धनयवद 10 provinces 3 territories Size of NB NS PEI to Nepal 133852 v 147180 km 2 Geography Canada Nepal Surface Area 9984670 km 2 2nd 147180 km 2 94th ID: 1041367
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1. Introduction to Canada
2. Thank you, merci, धन्यवाद
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5. 10 provinces, 3 territories
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7. Size of NB, NS, PEI = to Nepal (133,852 v 147,180 km2)
8. GeographyCanadaNepalSurface Area9,984,670 km2 (2nd)147,180 km2 (94th)Population36,703,888 (38th)28,704,260 (48th)Urban Population81.6% (2014)18.9% (2016)Capital average temperatureHigh: 11.3◦Low: 1.4◦High: 20◦Low: 10-12◦
9. Geography2948 m2730 m8848 m
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11. Geography
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15. EconomicsCanadaNepalGross Domestic Product (GDP)757.95 billion (2002)4.92 billion (1997)GDP per person(measure of production within country incl foreigners) (2016)44,025 $2,467 $GNI per person(measure of income from citizens)43,600 $730 $Net Migration (immigrants –emigrants, 2012)+1,175,000 -372,309
16. HealthCanadaNepalLife Expectancy (2015)82.5 yrs69.5 yrsTobacco Use (2015)17.7% male adults12.2% female adults48% males over 1514% females over 15Mortality btw 30-70 from CVS, diabetes, resp, cancer?21.6%Physicians per 100014.95 (2010)0.21 (2004)Out of pocket (% of total expenditure) (2014)13.6%47.7%Suicides (2012)15.7/100.00 males5.6/100,000 females24.9/100,000Deaths from Traffic Accidents (2013)8.6/100,000 males3.8/100,000 females17/100,000
17. Deaths in CanadaCauses30.2% Cancer19.7% Heart4.6% Accidents4.5% Chronic respiratory disease2.8% Diabetes2.6% Alzheimer's2.3% Influenza/pneumonia1.6% Suicides1.5% Kidney Disease24.9% Other
18. Cancer Statistics (cancerindex.org- 2008)CanadaNepalPopulation38.7 million28.7 millionNew Diagnosis/year (excl NMSkin Cancer)182,20027,800Age standardized rate(incidence/100,000)295.7141.6Death per year74,10020,000
19. Cancer RegistriesMandatory for Canadian Provinces/Territories to collect data:Diagnosis (method of diagnosis)Date StagePathology (ICD codes)Date of Death
20. Canadian Cancer Statistics -2017IncidenceCountry: 206,200Maritimes: 11,810Nova Scotia: 6200 (522/100,000)
21. Canadian Cancer Statistics -2017Incidence: 206,200 MenWomen20.7% Prostate25.5% Breast14.5% CRC13.8% Lung14.0% Lung11.5% CRC6.5% Bladder7.1% Uterus4.5% NHL4.1% Kidney2.3% Kidney (11th)2.1% Bladder (12th)1.1% Testes**14% ages 15-29
22. Deaths by CancerMenWomen26.1% Lung26.2% Lung12.0% CRC13.1% Breast9.6% Prostate11.3% CRC5.6% Pancreas4.0% Bladder1.8% Bladder (11th)2.8% Kidney (11th)1.8% Kidney (12th)
23. Canadian Health Care System“Universal” Health Care 1947 - Canada's first publicly funded hospital insurance plan1984 – Canada Health Care ActFederal and provincial/territory dollars fund itHow the money is spent is at a provincial levelMany people also have private insurance (usually through work)
24. Canadian Health Care SystemComplex, not totally universal, as costs increase so do restrictionsCovered:Basic health care (immunizations, regular family doctor visits)In hospital stays/procedures/treatmentsCancer screening (mammograms, paps..)What is not covered:Elective procedures (plastic surgery, “screening” CT scan, etc.)Out patient physio, counselling, etc.A lot of equipment (ostomy supplies, prosthesis, etc.)Non Health Canada approved treatmentsSome drugsAs a physician, you cannot privately bill a patient unless service is not coveredDisadvantages:Bureaucracy, not everything is funded, wait times
25. Canadian Health Care System for CancerDrugs:Health Canada approves drugs on efficacypCODR approves drugs on efficacy, ethics, and economicsCPA decides on whether it should be fundedProvinces/territories then have to decide if they are going to fundIf they do approve:IV drugs handled differently than oral drugs depending on where you liveMany gatekeepers in the system:Genetics – e.g. BRCA testing, genetic tumor testingOral VEGF TKIs – only med oncs can orderHigh cost drugs – need approval to prove the pt fits the indication
26. Comparison to the MaritimesMaritimesNepalPopulation1,813,576 923,598 (Nova Scotia)28,704,260Biggest City – Halifax316,701 (metro)403,390 (district)1,003,285 (metro)1,744,240 (district)Average Age43 yrs21.6 yrsOver 65 years19%<4%Medical Oncologists36?Radiation Oncologistssimilar?
27. Nova Scotia Size of Nova Scotia: 52,942 km2Size of Kosi and Karnali (province 1 and 6): 53,889 km2
28. QEII Health Sciences Center
29. Nova Scotia Cancer Center
30. Outpatient Clinics
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33. Outpatient Chemotherapy Areas
34. Outpatient Chemotherapy Areas
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37. Outpatient Chemotherapy Areas
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39. ResourcesEducationASCOUptodate.comEuropean Association of Urology - guidelinesOncologyeducation.comPatientsKidney: kidneycancercanada.ca; ikcc.orgBladder: bladdercancercanada.ca; bcan.orgTestes: tc-cancer.comProstate: prostatecancercanada.caDrug information/Preprinted orders
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42. ResourcesEducationASCOOncologyeducation.comPatientsKidney: kidneycancercanada.ca; ikcc.orgBladder: bladdercancercanada.ca; bcan.orgTestes: tc-cancer.comProstate: prostatecancercanada.caDrug information/Preprinted orders
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47. Canadian Medical Oncology Subspecialty TrainingGeneral Internal Medicine Residency X 3 yearsRoyal College of Physicians and Surgeons of Canada Exam – Written and OralMedical Oncology X 2 years Minimum:13 m Medical Oncology2 m Radiation Oncology2 m Malignant Hematology (maximum 3 m)1 m Palliative Care3 m Electives – clinical or scholarly (maximum 6)Royal College of Physicians and Surgeons of Canada ExamSeptember each yearMultiple choice and short answer, no oral component
48. Halifax Medical Oncology Program1-2 residents per year, maximum 3 per 2 yearsRotations (13 per year)Breast X 4GI X 4Lung X 3GU X 3Radiation X 3Hematology X3Palliative X 1Mixed X 1Elective X 5Longitudinal clinic starting September of first year
49. Canadian Radiation Oncology Residency5 year program, 65 – 4 week blocksFirst 2 years:5 medical specialties4 surgical specialties3 med oncology1 radiology1 anatomical pathology1 palliative care3 electives Next 3 years: Exposure to all tumors, including pediatrics and community basedMinimum: 3 blocks selectives (to include scholarly project)
50. Next 2 weeksDiscuss Genitourinary CancersProstateTesticularRenal CellBladderAnything else you want – Except Breast Cancer!Format – your choiceLecturesJournal ClubsCase Based
51. Questions?