|Measure ||Desired Direction ||As of this Report |
|Percentage of cancer surgery patients who had surgical consultation within priority access target for their wait, from the date the referral is received to surgical consultation (Wait 1) || || |
|Percentage of cancer patients surgically treated within priority access target for their wait, from decision to treat to surgical procedure date (Wait 2) || || |
| See Methodology and Approach to find out how the ratings are calculated. |
In 2015, despite increasing demand, 84% of all cancer surgery patients received their consult and 88% received their surgery within the recommended wait time. This represents stable access to surgical oncology consultations and slightly improved access to surgical treatment procedures, moving towards Cancer Care Ontario’s goal of 90%.
What is cancer surgery?
- Cancer surgery is commonly used to treat many types of cancer.
- Wait times for cancer surgery are captured by measuring Wait 1 and Wait 2.
- Wait 1 is the time period from the receipt of the referral to the date of first consultation with a surgical specialist.
- Wait 1 is applied only to patients who are proceeding to surgery, and it is associated with the surgeon who completed the surgery.
- Following consultation with the patient, the surgeon assigns each case a priority level. The appropriate priority level depends on many factors, including the type of cancer, the complexity of the particular case and progression of the disease.
- Wait 2 is the time period from decision to treat to the surgical procedure date.
Table 1. Adult Oncology Surgery—Wait 1 Priority Assessment Tool
|Priority||Definition|| Time period|
|Priority 1||High suspicion of cancer or a biopsy that is positive for cancer where patient has severe life- or limb-threatening symptoms and signs, and where imminent morbidity or mortality without immediate intervention is high||Within 24 hours|
|Priority 2||High suspicion of cancer or a biopsy that is positive for cancer where patient has high likelihood of having a highly aggressive malignancy||Within 10 days|
|Priority 3||All patients with high suspicion of cancer that does not meet the criteria of Priorities 2 or 4||Within 21 days|
|Priority 4||All patients with an intermediate level of suspicion of cancer or patients with a biopsy that is positive for cancer, but with a high likelihood of an indolent (slow-growing) malignancy||Within 35 days|
Table 2. Adult Oncology Surgery—Wait 2 Priority Assessment Tool
|Priority||Definition|| Time period|
|Priority 1||Patients require immediate emergency surgery||Within 24 hours|
|Priority 2||Patients are diagnosed with highly aggressive malignancies||Within 14 days|
|Priority 3||Patients have known or suspected invasive cancer that does not meet the criteria of Priorities 2 or 4||Within 28 days|
|Priority 4||Patients diagnosed with indolent (slow-growing) malignancies||Within 84 days|
What do the results show?
Overall, access to surgical consultations remained stable, with improvements in the rate of urgent cases having a consult within 10 days of referral (Figure 1 and 2).
- Wait 1 data demonstrates stable access to surgical oncology consultations, with consistently greater than 80% of patients seen within their respective Wait 1 priority access targets. Nonetheless, the rate remains below Cancer Care Ontario’s goal of 90%.
- In 2015, 79% of Priority 2 patients were seen by a specialist within the Wait 1 priority access target. This is an improvement from 75% in 2014. Access for Priority 3 and Priority 4 patients remained stable at 85% and 82%, respectively.
Variation exists for patients waiting for a specialist consult (Wait 1), depending both on type of disease and location (Figures 3 and 4).
- Regional variation exists for patients who require specialist consultation, depending on where in the province they see their specialist. For example, the overall percentage of patients who were treated within their priority access target for 2015 is 84%. The lowest performing LHIN was North West (78%) and the top performing LHIN was Central West (90%).
- The highest percentage of patients by disease type being consulted within Wait 1 priority access target are breast and neurosurgery cancer patients (each at 91%).
- The lowest percentage of patients consulted within target are ophthalmic cancer patients (70%).
For patients waiting to receive surgical oncology procedures (Wait 2), improvement is needed to reach Priority 2 (within 14 days) and Priority 3 (within 28 days) access targets (Figure 5 and 6).
- Over the past 8 years, the percentage of patients who had surgery within the Priority 2 access target (within 14 days) increased, up from 53% in 2008 to 82% in 2015.
- The percentage of patients who had surgery within the Priority 3 access target (within 28 days) also increased over the same period, up from 67% in 2008 to 84% in 2015.
- This is encouraging progress, given that Priorities 2 and 3 represent more urgent cancer cases. Further focus and improvement is required, however, if provincial benchmarks of 90% are to be met.
- Ontario continues to excel at meeting Priority 4 targets, with 95% of cases completed within the 84-day access target.
- Seasonal variations are observed when it comes to receiving oncology procedures, with fewer patients meeting targets around holiday periods.
Variation also exists for patients waiting for oncology surgery (Wait 2), both by disease type and hospital location (Figure 7 and 8).
- Regional variation exists for patients requiring access to surgical oncology procedures, depending on where in the province they are treated.
- For example, the overall percentage completed within target for Ontario in 2015 was 88%. The lowest performing LHIN was Hamilton Niagara Haldimand Brant (79%), and the top performing LHIN was Central (96%).
- The Wait 2 data show steady improvement since January 2010, with the best performing LHINs exceeding Cancer Care Ontario’s goal of 90% each month.
- The highest percentage of patients receiving surgery within the target are bone, joint and muscle cancer patients (94%) and neurosurgery patients (93%).
- The lowest percentage of patients receiving surgery within the target are ophthalmic cancer surgery patients (50%) and gynecologic cancer surgery patients (80%).
Timely access to cancer surgery improves outcomes and lessens patient anxiety.
- Surgery often is the first point of entry into the cancer treatment system for patients, so wait time for surgery has the potential to affect the entire patient journey.
- This report focuses solely on elective surgery for curative cases and does not include emergency, diagnostic, reconstructive or palliative procedures.
- About 80% of cancer patients will have surgery at some point during their cancer treatment1.
- Some cancers are more aggressive and should be treated quickly, while others do not need immediate treatment.
- While some waiting for appropriate treatment planning is reasonable (even necessary), treatment should be provided within the recommended time frame to ensure the best clinical outcomes.
- Research has shown that delays in surgical treatment can be associated with reduced survival for all types of cancer2, and that shortening the wait time can minimize unnecessary patient stress and anxiety3.
Wait times are a gauge of the cancer system’s performance.
- Wait times are a way to gauge how well the cancer system is working, and they provide valuable insight into how to distribute existing resources and plan services.
- Other jurisdictions with similar health systems that measure and publicly report on surgery wait times include New Zealand4, Australia5, and Sweden6, although their measures are not comparable to Ontario’s.
Find out more
More information on cancer surgery wait times is available on the Cancer Care Ontario website.
For up-to-date information on wait times at each of the regional cancer centres—and for specific types of surgery and wait times for other procedures—please see the Ministry of Health and Long-Term Care’s Ontario Wait Times website.
- Simunovic M, Gagliardi A, McCready D, Coates A, Levine M, DePetrillo D. A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario. CMAJ. 2001; 165:421–425.
- Yun Y, Kim Y, Min Y, Park S, Won Y, Kim D, et al. The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery. Annals of Oncology. 2012; 23(10):2731–2737.
- Eskander A, Devins G, Freeman J, Wei A, Rotstein L, Chauhan N, et al. Waiting for thyroid surgery: a study of psychological morbidity and determinants of health associated with long wait times for thyroid surgery. Laryngoscope. 2013; 123(2):541–547.
- New Zealand Ministry of Health [Internet]. Wellington: New Zealand Ministry of Health: 2013. National cancer programme: work plan 2012/2013; [cited 2016 Mar 8]. Available from: http://www.health.govt.nz/publication/national-cancer-programme-work-plan-2012-13.
- National Health Performance Authority [Internet]. Sydney; National Health Performance Authority; c2016. MyHospitals; [cited 2016 Mar 8]. Available from: http://www.myhospitals.gov.au/.
- Swedish Association of Local Authorities and Regions and Swedish National Board of Health and Welfare. Quality and efficiency in Swedish cancer care [Internet]. Stockholm: Swedish National Board of Health and Welfare; 2012. [cited 2016 Mar 8] Available from: http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/18641/2012-3-15.pdf.