Wait Times from Diagnosis to Radiation Treatment

Key findings

The wait times for radiation treatment look at the median time (measured in days) between the time a cancer patient is diagnosed and the start of radiation treatment. In patients who are being treated with radiation as their primary treatment for oropharynx cancer patients diagnosed in 2014 to 2015, the median wait time from diagnosis to start of treatment was reported as being 49 days. For cervical cancer patients diagnosed in 2014 to 2015, the median wait time in days from diagnosis to start of treatment was 61 days. Variation exists across regions with regard to median wait times for both oropharynx and cervical cancer patients, suggestive there may be room for improvement.

Measure	Desired Direction	As of this Report
Wait times (in days) from diagnosis to treatment for oropharynx cancer patients receiving radiation treatment
Wait times (in days) from diagnosis to treatment for cervical cancer patients receiving radiation treatment
See Methodology and Approach to find out how the ratings are calculated.

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 treatment

• 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 treatment 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, in patients’ whose primary cancer treatment is radiation treatment. 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 in these patient groups, a more complete picture of the patient wait time for radiation is presented.

What do the results show?

Oropharynx cancer patients diagnosed from 2014 to 2015 had a median wait time of 49 days from diagnosis to start of radiation treatment (Figures 1, 2 and 3).

• The median wait time of 49 days from diagnosis to start of radiation treatment for oropharynx cancer patients diagnosed from 2014 to 2015 is consistent with findings from last year (patients diagnosed from 2013 to 2014).
• 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 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 24, indicating that 50% of patients start treatment just over 3 weeks after having a consult with a radiation oncologist.
• Considerable variation exists in the wait time measure for time from the consult date to date of first treatment, despite meeting provincial targets in the ready-to-treat to start of treatment interval. This variation again suggests 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 2014 to 2015 had a median wait time of 61 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 2014 to 2015 was 25 days. The referral-to-consult median wait time was 6 days and consult-to-treatment median wait time was 21 days.
• Differences in the interpretation of the diagnosis date can affect the length of wait times from diagnosis to treatment.
• Evidence suggests 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.

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-time intervals.
• Having relevant integrated measures such as those 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 and provides relief from cancer symptoms. This includes use for palliative reasons in end-of-life care.
• 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 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 care.

Find out more

• Learn more about radiation wait times, go to Cancer Care Ontario’s website.
• For up-to-date information on wait times at each of the cancer centres in the region—as well as wait times for other procedures—please see the Ministry of Health and Long-Term Care’s Ontario wait times website.

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.