Malignant Hematology in Ontario
Age-standardized incidence rates for all 4 hematologic cancers have remained stable since 2014. In 2018 in Ontario, there were:
- 230 new cases of acute lymphocytic leukemia
- 710 new cases of acute myeloid leukemia
- 1,297 new cases of diffuse large B-cell lymphoma
- 1,415 new cases of multiple myeloma
Ontario’s 5-year relative survival ratio for multiple myeloma (55%) is among the highest in Canada. The 1-year relative survival ratios for malignant hematologic cancers increased between 2007 and 2018:
- from 71% to 74% for acute lymphocytic leukemia
- from 33% to 42% for acute myeloid leukemia
- from 68% to 71% for diffuse large B-cell lymphoma
- from 75% to 81% for multiple myeloma
Relative survival ratio compares the survival experience of individuals with cancer to that of people of the same age and sex in the general population.
Data from 1991 to 2010 indicate that 30% of First Nations females with leukemia survived 5 years or longer compared with 53% of other females with leukemia.
The incidence of myeloma was higher in First Nations females compared with other females in Ontario, and half as many First Nations males (19%) diagnosed with myeloma survived 5 years or longer compared with other males diagnosed with myeloma (39%) during the same period.
Although cancer patterns do not change drastically year over year, significant investments and advancements have been made in malignant hematology service delivery over the past several years. Future work will include investigating these disparities and developing an action plan to address them.
The following highlights bright spots and opportunities to help focus efforts in improving the quality of care delivery for people with hematologic cancers, particularly in allogeneic stem cell transplant and acute leukemia care.
Diagnosis and Treatment
- The median time in number of days from diagnosis to start of first systemic therapy treatment remained stable:
- For people with acute lymphocytic leukemia, at 7.5 days in 2017 and 7 days in 2018
- For people with acute myeloid leukemia, at 8 days in 2017 and 7.5 days in 2018
- The median time from diagnosis to start of first treatment for people with diffuse large B-cell lymphoma has remained stable at about 4 weeks between 2014 and 2018.
- Despite the increase in the number of people with multiple myeloma receiving systemic therapy, the median number of days from diagnosis to start of first treatment remained stable at about 26 days between 2014 and 2018.
- From 2017 to 2018, the median time from remission to allogeneic transplant for people with acute myeloid leukemia decreased from 78 days to 69 days.
- The median time in days from second-line chemotherapy to autologous transplant for people with diffuse large B-cell lymphoma ranged from 91 to 97.5 days between 2014 and 2018; more progress is needed to achieve the provincial target of 84 days for 80% of patients.
- The median number of days from first systemic treatment to autologous transplant for people with multiple myeloma decreased from 171 days in 2014 to 160 days in 2018, despite a significant increase in the number of people requiring transplant.
- Time to transplant will vary depending on the person’s disease, ability to identify a donor, and other clinical factors.
Recovery and End-of-Life Care
- Across the province, the percentage of patients who visited the emergency department in the last 30 days of life varied from 38% to 61% across the 4 hematologic cancers. Further study is required to understand the appropriate use of the emergency department by these patients.
- For people with acute lymphocytic leukemia, acute myeloid leukemia, diffuse large B-cell lymphoma or multiple myeloma, there was a large range in the percentage who were admitted to the intensive care unit or who received a transfusion during the last 2 weeks of life. This variation is largely due to the complex nature of these hematologic malignancies, as the level of care required varies across disease sub-groups.
- Cancer patients with progressive illness must have adequate access to the resources and supports they need to live and die in the setting of their choice. Understanding treatment patterns at the end-of-life can help to optimize appropriate care for these patients, including timely access to palliative care services.
For a visual summary of data on cancer burden and system performance for hematologic cancer across the cancer continuum, see Malignant Hematology Overview.