• 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 Time from Diagnosis to Radiation Therapy

 
Measure Desired DirectionAs of this Report
Wait times (in days) from diagnosis to treatment for oropharynx cancer patients receiving radiation therapyBlack Arrow DownYellow Arrow Level
Wait times (in days) from diagnosis to treatment for cervical cancer patients receiving radiation therapyBlack Arrow DownGrey Arrow Null
See Methodology and Approach to find out how the ratings are calculated.

Key findings

The wait time for radiation therapy looks at the median time (measured in days) between the time a cancer patient is diagnosed and the start of radiation therapy treatment. For oropharynx cancer patients diagnosed in 2014, the median wait time from diagnosis to start of treatment was reported as being 49 days. For cervical cancer patients diagnosed in 2014, the median wait time in days from diagnosis to start of treatment was 60 days. There is variation across regions with regard to median wait times for both oropharynx and cervical cancer patients, which suggests that there may be room for improvement.

What is radiation treatment?

  • Radiation treatment uses energy (radiation) from X-rays, gamma rays and electrons to destroy cancer cells. In high doses, radiation destroys cells in the area being treated.
  • Radiation destroys cells by damaging the DNA in cancer cell genes, making it impossible for them to grow and divide.
  • During radiation treatment, both cancer cells (which are growing in an uncontrolled way) and healthy cells are affected, but most healthy cells can repair themselves.

Wait times for radiation therapy

  • Cancer Care Ontario reports not only whether radiation wait times are improving, but also how many patients are being treated within the recommended time frame or targets, according to 3 intervals:
    • Diagnosis-to-referral: the time between the initial diagnosis and a referral to a radiation oncologist.
    • Referral-to-consult: the time between referral and being seen by a radiation oncologist.
    • Ready-to-treat to start of radiation treatment: the time between being ready for treatment and receiving first treatment.
  • Traditionally, the target wait time for the referral-to-consult interval is 14 days, while the targets for the ready-to-treat to start of treatment interval vary from 1 to 14 days (depending on the priority category, which is determined based on the patient’s condition).
  • The wait times for radiation in this report are shown as medians in days from the time of diagnosis to start of treatment, and they do not have a target. The median wait time is the point at which half of the patients have started their treatment and the other half are still waiting1.

What is an integrated wait time?

  • Cancer Care Ontario is working towards reporting radiation therapy wait time data in a way that increasingly represents the total wait time journey.
  • Figure 1 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 radiation oncologist, followed by the radiation treatment date.
  • By looking at the combined wait time, a more complete picture of the patient wait time for radiation is presented.
Figure 1. Median wait times (in days) from diagnosis to referral, referral to consult and consult to treatment for oropharynx patients, diagnosed 2013–2014, Ontario

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 median time a patient with oropharynx cancer waited at specific intervals from diagnosis to the start of treatment at a regional cancer centre in Ontario.

The text above the arrow defines the radiation therapy wait time indicator as the median wait times (in days) from diagnosis to referral, referral to consult, and consult to start of radiation treatment for patients diagnosed with oropharynx cancer in 2013 and 2014 in Ontario.

Four boxes with text in between lies on top of the arrow and visually illustrates the text: the median (or 50th percentile) wait time between diagnosis and referral is 14 days, the median wait time between referral and consult is 7 days, and the median wait time between consult and the start of radiation treatment is 23 days. This means that 50 % of patients with oropharynx cancer: received a referral within 14 days of receiving their diagnosis, had a consultation with a radiation oncologist within 7 days of receiving a referral, and started radiation treatment within 23 days of having a consultation with a radiation oncologist.

The text below the arrow states the current result of the indicator: the median wait time from diagnosis to radiation treatment for patients with oropharynx cancer is 49 days.

Additional text further below the arrow states that 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
Figure 4. Median wait times (in days) from diagnosis to referral, referral to consult and consult to treatment for patients with cervical cancer, diagnosed 2013–2014, Ontario

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 median time a patient with cervical cancer waited at specific intervals from diagnosis to the start of treatment at a regional cancer centre in Ontario.

The text above the arrow defines the radiation therapy wait time indicator as the median wait times (in days) from diagnosis to referral, referral to consult, and consult to start of radiation treatment for patients diagnosed with cervical cancer in 2013 and 2014 in in Ontario.

Four boxes with text in between lies on top of the arrow and visually illustrates the text: the median (or 50th percentile) wait time between diagnosis and referral is [24] days, the median wait time between referral and consult is 5 days, the median wait time between consult and the start of radiation treatment is 21 days. This means that 50 % of patients with cervical cancer: received a referral within 24 days of receiving their diagnosis, had a consultation with a radiation oncologist within 5 days of receiving a referral, and started radiation treatment within 21 days of having a consultation with a radiation oncologist.

The text below the arrow states the current result of the indicator: the median wait time from diagnosis to radiation treatment for patients with cervical cancer is 60 days.

Additional text further below the arrow states that 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).

What do the results show?

Oropharynx cancer patients diagnosed from 2013 to 2014 had a median wait of 49 days from diagnosis to start of radiation treatment (Figures 1, 2 and 3).

  • The diagnosis–to–referral median is 14 days, which indicates that 50% of patients are not referred more than 2 weeks after being diagnosed.
  • Variation seen across regions suggests there is room for improvement.
  • The referral-to-consult median is 7 days (Figure 3), and the provincial target of 85% of patients seen within 14 days is met in all regions of Ontario.
  • The median number of days from consult to treatment is 23, indicating that 50% of patients start treatment just over 3 weeks after having a consult with a radiation oncologist.
  • There is considerable variation from the consult date to date of first treatment. This is despite the fact that we are meeting provincial targets in the ready-to-treat to start of treatment interval. This variation again suggests there is room for improvement, presumably in the staging workup of patients and the coordination of care with other related disciplines (medical oncology, surgery, dental etc.).

Cervical cancer patients diagnosed from 2013 to 2014 had a median wait of 60 days from diagnosis to start of radiation treatment (Figures 4, 5 and 6).

  • The median wait time from diagnosis to referral for patients diagnosed with cervical cancer in Ontario from 2013 to 2014 was 24 days. The referral-to-consult median wait time was 5 days and consult-to-treatment median wait time was 21 days.
  • There is evidence that patients with cervical cancer who complete their radiation treatment (first external beam to end of brachytherapy) in fewer than 56 days have better outcomes2. In Ontario, 80% of patients meet the 56-day brachytherapy treatment duration.

Why is this important to patient care?

Measuring waiting times is a person-centred measure.

  • Measuring the time from diagnosis to radiation treatment captures a larger section of the patient journey. This may be more relevant from a patient perspective than other wait times intervals.
  • Having relevant integrated measures such as the ones discussed here addresses the importance of coordination of care for patients in the cancer system.

Shorter wait times result in better outcomes and reduced stress.

  • Radiation treatment shrinks tumours, destroys cancer cells or provides relief from cancer symptoms. This includes use for palliative reasons in end of life care.
  • Some cancers are more aggressive and should be treated more quickly, while others grow slowly and do not need immediate attention.
  • To ensure the best outcomes from radiation treatment—and to minimize undue stress—the wait time should be as short as reasonably possible3.
  • Unavoidable delays, such as patient preferences for consultation, contribute to a proportion of patients who do not meet the target for the referral-to-consultation interval.
  • Wait times serve as a gauge of how well the cancer system is working. They provide valuable insight when distributing existing resources and planning for future services.

It serves as a barometer of the health of the cancer system.

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

Find out more

View Notes

  1. Ministry of Health and Long-Term Care [Internet]. Toronto: Queen’s Printer for Ontario; c2013. Ontario wait times; 2015 Nov 2 [accessed 2014 Mar 7]. Available from: http://www.health.gov.on.ca/en/pro/programs/waittimes/surgery/data.aspx.
  2. Song S, Rudra S, Hasselle MD, Dorn PL, Mell LK, Mundt AJ, et al. The effect of treatment time in locally advanced cervical cancer in the era of concurrent chemoradiotherapy. Cancer. 2013; 119:325–32.
  3. Chen Z, King W, Pearcey R, Kerba M, Mackillop WJ. The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review of the literature. Radiother Oncol. 2008; 87:3–16.
  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.