Cancer Care Ontario offers recommendations for continuum of care, encouraging clinicians to “Expand and integrate access to palliative, psychosocial and rehabilitation services to improve quality of life and patient experience in cancer centres and the community”[1] The Plan recognizes the relationship between increasing numbers of survival rates with the challenges that Ontario faces in addressing services for survivors. CCO recognizes that cancer survivorship may also be associated with chronic conditions such as diabetes, heart disease and arthritis. These conditions affect the quality and type of care cancer survivors need.
The Canadian Cancer Society, along with the Heart and Stroke Foundation, the Canadian Diabetes Association and the Lung Association, published the Call for Action on Chronic Disease.[2] This media release recognizes that one of the four major chronic diseases that Canadians die from is cancer. They urge all levels of government to establish rehabilitative and palliative strategies to ensure that Canadians have access, and identify that many rehabilitation services are not adequately covered outside hospital care. Consequently, only a small percentage of Canadians who could benefit from these services are able to access them.
A study conducted by Realize Canada in 2013[3] surveyed rehabilitation services in Canada. 62 of the 179 cancer centres, 14 private clinics and 165 hospitals contacted completed the questionnaire. Of those, only 20 reported having rehabilitation services, and the majority (16 out of 20) reported not having a comprehensive rehabilitation program in place.
Realize Canada found that Toronto had the greatest number and variety of rehabilitation services, but there are no OHIP-funded clinics for occupational therapy or speech language therapy services. In addition, waitlists are common for publicly-funded clinics.
Another ground-breaking report published by the Canadian Partnership Against Cancer (CPAC) in January 2018, surveyed more than 30,000 Canadians, and demonstrates that more than half of cancer survivors have unmet physical, emotional or practical needs. CPAC recommends a series of changes that would enable survivors to communicate their physical, emotional and practical needs, and to be active participants in their care before diagnosis, during treatment and especially after treatment.
The Cancer Quality Council of Ontario (CQCO) advises Cancer Care Ontario (CCO) and the Ministry of Health and Long-Term Care in their efforts to improve the quality of cancer care in the province. CQCO also monitors and publicly reports on the performance of the cancer system and provides international comparisons and benchmarking so Ontario can learn from other jurisdictions.
The “Wellness beyond Cancer” program at the Ottawa Hospital offers rehabilitation services, but it is limited to breast, colorectal and endometrial cancer survivors. This program “provides care and support for people at the end of their active cancer treatment. It ensures they receive the follow-up care and the resources they need to best manage their health. Many people find their life returns to normal after cancer treatment ends. However, some survivors continue to have physical, emotional or financial concerns. Often this is referred to as their “new normal.” The objective of the Wellness beyond Cancer program is to empower survivors to manage their care and overall wellbeing as they move forward from being a cancer patient to living well beyond cancer. (Ottawa Hospital)
The Ottawa Regional Cancer Foundation offers cancer coaching for a fee. This coaching focuses on the survivor’s physical, informational, emotional and practical needs. It can help patients to:
- Develop skills, knowledge and confidence to understand and take charge of their cancer journey.
- Improve overall health and well-being.
- Manage side effects and reduce stress.
- Connect with others with similar experiences.
The University Health Network (UHN) in Toronto offers a Cancer Rehabilitation and Survivorship program, where a patient may be placed in one of three care plans: (1) Cancer Rehabilitation and Exercise Program (CaRE); (2) Specialized Rehab; and (3) Community and Wellness Programs. These programs are offered at their rehabilitation facility, which is called ELLICSR. This is a located away from the medical office and has a relaxed environment, access to a library, computers and many programs. Classes offered through ELLICSR include:
- Living Well with Cancer.
- Getting Back on Track.
- Lymphedema awareness.
- What you can do about Brain Fog.
- Sex and Intimacy.
- Healthy Steps.
- Yoga.
- Mindfulness Meditation.
The Princess Margaret Cancer Centre in Toronto has a psychosocial oncology clinic with social workers, psychologists and psychiatrists who provide counselling and therapies to help the patient and their family cope with the diagnosis of cancer as well as support after treatment. It recognizes the importance of rehabilitation during and after cancer treatment.
[1] Cancer Care Ontario Evidence-Based Series 5-3 IN REVIEW
[2] http://www.cancer.ca/~/media/cancer.ca/CW/for%20media/Media%20releases/2013/CallforAction-ChronicDisease-EN.pdf?la=en