More than 90 per cent of colorectal cancer cases are treatable and, unlike other types of cancer, if it recurs, there’s still reason for hope. “If you catch it at a time when it can still be cut out by a surgeon, it can still be cured,” says Dr. Jennifer Spratlin, a medical oncologist at Edmonton’s Cross Cancer Institute.
This makes followup surveillance extremely important but Spratlin found the surveillance just wasn’t happening in Alberta. In 2008, after tracking the followup blood tests of her clinic’s patients, she found that only 7.5 per cent of them (just over 150 patients) followed the recommendations regarding when and how often to be tested. The discoveries through her study, “Community Compliance With Carcinoembryonic Antigen: Followup of Patients With Colorectal Cancer” became a call to action for the province.
Now, more than five years later, Sanofi Canada and the Alberta Cancer Foundation are co-funding a provincial colorectal surveillance program to boost the number of patients receiving the recommended followup care to 90 per cent. “We’ve gone through all this time and expense and effort to treat these patients and to cure them of their disease. Yet if they’re not caught with a recurrence soon enough, [the treatment] could potentially be for nothing,” says Todd Shearer, Sanofi Canada’s manager of health outcomes for Western Canada in the area of oncology.
Both Spratlin and fellow oncologist Dr. Jay Easaw at the Tom Baker Cancer Centre in Calgary took strides towards that 90 per cent goal, even before Sanofi and the Alberta Cancer Foundation became involved. Prior to Spratlin’s study, the standard procedure at both clinics was to send letters to patients and their family physicians with a list of recommended followup procedures, including blood tests, CT scans and colonoscopies.
After 2007, doctors at the Tom Baker Centre decided to make those patient letters more detailed with specific dates for procedures. The staff at the Cross took a different approach, opting to take over surveillance itself and monitor it internally. But subsequent tracking by Spratlin showed that these measures, while they helped, hadn’t done enough. Still only 50 per cent of the 408 patients tracked at the Cross were receiving appropriate surveillance procedures.
Recent funding – $175,000 from the Alberta Cancer Foundation and $106,000 from Sanofi Canada – gives Easaw and Spratlin the chance to improve existing programs, as well as carefully track their outcomes for the next three years. Shearer explains that the goal is to take both oncologists’ programs, analyze the effects they’ve had and make recommendations to Alberta Health Services. “It’ll probably be a combination of the two systems that we move forward with,” he says.
The Cross’s current approach involves time and resources, explains Spratlin, and is something she hopes to improve by involving community members. Spratlin is introducing more education to her program to encourage more patient involvement in their own care and to relieve some of the burden on the Cross for tracking and
Easaw would like to get patients more involved in Calgary’s letter-writing system. “At the time of their last appointment, we’re going to ask the patient how they want to be contacted – text, email, letter or fax – and what we’ll do is send them reminders right before they’re to receive their next test,” he says. The idea is for the automated letters to prompt patients and ensure that their own surveillance tests get done.
Shearer says that including patients in all aspects of the programming particularly appealed to Sanofi Canada. “The key to it all is that patients have to be involved in their own care,” he says. “Hopefully patients will be more aware of why they need to undergo active surveillance.”
Regarding the patients that Easaw, and other doctors, have treated for colorectal cancer and are now tracking for followup, he says, “These patients are stage two and three colorectal patients,” says Easaw. “If the cancer does come back, hopefully we can find it early and still be thinking about a cure, and not having the disease progress to a point where a cure is no longer an option.”
With 1,900 Albertans diagnosed with colorectal cancer in 2011, it is the fourth most common cancer in the province and the second leading cause of cancer-related deaths for men and the third for women.
A program where patients are involved in their own care will hopefully save lives, says Shearer, but also save time and money. “The system itself is burdened by the recurrences and also by cumbersome followup, so the combination of the two programs should prove to be very cost-effective as well as enhance patient care.” Shearer predicts that programs to tackle surveillance will be needed in other parts of the country as well. “This is not a problem that is unique to Alberta. If we can show a positive outcome, I see it being in great demand across Canada.”