|Measure ||Desired Direction ||As of this Report |
|Percentage of referred cancer patients seen within 14 days for registered dietitian services || || |
|Percentage of head and neck cancer patients seen by a registered dietitian prior to or within 2 weeks of beginning curative systemic or radiation treatment || || |
| See Methodology and Approach to find out how the ratings are calculated. |
In 2015, 84% of cancer patients who had a referral date for dietitian services saw a registered dietitian at a regional cancer centre in Ontario within 14 days of their referral. This nearly meets Cancer Care Ontario’s goal of 85%.
Sixty-one percent (61%) of head and neck cancer patients in 2014 received dietitian services, either before their treatment or within 14 days of receiving curative radiation and/or systemic treatment. This is below Cancer Care Ontario’s program target of 85%.
What is psychosocial oncology?
Psychosocial oncology (PSO) is the interprofessional specialty concerned with understanding and treating the social, practical, psychological, emotional, spiritual and functional needs and quality-of-life impact that cancer has on patients and their families. PSO care spans from prevention, screening, diagnosis and treatment, through survivorship and end-of-life care1.
Core disciplines of PSO at Cancer Care Ontario include psychiatry, psychology, social work, occupational therapy, physiotherapy, dietitian services and speech language pathology.
Other disciplines that may be included in PSO programs include spiritual care providers, mental health nurses and medical psychotherapists.
How can we measure patient access to PSO services?
The Psychosocial Oncology Program at Cancer Care Ontario is driven by the Ontario Cancer Plan IV to support timely access to high-quality PSO care in order to improve the quality of life of patients. The program has developed a measurement plan that evaluates access to (and the effectiveness of) psychosocial support services for oncology patients across the province. As a starting point, the program focuses on measuring access to dietitians for patients identified as having a high need for nutritional intervention.
The figure is a large arrow with text above, within, and below the arrow.
The arrow is a visual to illustrate the text that describes the average time a cancer patient waited before seeing a registered dietitian at a regional cancer centre in Ontario.
The text above the arrow defines the psychosocial program indicator as the percent of cancer patients seen within 14 days for registered dietitian services in 2015 for Regional Cancer Centres in Ontario.
Two boxes with text in between lies on top of the arrow and visually illustrates the text: the median (or 50th percentile) wait time between referral date to consult date is  days and the 90th percentile wait time is  days. This means that 50 % of all patients were seen within  days and 90 % of patients were seen within  days.
The text below the arrow states the current result of the indicator: the percent of cancer patients seen within 14 days for registered dietitian services in 2015 is [83.45]%
What do the results show?
Eighty-four percent (84%) of cancer patients referred for dietitian services are seen within 14 days of referral, but fewer head and neck cancer patients are seen by a dietitian prior to or within two weeks of beginning curative radiation and/or systemic treatment (Figures 1 and 2).
- In 2015, 84% of cancer patients with a referral date for dietary services saw a registered dietitian within 14 days, nearly meeting Cancer Care Ontario’s goal of 85%.
- The median number of days from referral to consult is 2 days.
- Sixty-one percent (61%) of head and neck cancer patients saw a registered dietitian prior to or within 2 weeks of curative chemotherapy or radiation treatment in 2014. This has increased slightly from 56% in 2012.
- Cancer Care Ontario is working with multiple stakeholders to identify possible barriers to head and neck patients receiving timely dietitian services.
Why is this important to patient care?
Timely access to specialized care improves patient outcomes.
- Cancer patients frequently have dietary concerns related to their treatment and resulting symptoms. When a dietary or nutritional need is identified in a patient, it is important that they are referred appropriately to a dietitian and that they receive care in a timely fashion.
- Regional cancer centres report that patients’ needs frequently exceed resources, and that patient access to specialized psychosocial services can be affected as a result. By measuring wait times, the Psychosocial Oncology Program aims to measure patient access to psychosocial services.
- To determine appropriate wait times for registered dietitians, an expert panel comprised of registered dietitians, PSO experts, and patients and family advisors was convened. Based on expert consensus, it was concluded that 85% of all cancer patients referred to dietitian services should be seen within 2 weeks of referral to consult. The 85% target allows for delays due to circumstances around the patient or the clinic (e.g. a patient preference on whether they’d like to meet with a dietitian).
- Early nutritional intervention is important for head and neck cancer patients undergoing radiation therapy or concurrent chemotherapy/radiation. This allows dietitians to be proactive in supporting a patient’s nutritional needs.
- The Program in Evidence-Based Care’s The Management of Head and Neck Cancer in Ontario: Organizational and Clinical Practice Guideline Recommendations indicates that registered dietitians should be key members of the core healthcare team, which collectively is “responsible for the assessment, treatment, planning, management, survivorship, and rehabilitation” of the patient with head and neck cancer1.
- In a recent study evaluating the prevalence and influence of malnutrition among head and neck cancer patients, it was found that 36% of head and neck patients are malnourished before treatment. This results in higher scores for fatigue, appetite loss, nausea and vomiting2.
- Early nutrition intervention for head and neck cancer patients prior to receiving radiation therapy or concurrent chemotherapy/radiation is associated with minimizing weight loss and deterioration in nutritional status and reducing symptoms (such as grade 1 & 2 anorexia, nausea, vomiting, dry mouth and taste distortion). It also is linked to increasing energy and protein intake, quality of life measures, performance status and physical functioning2,3,4. Weight loss is significantly associated with deterioration in the quality of life, physical and social functioning, social eating and social contact5.
- In one study, patients undergoing concurrent chemotherapy/radiation who received early nutritional intervention had fewer breaks in treatment for toxicity (i.e. they had greater treatment tolerance). They also had fewer unplanned hospitalizations than the control group, suggesting nutritional intervention should occur before chemotherapy/radiation begins and continue until treatment is completed6.
The Psychosocial Oncology Program will continue to collect wait time information for PSO services in order to improve the quality of life of patients through access to high-quality, timely PSO services. Next year, the Program will focus on improving data quality for Mental Health and Cancer Rehab services.
The Program also will continue to develop a comprehensive PSO measurement plan and quality indicators (beyond wait times) in order to improve access. In collaboration with our partners, the Program will make recommendations for the delivery of PSO services in Ontario that ensure equitable, comprehensive care across the province. Furthermore, it will lead the development of PSO guidelines to improve the patient experience through establishing PSO services that are standardized across the province. This will be done through the regional adoption of evidence-based guidelines and through support for sexual health and depression Communities of Practice that create a forum for collaboration, knowledge transfer and professional development related to these areas of service delivery.
- 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.
- Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di Palma M. Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer. 2010; 18:433–437.
- Isenring EA, Capra S, Bauer JD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. British Journal of Cancer. 2004; 91:447–452. doi:10.1038/sj.bjc.6601962
- Ravasco P, Monteiro-Grillo I, Marque Vidal P, Camilo ME. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck. 2008; 27(8):659–68.
- Langius JAE, van Dijk AM, Doornaert P, Kruizenga HM, Langendijk JA, Leemans CR, et al. More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutrition and Cancer. 2013; 65(1):76–83. doi: 10.1080/01635581.2013.741749
- Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A, et al. Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer. 2010; 18:837–845. doi: 10.1007/s00520-009-0717-0