The “Initiative to Maximize Progress in Adolescent and Young Adult Cancer Therapy” (IMPACT) Cohort Study
Dr. Sumit Gupta, MD, PhD Hospital for Sick Children, Toronto, Canada World Cancer Congress, Paris, Nov, 2016
Outline
Canadian healthcare system
Canadian challenges for AYA with cancer
The IMPACT Cohort Study
Future directions
Canadian Healthcare System Universal healthcare delivered by provinces Single government payer; no private healthcare
delivery for medically necessary services
Challenges for AYA with Cancer
Dispersed population over long distances
Strict age limits for pediatric hospitals, usually 18 years
National taskforce attempting to create and guide AYA cancer policy, but not yet successful
Several individual and local initiatives
IMPACT Cohort
POGONIS
15-18 year olds treated at a pediatric center
Chart Abstraction
15-21 year olds treated at an adult center
Healthcare Data
POGONIS
POGONIS
15-18 year olds treated at a pediatric center
Chart Abstraction
15-21 year olds treated at an adult center
Provincial pediatric oncology registry
Active data collection in each of Ontario’s five childhood cancer centers
About half of 15-17 year olds with cancer
Detailed demographic, disease, treatment and outcome data
Chart abstraction
POGONIS
15-18 year olds treated at a pediatric center
Chart Abstraction
15-21 year olds treated at an adult center
No equivalent AYA resources
Trained chart abstractors obtaining equivalent data on all 15-21 year olds with leukemia, lymphoma, sarcoma, testicular cancer over a 20 year period
Validation of each case individually
Research Potential of Single Health Payer System
All physician encounters result in a billing record submitted to Ontario government with fee codes and diagnosis codes
Each hospital admission results in a record with diagnosis, procedure and outcome codes
Equivalent records for ER, outpatient, and home care visits
Physician Billings
Hospital Discharges
Home Care
Vital Statistics
Ontario Cancer Registry
Citizenship and Immigration Canada Database
Uses of Population-Based Healthcare Data
Clinical events like relapse, second cancers
Long term outcomes
Pre-diagnosis healthcare use and diagnostic delay
Planned Initial Analyses Predictors of locus of care
Diagnostic delay predictors and consequences
Differences in treatment and outcome by locus of
care
End of life healthcare use
Long term health outcomes and healthcare use
International Collaborations
Acknowledgments IMPACT investigators, abstractors, analysts, students