Technical Information

Percentage of referred cancer patients seen within 14 days for registered dietician services by regional cancer centres of treatment

Figure 1

The Psychosocial Oncology program has been collecting date of referral data through ALR since 2013 to report wait times.

OCP III and OCP IV highlight the need for cancer patients to have timely access to psychosocial services. “By 2019... Patients will have timely access to psychosocial and palliative care as appropriate”.

Cancer patients frequently have dietary concerns as it relates to their treatment and resulting symptoms. When a dietary or nutritional need is identified in a patient, it is important not only that they are referred appropriately to a dietitian, but that they receive care in a timely way.

Regional cancer centres report that frequently patient need exceeds resources and that patient access to specialized psychosocial services can be impacted as a result. In measuring PSO visit volume and wait times, the program aims to measure patient access to PSO services.

To determine appropriate wait times for the PSO disciplines, a PSO Wait Time Expert Panel was convened in 2013. The expert panel was comprised of registered dietitians, PSO experts, and patients and family advisors. Based on an expert consensus, it was concluded that 85% of all cancer patients referred to dietitian services should be seen within 2 weeks’ time (referral to consult) or 14 days. The 85% target allows for patient or clinically driven circumstances such as patient preference or clinical reasons for a delay.

(Total number of cancer patients who had their first consult with a dietitian within target (14 days)/ Total number of new patients with valid referral and consult dates to a dietitian) X 100

Total Province, and by regional cancer centre

Percentage of referred cancer patients seen within 14 days for registered dietician services

Activity Level Reporting (ALR)

Dietitian consults between October 1, 2015 to September 30, 2016

Regional cancer centre of treatment

Total number of new patients with valid referral and consult dates to a dietitian.

Inclusions:

• Patients that had a first consult visit with a dietitian within the specified time period
• Patients that are being seen at a regional cancer centre

Exclusions:

• Non cancers
• Cases with a Missing Date of referral to a dietitian
• Date of referral is after the consult date (Negative wait times)

Subset of the denominator: Total number of cancer patients who had their first consult with a dietitian within target (14 days)

The referral to consult activity for this indicator is limited to referral received in regional cancer centres and consult activity provided within the regional cancer centres. Visits to dietitians outside of the cancer centre or at other hospitals are not included.

Availability of referral date for all new first consults to a dietitian

Percentage of head and neck cancer patients seen by a dietician at a regional cancer centre prior to beginning treatment or within 2 weeks of beginning curative radiation and/or systemic treatment, Ontario, 2013-2015

Figure 2

This is an indicator of interest by the Psychosocial Oncology program. Best practice indicates that head and neck cancer patients should be seen by a registered dietitian early in their treatment journey (radiation, systemic therapy) to be proactive in supporting a patient’s nutritional needs (please see references below). The new systemic funding model has also allocated funds for PSO care during the first consult phase. Based on the literature and consensus with experts, the psychosocial oncology program supports that all head and neck cancer patient should have a consult with a registered dietitian prior to beginning any systemic or radiation treatment modality.

Capuano, G., Gentile, P.C., Bianciardi, F., Tosti, M., Palladino, A. & Di Palma, M. (2010). Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer, 18:433–437. Isenring, E.A., Capra, S., & Bauer, J.D. (2004). Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. British Journal of Cancer, 91, 447-452. doi:10.1038/sj.bjc.6601962

Langius, J.A.E., van Dijk, A.M., Doornaert, P., Kruizenga, H.M., Langendijk, J.A., Leemans, C.R., Weijs, P.J.M., & Verdonck-de Leeuw, I.M. (2013). More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutrition and Cancer, 65(1):76-83. doi: 10.1080/01635581.2013.741749

Paccagnella, A., Morello, M., Da Mosto, M.C., Baruffi, C., Marcon, M.L., Gava, A., Baggio, V., Lamon, S., Babare, R., Rosti, G., Giometto, M., Boscolo-Rizzo, P., Kiwanuka, E., Tessarin, M., Caregaro, L., & Marchiori, C. (2010). Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer, 18:837–845. DOI 10.1007/s00520-009-0717-0

Program in Evidence Based Care, Clinical Practice Guideline on the Management of Head and Neck Cancers in Ontario. [last updated December 2009]. Available from: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=58592

Psychosocial Oncology Resource Intensity Weights Project: Summary of Consensus. (2014). The Psychosocial Oncology Program, Cancer Care Ontario. Ravasco, P., Monteiro-Grillo, I., Marque Vidal, P., & Camilo, M.E. (2005). Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck, 27(8):659-68.

# of head and neck patients seen by a registered dietitian prior to beginning treatment or within two weeks of beginning curative radiation and/or systemic treatment/ # of patients diagnosed with head and neck cancer in the specified period X 100

By diagnosis year

N/A

Activity Level Reporting

Patients diagnosed from October 1, 2012 to September 30, 2015 are chosen for this analysis

N/A

The total number of patients diagnosed with head and neck cancer in 2012 to 2015 and treated with systemic or radiation within 12 months after diagnosis.

• Patients diagnosed in a specified period with:
  • MALIGNANT MELANOMA-ORAL CAVITY
  • LIP
  • BASE OF TONGUE
  • OTHER UNSPECIFIED PARTS OF TONGUE; GUM
  • FLOOR OF MOUTH
  • PALATE
  • OTHER & UNSPECIFIED PARTS OF MOUTH
  • PAROTID GLAND
  • OTHER UNSPECIFIED MAJOR SALIVARY GLANDS
  • TONSIL
  • OROPHARYNX
  • NASOPHARYNX
  • PYRIFORM SINUS
  • HYPOPHARYNX
  • OTHER LIP ORAL CAVITY & PHARYNX
  • MALIGNANT MELANOMA-NASAL CAVITY & MIDDLE EAR
  • NASAL CAVITY & MIDDLE EAR
  • MALIGNANT MELANOMA-ACCESSORY SINUS
  • ACCESSORY SINUSES
  • LARYNX
• Patients that received treatment at a Regional Cancer Centre within 12 months of diagnosis
• Treatment is defined as either chemotherapy or radiation
• Patients receiving radiation therapy or chemotherapy with curative, adjuvant and neoadjuvant intent

Exclusions:

• Patients with invalid health card numbers (e.g., invalid, out of province)
• Patients receiving chemotherapy or radiation therapy for palliative intent

Total number of patients among the denominator seen by a registered dietitian prior to beginning treatment or within two weeks of beginning curative radiation and/or systemic treatment

N/A

• Limited to patients that are receiving care at Regional Cancer Centres only
• Low volumes for head and neck patients
• Only some regional cancer centres offer treatment to head and neck patients
• Dietitian visits outside of cancer centres are not captured, so patients may be receiving dietitian services elsewhere

Limited to outpatient care, patients receiving early feeding tube insertions (admitted as inpatient) would not be included.

Percentage of referred cancer patients seen within 14 days for social worker services by Regional Cancer Centre of treatment, Ontario, 2016

Figure 3

The Psychosocial Oncology program has been collecting date of referral data through ALR since 2013 to report wait times.

OCP III and OCP IV highlight the need for cancer patients to have timely access to psychosocial services. “By 2019... Patients will have timely access to psychosocial and palliative care as appropriate”.

Regional Cancer Centres report that frequently patient need exceeds resources and that patient access to specialized psychosocial services can be impacted as a result. In measuring PSO visit volume and wait times, the program aims to measure patient access to PSO services.

N/A

Total number of cancer patients who had their first consult with a social worker within target (14 days)/ Total Number of New patients with valid referral and consult dates for a social worker 100

By Total Province and Regional Cancer Centre

N/A

Activity Level Reporting

October 1, 2015 to September 30, 2016

N/A

Total Number of New patients with valid referral and consult dates to a social worker

Inclusions:

• Patients that had a first consult visit with a social worker within the specified time period
• Patients that are being seen at a Regional Cancer Centre

Exclusions:

• Non cancers
• Cases with a Missing Date of referral to a social worker
• Date of referral is after the consult date (Negative wait times)

Subset of Denominator: Total number of cancer patients who had their first consult with a social worker within target (14 days)

Inclusions:

• Patients that have a first consult with a social worker within 14 days of their referral date to a social worker

The referral to consult activity for this indicator is limited to referral received in Regional Cancer Centres and consult activity provided within the Regional Cancer Centres. Visits to social workers outside of the cancer centre or at other hospitals are not included.

Availability of referral date for all new first consults to a social worker

Percent of questionnaire respondents who reported that they got enough information about possible changes in sexual activity

Figures 6 and 7

The diagnosis and treatment of cancer is often associated with significant sexual dysfunction. Sexuality may be affected by changes in appearance, physical side effects (e.g. pain, erectile dysfunction, vaginal dryness, etc.), and emotional changes that occur as a result of treatment or the diagnosis itself. Across disease sites, estimates of sexual dysfunction after various cancer treatments range from 40% to 100%. To date, there is little guidance available for healthcare providers on how to address sexual dysfunction in cancer patients.

The Patient Education program is interested in the quantity and quality of information patients receive related to sexuality. While sexual concerns have long been deemphasized, there is a growing awareness of the importance to identify patients with sexual concerns and support them with information, education, and psychosocial support to enhance their quality of life.

Derogatis LR, Kourlesis SM: An approach to evaluation of sexual problems in the cancer patient. CA Cancer J Clin 31 (1): 46-50, 1981 Jan-Feb.

Improving Sexual Dysfunction in Cancer Patients and Survivors: A systematic review. (2014). Evidence Search and Review Service, Cancer Care Ontario.

Number of Positive Responses/Number of Responses * 100%

N/A

Percentage of questionnaire respondents who reported that they received ​enough information​

Ambulatory Oncology Patient Satisfaction Survey (AOPSS) – National Research Corporation Canada (NRCC)

Annual data from FY2013/14 to FY 2015/16

The time frame for the analysis, stratified by disease site, is from FY2013/14 to FY 2015/16.

The time frame for the analysis by sex is FY 2015/2016 data only.

Provincial

Source:

AOPSS question number 50
Q50. Did you get enough information about possible changes in your sexual activity?

Exclusion criteria:
• Responses with “Does not apply” are not included in the calculation (numerator or denominator)
• Deceased patients
• Patients less than 18 years of age
• Patients who do not have a confirmed cancer diagnosis
• Patients who received only inpatient services

Subset of Denominator:

Number of positive responses= number of “Yes, completely” responses for the below question:

• Q50. Did you get enough information about possible changes in your sexual activity?

The numerator will be broken down by disease site and by sex to create the values that will be used to calculate the crude rates for each stratification.

N/A

• Included in the analysis are patients who, at the time of the survey, had received cancer services in the previous six months
  • Patients may not remember all of the elements of care that occurred in the previous six months (recall bias)
  • Palliative care patients may not be well represented in the survey results
  • In FY 2015/16, a total of 6954 individuals responded to the survey (inclusive to Q1) for an overall response rate of 51.6%
  • In FY 2014/15, a total of 7188 individuals responded to the survey for an overall response rate of 51.8%

In FY 2013/14, a total of 5701 individuals responded to the survey for an overall response rate of 53.4%