Cancer: the leading cause of death in the country - Canadian Cancer
Statistics 2010 Released by the Canadian Cancer Society with Special Focus on
Care and Support for Dying Patients

MONTREAL, May 19 /CNW Telbec/ - The latest Canadian cancer statistics published this morning by the Canadian Cancer Society (CCS) confirm that cancer is now the leading cause of death in the country - and not just in Quebec - and that the disease is still on the rise nationwide.

In 2005 (the latest available data), 230,132 people died nationwide - 29% from cancer compared to 28% for circulatory diseases. And given Canada's growing and ageing population, the CCS believes that the number of cancer-related deaths will grow in the coming years.

Fast facts: Canadian Cancer Statistics 2010

    
    - In 2010, there will be an estimated 45,200 new cancer cases in Quebec
      (173,800 in Canada(1)) and 20,300 cancer-related deaths (76,200 in
      Canada).
    - There will be an estimated 124 new cancer cases diagnosed daily in
      Quebec and 56 cancer-related deaths (475 new diagnoses and 209 deaths
      in Canada).
    - Overall, incidence and death rates are the highest in Quebec and
      Atlantic Canada and are the lowest in British Columbia.
    - Lung, colorectal, prostate and breast cancer will represent more than
      half (54.4%) of all cancers diagnosed in Canada.
    - Close to one-third of cancer deaths (32.5%) are due to lung cancer in
      Quebec (27% in Canada).
        - Quebec will record the highest lung cancer death rate among women
          (30% vs. 26% for Canada).
        - Among women, lung cancer incidence and death rates continue to
          rise - in fact, they have more than tripled since 1975. The result:
          In Quebec, lung cancer will kill twice as many women as breast
          cancer (2900 cases versus 1400).
        - Among men, the highest lung cancer incidence and death rates
          continue to be in Quebec.
    - More men than women are diagnosed with cancer, but the gap between the
      two sexes has narrowed in recent years (51.7 per cent of cases are in
      men vs. 48.3 per cent of women).
    - The odds of getting cancer increase with age (88% of the new cancers
      that will occur in 2010 will be diagnosed in the 50 and over group.)
    

Special focus: cancer and end-of-life care

In the special section of Canadian Cancer Statistics 2010, it is revealed that the type and quality of the care and services enabling a cancer patient to die with dignity wherever they wish is a function of where they live in Canada.

Caring for a dying cancer patient is part of a palliative approach that is provided when a patient's healthcare team determines that a cancer is unlikely to be cured. The goal of this type of palliative care is to improve quality of life. This includes:

    
    - managing physical symptoms such as pain, nausea and shortness of breath
    - meeting emotional needs such as anxiety and depression
    - addressing spiritual needs
    - support for caregiver
    

The special report presented in Canadian Cancer Statistics 2010 highlights a number of troubling facts when it comes to end-end-life care in Canada:

    
    - There are inadequate services to allow people to die at home when this
      is their preference.
        - One reason for this is because community-based services are not
          available for dying people in some jurisdictions - an estimated 85%
          of Canadians who need home hospice care do not have access to such
          specialized services(2).
    - Palliative care services exists, but are often not used.
        - Patients and their families sometimes are not aware of available
          services.
        - Because it is often difficult to anticipate death, healthcare
          providers may not be able to judge when people with cancer should
          begin receiving care that is focused on palliative needs rather
          than disease treatment. Late enrolment to palliative care can mean
          a patient will not receive the benefits from care specifically
          focused on the needs of the dying
    - Families caring for dying people experience significant psychological
      and financial burdens.
        - A recent Canadian study reveals that the costs associated with
          caring for a terminal family member at home are approximately
          $5000(3).
    

The CCS agrees that while thinking about the death of a cancer patient may be difficult, this issue must be addressed. "We must talk about cancer patients who will die of the disease to make sure they can maintain their quality of life and dignity until they die," says Dr. Gilles Pineau, Scientific Advisor of the Canadian Cancer Society's Quebec Division.

End-of-life healthcare in Quebec(4) :

    
    - Given that Quebec's population is ageing, more and more people will get
      cancer and need end-of-life care in the coming years.
    - Among adults aged 20 or more, 264,389 Quebecers died from various
      causes between 1997 and 2001. In all, 180,436 of these deaths (some 45%
      attributable to cancer) were attributed to a chronic disease that could
      have benefited from end-of-life palliative care.
    - In Quebec, the main places where people die include the home, hospices,
      extended care facilities and hospitals (general or specialized care
      facilities).

      Deaths in the home

        - In Quebec, only 9.7% of cancer patients who could benefit from
          palliative care die at home. Yet, if given the choice, up to 80% of
          patients with cancer would prefer to die at home(5).
        - Family and friends are often asked to become the primary
          caregivers. But even though they may be supported by a care-giving
          team, this responsibility is often a major source of stress and
          worry, especially when the patient requires specialized care and
          full-time supervision. The CCS believes that in such situations,
          provisions should be made to transfer such patients to hospices
          instead of hospitals or emergency rooms.
        - The home death in rate is lower in Quebec than in other countries
          like the U.K, Australia and the U.S. In the U.K., 25% of cancer-
          related deaths occurred at home in 1990. In Southern Australia, 14%
          of cancer-related deaths occurred at home from 1981 to 1990. In the
          U.S, 24.9% of chronically ill Americans over the age of 65 died at
          home in 1997.

      Deaths in hospices

        - In Quebec, 4.6% of cancer patients who could benefit from
          palliative care die in hospices (a facility specialized in end-of-
          life care for targeted clientele such as cancer patients).

      Deaths in extended care facilities

        - Between 1997 and 2001, 18.6% of cancer patients who could have
          benefitted from palliative care died in extended care facilities.
          Here, age was a determining factor: more than 30% of people aged 80
          or more who could have benefited from palliative care spent their
          final days in extended care facilities.

      Deaths in general or specialized care facilities (hospitals)

        - 49.6% of cancer patients die in short-term care beds (this figure
          does not include those who died in palliate care units).
        - Emergency rooms are highly frequented at the end of life in Quebec;
          42.3% of people who die of cancer visit the ER at least once in
          their last two weeks of life; 3.7% of them die there. Emergency
          rooms are the gateway for 78.7% of hospitalizations which end in
          death for all diseases combined (85.4% among people aged 80 or
          more).
        - In their last month of life, 12% of cancer patients are
          hospitalized two or more times and 35.6% spend more than 14 days in
          the hospital. These figures reveal the need to improve coordination
          and continuity of care efforts at the end of life.
        - The last days of life require highly specialized care but home
          caregivers are not always able to provide such care. Many people
          believe that when a patient must be taken to a general or
          specialized care facility to ensure he is given adequate palliative
          care for a stay of several hours or days prior to his death, the
          goal of keeping this person in his natural environment for as long
          as possible has been met. However, the length of the hospital stay
          in 41.8% of these cases is more than two days - hence the need to
          offer more home hospice services and to increase the number of
          hospices.
    

"Allowing a patient to die with dignity is critical," asserts Dr. Bernard Lapointe, Chief of the Palliative Care Division at the Jewish General Hospital and Director of Palliative Care at McGill. Relieving pain, accompanying patients until the end, and supporting family and friends through this period as well as the grieving period requires a major social commitment and the implementation of conditions that will ensure that all Quebecers have access to palliative care and services, regardless of where they live."

End-of-life healthcare services in Quebec

    
    - There are 23 hospices in Quebec (more than 10 others are in the works).
    - There are 14 hospitals with a palliative care unit in Quebec. This is
      not a comprehensive list, as it mostly includes university (or
      university-affiliated) hospitals but not regional hospitals. One must
      also consider that hospitals without a palliative care unit set aside a
      certain number of beds in other units for people who require this type
      of care.
    - Not all CHSLD-Residential and Long-Term Care Centres offer palliative
      care (as they lack the necessary personnel/equipment). The Réseau des
      soins palliatifs directory lists 5 in Quebec.
    - Some 60 organizations offer home hospice care (emotional support,
      medical care, or both).
    - Resources for caregivers: there are at least 215 resources for
      caregivers who offer respite care, emotional support, or both. These
      services are offered following the availability of the volunteers who
      work at these centres.

    CCS advocacy recommendations regarding end-of-life care and support for
caregivers

    - An analysis of Quebec end-of-life care resources reveals that not all
      citizens have access to palliative care when they need it and where
      they want it. Every health and social services centre has its own
      budget, which it manages according to its priorities (there are 95 such
      centres in Quebec). The care provided differs from region to region in
      Quebec. The CCS supports Quebec Minister of Health and Social Services,
      Dr. Yves Bolduc, who recently announced his intention to develop a
      network of hospices throughout Quebec (minimum of one per centre).
    - An overview of studies on the profitability of end-of-life services
      reveals that hospices offer interdisciplinary end-of-life services
      (care, support, etc.) at a lower cost than the services provided by
      short-term care hospitals. The CCS believes that efforts must be made
      to implement a palliative care network that will offer medical care and
      psychosocial support to end-of-life patients and psychosocial support
      to families and loved ones.
    - The importance of psychosocial support is essential for caregivers and
      remains to be developed, but the CCS is continuing to lobby the federal
      government to establish a national caregiver strategy so the loved ones
      caring for dying patients receive better financial support.
    

"In the early 2000s, Quebec adopted an excellent end-of-life palliative care policy. However, access to palliative care aimed at alleviating physical and emotional pain at the end of life is still very limited across Quebec," added Dr. Lapointe.

"The Quebec government must provide access to specialized resources to reassure the public that when the time comes, they will have access to quality end-of-life palliative care. We cannot allow terminal patients to end their lives in pain, in distress and alone," concluded Mrs. Suzanne Dubois, Executive Director of the Quebec Division of the Canadian Cancer Society.

Canadian Cancer Statistics 2010 is prepared, printed and distributed by the Canadian Cancer Society in collaboration with the Public Health Agency of Canada, Statistics Canada, provincial and territorial cancer registries, as well as researchers based in universities and provincial or territorial cancer agencies.

The Canadian Cancer Society fights cancer by doing everything it can to prevent this disease, save lives and help those living with cancer. For more information on cancer or on Canadian Cancer Statistics 2010, visit cancer.ca or call our toll-free bilingual Cancer Information Service line at 1 888 939-3333.

    
    --------------------------------
    (1) Excluding the 75,500 cases of non melonoma skin cancer (basocellular
        and squamous).
    (2) The 2000 Senate report - "Quality End-of-Life Care: The Right of
        Every Canadian".
    (3) Costs to the home caregiver include:
        - The purchase of prescription and non-prescription medication;
        - Nutritional supplements, special meals and vitamins;
        - Diapers, hygiene products, dressing and other supplies;
        - Special furniture and devices such as beds, armchairs and toilet
          seats;
        - Travel and parking expenses.

        The financial burden that must be carried by the caregiver also
        includes lost wages from taking time off work in order to care for
        the patient; primary caregivers spend an estimated 2.6 hours a day
        taking care of a loved one.
    (4) 1997-2001 analysis - INSPQ study, March 2006, Soins palliatifs de fin
        de vie au Québec : Définition et mesure d'indicateurs Partie 1 :
        Population adulte (20 ans et plus)
    (5) Burge, F., Lawson, B., and Johnston, G. "Trends in the place of
        death of cancer patients, 1992-1997." Canadian Medical Association
        Journal, 2003; 168(3): 265-269
    

SOURCE Canadian Cancer Society, Quebec Division

For further information: For further information: André Beaulieu, Spokesperson and Senior Advisor, Public Relations, Canadian Cancer Society, Quebec Division, (514) 393-3444, abeaulieu@quebec.cancer.ca


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