• 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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Head and Neck Centres

 
Measure Desired Direction As of this Report
Volume of HN surgeries performed in an HN centre Black Arrow Up Yellow Arrow Level
See Methodology and Approach to find out how the ratings are calculated.

Key findings

Six of the 8 head and neck (HN) centres in Ontario met the surgery volume requirement of a minimum of 80 HN surgeries in fiscal year 2015/16. Moreover, 85% of Ontario HN patients had their surgery performed in an HN centre in FY2015/16, an increase from fiscal year 2014/15. It is anticipated that, in the future, the aim of 90% of HN surgeries being performed in an HN centre will be met and all HN centres will reach the volume requirements.

What is HN surgery?

  • HN surgery refers to surgery that is performed for HN mucosal malignancies, including salivary and advanced skin cancer.
  • This includes surgery involving the oral cavity (e.g. tongue, gums and palate), skin of the face, facial bones, organs (e.g. ear or nose), sinuses, pharynx and larynx. It is important to note that HN surgery does not include surgery on the brain.
  • The standards established for HN centres in Ontario do not apply to surgery for thyroid cancer.

What is an HN centre?

  • In 2009, Cancer Care Ontario developed The Management of Head and Neck Cancer in Ontario: Organizational and Clinical Practice Guideline Recommendations (the Guideline), which outlines the optimal organization of HN centres in Ontario in order to ensure high-quality care and optimal cancer treatment outcomes for patients1.
  • The recommendations in the Guideline are based on evidence and expert consensus, and they include criteria regarding the number and training of surgeons, the availability of multidisciplinary care and hospital resources, and the expected minimum number of radiation and surgeries performed. An HN centre is an institution that meets—or is committed to meeting—those recommendations.
  • For maximum patient benefit, treatment of HN cancers requires input from a multidisciplinary team. All HN cancer patients require a multidisciplinary assessment by an HN surgical oncologist and a radiation oncologist with expertise in HN cancer. Assessment by a medical oncologist may also be needed in some instances.
  • Cancer Care Ontario—in collaboration with HN cancer experts—has identified a list of procedures that should be performed in HN centres. Based on a volume analysis, it was determined that an HN centre should perform a minimum of 80 HN surgical procedures per year.
  • There should be a minimum of 2 HN surgical oncologists at each HN centre, and surgery cases should be consolidated with a small number of specialized surgeons to ensure a high quality of care.
  • HN centres were designated in late 2014, and Guideline recommendations are currently being implemented across Ontario. Cancer Care Ontario’s goal is that 90% of HN surgeries will be performed in an HN centre.
  • While the opportunity to access care close to home is important for patients, the Guideline recommendations aim to balance access to care with the benefits of high-quality, specialized cancer treatment.
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What do the results show?

A significant proportion of HN surgeries are being performed in HN centres (Figure 1).

  • Figure 1 highlights the proportion of HN patients who had their surgery performed in an HN centre.
  • HN centres were designated in late 2014, and Guideline recommendations are currently being implemented across Ontario. Historical data show that a significant proportion of surgeries for HN cancer were performed at HN institutions, even prior to the formal designation of HN centres.
  • Overall, 85% of Ontario HN patients had their surgery performed in an HN centre in fiscal year 2015/16 (compared to 81% in fiscal year 2014/15). Cancer Care Ontario’s goal is that 90% of HN surgeries will be performed in an HN centre.

HN centres perform a high volume of HN surgeries in the province (Figure 2).

  • Figure 2 highlights the number of HN surgeries being performed in hospitals across the province in fiscal year 2014/15 and fiscal year 2015/16.
  • Currently, there are 8 HN centres in Ontario. In fiscal year 2015/16, 6 of the 8 centres met the surgery volume requirement of a minimum of 80 HN surgeries/year.
  • Non-HN designated hospitals performed a small number of HN surgeries in fiscal year 2015/16 that should be performed at HN centres.
  • Published evidence suggests that hospitals that perform a higher volume of HN cancer surgeries have better patient outcomes (such as better survival and lower complication rates after surgery)2.
  • While the opportunity to access care close to home is important for patients, the Guideline recommendations aim to balance access to care with the benefits of high-quality, specialized cancer treatment.

Find out more

For more information on HN centres, please visit the Cancer Care Ontario Guidelines

View Notes

  1. Gilbert R, Devries-Aboud M, Winquist E, Waldron J, McQuestion M, and the Head and Neck Disease Site Group. The management of head and neck cancer in Ontario: organizational and clinical practice guideline recommendations [Internet]. Toronto; Cancer Care Ontario; 2009. Available from: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=58592.
  2. Eskander A, Irish JC, Groome PA, Freeman JL, Gullane P, Gilbert R, et al. Volume-outcome relationships for head and neck cancer surgery in a universal health care system. Laryngoscope. 2008; 124(9):2081–8.