Technical Information

Percentage of patients with mammogram tests in the first (13–24 months from diagnosis), second (25–36 months from diagnosis) and third (37–48 months from diagnosis) follow-up years, for breast cancer patients diagnosed in 2011, by regional cancer centre of referral or consult.

Figure 1

Despite evidence for optimal follow-up care for patients with breast cancer, variation still exists in the way follow-up care is provided in Ontario. For example, one half of breast cancer survivors have more surveillance imaging studies for metastatic disease than recommended and one-quarter have fewer than recommended surveillance mammograms.

Consultation with key opinion leaders suggests that the existing guidance from the Canadian Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer is strong and current. This guideline recommends that women who have been diagnosed with breast cancer have at least one mammogram within the first follow-up year. This indicator will determine if the recommended surveillance mammograms are occurring for women in Ontario who have had breast cancer.

Grunfeld E, Hodgson D, del Guidice M, et al. Population-based longitudinal study of follow-up care for breast cancer survivors. J Oncol Practice. 2010; 6(4):174–181.

Steering Committee on Clinical Practice Guidelines for the Care Treatment of Breast Cancer. Clinical practice guidelines for the care treatment of breast cancer. Follow-up for treatment for breast cancer. CMAJ. 1998; 158:S65–S70.

[(# of breast cancer patients referred or treated at an RCC that have mammogram tests 37 to 48 months from diagnos)/(# of breast cancer patients diagnosed in 2011 that were referred or treated at an RCC)]x100 = mammogramutilization in 3rd follow up year (%)

N/A

Percentage of Patients

• Activity Level Reporting (ALR)
• Ontario Cancer Registry (OCR)
• Discharge Abstract Database (DAD)
• National Ambulatory Care Reporting System (NACRS)
• Ontario Health Insurance Plan (OHIP)
• Collaborative Staging Integration (CSI)

Patients diagnosed from Jan 1, 2011 to Dec 31, 2011 are chosen for this analysis

Regional Cancer Centre of Referral or Consult

The total number of patients diagnosed with breast cancer in 2011 that were referred or treated at an RCC who did not receive treatment or died in the first, second or third follow up year.

• Inclusion criteria:
  • Patients diagnosed in a specific diagnosis period with:
    • Breast cancer: C50
  • Patients that are either referred to or treated at an RCC
  • Referral is defined as the cases who had been referred to an oncologist to an RCC in either medical, radiological or surgical program
  • Treatment is defined as either one of the following events occurring in chemotherapy, radiation, or surgery by the following surgical codes: '1YK87LA', '1YK89LA', '1YK90LAXXE', '1YL87LA', '1YL89LA', '1YM87', '1YM88LA', '1YM89LA', '1YM89LAXXA', '1YM90LA', '1YM91', '1YM92', '1MD87LA'
  • Treatment window – is defined as the first 12 months from diagnosis.
• Exclusion criteria:
  • Patients with invalid or missing health card number or postal code
  • Patients that die or receive treatment (chemo, radiation or surgery) in the 1st, 2nd and third follow-up years
  • Patients with bilateral mastectomy before 25 months after diagnosis
  • Patients with stage 4 or NA

Total number of patients among the denominator that have one or more mammogram in the follow-up years.

• The 1st follow-up year: 13 months to 24 months from diagnosis
• The 2nd follow-up year: 25 months to 36 months from diagnosis
• The 3rd follow-up year: 37 months to 48 months from diagnosis
• Mammogram records for valid breast cancer patients were identified from OHIP using the following fee schedule codes: 'X184', 'X185','X172', 'X178', 'X194', 'J863', 'J663', 'Q002'

Only patients that started at an RCC were captured. The rate can be calculated by number of mammogram tests conducted, e.g. 1 and 2 or more, in the 1st follow up year.

• Patients diagnosed in calendar year 2011 were chosen for this analysis so that the third year of follow up is before 2016
• The results might be biased as this indicator includes RCC cases only

Percentage of patients diagnosed with colorectal cancer in 2011, 2012, and 2013 with at least one colonoscopy within 18 months of initial surgery, by regional cancer centre of referral or consult

Figure 2

There is some regional variation in the way follow-up care is provided for colorectal cancer survivors in Ontario.

There are guidelines for adult colorectal cancer survivors who have completed primary treatment for Stage II or III disease and are without evidence of disease. Measuring the concordance of this indicator will signal whether or not adult colorectal cancer survivors are receiving quality follow-up care according to guidelines.

Halpern, M. T., Viswanathan, M., Evans, T. S., Birken, S. A., Basch, E., & Mayer, D. K. (2014). Models of Cancer Survivorship Care: Overview and Summary of Current Evidence. Journal of Oncology Practice, JOP-2014.

Earle, C. C., & Neville, B. A. (2004). Under use of necessary care among cancer survivors. Cancer, 101(8), 1712-1719.

Erikson, C., Salsberg, E., Forte, G., Bruinooge, S., & Goldstein, M. (2007). Future supply and demand for oncologists: challenges to assuring access to oncology services. Journal of Oncology Practice, 3(2), 79-86.

Grunfeld, E., Gray, A., Mant, D., Yudkin, P., Adewuyi-Dalton, R., Coyle, D., ... & Vessey, M. (1999). Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluation. British journal of cancer, 79(7-8), 1227.

(Number of colorectal cancer patients diagnosed in 2011, 2012, and 2013 referred to or treated at an RCC who had a surveillance colonoscopy within 18 months from initial surgery / Number of colorectal cancer patients diagnosed in 2011, 2012, and 2013 who were referred to or treated at an RCC with an initial surgery) X 100 = % Colonoscopy concordance

Individual results will be presented for patients diagnosed in 2011, 2012 and 2013 independently

N/A

Percentage of Patients

• Activity Level Reporting (ALR)
  • Ontario Cancer Registry (OCR)
  • Discharge Abstract Database (DAD)
  • National Ambulatory Care Reporting System (NACRS)
  • Ontario Health Insurance Plan (OHIP)
  • Collaborative Staging Integration (CSI)

Patients diagnosed from Jan 1, 2011 to Dec 31, 2013 are chosen for this analysis.

Regional Cancer Centre of referral or consult

The total number of colorectal cancer patients diagnosed in 2011, 2012, and 2013 that were referred or treated at a Regional Cancer and who had an initial surgery

• Inclusion criteria:
  • Patients diagnosed in a specific diagnosis period with:
    Colorectal cancer: C18, C19, C20
  • Patients that are either referred to or treated at an RCC
  • Referral is defined as the cases who had been referred to an oncologist to an RCC in either medical, radiological or surgical program.
  • Treatment is defined as either one of the following events occurring in chemotherapy, radiation, or surgery by the following surgical codes:
    '1NQ89LH' '1NQ89LHXXG' '1NQ89RS' '1NQ89RSXXG' '1NM87DX' '1NM87DY' '1NM91DX' '1NQ87DX' '1NK87TF' '1NK87TG' '1NM87TF' '1NM87TG' '1NM89TF' '1NQ87TF' '1NK76DN' '1NK76DP' '1NM76DN' '1NK76RE' '1NK76RF' '1NK76RJ' '1NM76RE' '1NM76RN' '1NK87RF' '1NK77EN' '1NK77RR' '1NM77EP' '1NM77RS' '1NK82EN' '1NK82RE' '1NK82RR' '1NK82DP' '1NK82RF' '1NM82EP' '1NM82RN' '1NM82RS' '1NM82DF' '1NK87DN' '1NK87DP' '1NM87DE' '1NM87DF' '1NM87DN' '1NM89DF' '1NM91DF' '1NQ87DF' '1NQ89GV' '1NK87RE' '1NM87RD' '1NM87RE' '1NM87RN' '1NM89RN' '1NM91RD' '1NM91RE' 1NM91RN' '1NQ87PB' '1NQ87RD' '1NQ89KZ' '1NQ89SF' ‘1NQ90LA' '1NK87DA' '1NK87LA' '1NM87DA' '1NM87LA' '1NQ87DA' '1NQ87LA' '1NQ87CA' '1NQ87PF' '1NT87LA' '1NQ87DA' '1NQ87LA' '1NQ87CA' '1NQ87PF' '1NT87LA'
  • Treatment window is defined as the first 12 months from diagnosis
  • Initial surgery occurred in the treatment window
• Exclusion criteria:
  • Patients with invalid or missing health card number or postal code
  • Patients that died or received treatment (chemo, radiation or surgery) in the 1st follow up year

Patients with stage 4 cancer or NA at diagnosis

The total number of patients that have at least 1 recommended colonoscopy in a specific period.

• The specified periods are defined as:
  • 18 months following initial surgery
• Recommended colonoscopies are defined by the following fee codes: 'Z555A' 'Z499A' 'Z496A' 'Z497A' 'Z498A' 'E740A' 'E741A' 'E747A' 'E705A' 'E630A' 'E717A' 'E785A' 'E749A' 'Z513A' 'Z570A' 'Z571A' 'Z764A' 'Z765A' 'E687A' 'E685A' 'Z555B' 'Z499B' 'Z496B' 'Z497B' 'Z498B' 'E740B' 'E741B' 'E747B' 'E705B' 'E630B' 'E717B' 'E785B' 'E749B' 'Z513B' 'Z570B' 'Z571B' 'Z764B' 'Z765B' 'E687B' 'E685B' 'Z555C' 'Z499C' 'Z496C' 'Z497C' 'Z498C' 'E740C' 'E741C' 'E747C' 'E705C' 'E630C' 'E717C' 'E785C' 'E749C' 'Z513C' 'Z570C' 'Z571C' 'Z764C' 'Z765C' 'E687C' 'E685C'

Certain RCCs have lower volumes of patients and hence their rates have a higher degree of variability.

• Patients diagnosed in calendar year 2011, 2012, and 2013 were chosen so that the follow up visits of these patients in the specified period are before 2016.
• The results might be biased as this indicator includes RCC cases only.

Percent of respondents in each response category to illustrate, at a provincial level, how informed patients are about their plan of care after completing their treatment, Ontario, FY 2012-2015

Figures 3 and 4

The transition from active treatment to post-treatment care is important to long-term health. Awareness of their plan of care after treatment may increase cancer survivors’ knowledge of their heightened risks.

Advances in treatment and screening have led to an increased number of cancer survivors. The unique needs of this population are varied and include long-term physical effects of treatment, as well as psychological and socioeconomic sequelae. If care is not planned and coordinated, cancer survivors are left without knowledge of their heightened risks or a follow-up plan of action.

Cancer Care Ontario. Ontario Cancer Statistics 2016. Toronto: Cancer Care Ontario; 2016.

Hewitt M, Greenfield S, Stovall E, editors. From cancer patient to cancer survivor: lost in transition. Washington (D.C): The National Academies Press; 2005.

This calculation will be used for all figures generated using this indicator:

[(Number of responses in response category)/(Number of responses)] X 100 = Rate

Survey question selected for this indicator is from the Ambulatory Oncology Patient Satisfaction Survey (AOPSS):

• Q84 – How informed were you about the plan for your care when your treatment was completed?

Response options: (Very informed/Somewhat informed/Not at all informed)

All analyses will be performed at the provincial level:

1. Primary Analysis will show the response distributions over the four most recent fiscal years ( FY 2012/13 to FY 2015/16) available in AOPSS
2. Secondary Analysis will show the response distributions by disease for the combined data of the four most recent fiscal quarters (Q1 FY 2015/16 to Q4 FY 2015/16) available in AOPSS

Stratifications:

• By fiscal year for the primary analysis
• By disease for the secondary analysis

Crude rate by:

• Fiscal Year (primary analysis)
• Disease (Secondary Analysis)

Unit of Rate: Percent

N/A

Percentage of Positive Responses

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

Time frame: Annual data from FY2012/2013 to FY2015/16

All available data from the selected period will be reported:

• For FY2012/13 – April 1, 2012 to September 30, 2012 data is available
• For FY2013/14 – April 1, 2013 to September 30, 2013 data is available
• For FY2014/15 – April 1, 2014 to March 31, 2015 data is available
• For FY2015/16 – April 1, 2015 to March 31, 2016 data is available

Provincial

Source:

All respondents to AOPSS question number 84: How informed were you about the plan for your care when your treatment was completed?

Denominator:

Number of responses = Sum of number of “Very informed” responses, number of “Somewhat informed” responses, and number of “Not at all informed” responses

For the primary analysis, a separate denominator will be calculated for each fiscal year using the available data for the four most recent fiscal years (FY 2012/13 to FY 2015/16).

Additionally, separate denominators will be calculated by disease for the combined data of the four most recent fiscal quarters (Q1 to Q4 of FY 2015/16) available in AOPSS as part of the secondary analysis.

Exclusion criteria:

• Patients who reported that their treatment was incomplete
• Deceased patients
• Patients less than 18 years of age
• Patients who do not have confirmed cancer diagnosis
• Patients who received only inpatient services
• Patients who did not respond to the question of interest

Subset of Denominator:

Numerator= Number of responses in a specific response category (“Very informed” / “Somewhat informed” / “Not at all informed”)

For the primary analysis, separate numerators will be determined for each response category for each fiscal year using the available data for the four most recent fiscal years (FY 2012/13 to FY 2015/16).

In addition, separate numerators for each response category will be determined by disease for combined data of the four most recent fiscal quarters (Q1 to Q4 of FY 2015/16) available in AOPSS as part of the secondary analysis.

Restrictions: N/A

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)
• In FY 2012/13, a total of 6213 individuals responded to the survey for an overall response rate of 58.2%
• In FY 2013/14, a total of 5701 individuals responded to the survey for an overall response rate of 53.4%
• In FY 2014/15, a total of 7188 individuals responded to the survey for an overall response rate of 51.8%
• In FY 2015/16, a total of 6954 individuals responded to the survey, for an overall response rate of 51.6%