This document summarizes a presentation on colorectal cancer disease pathway management in North East Ontario. It provides background on the panelists and their lack of conflicts of interest. It then discusses disease pathway management and evidence-informed decision making. The presentation sequence is outlined, covering screening, diagnosis, treatment, survivorship and palliative care in separate panels. It also introduces the Regional Aboriginal Cancer Lead and their role in engaging primary care providers and championing a strategic vision for First Nations, Inuit and Métis cancer care. Statistics are presented on higher colorectal cancer rates in North East Ontario and among Ontario First Nations populations compared to provincial averages. A case example is also provided of a First Nations man who is assessed as higher

1. Colorectal Cancer
Disease Pathway Management:
North East Ontario Context
Amanda Hey MD CCFP FCFP
Regional Primary Care Lead
Northeast Cancer Centre, HSN

2. Faculty/Presenter Disclosure
Faculty: Amanda Hey, Annelind Wakegijig, Agnes
Kanawase, Roger Boyer II, Jamie White, Michael Loreto,
Kathleen Callaghan, Julie Whitten, Traci Franklin, Sherri
Baker, Silvana Spadafora, Patrick Critchley
Relationships with commercial interests:
•Grants/Research Support: none
•Speakers Bureau/Honoraria: none
•Consulting Fees: none
•Other: none

3. Disease Pathway Management

4. Disease Pathway Management
https://www.cancercare.on.ca/ocs/qpi/dispathmgmt/

5. Disease Pathway Management
https://www.cancercare.on.ca/ocs/qpi/dispathmgmt

6. Evidence Alone is Never Enough
Evidence
Context
Values
JAMA Users’ Guide to the Medical Literature
American Medical Association
Circumstance

7. Panel Sequence
• Panel facilitator presents case
• Panelist present their topic sequentially
• Audience Q&A at the END of each panel
Panel 1: Screening-Diagnosis
Panel 2: Treatment
Panel 3: Treatment-Survivorship-Palliative

8. Regional Aboriginal Cancer Lead
Will provide leadership on FNIM cancer care in the region
by:
• Engaging and collaborating with
primary care providers
• Championing the ACS II strategic
vision in collaboration with RCP staff
• Strategic planning and
program design
• Peer education and training
8

9. Colorectal Cancer:
A Case for Action
Annelind Wakegijig MD CCFP
Regional Aboriginal Cancer Lead
Northeast Cancer Centre, HSN

10. Colorectal Cancer Rates 2007
Rate per 100,000
Age Standardized Incidence and Mortality Rates
80
70
60
50
40
30
20
10
0
Male Incidence
Female
Incidence
North East
https://www.cancercare.on.ca/cms/ Accessed October 2013
Male Mortality Female Mortality
Ontario

11. CRC and Ontario First Nations
Colorectal cancer incidence, Ontario,
1968-2001, ages 15-74
Males
Age-standardized rate/100,000
Females
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
19681975
19761983
19841991
1992- 19971996 2001
Year of diagnosis
Rates age-standardized to the 1991 Canadian population
Horizontal bars around First Nations rates indicate 95%
confidence limits
19681975
19761983
19841991
19921996
19972001
Year of diagnosis
First Nations
All Ontario
Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)

12. Mr. TW: Case History 1
56 yr. First Nation male
• Mother was diagnosed with CRC age 66
• He was at Residential School as a child
• He seeks advice from his social worker
• He attends his community health centre
• His nurse practitioner assess him at
increased risk for CRC
• He is referred for colonoscopy