• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Modifiable Risk Factors

 

How does Ontario compare?

“Working together to create the best health systems in the world” is Cancer Care Ontario’s vision. Is Ontario succeeding with respect to cancer? To find out, we sought out national and international data against which to compare Ontario’s results. The selected findings presented below identify where Ontario is doing well and where improvement is needed in relation to other jurisdictions.

To find out more about modifiable risk factors in Ontario, see the Modifiable Risk Factors section of CSQI

A note on jurisdictional comparisons

  • This is the seventh year that the Cancer System Quality Index (CSQI) has showcased international benchmarks for Ontario’s performance.
  • We compare Ontario with select jurisdictions, primarily because they have healthcare and data systems that are similar to those in Ontario.
  • Ensuring that we have comparable data and measures from multiple jurisdictions is a challenge. It is wise to be mindful of the different data definitions, methodologies and years that are used in indicators measured outside Canada. Additionally, data may be missing or not publicly available for some countries. Cross-jurisdictional comparison is still useful, however, for providing a rough indication of how well Ontario is doing compared to other jurisdictions.

Table 1. Jurisdictional comparisons in modifiable risk factors: obesity

Obesity

Jurisdiction

Year

Age range

Type

Data

Source

Canada

2014

Adults (aged ≥ 18) with a BMI of 30 or more (BMI is a ratio of weight to height: kg/m2)

Self-reported

Both sexes:
20.2%
All men:
21.8%
All women:
18.7%

Canadian Community Health Survey 2014

Best in Ontario

2014

Individuals aged ≥ 18 with a BMI of 30 or more (BMI is a ratio of weight to height: kg/m2)

Self-reported

Toronto Central Health Local Health Integration Network (LHIN)


Both sexes:
12.3%
All men:
15.0%
All women:
9.5%

Canadian Community Health Survey 2014

Ontario

2014

Individuals aged ≥ 18 with a BMI of 30 or more (BMI is a ratio of weight to height: kg/m2)

Self-reported

Both sexes:
20.4%
All men:
22.1%
All women:
18.8%

Canadian Community Health Survey 2014

Best Province

2014

Individuals aged ≥ 18 with a BMI of 30 or more (BMI is a ratio of weight to height: kg/m2)

Self-reported

British Columbia
Both sexes:
16.0%
All men:
17.8%
All women:
14.1%

Canadian Community Health Survey 2014

Australia, New South Wales

2014

Percentage of individuals aged ≥ 16 who are obese (BMI ≥30)

Self-reported

Both sexes: 19.5%
All men: 18.6%
All women: 20.4%;

Health Statistics NSW

New Zealand

2014-2015

Percent of individuals aged ≥ 15 who are obese (BMI ≥30)

Self-reported

Both sexes: 30.7%
All men: 29.4%
All women: 32.0%

Annual Update of Key Results 2014/15: New Zealand Health Survey

Netherlands

2013

Percentage of individuals aged ≥ 15 who are obese (BMI ≥30)

Self-reported

Both sexes: 11.1%
All men: 10%
All women: 12.2%

Organization for Economic Co-operation and Development (OECD)

Sweden

2014

Percentage of individuals aged ≥ 16 who are obese (BMI ≥30)

Self-reported

Both sexes: 12.1%
All men: 12.1%
All women: 12%

Swedish Living Conditions Survey, 2014

United Kingdom

2014

Percentage of adults aged ≥ 16 who are classified as obese (BMI ≥30)

Measured

Both sexes:
Obese: 25.6%
All men:
Obese: 24.3%
All women
Obese: 26.8%

Health Survey for England, 2014 trend tables

United States, New York

2013

Weight classification by BMI, obese, ages 18 years and over, percent, age standardized to the year 2000 U.S. standard population

Self-reported

Both sexes: 25.4%
All men: 24.7%
All women: 26.1%

Behavioral Risk Factor Surveillance System (BRFSS)

United States, Best

2013

Percentage of individuals aged ≥ 18 years who are classified as obese (BMI ≥ 30)

Self-reported

Colorado
Both sexes: 21.3%
All men: 20.8%
All women: 21.8%

Behavioral Risk Factor Surveillance System (BRFSS)

United States: (states & DC)

2013

Percentage of individuals aged ≥ 18 years who are classified as obese (BMI ≥ 30)

Self-reported

Both sexes: 29.4%
All men: 29.1%
All women: 27.9%

Behavioral Risk Factor Surveillance System (BRFSS)

Table 2. Jurisdictional comparisons in modifiable risk factors: vegetable and fruit consumption

Vegetable and Fruit Consumption

Jurisdiction

Year

Age range

Type

Data

Source

Canada

2013

Percent of individuals aged ≥12 who report consumption of fruits and vegetables 5 times or more per day

Self-reported

Both sexes:
39.5%
All men:
32.1%
All women:
46.6%

Canadian Community Health Survey 2014

Best in Ontario

2013

Percent of individuals aged ≥12 who report consumption of fruits and vegetables 5 times or more per day

Self-reported

Toronto Central Health Integration Network
Both sexes:
41.4%
All men:
35.7%
All women:
46.5%

Canadian Community Health Survey 2014

Ontario

2013

Percent of individuals aged ≥12 who report consumption of fruits and vegetables 5 times or more per day

Self-reported

Both sexes:
38.1%
Males: 30.9%
Females: 44.9%

Canadian Community Health Survey 2014

Best Province

2013

Percent of individuals aged ≥12 who report consumption of fruits and vegetables 5 times or more per day

Self-reported

Quebec
Both sexes:
46.3%
All men:
37.1 %
All women:
55.2%

Canadian Community Health Survey 2014

New Zealand

2013-2014

Adults aged ≥15 who meet vegetable intake guidelines (3+ servings per day) and meet fruit guidelines (2+ servings per day)

Self-reported

Both sexes: 40.5%
All men: 34.0%
All women: 46.6%


Annual Update of Key Results 2014/15: New Zealand Health Survey

United Kingdom

2013

Percent of adults aged ≥16 who are consuming 5 or more portions of fruits and vegetables per day. Data has been weighted for non-response.

Self-reported

Both sexes: 26%
All men: 25%
All women: 28%

Goes up to 2013 (most recent data)

Health Survey for England,2013 trend tables

Table 3. Jurisdictional comparisons in modifiable risk factors: smoking

Smoking


Jurisdiction

Year

Age range

Type

Data

Source

Canada

2014

Individuals aged ≥12 who report smoking cigarettes every day and those who report smoking cigarettes occasionally

Self-reported

Both sexes:
18.1%
All men:
21.4%
All women:
14.8%

Canadian Community Health Survey, 2014

Best in Ontario

2014

Individuals aged ≥12 who report smoking cigarettes every day and those who report smoking cigarettes occasionally

Self-reported

Central West Local Health Integration Network (LHIN)
Both sexes:
11.4%
All men: 14.5%
All women: 8.4%

Canadian Community Health Survey, 2014

Ontario

2014

Individuals aged ≥12 who are current smokers (daily or occasional)

Self-reported

Both sexes:
17.4%
All men:
21.6%
All women:
13.3%

Canadian Community Health Survey 2014

Best Province

2014

Individuals aged ≥12 who report smoking cigarettes every day and those who report smoking cigarettes occasionally

Self-reported

British Columbia
Both sexes:
14.3%
All men:
17.4%
All women:
11.3%

Canadian Community Health Survey, 2014

Australia, New South Wales

2014

Individuals aged ≥16 who smoke daily or occasionally

Self-reported

Both sexes: 15.6%
All men: 18.9%
All women: 12.3%

Health Statistics New South Wales

Netherlands

2013

Percent of the population aged ≥15 who report being daily smokers

Self-reported

Both sexes: 18.5%
All men: 20.9%
All women: 16.3%

Organization for Economic Co-operation and Development (OECD)

New Zealand

2014–2015

Percent of individuals aged ≥15 who report being current smokers (daily or occasional) and daily smokers, age standardized

Self-reported

Current smokers – Daily or occasional
Both sexes: 16.6%
All men: 18.2%
All women: 15.0%
Daily Smokers
Both sexes: 15.0%
All men: 16.1%
All women: 13.9%

Annual Update of Key Results 2014/15: New Zealand Health Survey

Sweden

2014-2014

Percent of individuals aged 16-84 who report being current smokers (daily or occasional) and daily smokers, age-standardized

Self-reported

Both Sexes: 11.6%
All men:11.6%
All women: 11.6%

Swedish Living Conditions Surveys

Tobacco habits by indicator, age and sex.

United Kingdom

2014

Percent of adults aged ≥16 who report being current smokers. Data has been weighted for non-response.

Self-reported

Both sexes:
Current Smokers: 19%
All men:
Current Smokers: 21%
All women:
Current Smokers: 17%

Health Survey for England –
2013 trend tables

United States, New York

2013

Percent of adults aged ≥18 who are daily and occasional smokers, age standardized to the year 2000 U.S. standard population

Self-reported

Both sexes: 16.6%
All men: 19.3%
All women: 14.2%

Behavioral Risk Factor Surveillance System (BRFSS)

United States, Best
(excluding Utah & territories)

2013

Percent of adults aged ≥18 who are daily and occasional smokers, age standardized to the year 2000 U.S. standard population

Self-reported

California
Both sexes: 12.5%
All men: 16.1%
All women: 9.1%

Behavioral Risk Factor Surveillance System (BRFSS)

United States: (states & DC)

2013

Percent of adults aged ≥18 who are daily and occasional smokers, age standardized to the year 2000 U.S. standard population

Self-reported

Both sexes: 19.0%
All men: 21.6%
All women: 17.2%

Behavioral Risk Factor Surveillance System (BRFSS)

Table 4. Jurisdictional comparisons in modifiable risk factors: alcohol consumption

Alcohol Consumption

Jurisdiction

Year

Age range

Type

Data

Source

Canada

2012 reporting year

Percent of adults aged ≥ 18 who report exceeding low-risk drinking guidelines (an average of 2 drinks per day for males and 1 drink per day for females) in the last 12 months

Self-reported

Manitoba
Both sexes: 8.8%

Saskatchewan
Both sexes: 8.3%

Newfoundland
Both sexes:
12.8%

Ontario
Both sexes: 8.7%

Quebec
Both Sexes: 10.7%

Nunavut
Both Sexes: 7.8%



The 2014
Cancer System Performance Report
, Canadian Partnership Against Cancer (CPAC)

Statistics Canada, Canadian Community Health Survey
click to close graph
Close Graph

Obesity in Ontario: better than Australia and the United States, but higher than Sweden and the Netherlands (Table 1).

  • Obesity is a risk factor for a number of cancers including cancer of the esophagus (adenocarcinoma), colon and rectum, pancreas, breast (post-menopausal), endometrium and kidney. It has been associated with an increased risk of cancer of the gallbladder, ovary and prostate (advanced)1,2,3,4,5.
  • The rates reported here are primarily self-reported, so a degree of self-reporting bias should be expected. Self-reported height and weight in the Canadian Community Health Survey, for instance, have been shown to yield obesity estimates that are about 8% lower than estimates based on measured height and weight6. The use of measured height and weight instead of self-report is a likely contributor to the higher estimates of obesity for New Zealand and the United Kingdom that are reported in Table 1.
  • As a rough estimate, the prevalence of obesity based on self-reports in Ontario is lower than rates in Australia, New South Wales (Australia) and the United States, but it is higher than rates reported in the Netherlands and Sweden.
  • Within the countries with obesity measures based on self-report that are considered in this section, the country with the highest self-reported obesity rate is the United States. The country with the lowest is Sweden.

Vegetable and fruit consumption in Ontario: among the highest when compared to other provinces, New Zealand and the United Kingdom (Table 2).

  • Recommendations for reducing the prevalence of chronic diseases—including cancer, diabetes and cardiovascular diseases—routinely include healthy eating. Consumption of non-starchy vegetables and fruit probably protects against cancers of the mouth, pharynx, larynx, esophagus and stomach; fruits may protect against lung cancer1. Vegetable and fruit consumption also serves as a marker of a healthy diet7 that contains other constituents—carotene and lycopene, for instance—that probably protect against some cancers1.
  • As a rough estimate, vegetable and fruit consumption in Ontario appears to be among the highest of the jurisdictions considered in this section (along with New Zealand).
  • The United States was excluded from this analysis because as of 2010, the Behavioral Risk Factor Surveillance System changed how it reported on vegetable and fruit consumption.

Ontario smoking rate: higher than Australia, California, New York, New Zealand and Sweden (Table 3).

  • Smoking has a significant effect on cancer, particularly lung cancer incidence and mortality. Tobacco use is estimated to cause 29% of all cancer deaths in high-income countries like Canada8.
  • The prevalence of current (daily or occasional) smoking in Ontario is slightly lower than the Canadian estimate.
  • Smoking rates in Ontario, however, are higher than they are in Australia, British Columbia, California, New York, New Zealand and Sweden, while they are lower than the prevalence of current smoking in the Netherlands, the United Kingdom and the United States, which are relatively similar, ranging from 18% to 21%.

Alcohol consumption in Ontario: lower than in most reported provinces (Table 4).

  • The World Cancer Research Fund states that there is no “safe” level of alcohol consumption that does not increase the risk of cancer. There may be benefits in avoiding even small amounts of alcohol8.
  • There is convincing evidence that alcohol increases the risk of cancer of the mouth, pharynx, larynx, esophagus, colon and rectum, female breast and liver9.
  • Comparable measures of alcohol consumption in other jurisdictions were found across 5 of the 13 Canadian provinces and territories for adults (males reporting that they had more than 2 drinks per day and females reporting they had more than 1 drink per day). Nunavut had the lowest alcohol consumption rate (7.8%), followed by Saskatchewan (8.3%) and then Ontario (8.7%).

Moving forward

  • Cancer Care Ontario’s partnership with Public Health Ontario on the initiative Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario is a good step towards increasing surveillance and monitoring of chronic diseases and common risk factors10.
  • In the future, we hope to expand the number of jurisdictions compared with Ontario and increase the number of measures reported. This will allow us to provide a more meaningful analysis of Ontario’s relative progress compared to the international environment.
  • We hope this will be possible through the following steps:
    • Cancer Care Ontario’s continued participation in international benchmarking studies;
    • investigations into more research that offers meaningful comparisons; and
    • consideration of opportunities in data analysis (e.g. modifiable risk factors) where definitions may align more closely across jurisdictions.

View Notes

  1. World Cancer Research Fund (WCRF), American Institute for Cancer Research (AICR). Continuous update project report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective [Internet]. Washington, DC: AICR; 2013 [cited 2013 Mar 27]. Available from: http://www.dietandcancerreport.org/.
  2. WCRF, AICR. Continuous update project report summary. Food, nutrition, physical activity, and the prevention of breast cancer [Internet]. Washington, DC: AICR; 2010 [cited 2014 Dec 1]. Available from: http://www.dietandcancerreport.org/cancer_resource_center/downloads/cu/cu_breast_cancer_report_2008_summary.pdf.
  3. WCRF, AICR. Continuous update project. Colorectal cancer report 2010 summary. Food, nutrition, physical activity, and the prevention of cancer [Internet]. Washington, DC: AICR; 2011 [cited 2014 Dec 1]. Available from: http://www.dietandcancerreport.org/cancer_resource_center/downloads/cu/CUP_CRC_summary_2011.pdf.
  4. WCRF, AICR. Continuous update project report. Food, nutrition, physical activity, and the prevention of endometrial cancer [Internet]. Washington, DC: AICR; 2013 [cited 2014 Nov 5]. Available from: http://www.dietandcancerreport.org.
  5. WCRF, AICR. Continuous update project report. Food, nutrition, physical activity, and the prevention of pancreatic cancer [Internet]. Washington, DC: AICR; 2012 [cited 2014 Nov 5]. Available from: http://www.dietandcancerreport.org
  6. Shields M, Connor Gorber S, Tremblay MS. Estimates of obesity based on self-report versus direct measures. Health Reports. 2008; 19(2):61–76.
  7. Garriguet D. Diet quality in Canada. Health Rep. 2009; 20(3):41–52.
  8. Danaei G, Vander Hoorn S, Lopez AD, Murray CJL, Ezzati M. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet. 2005; 366:1784–93.
  9. International Agency for Research on Cancer (IARC). IARC monographs on the evaluation of carcinogenic risks to humans. Volume 100E. A review of human carcinogens. Part E: personal habits and indoor combustions. Lyon, France: IARC; 2012.
  10. Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. Taking action to prevent chronic disease: recommendations for a healthier Ontario; 2014 Nov 24 [cited 2012 Mar 26]. Available from: www.cancercare.on.ca/takingaction.