as is evidenced through initiatives such as: overall goal setting for the complete spectrum of regional cancer services; communities of practice for cancer surgery; evaluating and planning for health provider educational needs etc.