• 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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Treating Rectal Cancer According to Guidelines

 
Measure Desired Direction As of this Report
Preoperative assessment in rectal cancer cases

Percentage of rectal cancer patients receiving an MRI or TRUS in the 6 months prior to surgery   
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See Methodology and Approach to find out how the ratings are calculated.

Key findings

The percentage of patients having magnetic resonance imaging (MRI) or transrectal ultrasound (TRUS) prior to rectal cancer surgery varies, depending on whether or not a patient receives neoadjuvant chemotherapy/radiation treatment. The percentage of patients getting an MRI or TRUS in the 6 months prior to rectal surgery is higher among those who receive neoadjuvant treatment than it is among those who do not. Patients who receive neoadjuvant chemotherapy/radiation also are more likely to receive an MRI or TRUS in the most appropriate time period prior to surgery. Based on data from past years, it appears that the percentage of patients receiving an MRI or TRUS prior to rectal cancer surgery is improving for all rectal cancer patients, although this is the first year that this indicator has been captured in the Cancer System Quality Index (CSQI).

What is rectal cancer surgery?

  • Rectal cancer surgery is the primary treatment for rectal cancer. It is currently the only method that has the potential to cure rectal cancer1.
  • Rectal surgery may also be palliative (i.e. used to relieve symptoms of pain, bleeding, bowel blockage and perforation) in cases when a cure is not possible1.
  • Together, the rectum and colon form the large bowel:
    • the colon makes up the first 3 quarters of the large bowel; and
    • the rectum makes up the last quarter of the large bowel1.
  • Diagnostic tests, surgical procedures and adjuvant therapies often differ between colon and rectal cancers1. The data shown below presents the rate of preoperative pelvic MRI or TRUS in rectal cancer patients.

What is a preoperative MRI or TRUS?

  • An MRI is a medical imaging technique that creates detailed images of organs and tissues within the body.
  • A TRUS is a medical imaging technique that uses sound waves to form an image of body tissue, although it produces images with less anatomical detail than images created from MRI scans2,3.
  • Both TRUS and MRI are used to determine how deeply within the wall of the rectum or other structures the tumour has penetrated.
  • A pelvic MRI and/or TRUS may be performed to diagnose rectal cancer or to help plan cancer treatment4. The preferred method of preoperative imaging assessment is the pelvic MRI, but a TRUS is useful when an MRI is not readily available or in early rectal cancers2,3,5.
  • MRI/TRUS evaluation should be completed prior to the start of chemotherapy/radiation treatment. There is an expected interval of time between the completion of MRI/TRUS and surgery for patients during which patients are receiving chemotherapy/radiation treatment. This treatment interval varies depending on the clinical scenario but may last several months.
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What do the results show?

Patients who received neoadjuvant chemotherapy/radiation treatment were more likely to have an MRI or TRUS prior to rectal cancer surgery than patients who did not receive neoadjuvant chemotherapy/radiation treatment (Figure 1).

  • In FY2014/2015, 94% of patients with rectal cancer who received neoadjuvant chemotherapy/radiation treatment had an MRI or TRUS prior to their rectal cancer surgery (compared to 71% of patients who did not receive neoadjuvant chemotherapy/radiation treatment).
  • The percentages of patients receiving an MRI or TRUS prior to rectal cancer surgery have been improving every year since FY2011/2012 in both groups of patients (i.e. patients who received neoadjuvant chemotherapy/radiation and patients who did not). A more significant improvement has been seen among patients who received adjuvant chemotherapy/radiation.

The majority of patients who receive neoadjuvant treatment are having their MRI or TRUS in the most appropriate time period prior to surgery (Figure 1).

  • The ideal time period to have an MRI or TRUS prior to rectal cancer surgery differs, depending on whether or not a patient receives neoadjuvant chemotherapy/radiation.
  • Patients who receive neoadjuvant chemotherapy/radiation should have an MRI or TRUS prior to their chemotherapy/radiation. For this patient group in FY2014/2015, 80% of patients received an MRI or TRUS in that time period. This is an increase from previous years (from FY2011/2012 to FY2012/2013), where approximately 75% to 76% of patients had an MRI or TRUS in the 3 to 6 months prior to surgery.
  • Patients who do not receive neoadjuvant chemotherapy/radiation treatment should have an MRI or TRUS in the month preceding rectal cancer surgery. Since FY2011/2012, however, consistently more patients are having an MRI or TRUS 1 to 3 months prior to surgery (rather than the <1 month period).
  • However, a preoperative MRI or TRUS in the 6 months prior to surgery is acceptable for patients who do receive neoadjuvant chemotherapy/radiation treatment and those who do not. There was an increase of guideline-concordant preoperative MRI or TRUS from FY2011/2012 to FY2013/2014 in both of these populations. In FY2013/2014, 95% of patients who received neoadjuvant chemotherapy/radiation (and 71% of patients who did not receive neoadjuvant chemotherapy/radiation) had a guideline-concordant preoperative MRI or TRUS5.
  • Preoperative imaging recommendations for rectal cancer cases can be found in the Optimization of Preoperative Assessment in Patients Diagnosed with Rectal Cancer

There is considerable variation across the province in the percentage of patients who had an MRI or TRUS prior to rectal cancer surgery (Figure 2).

  • Among patients who received neoadjuvant chemotherapy/radiation treatment, the LHIN with the highest rate of patients who had an MRI or TRUS prior to rectal cancer surgery was Central West (97%). The LHIN with the lowest rate was Hamilton Niagara Haldimand Brant (79%).
  • Among patients who do not receive neoadjuvant chemotherapy/radiation treatment, the LHIN with the highest rate of patients who had an MRI or TRUS prior to rectal cancer surgery was Champlain (83%). The LHIN with the lowest rate was South West (50%).
  • In every LHIN, patients who received neoadjuvant treatment were more likely to have had an MRI or TRUS in the 6 months prior to rectal cancer surgery (compared to those who did not receive neoadjuvant treatment). This is similar to province-wide rates.

Why is this important to patient care?

  • An MRI or TRUS within the recommended time frame prior to surgery is important for preoperative decision-making regarding surgery, need for radiation and for predicting outcome in rectal cancer patients5.

Find out more

View Notes

  1. Nenshi R, Baxter N, Kennedy E, Simunovic M, Urbach DR. Surgery for colorectal cancer. In: Urbach DR, Simunovic M, Schultz SE, editors. Cancer surgery in Ontario: ICES atlas. Toronto: Institute for Clinical Evaluation Sciences; 2008.
  2. Dhawan PA. Medical imaging analysis. Hoboken (NJ): Wiley-Interscience Publication; 2003.
  3. National Cancer Institute [Internet]. Bethesda (MD): National Cancer Institute. NCI dictionary of cancer terms: transrectal ultrasound; [cited 2016 January 27]. Available from: http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46632.
  4. Canadian Cancer Society [Internet]. Toronto: Canadian Cancer Society; c2016. Magnetic resonance imaging (MRI); [cited 2016 January 25]. Available from: http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/magnetic-resonance-imaging-mri/?region=on.
  5. Kennedy E, Vella E, MacDonald B, Wong S, McLeod R. Optimization of preoperative assessment in patients diagnosed with rectal cancer [Internet]. Toronto: Cancer Care Ontario; 2014. Available from: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=294945.