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Sunnybrook/TSRCC Breast Program Strategic Planning Retreat

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Title: Breast Site Group Strategic Planning Retreat Author: ymatyas Last modified by: Martin Yaffe Created Date: 3/16/2007 12:40:57 PM Document presentation format – PowerPoint PPT presentation

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Title: Sunnybrook/TSRCC Breast Program Strategic Planning Retreat


1
Sunnybrook/TSRCC Breast ProgramStrategic
Planning Retreat
  • April 23, 2007

2
Breast Cancer State of the Union
  • What has changed?
  • What will change ?

3
Breast Cancer in Canada
  • Most common malignancy affecting women
  • in 2002 in Canada
  • 20,500 diagnosed
  • 5,400 died
  • Incidence rates have leveled over last 10 years
  • Mortality rates have dropped by 25 in last 20
    years

4
Preventive Oncology Key changes in the last 5
years
  • Increased demand for and utilization of genetic
    services for assessment of hereditary
    predisposition
  • Increased evidence to support risk reduction
    interventions in patients with hereditary
    predisposition to breast cancer
  • Chemoprevention of breast cancer
  • ?Research vs. standard of care
  • Clarification of Breast Cancer Risk Factors
  • e.g. HRT
  • Development of a provincial cancer prevention
    strategy
  • Cancer 2020

5
Preventive Oncology What can we expect in the
next 5 years?
  • More complex genetic assessment
  • More genes, more sophisticated testing
  • More prevention studies
  • More accountability re provincial targets/CSQI
  • More cancer
  • NOT more funding
  • MRI screening

6
MRI Screening in Canada
  • Currently being performed in a few large centres
    and a few private clinics
  • National Hereditary Taskforce Guidelines
    (Jan/07) Annual mammography should be
    supplemented by MRI where it is available.
  • Ontario PEBC Guideline in final stages. Like ACS
    but
  • 25 lifetime risk
  • Includes some patients with LCIS / atypia
  • Aim to bring MRI screening under umbrella of OBSP
    to ensure
  • Minimum standards are met by all centres
  • Access for all women who might benefit
  • Outcome analysis and CQI

7
Imaging Key changes in the last 5 years
  • Increasing volume
  • US MRI
  • Increasing interventions
  • Core vacuum assisted biopsies expense
  • Digital mammography
  • Choice of residents for teaching
  • Clinical research CAD
  • DMIST
  • ACRIN 6666 Screening Ultrasound
  • MRI high risk screening
  • CEDM DBT

8
Imaging What can we expect in the next 5 years?
  • Screening increasing diagnostic volume
    interventions
  • OBSP screening assessment centre
  • Conversion to all digital imaging
  • Timely diagnosis
  • Research MRI
  • Contrast enhanced digital mammography
  • Digital Breast Tomosynthesis
  • CE DBT

9
Surgical Oncology Key changes in the last 5
years
  • More emphasis on minimally invasive surgery
  • Importance of breast imaging for surgical
    decision-making
  • Importance of multidisciplinary care
  • Critical mass of breast surgeons at TSRCC

10
Surgical Oncology What can we expect in the next
5 years?
  • Increased emphasis on neoadjuvant treatments
  • Greater reliance on imaging (MRI as standard?)
  • Greater multidisciplinary care
  • More resources/patient
  • Better coordination of services/streamlining of
    appts needed
  • Consumer demand for patient-focused services
  • The challenge of maintaining referral base
  • Patient navigation
  • Admin support
  • Efficient triage and follow-up services

11
Pathology Key changes in the last 5 years
  • ? screen detected breast lesions
  • Difficult to assess borderline lesions
  • ? of non-palpable breast lesions
  • More volume to process
  • Development of new biological markers and their
    adoption as standard of care
  • Impact on HR, pathology lab budget
  • Pathology has become an integral part of clinical
    multidisciplinary teams (HR)
  • Pathology is a key player in breast cancer
    research (HR)

12
Pathology What can we expect in the next 5
years?
  • ? volume
  • ? discovery of new biological markers, both as
    prognostic and predictive markers
  • New molecular / genetic classification
  • Molecular finger printing of breast cancer
  • Increased use of image analysis for marker
    assessment
  • Identification of stem cell markers

13
Radiation Oncology Key changes in the last 5
years
  • Infiltrating Ductal Carcinoma
  • The Expanding Role of XRT
  • Increasing use of Locoregional XRT
  • Improved Techniques of XRT
  • Intensity-Modulated Radiation Therapy less
    toxicity
  • Boost for women lt 50 years old
  • Partial breast radiation (Brachytherapy)
  • Reducing the Toxicity of XRT
  • Cardiac toxicity
  • IMRT leads to less scatter
  • Ductal Carcinoma in Situ
  • Increasing incidence
  • Increasing evidence of benefit of XRT
  • Increasing concerns of under treatment and
    potential over treatment

14
Radiation Oncology What can we expect in the
next 5 years?
  • Early Stage Breast Cancer
  • Partial breast irradiation (external
    beam/brachytherapy/IORT)
  • Image guidance and Adaptive Radiotherapy
  • Is bolus necessary?
  • Locally Advanced Breast Cancer
  • Combined modality therapy
  • Increased intensity of treatment with reduced
    treatment time
  • Imaging for the evaluation of treatment response
    (US, PET, MRI)
  • DCIS
  • Identify factors predictive of invasive
    recurrence
  • Improved Risk Stratification
  • Lumpectomy /Lumpectomy XRT / Mastectomy
  • Improve XRT Techniques
  • Partial breast irradiation
  • Role of boost for young women

15
Medical Oncology Key changes in the last 5 years
  • Expanded indications for adjuvant chemotherapy
  • Node negative, HER2 positive
  • Dose-dense chemo
  • Use of G-CSRF, erythropoetin
  • Use of adjuvant taxanes
  • Increased use of neo-adjuvant therapy
  • AIs in adjuvant therapy
  • Length of adjuvant endocrine therapy
  • Wide use of bisphosphonates
  • Use of biologics
  • Herception met//adjuvant
  • Lapatinib

16
Medical Oncology What can we expect in the next
5 years?
  • New tests for prediction
  • Oncotype DX
  • Other molecular signatures
  • Use of biologics in adjuvant therapy
  • Use of adjuvant chemotherapy
  • Drugs for metastatic disease
  • Fewer patients with metastatic disease

17
Survivorship What has changed in the last 5
years?
  • Awareness of survivorship issues
  • Length of endocrine adjuvant therapy
  • More survivors for longer
  • Issues of
  • QOL
  • Exercise, body and weight
  • Other lifestyle issues

18
Survivorship What will change in the next 5
years?
  • Extended endocrine adjuvant therapy
  • Focus on lifestyle issues
  • Biologics and their long term effects

19
Palliative Care Key changes in the last 5 years
  • Expanding role in the care of patients prior to
    end-of-life
  • Clinical expertise in the management of symptoms
    associated with breast cancer lymphedema,
    brachial plexopathy, complex neuropathic/bony
    mets pain syndromes

20
Palliative Care What can we expect in the next
5 years?
  • As the research base within the field of
    palliative medicine expands, greater body of
    evidence for targeted and individualized pain and
    symptom management interventions
  • Expanding role for interventional pain management
    procedures nerve blocks
  • Ongoing source of care and support for patients
    with disease progression

21
Care Delivery Models Key changes in the last 5
years
  • Screening Programs (OBSP)
  • Diagnostic Assessment Units
  • Multidisciplinary Programs
  • Survivorship Programs

22
Diagnostic Assessment Units
  • Completing diagnostic evaluation in a
    streamlined, comprehensive and timely manner
  • Principles
  • Patient-focused
  • Multidisciplinary
  • Timely
  • Components
  • Triage mechanism
  • Breast imaging mammography, US, biopsy, MRI
  • Clinical assessment
  • Patient Navigator

23
Diagnostic Assessment Unit What might it look
like?
  • Triage referrals
  • Imaging
  • Screening or diagnostic
  • Clinic
  • Surgical or nonsurgical
  • Streamlined diagnostic imaging
  • All diagnostic studies (except MRI) same day
  • MRI and MRI-generated FU studies same day
  • Rapid turnaround of pathology
  • Prompt clinic appt after diagnostic evaluation
  • Patient navigation/nursing support

24
Breast cancer Summary of Key changes in the
last 5 years
  • Improved and expanded screening and early
    diagnosis
  • Reduced mortality rates
  • Reduced or stable incidence rates
  • Increased use of imaging
  • Use of sentinel node
  • More breast conserving surgery
  • New radiation approaches
  • Improved adjuvant endocrine therapy
  • New adjuvant chemotherapy
  • Biologics

25
Breast Cancer Key changes in the next 5 years
  • New approaches to surgery
  • Image-guidance
  • New approaches to radiation
  • Image-guidance
  • New approaches to systemic therapy
  • Especially biologics
  • Lifestyle approaches for survivors
  • More survivors for longer

26
What Do Women Want?
  • In-depth interviews with
  • Health care providers
  • Former patients
  • Informal caregivers
  • Telephone survey of 800 women without cancer
  • Cancer professionals

27
Executive Summary
  • The Problem
  • Lack of coordination of care
  • Gaps in communication between health care
    providers
  • Lack of psycho-social support with the shock of
    the diagnosis
  • Lack of information
  • Feeling numb and dumb at time of critical
    treatment decision-making
  • Provider knowledge
  • Many participants expressed disappointment with
    the breast cancer knowledge of their primary care
    providers

28
Executive Summary
  • The Potential Solution
  • Navigator ?
  • Multidisciplinary care ?
  • Increased Psychosocial support
  • Educational websites? Brochures? DVDs?
  • Well follow-up clinics?
  • The Problem
  • Lack of coordination of care
  • Gaps in communication between health care
    providers
  • Lack of psycho-social support with the shock of
    the diagnosis
  • Lack of information
  • Feeling numb and dumb at time of critical
    treatment decision-making
  • Provider knowledge
  • Many participants expressed disappointment with
    the breast cancer knowledge of their primary care
    providers

29
What Could Make Treatment for Breast Cancer a
Wonderful Experience?
  • Informed Participation
  • Emotional Support
  • Timeliness

30
Breast Cancer at TSRCC/Sunnybrook
31
Breast Cancer at TSRCC
  • One of 2 largest breast programs in Canada
  • One of 6 or 8 largest breast programs in North
    America
  • Primary nursing model
  • Multidisciplinary care
  • Interdisciplinary care
  • Strong emphasis on research/teaching
  • Volumes
  • Surgery volumes
  • Radiation volumes
  • Medical Oncology volumes
  • See handout in package for breast activity at
    TSRCC

32
Breast Site Group at TSRCC
  • 17 Medical Oncologists
  • 16 Radiation Oncologists
  • 4 Surgeons
  • 3 (4) Specialist pathologists
  • 2 (3) Specialist diagnostic imagers
  • 15 RNs
  • Social workers
  • Dietitians
  • Pharmacists
  • Physicists
  • Radiation therapists
  • Genetic counselors

33
Accomplishments
34
Honors and Awards
  • Prominent Role in NCIC/CTG Breast Group
  • Prominent Role in OCOG Breast Group
  • Fellowship Program
  • Campbell Endowed Fellowship
  • Industry Fellowships
  • CAMO Fellows
  • CBCF Fellows
  • CFI Awards
  • 11.2 x 106 for Breast Centre
  • Breast Centre 27 million dollars
  • As a primary fundraising target SHSC

35
Honours and Awards (contd)
  • Grants
  • Dr. Eileen Rakovitch largest CBCRA grant 2007,
    5 years
  • Dr. Arun Seth
  • CBCRA 2005-2010 Metastatic Breast Cancer Genome
    Anatomy 610,000
  • CBCRA (Grant Core Component) 2005-2010 New
    Approaches to Metastatic Disease in Breast Cancer
    (METS) 969,067
  • NIH, USA 2007-2012 The BCA2 Ubiquitin E3 Ligase
    as a Target in Breast Cancer 1,759,000 USD

36
Honours and Awards (contd)
  • Grants
  • Dr. Greg Czarnota
  • 2 OICR grants 300,000
  • CBCF 428, 000
  • Drs. Yaffe/Plewes Terry Fox Grant
  • Dr. Claire Holloway and others
  • OCRN grant 300,000
  • Plenary Session at ASTRO Dr. Jean-Philippe
    Pignol
  • O.H. Warwick Award - Dr. Kathleen I. Pritchard,
    2005

37
Landmark Papers
  • Warner E. et al. Surveillance of BRCA1 and BRCA2
    Mutation Carriers With Magnetic Resonance
    Imaging, Ultrasound, Mammography, and Clinical
    Breast Examination. JAMA. 2004 2921317-1325
  • Yaffe, M. et al. Diagnostic Performance of
    Digital versus Film Mammography for Breast-Cancer
    Screening. New England Journal of Medicine,
    Volume 3531773-1783 October 27, 2005 Number 17
  • Pritchard, K.I. et al. HER2 and Responsiveness
    of Breast Cancer to Adjuvant Chemotherapy. New
    England Journal of Medicine, Volume 354 2103-11,
    May 18, 2006 Number 26
  • Seth, A.K. et al. A Novel RING-Type Ubiquitin
    Ligase Breast Cancer-Associated Gene 2 Correlates
    with Outcome in Invasive Breast Cancer. American
    Association for Cancer Research.

38
Prevention Accomplishments
  • Comprehensive assessment of genetic and cancer
    risk
  • Accrual to chemoprevention studies
  • Follow-up of high risk women
  • Participation in collaborative research
  • Education/training
  • Regional role

39
SurgeryAccomplishments
  • Establishment of an academic program in breast
    surgery
  • Fellowship training program
  • Critical mass of academic surgeons
  • Standardized multi- and interdisciplinary care
  • Integrated research program
  • Multidisciplinary
  • Partnerships with U of T, ICES, CCO
  • Surgical representation at provincial, national
    organizations
  • Grants
  • Imaging and histopathology correlation after
    neo-adjuvant chemotherapy (CBCF)
  • Radioimmunoguided surgery (OCRN)
  • Evaluating the quality of sentinel lymph node
    biopsy quality in Ontario (CBCF)
  • Patterns of breast cancer surgery in Ontario (CCO)

40
Pathology Accomplishments
  • Sign-out of breast cases by dedicated specialized
    pathologists
  • Adoption of synoptic reporting
  • Testing for ER/PR and Her2/neu on all patients at
    the time of diagnosis
  • Improving TAT. In general, only 10 of cases are
    gt10 days for the whole department (all specimen
    types)
  • Leader for setting provincial and national Her2
    testing guidelines and QA program
  • Established TMA facility

41
Pathology Accomplishments
  • Academic achievements
  • a) Grants
  • b) CME activities
  • c) Tumour Boards
  • d) Regular clinicopathological rounds weekly
  • e) Member of expert panel and publication of
    CAP/ASCO guidelines
  • (Wolff AC, Hammond EH, Schwartz JN. Guideline
    Recommendations for Human Epidermal Growth
    Factor Receptor 2 Testing in Breast Cancer. J
    Clin Oncol 200725(1)1-28.)
  • f) Tumour Banking initiative (old new)

42
Radiation Oncology Accomplishments
  • Prevention / Screening
  • Population-based assessments of screening
  • Treatment
  • Development of a Permanent Breast Seed implant
  • PI of randomized clinical trial on Breast IMRT
  • Plenary Session at ASTRO
  • Development of international bone metastases
    module to accompany the EORTC QLQ-C30 for
    patients with bone metastases.
  • PI on International RCT of Single versus Multiple
    Fractions for Re-Irradiation of Painful Bony
    Metastases NCIC SC 20
  • Chemoradiation for LABC
  • Novel imaging of LABC to determine response to
    treatment
  • Outcomes
  • Establishment of population-based provincial
    cohort of DCIS, LCIS (Pathology)
  • Population-based assessment of cardiac toxicity
    following XRT for breast cancer

43
Medical Oncology Accomplishments
  • Strong contribution to new international
    standards for adjuvant endocrine, biologic and
    chemotherapy via NCIC CTG (MA.5, MA.17, MA.17R,
    MA.21, MA.27)
  • Strong phase II program
  • NCIC CTG
  • PMH Consortium
  • Strong Correlation phase I-IV programs
  • MA.22
  • MA.29
  • Chemo radiation
  • LABC programs
  • BLISS programs

44
Specialty Clinical Components
  • Primary Nursing Model
  • LABC
  • Brachytherapy
  • Lymphedema clinic
  • Breast prosthesis
  • BLISS

45
LABC Program
  • Mission
  • To provide consistent, high quality,
    multidisciplinary care in a patient-centered or
    needs-led format.
  • Objectives
  • Increase understanding of long-term clinical
    outcomes.
  • Design program of excellence.
  • Continue national preceptorship program for
    health
  • care professionals.

46
Ongoing Clinical Trials
Imaging MRI Study (Wright) MRI Technique
(Czarnota) Spectroscopy (Czarnota)
Neoadjuvant Therapy MA.22 (Trudeau) ATSEA
(Clemons/Holloway/Verma) Chemorads
(Spayne/Holloway)
Psychosocial Risk Perception Delayed
Presentation Male Partners Role (Fergus/Fitzgeral
d)
47
LABC The Future
  • Maintain high quality, multidisciplinary care for
    our patients
  • Re-institute RN lead program
  • Improve public awareness
  • Maintain LABC database
  • Improve outcomes for women with LABC

48
Breast Brachytherapy
  • 20 30 of patients with Early Stage Breast
    Cancer are potentially eligible
  • Unique to TSRCC in the GTA
  • Includes 2 types of procedures
  • Permanent Breast Seed Implant
  • High Dose Rate (HDR) brachytherapy

49
Permanent Breast Seed Implant
  • Developed at Sunnybrook
  • Not (yet) offered anywhere else
  • Huge PR impact
  • Visitors from USA and Europe
  • Main advantages
  • 1 hour procedure
  • Minimal toxicity
  • Minimal exposure of radiation to normal tissues
  • Current Status
  • Phase I/II Trial complete (65 patients)
  • Presented at international meetings

50
HDR Brachytherapy
  • Different technique
  • Insertion of multiple catheters
  • Treatment is delivered bid x 5 days
  • Advantages
  • can be used in cases where seeds not feasible
  • Large seroma
  • Large volumes
  • Great potential for Image Guided Brachytherapy
    research
  • Status
  • NSABP B-39

51
The Future of Breast Brachytherapy
  1. Identify SPACE
  2. Identify funding for seeds
  3. Create a Database
  4. Establish a Training Program
  5. Establish an Image-guided therapy Program

52
Lymphedema Clinic
  • 1990 N.P. 2 per week,2007 6 N.P.per wk.
  • Growth 2006, 300 N.P. F.U 700 from all sites
  • Now 2 Nurses
  • Clinics expanded to 2 ½ days per week

53
Lymphedema Highlights
  • Patient information booklet in progress
  • Education booklet in progress
  • Visiting Therapists
  • Palliative Care Physicians rotate through clinic
  • Inpatient consults
  • XRT Student Research
  • Staff inservice and staff orientation
  • Delta Study participation

54
Breast Prosthesis
  • Craniofacial Prosthetic Unit
  • Trial currently underway comparing artistic
    custom breast prostheses against current standard
    prostheses
  • Assessing patient demand, patient preference,
    business model, and technical methods
  • Early results extremely encouraging
  • Objective is to integrate custom breast
    prostheses into breast site care path

55
BLISS A Program for Young Women With Breast
Cancer
  • Breast cancer before 40
  • Life after cancer
  • Innovative treatments
  • Scientific research
  • Support for women and their families

56
BLISS Executive Summary
  • 5 of breast cancers occur in women lt age 40 at
    diagnosis (10 of TSRCC patients)
  • Disproportionately represent breast cancer
    burden of excess morbidity, mortality, and loss
    to society.
  • Women have special clinical needs which are
    currently not being met
  • Large research gaps exist
  • CLINICAL AND RESEARCH CHALLENGE
  • BLISS
  • Interdisciplinary treatment and research program
  • Opportunity to
  • Create a new model of care
  • Improve outcomes of all young women with breast
    cancer

57
Research
58
External funding has more than tripled
59
(No Transcript)
60
Our Research Directions
  • Improved detection
  • Developments in breast MRI, tomosynthesis
  • Population-based assessments of screening
  • More accurate diagnosis
  • 3D pathology, high field MRI
  • Efficient and accurate localization for
    biopsy/therapy
  • MRI, US
  • More precise, less invasive surgical treatment
  • Image-guided surgical intervention
    (Intraoperative US, specialized surgical
    instruments)
  • New radiation techniques
  • Brachytherapy
  • Image-guided radiation therapy

61
Our Research Directions
  • Phase II/III trials
  • With major correlational components
  • Monitoring response to therapy
  • High and mid freq ultrasound
  • Patient-specific treatment
  • Molecular profiling, correlative
    studies(tumour/tissue/image data warehouse), and
    mid/high frequency US and MRI
  • Better understanding of disease processes
  • High field MRI, molecular pathology, 3D pathology
  • Identifying tumour signatures leads to improved
    detection, diagnostic and therapeutic techniques,
    preventive measures

62
Our Research Directions
  • Palliative research
  • Psychosocial research
  • Psychosocial and Behavioral Research Unit (790
    Bay Street)
  • Community Research Initiative (survivorship
    issues, health disparities, participatory
    research expertise)
  • Ontario Breast Cancer Information Exchange
    Partnership (needs assessment, dissemination
    expertise)
  • Outcomes Research
  • Ongoing independent research projects evaluating
    breast cancer outcomes
  • DCIS, LABC, young women, BRCA, Henrietta Banting
    Database
  • No formal organization or co-ordination of
    projects or resources
  • CFI funded data server for patient data and
    imaging (hardware in H wing)

63
Clinical Outcomes Unit Future
  • COU planning group (ER, LP, MLQ) meeting
    bimonthly to shape the initial vision of the COU
  • Collaborate with existing provincial resources to
    determine the elements of the TSRCC Outcomes Unit
  • Develop a comprehensive provincial
    population-based patient database
  • Acquisition of complete data on treatment and
    outcomes
  • Develop research priorities

64
Breast Cancer Research at SHSC
Increased Convenience
Lower morbidity
Greater support
Higher cure rates
Survivor
Improving the QOL of women with Breast Cancer
65
Breast Cancer Research at TSRCC
Increased Convenience
Lower morbidity
Greater support
Higher cure rates
Survivor
Improving the QOL of women with Breast Cancer
Breast Brachytherapy
IMRT
Scatter Study
Image-guidance
Palliation of Bone Mets
Cardiac Toxicity
Bolus Study
DCIS / LCIS
Education / Preferences
Outcomes
66
Breast Cancer Research at TSRCC
Increased Convenience
Lower morbidity
Greater support
Higher cure rates
Survivor
Improving the QOL of women with Breast Cancer
Adjuvant Chemotherapy Endocrine, Biologics
Hot Flash Therapy Trials
Studies of Cognitive Change on Chemotherapy
Phase II
Breast Brachytherapy
IMRT
Scatter Study
Image-guidance
Palliation of Bone Mets
Cardiac Toxicity
Bolus Study
DCIS / LCIS
Education / Preferences
Outcomes
67
Breast Cancer Research at TSRCC
Increased Convenience
Lower morbidity
Greater support
Higher cure rates
Survivor
Improving the QOL of women with Breast Cancer
Adjuvant Chemotherapy Endocrine, Biologics
Hot Flash Therapy Trials
Studies of Cognitive Change on Chemotherapy
Phase II
Survivorship Program
Breast Brachytherapy
Chemoradiation
LABC clinic
IMRT
BLISS clinic
Scatter Study
Image-guidance
Palliation of Bone Mets
Cardiac Toxicity
Bolus Study
DCIS / LCIS
Education / Preferences
Outcomes
68
Breast Cancer Research at TSRCC
Increased Convenience
Lower morbidity
Greater support
Higher cure rates
Survivor
Improving the QOL of women with Breast Cancer
Adjuvant Chemotherapy Endocrine, Biologics
Hot Flash Therapy Trials
Studies of Cognitive Change on Chemotherapy
Phase II
Survivorship Program
Experimental OR
LABC clinic
Breast Brachytherapy
Chemoradiation
IMRT
BLISS clinic
Image-guidance
Scatter Study
Palliation of Bone Mets
Bolus Study
Cardiac Toxicity
DCIS / LCIS
Education / Preferences
Outcomes
69
Breast Cancer Research at TSRCC
Increased Convenience
Lower morbidity
Greater support
Higher cure rates
Survivor
Improving the QOL of women with Breast Cancer
Adjuvant Chemotherapy Endocrine, Biologics
Hot Flash Therapy Trials
Studies of Cognitive Change on Chemotherapy
Phase II
Survivorship Program
Image-guided surgery
LABC clinic
Breast Brachytherapy
Chemoradiation
IMRT
BLISS clinic
Image-guidance
Scatter Study
Palliation of Bone Mets
Bolus Study
Cardiac Toxicity
DCIS / LCIS
Education / Preferences
Outcomes
70
Education
71
Health Care Education Activities
  • Undergraduate
  • Postgraduate
  • Residents
  • Fellows
  • Other health care professionals
  • Oncologists
  • Regional Cancer Centers
  • Family Physicians
  • Nurses and Pharmacists
  • Allied health care workers

72
Health Care Education Activities
  • Current Key Education Activities
  • Local
  • Breast Cancer Rounds
  • Breast Cancer Visiting Professorship
  • Toronto Breast Cancer Guidelines
  • Fellowship Program
  • Current Key Education Activities
  • National and International
  • Breast Cancer Fellowship Program
  • www.oncologyeducation.ca
  • Toronto Breast Cancer Symposia

73
Patient Education
  • Patient Education Program strategic priority
    for TSRCC
  • Providing Patients with the right information, at
    the right time, in the right way, by the right
    people
  • Breast Site including Breast Centre has
    identified commitment to patient education
    throughout draft functional program

74
Patient Education Initiatives
  • Breast Cancer Patient Portal
  • Breast site patient education package
  • Development of Internal Breast Resources
    (lumpectomy, mastectomy, lymphedema booklet)
  • Patient Education and Learning Resource Centre
    (PEARL)
  • Patient Education Satellite Site (Breast Centre)

75
Ontario Breast Screening Program
76
GTA OBSP Growth Pattern
77
GTA OBSP Growth Pattern
78
Toronto Central OBSP Growth Pattern
79
Toronto Central OBSP Growth Pattern
80
Breast Activity at TSRCC
81
Data for March is projected, only data for
February 2007 is currently available. Data for
Preventative Oncology is under review.
82
The number of new cases were compared to the
pervious years cases to determine the percent
change. All new cases to all areas were included
and as a result, an individual patient may be
counted more than once. Data for March is
projected, only data for February 2007 is
currently available. Data for Preventative
Oncology is under review.
83
The number of new cases were compared to the
pervious years cases to determine the percent
change. All new cases to all areas were included
and as a result, an individual patient may be
counted more than once. Data for March is
projected, only data for February 2007 is
currently available. Data for Preventative
Oncology is under review.
84

Data for March is projected, only data for
February 2007 is currently available. Data from
Preventative Oncology will be provided at a later
date.
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