• 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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Quality and Efficiency of Radiation Equipment and Treatment

 
Measure Desired Direction As of this Report
Number of treated cases per linear accelerator  Black Arrow Up  Yellow Arrow Down
See Methodology and Approach to find out how the ratings are calculated.

Key findings

By investing in people, facilities and technology—and by maximizing the use of existing investments—the capacity and efficient use of radiation machines in Ontario has increased over the last decade. The current radiation machine capacity in Ontario meets projected demands based on 2015 volumes, but the current and planned capacity must increase in order to continue to meet the increased demand for treatment.

What is efficiency?

  • Efficiency is a dimension of health service quality that tracks whether we are making the best use of our existing resources (such as best use of machines, staff or hospital beds) to achieve desired outcomes. 
  • The results tell us about the preparation of patients who are being treated according to guidelines. It also provides information that helps us consider the utilization of these unique technologies and experts, and whether they are being used to their maximum potential—or whether there is an opportunity to use the capacity of a limited resource more efficiently for those patients who need it most.

What types of radiation treatment are available?

  • Linear accelerator use is shown in this report as the total number of patients treated. It also is shown as the number of patients treated with radiation, adjusted for complexity, per linear accelerator per year. The numbers also include treatments from one specialized cobalt unit (gamma knife) in the province.

What is stereotactic radiation therapy?

  • Stereotactic radiation therapy is a technique that uses a linear accelerator to deliver a high dose of radiation to a very specific area3.
  • Stereotactic radiosurgery requires specialized equipment and training, and it may not be available at every regional cancer centre in Ontario4.

What is total body irradiation (TBI)?

  • TBI is a technique of radiotherapy that also uses a linear accelerator, but it does so primarily as part of the preparative regimen for haematopoietic stem cell (or bone marrow) transplantation5.

What is brachytherapy?

  • In brachytherapy, a radioactive substance is placed directly into—or very close to—a tumour or in the area where a tumour was removed6
  • Brachytherapy also is called internal radiation therapy, short-distance radiation therapy, implant therapy or sealed radiation therapy7.
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What do the results show?

Access to specialized services and the number of linear accelerators increased across Ontario from 2006 to 2015 (Figures 1 and 2).

  • There is some variation in the types of radiation treatments available across Ontario. Due to investments made in radiation therapy, Intensity modulated radiation therapy (IMRT) is available at every regional cancer centre throughout the province. Brachytherapy and stereotactic radiation therapy are offered at most regional cancer centres; TBI is not offered at every centre, as it is an extremely specialized service (Figure 1).
  • The total number of linear accelerators increased from 77 in 2006 to 104 in 2015 (Figure 2).
  • The number of linear accelerators either increased or remained stable at every regional cancer centre (Figure 2).

From 2006 to 2015, the yearly average for new capital investment and radiation equipment replacement grant funding was approximately $37.6 million (Figure 3).

  • From 2006 to 2015, the radiation equipment capital investment and grant funding fluctuated based on need and the Radiation Treatment Capital Investment Strategy.
  • While new capital investment and replacement grant funding appears large, it should be noted that a linear accelerator’s life cycle is more than 10 years, and on average, each linear accelerator treats approximately 350 patients per year. That makes radiation therapy a cost-effective treatment on a per patient basis. For example, the average total cost of curative radiation treatment for prostate cancer was $13, 796 in 2015 based on 39 daily treatments over 8 weeks8, and the cost for a single palliative radiation treatment was $3,866 for 5 treatments over 1 week in 20159.

The number of people treated with radiation steadily increased from 2006 to 2015 (Figure 4).

  • The number of treated cases increased by approximately 32% from 2006 to 2015, a marked increase (approximately 9,500 treated cases over the 10 years).
  • Significant investments in radiation treatment equipment have been made over the past 10 years. This has increased access to radiation treatment equipment, contributing to an increase in the number of patients treated and a decrease in wait times.
  • The increased radiation treatment capacity is a result of investment in people, facilities and technology, as well as program-level efficiencies.

Radiation treatment wait times significantly decreased from 2006 to 2015 (Figure 5).

  • From 2006 to 2015, the median wait times for radiation from referral to consult decreased, down from 14 days in 2006 to 7 days in 2015. This occurred despite an increase in the complexity of cases.
  • The median wait time for radiation from ready-to-treat to start of treatment also decreased over that period, down from 15 days in 2006 to 7 days in 2015.
  • The investment in radiation treatment capacity, extending hours of operation, standardizing care across the province and introducing efficiencies at the level of Regional Cancer Programs have all helped to reduce wait times and allow more patients to receive care closer to home10.

The number of treated patients per linear accelerator has increased, with some regional variation (Figures 6 and 7).

  • One factor in measuring utilization is the complexity of the cases treated in a cancer centre. 
  • In some cases, the complexity of radiation treatment has increased due to the implementation of IMRT and other high-precision treatments that require additional time for treatment delivery.
  • Figures 6 and 7 present data that are adjusted (for the complexity of cases in the different regions) and unadjusted (in order to show the total number of patients treated per machine).
  • When comparing the 2 indicators, the patterns across regions are similar.  
  • For the adjusted cases, the overall number of cases treated per machine has increased from 329 in 2013 to 350 in 2015 (Figure 6).

Several factors contribute to linear accelerator efficiency.

  • Several variables contribute to a linear accelerator productivity measure.
  • For example, the number of treated cases per linear accelerator will vary between centres, depending on their case mix or type of cancers they treat.
  • This indicator is calculated on the expectation that linear accelerators will be run from 10 to 12 hours day (which is Cancer Care Ontario’s operating standard for the province, based on the Radiation Treatment Capital Investment Strategy
  • Machine efficiency can be affected by unexpected downtime due to major or minor component failure. When this occurs, departments realign caseload to reduce impact on wait lists.

Why is this important for patient care?

The province’s investment in people, facilities and technology has increased radiation treatment capacity. This, in turn, has provided more access to treatment.

  • From 2006 to 2015, wait times for radiation treatment decreased and the number of patients treated increased. These are 2 important and positive outcomes of the investment in radiation facilities and technology.

Higher linear accelerator efficiency equals more timely access to radiation.

  • Radiation treatment shrinks tumours, destroys cancer cells or provides relief from cancer symptoms. This includes the use of radiation for palliative and symptom relief when a cure is not possible.
  • In some cases, radiation is the only option for treatment. In other cases, radiation is combined with surgery and/or chemotherapy to destroy cancer cells and prevent the cancer from returning (known as “recurrence”).
  • Evidence has shown that using radiation treatment can decrease the risk of occurrence and improve survival. It also can decrease pain in patients with terminal illness11.
  • Efficient use of linear accelerators improves timely access to radiation and indicates whether the cancer system is making efficient and effective use of capital resources.

Find out more

For more information on the Radiation Treatment Program, visit Cancer Care Ontario’s website.

View Notes

  1. National Cancer Institute at the National Institutes of Health [Internet]. Bethesda (MD): U.S. Department of Health and Human Services. Radiation therapy for cancer; 2010 June 30. Available from: http://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/radiation-fact-sheet.
  2. National Cancer Institute at the National Institutes of Health [Internet]. Bethesda (MD): U.S. Department of Health and Human Services. Radiation therapy for cancer; 2010 June 30. Available from: http://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/radiation-fact-sheet.
  3. Cancer.ca [Internet]. Toronto: Canadian Cancer Society; c2016. Stereotactic radiation therapy. Available from: http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/radiation-therapy/stereotactic-radiation-therapy/?region=on.
  4. Cancer.ca [Internet]. Toronto: Canadian Cancer Society; c2016. Stereotactic radiation therapy. Available from: http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/radiation-therapy/stereotactic-radiation-therapy/?region=on.
  5. Cancer Research UK [Internet]. London (UK): Cancer Research UK. Total body irradiation (TBI); 2015 Mar 16. Available from: http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment/transplant/TBI-total-body-irradiation.
  6. Cancer.ca [Internet]. Toronto: Canadian Cancer Society; c2016. Brachytherapy. Available from: http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/radiation-therapy/brachytherapy/?region=on
  7. Cancer.ca [Internet]. Toronto: Canadian Cancer Society; c2016. Brachytherapy. Available from: http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/radiation-therapy/brachytherapy/?region=on
  8. Yong JHE, McGowan T, Redmond-Misner R, Beca J, Warde P, Gutierrez E, et al. Estimating the costs of intensity-modulated and 3D conformal radiotherapy in Ontario. Accepted for publication in Current Oncology, 2016.
  9. Yong JHE, McGowan T, Redmond-Misner R, Beca J, Warde P, Gutierrez E, et al. Estimating the costs of intensity-modulated and 3D conformal radiotherapy in Ontario. Accepted for publication in Current Oncology, 2016.
  10. Cancer Care Ontario. Business plan: 2014–2017. Toronto: Cancer Care Ontario. Available from: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=335455.
  11. Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005; 104(6):1129–1137.