1. ΠVOL. 6, N0. 1, FEBRUARY 2007 53
CROSSROADS Profiles in innovative care
Pan-Canadian leadership
The Canadian Strategy for Cancer Control (CSCC)
is a coordinated national health initiative aiming to
enable Canada’s health system to meet the growing
cancer challenge. When unveiled in 2002, however,
it lacked dedicated funding. The National Cancer
Leadership Forum (NCLF) and its Campaign to Control
Cancer (C2CC) is a unique case study illustrating
that collaboration among patients and professionals
advocating for system changes results in improved
care for Canadians affected by cancer. Beginning in
2003, this pan-Canadian group played a significant
role in securing $260 million from 2006 through the
next 5 years to fund the CSCC. This article outlines
the process undertaken by cancer leaders, profes-
sionals and patients working in collaboration, and
its successes so far in securing federal funding and
policy commitment.
ADVOCACY
TO ADVANCE
CANCER CARE
POLICY
Profile of the National
Cancer Leadership Forum
and the Campaign to
Control Cancer
Esther Green, RN, MScT, Beth Kapusta, Pat Kelly
Esther Green, RN, MScT is President of the Canadian Association
of Psychosocial Oncology.
Beth Kapusta is Stakeholder Relations Manager for the Campaign
to Control Cancer, and a two-time cancer survivor.
Pat Kelly is a long-time activist and patient advocate and is Program
Director of the Campaign to Control Cancer.
Address for correspondence: Esther Green, RN, MScT, Canadian
Association of Psychosocial Oncology, 296 Jarvis Street, Unit 7,
Toronto, ON M5B 2C5; Tel: (416) 968-0207; Fax: (416) 968-6818;
Email: Esther.Green@cancercare.on.ca
In 1999, over 700 cancer experts and cancer
survivors met to begin development of the
Canadian Strategy for Cancer Control, a coor-
dinated plan to “prevent cancer, cure cancer,
and increase survival and quality of life for
those who develop cancer, by converting the
knowledge gained through research, surveil-
lance and outcome evaluation into strategies
and actions.”1
Similar initiatives were undertaken in countries such as the
U.K. and Australia, with professionals collaborating with
patients and advocacy groups to develop a national approach
to government-funded cancer control.
THE ISSUES
In 2006, an estimated 153,100 new cases of cancer were
diagnosed and 70,400 deaths from cancer occurred in Canada.
Cancer incidence rises as the population ages: 43% of new
cancer cases and 60% of deaths occur in those over the age
of 70 years.2
There is much good news in cancer, as over the
past decades new treatments have been successful and more
people are surviving. While cancer treatment is improving,
however, prevention programs lag far behind. Screening and
early detection methods are suboptimal, and psychosocial,
supportive and palliative care services are delivered incon-
sistently across the country. For survival rates and quality of
life of cancer patients to improve, major initiatives linking
prevention, diagnosis, treatment, psychosocial care, sup-
portive care, pain management, palliative care and research

2. 54 ΠVOL. 6, N0. 1, FEBRUARY 2007
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initiatives are needed. While each province and territory
provides many cancer services, much more can be done to
control cancer and achieve better outcomes.
Other countries have instituted national strategies. The
U.K.’s National Health Service launched their Cancer Plan in
2000, focusing on new investments in cancer service delivery,
prevention strategies, shorter waiting times from diagnosis
to treatment, and more hospice and specialist palliative care.
Similarly, the Cancer Institute of New South Wales formulated
a comprehensive plan to meet the goals for cancer control,
backed by substantial funding.3
In the U.S., a collaborative
group including the American Cancer Society, American College
of Surgeons, the National Cancer Institute, North American
Association of Central Cancer Registries, Centers for Disease
Control and Prevention, and several other organizations created
the Comprehensive Cancer Control Leadership Institutes
(CCCLI) with the purpose of supporting implementation
efforts for a comprehensive cancer control approach.4
LEADERSHIP
The CSCC was a policy framework that spanned prevention,
surveillance, guidelines, human resources planning and
rebalancing the focus from tumour-centered treatment to
patient-centered supportive and psychosocial care. It had
been formulated by 2002, but was largely invisible to the
general public and even within the professional cancer care
community, and the federal government had not commit-
ted sustained funding. A collaborative of over 40 Canadian
cancer organizations came together in December 2003 to
mobilize public and political support for implementation of
the CSCC. The challenge was to engage stakeholders,
advocacy groups, cancer survivors, cancer leaders and pro-
fessionals to move the agenda forward, not only to create
awareness of the need for a national strategy, but to formu-
late a loud, strong collective voice that politicians and the
public would hear and that would enable them to act.
Called the National Cancer Leadership Forum (NCLF), the
group’s leadership team devised a strategic action plan focusing
on several key activity areas: government relations, stakeholder
relations and public relations/communications. The first goal
was to create a sense of urgency with a practical and realistic
approach, offering solutions and collaborative problem
solving. The NCLF created the Campaign to Control Cancer
and a new social marketing plan to launch a series of news-
paper ads, with the support of the member organizations.5
ACTION
Once an organizational structure for accountability and
decision-making was in place, the group established a bilin-
gual secretariat and website and hired a program director.
Member organizations conducted a survey to define expec-
tations and needs for advocacy activities. Several public events
provided NCLF with more fuel for the “burning platform”
(to increase the sense of urgency), such as Senator Carstairs’
speech in the Senate in March 2004 supporting the CSCC.
The release of the 2004 Canadian Cancer Statistics from the
Canadian Cancer Society/National Cancer Institute supplied
a focus for explaining the need for government to support
a national strategy for cancer control. With an election
looming in 2004, organizations such as the Canadian Cancer
Society (CCS) and the Canadian-Cancer Advocacy Network
(C-CAN) launched campaigns to educate political candidates
about cancer statistics and the need for sustained commit-
ment of pan-Canadian cancer control efforts. During the
2004 federal election, Prime Minister Paul Martin chaired a
Liberal candidates’ forum in Oakville, Ontario where
patients, advocacy groups and providers presented on the
systemic causes and impact of waiting times for cancer care.
The NCLF also developed Leadership Training Workshops
to support groups across the country, bringing together leaders
from each provincial cancer community and professionals to
expand the network across the nation and engage new leaders
for the task of advancing the cancer control agenda. Workshop
participants followed up by meeting with Members of Parlia-
ment, Members of Provincial Parliaments and Members of Leg-
islative Assemblies, writing letters to newspapers, circulating
petitions and engaging their organizations in the effort to fund
and implement the CSCC. Cancer communities began aligning
to support the Strategy. One example that illustrates the impact
of this work occurred in New Brunswick in 2005, when advo-
cates Elaine Gunter and Carol Loughrey drafted an all-party
resolution that called upon the federal government to fund and
implement the CSCC. The resolution passed, making New
Brunswick the first province in the country to assert the need
for a Canadian strategy for cancer control.6
A number of key newspaper ads were developed with the
intent to reframe cancer and people’s perception of it. The
FIGURE 1. Conceptual framework for the
Canadian Strategy for Cancer Control
Conceptual circular spaces represent different
domains of the CSCC.
The inner space depicts the relationships between stakeholders,
governments and public relations bodies.
In the middle space, collaboration and a unified message is
key. The outer space is the Canadian public and the broader
cancer community. Here, the Strategy’s effect in influencing
behaviour, lifestyle choices, attitudes and the actual delivery of
preventive care, screening and treatment will change outcomes.

3. ΠVOL. 6, N0. 1, FEBRUARY 2007 55
CROSSROADS
ads identified the massive gap between knowledge about
controlling cancer and actions being taken to put this
knowledge to work. They called for fundamental improve-
ments in Canada’s response to cancer control by “putting
what we know to work to cut cancer down to size,” a
phrase coined by Mark Sarner of Manifest Communications
that subsequently became a mantra unifying the cancer
community. Once the media seized upon the topic, multi-
ple stories began to unfold on CTV National News, CBC’s
Canada Now, Global TV News and many radio stations,
gathering public responses through letters and political
attention for the Canadian Strategy. A prominent example
of how the media responded to the campaign occurred in
May 2005 when André Picard, a respected health writer,
penned an article in the Globe and Mail using the statistics
assembled by the Canadian Cancer Society and giving
unequivocal support for the Strategy. Picard’s column set
the tone for the campaign and positioned the lack of atten-
tion to the Strategy as a major election issue.6
MILESTONES
At the outset in 2003, NCLF participants wanted to see the
CSCC fully funded, with a formal funding commitment in
the federal budget and a structure that provides a flow of
money to implement the Strategy. The campaign achieved
partial success in June 2005 when the Opposition Health
Critic, Steven Fletcher from Manitoba, introduced a motion
to support the funding and implementation of the CSCC.
The motion was passed with unanimous support from the
Conservatives, NDP and Liberals. The Liberal government’s
preference, however, was to commit funds for an Integrated
Strategy on Healthy Living and Chronic Disease. The
embedding of committed funds in a different strategy and
structure than envisioned by the leaders of CSCC created
some concern that cancer control might be subsumed within
this other entity and not be fully implemented.6
NCLF continued to nurture the Campaign to Control
Cancer and found additional ways to place the policy issue of
cancer control at the forefront. More media advertisements
were placed that underscored the need to implement the
plan as a disease-specific strategy. NCLF members gave a
presentation about CSCC to the federal, provincial and terri-
torial meeting of the Ministers of Health, at the invitation of
the co-chairs, the Ontario Minister of Health and New
Brunswick Minister of Health and Wellness. At the second
NCLF Forum in January 2006, NCLF’s first leadership
award recognized Steven Fletcher’s contribution in forward-
ing the motion and engaging the parties to support the
funding and implementation of the CSCC. Federal Minister
of Health Tony Clement attended the event and committed
to including the funding in the proposed federal budget.6
On November 24, 2006, the funding was reconfirmed for a
renamed non-profit initiative called the Canadian Partner-
ship Against Cancer, with the mandate of implementing the
CSCC, and an arms-length governance structure was put in
place. It is chaired by Jeff Lozon, CEO of St. Michael’s
Hospital in Toronto. Dr. Simon Sutcliffe, CEO of the BC
Cancer Agency, will be Vice-chair. The Strategy has been
funded to receive $52 million for each of the next 5 years.
MOVING FORWARD
While gains have been accomplished and the federal govern-
ment has committed to sustained funding for 5 years, the work
is not finished. Collaborative partnerships that speak with a
strong voice promoting a pan-Canadian approach for cancer
control are essential. Figure 1 shows the conceptual framework
developed for the CSCC at the second Stakeholder Forum in
2006. Besides representing the obvious spheres of influence of
the Strategy’s activities, the successive spaces speak to the con-
cept that cancer is not an event that happens at a certain point
in time, but rather is a process that starts in health and develops
over varying lengths of time as symptoms become evident, the
diagnosis is made, treatment begins, and after treatment. We
know that much takes place before diagnosis, and thus cancer
control is about benefiting the entire population. In fact cancer
control has as much to do with those who are healthy as with
those who are ill, as the greatest potential impact on controlling
cancer is in the period before it develops. The CSCC encom-
passes all subpopulations: people who are healthy; those with
higher risk due to genetic predisposition, habits or lifestyle
choices; those acutely ill with cancer; those with chronic cancer
illnesses; those cured of cancer; and those dying of cancer. It
attempts to reach each subgroup through structured interven-
tions in order to improve outcomes.
NCLF has learned over the past 3 years that strength lies
in having a clear roadmap, a unified vision and common voice.
Collective action works but fragmentation, competition
and distraction do not. The focus must be on reinforcing
the goal, message and priorities if success and progress are
to be achieved. Œ
References
1. Definition of cancer control from website www.cancercontrol.org.
2. Canadian Cancer Society/National Cancer Institute of Canada: Canadian Cancer Statistics 2006.
3. More information is available at www.health.nsw.gov.au/cancer.
4. More information is available at www.cdc.gov/cancer.
5. NCLF Leadership Team. Final Report of the 2nd
National Cancer Leadership Forum. Toronto, ON, 2006.
6. Beth Kapusta, Jayne Akizuki, Pat Kelly. A Brief History of the Campaign to Control Cancer.
Toronto, ON, 2006.
Lessons learned
Cancer control advocates have learned several overarch-
ing principles that foster pan-Canadian leadership to
advance policy:
· Keep up the pressure and momentum
· Pay attention to timing
· Be highly organized and informed
· Be forceful yet flexible
· Share success with others
· Be visible with politicians and within communities
· Build win-win situations
· Learn from the business communities how models of
efficiency can work