Models of care toolkit

About this section

This section of the toolkit describes how innovative models of care can be used to enhance the scope of practice of cancer care team members.

Optimizing scope of practice

In cities and metropolitan centres cancer care is delivered by a multidisciplinary team that includes oncology specialists, physicians, nurses, pharmacists, therapists and other allied health professionals. While practice decisions ultimately rest with the primary oncologist, the patient and their family, there are opportunities within innovative models of care to engage other providers in the care team in decisions. For non-oncology providers, this may require a formal or informal change to professional scopes of practice as legislation, certification or health care centre allows.

By contrast, in rural and remote communities, cancer care is often supported by family physicians or other primary care teams with nurses, nurse practitioners and clinical practitioners in oncology (CPO). This reflects the availability of specialists within these communities and is considered a practical approach to care.

Models that limit routine cancer care to specialists can require patients to travel long distances to receive care. Ongoing staffing shortages, burnout, and attrition due to retirement, together with the challenge of recruiting and retaining people in certain professions increases pressure on cancer systems already under strain. These capacity issues are exacerbated by the COVID-19 pandemic.

The importance of supporting nurses

icon three nursesExcessive demands placed on nurses is causing attrition, work-related stress and exhaustion, and potentially causing mental health disorder symptoms. This situation has been exacerbated during the COVID-19 pandemic. Persistent burnout and staff leaving the practice require innovative ways to use existing resources effectively, while ensuring safe and ethical work environments and providing mental health and wellness supports. Support resources are available through leading Canadian organizations including: the Canadian Association of Mental Health, the Canadian Mental Health Association, and the Canadian Centre on Substance Use and Addiction.

A note on terminology

In Canada, primary care doctors are eligible to receive additional training in cancer care. Depending on the province or territory and the type and level of specialized training received, they can be called clinical practitioners in oncology (CPO) or general practitioners in oncology (GPO). In this toolkit, the term CPO is used, which is inclusive of family physicians and general internists; however, other terms may be used to refer to this type of practitioner. For more information on practitioners who provide cancer services visit The Canadian Association of General Practitioners in Oncology’s website.

Scalable and spreadable models

Models of care with potential for scale and spread across jurisdictions were identified using evidence from a rapid synthesis by McMaster Health Forum and existing best practices.

  1. Williamson S, Beaver K, Gardner A, Martin-Hirsch P. Telephone follow-up after treatment for endometrial cancer: A qualitative study of patients’ and clinical nurse specialists’ experiences in the ENDCAT trial. Eur J Oncol Nurs. 2018;34:61-67.
  2. Beaver K, Williamson S, Sutton CJ, Gardner A, Martin-Hirsch P. Endometrial cancer patients’ preferences for follow-up after treatment: A cross-sectional survey. Eur J Oncol Nurs. 2020;45(101722):101722..
  3. Beaver K, Williamson S, Sutton C, et al. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG. 2017;124(1):150-160.
  4. Cohen PA, Webb PM, King M, et al. Getting the MOST out of follow-up: a randomized controlled trial comparing 3 monthly nurse led follow-up via telehealth, including monitoring CA125 and patient reported outcomes using the MOST (Measure of Ovarian Symptoms and Treatment concerns) with routine clinic based or telehealth follow-up, after completion of first line chemotherapy in patients with epithelial ovarian cancer. Int J Gynecol Cancer. Published online 2021:ijgc-2021-002999.
  5. Schenker Y, Althouse AD, Rosenzweig M, et al. Effect of an oncology nurse-led primary palliative care intervention on patients with advanced cancer: The CONNECT cluster randomized clinical trial: The CONNECT cluster randomized clinical trial. JAMA Intern Med. 2021;181(11):1451-1460.
  6. Komatsu H, Yagasaki K, Yamaguchi T, et al. Effects of a nurse-led medication self-management programme in women with oral treatments for metastatic breast cancer: A mixed-method randomised controlled trial. Eur J Oncol Nurs. 2020;47(101780):101780.
  7. Nelson S, Turnbull J, Bainbridge L, et al. Optimizing Scopes of Practice: New Models for a New Health Care System.; 2014. Accessed November 22, 2021. https://www.cahs-acss.ca/wp-content/uploads/2014/08/Optimizing-Scopes-of-Practice_REPORT-English.pdf
  8. BC Cancer. Primary Care Nurse Practitioners. Accessed December 2, 2021. http://www.bccancer.bc.ca/our-services/services/primary-care
  9. Bayshore Health Care. CareChart. Accessed December 2, 2021. https://www.bayshore.ca/services/government/care/?gclid=CjwKCAjw7fuJBhBdEiwA2lLMYeRHHHTW01oLkWjEuxEeotQ1xyCr14JRceToJfkl_rnOhyYHhVqg4RoCIFEQAvD_BwE
  10. Ontario Health (Cancer Care Ontario). Complex Malignant Hematology Models of Care: Recommendations for Changes in the Roles and Composition of the Multidisciplinary Team and the Setting of Care to Improve Access for Patients in Ontario – March 2017. Accessed December 2, 2021. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/43051%5d
  11. BC Cancer. Community Oncology Network. Accessed December 2, 2021. http://www.bccancer.bc.ca/health-professionals/networks/community-oncology-network
  12. Health Sciences North. Cancer Care. Accessed December 2, 2021. https://hsnsudbury.ca/en/Services-and-Specialties/Cancer-Care
  13. BC Cancer. General Practitioner in Oncology Education Program. Accessed December 2, 2021. http://www.bccancer.bc.ca/health-professionals/networks/family-practice-oncology-network/general-practitioner-in-oncology-education-program
  14. BC Cancer. Family Practice Oncology Network. Accessed December 2, 2021. http://www.bccancer.bc.ca/health-professionals/networks/family-practice-oncology-network
  15. Ontario Health (Cancer Care Ontario). Advanced Practice Nursing Toolkit. Accessed December 2, 2021. https://www.cancercareontario.ca/en/guidelines-advice/treatment-modality/nursing-care/advanced-practice-nursing-toolkit
  16. Ontario Health (Cancer Care Network). Oncology Nursing Program. Accessed December 2, 2021. https://www.cancercareontario.ca/en/cancer-care-ontario/programs/clinical-services/oncology-nursing-program
  17. University of Manitoba. Cancer Care Enhanced Skills Residency. Accessed December 2, 2021. https://umanitoba.ca/medicine/department-family-medicine/cancer-care-enhanced-skills-residency
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