• 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 from Diagnosis to Chemotherapy

Measure Desired Direction As of this Report
Percentage of patients diagnosed with lymphoma who started chemotherapy within 30 days of diagnosis Black Arrow Up Yellow Arrow Level
See Methodology and Approach to find out how the ratings are calculated.

Key findings

Forty-eight percent (48%) of lymphoma patients started chemotherapy within 30 days following diagnosis in 2010-2013, with significant variation across the province. The rates of lymphoma patients starting chemotherapy within 30 days following diagnosis have not significantly changed from previous years.

What is chemotherapy?

  • Chemotherapy uses drugs to slow or stop cancer cells from growing, multiplying or spreading to other parts of the body1. Treatment can be taken as pills, injection or intravenously (IV).
  • In my words

    Integrated means that all of the different people involved in my care understand what has been done and what needs to be done and add to the treatment plan not delay or decrease its effectiveness. It’s important because as a cancer patient we need to know that nothing is being missed and we are receiving the best treatment possible because everyone understands what is being done and what the timeline is.

    Laurie P.
    Patient/Family Advisor
  • For some cancers (like lymphoma) chemotherapy is the primary type of treatment and is meant to kill cancer cells. Depending on the type of lymphoma, chemotherapy also may be given to prolong life or (in the cases of aggressive non-Hodgkin lymphoma) to cure the cancer.

What is an integrated wait time?

  • Cancer Care Ontario is working towards reporting systemic wait time data in a way that increasingly represents the total wait time journey.
  • The diagram below shows the progression of a patient’s wait time beginning with the date of diagnosis to referral date. The referral then leads to a consultation date with the medical oncologist, followed by the start of chemotherapy treatment.
  • By looking at the combined wait time, a more complete picture of the patient wait time for chemotherapy is presented.
  • Cancer Care Ontario measures the percentage of patients with aggressive non-Hodgkin lymphoma who receive chemotherapy within 30 days of diagnosis.
Wait time from Diagnosis to Chemotherapy

Wait Times from Diagnosis to Chemotherapy–

Systemic Wait Times (in days) from diagnosis to chemotherapy, from diagnosis to referral, from referral to consult, from consult to chemotherapy, for Lymphoma cancer patients diagnosed in CY 2010-2013, Ontario

The figure has two arrow charts. Each arrow label includes the relevant median, 90 percentile wait times for lymphoma patients in Ontario.

First arrow shows the overall wait time from diagnosis to first chemotherapy treatment. For Ontario, 48% of patients receive chemotherapy within 30 days of diagnosis and median and 90 percentile wait time are 32 and 70 days respectively.

Second arrow shows the wait times broken down by individual journeys, that is, diagnosis, referral, consult, and chemotherapy treatment. 

  • Diagnosis to referral: median=13 days, 90 percentile=35 days
  • Referral to consult: median=6 days, 90 percentile=21 days
  • Consult to the first chemotherapy treatment: median=13.5 days, 90 percentile=39 days

Please note the overall median wait times for the entire patient journey (diagnosis to treatment) cannot be compared to the summation of the individual parts of the journey (diagnosis to referral, referral to consult and consult to treatment)

click to close graph
Close Graph

What do the results show?

In 2010-2013, 48% of lymphoma patients began treatment within 30 days of diagnosis (Figures 1 and 2).

  • The most recent data for wait times from diagnosis to chemotherapy are from 2013 (because staging information is required).
  • The proportion of lymphoma patients receiving chemotherapy treatment within 30 days following diagnosis in 2013 was similar to the proportion in previous years (data not shown). 
  • Overall, 46% of lymphoma cancer patients in 2013 started chemotherapy within 30 days following diagnosis (compared to 50% in 2012).
  • There is notable regional variation in the percentage of lymphoma cancer patients who received chemotherapy within 30 days following diagnosis (ranging from 37% to 61% for the period from 2010 to 2013).

The median wait time in days is 32 days from the date of diagnosis to the start of treatment (Figure 3).

  • The journey from diagnosis to chemotherapy includes clinically important events, including:
    • diagnostic testing
    • pathology analysis
    • staging of the cancer
    • treatment plan development.
  • Lymphoma cancer patients have a median wait time of 32 days from diagnosis to the start of chemotherapy.
  • The shortest component of the entire wait period is the referral-to-consult phase, averaging a median wait time of 6 days.
  • The time from diagnosis to referral and from consult to chemotherapy are similar, averaging a median wait time of 13 days and 14 days respectively.
  • Diagnosis to referral had the largest regional variation, ranging from 10 to 18 days.

The percentage of lymphoma patients receiving treatment within 30 days following diagnosis varies with age (Figure 4).

  • Approximately 55% of patients aged 18 to 29 received chemotherapy within 30 days following diagnosis, compared to 44% of patients aged 65 to 79 and 43% of patients ages 80 and older.
  • Similar age trends in wait times were seen for colon cancer patients who received adjuvant chemotherapy within 60 days after surgery
  • According to a report by the Canadian Partnership Against Cancer, differences in access to chemotherapy among older patients may be because older patients are more likely to have other health conditions or be taking medications that may interact negatively with chemotherapy2.

Why is this important to Ontarians?

Identifying barriers to improve wait times

  • Planning treatment for patients with lymphoma must consider individual factors such as patient age, performance status, histological subtype and disease extent and severity. Improvements in survival rates of lymphoma are a result of new drugs and the use of best evidence3.

Wait times are a person-centred measure.

  • Measuring the time from diagnosis to systemic treatment captures a larger section of the patient journey, and it is more relevant than other wait times. This addresses the importance of continuity of care for patients in the cancer system.
  • After diagnosis, several steps need to be completed before a patient is ready for chemotherapy. These include waiting for pathology results, consulting with the medical oncologist and planning treatment.

Wait times are a barometer for the health of the cancer system.

  • Wait times serve as an important barometer for how well the cancer system is working.
  • Measuring these time segments is important for identifying aspects of treatment and processes that add to wait times and effect access to care4.

Find out more

More information on the Systemic Treatment Program is available on the Cancer Care Ontario website.

View Notes

  1. Zanke B, Evans WK. Systemic therapy: building on a strong base. In: Sullivan T, Evans W, Angus H, Hudson A, editors. Strengthening the quality of cancer services in Ontario. Ottawa: CHA Press; 2003.
  2. Canadian Partnership Against Cancer. The 2014 cancer system performance report [Internet]. Toronto: Canadian Partnership Against Cancer; 2014. Available from:  http://www.cancerview.ca/idc/groups/public/documents/webcontent/sp_report_2014.pdf.
  3. National Cancer Institute [Internet]. Bethesda (MD): US Department of Health and Human Services. Adult non-Hodgkin lymphoma treatment; 15 Jan 2016 [cited 2015 Mar 3]. Available from: http://www.cancer.gov/cancertopics/pdq/treatment/adult-non-hodgkins/HealthProfessional/page7.
  4. Saint-Jacques N, Rayson D, Al-Fayea T, Virik K, Morzychi W, Younis T. Waiting times in early-stage non-small cell lung cancer. J Thorac Oncol. 2008; 3(8):865–870.