• 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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Wait Times for Diagnostic Assessment Program

Measure Desired DirectionAs of this Report
Percentage of lung/thoracic patients who entered a DAP diagnosed within target (28 days) from referral to diagnosisBlack Arrow UpYellow Arrow Up
See Methodology and Approach to find out how the ratings are calculated.

Key findings

Approximately half of Ontario patients receiving a diagnosis of lung cancer in 2015 were diagnosed following assessment at one of Ontario’s 15 lung/thoracic Diagnostic Assessment Programs (DAPs). Fifty-seven percent (57%) of individuals suspected of having lung/thoracic cancer who had been assessed through one of Ontario’s lung/thoracic DAPs were diagnosed within the 28-day target time following a referral from their primary care provider or another healthcare professional. From 2012 to 2015, the percentage of patients diagnosed within the 28-day target time has increased.

There is, however, significant variation in the wait times for lung cancer diagnosis across regions. While this is a report only on lung/thoracic patients seen in a DAP, Cancer Care Ontario continues to work with DAPs to improve wait times for diagnosis while developing approaches to understand the experience of patients who are not served by a DAP.

Diagnosing lung cancer

  • In Canada, lung cancer is the most commonly diagnosed cancer, and it is the leading cause of death from cancer for both men and women
  • Diagnosing lung cancer is a complex process that can be long and frustrating for people experiencing the relevant signs and symptoms. It requires several diagnostic tests and procedures to help the physician rule out other health problems and make a cancer diagnosis.
  • Overall, the existing literature does not suggest a clear link between diagnostic wait time and patient survival outcomes1,2.

Lung DAPs

  • To help transform the experience in the diagnostic phase of the cancer journey for both patients and healthcare providers—and to improve the efficiency and effectiveness of the overall healthcare sector—Cancer Care Ontario has developed and supported the implementation of DAPs across the province for individuals suspected of having colorectal, lung/thoracic or prostate cancers. More programs for streamlined diagnostic assessment also have been introduced for other cancer types, based on regional needs.
  • The structure and organization of a DAP are influenced by the geographic realities of each jurisdiction3. DAPs in Ontario are designed to provide a single point of access for providers and patients to access coordinated diagnostic services. DAPs may be physical or virtual to facilitate care close to home.
  • There are currently more than 39 DAPs in Ontario, including 15 lung DAPs that specialize in the diagnosis and staging of lung/thoracic cancer in each Regional Cancer Program.
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What do the results show?

Over half of the patients suspected of having lung/thoracic cancer who were seen in a lung DAP were diagnosed within 28 days of referral.

  • There is regional variation in the percentage of patients suspected of having lung/thoracic cancer who are being diagnosed within a 28-day period from referral. Overall, the percentage of patients suspected of having lung/thoracic cancer who are diagnosed within 28 days of referral has increased from 48% in 2012 to 57% in 2015.
  • Data collection started in 2011 and a target was set in 2013. The target was 50% for FY 2013/14 and raised to 65% in FY 2014/15 in order to support continued improvement in the system.
  • Compared to the 2014 CSQI outcomes—when only Waterloo Wellington met the annual improvement program target of 65%—3 regions surpassed the target in 2015: Toronto Central North (71%), Waterloo Wellington (69%) and Champlain (80%).
  • From 2014 to 2015, improvement in the percentage of patients diagnosed within a 28-day period from referral was observed in Central East, Erie St. Clair, Mississauga Halton/Central West, North East, South East, Toronto Central North, Toronto Central South, Hamilton Niagara Haldimand Brant, and Champlain. Declines in wait time performance from 2014 to 2015, however, were observed in Central, North Simcoe Muskoka, North West, South West and Waterloo Wellington.
  • Regional variability can be explained in part by differences in entry criteria when regional DAPs assess the eligibility of patients for enrolment in their program. For example, some regions enroll patients if they have an abnormal chest x-ray, while others may require a chest CT scan with the referral, which is likely to shorten wait times.
  • Challenges meeting wait time targets in lung/thoracic DAPs still persist, and in some cases are worsening for a number of reasons. These include timely access to CT-guided biopsy, increased patient volumes in excess of capacity and accommodation of patient scheduling preferences. Cancer Care Ontario is continuing to perform analyses to better understand the extent of the issue and the contributing factors.
  • To address these challenges and improve wait times, Cancer Care Ontario is facilitating the sharing of best practices and successful strategies from regions meeting target and those making steady improvements. Individual regions are continuously developing and executing action plans to improve wait times. New recommended entry and transfer of care criteria for lung/thoracic DAPs have been developed and awareness of DAPs continues to increase among primary care providers which may further increase patient volumes.
  • Cancer Care Ontario also is evaluating different models of diagnostic assessment that feature sustainability as a key component.

Why is this important to Ontarians?

Delay between patient referral and diagnosis can lead to increased stress and anxiety for patients and caregivers.

  • Psychological distress intensifies as the waiting time for diagnosis gets longer4.
  • Organized diagnostic assessment occurring within DAPs streamlines appropriate testing and ensures that patients are informed of the steps in the diagnostic process.

Wait times can help with the allocation of resources for the health system.

  • By monitoring wait times data, the province can more effectively and accurately distribute existing resources and plan for future services.

Find out more?

  • More information about Cancer Care Ontario’s DAPs is available on their website.
  • The Cancer System Quality Index (CSQI) reports on the experience of cancer patients who go through Cancer Care Ontario’s DAPs.
  • Cancer Care Ontario’s Disease Pathway Management (DPM) has published several maps that outline the screening, diagnosis and treatment pathways for specific diseases (including lung cancer). Individuals with signs and/or symptoms of lung cancer are typically referred directly to a lung DAP by a family physician or other healthcare provider.

View Notes

  1. Tørring ML, Frydenberg M, Hamilton W, et al. Diagnostic interval and mortality in colorectal cancer: U-shaped association demonstrated for three different datasets. J Clin Epidemiol. 2012; 65(6):669–678.
  2. National Cancer Intelligence Network. Routes to diagnosis: technical supplement. London (UK): National Cancer Research Institute; 2010.
  3. Brouwers M, Crawford J, Elison P, Evans WK, Gagliardi A, Holmes D, et al. Organizational standards for diagnostic assessment programs. Toronto: Cancer Care Ontario; 2007.
  4. Risberg T, Sorbye SW, Norum J, Wist EA. Diagnostic delay causes more psychological distress in female than in male cancer patients. Anticancer Res. 1996; 16(2):995–99.