• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
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Reporting of Cancer Stage at Diagnosis

Measure Desired DirectionAs of this Report
Reporting of cancer stage at diagnosis for stageablebreast, cervix, colorectal, lung and prostate cancersBlack Arrow UpGreen Arrow Up
Reporting of cancer stage at diagnosis for all stageablecancerBlack Arrow UpRed Arrow Up
See Methodology and Approach to find out how the ratings are calculated.

Key findings

Stage capture rates are greater than 90% breast, prostate, colorectal, lung and cervix cancers and they are within the desired range required for analytic purposes. When all the stageable types of cancer are combined, the stage capture rate for all cases diagnosed in 2015 drops to 57%. This does not mean that patients are not being staged prior to treatment by their clinicians; rather, the stage capture rate reflects whether the data are part of the provincial cancer registry.

What is cancer staging?

  • Staging describes the extent or severity of a person’s cancer, based on the size and/or extension of the original (primary) tumour and how far it has spread in the body1.
  • Almost all cancer patients begin their involvement with the cancer system through a series of diagnostic tests. These likely include imaging and, in many cases, removal of tissue or cells from the body for examination (biopsy) so that the nature and extent of the cancer can be determined.
  • Stage values for invasive cancer range from stage I, which means the disease is in the early phase, to stage IV, which means the cancer has spread (or metastasized) to other organs or places in the body. An unknown stage is the result of either limited stage workup and/or limited documentation within the patient record.
  • In my words

    Cancer diagnosis means accuracy of that diagnosis and knowing exactly what the next steps will be. There can be no doubt because as soon as those words are spoken a different journey in life begins.

    Laurie P.
    Patient/Family Advisor
  • The Ontario Cancer Registry captures population-level stage at diagnosis for several cancers.

Why is staging information important to patient care?

  • Knowing the clinical stage of the disease helps physicians plan appropriate treatment and determine the likely outcome or course of the disease2.
  • From a system performance perspective, capturing population-level stage, for all newly diagnosed cancer patients by cancer registries, generates critically important information that is used for cancer surveillance, as well as health care planning3. Knowing the distribution of cancer stage allows cancer agencies to better evaluate the appropriateness and effectiveness of cancer treatments delivered throughout the province and to plan for future needs.
  • Accurate cancer stage information can improve quality of care and decision-making in the cancer system. Linking the stage of cancer with outcome and treatment data provides valuable information, allowing the cancer system to assess the quality of cancer care and identify new ways to improve the delivery of that care.
  • The value of stage capture on a population basis not only includes the evaluation of successful screening programs, but also the prioritization of resources for treatments of disease sites with a high incidence of advanced cancers3. The information is also valuable for identifying high-risk groups for education and screening.

What is the Collaborative Staging data Collection System and how is it different from Tumour, Node and Metastases stage data?

  • CS is a standard method of collecting staging information that uses a minimum dataset of coded elements from a cancer pathology report, supplemented by clinical data found in diagnostic imaging reports, laboratory tests and physician summaries. The information can be used and shared electronically by organizations that study cancer data.
  • The CS common dataset describes key cancer tumour characteristics and ensures cancer agencies around the world interpret and analyze the data in the same way.
  • CS attempts to stage all cases of a specific type (e.g. breast cancer) so that meaningful inferences about that cancer can be made at the provincial level.
  • Cases that contribute to the category “No Stage” include cancers that were neither diagnosed nor treated in a hospital (i.e. only contact with private labs and physician offices resulting in no Cancer Care Ontario access to patient records). “No Stage” may also include cases that have been staged by the registry but for which manual review is still required. For 2015, approximately 5% of cases for breast, cervix, colorectal, lung and prostate cancers have no stage or 1,817 of 35,475 cases (Figure 3).
  • The tumour, node and metastases system, like CS, classifies cancers by the size and extent of the primary tumour (T), involvement of regional lymph nodes (N) and the presence or absence of distant metastases (M). In recent years, this has been supplemented by non-anatomic prognostic factors (such as biomarkers).
  • Unlike CS, TNM does not retain the raw data elements (e.g. the exact tumour size or number of lymph nodes involved), and it does not generate a combined stage based on both clinical and pathologic sources.
  • TNM staging from the regional cancer centres is meaningful for the individual cases and the reporting facilities, but it does not capture all cancers of a single type across the province (i.e. those cases not referred to a regional cancer centre during diagnosis and first course of treatment).
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What do the results show?

CS rates have improved for breast, colorectal, lung and prostate cancers, but the overall cases with CS have decreased (Figures, 1, 2 and 3).

  • The number of stageable cases in Ontario decreased slightly from 64,740 in 2010 to 63,757 in 2015 (Figure 1).
  • Breast, lung, colorectal and prostate cancers have been staged by the registry since the 2010 diagnosis year; cervical cancer had been staged since the 2011 diagnosis year.
  • The scope of Cancer Care Ontario’s stage capture program in years prior to the 2014 diagnosis year included non-cervix gynecological cancers, melanoma and thyroid. Mainly as a result of this change in staging scope during 2015, the overall stage capture rate for all stageable cancers is 57% in the 2015 diagnosis year (from 55% in 2010) (Figure 2).
  • With the focus on staging breast, colorectal, lung and prostate cancers, an increase was observed in the stage capture rates for those 4 sites that exceeded Cancer Care Ontario’s aim of 90% completion rate. The highest rate was for breast and lung cancers at 97% (Figure 3).

Breast, cervical, colorectal and prostate cancers had consistent stage distribution from 2010 to 2014. The exception is lung cancer, for which stage I cases have increased over time (Figures 4, 5, 6, 7 and 8).

  • The stage distribution of breast cancer has had little variation over the 5 years examined, with approximately 80% of cases diagnosed at early stage I and II (Figure 4).
  • Similarly, around 75% of cases for prostate cancer were in the first 2 stages (Figure 8). This is in contrast to colorectal cancer, for which approximately 50% of cases were Stage I and II (Figure 6).
  • The stage distribution of lung cancer increased in the percentage of stage I cases (from 17% in 2010 to 24% in 2015). The percentage of late-stage IV cases decreased from 57% in 2010 to 47% in 2014. However, stage IV still remained the most common stage at diagnosis for lung (Figure 7). CCO lung cancer stage distribution rates for 2010-2015 are consistent with those of other jurisdictions and indicative of the issues preventing early detection, specifically asymptomatic disease and the lack of screening programs4.
  • Cervical cancer stage distribution was fairly consistent across years, with 2015 seeing a slight decrease in the percentage of early stage I cases (from 59% in 2010 to 56% in 2014) (Figure 5).

Some variation exists with lower income individuals and individuals from urban areas having higher rates of stage IV cancer though it differs by type of cancer (Figures 9 and 10).

  • Individuals in the lowest income quintile were significantly more likely to have a stage IV at diagnosis for breast, colorectal, lung and prostate cancer (Figure 9). For example, 12% of prostate cancers were in stage IV for the lowest quintile compared to 8% of individuals in the highest quintile.
  • Similar to these findings, a report by the Canadian Partnership Against Cancer (CPAC) identified lower incomes were associated with later stage at diagnosis for lung cancer, but no clear patterns for later stage at diagnosis for breast, colorectal or prostate cancers.5
  • Ontarians living in urban areas are significantly more likely to have a stage IV diagnosis for breast, colorectal and lung cancers (Figure 10). The largest contrast was for lung cancer, where 51% of cases were of stage IV in urban areas compared to 48% in rural areas.
  • These findings are in contrast to the CPAC report on disparities, which found only lung cancer had variation between urban and rural areas with individuals from rural areas being diagnosed at a later stage5.

Accurate cancer stage information can improve quality of care and decision-making in the cancer system.

  • Determining the exact location, size and spread of the cancer (i.e. the stage) is essential for selecting the best treatment for the patient2.
  • Linking the stage of cancer with outcome and treatment data provides valuable information, allowing the cancer system to assess the quality of cancer care and identify new ways to improve the delivery of that care. For example, this CSQI provides performance information on the following indicators (which depend on accurate stage information):
  • For many patients who are going through the cancer diagnostic journey—from when cancer is suspected, to its diagnosis and determination of stage (or to it being ruled out)—it can be a confusing and anxious time. To help transform the diagnostic phase of the cancer journey for patients, health care providers and the health care sector as a whole, Cancer Care Ontario developed Diagnostic Assessment Programs (DAPs) across the province.

Find out more

More information is available on stage capture on the Cancer Care Ontario website.

View Notes

  1. Cancerstaging.org [Internet]. Chicago: American Joint Committee on Cancer; c2016. What is cancer staging?; [cited 2017 Jan 24]. Available from: https://cancerstaging.org/references-tools/Pages/What-is-Cancer-Staging.aspx.
  2. National Cancer Institute [Internet]. Bethesda (MD): National Institute of Health. Purpose of staging; [cited 2017 Jan 24]. Available from: http://training.seer.cancer.gov/staging/intro/purpose.html.
  3. Brierley JD, Srigley JR, Yurcan M, Li B, Rahal R, Ross J, et al. The value of collecting population-based cancer stage data to support decision-making at organizational, regional and population levels. Healthcare Quart. 2013; 16(3):27–33.
  4. Canadian Partnership Against Cancer. The 2015 cancer system performance report [Internet]. Toronto: Canadian Partnership against Cancer; 2015 [cited 2017 Jan 24]. Available from: http://www.cancerview.ca/idc/groups/public/documents/webcontent/the_2015_cancer_system_performance_report_en.pdf.
  5. Canadian Partnership Against Cancer. Examining Disparities in Cancer Control. (2014). [Internet] Toronto: Canadian Partnership against Cancer; 2014 [cited 2017 Feb 9] Available from: https://content.cancerview.ca/download/cv/quality_and_planning/system_performance/documents/spexamdispreportpdf?attachment=0