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Methodology 4.8.a

Access to Radiation Treatment Methodology
Short description of Indicator Percentage of patients treated with radiation at any time in the course of their illness, 2011 to 2017 by LHIN​
Rationale for measurement
  • Radiation utilization rates will need to increase just to keep up with the resulting growing demand for care. As the incidence of cancer increases, the additional volumes for radiation affect utilization rates. A 3% increase in number of cases treated is needed to maintain the same utilization rate from one year to the next, and an additional 3% increase in the number of cases treated is needed to improve the overall utilization rate by 1% over a one-year period.
  • Utilization rates across the province have increased over the past several years. All Local Health Integration Networks (LHINs) have shown improvements since 2012/2013 (download excel file for additional data).
  • Overall, 39% of cancer patients in the province received radiation treatment at some point during their illness in 2016/2017.
  • However, this is below CCO’s radiation treatment lifetime utilization rate aim of 48%. This aim refers to the percentage of patients with a new diagnosis of cancer that should receive at least one course of radiation over the duration of their illness. The target is a longer term goal and does not change from year to year.
  • Regional variation exists in the use of radiation treatment across the province. The use of radiation treatment varies across LHINs as well as across counties within each LHIN.
  • This variability in treatment patterns at the county level likely reflects differences in physician referral patterns, in access to radiation treatment facilities, and in the distance of the treatment facilities from patients’ homes. By measuring county -level radiation utilization rates, we can identify areas where physicians are less likely to refer patients for radiation treatment.
  • Continuing to measure this indicator is important in order to further understand radiation utilization rates across the province and in each cancer centre, and regional variations. Ongoing measurement will inform us as to whether performance is improving or not.
  • Enhancing our understanding of the regional variation may help to identify areas in which quality improvement initiatives would be beneficial and inform potential KTE/sharing of best practices between regions.
Evidence/references for rationale

Medical evidence has shown that not using radiation treatment when it is indicated can lead to serious adverse outcomes, such as a higher chance that the cancer will return (recurrence) and reduced survival time.

Calculations for the indicator

​Estimated using Multi-cohort Current Utilization Table (MCUT) method.

Reference: J. Zhang-Salomons and W.J. Mackillop, “Estimating the lifetime utilization rate of radiotherapy in cancer patients: The Multicohort Current Utilization Table (MCUT) method”, Computer Method and Programs in Biomedicine, 92, (2008) 99-108

Standardized Rate Calculation N/A
Unit N/A
Data sources
  • Activity Level Reporting, Cancer Care Ontario
  • Ontario Cancer Registry, Cancer Care Ontario
  • Historical radiotherapy data from OPIS and PMH
Time Frame ​2011 to 2017
Geographic Scale ​Provincial and by LHIN of residence
Denominator description

​Cancer cases diagnosed in Ontario as identified through the Ontario Cancer Registry (OCR).

Exclusions: Cases of in-situ diseases, non-malignant diseases, malignant skin cancers, and cases reported solely on the basis of death certificates were excluded. Multiple cancers diagnosed for the same patient on the same body site were represented by the first cancer diagnosis of the same site; Subsequent diagnoses on the same body site with different histology, different sub-site (e.g. different quadrants of the breast, different lobes of the lung) did not enter the denominator. The rationale is that these subsequent diagnoses would not be considered as new cases in clinical sense; previous radiation to the same body region could be a counter-indication to radiotherapy.

Numerator description ​​Cancer cases, as defined in the above denominator description, who received radiation treatment for their disease at any time after diagnosis.
Considerations  ​The accuracy of the estimated utilization rate relies on the linkage rate of the clinical radiotherapy data to the cancer cases identified through the Ontario Cancer Registry.  Caution should be exercised when interpreting the results when the case count is small, e.g. rectal cancer in the counties without an urban core.
Data availability & limitations ​Because many patients residing in county Kenora travel to the neighboring province for treatment, the utilization rate for Kenora is not reportable.
CSQI Year 2018