A Framework for the Organization and Delivery of Systemic Treatment

Ted Vandenberg, Nadia Coakley, Jeff Naylor, Cathy DeGrasse, Esther Green, Jean A Mackay, Cynthia McLennan, Anne Smith, Laura Wilcock, Maureen E Trudeau


Background: Increased systemic treatment and shortages of oncology professionals in Canada require innovative approaches to the safe and effective delivery of intravenous (IV) cancer treatment. We conducted a systematic review of the clinical and scientific literature as well as an environmental scan of models in Canada, the United Kingdom, Australia, and New Zealand. We then developed a framework for the organization and delivery of IV systemic treatment. Methods: The systematic review used MEDLINE, EMBASE, CINAHL, and HealthStar. The environmental scan retrieved published and unpublished sources, coupled with a free keyword GOOGLE search. The Systemic Treatment Working Group reviewed the evidence and developed a draft framework, using evidence-based analysis, existing recommendations from various jurisdictions, and expert opinion based on experience and consensus. The draft was assessed by Ontario stakeholders and reviewed and approved by Cancer Care Ontario. Results: The poor quantity and quality of the evidence necessitated a consensus-derived model. That model comprises four levels of care determined by a regional systemic treatment program and three integrated structures: Integrated Cancer Programs, affiliate institutions, and satellite institutions, each with a defined scope of practice and a specific organizational framework. Interpretation: New models of care are urgently required beyond large centres, particularly in geographically remote or rural areas. Despite limited applicable evidence, the development and successful implementation of this framework is intended to create sustainable, accessible, quality care and measurably improve patient outcomes.

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DOI: http://dx.doi.org/10.3747/co.v16i1.297

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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)