• 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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Colorectal Cancer Screening Quality and Efficiency

 
Measure Desired DirectionAs of this Report
Perforation: Number of outpatient colonoscopies followed by hospital admission for perforation within 7 days of colonoscopy per 1,000 colonoscopiesBlack Arrow DownGreen Arrow Level
Subsequent colonoscopy: Percentage of Ontario men and women,aged 53 and older, who had a colonoscopy within 36 months of anormal and complete outpatient colonoscopyBlack Arrow DownGrey Arrow Down
See Methodology and Approach to find out how the ratings are calculated.

Key findings

The rate of perforation within 7 days of an outpatient diagnostic or therapeutic colonoscopy has decreased annually since 2013. In 2015, the rate was 0.40 per 1,000 colonoscopies. This rate is well below Cancer Care Ontario’s target of less than 1 perforation per 1,000 colonoscopies1.

In 2015, 10,273 Ontarians aged 53 and older had a colonoscopy within 36 months of a previous outpatient colonoscopy that was normal and complete. These 10,273 colonoscopies represent 3.6% of the 281,977 outpatient colonoscopies performed in 2015. The percentage of colonoscopies performed within 36 months of a previous outpatient colonoscopy has decreased annually since 2013, dropping from 4.4% to 3.6% in 2015.

What is a colonoscopy?

  • A colonoscopy is a procedure that allows a doctor to look at the lining of the rectum and colon using a long, flexible tube with a tiny camera on the end.
  • During a colonoscopy, polyps (pre-cancerous lesions) may be removed and sent to pathology for analysis.
  • In my words


    [Efficiency to me means] optimal use of resources in order to deliver the right care in the right place at the right time.

    Anonymous
    Patient/Family Advisor
  • ColonCancerCheck recommends that people at increased risk of colorectal cancer due to a family history in a first-degree relative (i.e. they have a parent, sibling or child who has been diagnosed with the disease) screen with colonoscopy beginning at age 50, or 10 years earlier than the age at which their relative was diagnosed, whichever occurs first2. Colonoscopy is also used as a diagnostic test for people with abnormal fecal occult blood test (FOBT) results or symptoms of colorectal cancer, as well as for a number of other reasons.
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What do the results show?

The number of colonoscopy-related bowel perforations in Ontario has decreased (Figure 1).

  • The rate of patients admitted to hospital with a perforation within 7 days of outpatient colonoscopy decreased annually from 2013 (0.50 per 1,000 colonoscopies) to 2015 (0.40 per 1,000 colonoscopies), representing an overall improvement in performance for this indicator.
  • Ontario’s perforation rate was well under the target of less than 1 perforation per 1,000 colonoscopies.

A minority of Ontarians have a second colonoscopy within 36 months of a normal and complete outpatient colonoscopy, although there is notable regional variation (Figure 2).

  • The percentage of colonoscopies within 3 years of a normal and complete outpatient colonoscopy is an indicator that measures the appropriateness of colonoscopy and its potential overuse.
  • In 2015, 3.6% of Ontarians had a second colonoscopy within 36 months of a normal and complete outpatient colonoscopy, compared to 4.4% in 2013.
  • Regional variation for this indicator was present. The Local Health Integration Network (LHIN) with the highest percentage of colonoscopies within 36 months of a normal and complete outpatient colonoscopy in 2015 was Erie St. Clair (4.5%), which improved since 2014 (5.1%).
  • The LHIN with the lowest percentage of colonoscopies within 36 months of a normal and complete outpatient colonoscopy was Waterloo Wellington (2.1%).

Colonoscopy within 36 months of a normal and complete outpatient colonoscopy varies by demographic factor.

  • The percentage of repeat colonoscopies within 36 months of a normal and complete outpatient colonoscopy was highest in the oldest age groups in 2015:
    • 3.7% for people aged 65 to 69;
    • 4.1% for people aged 70 to 74; and
    • 4.7% for people over age 75.
  • In 2015, a greater percentage of women than men had a colonoscopy within 36 months of a normal and complete outpatient colonoscopy (3.8% vs. 3.5%, p< 0.001).

Why is this important to Ontarians?

  • Ontario is performing well with respect to perforations (target of less than 1 perforation for 1,000 colonoscopies)1. Close monitoring is warranted, however, given the potential serious risks associated with colonoscopy (perforations can lead to death in rare cases)3.
  • The percentage of colonoscopies within 3 years of a normal and complete outpatient colonoscopy is an indicator that measures the appropriateness of colonoscopy and potential overuse. One potential reason for the overuse of colonoscopy is poor continuity of care. Overuse of colonoscopy may expose patients to needless risks and is an inappropriate use of health care resources.
  • Although a repeat colonoscopy within 3 years of a normal and complete colonoscopy may be necessary in specific circumstances (e.g. due to the development of a new symptom, such as weight loss or diarrhea), it is anticipated that it should only occur in a minority of cases4.

Next steps

  • Minimizing harms to patients is an essential component of an organized screening program. Cancer Care Ontario will continue to monitor colonoscopy indicators, including perforation rates and repeat colonoscopies.
  • Beginning in 2017, these indicators will also be monitored annually at the facility and physician levels through the Quality Management Partnership to support quality improvement. TheQuality Management Partnership is a partnership between Cancer Care Ontario and the College of Physicians and Surgeons of Ontario.
  • Cancer Care Ontario is also updating its adenoma surveillance guidelines and educating physicians about appropriate colonoscopy intervals in patients who have had polyps removed in the past.

View Notes

  1. Tinmouth J, Kennedy E, Baron D, Burke M, Feinberg S, Gould M, et al. Guideline for colonoscopy quality assurance in Ontario. Toronto: Cancer Care Ontario; 2013.
  2. Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. How Ontarians participate in the program; 2015 July 16 [cited 2016 Mar 7]. Available from: https://cancercare.on.ca/pcs/screening/coloscreening/cccworks/cccparticipation
  3. Rabeneck L, Paszat LF, Hilsden RJ, Saskin R, Leddin D, Grunfeld E, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008; 135:1899–1906.
  4. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology [Internet]. 2012 Sep [cited 2016 Mar 6]; 143(3):844–857. Available from: http://www.sciencedirect.com/science/article/pii/S0016508512008128.