| Ontario Health - Cancer Care Ontario's Data Book - 2022-2023 |
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Updated in December 2021
Introduction
This section describes each SSO program, including Stem Cell Transplant, Sarcoma, Acute Leukemia, and CAR T-cell Therapy programs.
1.1 Stem Cell Transplant
A. Provincial Program
Stem Cell Transplant (SCT) or Hematopoietic Cell Therapy (HCT) includes Bone Marrow Transplant and is an essential component of treatment for selected patients with lymphoma, acute leukemia, myeloma and stem cell and immunologic disorders. Stem cells can be acquired from several sources. Traditionally, they were extracted from the marrow of large bones, such as the hip bone. This procedure is usually called bone marrow transplant. Stem cells are now commonly extracted from a donor’s peripheral blood through a process called apheresis. This procedure is usually referred to as stem cell transplant.
In follow-up to CCO’s 2008 report “Ensuring Access to High Quality Bone Marrow and Stem Cell Transplantation Services in Ontario, CCO is implemented an oversight program for services in Ontario in 2010/11.CCO has developed an application to enhance, capture and analyze the minimum data set required to support the SCT Program’s objectives.
B. SCT High Cost Drugs
In 2017/18 Cancer Care Ontario, introducted funding to support the per milligram costs of stem cell transplant related use for thiotepa, carmustine (and defibrotide in 2019/20). Manual data collection takes place to support the provision of funding for the delivery of these drugs.
1.2 Sarcoma
Implementation of a sarcoma oversight program will ensure patients across Ontario have appropriate and equitable access to the expertise of the Multidisciplinary Sarcoma Team and high quality clinical care. The Provincial Sarcoma Services Plan lays the foundation for how adult sarcoma services are organized in Ontario. It was developed collaboratively by regional, clinical and patient representatives through a Steering Committee facilitated by CCO and includes an open and transparent process for funding sarcoma services. The SSO IS Sarcoma Program data submission is used to support funding, provincial planning and quality improvement related to specific chemotherapy regimens, expert pathology review and molecular diagnostics.
1.3 Acute Leukemia
A. Provincial Program
The Acute Leukemia Provincial Plan, released in August 2017, provides an overview of how adult services are defined and how they should be organized and delivered in Ontario. It was created collaboratively by regional, clinical and patient representatives and facilitated by Cancer Care Ontario. This Plan sets the stage to achieve a vision of care in Ontario where there will be strong networks of service providers that deliver coordinated care across the province and is designed to:
- Provide timely access for adults to high-quality, coordinated acute leukemia services as close to home as possible
- Focus on better outcomes and improved patient experience
- Encourage hospitals and providers to work together to form a networks of services which are person-centred, evidence based and support evolving clinical practices
Data collection will be required to support the implementation of the Acute Leukemia Provincial Plan, including planning, performance management and funding.
The Acute Leukemia Manual Data Collection Strategy, along with acute leukemia chemotherapy treatments submissions made to CIHI-DAD and Activity Level Reporting (ALR), will be used to support quality improvement, performance management, planning and funding related to acute leukemia care in Ontario. The data submitted through the Acute Leukemia Manual submission, CIHI and ALR will be used to fund the Acute Leukemia Induction, Inpatient Consolidation, Induction Following Remission and Subsequent Relapse and Supportive Care bundles. The double submission through the Acute Leukemia Manual Data Collection Strategy and CIHI-DAD will be used help centres work to develop processes to ensure consistency between the CIHI and OH Acute Leukemia Manual data sets. This document contains the data dictionary for the Manual Data Collection Strategy only.
B. Midostaurin
Starting in 2018/19, manual data collection will take place to monitor the utilization of midostaurin to acute myeloid leukemia patients who are FLT3 positive.
C. Anti-thymocyte globulin (ATG)
In 2019/20 Cancer Care Ontario, introducted funding to support the per milligram cost of equine ATG treatment for patients with aplastic anemia. Manual data collection will take place to support the provision of funding for the delivery of this treatment.
1.4 CAR T-cell Therapy
Chimeric antigen receptor (CAR) T-cell therapy is a new treatment for some types of leukemia and lymphoma. CAR T-cell therapy is a type of immunotherapy called “adoptive T-cell immunotherapy.” Immunotherapy uses a person’s own immune cells to fight cancer. CAR T-cell therapy reprograms the genetics of a person’s immune cells to find and attack cancer cells throughout their body. The CAR T-cell Therapy Program is working to achieve timely access to high quality, sustainable, CAR T-cell therapy services in Ontario, through the development of evidence-based care guidelines, system planning, and performance monitoring.
In 2019/20 the CAR T-cell Therapy Program began collecting post-treatment data on a monthly basis from CAR T treatment centres in Ontario, via a manual data collection process utilizing MFT. This data is used for program planning, reporting, and funding. This manual monthly data collection process will continue until further notice.
1.5 Cancer Imaging Program
A. Provincial Program
Diagnostic imaging is an integral part of cancer patient care. It helps guide clinical decision-making to ensure safe, high-quality, appropriate care. The Cancer Imaging Program promotes timely access to high-quality imaging and image guided treatments in Ontario. The Cancer Imaging Program seeks to improve quality, access, safety and the appropriate use of cancer imaging and image guided treatments as well as facilitate and accelerate evidence-based change and improve effective communication within the radiology community.
Focal ablation is a minimally invasive image guided treatment option for patients with certain cancers, including cancers of the lung, liver and kidney. There are several focal ablation procedures which directly apply thermal (extreme heat or cold), chemical, or radiation-based therapies to specific tumours and surrounding areas. These therapies include thermal ablation, which includes radiofrequency ablation (RFA), microwave ablation and cryoablation, as well as transcatheter arterial chemoembolization (TACE) and transarterial radioembolization (TARE).