CancerCare Manitoba
IN SIXTY - Questions and Answers

What is IN SIXTY?
IN SIXTY is the new strategy of action and quality care for patients during their first days of cancer suspicion, diagnosis and to a first treatment if needed. In June 2011, the Province of Manitoba announced a $40 million investment towards transforming the cancer patient journey. In November 2011 the development of IN SIXTY (also known as the Cancer Patient Journey Initiative) began with a Manitoba Cancer Partnership Steering Committee and an overarching goal to reduce the time from suspicion of cancer to first treatment to 60 days or less, by no later than 2016, and to do so in a sustainable manner that also improves the quality of the cancer patient experience.

Why do we need IN SIXTY?
Cancer can affect anyone at anytime. In Manitoba, over 6100 patients are diagnosed annually and up to ten times more undergo investigations for suspected cancers. Many patients and their families have found the cancer journey complex, difficult to understand and highly stressful, especially in the first few weeks when testing procedures and specialist appointments are occurring. Any delay in tests and care during this time heighten anxiety and may critically affect clinical outcomes, such as patients requiring more intensive treatments. When IN SIXTY began, the suspicion to treatment phase for patients took anywhere from 3 to 9 months. Some delays were rooted in: a lack of coordination, integration, and information flow among the multiple health care organizations involved - resulting in complex care pathways and patient handoffs; lack of clinically-defined diagnostic and treatment care pathways- resulting in diagnosis and treatment delays; poor communication between the health care system and patients during this initial stage in their cancer journey. Services need to be streamlined and new approaches across organizations are needed to make the best use of the skills available in the cancer workforce.

When will the improvements happen?
While the 60 day goal will take several years to achieve, many improvements are occurring along the way. So far:
  • A Patient Participation Advisory Group of cancer survivors and current cancer patients was formed to participate and advise the work occurring on the cancer journey in Manitoba. This is the first time a patient group has been directly involved from start to finish in health care changes;
  • Breast Cancer guidelines to explain the referral to testing and specialists process were improved and provided to referring physicians;
  • An advanced diagnostics machine that helps determine the best therapy for breast cancer patients, thus getting the right treatment for patients faster, was added in Manitoba;
  • New wait time targets for diagnosis and treatment are being developed by cross sector groups of physicians and surgeons for several major cancers including: breast, colorectal, lung, prostate, and lymphoma;
  • Improved access via texting and web forms for UPCON, the cancer helpline service for health care professionals;
  • Enhanced and integrated services are being added to rural the Community Cancer Program Network across Manitoba, bringing cancer counselling and cancer navigation expertise closer to people in their own communities;
  • Nurse Navigators have been added to Cancer Navigation Services to help connect and guide suspected or diagnosed cancer patients and their family physicians with the diagnostic services and specialist care they need.
  • A vulnerable population program has been added to CancerCare Manitoba to assess and address the unique needs of demographic groups who are at higher risk of barriers in care transitions;
  • A Program and Evaluation Monitoring group is reviewing and improving the data collection processes to better understand where and when delays occur during the cancer journey;
  • Site specific improvements have been taking place at several hospitals and clinics across the province to tighten administrative processes at the front line of care.
  • An Information Management group is focused on developing a tracking system to alert providers if patients are at risk of not meeting the 60 day targets.

Who is part of IN SIXTY to improve the cancer journey?
IN SIXTY is a partnership of Manitoba Health, CancerCare Manitoba, Diagnostic Services of Manitoba, all regional health authorities in Manitoba, family physicians and other health care providers. These partners have brought together key players and patients from across Manitoba to work together on many improvements in key areas related to primary care, diagnostics, specialty care, IT support, and communication.