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Lung Cancer in Ontario

Lung cancer is among the most commonly diagnosed cancers in Ontario, with 9,958 new cases of lung cancer diagnosed in 2016. It is also the most commonly diagnosed cancer among First Nations people, with over 1,000 new cases diagnosed from 1991 to 2010.

Smoking is the most important modifiable risk factor associated with lung cancer. In 2017, approximately 17% of Ontarians ages 20 years and older self-reported as daily or occasional smokers. By screening new ambulatory patients for tobacco use, regional cancer centres can better identify those who smoke and support them in quitting. Smoking cessation improves outcomes in all patients receiving chemotherapy, not just lung cancer patients. From January 2016 to December 2018, the proportion of new ambulatory patients screened for tobacco use in Ontario’s regional cancer centres increased from 50% to 69%.

Overall, Ontario’s cancer system as a whole is performing well with respect to lung cancer care compared with other jurisdictions nationally and internationally. Ontario has the best survival rates for lung cancer among all Canadian provinces. The 5-year relative survival ratio increased from 18% to 24% between 2002 and 2016. Relative survival is a ratio that compares the survival of people with cancer to the expected survival of people of the same age and sex in the general population.

The following highlights bright spots and opportunities, based on available indicators, to help focus efforts in improving the quality of care for people with lung cancer.

Diagnosis and Treatment

  • Stage at diagnosis is one of the most important prognostic factors for cancer. In Ontario, only 24% of staged lung cancers were diagnosed at stage 1, while 47% were diagnosed at stage 4. The proportion of lung cancer cases found in stage 1 is higher in Ontario than in both Norway and Scotland. However, across all 3 jurisdictions, most lung cancer patients were diagnosed at the last stage of the disease (stage 4 or distant). For detailed comparisons, see Reporting of Cancer Stage at Diagnosis.
  • The proportion of non-small cell lung cancer patients who had a PET/CT scan before radical treatment has increased steadily since 2013. In 2017, 86% of non-small cell lung cancer patients in Ontario had a PET/CT scan before radical treatment. However, Scotland performed better than Ontario in this indicator and exceeded its target. For detailed comparisons, see Access to PET/CT Scans.
  • Typical treatment options for lung cancer include surgery, systemic drug therapy (chemotherapy), radiation therapy and other novel therapies developed through clinical trials. Treatment often depends on the type of cancer, stage and patient choice.
  • Surgical resection has always been the treatment of choice for early stage non-small cell lung cancers.  From 2013 to 2017, the percentage of stage 1 lung cancer patients (non-small cell lung cancer and small cell lung cancer) receiving surgery decreased from 62% to 55%. This decline may reflect new techniques in radiation therapy that are under review.
  • The percentage of patients who visited the emergency department or were readmitted to hospital within 30 days following lung cancer surgery was 25%.  Reviewing unplanned hospital visits in post-surgical patients is beneficial for monitoring complications and adverse events associated with cancer surgery. The risk of death following surgery for lung cancer is low, ranging from 1.5% 30 days after surgery to 3.2% 90 days after surgery. Ontario’s post-surgical mortality rates are similar to rates in Scotland. For detailed comparisons, see Post-surgery Mortality – Lung.

Recovery

  • Recovering from cancer is different for each individual. People need access to the necessary healthcare services to help improve their quality of life after cancer treatment has ended.
  • Ongoing symptoms are common after cancer treatment. These may be related to the cancer or side effects of the treatment. Tracking symptoms over time helps clinicians identify changes that may be meaningful to patients and start conversations about symptom management. Electronic symptom screening can result in a greater focus on issues that are most important to the patient. In symptom screens completed by lung cancer patients in 2018:
    • 70% reported experiencing at least 1 moderate or severe symptom
    • over one third reported a moderate to severe level of shortness of breath during treatment or follow-up
    • nearly 20% reported severe tiredness
    • 10% reported severe anxiety

For a visual summary of data on cancer burden and system performance for lung cancer across the cancer continuum, see Lung Cancer Overview