SMOKING CESSATION LEAN INITIATIVES
WESTERN MANITOBA FIRST NATIONS, CANCER CENTRE METIS, INUIT PROGRAM SCREENING PREVENTION Transformation, Step by Step RESEARCH
PROGRAMS CLINICAL TRIALS VOLUNTEERS IN SIXTY: CANCER PATIENT JOURNEY INITIATIVE MESSAGE FROM THE CHAIRMAN OF THE BOARD 1 REPORT FROM THE PRESIDENT & CEO 2 ABOUT US 4 IMPROVING PREVENTION 8 IMPROVING EARLY DIAGNOSIS 10 IMPROVING PATIENT EXPERIENCE 14 EFFICIENCY AND EFFECTIVENESS 20 CONDENSED FINANCIAL STATEMENTS 22 CORPORATE INFORMATION 24 VOLUNTEERISM 26 AWARDS AND ACHIEVEMENTS 28 CANCERCARE MANITOBA FOUNDATION 29
OUR VISION OUR VALUES Working together, we will reduce the PATIENT > FAMILY > CONTINUOUS LEARNING AND impact of cancer on all Manitobans. COMMUNITY FOCUS IMPROVEMENT We believe in a balanced patient, We continuously work to improve OUR MISSION family and community centered everything we do and to deepen our focus where care is delivered with understanding of our work and the Through early detection, care, compassion and sensitivity. conditions that affect it. We believe research, education and public in the roles of research, education outreach, CancerCare Manitoba will RESPECT and systematic evaluation. contribute to the prevention We believe in the dignity and worth of cancer and improve the outcomes of every individual and in each STEWARDSHIP and quality of life for Manitobans person’s right to be treated with We endeavor to make wise use with cancer and blood disorders. respect, honesty, openness and of the resources available to CCMB. fairness. We listen to and learn In accepting the responsibilities from each other in an open and entrusted to us by the people of trusting manner. Manitoba, we strive to serve others – and each other – in a manner that TEAMWORK is effective and accountable. We foster a working environment that is motivating, rewarding, CANCERCARE MANITOBA’S VISION, collegial and characterized by MISSION AND VALUES ARE CULTIVATED teamwork. We believe in working WITH PATIENT, PUBLIC AND PARTNER cooperatively with others through INPUT, AND ARE ADVANCED THROUGH partnership and collaboration, PUBLIC OUTREACH. valuing collective achievement. A Message From The Chairman of the Board
I AM PLEASED TO PRESENT THE CANCERCARE MANITOBA (CCMB) ANNUAL PROGRESS REPORT FOR THE FISCAL
YEAR ENDING MARCH 31, 2013. THIS REPORT HAS BEEN PREPARED ON BEHALF OF THE CCMB BOARD OF
DIRECTORS, IN ACCORDANCE WITH THE REGIONAL HEALTH AUTHORITIES ACT, AND WITH GUIDANCE FROM
MANITOBA HEALTH AND MANITOBA HEALTHY LIVING, SENIORS & CONSUMER AFFAIRS DEPARTMENTS.
Each year at CCMB milestones are reached, challenges cancer associated with an aging population by focusing are met, opportunities to improve the quality of services on innovations that will increase efficiency of service to patients are seized, new knowledge about cancer and delivery. In 2012-2013 work continued on the Patient related disorders is discovered and applied, and nascent Journey Initiative, the strengthening of the Provincial health professionals are educated and trained. Examples Cancer Strategy, the planning for an expansion of of all of these aspects of CCMB’s activities and more are facilities in Winnipeg and for expanding access to contained in the pages of this report. existing facilities and services.
The achievements of CCMB depend on the hard work With Dr. Dhali Dhaliwal’s term as president and chief and dedication of many individuals and groups and on executive officer coming to an end in 2013-2014, the an ecosystem of supportive institutions, associations Board of CCMB established a search and recruitment and partnerships. This year we celebrated the 50th process, early in the 2012-2013 fiscal year, to identify anniversary of volunteerism at CCMB, recognizing his successor. During the transition period CCMB the many individuals who selflessly devote thousands will maintain momentum in pursuing the foregoing of hours each year to helping patients and their initiatives and others that have marked the decade of families in Winnipeg and Brandon, and in other Dr. Dhaliwal’s leadership and that will provide a solid centres throughout Manitoba that participate in our foundation for the future. Community Cancer Program. Little of what has been accomplished by CancerCare CCMB is also the beneficiary of the remarkable Manitoba in 2012-2013 would have been possible contributions of those who serve on the CancerCare without the efforts of our outstanding clinical, Manitoba Foundation (CCMF) Board and its scientific, technical, administrative and support staff administrative staff and the financial support they members whose commitment to exemplary patient- attract from the thousands of Manitobans who respond centered service is widely and deservedly lauded and to so generously to the CCMF’s fund-raising and “friend- them I express the heartfelt gratitude and appreciation raising” activities. The Foundation in turn provides of CCMB’s Board of Directors. grants to CCMB that permit us to sustain a high standard of performance in mission-critical aspects of our programs and to stay abreast of new developments in prevention, diagnosis and treatment.
Despite the intensification of fiscal constraints, CCMB Dr. Arnold Naimark chair, board of directors continues to maintain its commitment over the long term cancercare manitoba to meeting the challenge of an increasing incidence of
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 1 A Message From The President and CEO
I AM PLEASED TO SUBMIT CANCERCARE MANITOBA’S (CCMB) ANNUAL PROGRESS REPORT FOR THE FISCAL YEAR
2012-2013 FOR REVIEW. I DO SO TO THE CCMB BOARD OF DIRECTORS, OUR STAKEHOLDERS AND MANY PARTNERS,
AND TO ALL CANCER PATIENTS AND THEIR FAMILIES IN MANITOBA. THIS PAST FISCAL YEAR WAS SUCCESSFUL
IN TERMS OF THE PROGRESSION OF ESTABLISHED INITIATIVES WHICH WILL BE OUTLINED FURTHER IN THIS REPORT.
The end of the 2013 calendar year brings my ten year › Extensive Community Cancer Program Network, term as President and Chief Executive Officer of CCMB strongly based on primary care, in urban, rural to its conclusion. and northern communities, which is now being transformed into regional and community cancer Progress in cancer, as in much of medicine, often appears hubs to provide local, broad spectrum cancer painfully slow. Reflecting on the past decade locally, expertise and support for rapid diagnosis, treatment and the broader progress since CCMB’s inception in 1930, and palliative care. shows major achievements, and one senses we are on the cusp of a major revolution in cancer. › Aboriginal Cancer Control Program to improve cancer outcomes and access to services for First Already the leading cause of death in Canada, the number Nations, Metis and Inuit people. of cancer cases will increase by 50 percent within two decades, so our health care system must prepare for › Western Manitoba Cancer Centre was planned, unprecedented demand. However, the incidence and completed and is already functioning at near capacity; death rates for many cancers have been steadily falling the first modern radiation facility outside of Winnipeg. for two decades, illustrating the impact of prevention › Quality & Safety Program – proactive monitoring (smoking related cancers,) early detection (cancer of risk areas through real-time incident reporting screening) and treatment. and improvements based on analysis and This report details the recent activities of CCMB, multidisciplinary solutions. but highlights of a few major initiatives over the past › Progressive compliance with Accreditation Canada decade include: requirements until the highest possible standard › A robust progressive Provincial Oncology Drug Program, reached: Accreditation with Exemplary Standing and strongly supported by the provincial government, Leading Edge Practises. with evidence-based use of all drugs to increase › Extensive recruitment, particularly of oncologists access, and contain costs. Manitoba now has the most (30+), oncology nurses, radiation therapists and comprehensive oncology drug coverage program, physicists, until the only remaining vacancies are with the least financial burden on patients in Canada. in medical oncology.
2 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT › Centralised referral system to enhance rapid Major challenges lie ahead however, as the demand for response and triage of most cancer patients and services increases relentlessly, fueled by unprecedented those with blood disorders. expansion of therapeutic options (new expensive drugs, technologies), based on molecular medicine, › Improved the quality of cancer registry data new surgical and radiation technologies, in an age and expanded research and analytic capacity of where knowledgeable patients have instant access to epidemiology to evaluate system performance, patterns information. Shortage of expert staff in a competitive of care, and areas for attention. Ongoing participation environment at a time of fiscal restraint will make in the International Cancer Benchmarking Project recruitment and retention difficult. reflects the high standard of CCMB data and provides meaningful international comparisons. But somehow, whatever the economic environment, we must not be daunted or waver from our convenance › Improved systemic therapy safety, through with patients to offer the best care possible. As treatment implementation of new standards of care, e.g., costs spiral, greater investment in prevention and early Computerized Physician Order Entry, (increased detection will be imperative. Education and research from 30 percent to 85 percent); and adoption of will be the foundation of progress in these areas, to cutting edge analysis of human factors in safety, reduce the anticipated burden of cancer. My successor, has reduced risks for patients. Dr. Sri Navaratnam, is familiar with these challenges › Shortest wait times for radiation therapy in Canada. and shares the commitment to patient care, system (Median 1 week). innovation and progress.
› Cancer Patient Journey Initiative, an ambitious, It has been an exciting and exhilarating journey with transformative, province-wide effort (also first of its enormous support from CCMB’s dedicated staff, kind in Canada), to rapidly diagnosis and treat all progressive Board and volunteers. The provincial patients within 60 days from suspicion of cancer. government’s commitment to cancer care and improving the health care system in general is evident › CCMB has participated in many pan-Canadian and appreciated. The CancerCare Manitoba Foundation initiatives, such as the Systemic Therapy Safety and its leadership has inspired Manitobans and all of Standards; Surgical Synoptic Reporting; Cancer us to marshal enormous financial and moral support System Performance Measurement, and a national towards the goal of beating cancer and providing strategy for First Nation, Metis and Inuit cancer more tomorrows. For all that, I am grateful, and feel control, to name a few. humbled and honoured to have had the privilege of serving Manitobans.
Dr. H.S. Dhaliwal president & chief executive officer cancercare manitoba (Dec. 31, 2013)
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 3 ABOUT US CancerCare Manitoba
AS THE PROVINCIALLY MANDATED CANCER AGENCY IN MANITOBA, CANCERCARE MANITOBA (CCMB) IS RESPONSIBLE FOR DELIVERY OF CANCER SERVICES ACROSS THE PROVINCE. CCMB PROVIDES CARE, TREATMENT AND SUPPORT SERVICES ACROSS THE ENTIRE CANCER CONTINUUM, FROM PREVENTION, EARLY DIAGNOSIS, TREATMENT AND CARE, TO PALLIATION AND END OF LIFE CARE.
With the support of the government of Manitoba, CCMB works closely with our partners across the provincial health care system. Our valued partners include Manitoba’s five regional health authorities, such as the Winnipeg Regional CancerCare Manitoba, Winnipeg; Western Manitoba Cancer Centre, Brandon; St. Boniface Hospital, Winnipeg, Health Authority (WRHA), the University of Manitoba’s Department of Medicine, and Diagnostic Services Manitoba. province-wide health centres, by health care professionals We are especially appreciative of the financial support we who have received specialized training from CCMB, and receive from our volunteer funding agencies, and extend also have access to expert support for ongoing patient care. a special thanks to the CancerCare Manitoba Foundation. Since June 2011, CCMB and our partners have been CCMB has two tertiary locations in Winnipeg, with at the forefront of joint efforts to better control cancer our main site at the Health Sciences Centre campus, in this province. A top priority for the government of Manitoba’s largest health care facility. Services at our Manitoba, the Cancer Patient Journey Initiative, known main site include clinical treatments such as medical as IN SIXTY, is a $40 Million provincial commitment and radiation oncology, patient and family support to streamline cancer services, and to improve wait times through psychosocial services, and a combined clinical for cancer patients. The five year initiative, the first of its and research program for staff. kind in Canada, is reviewing, assessing and improving all Our second site is located at the St. Boniface Hospital, segments of the health care system, through efficiencies and provides chemotherapy and support services to and key placement of staff. The far reaching initiative patients. Thanks to a collaborative partnership with the aims to reduce the time from suspicion of cancer to first WRHA, CCMB specialists also work with health care treatment in less than 60 days. providers at six additional hospitals across the city, such as CancerCare Manitoba has approximately 800 staff, through the Leukemia/Bone Marrow Transplant Program including world class experts in medical and radiation at the Health Sciences Centre, and chemotherapy and oncology, top researchers, nursing staff including those support services at the Grace, Concordia, Victoria and with an expanded role as nurse practitioners, and many Seven Oaks hospitals. other health care professionals. CCMB is currently in the CancerCare Manitoba has relied on the partnership of planning phase of establishing a second co-located site the province’s four additional health authorities across on the HSC campus, where expanded research facilities, Manitoba, through the Community Cancer Program multi disciplinary based medical teams, and improved Network. The program is a provincial network of cancer patient services will be developed. services and support services delivered through 17
4 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT MacCharles Unit Community Cancer Programs Network 675 McDermot Avenue The Community Cancer Programs Network (CCPN) (204) 787-2197 is a provincial program of CancerCare Manitoba that Toll free: 1-866-561-1o26 allows patients to receive cancer care in, or near, their home communities. Working in partnership with St. Boniface Unit regional health authorities, the CCPN currently O Block - 409 Taché Avenue supports 17 Community Cancer Programs, and the (204) 237-2033 network is growing. Patient Representative: Bethesda Health/Bethesda Place (Steinbach) (204) 787-2065 Boundary Trails Health Centre Communications & Public Affairs: Dauphin Regional Health Centre (204) 787-4540 Deloraine Health Centre Human Resources: Eriksdale Community Cancer (204) 787-8503 Resource & Support Centre School of Radiation Therapy: Flin Flon General Hospital (204) 789-0909 Gimli Community Health Centre Volunteers: Hamiota Health Centre (204) 787-2121 Neepawa Health Centre
CancerCare Manitoba Pinawa Hospital Breast Cancer Centre of Hope Portage District Hospital 691 Wolseley Avenue Russell District Health Centre (204) 788-8080 Toll free: 1-888-660-4866 Selkirk & District General Hospital Swan Valley Health Centre CancerCare Manitoba Screening Programs The Pas Health Complex 5-25 Sherbrook Street Administration office: (204) 788-8633 Thompson General Hospital Western Manitoba Cancer Centre (Brandon) BreastCheck Appointment inquiry: (204) 788-8000 Toll free: 1-800-903-9290 For information call: (204) 787-5159 CervixCheck Toll-free: 1-866-561-1026 (204) 788-8626 Toll free: 1-866-616-8805 Visit our website at www.cancercare.mb.ca
ColonCheck (204) 788-8635 Watch us on YouTube Toll free: 1-866-744-8961 Follow us on Twitter
CancerCare Manitoba Foundation (204) 787-4143 Toll free: 1-877-407-2223
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 5 ABOUT US Achievements & Challenges
The transformation of cancer services in Manitoba ACHIEVEMENTS: continued in 2012-2013, as CancerCare Manitoba D Development of the Community Oncology Program, and our many partners aligned to improve care and and further development of cancer hubs in Manitoba. treatment for patients across the province. Expedited, D Further expansion of the Manitoba Home Cancer Drug Program. high quality care has been identified as a key objective D Increased utilization of the Western Manitoba Cancer Centre. of the government of Manitoba as more Manitobans D Fifty years of volunteer support from Manitobans. than ever face cancer. Building on a foundation created D Risk Management framework developed. through community cancer programming, staff D The colorectal cancer screening program ColonCheck recruitment and training, and provincial partnerships, is now province-wide. CancerCare Manitoba continued to increase access to CHALLENGES: cancer services for all Manitobans. D Ongoing shortages of clinic and treatment space. Still, 2012-2013 was not without challenges. Fiscal D Human resources in nursing, information technology areas. restraints increased due to the current economic climate, D Limited resources for adequate and advanced training for staff. while patient numbers continued their upward climb, D Research constraints and its impact on staff retention due with the patient load expected to increase by 50 percent to limited lab space. in the next two decades. D Budgetary constraints. D An increasing workload for frontline staff. CancerCare Manitoba’s achievements and challenges D Electronic medical records implementation. of 2012-2013 include:
THE UTILIZATION OF ALL CANCER SERVICES HAS STEADILY INCREASED OVER THE PAST DECADE. WITH AN ANTICIPATED 50 PERCENT IN CANCER CASES IN THE NEXT 15- 20 YEARS, GOVERNMENT AND PUBLIC SUPPORT IS PARAMOUNT TO MEETING INCREASING DEMAND.
10,000 85,000 9,000
9,500 80,000 8,500 75,000 9,000
70,000 8,000 8,500 65,000 8,000 7,500 60,000
7,500 55,000 7,000 7,000 50,000
6,500 45,000 6,500 year » 03 04 05 06 07 08 09 10 11 12 2013 year » 03 04 05 06 07 08 09 10 11 12 2013 year » 03 04 05 06 07 08 09 10 11 12 2013
Community Cancer Program Sites – Clinic visits to physicians New cancer cases Systemic Therapy Treatments seen at CancerCare Manitoba
6 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT Manitoba Cancer Plan 2011-2015 » Year Two Progress Report In 2011, CancerCare Manitoba released its five year plan for cancer services in Manitoba. The plan included five objectives with supporting strategic priorities and activities. Here are a few highlights of what has been achieved in the past year, and indicators of where challenges remain: ON TRACK SOME PROGRESS WITH CHALLENGES SLOW PROGRESS WITH SIGNIFICANT CONCERNS
GOAL: PREVENTION We will enhance efforts aimed at reducing the incidence of cancer. Reduce use of tobacco products through smoking cessation programs. 1. For individuals, patients, families, public.
2. Target workplaces for smoking cessation program.
Increase cancer surveillance and epidemiology. 1. Expand surveillance activities to measure, monitor and report regional and community level risk factors.
GOAL: ACCESS We will ensure timely access to cancer services for all Manitobans. Work with First Nations, Metis and Inuit populations to implement an enhanced First Nations, Metis and Inuit Cancer Control Program. 1. Design culturally responsive services including translation, traditional healing, spiritual, role of family.
2. Increase Cancer Control Coordinators to provide a focus service delivery, connecting people to care and support services.
Reduce the percentage of Manitobans who do not have access to adequate care. 1. Increase patients understanding of access to treatment.
2. Work with partners to dramatically reduce the entire cancer journey.
GOAL: SAFETY AND PATIENT-CENTRED CARE We will keep people safe and put patients and their families at the centre of care. 1. Improve outcomes through evidence-based care.
2. Map patient journeys and develop care pathways.
3. Further integrate safety and improvement practices.
4. Enhance the availability of psychosocial care across the province.
GOAL: EFFICIENCY AND EFFECTIVENESS Meet the escalating demand for cancer services through increased infrastructure. 1. Expand cancer drug program to increase access and appropriate use.
2. Implement electronic oncology health record.
3. Begin construction of new CCMB facility.
GOAL: EDUCATION AND RESEARCH We will prioritize the roles of research and education to promote improvements in cancer control and treatment. 1. Expand continuing education for all staff and extend opportunities for staff participation in conferences and seminars.
Promote cancer research and its translation into improved control. 1. Foster an increased awareness of CCMB’s efforts in research and encourage collaboration with partners.
Support research on cancer survivorship to improve the health and quality of life of all cancer patients. 1. Increase research on patient’s responses to disease treatment and recovery.
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 7 IMPROVING PREVENTION Prevention & Awareness
CancerCare Manitoba’s Virtual Prevention Unit
THE NUMBER OF CANCER CASES IS EXPECTED TO concentrate CCMB’s prevention efforts. Formed from RISE BY 50 PERCENT IN THE NEXT TWO DECADES, senior leadership and several CCMB departments, the YET STUDIES SUGGEST UP TO HALF OF THESE unit has initiated a complete review of CCMB’s cancer CANCERS CAN BE PREVENTED. WHILE FACTORS prevention activities to enhance the reach and efficiency CONTRIBUTING TO CANCER, SUCH AS AGING, of current and future prevention activities through CANNOT BE CHANGED, MANY OTHERS CAN. effective partnerships. Increased funding for prevention efforts remains an issue. The vast majority of cancer causes stem from lifestyle Working groups have been created within the Virtual choices. There is strong evidence that better lifestyle Prevention Unit, to focus prevention efforts, and to identify choices by each of us will significantly reduce our risk and initiate new opportunities, such as community of getting cancer, such as quitting smoking, exercising partnerships and research. CCMB is already a strong and maintaining a healthy weight. partner in most prevention efforts with the province, Recognizing the potential for reducing the anticipated all regional health authorities, and organizations such as increased patient load, CancerCare Manitoba has initiated the Alliance for the Prevention of Chronic Disease. a Virtual Prevention Unit within the agency that will
Cultural and Community Driven Cancer Prevention
With support from the CancerCare Manitoba Foundation, The FNMICC program also increased cancer prevention CCMB’s First Nations, Metis and Inuit Cancer Control awareness by participating in festivals, pow wows, and program (FNMICC program) has been working with First community celebrations in a number of First Nation Nations and Metis communities to develop culturally communities during the past year. Concentrated media appropriate and community driven cancer prevention relations efforts through First Nations, Metis and Inuit initiatives. The FNMICC program is collaborating directly media outlets have also assisted in raising awareness of with community leadership to increase cancer awareness how cancer can be prevented. and to develop prevention activities. The need for increased cancer prevention awareness is In the fall of 2012, the FNMICC program held the Gitchi- becoming increasingly evident through mounting data twa-mama-ohni-tea-what, or Sacred Gathering of Nations, on rising cancer rates in First Nations, Metis and Inuit a first of its kind three day event with the community populations. Rates appear to be rising more rapidly than of Sagkeeng First Nation. The event carefully combined in non-First Nations, Metis and Inuit groups. traditional teachings and personal stories with expert cancer information. Feedback was excellent.
FNMI PROGRAM OUTREACH EFFORTS:
Events Northern and rural People reached (presentations, feasts, communities visited 3,000+ 25groups, trade shows) 12
8 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT Awareness
CANCERCARE MANITOBA CONTINUED TO RAISE AWARENESS OF RISK REDUCTION STRATEGIES
AND THE BENEFITS OF SCREENING IN 2012-2013.
Programs such as CCMB’s Sun/UV Safety helped educate Manitobans on how to reduce their risk of skin cancers related to overexposure to the sun and ultraviolet rays. Working with Partners in Planning for Healthy Living, CCMB helped initiate the 2012 Youth Health Survey, the second comprehensive survey of Manitoba youth that gathers information on chronic disease risk factors.
CCMB also launched an important online source of information for patients and their families, through the CancerCare Manitoba YouTube channel. Over 30 videos feature the cancer services available to CCMB patients.
Meant as a navigational tool, the videos provide clear and straightforward information on topics such as what to expect during a first chemotherapy treatment, what happens during a radiation treatment and information on some of the Patient and Family Support Services available to patients and family members. The CancerCare Manitoba Foundation also has several videos on the service. Additional videos will be added as the CCMB YouTube Channel develops. The online channel can be accessed at http://www.youtube.com/user/CancerCareMB
Sun/UV Safety
Thanks to the CancerCare Manitoba Foundation’s In addition, Dr. Marni Wiseman, dermatologist at additional support of the 2012-2013 Risk Reduction grant, CancerCare Manitoba, organized the first-ever Skin Cancer this year’s Sun/UV Safety campaign continued to raise Prevention and Screening Clinic at the Reh-Fit Centre. awareness about skin cancer prevention. Open to the public, the clinic was quite successful, with 90 individuals participating. The CancerCare Manitoba Foundation funded UV Detection Camera has proven an excellent tool for public interaction. UV photos reveal the damage of too much exposure to the sun.
CCMB SUN/UV SAFETY NUMBERS
2013 2012
Community events/conferences attended 19 4
Media interviews 8 (with UV camera) 1 (without UV camera) Partner requests for CancerCare Manitoba materials 9 0 Individuals engaged during events 2500+ 700+ UV detect pictures taken 1200+ 350+
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 9 IMPROVING EARLY DIAGNOSIS Screening Programs PARTNERING TO PROMOTE AWARENESS
To help increase screening participation rates in Lead, Screening for Canadian Partnership Against Manitoba, the Check programs connect with primary care Cancer, was part of a panel discussion on the risks and providers. In 2011 the It Matters to Them! campaign was benefits of screening. The conference day was a success launched to engage primary care givers, to update them with 66 people attending in person and 45 people on screening guidelines, and to inform them about recent attending via MBTelehealth. advancements in screening research and technology. To help support adherence to cancer screening guidelines, As part of continuing this campaign, the programs BreastCheck, CervixCheck and ColonCheck developed offered a day of continued medical education (CME) and distributed a combined breast, cervical and colorectal to physicians and other primary care providers in June cancer screening guidelines document. 2012. In addition to local experts, Dr. Verna Mai, Expert
46,243 5,201 4.3 Women were screened from Women over the age of 69 Cancer detection rate Apr 1 2012 – Mar 31 2013. were screened at BreastCheck. for 1,000 screened.
66.8% 134 107 Percentage of eligible women Number of Pap test clinics that Number of communities in Manitoba had at least one Pap test between provided increased access to providing increased access to cervical 4/1/2009 to 3/31/2012. cervical cancer screening services. cancer screening services.
94,415 29% 3% Number of FOBT kits distributed Percentage of invited Manitobans Percentage of ColonCheck participants in 2012-2013. who completed ColonCheck’s FOBT. requiring follow-up testing.
Independent national surveys confirm Manitoba has the highest overall screening rates for colorectal cancer. (Source: CPAC System Performance Report 2012)
10 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT BreastCheck CervixCheck
D With breast screening mobile sites added at D CervixCheck changed its guidelines for cervical Peguis First Nation and Opaskwayak Cree Nation, cancer screening in Manitoba. Changes were made BreastCheck continues to extend services to increase to the recommendations for screening initiation and access across Manitoba, with over 90 screening screening interval (every three years). locations in the province. D Reports were distributed to 1,500 clinicians that D Continuing work with under-screened populations, provided feedback about their individual screening BreastCheck transports women from remote northern activity as compared to the provincial averages. communities to the nearest mobile sites for a D A webinar was hosted for primary care, and new public mammogram. This past year women were flown from health promotion materials were developed to educate Little Grand Rapids, Pauingassi First Nation, Lac Brochet, the public and clinicians about the new cervical cancer Brochet, Tadoule Lake First Nation, and Pukatawagan. screening guidelines. D W orking with immigrant and First Nations, Metis D Data quality enhancements continued to be a focus of and Inuit communities to deliver information in their the program. first languages, BreastCheck works with facilitators in various cultural communities to organize screening D Traffic to the TellEveryWoman.ca URL doubled from trips for women. BreastCheck developed a multi- 2011-2012 to 2012-2013. language insert that is included with invitation letters which has increased the use of interpreter services, ColonCheck indicating increased participation. D ColonCheck completed the provincial roll out of the direct D BreastCheck is partnering with IN SIXTY, the cancer mail invitation component of the program. Individuals patient journey initiative. Through this initiative from all Regional Health Authorities in Manitoba are now BreastCheck is working on: included in this component. The number of kits sent out • developing and implementing a process for booking increased by 25 percent from the previous year. and screening First Nations clients that is more The diet instructions of the home screening test were culturally aligned, and is more efficient and effective, D modified to simplify completion of the test. Results to increase participation. show that participation and the time it takes for people • gathering data on response and recruitment rates of to do the test improved after the modification. women in their early 50s to screening, researching how to improve their participation rates. D The Colorectal Cancer Awareness Month events D Through the Provincial Digital Mammography included TV and radio Committee, BreastCheck is participating in the advertising, as well as a preliminary implementation of provincial digital flag raising at Winnipeg mammography. City Hall with Mayor Sam Katz, all of which increased awareness of ColonCheck.
D C olonCheck is working with electronic medical record experts to facilitate collaborations between the program and primary care providers. Using electronic medical technology has reduced practice barriers to promote screening.
D Staff made significant contributions to the reports of the Canadian Colorectal Cancer Screening Network. This network is an initiative of the Canadian Partnership Against Cancer.
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 11 IMPROVING EARLY DIAGNOSIS Role of Research RESEARCH HOLDS THE BEST HOPE OF GIVING PATIENTS TOMORROW’S TREATMENT TODAY.
Over the past decade, the role of research at CancerCare Manitoba has increased significantly, with more studies conducted on the patterns, causes, and effects of cancer on communities.
“There has been tremendous growth in epidemiology and prevention oncology research. We’ve also seen growth in palliative care and clinical trials,” says Dr. Spencer Gibson, Provincial Director of Research. “We’re becoming more involved with clinical trials because that’s where new treatments come from.”
Dr. Gibson says the future of treatment will involve personalized medicine, as no two people have exactly the DR. SPENCER GIBSON, Provincial Director of Research same cancer. Research is needed to determine why cancer behaves aggressively in some people and not in others. Translational research, which takes information gathered “Our knowledge of cancer has grown vastly. We’re starting in the lab and applies it directly to patients, has been an to answer the fundamental questions. We have a better increasing focus at CCMB since 2008. understanding of how cancer becomes cancer,” he says. “We’re developing networks of research projects within “Personalizing treatment moves the goal posts closer, so CancerCare Manitoba—we always have to move forward,” people will live longer and with a better quality of life.” Dr. Gibson says. “Without research, we couldn’t adapt CancerCare Manitoba’s tumour bank at the Manitoba to new advances at other centres because we wouldn’t Institute of Cell Biology, a partnership with the University understand them. If we do not have research, we will not of Manitoba, is a resource for scientists at home and be able to keep up with the current standard of treatment. around the world. Originally, there were only breast Research pushes us to the edge of knowledge.” cancer tumours available for study. Under CEO Dr. Dhali Dhaliwal’s leadership, the tumour bank has expanded to include prostate, ovarian, lung, head and neck, Chronic Lymphocytic Leukemia, all leukemias and multiple myeloma tumours.
Research Grants by Disease 2012-2013 for all of CCMB
Ovarian Breast Lung Palliative Cancer Lymphoma Pediatrics Colorectal Myeloma Prostate Epigenetics Other e.g. Genetics / Blood FASD Protein Research Brain Leukemia
12 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT Solving a Medical Mystery DR. RYAN ZARYCHANSKI
A FAMILY REUNION HELPED CANCERCARE MANITOBA’S DR. RYAN ZARYCHANSKI SOLVE A 40 YEAR MEDICAL MYSTERY, STEMMING FROM A BLOOD DISORDER.
With support from the Manitoba Medical Services Foundation, Zarychanski’s team of researchers from CancerCare Manitoba and the University of Manitoba discovered a genetic mutation responsible for hereditary xerocytosis, a disorder that causes the destruction of red blood cells.
“When people have it, their bodies essentially over- accumulate iron over time, which eventually becomes toxic and leads to organ failure,” Zarychanski explains.
Patient’s affected with this blood disorder have a severely reduced survival of their red blood cells. Cells that normally circulate for over 100 days are destroyed in about a week. Dr. Zarychanski also completed a study of a controversial CancerCare Manitoba’s Hematology/Medical Oncology blood expander which found the product to be associated department founder, Dr. Lyonel Israels, saw the first with increased death. The drug is now being withdrawn Manitoban with the disease more than 40 years ago. from practice around the world. As he investigated further, Dr. Israels became convinced “This will prevent unnecessary deaths and improve patient the disease was hereditary, as other family members were care around the world. Not only were these blood products affected. Decades later, Dr. Zarychanski decided to get as harmful, the studies of their effectiveness were clouded by much input from the original family as possible to solve academic fraud,” he says. the mystery. “We organized a great family reunion in small-town “We found glaring areas needing improvement Manitoba—our team went there and took blood samples and everyone’s medical histories. Over 130 people in how we care for people,” says Zarychanski. attended,” he says. “The family was incredibly supportive. “We’re changing the entire process.” They organized themselves and welcomed the investment of our time.” The hematologist and intensive care doctor is currently The implications of the study are far greater than the in the process of rolling out a new system that could discovery itself. Zarychanski says that this research could dramatically change the outcome for patients in need of eventually explain many other diseases as well. massive blood transfusions.
“The research discovered a protein on the surface of red blood cells that no one knew existed,” he adds. “We can now easily identify the disease and prevent and reduce complications.”
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 13 IMPROVING PATIENT EXPERIENCE The Cancer Patient Journey Initiative
THE CANCER PATIENT JOURNEY INITIATIVE, ALSO Rapid Improvement Event locations KNOWN AS IN SIXTY, ENTERED ITS SECOND YEAR IN DIAGNOSTIC IMAGING RIE’S 2012-2013, AS THE $40 MILLION PROJECT BEGAN TO D Radiology Consultants of Manitoba – Winnipeg (multiple sites) D Manitoba X-Ray - Winnipeg REACH ACROSS THE PROVINCIAL HEALTH CARE SYSTEM, D BreastCheck - Winnipeg IN A BID TO IMPROVE CANCER SERVICES FOR ALL D Brandon Hospital - Brandon - Winnipeg MANITOBANS. IN SIXTY AIMS TO REDUCE WAIT TIMES D Breast Health Centre D Boundary Trails Health Centre Morden/Winkler FOR CANCER PATIENTS FROM SUSPICION OF CANCER D Health Sciences Centre - Winnipeg TO THE START OF TREATMENT, TO UNDER 60 DAYS. D Thompson Hospital - Thompson
PATHOLOGY RIE’S CCMB, and all Manitoba regional health authorities, D Grace Hospital - Winnipeg providers such as Diagnostic Services Manitoba, primary D Westman Lab - Brandon health care physicians and health professionals across the SURGERY RIE’S province have partnered in the initiative. D Grace Hospital - Winnipeg D Victoria Hospital - Winnipeg The second year of the $40 Million provincial initiative D Brandon Hospital - Brandon launched a series of Rapid Improvement Events (RIE) D Boundary Trails Health Centre - Morden/Winkler in 20 locations across Manitoba, focused on the patient D Seven Oaks Hospital - Winnipeg journey of a breast cancer patient. Frontline health care D Health Sciences Centre - Winnipeg professionals at each site advised system engineers on D Thompson Hospital - Thompson process improvements using Lean Six Sigma methodology, PRIMARY CARE RIE’S a business improvement system. D Burntwood Primary Care - Thompson D Agassiz Medical - Morden D Access River East - Winnipeg
LEAN
LEAN Six Sigma, a system used to improve business providers to learn and apply LEAN methodologies to processes and efficiencies, has been successfully applied create a sustainable culture of quality, patient-focused in many other health care settings, nationally and care. CCMB’s staff, physicians and nurses are in internationally. Manitoba Health provides consultation the best position to identify problems and solutions,” and LEAN training for staff at CancerCare Manitoba explains Valerie Wiebe, VP and Chief Officer Patient and other health care facilities through its Pursuing Services and CCMB’s Executive Champion for LEAN. Excellence Program. To effectively implement the LEAN method, staff must The government’s goal is to save $4.2 Million in health care have a profound understanding of their systems and costs, that can be reallocated to better use in Manitoba’s processes. This understanding is acquired through a health care system. System savings are generated either LEAN practise known as value stream mapping, which directly, as in eliminating the purchase of excess inventory, analyzes and helps design the most efficient flow of or indirectly, such as freeing employees’ time for more material, information and services. productive work. “The end goal is to improve the patient experience “The Pursuing Excellence initiative is not about hiring by minimizing wait times and reducing inefficiencies,” new staff to make improvements. Rather, the initiative says Pamela Johnston, Director of Quality Patient Safety provides an opportunity for dedicated direct care and Risk, and coordinator of LEAN initiatives.
14 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT CHANGING THE COURSE OF CANCER TOGETHER
Collaboration is key to the success of improving the cancer journey. Even before IN SIXTY’S Neutropaenic Fever Protocol Algorithm Triage-to-initial empirical anti-bacterial therapy start, CancerCare Manitoba and the Winnipeg Regional Health Authority (WRHA) identified potential risks in the complex shared system of TRIAGE care that is the cancer patient journey. One such risk is Febrile Neutropaenic Fever Syndromes ASSUMPTION (FNE), a lowered blood cell count that can occur Neutrapaenic Fever Syndromes are Medical Emergencies (CTAS Level II) in chemotherapy patients. Prompt treatment is
necessary to prevent progression to severe sepsis, 15 MEDICAL ASSESSMENT MINUTES septic shock and possibly death. (Full history, examination, blood tests and blood cultures)
FNE presents a challenge as its symptoms mimic more common and less serious ailments, such as influenza. FNE symptoms include chills, muscle aches, joint pain, and general malaise. SEVERE SEPSIS/SEPTIC SHOCK The non-specific symptoms sometimes resulted in misdiagnosis or longer than safe waits in clinics or YES NO
emergency rooms. In 2012, CCMB and the WRHA Immediate hospitalization created a new triage to treatment pathway for cancer Intravenous Antibacterial Therapy Supportive and Critical Care 30 patients seeking emergency medical care. Now, recent MINUTES chemotherapy patients who present with FNE symptoms are treated within 60 minutes.
“Triage of patients presenting with fever in the WRHA THERAPY now includes two important questions: are you a cancer patient, and have you had chemotherapy in the last six weeks,” says Dr. Eric Bow, CCMB’s Medical Director, Clinical & Academic Services and Infection Control Services, who led the effort.
A CCMB LEAN project also helped increase FNE RISK FOR COMPLICATIONS awareness of staff and patients. Initiated outside of IN SIXTY, the joint CCMB/WRHA effort to reduce the risk of 60 FNE supports the initiative’s aim of providing high quality MINUTES and efficient care to all Manitobans.
HIGH RISK LOW RISK
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 15 IMPROVING PATIENT EXPERIENCE Partnerships
While CCMB is the legislated cancer agency in Manitoba, the provision of cancer services, such as chemotherapy, are shared across the province. Over the past two years, joint efforts have been made across the health care system to improve care pathways and make the cancer journey less complex for patients from every corner of the province.
Currently in Manitoba, the suspicion of cancer, or a diagnosis, results in patients being funneled from all over the health care system into cancer services. The pathway is not always clear, and the complexity of cancer and its treatment can impact where care is given.
Regional and Community Cancer Program Hubs
Four additional regional cancer hubs were announced in estimated 11,224,000 kilometres in driving, by being able 2012, to bring enhanced cancer services closer to home for to access cancer services closer to their home community. all Manitobans. The new hubs will be located in Brandon, The need for expanded cancer services is growing, as patient Selkirk, Steinbach and Thompson, in partnership with numbers increase in the coming decades. each health region. As the cancer hubs develop, enhanced cancer services All regional and community cancer program hubs will include: build upon the Community Cancer Program network D Expert support for patients and primary care providers. (CCP’s), which currently provides chemotherapy in 16 D Patient and family information and resources. communities, and support services in Eriksdale. D End of life care. Initiated in 1978, the CCP network has significantly reduced D P atient Navigation services. burdens such as travel for treatment and lost work days, D Psychosocial support. for rural Manitobans. In 2013 alone, rural patients saved an
Boundary Trails Regional Cancer Program Hub Update
Manitoba’s first regional cancer program hub in Southern through the complex array of testing, referrals, and Health – Santé Sud, at the Boundary Trails Health Centre oncology care. Of almost 100 referrals represented by (BTHC), initiated delivery of a new model of care in the 50 different primary care providers, 57 percent of patient spring of 2013. Led by Family Physician in Oncology inquiries received navigation support within one day. (FPO) Dr. Cornelius Woelk, the Southern Health – Santé Almost 100 percent of the patients received support Sud began offering enhanced cancer services that had an within three days. The Navigators ability to expertly immediate positive impact on cancer care in the region. traverse a system of multiple health care providers reduced the time patients had to wait for treatment. For example, a Nurse Navigator began to assist patients, their families, local family physicians and other health care professionals, in finding the most efficient way
16 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT Western Manitoba Cancer Centre Delivers Expanded Cancer Services
By the end of March 2013, the WMCC had received 1275 new cancer patient referrals, with over half receiving radiation treatments. More patients from Brandon and western Manitoba are accepting radiation therapy as part of their cancer treatment, as compared to when radiation treatments were only available in Winnipeg. As the average course of radiation therapy includes multiple treatments on a daily basis, accepting treatment used to mean being away from home for some time for Brandon and regional cancer patients.
Thanks to CCMB’s Clinical Trials Office and WMCC staff, clinical trials have also been made available to some patients through the centre. If eligible, a clinical trial means patients can help research new and emerging The Western Manitoba Cancer Centre (WMCC) continues treatments in cancer care, by being part of a study as to to prove itself as a prudent investment in expanded the effectiveness of treatment. Currently, clinical trials in cancer services. Opened in June 2011 with a $24 Million radiation therapy are underway at the WMCC. investment by the province of Manitoba, the WMCC provides a centre of cancer expertise in the western part of the province. The WMCC has the ability to offer some cancer treatments once only available in Winnipeg, such as radiation therapy.
Goal of IN SIXTY
To reduce the time of suspicion of cancer to first treatment to no longer than 60 days, by no later than
Announced 2016, in a sustainable manner that improves the quality Regional Cancer Program Hubs of the cancer patient experience. as of September 2013 PARTNERS
THOMPSON MANITOBA HEALTH CANCERCARE MANITOBA ALL REGIONAL HEALTH AUTHORITIES IN MANITOBA DIAGNOSTIC SERVICES MANITOBA PRIMARY HEALTH CARE MANITOBA EHEALTH PATIENTS WITH CANCER JOURNEY EXPERIENCE HEALTH CARE PROFESSIONALS ACROSS MANITOBA
SELKIRK BRANDON STEINBACH MORDEN/WINKLER
Additional communities are to be announced.
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 17 IMPROVING PATIENT EXPERIENCE CancerCare Manitoba
First Nations, Metis and Inuit Cancer Control Program
AS PART OF THE CANCER PATIENT JOURNEY INITIATIVE, CANCERCARE MANITOBA FORMED THE FIRST NATIONS, METIS AND INUIT CANCER CONTROL PROGRAM (FNMICC), DURING THE SECOND YEAR OF THE FIVE YEAR INITIATIVE TO IMPROVE CANCER WAIT TIMES IN MANITOBA.
The program is focused on increasing access to diagnosis, In September 2012, the program added an FNMICC treatment and support for Manitobans facing barriers Patient Access Coordinator to the team, who helps prevent to cancer services, through challenges such as cultural or resolves delays in diagnostic testing, streamlines the differences and geography. referral process, and coordinates care with physicians, patients and their families. The Patient Access Kali Leary, of the FNMICC, leads a team committed to Coordinator acts as a troubleshooter, helping patients creating a culturally safe environment at CCMB and access the services they need, when they need them. improving equitable access to care. The program also recognizes the important role of traditional and holistic Future plans for the FNMICC include expanding its role healing practices, and works with community leaders and to include additional vulnerable populations, such as elders to blend and balance different cultural practices new Canadians. through the provision of respectful health care.
Survivors’ Care
With support from the CancerCare Manitoba Foundation, Complex treatments and the potent medications required the departments of Pediatric Oncology and Nursing are to treat cancer can have long lasting impacts. To meet the developing a Long Term Follow Up (LTFU) clinic for needs of this fastest growing group of cancer survivors, pediatric cancer survivors. Survival rates of pediatric and the LTFU will educate on health maintenance, identify young adults cancer patients have increased dramatically potential long term health risks, and more. in the past two decades, as a result of new treatments.
CHILDHOOD CANCER LONG TERM SURVIVAL RATES
1962 2003
Acute Lymphoblastic Leukemia (ALL) 4% 84%
Acute Myeloid Leukemia (AML) 4% 50%
CNS/Brain Tumours 35% 74%
Hodgkin’s Disease 50% 95%
Non Hodgkin’s Lymphoma 6% 84%
18 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT Medical Oncology/Hematology Retreat
CancerCare Manitoba’s Medical Oncology/Hematology Topics important to the cancer patient staff, were joined by members of CCMB’s Nursing, journey included: Community Oncology Program, Radiation Therapy, D Shared cancer patient care with our UPCON, Population Oncology, and Pharmacy largest partner, the WRHA. departments for a weekend retreat in Winnipeg. D Community Oncology sites. D Urgent care for cancer patients outside of CCMB. D Care transition.
Along with joint efforts with partners across the D Increasing clinic space D Extending treatment hours health care system, CancerCare Manitoba is • 3100 Additional hours per year at CCMB driving internal change to meet the overall goal MacCharles (Health Sciences Centre) • 500 Additional hours per year at CCMB Tache of the cancer patient journey initiative. (St. Boniface Hospital) D Expedited surgical referrals. Initiatives both large and small have begun across the D Treatment location based on patient postal code. agency, as staff support the work being done to improve D Plans underway to increase treatment chairs cancer services along the entire cancer continuum. at CCMB MacCharles Some of the IN SIXTY projects underway at CancerCare D Clinical Process Redesign Manitoba as of March 31, 2013, all aimed at improving the • Physician Order Entry Implementation cancer patient journey for Manitobans with cancer: • Standardization of booking templates
Still to come in 2013… robotic intravenous automation (riva) lynch syndrome testing
CCMB has purchased a state-of-the-art system to prepare In a unique partnership, the CancerCare Manitoba chemotherapy drugs with a high degree of precision, Foundation contributed $75,000 to bring Lynch which will result in increased patient and staff safety. Syndrome Testing to Manitoba. Working with Diagnostic Services Manitoba, implementation is expected this fall. The Robotic Intravenous Automation (RIVA) technology prepares complex chemotherapy treatments, while Lynch Syndrome is an inherited genetic disorder that performing multiple checks to ensure dose accuracy significantly increases a person’s risk of cancer. and appropriate mixing. CancerCare Manitoba will be the third facility in Canada to install the high-tech RIVA system, once operational later this year.
RIVA technology will reinforce CancerCare Manitoba’s position as a national leader in cancer treatment, including chemotherapy safety.
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 19 Efficiency and Effectiveness
MEASURES OF The indicators are: CANCER SYSTEM PERFORMANCE Prevention: Highlighting risk factors for cancer including Using CancerCare Manitoba’s Community Health obesity, smoking, alcohol consumption, poor diet and Assessment (CHA) as a blueprint, CCMB demonstrated physical inactivity. its commitment to providing indicators about Manitoba’s Screening: Measures of screening tests for breast, cervical cancer system performance. The latest figures and trends and colorectal cancer. are provided on the next page. Data sources reflect the most current, complete data, including: Access (diagnosis and treatment): Measures related to radiation oncology and breast cancer diagnosis. D Canadian Community Health Survey (CCHS) D Manitoba Health Outcomes: Incidence, survival and patient satisfaction. NRC Picker’s Ambulatory Oncology Survey D Infrastructure: Basic availability of key information in the D CCMB, specifically the Manitoba Cancer Registry, Manitoba Cancer Registry (stage at diagnosis), and linear Screening Programs and Radiation Therapy Program. accelerators (a key piece of radiation treatment equipment).
Currently there is no single data system in place to Trends are indicated by arrows: answer all of our cancer questions, but there is growing consensus among national and international researchers A increases of 10% or more that certain indicators can help describe the cancer system’s performance. The indicators of cancer system D little change performance shown in this report and the CHA were a drop of 10% or more chosen using three guiding principles: G 1. Use reliable data that is already published or are routinely cited, wherever possible; Colour shows whether the trend is: 2. Use indicator definitions that are used by at least one good other partner (provincial or national) wherever possible; neutral 3. Provide an indication of whether CCMB is improving in a particular cancer-related area by indicating the trend. or needs to improve
Until standardized measurements are adopted across provinces (and ultimately, international jurisdictions), readers are cautioned that comparisons to data from other sources are not always valid and should, therefore, be avoided.
20 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT Current Trend Index Change of PREVENTION 10% or more Obesity 19.9% % of adults (ages 18+) with Body Mass Index classified as “obese.”1 Smoking 20.1% % of daily current or occasional smokers, (ages 12+).1 Alcohol 19.6% % consuming five or more drinks on one occasion, at least once a month in the past year (ages 12+).1
SCREENING Colorectal Cancer Screening 64% % of men and women (ages 50-74) who had a fecal occult blood test in the last two years, or colonoscopy in the last five years.2 Cervical Cancer Screening 66.8% % of women (ages 20-69) who had a Pap test in the last three years.3 Breast Cancer Screening 64.8% % of women (ages 50-69) who had a mammogram in the last two years.4
ACCESS (DIAGNOSIS AND TREATMENT) Breast Cancer Assessment Waits 21 days media waiting time (in days) for women (ages 50-69) from screening mammograms at BreastCheck to final diagnosis.5 Radiation Oncology Waits 100% % of patients treated with radiation therapy within four weeks from ready to treat to start of treatment.6
OUTCOMES Cancer Incidence 6,280 annual number of cancers diagnosed. (age-standardized incidence rate per 100,000)7 (467 per 100,000) Cancer Survival 59.3% five-year relative survival for all invasive cancers.7 Patient Satisfaction 96.6% % of patients satisfied with outpatient care based on patient satisfaction survey.8
INFRASTRUCTURE Capture of Stage Data 7 100.0%
Linear Accelerators in Regular Use 6 8
1 Based on self-report in the Canadian Community Health Survey (CCHS) 2011. 4 From Manitoba Health – includes women who had a mammogram through 7 From the Manitoba Cancer Registry, incidence data for invasive cancers Statistics Canada Table 105-0501 – Health indicator profile, annual estimates, BreastCheck or a bilateral mammogram outside the Program, data for (excluding non-melanoma skin cancer) diagnosed in 2010, rates age- by age group and sex, Canada, provinces, territories, health regions (2011 April 1, 2010 - March 31, 2012. standardized to the Manitoba 2001 population; five-year survival for patients boundaries) and peer groups, occasional, CANSIM (database). 5 From BreastCheck, data for April 1, 2010 - March 31, 2012. diagnosed in 2005-2007. Stage percentage excludes cancer sites where TNM 2 staging is not applicable. Canadian Partnership Against Cancer, 6 From Radiation Therapy, CancerCare Manitoba, data for April 1, 2011 - 8 http://www.partnershipagainstcancer.ca/2012/02/02/world-cancer-day- March 31, 2012. Wait times: excludes patients delayed for medical reasons. Picker Patient Satisfaction Survey, 2008. Respondents giving a positive marked-with-new-canadian-survey-results-showing-increase-in-colon- Linear accelerators: CCMB had seven linear accelerators operational in score regarding the quality of all of cancer care in the past 6 months. cancer-screening/ 2010/2011 fiscal year; new unit opened in Brandon in June 2011. 3 From CervixCheck, data from April 1, 2009 - March 31, 2012.
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 21
CANCERCARE MANITOBA CONDENSED STATEMENT OF FINANCIAL POSITION Year ended March 31, 2013, with comparative figures for 2012 2013 2012 clinical, basic research and general capital special projects fund fund fund total total Assets Current assets: Cash $ 5,489,405 $ – $ 13,058 $ 5,502,463 $ 3,599 Restricted cash 2,061,761 – – 2,061,761 2,041,296 Short-term investments 1,258,785 – 947,930 2,206,715 5,070,612 Due from Manitoba Health 6,314,667 – – 6,314,667 4,628,756 Accounts receivable 2,671,117 – 6,708,869 9,379,986 11,987,698 Inter-fund accounts (2,439,324) 3,093,472 (654,148) – – Prepaid expenses 579,303 – – 579,303 748,500 Vacation entitlements receivable 1,730,141 – – 1,730,141 1,730,141 17,665,855 3,093,472 7,015,709 27,775,036 26,210,602
Restricted cash 3,673,087 – – 3,673,087 3,636,629 Retirement entitlement obligation receivable 1,419,400 – – 1,419,400 1,419,400 Investments 6,965,020 – 3,018,901 9,983,921 9,426,734 Capital assets – 59,251,858 1,614,535 60,866,393 63,890,099 $ 29,723,362 $ 62,345,330 $ 11,649,145 $ 103,717,837 $ 104,583,464
Liabilities, Deferred Contributions and Fund Balances Current liabilities: Bank indebtedness $ – $ – $ – $ – $ 1,452,998 Accounts payable and accrued liabilities 13,755,970 – 114,674 13,870,644 12,475,944 Due to Manitoba Health 2,230,728 – – 2,230,728 617,624 Deferred contributions - expenses of future periods 2,618,408 – – 2,618,408 2,546,438 18,605,106 – 114,674 18,719,780 17,093,004
Deferred contributions - capital assets – 62,184,881 1,236,644 63,421,525 66,280,951 Employee future benefits 7,332,590 – – 7,332,590 6,955,558 25,937,696 62,184,881 1,351,318 89,473,895 90,329,513
Fund balances: Invested in capital assets – 160,449 377,891 538,340 530,719 Externally restricted – – 9,013,173 9,013,173 9,031,773 Internally restricted 2,061,761 – 940,400 3,002,161 2,931,678 Unrestricted 1,759,746 – – 1,759,746 1,759,781 3,821,507 160,449 10,331,464 14,313,420 14,253,951
Accumulated remeasurement gains (losses) ( 3 5 , 8 4 1 ) – ( 3 3 , 6 3 7 ) ( 6 9 , 4 7 8 ) – 3,785,666 160,449 10,297,827 14,243,942 14,253,951 $ 29,723,362 $ 62,345,330 $ 11,649,145 $ 103,717,837 $ 104,583,464
CANCERCARE MANITOBA ADMINISTRATIVE COSTS
Summary of Administrative Expense percentage of total percentage of total 2012/13 expenses 2011/12 expenses Corporate 2.4 2.6 Patient-Care Related 0.7 0.7 Human Resources and Recruitment 1.0 0.7 Total 4.1 4.0
A complete set of financial statements, Public Sector ompensationC information, and the Auditor’s report can be obtained from CancerCare Manitoba. Call (204)787-1662.
22 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT
CANCERCARE MANITOBA CONDENSED STATEMENT OF OPERATIONS AND CHANGES IN FUND BALANCES Year ended March 31, 2013, with comparative figures for 2012 2013 2012 clinical, basic research and general capital special projects fund fund fund total total Revenue: Manitoba Health $ 117,310,645 $ – $ 409,097 $ 117,719,742 $ 113,026,065 Other recoveries 1,432,740 – – 1,432,740 1,773,420 Grants – – 13,631,785 13,631,785 14,635,077 Amortization of deferred contributions – 5,656,678 – 5,656,678 5,883,659 118,743,385 5,656,678 14,040,882 138,440,945 135,318,221
Expenses: Compensation 48,943,213 – 8,417,415 57,360,628 55,179,939 Medical remuneration 14,738,518 – – 14,738,518 15,432,799 Building occupancy 1,899,057 – – 1,899,057 1,782,767 Amortization of capital assets – 5,656,678 164,277 5,820,955 6,087,794 General administration 3,385,825 – – 3,385,825 3,276,697 Equipment rentals and maintenance 1,335,058 – 198,672 1,533,730 1,386,481 Supplies and other departmental expenses 4,344,469 – 5,214,498 9,558,967 10,722,637 Drugs: Provincial oncology drug program 35,808,240 – – 35,808,240 34,666,451 Neupogen 3,541,610 – – 3,541,610 – Other 1,085,378 – – 1,085,378 1,014,467 Referred-out services 4,017,986 – 160,480 4,178,466 4,025,344 119,099,354 5,656,678 14,155,342 138,911,374 133,575,376
Excess (deficiency) of revenue over expenses before the undernoted (355,969) – (114,460) (470,429) 1,742,845 Investment income 402,707 – 146,807 549,514 656,028 Excess of revenue over expenses 46,738 – 32,347 79,085 2,398,873 Fund balances, beginning of year 3,801,077 160,449 10,292,425 14,253,951 11,855,078 Adjustment on adoption of the financial instruments standard ( 2 6 , 3 0 8 ) – 6 , 6 9 2 ( 1 9 , 6 1 6 ) – Fund balances, beginning of year, as restated 3,774,769 160,449 10,299,117 14,234,335 11,855,078 Fund balances, end of year $ 3,821,507 $ 160,449 $ 10,331,464 $ 14,313,420 $ 14,253,951
Total Revenues for the Year ended March 31, 2013 Total Expenses for the Year ended March 31, 2013
medical remuneration 11% building occupancy 1% manitoba health 85% amortization of capital assets 4% general administration 3% other recoveries 1% equipment rentals and maintenance 1% supplies and other expenses 7% grants 10% compensation 41% amortization of deferred contributions 4% referred-out services 3% drugs 29%
These condensed financial statements do not contain all of the disclosures required by Canadian public sector accounting standards. Readers are cautioned that these statements may not be appropriate for their purposes. For more information on the Company’s financial position, results of operations, changes in fund balances, cash flows and remeasurement gains and losses, reference should be made to the related complete financial statements of CancerCare Manitoba as at and for the year ended March 31, 2013, on which KPMG LLP expressed an opinion without reservation in their report dated June 20, 2013. The complete set of financial statements can be downloaded at www.cancercare.mb.ca
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 23 CANCERCARE MANITOBA BOARD CORPORATE INFORMATION EFFECTIVE MARCH 31, 2013 Board Board of Directors Committees
Dr. Arnold Naimark PLANNING COMMUNITY ADVISORY COUNCIL CHAIR Mr. Ben Lee Ms. Bonnie Hoffer-Steiman Mr. Lorne DeJaeger CHAIR CHAIR PAST CHAIR Mr. George Campbell Ms. Gina Guiboche Mr. Greg Tallon VICE-CHAIR Mr. Lorne DeJaeger Dr. Tricia Magsino Barnabe Mr. David Popke Ms. Vera Derenchuk Ms. Dolores Samatte SECRETARY Ms. Susan Boulter Ms. Gloria Paziuk Ms. Barb Lillie TREASURER Dr. Arnold Naimark Dr. Fred Shore EX-OFFICIO Dr. Tricia Magsino Barnabe Dr. Arnold Naimark EXTERNAL MEMBERS: EX-OFFICIO Ms. Susan Boulter Mr. Martin Hak Mr. George B. Campbell COMMUNICATIONS & PARTNERS Mr. Richard Johnson Ms. Vera Derenchuk RELATIONS Ms. Annitta Stenning Dr. Gary Glavin Mr. David Popke Ms. Gina Guiboche CHAIR FINANCE & AUDIT Ms. Bonnie Hoffer-Steiman Ms. Bonnie Hoffer-Steiman Ms. Barb Lillie Mr. Donald MacDonald Ms. Alyson Kennedy CHAIR Ms. Anna Maria Magnifico Mr. Ben Lee Mr. Donald MacDonald Dr. Fred Shore Mr. Donald MacDonald Ms. Alyson Kennedy Dr. Arnold Naimark Ms. Anna Maria Magnifico Dr. Arnold Naimark EX-OFFICIO
Ms. Teresa Mrozek EXTERNAL MEMBERS: EXTERNAL MEMBERS: DESIGNATE OF MINISTER OF HEALTH Ms. Gloria Paziuk Mr. Keith Findlay Ms. Annitta Stenning Ms. Wendy Rudnick OFF BY MARCH 31, 2013: Mr. Lorne DeJaeger ADVISORY MEDICAL BOARD Ms. Dolores Samatte Dr. Fred Shore Dr. John Foerster QUALITY & PATIENT SAFETY CHAIR EX-OFFICIO: Ms. Susan Boulter Dr. Arnold Naimark Dr. Dhali Dhaliwal CHAIR EX-OFFICIO PRESIDENT AND CEO, CCMB Mr. Lorne DeJaeger Dr. Shahida Ahmed NOMINATIONS & GOVERNANCE PRESIDENT, MSA, CCMB Mr. Donald MacDonald Mr. Donald MacDonald Ms. Vera Derenchuk GUESTS CHAIR Ms. Anna Maria Magnifico Ms. Annitta Stenning Mr. Greg Tallon EXECUTIVE DIRECTOR, CCMF Dr. Arnold Naimark EX-OFFICIO Mr. Lorne DeJaeger Mr. Jeff Peitsch Mr. David Popke COO, CCMB EXTERNAL MEMBERS: Dr. Arnold Naimark CANCERCARE MANITOBA WISHES TO THANK: Mr. William (Bill) Daviduk Ms. Vera Derenchuk EXTERNAL MEMBERS:
FOR HER DEDICATION AND COMMITMENT TO CANCERCARE MANITOBA AND MANITOBANS, Dr. Tom Hack DURING HER TERM OF SERVICE ON THE CCMB Ms. Barb Metcalfe BOARD OF DIRECTORS.
24 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT Senior Management ORGANIZATIONAL CHART & Clinical Leads
Dr. H. S. Dhaliwal PRESIDENT & CEO PRESIDENT & CEO Mr. Jeff Peitsch CHIEF OPERATING OFFICER
Ms. Valerie Wiebe CHIEF NURSING OFFICER
Dr. Spencer Gibson CHIEF DIRECTOR, OPERATING OFFICER MANITOBA INSTITUTE OF CELL BIOLOGY, ACTING DIRECTOR, RESEARCH, CCMB
Dr. Donna Turner PROVINCIAL DIRECTOR, POPULATION ONCOLOGY
HUMAN Ms. Laurel Grindey MEDICAL STAFF RESOURCES ACTING DIRECTOR, HUMAN RESOURCES ASSOCIATION Dr. John Doyle HEAD, PEDIATRIC ONCOLOGY/HEMATOLOGY
Dr. Andrew Cooke VICE PRESIDENT, ACTING MEDICAL DIRECTOR, CLINICAL ONCOLOGY RADIATION ONCOLOGY PROGRAM COMMUNICATIONS MEDICAL & ADMIN. AND DIRECTORS Dr. Sri Navaratnam PUBLIC AFFAIRS DIRECTOR WRHA ONCOLOGY HEAD, DEPARTMENT OF MEDICAL ONCOLOGY/HEMATOLOGY
Ms. Kathy Suderman CHIEF NURSING ADMINISTRATIVE DIRECTOR, QUALITY, PATIENT SAFETY OFFICER RADIATION ONCOLOGY PROGRAM AND RISK MANAGEMENT Executive Transition effective to PROVINCIAL DIRECTOR, Team December 31, 2013: RESEARCH PATIENT REPRESENTATIVE Dr. Dhali Dhaliwal PRESIDENT & CEO Mr. Jeff Peitsch VICE PRESIDENT & CHIEF OFFICER,OPERATIONS PROVINCIAL DIRECTOR, Dr. Sri Navaratnam, POPULATION ONCOLOGY VICE PRESIDENT & CHIEF OFFICER, CLINICAL SERVICES Ms. Valerie Wiebe VICE PRESIDENT & CHIEF OFFICER, PATIENT SERVICES Dr. Donna Turner DIRECTOR, POPULATION ONCOLOGY Dr. Spencer Gibson DIRECTOR, MANITOBA INSTITUTE OF CELL BIOLOGY Ms. Laurel Grindey INTERIM DIRECTOR, HUMAN RESOURCES Ms. Jackie Shymanski DIRECTOR, COMMUNICATIONS & PUBLIC AFFAIRS
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 25 Cheers to 50 years of Volunteerism
FOR FIVE DECADES, OUR VOLUNTEERS HAVE PROVIDED SUPPORT NOT ONLY TO CANCERCARE MANITOBA STAFF, BUT PATIENTS AND THEIR FAMILIES DURING THEIR CANCER JOURNEY.
JASKIRAN SIDHU
JASKIRAN SIDHU’S EXPERIENCE WITH CANCERCARE MANITOBA’S VOLUNTEER SERVICES HAS COME FULL CIRCLE.
Jaskiran started volunteering in January 2006 when she was a biochemistry student at the University of Winnipeg. This experience inspired her to further her studies at the University of Alberta where she did a Masters that was a crossover between pediatrics and oncology. After completing her Masters, Jaskiran moved back to Winnipeg where she resumed volunteering at CCMB. In October 2012 she was hired as the Assistant Coordinator at Volunteer Services.
Jaskiran chose to volunteer specifically at CancerCare What began as a humble operation of just eight Manitoba because of her interest in health care and cancer. volunteers providing Refreshment Services in 1963, She says it is a very rewarding field. now includes 400 volunteers each year, who collectively “There is a lot of opportunity for growth because of the contribute 24,000 hours of their time and talent at all [unfortunate] increase in cancer, but you are contributing our sites (MacCharles, St. Boniface, the Breast Cancer to what will hopefully be a cure.” Centre of Hope, the CCMB screening programs, and in communities throughout the province). Recently while Jaskiran was helping volunteers, a patient came up to her who was very frail. The patient, who was a Volunteer Services continues to change and grow. complete stranger, shared the news with Jaskiran that she Currently, we have 44 unique positions within 17 different had gained weight. Although this was a terminal patient, departments where volunteers assist with a wide array Jaskiran said they were still positive. of tasks. These positions range from governance and fundraising activities, to handing out welcome refreshments “Working with patients directly you can see their appreciation. (courtesy of the CancerCare Manitoba Foundation), to acting It [CCMB] is a really rewarding place to volunteer because as guides for patients and families, sharing information and you see firsthand how you’re helping and there is such a resources, or providing peer support. team spirit here.”
This February, the 50th anniversary of volunteerism was Jaskiran continues to volunteer at CCMB for their special celebrated by the Lieutenant Governor of Manitoba, His events. She also volunteered as a Refreshment Server and Honour Philip Lee, and his wife, Her Honour Anita Lee, a Runner. However, she said her favourite position, which who held a reception at Government House. In addition, was her longest-held position, was as a Patient Guide. CCMB’s Volunteer Services was chosen as the recipient of “I enjoyed it because you would get more interaction with the prestigious Premier’s Volunteer Service Award, which patients since you would end up talking to them.” is presented to organizations that have improved quality of life in Manitoba. Along with working at CCMB, Jaskiran is also pursing her PhD at the University of Manitoba in cancer research. Her PhD will focus on a translational oncology project.
26 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT LARRY VILK
LARRY VILK IS VERY FAMILIAR WITH THE EXPERIENCES OF CANCER PATIENTS NOT ONLY A CANCERCARE MANITOBA VOLUNTEER, BUT AS A CANCER SURVIVOR.
In 2002, Larry broke his ankle and developed a hospital infection. He was being treated at another facility when CCMB got involved because they anticipated internal bleeding. During his treatment, Larry received a SHIRLEY POOLE colonoscopy, because his father had passed away from colon cancer. The test revealed Larry had the same cancer. SHIRLEY POOLE WAS 47-YEARS-OLD WHEN SHE BEGAN VOLUNTEERING WITH CANCERCARE “It was a big surprise because I wasn’t portraying MANITOBA IN 1973. SHIRLEY WAS COMPELLED any symptoms.” TO VOLUNTEER AT CCMB, AFTER BOTH HER After having an operation, medical staff found that MOTHER AND AUNT DIED SUDDENLY OF CANCER. the cancer had spread to his liver. Larry went through chemotherapy at CCMB’s St. Boniface Unit, which was “My aunt died of pancreatic cancer only a week after being successful. However, in April 2008, another tumour was diagnosed. My mom died of bile duct cancer just three found, which was treated with chemotherapy. weeks after her diagnosis.”
“Watching what volunteers did made me want to help This year, Shirley celebrates her 40th anniversary with CCMB, as she turns 87. and give back,” said Larry. Shirley says volunteering has helped her understand Since joining Volunteer Services in 2005, Larry has been what patients go through, as each patient experience a Patient Guide and assisted in the Patient Resource is different. Centre and has contributed about 12,000 hours. However, Shirley remembers vividly when she was offering Larry can usually be found as a Runner, delivering beverages to a couple and their teenage daughter, different medical information to various locations within who was a cancer patient. Shirley said the girl’s face was CCMB and the Health Sciences Centre. wreathed in a smile, despite her being in a wheelchair “It’s my favourite position because you’re active; it’s great after suffering the loss of a limb. exercise and you’re constantly running around during “She was a beautiful girl in both looks and attitude,” she said. your shift.” Shirley has held different positions since she joined “I get joy out of giving back and helping out. The staff CCMB’s volunteer team, including the cleaning and caring and everyone at CCMB are so kind and considerate you of wigs, and taking part in craft sales. Even after so many don’t mind going out of your way.” years, she still helps out as a Refreshment Server, and can be found providing beverages and cookies to patients and families every Monday.
“I love volunteering. You appreciate how lucky you are, and you take that with you each time.”
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 27 Awards, Honours & Achievements BRIEF HIGHLIGHTS OF SOME OF OUR SUCCESSES IN 2012-2013
ACHIEVEMENTS CancerCare Manitoba was recognized for a wireless patient tracking project by Accreditation Canada, an independent CCMB staff travelled to Mumbai, India, to take part in peer reviewer of health care organizations. The initiative an international conference on hematology, as well as was recognized as a Leading Practise, or an innovative to Delhi to continue an international collaboration with solution that improves the quality of care. Using WiFi the All India Institute of Medical Sciences in lympho technology, CCMB tracked onsite patient wait times in proliferative disorders (blood cancer). chemotherapy, and identified delays and reasons for delays. Improvements were made in response, resulting in reduced wait times for patients.
dr. brent schacter was the recipient of the Distinguished Service Award from Doctors Manitoba, the professional association of doctors in this province. The award is the highest its members can bestow, and is given in recognition of service rendered to patients and community, devotion to the highest ideals of medicine, and the furthering of the profession through teaching, writing and administration.
dr. jeff sisler The Manitoba College of Family Physicians recognized Dr. Sisler as recipient of their Award of Excellence. Dr. Sisler was recognized for his outstanding work in developing the Uniting Primary Care and Oncology (UPCON) project, an innovation that has better connected CCMB expertise with family physicians across Manitoba.
Congratulations to janice filmon, Chair of the CancerCare Manitoba Foundation, who was appointed to the Order of Canada, in recognition for her outstanding DR. ANNE KATZ contribution to charitable works. dr. tom hack was awarded a Research Chair in AWARDS Psychosocial and Supportive Care Oncology Research, CCMB’s dr. anne katz was named as one of the from the Canadian Breast Cancer Research Foundation 10 Manitoba nurses that have made a difference in (September, 2012) and was named a Visiting Professor, the lives of Manitobans by the College of Registered University of Central Lancashire, UK, on January 1, 2013. Nurses of Manitoba, as the college celebrated its 100th Congratulations to genevieve thompson, Palliative anniversary. Dr. Katz was also appointed as the editor Care Research, on receiving the Canadian Institute of of the Oncology Nursing Society’s research journal, Health Research (CIHR) New Investigator Award, and the Oncology Nursing Forum. being named the Outstanding New Investigator by the Congratulations to dr. rajat kumar, CCMB Canadian Association of Nursing Research. hematologist, who has been named 2013 Specialist of the Year/Prix d’excellence, Manitoba/Saskatchewan region, by the Royal College of Physicians and Surgeons of Canada.
28 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT CANCERCARE MANITOBA FOUNDATION Giving More Tomorrows
CANCERCARE MANITOBA FOUNDATION’S MISSION IS CRYSTAL CLEAR –
TO RAISE FUNDS EXCLUSIVELY FOR CANCERCARE MANITOBA.
This means CancerCare Manitoba can continue to provide the best cancer research, care and patient support available for Manitobans and their families living with cancer. Each year tens of thousands of Manitobans entrust us with their donations. We are stewards of these dollars and are proud each year to tell donors exactly how and where their money is spent. This report is for the fiscal year ending March 31, 2013.
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 29 CANCERCARE MANITOBA FOUNDATION Giving More Tomorrows
IN THESE PAGES YOU WILL READ SOPHIA’S Forecasts tell us cancer is on the rise in Manitoba, and in STORY. THIS IS THE STORY OF A CHILD WHO NOW the coming years the Foundation will need to significantly increase its financial support to CancerCare Manitoba. HAS MANY MORE TOMORROWS TO LIVE, AND A We need only look around to our families and our friends MANITOBA FAMILY WHO “HAS THREE CHILDREN to know this is so. We need to be bold. Bold in asking that NOT TWO”. IT IS A STORY THAT LEAVES US ALL we all work together to fight this disease and help provide
WITH JOYFUL TEARS. more tomorrows for all Manitobans and their families living with cancer. Bold in asking more of us to give. Bold enough to continue to invest in attracting and You will also read the story of Perry Ross, a man who retaining the best and brightest cancer specialists because “held CancerCare Manitoba in high regard” and left a we need them right here – at CancerCare Manitoba – significant portion of his estate to the Foundation. It is to help give more tomorrows to the patients and their the story of one man who cared deeply about other people families we are here to serve and support. and chose a Legacy Gift as his way to help Manitobans and families living with cancer. The road ahead is formidable but if we all commit These are only two of thousands of stories that together to this goal, we can and we will triumph. help illustrate what the Foundation and CancerCare Manitoba are accomplishing with the help of our We invite you to join us in Giving More Tomorrows. corporate partners, dedicated volunteers and staff, and most especially, our very generous donors. They also tell a story of hope – hope that one day we can reduce the incidence of cancer in our province, and provide even More Tomorrows for those touched by this awful disease.
Since CancerCare Manitoba Foundation first started fundraising in 2000, we have worked tirelessly each day to earn the trust of all Manitobans. This year that trust was again rewarded as more than 400 community events registered to raise funds for the Foundation and more than 30,000 individuals entrusted us with their donations. This Janice Filmon Annitta Stenning allowed the Foundation to provide $5.36 Million in grants chair executive director cancercare manitoba cancercare manitoba to CancerCare Manitoba increasing our total contribution foundation foundation to nearly $80 Million. We are extremely proud of this achievement but we know much more must be done.
30 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT ALL FUNDS RAISED STAY IN MANITOBA Sources of Funding
The Foundation is proud to support CancerCare Manitoba’s research and patient care programs thanks to the ongoing generosity of the community. This year more than 41,000 donors supported CancerCare Manitoba Foundation by making direct contributions or by supporting our signature or community events.
CONTRIBUTIONS This year thousands of individual donors contributed to CancerCare Manitoba Foundation to support a loved one, friend or colleague living with cancer, to remember someone lost to the disease, or simply to help provide More Tomorrows for Manitobans and their families living with cancer. From seven year old Kaiya Krahn who “made a grape juice stand” and donated to remember her grandmother, to Perry Ross who left a legacy gift in his estate, every gift counts. You make a difference.
SPECIAL EVENTS CancerCare Manitoba Foundation presents four signature events each year and another 400+ community events register to raise funds for the Foundation. A Gold-Plated Evening, the sixth bi-annual dinner in In 2012-2013 Special Events accounted for approximately support of Prostate Cancer Research and Treatment, 35 percent of the Foundation’s total net revenue. was held on Monday, May 14th, 2012 at the Winnipeg Convention Centre. The event raised $164,000 that was Signature Events invested in CancerCare Manitoba’s Prostate Tumour Bank The Challenge for Life 20km Walk raises funds for all - a critical factor in the control, early detection, treatment cancers and provides an opportunity for participants and improving long-term outcomes for all Manitoba men to reduce their own risk of cancer by improving their living with prostate cancer. personal fitness. The 2012 CFL raised $1 Million thanks to corporate sponsors and more than 15,000 individual CancerCare Manitoba Foundation and the Children’s donors who supported more than 600 individuals that Hospital Foundation of Manitoba co-sponsored the 2012 walked 20km and ‘rang the bells’ as they crossed the Manitoba Dragon Boat Festival. More than 100 teams and finish line in Assiniboine Park. 2500 paddlers raised more than $300,000 to help support pediatric clinical trials and other key projects for Manitoba The Guardian Angel Benefit for Women’s Cancer has kids with cancer. been organized by volunteer Angels for twenty-one years. The October 2012 Benefit raised more than $300,000 Community Events to support strategic investments in prevention, early More than 400 Community Events registered to raise detection, research, treatment and patient and family funds for CancerCare Manitoba Foundation. Over half of support, for women and their families touched by cancer. these events began as one-time memorial events and have
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 31 CANCERCARE MANITOBA FOUNDATION
19% 35%
gone on to become annual events. This year community 3 events raised more than $1.5 Million for the Foundation. %
By registering with CancerCare Manitoba Foundation, event organizers had access to our marketing support and 43% could provide charitable tax receipts for eligible donations.
INVESTMENT INCOME In fiscal 2013 the CancerCare Manitoba Foundation had funding reserves of $38.6 Million, of which 39 percent SOURCES OF FUNDING were donor endowed and restricted funds. The funds
are managed by GWL Investment Management, Invesco, CONTRIBUTIONS Jarislowsky Fraser Ltd, Phillips, Hager & North Investment SPECIAL EVENTS Management. Our Custodian is CIBC Mellon Global OTHER DONATIONS Security Services Co. INVESTMENT INCOME
Perry Ross A Man of Many Legacies
Perry Ross passed away Sunday April 8, 2012, seven of a mountain skiing I’ve had a great life”, weeks before his 90th birthday but not before living an he would say to Betton. extraordinary life filled with friendship, joy and adventure. Perry’s larynx cancer would ultimately A bachelor, Perry left his entire estate to a number of result in the loss of his speaking important community institutions, including CancerCare voice but he found other ways to Manitoba Foundation. communicate with his close neighbours “Perry identified CancerCare Manitoba Foundation in and friends who would become his his estate long before being diagnosed with cancer of lifeline in his last years. He continued the larynx”, said his longtime business advisor, friend to walk when possible, often seen in and executor Fred Betton. “He held the organization Assiniboine Park, and was always “in” in high regard and wanted to support their work in the for visitors at his modest home in Winnipeg. community and help Manitobans fighting cancer.” Perry’s estate gift to CancerCare Manitoba Foundation Perry had a successful business career in Winnipeg that truly will make a difference in the lives of Manitobans and spanned 45 years. He was an avid jogger and skier and families fighting cancer. worked hard on his physical conditioning throughout his Perry Ross may have lost his voice but his gift will life. Perry was perhaps most at home skiing at Whistler continue to speak for him. For that CancerCare Manitoba Mountain in British Columbia. He enjoyed the beauty Foundation and all Manitobans and families fighting surrounding him and the ability to push his competitive cancer are forever grateful. limits to the maximum on the slopes. “If I fall off the end
32 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT ALL FUNDS RAISED STAY IN MANITOBA Your Money at Work
The Foundation supports CancerCare Manitoba’s This fiscal year CancerCare Manitoba Foundation key strategic objectives by: provided $5.36 Million in grants to CancerCare Manitoba. Your dollars are put to work right here in Manitoba, Providing gap funding for programs and services making a real difference for Manitobans and their families that may not be eligible for government funding living with cancer.
Funding the research infrastructure to attract CANCERCARE MANITOBA FOUNDATION and retain the best and brightest cancer specialists GRANT ALLOCATION TO CCMB 2012-2013 to CCMB (and improve outcomes for Manitobans diagnosed with cancer) RESEARCH 58%
Educating Manitobans about how to reduce their PATIENT CARE - SUPPORT & TRAINING 21% personal risk of Cancer PEDIATRIC AND ADULT CLINICAL TRIALS 12%
EQUIPMENT 5 % Funding programs and services to support Manitobans AWARENESS AND RISK REDUCTION 4 % and their families throughout their cancer journey
THE FOLLOWING SPECIFIC PROJECTS WERE FUNDED IN 2012-2013.
Equipment, Research & Clinical Trials • Pediatric and Adult Clinical Trial • Follow up Care after cancer – • Core Infrastructure funding to CancerCare core funding for survivors of childhood cancer Manitoba’s Institute of Cell Biology • Molecular determinants of chromosone • Establishment of Canadian Blood and • Research Operating grants in Breast, instability-equipment that will assist Marrow Transplant Program in Manitoba Leukemia, Colorectal, Multiple Myeloma, to identify novel therapeutic targets- • Medical Physics Academic Program – Lung, Ovarian, Brain and Prostate focused on colorectal cancer (co-funder) Core Funding cancers; a study in DNA sequencing and • Robotic Intravenous Automation System • Community CancerCare provincial Adaptive Radiotherapy Planning. (RIVA machine) – automated preparation Educational Conference of chemotherapy (co-funder) • International Collaborations in Leukemia • Community CancerCare Scholarships – Translational Research Patient & Family Support Services Enhanced skills training for health care • Twelve Studentship and Fellowship Awards • Patient and Family Resource Centre, professionals affiliated with Cancer partnering with Senior Investigators accessible free of charge to patients and Programs (CCP’s) and primary care • Core funding to the Office of the their families physicians and nurse practitioners Provincial Director of Research • Volunteer and Community-Based • Cancer Specific Information and Support • Core Infrastructure funding for the Breast Information and Support programs, Sessions for patients and families and Prostate Tumour Bank including Refreshment Service and • Stipend support for undergraduate • Acute Leukemia/Blood Marrow “Music To My Ears” program medical student researchers at CCMB Transplant Program Fellowship • Guardian Angel Caring Room enrolled in the B.Sc. (Medicine) Program • Epidemiology and Cancer Registry • Publication and distribution of The Risk Reduction Awareness core funding Navigator for patients and families • A comprehensive Sun Safety Program • Manitoba Palliative Care Research • Camp Indigo Pediatric Oncology Camp for helping to reduce the risk of skin cancer core funding children in treatment and their siblings • GetChecked Manitoba campaign to • Start-up Research funding to Dr.’s V. • Palliative Care, Transition and End of Life promote cancer screening and S. Banerji Care Programming at CCMB • The Bear Facts campaign promoting the • Margaret A. Sellers Chair • Manitoba’s TLC (Teens Living with Cancer) five steps everyone can take to reduce • Study of hematopoietic stem cell • The Road to cGMP Redux – Part 3 their personal risk of cancer transplantation in non-malignant disease
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 33 CANCERCARE MANITOBA FOUNDATION Your Donations Help Manitoba Families
A GENERATION AGO, JORDAN AND JODI PENNER WOULD BE RAISING TWO YOUNG CHILDREN, NOT THREE.
But today, three and a half years after their youngest daughter, Sophia, was diagnosed with acute lymphoblastic leukemia – that’s cancer of the white blood cells – the now- eradicate – the deadly disease. That’s why you don’t need to gap-toothed six-year-old loves playing baseball and jumping fly down to a Mayo Clinic, Cuvelier said. on the trampoline in the backyard with her sister, Alexis, 7, “It gives us access to specialists around the world. If I have and brother, Ryland, 9. a complex case, I can touch base with an expert in the The Penner family’s odyssey started on February 12, 2010. U.S. because we’re all part of the same network. I can get After looking after a sick little girl for a week, they headed second opinions without sending the child out for a second to the Children’s Hospital. The medical professionals there opinion; I can just pick up the phone,” he said. realized what they had on their hands right away. Extra vials One of the most crucial elements in the fight against of blood were taken from her and then the doctor came in cancer is fundraising. The funding helps CancerCare and sat down. “He was very quick and very straightforward,” Manitoba attract and retain “world-class cancer specialists,” Jordan said. “He said, ‘I have some bad news – your according to Annitta Stenning, CancerCare Manitoba daughter has leukemia.’” Foundation’s executive director. It also provides an incentive Almost immediately Sophia began more than two years for homegrown experts to wage war on the disease without of treatments, including chemotherapy and bone marrow leaving the province to do so. transplants and other “big words that you hear on the “Without research, they can only provide yesterday’s doctor shows.” The chemo, in particular, sapped her of her treatment,” she said. “There are so many types of cancer, strength. Soon, she couldn’t walk. She had to take penicillin it’s such a complex disease. The more we know about it, the on the weekend because she essentially had no immune more the treatment can be tailored to the patient,” and be system. She lost her hair. less toxic, she said. Luckily for the Penners, there was no questioning whether More good news from Stenning: Not only have clinical trials they could get better treatment by leaving the province or dramatically increased children’s survival rates, Manitoba the country. has the highest rate of participation in pediatric clinical Dr. Geoff Cuvelier, the pediatric oncologist who treated trials in the country. Sophia at CancerCare Manitoba, said acute lymphoblastic Slowly but surely, Sophia regained muscle in her legs and leukemia (ALL) has an 85 percent cure rate today. That’s a learned to walk again. Her hair grew back. far cry from the early 1980s when such a diagnosis meant a far different fate. And then on May 25, 2012, she got what her family had “Thirty years ago, most children with acute leukemia were been waiting for – the all-clear from her doctor. not long-term survivors,” he said. “Today, there is a cost to the cure. It’s hard and it’s challenging.” She’s not completely out of the woods, as she had to go in every four weeks for blood work – a gap that has now The survival rate is rising all the time, primarily due to been extended to eight weeks. As time goes on, she will go medical institutions and caregivers around the world in less frequently. When she hits five years of good news, realizing they can’t cure cancer in isolation. Only by she’ll truly be considered cancer-free. Then, and only banding together and sharing research from clinical trials maybe then, will Jodi be willing to relax. and best practices can they hope to control – and eventually Reprinted and edited with permission from The Winnipeg Free Press. Original article by Geoff Kirbyson, Photo by Ruth Bonneville.
34 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT ALL FUNDS RAISED STAY IN MANITOBA Board of Directors CancerCare Manitoba Foundation
Missing from the photograph: Paul Mahon, Raymond L. McFeetors, Andrew B. Paterson, Dr. Arnold Naimark
Executive Officers Directors CCMB Board Representatives
Janice Filmon, O.C., O.M., LLD Joyce Berry Dr. Arnold Naimark, M.D., O.C., O.M. CHAIR CHAIR Keith Boyd James W. Burns, O.C., O.M. Greg Tallon SECRETARY Gary Buckley VICE CHAIR Robert G. Puchniak Hennie Corrin Barb Lillie VICE CHAIR, TREASURER AND FINANCE CHAIR Dr. Mark Evans, Ph.D. TREASURER Hal Ryckman Doug Harvey David Popke MARKETING CHAIR SECRETARY Dr. Sara Israels, M.D. Dr. Emoke˝ J.E. Szathmáry, Dr. H.S. (Dhali) Dhaliwal, M.D. C.M., O.M., Ph.D. Paul Mahon PRESIDENT AND CEO PROJECTS, GRANTS & AWARDS CHAIR Jeffrey Morton, FCA Annitta L. Stenning EXECUTIVE DIRECTOR Glen R. Peters
Raymond L. McFeetors DIRECTOR EMERITUS Andrew B. Paterson DIRECTOR EMERITUS
CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT 35 CANCERCARE MANITOBA FOUNDATION Long Term Impact
CANCERCARE MANITOBA IS HAVING A MAJOR
IMPACT ON CANCER IN MANITOBA. SINCE CCMF CANCERCARE MANITOBA FOUNDATION MADE ITS FIRST GRANT IN 2000, TOTAL FUNDING FUNDING SUPPORT TO CCMB 2000-2013 TO CANCERCARE MANITOBA TOTALS NEARLY $80 MILLION.
What does this mean for Manitobans and families living with cancer?
More Tomorrows for Manitobans diagnosed with Cancer
The ability for CCMB to attract and retain the best and brightest cancer specialists and provide Manitobans with world-leading treatment and services
Caring support for patients and families during the most difficult time in their lives RESEARCH 41%
Break-through research that benefits Manitobans CAPITAL 24% and all mankind PATIENT CARE 12%
A new cancer control strategy that allows treatment EPIDEMIOLOGY 7 % and services to be targeted by region and other factors, PEDIATRIC AND ADULT CLINICAL TRIALS 7 %
to improve effectiveness for every dollar spent on EQUIPMENT 5 % cancer in Manitoba AWARENESS/RISK REDUCTION 3 %
OTHER 1 % Education to help Manitobans reduce their risk of cancer
The ability to provide more and more cancer patients who qualify with the opportunity to participate in a clinical trial – and gain the enhanced outcomes that result
A world-class tumour bank accessible to researchers across Manitoba and the world that can help improve outcomes for all cancer patients
Better access to cancer treatment and services throughout the province
36 CANCERCARE MANITOBA 2012-2013 PROGRESS REPORT The Public Interest Disclosure Act (Whistleblower Protection Act)
The Public Interest Disclosure (Whistleblower Protection) Act came into effect in April 2007. This law gives employees a clear process for disclosing concerns about significant and serious matters (wrongdoing) in the Manitoba public service, and strengthens protection from reprisal. The Act builds on protections already in place under other statutes, as well as collective bargaining rights, policies, practices and processes in the Manitoba public service. Wrongdoing under the Act may be: contravention of federal of provincial legislation; an act or omission that endangers public safety, public health or the environment; gross mismanagement; or, knowingly directing or counseling a person to commit a wrongdoing. The Act is not intended to deal with routine operational or administrative / human resource matters. A disclosure made by an employee in good faith, in accordance with the Act, and with a reasonable belief that wrongdoing has been or is about to be committed is considered to be a disclosure under the Act, whether or not the subject matter constitutes wrongdoing. All disclosures receive careful and thorough review to determine if action is required under the Act, and must be reported in the regions annual report in accordance with Section 18 of the Act. The following is a summary of disclosures received by CancerCare Manitoba for fiscal year 2012 - 2013: 0 The number of disclosures received, and the number acted on and not acted on Subsection 18(2)(a): 0 The number of investigations commenced as a result of disclosure: Subsection 18(2)(b): 0 In the case of an investigation that results in a finding of wrongdoing, a description of the wrongdoing and any recommendations or corrective action taken in relation to the wrongdoing, or the reasons why no corrective action was taken Subsection 18(2)(c): 0 www.cancercare.mb.ca
CancerCare Manitoba 2012/2013 Progress Report
Questions? Email: [email protected]