• 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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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 (FY) 2014/2015. Moreover, 81% of Ontario HN patients had their surgery performed in an HN centre in FY2014/2015, a rate similar to FY2013/2014. It is anticipated that, in the future, all of Cancer Care Ontario’s HN centres will meet the goal of 90% of HN surgeries being performed in an HN centre.

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 or organs (e.g. ear or nose), sinuses, pharynx and larynx. It is important to note that HN surgery does not include neurosurgery.
  • 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 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 an assessment by an HN surgical oncologist and a radiation oncologist with expertise in HN cancer. Assessment by a medical oncologist also may 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, 81% of Ontario HN patients had their surgery performed in an HN centre in FY2014/2015 (compared to 83% in FY2013/2014). 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 FY2013/2014 and FY2014/2015.
  • There are currently 8 HN centres in Ontario. In FY2014/2015, 6 of the 8 centres met the surgery volume requirement of a minimum of 80 HN surgeries. Although there was a slight volume decrease in 2 centres from FY2013/2014 to FY2014/2015, it is anticipated that all HN centres will meet target volumes in the future as implementation of the standards continues.
  • Non-HN designated hospitals performed a small number of HN surgeries in FY2014/2015 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.