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Methodology 4.5.b

Access to Psychosocial Oncology Services Methodology
Short description of Indicator Percentage of head and neck cancer patients diagnosed in 2014 to 2016 that were seen by a dietitian at an RCC prior to beginning treatment or within two weeks of beginning curative radiation and/or systemic treatment, Ontario
Rationale for measurement This is an indicator of interest by the Psychosocial Oncology program. Best practice indicates that head and neck cancer patients should be seen by a registered dietitian early in their treatment journey (radiation, systemic therapy) to be proactive in supporting a patient’s nutritional needs (please see references below). The new systemic funding model has also allocated funds for PSO care during the first consult phase. Based on the literature and consensus with experts, the psychosocial oncology program supports that all head and neck cancer patient should have a consult with a registered dietitian prior to beginning any systemic or radiation treatment modality.
Evidence/references for rationale

Capuano, G., Gentile, P.C., Bianciardi, F., Tosti, M., Palladino, A. & Di Palma, M. (2010). Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer, 18:433–437.

Isenring, E.A., Capra, S., & Bauer, J.D. (2004). Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. British Journal of Cancer, 91, 447-452. doi:10.1038/sj.bjc.6601962

Langius, J.A.E., van Dijk, A.M., Doornaert, P., Kruizenga, H.M., Langendijk, J.A., Leemans, C.R., Weijs, P.J.M., & Verdonck-de Leeuw, I.M. (2013). More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutrition and Cancer, 65(1):76-83. doi: 10.1080/01635581.2013.741749

Paccagnella, A., Morello, M., Da Mosto, M.C., Baruffi, C., Marcon, M.L., Gava, A., Baggio, V., Lamon, S., Babare, R., Rosti, G., Giometto, M., Boscolo-Rizzo, P., Kiwanuka, E., Tessarin, M., Caregaro, L., & Marchiori, C. (2010). Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer, 18:837–845. DOI 10.1007/s00520-009-0717-0

Program in Evidence Based Care, Clinical Practice Guideline on the Management of Head and Neck Cancers in Ontario. [last updated December 2009]. Available from: https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=58592

Psychosocial Oncology Resource Intensity Weights Project: Summary of Consensus. (2014). The Psychosocial Oncology Program, Cancer Care Ontario.

Ravasco, P., Monteiro-Grillo, I., Marque Vidal, P., & Camilo, M.E. (2005). Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck, 27(8):659-68.

Calculations for the indicator Number of head and neck patients seen by a registered dietitian prior to beginning treatment or within two weeks of beginning curative radiation and/or systemic treatment/# of patients diagnosed with head and neck cancer in the specified period X 100
Standardized Rate Calculation By Diagnosis Year
Unit N/A
Data sources Activity Level Reporting (ALR)
Time Frame

Diagnosis Year 2014: Jan 1, 2014 to Dec 31, 2014

Diagnosis Year 2015: Jan 1, 2015 to Dec 31, 2015

Diagnosis Year 2016 (9 months only): Jan 1, 2016 to Sep 30, 2016. The complete year for systemic or radiation treatment data for ALR at the time of running the indicator in December is unavailable.

Geographic Scale N/A
Denominator description The total number of patients diagnosed with head and neck cancer in 2014 to 2016 and treated with systemic or radiation within 12 months after diagnosis.
  • Patients diagnosed in a specified period with:
    • MALIGNANT MELANOMA-ORAL CAVITY
    • LIP
    • BASE OF TONGUE
    • OTHER UNSPECIFIED PARTS OF TONGUE; GUM
    • FLOOR OF MOUTH
    • PALATE
    • OTHER & UNSPECIFIED PARTS OF MOUTH
    • PAROTID GLAND
    • OTHER UNSPECIFIED MAJOR SALIVARY GLANDS
    • TONSIL
    • OROPHARYNX
    • NASOPHARYNX
    • PYRIFORM SINUS
    • HYPOPHARYNX
    • OTHER LIP ORAL CAVITY & PHARYNX
    • MALIGNANT MELANOMA-NASAL CAVITY & MIDDLE EAR
    • NASAL CAVITY & MIDDLE EAR
    • MALIGNANT MELANOMA-ACCESSORY SINUS
    • ACCESSORY SINUSES
    • LARYNX
  • Patients that received treatment at a Regional Cancer Centre within 12 months of diagnosis
  • Treatment is defined as either chemotherapy or radiation
  • Patients receiving radiation therapy or chemotherapy with curative, adjuvant and neoadjuvant intent

Exclusions:

  • Patients with invalid health card numbers (e.g., invalid, out of province)
  • Patients receiving chemotherapy or radiation therapy for palliative intent
Numerator description

Subset of the denominator:

Total number of patients among the denominator seen by a registered dietitian prior to beginning treatment or within two weeks of beginning curative radiation and/or systemic treatment

Considerations  N/A
Data availability & limitations
  • Limited to patients that are receiving care at Regional Cancer Centres only
  • Low volumes for head and neck patients
  • Only some regional cancer centres offer treatment to head and neck patients
  • Dietitian visits outside of cancer centres are not captured, so patients may be receiving dietitian services elsewhere

Limited to outpatient care, patients receiving early feeding tube insertions (admitted as inpatient) would not be included.

CSQI Year 2018