Measure: Percentage of breast cancer patients receiving guideline- recommended mammogram tests in first, second and third follow-up year
As of this Report:
Seventy-four percent (74%) of breast cancer patients had a guideline-recommended mammogram in the first follow-up year, and 74% of colorectal cancer patients diagnosed in 2014 had a surveillance colonoscopy within 18 months of surgery.
Based on questionnaire responses from a patient survey for fiscal year 2016/2017, 70% of patients felt very informed of the plan for their post-treatment care.
What is survivorship?
- As many cancer treatments improve and survival rates increase, the number of people living beyond their cancer treatment will continue to grow. See Cancer in Ontario for more information.
- Following treatment, some patients experience late and long-term effects of treatment, cancer recurrence or new cancers. These events need to be addressed and appropriate care provided for all cancer survivors.
- Care guidelines help to apply best scientific evidence in the practice and decisions for treating different types of cancer. They also provide guidance for care during the survivorship phase for patients who have completed their cancer treatment.
- The transition from active treatment to post-treatment care is important, because if care is not planned and coordinated, cancer survivors may be left without knowledge of their heightened risks or a follow-up plan of care .
Measure: Percentage of colorectal cancer patients receiving guideline- recommended surveillance colonoscopy in first follow-up year
As of this Report:
- To measure whether patients know their next steps of care, this analysis uses the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) question of how informed a patient is about their plan of post-treatment care. Response options are “very informed,” “somewhat informed” and “not at all informed.”
- This analysis specifically looks at patients who have indicated they have completed their treatment.
What is breast cancer follow-up care?
- Despite the evidence for optimal follow-up care for patients with breast cancer, significant variation still exists in the way follow-up care is provided in Ontario. For example, one-half of breast cancer survivors have more surveillance imaging studies for metastatic disease than recommended and one-quarter have fewer .
- Cancer Care Ontario has endorsed the consensus document developed by Health Canada’s Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer .
- Breast cancer survivors thought to be at high risk for recurrence should be referred to Cancer Care Ontario’s Ontario Breast Screening Program (OBSP) High Risk Screening Program to be assessed for potential participation .
- For more information on survivorship for breast cancer patients, see the Breast cancer well follow-up pathway map.
What is colorectal cancer follow-up care?
- The guideline Follow-up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer by the Program in Evidence-based Care (PEBC) at Cancer Care Ontario recommends the following for Stage II or III survivors:
Measure: Percentage of patients who are informed of their plan of care
As of this Report:
- An abdominal Computerized Tomography (CT scan) is recommended annually for 3 years.
- A surveillance colonoscopy should be performed approximately 1 year after initial surgery and again 3 to 5 years after that.
- The guideline provides follow-up care recommendations for adult colorectal cancer survivors who have completed primary treatment for Stage II or III disease. Whether the recommendations are applicable for Stage I survivors is left to the discretion of individual healthcare providers.
- For more information on survivorship for colorectal cancer patients, see the “Colorectal cancer follow-up pathway map.”
Survivorship = waiting for cancer to return. Survivorship means fighting to live to see your daughter graduate from secondary school. And continuing to fight to see your daughter's under-graduate achievement from University.
– Anne N., Patient/Family Advisor
What do the results show?
Seventy-four percent (74%) of breast cancer patients received 1 or more mammograms in the first year of follow-up (Figure 1).
- Seventy-four percent (74%) of breast cancer patients received 1 or more mammograms 13 to 24 months after their diagnosis. These rates are similar to the second (75%) and third year (70%) of follow-up, indicating that surveillance imaging appears to continue at a stable rate.
- Some regional variation can be seen, but regions seem consistent in their follow-up practices in each follow-up year.
The majority of colorectal cancer patients received a surveillance colonoscopy within 18 months of surgery (Figure 2).
- Of colorectal cancer patients diagnosed in 2014, 74% received a surveillance colonoscopy within 18 months of surgery.
- Some regional variation is present, with a range of 67% to 78% for patients diagnosed in 2014.
- Overall, there is a notable increasing trend for the London and Ottawa Regional Cancer Centres (RCCs) over the past 3 years. There is a decreasing trend for the Grand River, Juravinski and R.S. McLaughlin Durham RCCs over the same period.
Most patients feel informed about their plan for post-treatment care, with some variation between types of cancer (Figures 3 and 4).
- According to patient questionnaire responses for fiscal year 2016/2017, 70% of patients are very informed about their care plan, while 4% are not at all informed about their care plan. These metrics have improved from fiscal year 2013/2014 (Figure 3).
- Moreover, this 5% increase over the last few reported years can potentially be attributed to investments in pilot follow-up programs regionally and because follow-up care is now openly being discussed.
- Some variation exists between types of cancer, with 55% of brain cancer patients very informed about their plan of care compared to 77% of stomach cancer patients (Figure 4).
Why is this important to patient care?
The right surveillance
- Over the past 3 decades, there has been great progress in the early diagnosis and treatment of cancers. This, in turn, has led to better survival.
- Surveillance strategies involve detecting disease recurrence as early as possible, but not all tests have the ability to do this . Recommended tests also vary depending on the type of cancer.
- It is important to monitor for recurrence using the appropriate surveillance to avoid needlessly putting people through tests with no overall impact.
Integration of primary care and specialists for follow-up improves patient care
- Addressing patient anxiety is the key to a successful transfer from specialty to primary care, and simple strategies (such as discussing plans for follow-up with patients and designing a standardized transition plan) can ease the transition. Research points to the importance of setting expectations and planning for follow-up early in the care process .
- Many breast cancer survivors in Canada have regular follow-up visits with oncologists for many years after treatment is complete . Evidence, however, shows that a proportion of these patients do not require this level of specialist-led follow-up care [6, 7].
- Other research suggests that primary care involvement in follow-up care improves the likelihood that patients will receive necessary care for other chronic medical conditions .
- In 2012, Cancer Care Ontario provided one-time catalyst funding to all 14 RCCs for a Well Follow-up Care Program for breast and colorectal cancer patients. Preliminary results show that breast cancer patients in the Well Follow-up Care Program had less costly care and more appropriate use of mammograms compared to a control group .
Find out more
To find out more about Cancer Care Ontario’s Breast Cancer Pathway, please click here.
For more information on survivorship care, see the guideline Models of Care for Cancer Survivorship, developed by the PEBC at Cancer Care Ontario.