Panel 3:
Creating a Responsive Health
Care System for Patients with
Advanced Rectal Cancer
Panelists:
Sherri Baker NCFW BS...
Mr. TW: Case History 3
• Mr. TW completes therapy and is followed
appropriately over the next 10 years
• He presents with ...
The Role of the
Aboriginal Patient Navigator
Sherri Baker NCFW BSW RSW
Aboriginal Patient Navigator
Northeast Cancer Centr...
Role of Aboriginal Navigator
• Support at clinical visits
– Attending or speaking with attending physicians regarding pati...
Accessing services
All people who self identify as First Nations, Métis & Inuit
are in need of supportive services.

Refer...
Management of CRC
Liver Metastases
Silvana Spadafora MD FRCP(C)
Medical Director Algoma District Cancer Program
Regional C...
Role of Liver Metastasectomy
CCO’s Program in Evidence Based Care:
• Liver resection…offers the possibility of cure in
sta...
The pathway for a real patient
2008:
• 77 yr. male with rectal bleeding → rectal
lesion → staging negative, CEA 1.6.
• Neo...
The pathway for a real patient
2010
• CEA 10; R lobe liver metastases on CT
• Reviewed by Toronto Hepatobiliary Team
• Met...
Clinical Tools and
Guidelines for Primary Care
Patrick Critchley MD CCFP FCFP
Regional Primary Care Lead: Northern Distric...
Objectives
• ESAS - Edmonton Symptom Assessment
Scale
• PPS - Palliative Performance Scale
• Cancer Care Ontario Symptom
M...
Primary Care
Ideal position to provide and coordinate
palliative care:
– Long-established relationships with our
patients
...
Health Care Team
• Expanding number of members
• Changing and expanding roles
• Working in multiple settings
• Communicati...
Would you be surprised if your patient
were to die in the next 6-12 months?
– General Indicators of decline and increasing...
If the answer is “no I would not
be surprised”….
– consider palliative care approach
– involve appropriate resource/team m...
Tools
• Edmonton Symptom Assessment Scale
(ESAS)
– Validated multidimensional symptom
assessment tool
– Self-rating using ...
ESAS - uses
• Measure and document common
symptoms in EOL
• Provide a good overview of symptoms in
individual patients
• H...
ESAS Benefits
• Common language between health care
providers
• Efficiency
• Monitoring benefits of treatment plan
ESAS utilization in Primary Care
• TPC Demonstration project 2004-2006
– Visiting home RNs collected ESAS at each
visit
– ...
ESAS utilization in Primary Care
• Family Physician office
• Patient completes the ESAS and responses are
entered into a s...
Tools
• Palliative Performance Scale (PPS)
– Originally developed for hospice patients
– Based on Karnofsky’s Performance ...
PPS
• 70-100% - stable
• 40-60% - transitional
• 0-30% - end of life
PPS - uses
• Useful in determining prognosis in
advanced cancer
PPS - Benefits
• Common language
• Prognosis:
– prepare patient, family, team
– facilitate discussions regarding care wish...
So now what?
• I’ve had the patient complete the ESAS now what?
Care Care Ontario Website
• CCO Toolbox Tab
– Palliative Care Tools
• PPS - tool and description (PDF)
• Collaborative car...
Care Care Ontario Website
• CCO Toolbox Tab
– Symptom Management Tools
• ESAS - description (PDF)
• ESAS Tool - (languages...
CCO - Symptom Management
Guide App
• Pain, Dyspnea, Depression, Anxiety,
Nausea and Vomiting, Delirium
• App is an algorit...
North East Oncology News

www.hsnsudbury.ca under Northeast Cancer Centre, Professional Resources and Networks, Primary Ca...
In conclusion
• Consider:
– asking the question “would I be surprised?”
– utilizing the PPS and ESAS in your
management pl...
Download your CCO-SMG
App today!
To Download, Search:
App Library CCO
Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana ...
Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana ...
Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana ...
Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana ...
Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana ...
Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana ...
Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana ...
Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana ...
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Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana Spadafora, Dr. Patrick Critchley

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Panel #3 from the 2013 Regional Oncology Conference.

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Panel 3: Creating a Responsive Health Care System for Patients With Advanced Rectal Cancer, Ms. Sherri Baker, Dr. Silvana Spadafora, Dr. Patrick Critchley

  1. 1. Panel 3: Creating a Responsive Health Care System for Patients with Advanced Rectal Cancer Panelists: Sherri Baker NCFW BSW RSW Silvana Spadafora MD FRCP(C) Patrick Critchley MD CCFP FCFP
  2. 2. Mr. TW: Case History 3 • Mr. TW completes therapy and is followed appropriately over the next 10 years • He presents with liver metastases and is referred to the cancer centre • His case is assessed for “HPB” rounds. He has pre-op chemo and metastasectomy • Over some time his disease slowly progresses. He enters the palliative phase
  3. 3. The Role of the Aboriginal Patient Navigator Sherri Baker NCFW BSW RSW Aboriginal Patient Navigator Northeast Cancer Centre, HSN
  4. 4. Role of Aboriginal Navigator • Support at clinical visits – Attending or speaking with attending physicians regarding patient status. • Communication with health care providers & make appropriate referrals to other services – i.e. hospice, health services in the patients community. • Language and cultural translation – Accessing services through the medicine lodge • Address the cultural and spiritual needs / travel / finance/ caregiver and family needs. – Assisting with accessing any NIHB, ODSP, elders or other community services both in Sudbury and their home community. • Other psychosocial needs – Counselling or supportive services
  5. 5. Accessing services All people who self identify as First Nations, Métis & Inuit are in need of supportive services. Referral to services can come from an Internal source, Self and or a community referral. Patients must have a diagnosis of cancer and are ambulatory patients.
  6. 6. Management of CRC Liver Metastases Silvana Spadafora MD FRCP(C) Medical Director Algoma District Cancer Program Regional Clinical and Quality Co-Lead for Systemic Treatment
  7. 7. Role of Liver Metastasectomy CCO’s Program in Evidence Based Care: • Liver resection…offers the possibility of cure in stage IV disease limited to the liver. • Patients who have complete resection of the liver metastases have a 5 yr. survival rate of ~ 45% and a 10 yr. survival rate of 25% • Patient selection is very important and done through Multidisciplinary Case Conferences CCO PEBC Evidence-based Series 17-7: The role of liver resection in colorectal cancer metastases June 2012
  8. 8. The pathway for a real patient 2008: • 77 yr. male with rectal bleeding → rectal lesion → staging negative, CEA 1.6. • Neoadjuvant chemo-radiotherapy → surgery → margins not identified, N2 • 6 months oral adjuvant → staging negative, CEA 0.8. • Appropriate CEA & imaging follow-up
  9. 9. The pathway for a real patient 2010 • CEA 10; R lobe liver metastases on CT • Reviewed by Toronto Hepatobiliary Team • Metastasectomy performed in Toronto • No chemotherapy required • Post-op CEA 1.0 2013 • Age 83 and CEA remains 0.8-1.2
  10. 10. Clinical Tools and Guidelines for Primary Care Patrick Critchley MD CCFP FCFP Regional Primary Care Lead: Northern Districts Northeast Cancer Centre, HSN
  11. 11. Objectives • ESAS - Edmonton Symptom Assessment Scale • PPS - Palliative Performance Scale • Cancer Care Ontario Symptom Management Guidelines
  12. 12. Primary Care Ideal position to provide and coordinate palliative care: – Long-established relationships with our patients – Use to dealing with co-morbidity and uncertainty – Trained to treat patients holistically
  13. 13. Health Care Team • Expanding number of members • Changing and expanding roles • Working in multiple settings • Communication and use of a common language are key to success
  14. 14. Would you be surprised if your patient were to die in the next 6-12 months? – General Indicators of decline and increasing needs • change in performance status, co-morbidity, advanced disease, decreasing response to treatment, weight loss, etc. – Specific Clinical Indicators • Cancer - may see rapid or predictable decline • Organ failure - erratic decline • Frailty/dementia - gradual decline
  15. 15. If the answer is “no I would not be surprised”…. – consider palliative care approach – involve appropriate resource/team members – initiate proactive management (less crisis management) – plan according to patient’s preferences – assess patient and family needs ongoing and regular basis – utilize tools for assessment and symptom management
  16. 16. Tools • Edmonton Symptom Assessment Scale (ESAS) – Validated multidimensional symptom assessment tool – Self-rating using scale of 0 - 10 for severity of 9 common symptoms and one additional symptom described by the patient – Measures how the patient is feeling at the time of completing the scale
  17. 17. ESAS - uses • Measure and document common symptoms in EOL • Provide a good overview of symptoms in individual patients • Highly effective in the recognition of unreported symptoms particularly when combined with further interviewing to obtain the details of the positive responses
  18. 18. ESAS Benefits • Common language between health care providers • Efficiency • Monitoring benefits of treatment plan
  19. 19. ESAS utilization in Primary Care • TPC Demonstration project 2004-2006 – Visiting home RNs collected ESAS at each visit – Sent in to CCAC office – Entered into patient chart – Team rounds - ESAS graphs for each patient was presented and reviewed at regular team meeting – Management and education plan was formulated
  20. 20. ESAS utilization in Primary Care • Family Physician office • Patient completes the ESAS and responses are entered into a stamp by secretary or RN • Practice Solutions • Can graph the scale • Can track medications on the scale • Facilitates a efficiency in the office assessment and treatment plan
  21. 21. Tools • Palliative Performance Scale (PPS) – Originally developed for hospice patients – Based on Karnofsky’s Performance Scale – Clinician rated on 0% - 100% scale – 0 - deceased – 100- fully functional
  22. 22. PPS • 70-100% - stable • 40-60% - transitional • 0-30% - end of life
  23. 23. PPS - uses • Useful in determining prognosis in advanced cancer
  24. 24. PPS - Benefits • Common language • Prognosis: – prepare patient, family, team – facilitate discussions regarding care wishes and planning including - Will, POA, funeral – advocate for additional services (CCAC)
  25. 25. So now what? • I’ve had the patient complete the ESAS now what?
  26. 26. Care Care Ontario Website • CCO Toolbox Tab – Palliative Care Tools • PPS - tool and description (PDF) • Collaborative care plans linked to PPS score (PDF) – App Library • Symptom Management Guidelines (link to App store) • Drug Formulary (link to App store)
  27. 27. Care Care Ontario Website • CCO Toolbox Tab – Symptom Management Tools • ESAS - description (PDF) • ESAS Tool - (languages) – Symptom Management Guides • 10 symptoms • Algorithms, Pocket Guides, Guide-to-practice (PDF, printable, downloadable), Videos
  28. 28. CCO - Symptom Management Guide App • Pain, Dyspnea, Depression, Anxiety, Nausea and Vomiting, Delirium • App is an algorithm – Based on severity of patient’s identified symptom (ESAS) – Guide assessment – Assist with care planning including both nonpharmacological and pharmacological – DOES NOT REQUIRE WIFI TO FUNCTION
  29. 29. North East Oncology News www.hsnsudbury.ca under Northeast Cancer Centre, Professional Resources and Networks, Primary Care Resources
  30. 30. In conclusion • Consider: – asking the question “would I be surprised?” – utilizing the PPS and ESAS in your management plan for palliative patients – Exploring CCO Website for these tools and symptom management guidelines - proactive not during a crisis
  31. 31. Download your CCO-SMG App today! To Download, Search: App Library CCO

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