Addressing Cancer Care Workforce Challenges

Lead: Monika Krzyzanowska

Background: Cancer care patient volumes are increasing with approximately 1 in 2 people expected to develop cancer within their lifetime. Coupled with having an aging population, advances in diagnosis and treatment have led to greater proportions of patient surviving and going on to receive treatment and follow-up care in the cancer system longer. Provision of timely access to appropriate treatment is paramount to maintaining quality of care and improving clinical outcomes. However, cancer systems are facing significant challenges related to staff shortages due to high levels of workforce burnout and turn-over, inadequate role clarity, and fragmented care, which can impact the delivery of effective cancer care.

Objectives:

  • Implement an educational collaborative (CAREFORCE) that optimizes the existing cancer care workforce for improved patient care, reduced costs, and sustainable cancer healthcare delivery;
  • Construct an updated workforce planning model for Medical Oncology; and
  • Use simulation to identify optimal strategies to address cancer care workforce issues.

Co-Creation of a Supportive Care Program to Improve the Quality of Breast Cancer Care Delivered to Patients who Self-Identify as Black

Lead: Melanie Powis

Background: In partnership with the Canadian Cancer Society, The Olive Branch Of Hope, Gilda’s Club, and Women’s College Hospital we are operationalizing the findings of our previous Pan-Canadian needs assessment to co-create a supportive care program tailored to patients who are undergoing treatment for breast cancer and self-identify as Black.

Objectives:

  • Synthesize the current literature on tailored patient navigation and supportive care programs;
  • Utilize community-based participatory research methods to co-create a navigation program, as well as tailored educational and supportive care services; and
  • Implement and pragmatically evaluate the supportive care program in practice.

Leveraging AI to Improve and Align Cancer Care Delivery

Co-Lead: Melanie Powis
Co-Lead: Robert Grant

Background: While the number of AI models is ever increasing, their acceptance and embedding within routine cancer care remains a challenges.  The aim of this project is to conceptualize and address barriers to AI deployment and adoption in cancer care, and to implement solutions with high clinical utility and clinician buy-in.

Objectives:

  • Identify optimal use cases for AI copilots in clinical cancer care;

  • Examine how policy impacts effective patient and community engagement in the development, deployment and evaluation of AI-driven technologies.

  • Develop and validate a comprehensive framework for AI deployment and adoption in routine clinical practice; and

  • Leverage AI to develop a national unmet cancer supportive care roadmap;

Co-creation of a New Model of Cancer Care for Patients who Use Drugs

Co-Lead: Melanie Powis
Co-Lead: Jenny Lau

Background: Leveraging community-based participatory research methods, we will examine the structural determinants of health for people with cancer who use drugs by conducting a policy analysis and PhotoVoice project.  We will then synthesize the findings alongside patient partners and community advocacy organizations to develop a national strategy for improved, equitable cancer care for patients who use drugs.

Objectives:

  • Conduct an analysis of structural barriers to equitable care for people who use drugs;
  • Characterize the experiences of people who use drugs with accessing/ receiving care;

  • Synthesize the findings into a co-created roadmap for addressing these barriers to equitable care, to be implemented in the next phase of the project.

Improving Lymphoma Survivorship Care

Co-Lead: Melanie Powis
Co-Lead: Vishal Kukreti

Background: Building off of our previous work conducting a systematic literature search of current lymphoma survivorship practices, opportunities and challenges, we will undertake a population-level analysis of patterns of survivorship care in Ontario.  This work will inform the implementation and evaluation of a new model of lymphoma survivorship care.

Objectives:

  • Evaluate incidence of late term effects and factors associated with high cumulative toxicity burden in patients treated for diffuse large B-cell lymphoma;
  • Characterize current patterns of survivorship care and clinical outcomes; and
  • Examine patients’ preferences and priorities for their survivorship care.

Dr. Monika Krzyzanowska MD MPH FRCSC

Dr. Monika Krzyzanowska is a medical oncologist and health services researcher. She obtained her medical degree the University of Toronto and her Master of Public Health in quantitative methods from Harvard University. Dr. Krzyzanowska serves as the Director of the CQuaL lab, an Academic Physician at Princess Margaret Cancer Centre, a Professor of Medicine at the University of Toronto, and the Clinical Lead, Quality Care and Access, Systemic Treatment Program at Cancer Care Ontario. Dr. Krzyzanowska‘s research seeks to understand and improve the quality of cancer care in routine settings.

Publications:

  1. Howell D, Powis M, Kirkby R, Amernic H, Moody L, Bryant-Lukosius D, O’Brien MA, Rask S, Krzyzanowska MK. Improving the quality of self-management support in ambulatory cancer care: a mixed-method study of organisational and clinician readiness, barriers and enablers for tailoring of implementation strategies to multisites. BMJ Qual Saf. 2021 Mar 16;bmjqs-2020-012051.
  2. Berlin A, Lovas M, Truong T, Melwani S, Liu J, Liu ZA, Badzynski A, Carpenter MB, Virtanen C, Morley L, Bhattacharyya O, Escaf M, Moody L, Goldfarb A, Brzozowski L, Cafazzo J, Chua MLK, Stewart AK, Krzyzanowska MK. Implementation and Outcomes of Virtual Care Across a Tertiary Cancer Center During COVID-19. JAMA Oncol. 2021 Jan 7:e206982.
  3. Enright KA, Taback N, Powis ML, Gonzalez A, Yun L, Sutradhar R, Trudeau ME, Booth CM, Krzyzanowska MK. Setting Quality Improvement Priorities for Women Receiving Systemic Therapy for Early-Stage Breast Cancer by Using Population-Level Administrative Data. J Clin Oncol. 2017 Oct 1;35(28):3207-3214.

Melanie Powis MSc RAQC PhD

Dr. Melanie Powis is the Scientific Director for the Cancer Quality Lab at Princess Margaret Cancer Centre, an Assistant Professor in the Institute for Health Policy, Management and Evaluation at the University of Toronto, and Adjunct Scientist at the Institute for Clinical Evaluative Sciences. As a Health Services Researcher and Implementation Scientist, her work focuses on leveraging quality improvement (QI) and implementation research methodologies to implement and pragmatically evaluate interventions to improve the quality of cancer care delivered to underserved patients. To maximize uptake and policy impacts of her work, she has ongoing collaborations with community partner organizations, and knowledge users from across Canada and internationally. She has published in top journals, including: the JCO, JAMA Oncology and BMJ, and holds leadership roles in International Collaborative for Digital Health Translation (Canadian Hub Lead for Digital Health Translation) and the Consortium for Cancer Implementation Science of the National Cancer Institute (Vice-Chair, Technology in Implementation Science Action Group).

Publications:

  1. Nagarajah S, Powis ML, Fazelzad R, Krzyzanowska MK, Kukreti V. Implementation and Impact of Choosing Wisely Recommendations in Oncology. JCO Oncol Pract. 2022 Oct;18(10):703-712.

  2. Powis M, Sutradhar R, Singh S, Alibhai S, Hack S, Baiad A, Chen K, Li H, Mohmand Z, Krzyzanowska MK. The Impact of the Pandemic on the Quality of Colorectal and Anal Cancer Care, and 2-Year Clinical Outcomes. Curr Oncol. 2024 Apr 19;31(4):2328-2340.

  3. Powis M, Sutradhar R, Gonzalez A, Enright KA, Taback NA, Booth CM, Trudeau M, Krzyzanowska MK. Establishing achievable benchmarks for quality improvement in systemic therapy for early-stage breast cancer. Cancer. 2017 Oct 1;123(19):3772-3780.

Dr. Robert Grant PhD MD

Robert Grant is a Medical Oncologist and Clinician Investigator at the Princess Margaret Cancer Centre and an Assistant Professor of Medicine at the University of Toronto. He completed his MD and PhD at the University of Toronto. His research applies machine learning to improve outcomes for people with cancer.

Publications:

Grant RC, Moineddin R, Yao Z, Powis M, Kukreti V, Krzyzanowska MK. Development and Validation of a Score to Predict Acute Care Use After Initiation of Systemic Therapy for Cancer. JAMA Netw Open. 2019 Oct 2;2(10):e1912823.

Nadler M, Rose AAN, Prince R, Eng L, Lott A, Grant RC, Jones JM, Enright K. Increasing Referrals of Patients with Gastrointestinal Cancer to a Cancer Rehabilitation Program: A Quality Improvement Initiative. JCO Oncology Practice.2021;17(4):e593-e602

Duan K, Jang GH, Grant RC, Wilson JM, Notta F, O’Kane G, Knox JJ, Gallinger S, Fischer S. The value of GATA6 Immunohistochemistry and Computer-Assisted Diagnosis to Predict Clinical Outcome in Advanced Pancreatic Cancer. Scientific Reports. 2021;11(1):14951.

Dr. Vishal Kukreti MD FRCPC

Bio coming soon

Publications:

  1. Pardhan A, Vu K, Gallo-Hershberg D, Forbes L, Gavura S, Kukreti V. Evolving Best Practice for Take-Home Cancer Drugs. JCO Oncol Pract. 2020 Oct 20:OP2000448. doi: 10.1200/OP.20.00448.
  2. Moradian S, Krzyzanowska M, Maguire R, Kukreti V, Amir E, Morita PP, Liu G, Howell D. Feasibility randomised controlled trial of remote symptom chemotherapy toxicity monitoring using the Canadian adapted Advanced Symptom Management System (ASyMS-Can): a study protocol. BMJ Open. 2020 Jun 17;10(6):e035648.
  3. Grant RC, Moineddin R, Yao Z, Powis M, Kukreti V, Krzyzanowska MK. Development and Validation of a Score to Predict Acute Care Use After Initiation of Systemic Therapy for Cancer. JAMA Netw Open. 2019 Oct 2;2(10):e1912823.