Report from the Ready for the Next Round Thought-Leadership Roundtables on Building Resilience in Cancer Care and Control in Canada-Colorectal Cancer Canada; 2021
, Radmila Day 1, Lavina Matai 1, Fred Horne 2, Timothy P. Hanna 3,4, David Armstrong 5, Susan Marlin 6, Olivier Jérôme 7, Darren R. Brenner 8,9, Winson Cheung 8, Laszlo Radvanyi 10, Eva Villalba 11, Natalie Leon 12, Chana Cohen 1, Karine Chalifour 13, Ronald Burkes 14,15, Sharlene Gill 16,17, Scott Berry 3, Brandon S. Sheffield 18, add
Show full author list
Round 1
Reviewer 1 Report
Review of the manuscript:
Conference report: Report from the Ready for the Next Round Thought-Leadership Roundtables on Building Resilience in Cancer Care and Control in Canada- Colorectal Cancer Canada; 2021
The COVID-19 pandemic illuminated vulnerabilities of health care systems in a high number of countries all over the world especially when it comes to cancer care. Similarly to Canada many countries are still experiencing “significant disruptions to cancer-related services”.
The aims of the reported conference were rather clear and straightforward - to understand the impact of the pandemic on cancer care; to identify strategies to address current backlogs and prevent future failures; to learn the lessons of the pandemic that could be useful improving cancer care in the future, and to find innovative strategies to strengthen our healthcare and research systems. These questions and proposed solutions are of great importance for health care systems in various countries - developed, developing, and, especially, underdeveloped.
The most important issues addressed during the conference, to my opinion, was further elaboration of electronic medical records and development of “telehealth”. Improved EMR could result in collecting data in a systematic way allowing better identification outcomes amongst various groups of patients. What is of the utmost importance this data should be shared and available for “nationwide collaborative decisions”. Summarizing there is a high need for improved cancer patient data collection and reporting. Simultaneously telehealth, when combined with advanced EMR may play an important role organizing remote patient consultation, follow-up sessions etc.
However the discussion on the role of the healthcare system to “address and assuage burnout among healthcare workers” was somehow standard and formal, not providing newer concepts to salvage healthcare workers. It is of importance to notice that nearly all discussed issues are meant to foster efficiency of healthcare tasks, however all of these are somehow associated with increasing workload for this particular vulnerable group.
Patient centricity is being practiced and promoted in some countries, however process-centricity still prevails. It was mentioned that inclusion of all stakeholders is absolutely crucial to achieve that clinicians, patients, and researches would feel they are “a single community working for everyone’s benefit.”
Another important message communicated is the need for continuous long-term funding for health-related research instead of having various research groups competing for research grants and opportunities.
Summarizing this conference report seems to be quite timely and of high value, depicting vulnerable issues of health care system not only in Canada. There are a lot of common problems that are or will have to be addressed with engagement of all stakeholders.
Author Response
Response to comments raised by Reviewer 1
Manuscript # Curroncol-1602371: Report from the Ready for the Next Round Thought-Leadership Roundtables on Building Resilience in Cancer Care and Control in Canada- Colorectal Cancer Canada; 2021
General Comment: The COVID-19 pandemic illuminated vulnerabilities of health care systems in a high number of countries all over the world especially when it comes to cancer care. Similarly to Canada many countries are still experiencing “significant disruptions to cancer-related services”.
The aims of the reported conference were rather clear and straightforward - to understand the impact of the pandemic on cancer care; to identify strategies to address current backlogs and prevent future failures; to learn the lessons of the pandemic that could be useful improving cancer care in the future, and to find innovative strategies to strengthen our healthcare and research systems. These questions and proposed solutions are of great importance for health care systems in various countries - developed, developing, and, especially, underdeveloped.
Response: We thank the Reviewer for the accurate representation of our conference report.
Comment 1: The most important issues addressed during the conference, to my opinion, was further elaboration of electronic medical records and development of “telehealth”. Improved EMR could result in collecting data in a systematic way allowing better identification outcomes amongst various groups of patients. What is of the utmost importance this data should be shared and available for “nationwide collaborative decisions”. Summarizing there is a high need for improved cancer patient data collection and reporting. Simultaneously telehealth, when combined with advanced EMR may play an important role organizing remote patient consultation, follow-up sessions etc.
Response 1: We completely agree with the Reviewer. With a standardized EMR system, individuals can switch health providers, and the medical data can seamlessly transfer to the new institutions. It reduces duplication of records and identifies missing patient data. In addition, compared to the traditional paperwork, EMRs significantly decreases disease identification time, making healthcare more time efficient and cost effective. In conjugation to the wide implementation of EMRs, telehealth could reinforce EMR efforts and alleviate backlogs in the healthcare system, allowing patients to get seen, diagnosed, and treated timely.
Comment 2: However, the discussion on the role of the healthcare system to “address and assuage burnout among healthcare workers” was somehow standard and formal, not providing newer concepts to salvage healthcare workers. It is of importance to notice that nearly all discussed issues are meant to foster efficiency of healthcare tasks, however all of these are somehow associated with increasing workload for this vulnerable group.
Response 2: We appreciate the Reviewer’s point-of-view in relation to not providing newer concepts to salvage healthcare workers. We have revised the recommendations section and added a few more discussion points that could potentially assuage some of the burnout among health providers.
Added discussion points (page 15, lines 529-534):
- Structure multi-disciplinary team for psychosocial support.
- Provide and compensate health care professionals with practical support while at work (i.e., transportation, social services for children, elderly, or animal care).
- Implement regular attending rotations and reduced durations of front-line shifts.
- Allow for planned vacations even during an outbreak.
- Implement strategies to reduce the stigma associated with mental illness.
Comment 3: Patient centricity is being practiced and promoted in some countries, however process-centricity still prevails. It was mentioned that inclusion of all stakeholders is absolutely crucial to achieve that clinicians, patients, and researches would feel they are “a single community working for everyone’s benefit.”
Another important message communicated is the need for continuous long-term funding for health-related research instead of having various research groups competing for research grants and opportunities.
Response 3: We thank the reviewer for this comment, which was also raised by another reviewer. Patient engagement is an essential aspect in the research/development of biopharmaceutical products and disease management. Improving the lives of patients requires a deep understanding of their medical conditions, experiences, needs and priorities. This ties in to the Patient Values and Preferences program run by Colorectal Cancer Canada that aims to define patient values, and measure and assign a weight to patient values in cancer drug treatment to ensure Canadian patients are heard in the evaluation of cancer care and the reimbursement of cancer drugs by public agencies.
Comment 4: Summarizing this conference report seems to be quite timely and of high value, depicting vulnerable issues of health care system not only in Canada. There are a lot of common problems that are or will have to be addressed with engagement of all stakeholders.
Response 3: We thank the reviewer for recognizing the significance of the synthesized information in this report.
Reviewer 2 Report
In the article “Report from the Ready for the Next Round Thought-Leadership Roundtables on Building Resilience in Cancer Care and Control in Canada- Colorectal Cancer Canada” El Birzi et al address the problems in cancer-related services caused by the COVID-19 pandemic and propose decisions aiming to close emerging gaps across the cancer care continuum. To reach this goal, they facilitated a series of four thought-leadership roundtables, each representing the views of four different stakeholder groups: patients, physicians, healthcare system leaders, and researchers. Finally, six themes of strength were identified to serve as a springboard for building resilience within Canada’s health care systems including 1) advancing virtual care and digital health technologies to prevent future interruptions in cancer care delivery, 2) developing real-time data metrics, data sharing, and evidence-based decision-making, 3) enhancing public-private-non-profit partnerships to advance research and strengthen connections across the system, 4) advancing patient-centricity in cancer research to drive and encourage precision medicine approaches to care, 5) investing in training and hiring a robust supply of health care human resources, 6) implementing a national strategy and infrastructure to ensure inter-provincial collaborative data sharing.
I would like to thank the authors for their innovative approach with the involvement of all four different groups dealing with a health care system: physicians, healthcare system leaders, researchers and finally patients themselves. In my opinion, such a comprehensive approach is the best way to improve the patient care not only in the COVID-19 pandemic but also in general. The problems, which emerged within the COVID-19 pandemic, are discussed in an open way and reflect every day challenges in a patient care.
It was a pleasure for me to read this article. To be honest, I have nothing to add. I am sure the readers of Current Oncology and the medical society will benefit and learn a lot from this article for the future. The conclusion is ideal: “A resilient health care system that can respond to shocks and threats is not an emergency system; it is a robust everyday system that can respond to emergencies”. This statement we all should keep in our minds.
Author Response
Response to comments raised by Reviewer 2
Manuscript # Curroncol-1602371: Report from the Ready for the Next Round Thought-Leadership Roundtables on Building Resilience in Cancer Care and Control in Canada- Colorectal Cancer Canada; 2021
General Comment: In the article “Report from the Ready for the Next Round Thought-Leadership Roundtables on Building Resilience in Cancer Care and Control in Canada- Colorectal Cancer Canada” El Birzi et al address the problems in cancer-related services caused by the COVID-19 pandemic and propose decisions aiming to close emerging gaps across the cancer care continuum. To reach this goal, they facilitated a series of four thought-leadership roundtables, each representing the views of four different stakeholder groups: patients, physicians, healthcare system leaders, and researchers. Finally, six themes of strength were identified to serve as a springboard for building resilience within Canada’s health care systems including 1) advancing virtual care and digital health technologies to prevent future interruptions in cancer care delivery, 2) developing real-time data metrics, data sharing, and evidence-based decision-making, 3) enhancing public-private-non-profit partnerships to advance research and strengthen connections across the system, 4) advancing patient-centricity in cancer research to drive and encourage precision medicine approaches to care, 5) investing in training and hiring a robust supply of health care human resources, 6) implementing a national strategy and infrastructure to ensure inter-provincial collaborative data sharing.
Response: We thank the Reviewer for the accurate representation of our conference report.
Comment 1: I would like to thank the authors for their innovative approach with the involvement of all four different groups dealing with a health care system: physicians, healthcare system leaders, researchers and finally patients themselves. In my opinion, such a comprehensive approach is the best way to improve the patient care not only in the COVID-19 pandemic but also in general. The problems, which emerged within the COVID-19 pandemic, are discussed in an open way and reflect every day challenges in a patient care.
It was a pleasure for me to read this article. To be honest, I have nothing to add. I am sure the readers of Current Oncology and the medical society will benefit and learn a lot from this article for the future. The conclusion is ideal: “A resilient health care system that can respond to shocks and threats is not an emergency system; it is a robust everyday system that can respond to emergencies”. This statement we all should keep in our minds.
Response 1: We thank the reviewer for recognizing the significance of the synthesized information in this report. Indeed, a resilient health care system that can respond to shocks and threats is not an emergency system; it is a robust everyday system that can respond to emergencies. We hope that through this report, we not only highlight some of the major challenges and obstacles we are facing today but also confer recommendations, short- as well as long-term strategies that could alleviate some of the burdens on the healthcare system. "Even before the pandemic, hospitals in Canada were running at 110% to 120% capacity. To return to former capacity levels as well as to accommodate backlogs created by the pandemic will be a challenge. We need resilience within the healthcare system, but also re-engineering of the frameworks within which the system operates." – David Armstrong. We concur with the words of Dr David Armstrong; we need to re-engineer and rebuild an infrastructure that would and could withstand any future system shocks.
