Development of Practice Recommendations for the Use of Sedation for Hospital-Based Routine Colonoscopies
For many patients, sedation improves the experience of colonoscopy. However, endoscopists lack guidance on the appropriate use of sedation, leading to variation in agents used and methods of delivery and monitoring. These variations can have major cost implications and may affect the quality of care provided to patients. Given the importance of colonoscopy in reducing the burden of colorectal cancer, it is critical to ensure colonoscopy is delivered efficiently while maintaining an excellent patient experience. To provide guidance to the field we evaluated the evidence supporting various sedation practices (Specific Aim 1: Evidence Reviews) and the cost impact of common sedation practices (Specific Aim 2: Cost Analysis). We then gathered experts and stakeholders to review the evidence and develop practice recommendations to guide practice regarding the use of sedation for routine hospital-based colonoscopy in Ontario (Specific Aim 3: Development of Practice Recommendations).
The final report for this work is available below:
"Report on the Development of Practice Recommendations for the Use of Sedation for Hospital-Based Routine Colonoscopies". We welcome any comments on the report via email to: sorvaria@smh.ca.
Improving the quality of Oncofertility Decision Making Through a CCSRI Quality of Life grant,we have created the first Canadian oncofertility decision aid with the goal of providing information to young breast cancer patients on the available fertility options prior to treatment that may cause infertility in survivorship and to assist young breast cancer patients in making fertility-related decisions that align with their values. The online version of the decision aid is available here: Begin Exploring Fertility Options, Risks and Expectations (BEFORE) decision aid.
This decision aid aims (1) to provide information to young breast cancer patients on the available fertility options prior to treatment that may cause infertility in survivorship; (2) to assist young breast cancer patients in making fertility-related decisions that align with their values; and (3) to act as an adjunct to consultation and help young breast cancer patients and health care providers to discuss treatment-related fertility risks and make fertility preservation decisions more effectively.
Laparoscopic versus Open Resection for the Surgical Management of Rectal Cancer
Through a CIHR Knowledge Synthesis Grant, we are seeking to determine whether laparoscopic surgery is non-inferior to open surgery for rectal cancer in terms of oncologic outcomes. Given the short-term advantages of laparoscopic surgery (faster postoperative recovery, shorter hospital stay, fewer complications, and better cosmetic results), most randomized controlled trials were designed to test for non-inferiority of the laparoscopic approach in terms of oncological outcomes. Non-inferiority trials aim to demonstrate that a novel treatment is not clinically worse than the comparator by more than a pre-specified small amount (Δ), known as the non-inferiority margin. Towards that end, we will systematically review available randomized controlled trials in accordance with recommendations for non-inferiority meta-analysis.
Reducing the Public Health Burden of Colorectal Cancer (CRC) Through Policy-Relevant Research Integrated in Programmatic Screening Through a CIHR Foundation Grant, we are seeking to reduce the public health burden of colorectal cancer by improving the quality of screening programs. Our objectives are to: (1) identify the best direct correspondence strategy to improve CRC screening program participation and (2) compare the effectiveness and cost-effectiveness of two screening tests, Fecal Immunochemical Testing (FIT) and Flexible Sigmoidoscopy (FS).
What Comes Next: Real World Health Services Utilization, Outcomes and Cost-Effectiveness after BRCA1 and BRCA2 Testing in Canada Through a CBCRF Grant, we aim to evaluate the impact of genetic testing for BRCA 1/2 mutations by developing a dataset of over 10,000 women who have undergone genetic testing at Mount Sinai and North York General Hospitals (this constitutes almost 70% of such tests in Ontario). Genetic testing data will be linked to health care databases to find cancer diagnosis, screening, surgery, and death information, and will be used to determine patterns of screening and surgery for women who have undergone gene testing, incidence of cancer and mortality among the population, factors influencing adherence to gene test result recommendations, and the cost-effectiveness of gene testing. Results will enhance understanding of how genetic testing affects patient outcomes and improve care for these women in Ontario, and could help inform decisions to improve testing and screening program delivery.
Knowledge to Action: Improving Local Therapy for Young Women with Breast Cancer across Canada. The main goal of this sub-project is to understand the frequency, predictors and impact of treatment delay for young women diagnosed with breast cancer. The investigators are also planning on evaluating the impact of breast conserving treatment on the survival of young women, and optimizing multi-disciplinary local therapy of primary breast cancer care for young women.
Initiative to Maximize Progress in AYA Cancer Therapy (IMPACT) Through POGO, C17 and CIHR grants, we are performing chart abstraction of all adolescents and young adults (AYA, aged 15-21 years) diagnosed and treated for cancer at in Ontario between 1992 and 2013 to create a retrospective database. We will perform a number of analyses that examine the impact of the location of cancer therapy (cancer centre vs. pediatric centre vs. community hospital) on entirety of the cancer journey, from diagnosis through end of life.
Effectiveness of Cancer Screening in Ontario Through CCO and CCSRI grants, we have identified patient and provider factors associated with participation in colorectal cancer (CRC) screening since the introduction of the population-based ColonCancerCheck program in Ontario. Through administration of a survey, we have examined the uptake of cancer screening facilitators, such as electronic medical records, among primary care physicians in Ontario. The survey data will be linked to administrative data bases at ICES to investigate factors related to keeping patients up to date with cancer screening. Using a meta-study methodology, we are also conducting a qualitative synthesis to identify contextual factors that influence participation in colorectal cancer screening.
For many patients, sedation improves the experience of colonoscopy. However, endoscopists lack guidance on the appropriate use of sedation, leading to variation in agents used and methods of delivery and monitoring. These variations can have major cost implications and may affect the quality of care provided to patients. Given the importance of colonoscopy in reducing the burden of colorectal cancer, it is critical to ensure colonoscopy is delivered efficiently while maintaining an excellent patient experience. To provide guidance to the field we evaluated the evidence supporting various sedation practices (Specific Aim 1: Evidence Reviews) and the cost impact of common sedation practices (Specific Aim 2: Cost Analysis). We then gathered experts and stakeholders to review the evidence and develop practice recommendations to guide practice regarding the use of sedation for routine hospital-based colonoscopy in Ontario (Specific Aim 3: Development of Practice Recommendations).
The final report for this work is available below:
"Report on the Development of Practice Recommendations for the Use of Sedation for Hospital-Based Routine Colonoscopies". We welcome any comments on the report via email to: sorvaria@smh.ca.
Improving the quality of Oncofertility Decision Making Through a CCSRI Quality of Life grant,we have created the first Canadian oncofertility decision aid with the goal of providing information to young breast cancer patients on the available fertility options prior to treatment that may cause infertility in survivorship and to assist young breast cancer patients in making fertility-related decisions that align with their values. The online version of the decision aid is available here: Begin Exploring Fertility Options, Risks and Expectations (BEFORE) decision aid.
This decision aid aims (1) to provide information to young breast cancer patients on the available fertility options prior to treatment that may cause infertility in survivorship; (2) to assist young breast cancer patients in making fertility-related decisions that align with their values; and (3) to act as an adjunct to consultation and help young breast cancer patients and health care providers to discuss treatment-related fertility risks and make fertility preservation decisions more effectively.
Laparoscopic versus Open Resection for the Surgical Management of Rectal Cancer
Through a CIHR Knowledge Synthesis Grant, we are seeking to determine whether laparoscopic surgery is non-inferior to open surgery for rectal cancer in terms of oncologic outcomes. Given the short-term advantages of laparoscopic surgery (faster postoperative recovery, shorter hospital stay, fewer complications, and better cosmetic results), most randomized controlled trials were designed to test for non-inferiority of the laparoscopic approach in terms of oncological outcomes. Non-inferiority trials aim to demonstrate that a novel treatment is not clinically worse than the comparator by more than a pre-specified small amount (Δ), known as the non-inferiority margin. Towards that end, we will systematically review available randomized controlled trials in accordance with recommendations for non-inferiority meta-analysis.
Reducing the Public Health Burden of Colorectal Cancer (CRC) Through Policy-Relevant Research Integrated in Programmatic Screening Through a CIHR Foundation Grant, we are seeking to reduce the public health burden of colorectal cancer by improving the quality of screening programs. Our objectives are to: (1) identify the best direct correspondence strategy to improve CRC screening program participation and (2) compare the effectiveness and cost-effectiveness of two screening tests, Fecal Immunochemical Testing (FIT) and Flexible Sigmoidoscopy (FS).
What Comes Next: Real World Health Services Utilization, Outcomes and Cost-Effectiveness after BRCA1 and BRCA2 Testing in Canada Through a CBCRF Grant, we aim to evaluate the impact of genetic testing for BRCA 1/2 mutations by developing a dataset of over 10,000 women who have undergone genetic testing at Mount Sinai and North York General Hospitals (this constitutes almost 70% of such tests in Ontario). Genetic testing data will be linked to health care databases to find cancer diagnosis, screening, surgery, and death information, and will be used to determine patterns of screening and surgery for women who have undergone gene testing, incidence of cancer and mortality among the population, factors influencing adherence to gene test result recommendations, and the cost-effectiveness of gene testing. Results will enhance understanding of how genetic testing affects patient outcomes and improve care for these women in Ontario, and could help inform decisions to improve testing and screening program delivery.
Knowledge to Action: Improving Local Therapy for Young Women with Breast Cancer across Canada. The main goal of this sub-project is to understand the frequency, predictors and impact of treatment delay for young women diagnosed with breast cancer. The investigators are also planning on evaluating the impact of breast conserving treatment on the survival of young women, and optimizing multi-disciplinary local therapy of primary breast cancer care for young women.
Initiative to Maximize Progress in AYA Cancer Therapy (IMPACT) Through POGO, C17 and CIHR grants, we are performing chart abstraction of all adolescents and young adults (AYA, aged 15-21 years) diagnosed and treated for cancer at in Ontario between 1992 and 2013 to create a retrospective database. We will perform a number of analyses that examine the impact of the location of cancer therapy (cancer centre vs. pediatric centre vs. community hospital) on entirety of the cancer journey, from diagnosis through end of life.
Effectiveness of Cancer Screening in Ontario Through CCO and CCSRI grants, we have identified patient and provider factors associated with participation in colorectal cancer (CRC) screening since the introduction of the population-based ColonCancerCheck program in Ontario. Through administration of a survey, we have examined the uptake of cancer screening facilitators, such as electronic medical records, among primary care physicians in Ontario. The survey data will be linked to administrative data bases at ICES to investigate factors related to keeping patients up to date with cancer screening. Using a meta-study methodology, we are also conducting a qualitative synthesis to identify contextual factors that influence participation in colorectal cancer screening.
