2008 marks Cancer Care Ontario’s 65th anniversary. While improving the cancer system in Ontario is an ongoing evolution, we’re proud of all we’ve accomplished so far and invite you to explore the interactive timeline below which charts 65 years of our history. To use the timeline, simply move your mouse inside the frame and place it on the year you’d like to view.
Two significant events took place in 1943 that would alter the history of cancer care in Ontario: the province enacted the Cancer Act and, as a result, the Ontario Cancer Treatment and Research Foundation (OCTRF) – now known as Cancer Care Ontario – was established in April of the same year.
With nine members in place, the Foundation held its first board meeting on June 22, 1944. Less than three months later, the Foundation’s advisory medical board convened its first meeting, led by Dr. Gordon E. Richards, who was named as OCTRF’s managing director.
It was at a subsequent medical advisory board meeting that the idea of centralized cancer care for the province was first brought up. The board recommended that cancer therapy should be concentrated in the present Ontario government clinics, and that three university centres should be developed, particularly for the teaching of the subject of cancer. The board also created six committees, each to focus on one aspect of the Foundation’s program, namely scientific and clinical research, public and professional education, cancer centres, and management.
With a $500,000 grant from the province, the Foundation set out to implement its program. It moved into its offices at 22 College Street in Toronto, where the rent was $204 a year. The office accommodated Dr. Richards, a full-time secretary, and a part-time secretary treasurer by the name of F. D. Beauchamp.
From this modest but ambitious beginning, the Ontario Cancer Research and Treatment Foundation would grow into the Cancer Care Ontario we know today – a vital provincial agency responsible for directing and overseeing nearly $700 million public health care dollars. And from its original team of three people, the Foundation would become home to nearly 500 employees occupying offices at 620 and 505 University Avenue in Toronto, and a satellite office in London, Ontario.
A chemotherapy nurse administers an intravenous
The effects of mustard gas on blood and bone marrow were noted in World War I and published in 1919. This eventually led to the experimental use of nitrogen mustard – a derivative of mustard gas – on patients with advanced lymphomas. Although short-lived, the positive results from these trials encouraged scientists to explore other drugs as potential cancer fighters. The era of cancer chemotherapy had begun.
Among the pioneers in cancer chemotherapy research was Dr. O. Harold Warwick, who is recognized as Canada’s first medical oncologist. In 1946, a fellowship took Dr. Warwick to London, England, where he conducted and published a clinical trial using nitrogen mustard. “I was convinced that these methods of treatment, though still in their infancy, would one day take their place alongside surgery and radiation in the treatment of cancer,” he observed.
These words have proven to be prophetic. Today, chemotherapy – also referred to as systemic treatment – plays a crucial role in the management of cancer. To further improve the quality and safety of chemotherapy, Cancer Care Ontario is working with its regional partners to develop a Regional Systemic Treatment Plan to enable, where possible, the delivery of chemotherapy treatment closer to home.
Kingston General Hospital's Victory Wing, the home
of the first Ontario Cancer Foundation Clinic.
Since the mid 1930s, there were radiotherapy institutes across Ontario, each associated with a large general hospital. On March 20, 1947, almost three years after it came into being, the Ontario Cancer Treatment and Research Foundation opened its first cancer clinic. Occupying 4,000 square feet in the newly completed Victory Wing of Kingston General Hospital, the Ontario Cancer Foundation Kingston Clinic – formerly the Institute of Radiotherapy – brought together for the first time the many disciplines of cancer care, with radiotherapists, cancer surgeons and specialists working together under one roof.
By 1954 the Foundation had taken over clinics in Hamilton, Ottawa, London, Windsor, and Port Arthur near Thunder Bay. Clinics in Sudbury and Toronto were added later. In 1984 these eight Ontario Cancer Foundation clinics were renamed regional cancer centres. Twenty years later, in January 2004, Cancer Care Ontario transferred the operation of these regional cancer centres to their host hospitals, and the hospital and cancer centre oncology activities were integrated into a single program. Since 2003, Ontario has added six new cancer centres to the original eight.
Demonstrating the new Cobalt-60 beam therapy unit
In 1951, against the backdrop of the Cold War, the world’s first commercial cobalt-60 beam therapy units were installed in London, Ontario, and Saskatoon, Saskatchewan. In October of that year, London’s Victoria Hospital became the first to treat a patient with this breakthrough treatment involving gamma radiation from the cobalt-60 isotope. Cobalt-60 beam therapy was more effective against deep-treated cancers than the older radiation units.
A computer-generated DNA structure (photo
courtesy Robert Guy, National Cancer Institute)
In February 1953, a decade after it had been confirmed that deoxyribonucleic acid carried genetic information, Cambridge University researchers James Watson and Francis Crick uncovered DNA’s double-helix structure and how it “unzips” to reproduce itself during cell division. Watson and Crick, along with Maurice Wilkin – who was working on his own DNA research at King’s College in London – received the Nobel Prize for physiology/medicine in 1962. Their work continues to provide the foundation for research in molecular oncology.
The main waiting room at the new Ontario Cancer
Institute and Princess Margaret Hospital
With major financial support from the Ontario Cancer Treatment and Research Foundation, the newly formed Ontario Cancer Institute and Princess Margaret Hospital opened their doors on September 25, 1958. Soon after, the new building also became home to the Ontario Institute of Radiology, which moved its equipment, staff and activities from the Toronto General Hospital. In October of the same year, Ontario’s premier unveiled a new lodge for the Princess Margaret Hospital designed to accommodate ambulatory patients.
1958 also marked another important milestone in cancer history: the discovery of the anti-cancer drug vinblastine by Robert Noble and Charles Thomas Beer. Derived from the Madagascar periwinkle and initially consumed as tea, vinblastine was shown to decrease the number of white blood cells. This led scientists to explore its effectiveness in fighting cancers such as lymphoma. Drs. Noble and Beer were inducted into the Canadian Medical Hall of Fame in 1997. The largest early study demonstrating the drug’s effectiveness in patients with Hodgkin’s Disease was carried out by O. Harold Warwick and his staff at Princess Margaret Hospital.
Drs. James Till and Ernest McCulloch in 2005 (photo
courtesy of Princess Margaret Hospital)
Recognizing that many cancer patients could simply not afford the cost of chemotherapy and other drugs such as pain relievers, the Ontario Cancer Treatment and Research Foundation launched its therapeutic drug plan in 1960. The plan, which was initially available to cancer patients being treated at home, was later extended to outpatients being treated at regional cancer centres.
Around this time, Drs. Ernest McCulloch and James Till – a biologist and physicist working together at the Ontario Cancer Institute – began testing bone marrow cells as part of experiments to accurately measure the radiation sensitivity of bone marrow. But the nodules, which developed in the spleen of the mice, led to a groundbreaking chance discovery: that each nodule came from a single marrow cell. This finding demonstrated the existence of stem cells and led the way for bone marrow transplants and other treatments for chronic diseases.
In 1970 the Cancer Statistics section of the Research and Planning Branch of the Ontario Department of Health transferred to the head office of the Ontario Cancer Treatment and Research Foundation. This move led to the Foundation taking over the Ontario Cancer Registry, the repository of cancer data in the province, including information about newly diagnosed cases of cancer in Ontario since 1964. Today Cancer Care Ontario uses this data to monitor the incidence of cancer, mortality and survival patterns, and cancer trends – all factors that are used to plan cancer care in the province.
The 1970s were also an important decade for cancer research. At the National Cancer Institute of Canada, Dr. Anthony Miller was busy studying the effectiveness of Pap smears in reducing the number of deaths from uterine cancer in Canada. The result of his efforts: a demonstrable link between regular Pap smear screening and a significant decline in deaths from uterine cancer among Canadian women aged 30 to 64.
The GE 265 Mark I computer filled an entire room.
The Ontario Cancer Treatment and Research Foundation entered the technology era in 1972, thanks to a gift from the Canadian General Electric Company – the GE 265 Mark I Computer. The Mark I, which was acquired for the Foundation by its chief medical statistician Alf Sellers, filled an entire room at the General Electric office on King Street in Toronto. The Foundation and clinics throughout the province were linked to the computer by a telecommunication network. Today Cancer Care Ontario is a leader in creating information management systems that improve the safety and experience of cancer patients.
Even from its early years, the Ontario Cancer Treatment and Research Foundation was very much committed to developing and promoting cancer clinical trials in the province. So in 1982 it brought together all the cancer centres and created the Ontario Clinical Oncology Group, an affiliate organization that carries out cancer clinical trials throughout the province and the country. Dr. Peter McCulloch was the Group’s first director.
To date, more than 8,000 patients have participated in the Ontario Clinical Oncology Group’s trials for numerous types of cancer. The Group has a team of about 45 specialists, including methodologists, statisticians, clinician researchers and trials staff.
Cancer researcher Dr. Tak Mak (photo
courtesy of Princess Margaret Hospital)
Dr. Tak Mak at the Ontario Cancer Institute published his now world-famous article on the cloning of T-cell receptor genes, a discovery that has proven to be critical to developing new cancer treatment and prevention strategies, including anti-cancer vaccines.
In 1984, to improve cancer patients’ access to information about their disease and the resources available to them, the Ontario Cancer Treatment and Research Foundation partnered with the Canadian Cancer Society to create a provincial Cancer Information Service. Today the Canadian Cancer Society continues to operate this important program, which has expanded to support cancer patients and their families across the country. To reach the toll-free service, call 1-888-939-3333.
Mammography screening for breast cancer can
detect small cancers before they can be felt.
Just as scientists in the United States were launching the Human Genome Project to shed light on the genetic makeup of humans, the Ontario Cancer Treatment and Research Foundation was staging its own launch with the new Ontario Breast Screening Program, the first system for organized breast cancer screening in the province. By 2003, the Ontario Breast Screening Program hit a milestone with 100 screening sites in its network. As of 2008, the program counted 139 screening sites.
Demonstrating leadership and innovative thinking, in the face of longer-than-acceptable wait times for radiation treatment, the Ontario Cancer Treatment and Research Foundation set up a temporary central office for referring patients to cancer centres further from home. While not everyone in the province approved of this tactic, the Foundation’s leaders felt it was the best way at the time to give all Ontarians access to timely radiation treatment. The Central Re-referral Office was re-opened in 1999 when waits for radiation treatment again became too long.
1994 was especially busy for the Ontario Cancer Treatment and Research Foundation. This was the year it established the Ontario Cancer Treatment Practice Guidelines Initiative to begin the critical task of developing, implementing, and monitoring province-wide practice guidelines and standards. This initiative, known today as the Program in Evidence-Based Care, continues to improve the quality of cancer care by helping to apply the best scientific evidence in practice and decisions.
This year also saw the creation of the Ontario Cancer Genetics Network, which oversees research on familial and inherited cancer, and the Ontario Task Force on the Primary Prevention of Cancer. The latter group’s recommendations on how family physicians and other primary care providers can help reduce the incidence of cancer was published the following year.
The Ontario government got tough on smoking in 1994, with the Tobacco Control Act. Among other things, the Act imposed rules on selling and smoking tobacco, especially among younger Ontarians. In 2006, in an effort to limit exposure to second-hand smoke, the legislation was expanded to prohibit smoking in enclosed workplaces and enclosed public places, and renamed the Smoke-Free Ontario Act.
At the same time, the Ontario government released Life to Gain, its cancer strategy for the province, which came out of a public consultation that took place in 1993. The plan resulted in the creation of the Provincial Cancer Network, a group representing cancer patients, health care providers, agencies, community groups, hospitals, and planners. The Network’s mandate was to develop a broad framework for cancer services in Ontario. Its recommendations were published in April 1995 in the provincial government’s Cancer Action Plan.
A computer-generated model
of a Taxol molecule (photo
courtesy George McGregor,
National Cancer Institute)
With the new chemotherapy drug Taxol now approved for use in the province, the Ontario Cancer Treatment and Research Foundation received $5 million to lead a pilot program for its use. Close to 1,000 cancer patients in Ontario received Taxol through this program.
Today’s New Drug Funding Program covers about 75% of the overall cost of all intravenous cancer drugs in Ontario, spending $176 million in 2007. By 2011 this amount is expected to reach $446 million.
Another noteworthy event in 1995 was the formation of the Division of Information Services within the Foundation to further leverage the use of information technology in gathering, analyzing, and using cancer data to enhance cancer care in the province.
By 1996 it had become clear that Ontarians needed a more organized and aligned cancer system. Ontario’s Minister of Health appointed a transition team to implement a new provincial framework for cancer care. This new framework included the transformation of the Ontario Cancer Treatment and Research Foundation into Cancer Care Ontario, an agency that would have a stronger and more comprehensive mandate to improve cancer services in the province.
1996 was also the year that the Foundation broke new ground by joining forces with representatives of Ontario’s Aboriginal organizations to improve cancer care for the province’s Aboriginal communities. This partnership acknowledged that conventional cancer care services were not adequately reaching Aboriginal people.
The next chapter in the identity of Ontario's cancer agency
What’s in a name: On April 29, the Ontario Cancer Treatment and Research Foundation officially changed its name to Cancer Care Ontario. The new agency took on the task of coordinating and integrating cancer treatment services across the province.
Early in its mandate, Ontario’s new cancer agency began implementing an ambitious plan for changes to the cancer care system. Taking aim at cancer prevention and screening, the agency created a Cancer Prevention Unit focused on the most well-established cancer risks: smoking, obesity and physical inactivity. Today’s prevention efforts continue to focus on these areas, and on developing a better understanding of how occupational and environmental carcinogens cause cancer.
In 1998, Cancer Care Ontario also formed the Surgical Oncology Network to generate and provide information on cancer surgery. Serving as a communication link between cancer centres, referring surgeons, family physicians, and patients, the Network was intended to help drive better decisions and enhance patient care. Today, the Surgical Oncology Program continues to improve the quality and accessibility of cancer surgery across Ontario.
A regular Pap test can save your life. That’s the message driven home by Cancer Care Ontario and the Ministry of Health and Long-Term Care at the launch of the Ontario Cervical Screening Program, created in 2000 to help reduce cervical cancer rates in Ontario. Each year an estimated 500 women are diagnosed with cervical cancer and about 150 die from the disease.
Today the Program works with a variety of partners to make sure Ontario women have access to a comprehensive, coordinated system that supports high-quality cervical screening.
Between April 1999 and May 2001 about 1,500 patients had been referred to the United States for radiation treatment. In February 2001, Cancer Care Ontario opened an after-hours clinic in Toronto to provide timely radiation services closer to home for breast and prostate cancer patients. The clinic was managed by Canadian Radiation Oncology Services through a contractual agreement with Cancer Care Ontario. Though controversial, this innovative solution to improve access to radiation treatment successfully eliminated the need to send Ontario cancer patients to the United States.
The Toronto-Sunnybrook Regional Cancer Centre – now the Odette Cancer Centre – and the R.H. McLaughlin Durham Regional Cancer Centre took over management of the clinic in September 2003. Since then, Ontario’s wait times for radiation treatment have improved steadily and significantly thanks to better planning and new investments in cancer centres, radiation equipment replacement and personnel.
Established to monitor and guide quality improvement efforts and publicly report on the performance of the cancer system, the Cancer Quality Council of Ontario was the first of its kind in Canada. The Council provided a unique opportunity to work with patients, cancer service providers and policy makers to improve Ontario’s cancer system.
Working in partnership with Cancer Care Ontario, the Council continues to identify and assess gaps in cancer system performance and quality, and advise on planning and strategic priorities. Each year, the Council and Cancer Care Ontario jointly publish the Cancer System Quality Index, a web-based report on the cancer system’s performance.
Released in the spring of 2003, the Cancer 2020 report Targeting Cancer: An Action Plan for Cancer Prevention and Detection, laid out an ambitious action plan for Cancer Care Ontario and other organizations involved in cancer prevention and early detection. A progress report was published three years later. Thanks to the efforts of a wide range of organizations and individuals, important gains have been made in cancer prevention and early detection since Cancer 2020 was released, particularly in lowering smoking rates.
Also during this year, the Cancer Quality Council of Ontario published its inaugural report, a two-volume book that described the state of the province’s cancer programs and services. Strengthening the Quality of Cancer Services in Ontario included contributions from over 30 experts in the field of oncology, addressing major quality issues in the cancer system.
The Ontario Cancer Plan, Ontario's roadmap for the
The new year started with a bang: January 1, 2004 was the day that Cancer Care Ontario and its partner hospitals realized a shared vision for an integrated cancer system to improve care for all cancer patients in the province. The regional cancer centres previously managed by CCO were formally integrated with the hospitals to provide more comprehensive care under one umbrella. The goal? To create a coordinated, seamless journey for cancer patients and their families.
This unprecedented policy shift moved CCO’s attention away from the day-to-day management of cancer services to focus on quality, accountability and innovation and more effectively advise government on cancer system change.
In support of its new mandate, Cancer Care Ontario released the Ontario Cancer Plan 2005-2008, a three-year action plan and roadmap for Ontario’s new cancer system. Building on the progress made since then, the second , launched in March 2008, articulates a vision and strategy for transforming Ontario’s good cancer system into a great cancer system that will give Ontarians access to high-quality, timely and patient-focused care, regardless of their location, language or income. Ontario Cancer Plan
In November, Cancer Care Ontario was appointed by Ontario’s Ministry of Health and Long-Term Care to operate the Wait Time Information System because of its experience working with complex provincial health information systems. This system – a key part of the Ontario government’s Wait Time Strategy – is the first-ever information system to monitor, measure and publicly report wait times across the province.
Continuing the cancer system transformation that started in 2004 with the integration of regional cancer centres with hospitals, in 2005 Cancer Care Ontario established Regional Cancer Programs to respond to local cancer issues and needs, act on provincial standards and programs locally, and improve access, wait times and quality of cancer care. Comprising stakeholders, health care professionals and organizations involved in cancer prevention and care, Regional Cancer Programs manage and coordinate care across local and regional health care providers.
In partnership with the Cancer Quality Council of Ontario, Cancer Care Ontario unveiled the Cancer System Quality Index. A first in North America, the web-based index evaluated progress against the disease and identified areas for improvement in prevention, treatment and care. The Cancer System Quality Index is updated annually.
Recognizing the great potential for cancer research in Ontario, in December 2005, the Ontario government committed $142 million over four years to create the Ontario Institute for Cancer Research. In July 2006, Dr. Tom Hudson, an experienced leader and internationally recognized genetics researcher, was appointed President and Scientific Director of the Institute. Under his leadership, this new major hub for cancer research in Ontario would bring together leading researchers and partner with other provincial, national and international research institutions. Over time, this collaborative approach will strengthen Ontario’s reputation for innovation in cancer research and bring advanced cancer therapies sooner to patients.
ISAAC allows patients to track their own symptoms.
To help cancer patients cope with the physical and emotional effects of their illness and treatment, Cancer Care Ontario developed ISAAC – short for Interactive Symptom Assessment and Collection – an easy-to-use electronic tool that allows cancer patients to track their symptoms through a touch-screen computer kiosk at their local cancer centre, or from home via the Internet. Assessments are automatically sent to the patient's care team so their symptoms can be identified quickly and managed more effectively.
Initially developed as part of a short-term project, today ISAAC continues to be expanded across the province. In 2008, the tool was adopted by the British Columbia Cancer Agency, and also won the top award for Innovation in Health Information Management at the Celebrating Innovations in Health Care Expo.
The ColonCancerCheck program
distributes Fecal Occult Blood
Test (FOBT) kits across the
Canada’s first population-based colorectal cancer screening program was launched in Ontario in January 2007. The second deadliest form of cancer in Canada, colorectal cancer is preventable, and, if detected early, has a 90% chance of being effectively treated or cured. ColonCancerCheck boosts colorectal cancer screening for Ontarians aged 50 years or older by widely distributing fecal occult blood test kits for those at average risk, and increasing access to colonoscopies for those who test positive or are deemed to be at increased risk.
Like colorectal cancer, cervical cancer, which is caused by persistent human papillomavirus (HPV) infections, is also preventable. In 2007, Ontario adopted a powerful new tool in the battle against cervical cancer: a vaccine that can block many HPV infections before they occur. The vaccine is most effective if given to girls before they become sexually active.
Ontario’s voluntary, school-based HPV vaccination program for Grade 8 girls was launched at the beginning of the 2007 school year. Together, the HPV vaccine and regular Pap tests provide the best protection against cervical cancer.
Meanwhile, a group of health care partners began a major, long-term research project to improve our understanding of the risk factors that lead to cancer and other chronic diseases. The Ontario Population Cohort Study will eventually involve approximately 150,000 Ontarians, aged 35 to 69 years, whose health will be tracked for more than 30 years. In the long term, the study will yield an unprecedented wealth of new information about the health of Ontarians.
Scientific research is the engine that drives improvements in cancer prevention, detection and care when it is rapidly translated into the delivery of care. Today, cancer patients in Ontario live longer and enjoy a better quality of life because of advancements stemming from research.
In 2008, Cancer Care Ontario introduced a new Research Chairs Program, to strengthen research in Ontario in four thematic areas. An expanded pool of researchers will allow Ontario to build a critical mass of scientists focused on transferring research from the laboratory to the bedside to benefit patients and the cancer system.
2008 also saw a commitment by the Ontario government to fund the Anna Maria de Souza Knowledge Transfer Centre for Oncology Nursing, a partnership between Cancer Care Ontario and Princess Margaret Hospital. This Centre will provide specialized education for new graduates and nurses working in cancer programs to help them meet the complex needs of cancer patients.
From its modest beginnings 65 years ago, Cancer Care Ontario has evolved into an organization that directs close to $700 million annually for cancer services in Ontario, with an extensive network that includes 13 Regional Cancer Programs led by Regional Vice Presidents. Our efforts have led to a number of significant improvements in the cancer system. We now have a common set of measures for monitoring and reporting on the performance of the cancer system. Through a more integrated model for delivering cancer services, experts in radiation, chemotherapy and surgery have come together in a multidisciplinary team environment. And the creation of programs in prevention, screening, palliative care, and disease assessment and management is driving a more comprehensive approach to managing cancer in Ontario.
It’s hard to imagine what discoveries and opportunities the next 65 years will bring. But by building on the solid foundation and partnerships established over the last 65 years, Cancer Care Ontario will continue its efforts to reduce cancer rates and provide better cancer care every step of the way. Year by year, decade by decade, we are moving towards our goal of creating the best cancer system in the world -- a system all Ontarians will be proud of. And more importantly, a system they can count on to deliver the timely and high quality cancer care all Ontarians deserve.