What do the results show?

Most cancer patients referred for registered dietitian services are seen within 14 days of referral, but fewer head and neck cancer patients are seen either before their treatment or within the target of 14 days (Figures 1 and 2).

• In 2017, 84% of referred cancer patients saw a registered dietitian within 14 days, nearly meeting Cancer Care Ontario’s target of 85%.
• There are regional differences in the wait time data for registered dietitians. Some reasons for this could include different staffing ratios and different models of service delivery. The Psychosocial Oncology Program will work with stakeholders at many levels, including a CCO-sponsored Community of Practice for Registered Dietitians, to address and resolve these issues.
• Fifty-eight percent (58%) of head and neck cancer patients saw a registered dietitian prior to or within 2 weeks of curative chemotherapy or radiation treatment in 2016. This has remained below Cancer Care Ontario’s target of 80% over the last 3 years, and it is relatively unchanged over that period.
• Cancer Care Ontario is working with multiple stakeholders to identify possible barriers to head and neck patients receiving timely registered dietitian services.
• The Psychosocial Oncology Program will work with stakeholders at many levels, including a CCO-sponsored Community of Practice for Registered Dietitians to address and resolve these issues.

Most cancer patients referred for social work services are seen within 14 days of referral (Figure 3). Access to psychiatry and psychology services varies significantly across the province (Figures 4 and 5).

• In 2017, 84% of cancer patients who had a referral date for social work services saw a social worker at a RCC in Ontario within 14 days of their referral.
• Access to social workers varies considerably between cancer centres across the province. This could be due to different staffing ratios and different models of service delivery. The Psychosocial Oncology Program will work with stakeholders at many levels, including a CCO-sponsored Community of Practice for Depression and Anxiety to address and resolve these issues.
• Figures 4 and 5 highlight the regional availability of timely services from psychiatry and psychology. To be included on the map as a psychiatrist or psychologist in the community, the practitioner would have to have expertise in cancer, a partnership relationship with the cancer centre and timely availability.
• Of the 14 RCCs, 3 have no access to psychiatry within either the cancer centre or the hospital.
• For psychology, there is even less access across the province: 8 of 14 cancer centres have no access to psychologists.
• RCCs report that patient need frequently exceeds resources, and that patient access to specialized psychosocial services can be affected as a result.

About half of AOPSS respondents found they had enough information about changes in sexual activity (Figures 6 and 7).

• Forty-nine percent (49%) of respondents stated they received enough information about possible changes in sexual activity. This varied by type of cancer, ranging from 33% of patients diagnosed with stomach cancer stating their information on sexual activity was sufficient to 68% of prostate/testicular cancer patients (Figure 6).
• A higher percentage of males (53%) than females (46%) stated they received enough information about possible changes in their sexual activity (Figure 7).

Why is this important to patient care?

Timely access to specialized registered dietitian services improves patient outcomes.

• Early nutritional intervention is important for head and neck cancer patients undergoing radiation therapy or concurrent chemotherapy/radiation. This allows registered dietitians to be proactive in supporting a patient’s nutritional needs.
• Guidelines developed by CCO’s Program in Evidence-Based Care (PEBC) indicate that registered dietitians should be key members of the core healthcare team, which collectively is “responsible for the assessment, treatment, planning, management, survivorship and rehabilitation” of head and neck cancer patients ^[1].
• In a recent study, researchers found that 36% of head and neck patients are malnourished before treatment. This is associated with fatigue, appetite loss, nausea and vomiting ^[2].
• Early nutrition intervention for head and neck cancer patients prior to receiving radiation and/or chemotherapy treatment is associated with minimizing weight loss, deterioration in nutritional status and reducing symptoms (such as anorexia, nausea, vomiting, dry mouth and taste distortion). It is also linked to increasing energy and protein intake, quality-of-life measures, performance status and physical functioning ^[2–4].
• Weight loss is significantly associated with deterioration in the quality of life, physical and social functioning, social eating and social contact ^[5].

Cancer patients frequently have dietary, emotional, functional, occupational and physical concerns related to their treatment and resulting symptoms.

• Social work has a unique role that can support the emotional, functional, psychological, social and spiritual concerns that patients have about cancer. It can also play a very important role in supporting patients and their families to address the financial burden that can occur while a person is undergoing or recovering from treatment ^[6]. 

• Emotional distress is common in the cancer experience and sometimes is a consequence of cancer treatment ^[7]. Estimates suggest about 25% of cancer patients will suffer from clinically significant depressive symptoms, and these may affect adherence to cancer treatment, physical health outcomes and quality of life; they also are a major factor associated with suicide in cancer patients ^[8–12]. Other outcomes of concern include anxiety (including extreme recurrence fears), relationship problems, body image disturbances, sexual dysfunction and problems with substance abuse and addiction ^{[3, 13]}.
• Having prompt access to specialized psychiatry and psychology services can reduce suffering, improve quality of life, reduce the likelihood of suicide and treatment non-adherence, and possibly improve health outcomes for patients ^{[6, 14]}.

Access to sexual health information and resources can improve patient quality of life.

• The diagnosis and treatment of cancer often is associated with significant sexual dysfunction ^[10]. Sexuality may be affected by changes in appearance, physical side effects (e.g., pain, erectile dysfunction or vaginal dryness), and emotional and relationship changes that occur because of treatment or the diagnosis itself. Across disease sites, estimates of sexual dysfunction after cancer treatment range from 40% to 100% ^[10].
• CCO’s PEBC recently released a guideline on sexual health that provides guidance on effective strategies and interventions to manage sexual function side effects as a result of cancer diagnosis and treatment. A corresponding patient guide has been developed by the Patient Education Program at CCO. Additionally, the Psychosocial Oncology Program maintains a Sexual Health in Cancer Community of Practice.
• The Patient Education Program continues to evaluate the quality and quantity of information that patients receive about sexuality to inform potential quality improvement initiatives. Historically, sexual health concerns have not been explicitly addressed by clinicians, but there is a growing awareness of the importance of identifying sexual health issues and supporting people with sexual health information, education and psychosocial support to enhance their quality of life.

Next steps

• The Psychosocial Oncology Program is working with regional partners to implement the newly released Psychosocial Oncology Service Delivery Framework Recommendations. The recommendations address the components and providers of service for high-quality and equitable PSO services within a Regional Cancer Program (RCP). It also articulates the relationships and important linkages between PSO and other programs and services within RCPs.
• The goal is to ensure the range of necessary PSO services are provided consistently and in a timely fashion to all cancer patients and their families who require them. This will be done through the regional adoption of evidence-based guidelines and support for sexual health, nutrition therapy, and depression and anxiety communities of practice that create a forum for collaboration, knowledge transfer and professional development.
• The program will also continue to develop a comprehensive measurement plan and quality indicators (beyond wait times) to improve access. This includes measuring the availability of occupational therapy, physiotherapy and speech language therapy, as well as other rehabilitation programs (such as the availability of services for group programing or services that treat lymphedema).

Find out more

For more information about the Psychosocial Oncology Program, visit the CCO website.