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Time from Diagnosis to First Treatment

Key findings

For people with acute lymphocytic leukemia and acute myeloid leukemia, the median time from diagnosis to start of first treatment (chemotherapy) remained stable between 2017 and 2018 at approximately 7 days, with improvements seen in the 75th and 90th percentile. The median time for patients with diffuse large B-cell lymphoma and multiple myeloma to start treatment following their diagnosis has also remained stable between 2014 and 2018. First treatment is defined as first funded induction or other systemic treatment.

Why is this important to Ontarians?

Timely access to treatment improves outcomes and minimizes unnecessary stress and anxiety.

  • Systemic therapy is the first point of entry into the cancer treatment system for many people with hematologic malignancies – longer time intervals have the potential to affect the entire patient journey.
  • Hematologic malignancies are aggressive and should be treated quickly to increase treatment options and ensure the best clinical outcomes.
  • Delays in getting treatment after a cancer diagnosis can worsen stress and anxiety for patients and caregivers.
  • The time from diagnosis to first treatment is also a measure of capacity within the system to provide timely access to treatment after a cancer diagnosis.
  • Longer time intervals can indicate limited system capacity for pre-treatment evaluations (e.g., laboratory tests, imaging and results) and first-line systemic therapy.
  • Measuring time to start of first treatment is important for identifying aspects of pre-treatment evaluations or processes that add to time intervals and affect access to care.
  • By monitoring these time intervals, the province can more effectively and accurately distribute existing resources and plan for future services.

See Time From Diagnosis to First Treatment Methodology for technical information.

Report date: August 2020        

Data sources: Ontario Cancer Registry (OCR), Ontario Health (Cancer Care Ontario) Acute Leukemia Manual Data Submission, Registered Persons Database (RPDB), Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Report date: August 2020        

Data sources: Ontario Cancer Registry (OCR), Ontario Health (Cancer Care Ontario) Acute Leukemia Manual Data Submission, Registered Persons Database (RPDB), Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Report date: August 2020        

Data sources: Ontario Cancer Registry (OCR), Specialized Service Oversight Information System (SSOIS), Registered Persons Database (RPDB), Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Report date: August 2020        

Data sources: Ontario Cancer Registry (OCR), Specialized Service Oversight Information System (SSOIS), Registered Persons Database (RPDB), Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 1: Time (in days) from diagnosis to start of treatment for acute lymphocytic leukemia, 2017 to 2018
Year of Diagnosis Number of Patients Receiving Systemic Treatment Wait Time 25th percentile Wait Time Median WAit Time 75th percentile Wait Time 90th percentile
2017 92 2 7.5 18 46
2018 101 3 7 10 40

Report date: August 2020

Data sources: Ontario Cancer Registry (OCR), Ontario Health (Cancer Care Ontario) Acute Leukemia Manual Data Submission, Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 2: Time (in days) from diagnosis to start of treatment for acute myeloid leukemia, 2017 to 2018
Year of Diagnosis Number of Patients Receiving Systemic Treatment Wait Time 25th percentile Wait Time median Wait Time 75th percentile Wait Time 90th percentile
2017 520 2 8 22 53
2018 568 2 7.5 20 46

Report date: August 2020

Data sources: Ontario Cancer Registry (OCR), Ontario Health (Cancer Care Ontario) Acute Leukemia Manual Data Submission, Registered Persons Database (RPDB), Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 3: Time (in days) from diagnosis to start of treatment for diffuse large B-cell lymphoma, 2014 to 2018
Year of Diagnosis Number of Patients Receiving Systemic Treatment Wait Time 25th percentile Wait Time median Wait Time 75th percentile Wait Time 90th percentile
2014 1078 16 29 46 68
2015 1159 16 29 44 65
2016 1101 15 27 43 63
2017 1156 17 29 43 66
2018 1070 15 28 43 62.5

Report date: August 2020

Data sources: Ontario Cancer Registry (OCR), Specialized Service Oversight Information System (SSOIS), Registered Persons Database (RPDB), Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 4: Time (in days) from diagnosis to start of treatment for multiple myeloma, 2014 to 2018
Year of Diagnosis Number of Patients Receiving Systemic Treatment 25th percentile median 75th percentile 90th percentile
2014 755 12 26 50 108
2015 818 12 25 49 99
2016 850 12 25 49 113.5
2017 948 11 26 50.5 104
2018 901 13 27 53 105

Report date: August 2020

Data sources: Ontario Cancer Registry (OCR), Specialized Service Oversight Information System (SSOIS), Registered Persons Database (RPDB), Activity Level Reporting (ALR), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Results

  • From 2017 to 2018, the median number of days from diagnosis to start of first systemic treatment for people with acute lymphocytic leukemia and acute myeloid leukemia remained stable at approximately 7 days. Improvements were seen in the 75th and 90th percentiles.
  • For people with diffuse large B-cell lymphoma, the median number of days from diagnosis to start of first chemotherapy treatment remained stable between 2014 and 2018 at about 4 weeks.
  • The number of people with multiple myeloma receiving systemic treatment increased from 755 in 2014 to 901 in 2018, yet the median number of days from diagnosis to start of first treatment remained stable at about 26 days during this same period.

Opportunities

  • After a cancer diagnosis, patients have many different tests, procedures and consultations to determine the best treatment pathway.
  • People with hematologic malignancies need highly specialized resources and tests specific to their clinical profile and disease progression. This may contribute to the differences seen in this time interval.
  • More analysis of these components of care is needed to understand access issues and ensure time to treatment is optimized.
  • More data is also needed to understand the effect of longer time intervals on clinical outcomes.