Since 2012, the Cancer SCN has worked with patients, families, operational leaders and other health and community partners to address care gaps and develop provincial standards and clinical best practices that improve patient safety, care and outcomes.

Provincial Breast Health Initiative

In 2016, the Cancer SCN established the Provincial Breast Health Initiative in partnership with the Surgery SCN and Cancer Control Alberta. The initiative brought together patients, providers, and administrators to achieve provincial consensus on an end-to-end breast health pathway. Using data, best practices and input from patients and families, the team designed and implemented improvements to address priority gaps in care.

The work has several components, which focus on improving health outcomes, patient experience, access to information, screening and coordinated, and earlier diagnosis. Learn more

Outcome improvements

• Since implementing the care pathways, the wait time between a suspicious test result and confirmed breast cancer diagnosis decreased by 60% (from 19 days in 2016 to 6 days in 2018)
• In 2014-15, 5% of mastectomies in Alberta were performed as day surgeries. By 2018-19, this increased to 46% with no increase in complications or readmission rates. This means that women can return home sooner, and hospital beds previously used for surgical recovery are open to other patients. Project profile

This work received a President’s Excellence Award for Quality Improvement. The award recognizes teams who made evidence-based quality improvements that improved health outcomes for patients and their families and/or clinical effectiveness.

Genetics Mainstreaming: Hereditary Cancer Program

Approximately 10-15% of cancer is due to an inherited genetic change (mutation) in a cancer gene. For breast and ovarian cancer, gene mutations are most commonly found in the BRCA1 or BRCA2 gene. Identifying BRCA gene mutations early can impact treatment decisions, indicate risk for other cancers, and inform risks for cancer among family members.

In collaboration with Hereditary Cancer Clinic (HCC) and Cancer Care Alberta, the Cancer SCN implemented a new process―called mainstreaming―to increase access to genetic testing for ovarian and breast cancer.

Outcome improvements

• Since implementing mainstreaming, oncology clinicians can directly order hereditary cancer genetic testing for ovarian cancer patients, bypassing the need for separate pre-test genetic counselling in the HCC.
• Provincial implementation of mainstreaming ovarian and breast cancer genetics has resulted in more timely genetic testing for high-risk patients, reduced wait times for results, and realized treatment cost savings of $880,212 over one year (based on prevention of secondary breast and ovarian cancers; 2019-20 data)
• For more information on outcome improvements, including wait-times, improved patient experience, and cost-savings, see the 2019-20 Year-End Report

Head & Neck Cancer (HNC) Surgery Inpatient Care Pathway

This work involved co-designing a provincial clinical care pathway for HNC patients in collaboration with Head and Neck surgical teams in Edmonton and Calgary and the Cancer, Critical Care and Surgery SCNs. The care pathway incorporated best practices and aimed to reduce inappropriate variation and maximize value from existing capacity.

Outcome improvements

• This work resulted in changes to perioperative care, including a more consistent approach to pre- and post-operative education, establishment of nutrition and mobilization protocols, development of an automated monthly dashboard report, improved quality and consistency of post-surgical care, and significant improvements to health outcomes.
• Pathway implementation has led to reduced length of stay in hospital and ICU, an 8.5% reduction in ICU readmissions, and estimated >5,500 hospital bed days avoided to date.
• Reduced health services utilization has resulted in more than $6.9 million in gross savings (2012-2019).

For more information, see:

• Efficacy of a high‐observation protocol in major HNC surgery: A prospective study
• Optimal perioperative care in major HNC surgery with free flap reconstruction: A consensus review and recommendations from the ERAS Society

Palliative Care for Patients with End-Stage Illness

This work focused on patients with unmet palliative care needs who present to emergency. The Cancer SCN collaborated with the Emergency Medicine Research Group and Alberta emergency departments (EDs) to determine the frequency of their hospital visits, investigate ED provider and patient perspectives on unmet end-of-life (EOL) care needs, and conduct systematic literature reviews on the effectiveness of ED-based palliative care screening tools and interventions.

Outcome improvements

• This study generated evidence that presentations to the ED for EOL conditions require significant resources, and opportunity exists to improve how these patients are managed and cared for in Alberta. Although many patients presented to the ED with unmet palliative care needs, few were referred to palliative services or community supports. Learn more

Rectal Cancer Post-Diagnostic Care Pathway

With funding from an Alberta Innovates Partnership for Research and Innovation in the Health System (PRIHS) grant, the Cancer SCN focused on multidisciplinary team care for stage II and III rectal cancer patients. The team developed and implemented a rectal cancer clinical care pathway with an aim to reduce unwarranted variation, optimize care and improve outcomes, including recurrence rates.

Outcome improvements

• The pathway addressed appropriate pre-operative staging, consideration of neo-adjuvant and adjuvant therapy, and appropriate surgery. It was developed in collaboration with a multidisciplinary physician group (radiologists, surgeons, oncologists, and pathologists) as a comprehensive sequence of interventions tailored for local practice environments. Learn more

Treatment Prioritization Framework for Cancer Care Alberta

In 2020, the Cancer SCN co-developed a Treatment Prioritization Framework with provincial tumor teams and supportive care leads as part of its pandemic contingency planning. The framework guides the delivery of CCA services (systemic therapy, radiation therapy and supportive care) in the event of staff shortages during a pandemic to ensure standard of care is maintained. The framework does not include cancer services outside CCA such as surgery.

Understanding Patients’ Experience with Bladder Cancer

A collaboration between the Cancer SCN, Dr. Nimira Alimohamed (an oncologist with the Tom Baker Cancer Centre in Calgary), Susan Nguyen (a Patient and Community Engagement Researcher [PaCER] and two-time bladder cancer survivor), and Marlyn Gill (a fellow PaCER researcher familiar with cancer and chronic disease). Together they set out to understand the experiences of people with bladder cancer in Alberta. Final report (2018)