Key Findings

Prevention
Indicator	Key Findings 2011
Modifiable Risk Factors	Large variations exist among Ontario sub-populations in different measures of sociodemographic status and how they relate to protective and risk factors for cancer. People who live in urban areas, in higher income neighbourhoods, with a high level of education have healthier behaviours than their counterparts. Immigrant populations are more likely to engage in healthy behaviours, and not to smoke or drink in excess of low risk guidelines. They are also less likely to be obese.
Smoking by Sociodemographic Status	While tobacco use has declined, the improvements are not distributed equitably throughout the population. Members of many population groups do not benefit as much as they could from tobacco control activities . Smoking rates are higher in lower income neighbourhoods, and among those born in Canada, those without post-secondary education and those living in rural areas. These patterns are similar for non-smokers exposed to second-hand smoke.
Teen Behaviours for Modifiable Risk Factors	Teens are more likely both to engage in sedentary behaviours, and to be more physically active, than adults.
Screening
Breast Cancer Screening (Mammography) Participation	The percentage of women screened for breast cancer is approaching the provincial target of 70% by 2011. An increasing proportion of women are being screened through the organized Ontario Breast Screening Program (OBSP).
Colorectal Cancer Screening (FOBT) Participation	Rates of colorectal cancer screening participation using the fecal occult blood test (FOBT) have risen steadily over the last several years but still fall short of the provincial target.
Cervical Cancer Screening (Pap Test) Participation	Participation in cervical cancer screening among eligible women has risen only slightly and still falls short of the provincial target. Important age differences remain in screening uptake.
Screening Completeness	While colorectal, cervical and breast cancer screening participation among women all increased in this reporting period, just under 30% of Ontario women are up-to-date on all of their screening.
Diagnosis
Abnormal Breast Cancer Screen (OBSP) to Resolution	The percentage of women whose abnormal mammogram was resolved within a five week interval (with no need for a tissue biopsy) is approaching the national target of 90%. The percentage of women who needed to have a tissue biopsy and whose abnormal mammograms were resolved within seven weeks falls far short of the 90% national target.
Follow-up Colonoscopy and Wait Times after an Abnormal (Positive) Fecal Occult Blood Test (FOBT)	The percentage of Ontarians who have a colonoscopy after an abnormal (positive) fecal occult blood test (FOBT) is too low. The percentage of people receiving a colonoscopy within the recommended eight weeks after a positive FOBT has increased, but too much regional variability remains.
Quality in Cancer Pathology and Surgery: Lymph Node Sampling for Colorectal Cancer	The vast majority (87%) of surgical reports completed following colon and rectum surgery (resection reports) confirm that 12 or more lymph nodes have been examined. This is in keeping with Cancer Care Ontario best practice quality guidelines.
Quality of Pathology and Cancer Surgery: Margin Status in Prostate Cancer Surgery	New measures of the quality of cancer care in surgery and pathology indicate very good rates of effective cancer surgery, surpassing provincial targets for prostate cancer. The overall Ontario rate of positive margins for prostate cancer surgery is 20%, while the provincial goal is to achieve positive margins rates lower than 25%.
Reporting of Cancer Stage at Diagnosis	The percentage of cancer cases in Ontario for which we have valid stage reporting continues to increase and has reached almost full completion for the four most common cancers (lung, colorectal, breast and prostate.)
Synoptic Pathology Reporting	The quality of pathology reporting in Ontario has substantially improved, with pathology reports now being submitted in a standardized, electronic format. Structured, or synoptic reporting, uses common standards endorsed across North America based on the College of American Pathologists (CAP) cancer checklists, which represent the gold standard for reporting.
Treatment
Cancer Surgery Waits	Overall, the ability to meet priority access targets for more urgent surgeries (priority 2 and 3) is significantly lower than for less urgent surgeries (priority 4). In 2010, more priority 2 cases were completed within the target than in 2009. Overall, three-quarters of patients receive their surgery within the recommended time.
Multidisciplinary Cancer Conferences (MCC)	The quality of reported MCCs has improved, with more than three-quarters of MCCs meeting the minimum criteria as set out in the MCC standards.
Thoracic Cancer Surgery Standards	The successful regionalization of thoracic (lung and esophageal) cancer surgeries in highly specialized “designated centres” is now almost complete—improving the quality of this surgery and facilitating improved patient safety and outcomes
Hepato-Pancreatic-Biliary (HPB) Cancer Surgery Standards	Almost all of the hepato-pancreatic-biliary cancer surgeries in Ontario take place at a hospital that meets the minimum volume requirements for safe and high-quality surgery.
Wait Times for Radiation Treatment	Wait times for the “ready-to-treat” to “start of treatment” interval are approaching Cancer Care Ontario’s target of 85%, but wait times for the interval “referral to consult” are still a ways from target. There is widespread regional variation for patients being treated within both wait time targets.
Radiation Treatment Utilization	Radiation treatment utilization remains unchanged from last year and is up 1% from 2007/2008. Large regional variation persists at the county level for prostate cancer.
Intensity Modulated Radiation Therapy (IMRT)	The use of IMRT is increasing across Ontario with approximately one-third of all cancer centres in Ontario delivering this gold standard of radiation therapy for the last half of 2010. Almost all head and neck cancers are treated with IMRT, though there is significant variation between the regions for all cancers.
Radiation Machine Efficiency	The efficient use of radiation treatment machines has improved between the 2008/09 and 2009/10 fiscal years.
Wait Times for Systemic Treatment (Chemotherapy)	Wait times have improved for referral to consult and are approaching the program target of 60%, but large variation exists between regions.
Wait Times from Surgery to Adjuvant Chemotherapy	Nearly all patients started adjuvant chemotherapy within 90 days (13 weeks) of surgery.
Treating Non-Small Cell (NSC) Lung Cancer According to Guidelines	There is enough evidence to suggest that we can, and likely should, be treating some lung cancer patients more aggressively to save lives: Only half of Stage II or IIIA resected non-small cell lung cancer patients (those who have had surgery to remove the tumour), and less than a third of unresectable (inoperable) later-stage patients, receive the treatment recommended by practice guidelines. No overall increase has occurred from 2007 to 2008 in the percentage of unresected Stage IIIA or IIIB non-small cell lung cancer patients treated according to guidelines.
Emergency Department Visits after Chemotherapy	More than one-third of women who receive one of the new adjuvant (after surgery) chemotherapy regimens for breast cancer end up visiting the emergency department (ED) or are admitted to hospital at least once within four weeks of receiving chemotherapy. For a little over half of these women, this is because of neutropenia (low white blood cell count), infection or fever.
Systemic Treatment Safety	Hospital implementation of automated chemotherapy drug ordering systems continues to improve at a slow rate. More hospitals across the province have current policies and procedures related to safe handling of cytotoxic agents.
Patient Experience with Outpatient Cancer Care	Cancer patients treated in ambulatory care settings continue to report a reasonably high degree of satisfaction with most aspects of care. Emotional support scores remain significantly lower than scores in other dimensions.
Symptom Assessment	Access to symptom assessment by cancer patients has been steadily increasing, with very high rates of assessment in several regions, especially for lung cancer patients. However, overall rates are still below the program targets.
End-of-Life
End-of-Life Care	Cancer patients at the end of life, and their families, may not have adequate access to the resources and supports they need to live and die in the setting of their choice. We urgently need more up-to-date data to support quality improvement initiatives.
Chemotherapy in the Last Two Weeks of Life	Approximately 6% of patients who died of cancer received chemotherapy in the last two weeks of life. This is likely too high, and there is variability in this rate across Ontario.