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Wait Times from Diagnosis to Radiation Treatment

Key findings

Measure:  Wait times (in days) from diagnosis to start of treatment for head and neck cancer patients receiving radiation treatment

 

Desired Direction:

 

An image of an arrow pointing downwards. This indicates that desired direction for this action is downwards.

 

As of this Report:

 

An image of an arrow pointing downwards in a yellow box. This indicates that there has been an increase in performance over the previous years identified and this action is below but approaching target or has notable regional variation.

The wait times for radiation treatment look at the median time (measured in days) between the time a cancer patient is diagnosed and the start of radiation treatment. For head and neck cancer patients diagnosed from 2015 to 2016 who are being treated with radiation as their primary treatment, the median wait time from diagnosis to start of treatment was 47 days. For cervical cancer patients diagnosed in 2015 to 2016 who are being treated with radiation as their primary treatment, the median wait time from diagnosis to start of treatment was 55 days. Variation exists across regions with regard to median wait times for both head and neck cancer patients and cervical cancer patients, suggesting there may be room for improvement.

What is radiation treatment?

  • Radiation treatment uses energy (radiation) from X-rays, gamma rays and electrons to destroy cancer cells. In high doses, radiation destroys cells in the area being treated.
  • Radiation destroys cells by damaging the DNA in cancer cell genes, making it impossible for them to grow and divide.
  • During radiation treatment, both cancer cells (which are growing in an uncontrolled way) and healthy cells are affected, but most healthy cells can repair themselves.

Wait times for radiation treatment

  • Cancer Care Ontario reports not only whether radiation wait times are improving, but also how many patients are being treated within the recommended time frame or targets, according to 3 intervals.
    • Diagnosis-to-referral: the time between the initial diagnosis and a referral to a radiation oncologist.
    • Referral-to-consult: the time between referral and being seen by a radiation oncologist.
    • Ready-to-treat to start of radiation treatment: the time between being ready for treatment and receiving first treatment.

Measure:  Wait times (in days) from diagnosis to start of treatment for cervical cancer patients receiving radiation treatment

 

Desired Direction:

 

An image of an arrow pointing downwards. This indicates that desired direction for this action is downwards.

 

As of this Report:

 

An image of an arrow pointing upwards in a yellow box. This indicates that there has been a decrease in performance over the previous periods identified and this action is below but approaching target or has notable regional variation.

  • Traditionally, the target wait time for the referral-to-consult interval is 14 days, while the targets for the ready-to-treat to start of treatment interval vary from 1 to 14 days (depending on the priority category, which is determined based on the patient’s condition).
  • The wait times for radiation in this report are shown as medians in days from the time of diagnosis to the start of treatment, and they do not have a target. The median wait time is the point at which half of the patients have started their treatment and the other half are still waiting [1].

What is an integrated wait time?

  • Cancer Care Ontario is working towards reporting radiation treatment wait time data in a way that increasingly represents the total wait time journey.
  • The diagram below shows the progression of a patient’s wait time from date of diagnosis to referral date (“diagnosis-to-referral”) for patients whose primary cancer treatment is radiation treatment. The referral then leads to a consultation date with the radiation oncologist (“referral-to-consult”), followed by the radiation treatment date (“consult-to-treatment”).
  • By looking at the combined wait time in these patient groups, a more complete picture of the patient wait time for radiation is presented.

 

Figure 1. Median wait times (in days) from diagnosis-to-referral, referral-to-consult, and consult-to-treatment for patients with head and neck cancer (diagnosed 2015 to 2016)

More information regarding the methodology is available.

Figure 2. Median wait times (in days) from diagnosis-to-referral, referral-to-consult, and consult-to-treatment for patients with head and neck cancer (diagnosed 2011 to 2016)

More information regarding the methodology is available.

Report date: January 2018

Data source: OCR, ALR, DAD, NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for inclusions/exclusions.
  2. Not all Regional Cancer Centres (RCCs) treat head and neck cancer. Waterloo Wellington and North Simcoe Muskoka Regional Cancer Centres are excluded from the median wait time calculation.
  3. Diagnosis date in OCR is based on the earliest date from all the source records associated with the incident case of interest (i.e., DAD: the admission date, NACRS: the registration date; ALR: the diagnosis date on the disease record; pathology: the specimen collection date).

Figure 3. Median wait times (in days) from diagnosis to start of treatment for patients with head and neck cancer, diagnosed from 2011 to 2016, by Regional Cancer Program (RCP) of treatment

More information regarding the methodology is available.

Report date: January 2018

Data source: OCR, ALR, DAD, NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for inclusions/exclusions.
  2. Not all Regional Cancer Centres (RCCs) treat head and neck cancer. Waterloo Wellington and North Simcoe Muskoka Regional Cancer Centres are excluded from the median wait time calculation.
  3. Diagnosis date in OCR is based on the earliest date from all the source records associated with the incident case of interest (i.e., DAD: the admission date, NACRS: the registration date; ALR: the diagnosis date on the disease record; pathology: the specimen collection date).

Figure 4. Median wait times (in days) from diagnosis-to-referral, referral-to-consult, and consult-to-treatment for patients with cervical cancer (diagnosed 2015 to 2016)

More information regarding the methodology is available.

Figure 5. Median wait times (in days) from diagnosis-to-referral, referral-to-consult, and consult-to-treatment for patients with cervical cancer (diagnosed 2011 to 2016)

More information regarding the methodology is available.

Report date: January 2018

Data source: OCR, ALR, DAD, NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for inclusions/exclusions.
  2. Centres with low volumes are not shown.
  3. † Values have been suppressed due to small cell counts.
  4. Diagnosis date in OCR is based on the earliest date from all the source records associated with the incident case of interest (i.e., DAD: the admission date, NACRS: the registration date; ALR: the diagnosis date on the disease record; pathology: the specimen collection date).

Figure 6. Median wait times (in days) from diagnosis to start of treatment for patients with cervical cancer, diagnosed from 2011 to 2016, by Regional Cancer Program (RCP) of treatment

More information regarding the methodology is available.

Report date: January 2018

Data source: OCR, ALR, DAD, NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for inclusions/exclusions.
  2. Centres with low volumes are not shown.
  3. † Values have been suppressed due to small cell counts.
  4. Diagnosis date in OCR is based on the earliest date from all the source records associated with the incident case of interest (i.e., DAD: the admission date, NACRS: the registration date; ALR: the diagnosis date on the disease record; pathology: the specimen collection date).

Data Table 2. Median wait times (in days) from diagnosis-to-referral, referral-to-consult, and consult-to-treatment for patients with head and neck cancer (diagnosed 2011 to 2016)

Diagnosis year Median wait time (in days) from diagnosis-to-referral Median wait time (in days) from referral-to-consult Median wait time (in days) from consult-to-treatment Median wait time (in days) from diagnosis to start of treatment Case volume
2011 to 2012 14 7 23 50 1,483
2013 to 2014 15 7 21 48 1,721
2015 to 2016 14 7 21 47 1,698

Report date: January 2018

Data source: OCR, ALR, DAD, NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for inclusions/exclusions.
  2. Not all Regional Cancer Centres (RCCs) treat head and neck cancer. Waterloo Wellington and North Simcoe Muskoka Regional Cancer Centres are excluded from the median wait time calculation.
  3. Diagnosis date in OCR is based on the earliest date from all the source records associated with the incident case of interest (i.e., DAD: the admission date, NACRS: the registration date; ALR: the diagnosis date on the disease record; pathology: the specimen collection date).

Data Table 3. Median wait times (in days) from diagnosis to start of treatment for patients with head and neck cancer, diagnosed from 2011 to 2016, by Regional Cancer Program (RCP) of treatment

RCP Median wait time (in days) from diagnosis to start of treatment, diagnosed 2011 to 2012 Case volume, diagnosed 2011 to 2012 Median wait time (in days) from diagnosis to start of treatment, diagnosed 2013 to 2014 Case volume, diagnosed 2013 to 2014 Median wait time (in days) from diagnosis to start of treatment, diagnosed 2015 to 2016 Case volume, diagnosed 2015 to 2016
Ontario 50 1,483 48 1,721 47 1,698
Erie St. Clair 56 52 54 71 50 56
South West 42 211 38 204 39 206
Hamilton Niagara Haldimand Brant 46 215 43 231 45 216
Toronto Central South 51 527 49 578 46 562
Toronto Central North 50 190 49 232 51 247
South East 54 50 53 92 51 61
Champlain 62 150 53 199 53 227
North East 46 79 45 79 46 84
North West 49 9 53 35 50 39

Report date: January 2018

Data source: OCR, ALR, DAD, NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for inclusions/exclusions.
  2. Not all Regional Cancer Centres (RCCs) treat head and neck cancer. Waterloo Wellington and North Simcoe Muskoka Regional Cancer Centres are excluded from the median wait time calculation.
  3. Diagnosis date in OCR is based on the earliest date from all the source records associated with the incident case of interest (i.e., DAD: the admission date, NACRS: the registration date; ALR: the diagnosis date on the disease record; pathology: the specimen collection date).

Data Table 5. Median wait times (in days) from diagnosis-to-referral, referral-to-consult, and consult-to-treatment for patients with cervical cancer (diagnosed 2011 to 2016)

Diagnosis year Median wait time (in days) from diagnosis-to-referral Median wait time (in days) from referral-to-consult Median wait time (in days) from consult-to-treatment Median wait time (in days) from diagnosis to start of treatment Case volume
2011 to 2012 22 6 20 55
2013 to 2014 21 5 20 53
2015 to 2016 23 6 19 55 383

Report date: January 2018

Data source: OCR, ALR, DAD, NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for inclusions/exclusions.
  2. Centres with low volumes are not shown.
  3. † Values have been suppressed due to small cell counts.
  4. Diagnosis date in OCR is based on the earliest date from all the source records associated with the incident case of interest (i.e., DAD: the admission date, NACRS: the registration date; ALR: the diagnosis date on the disease record; pathology: the specimen collection date).

Data Table 6. Median wait times (in days) from diagnosis to start of treatment for patients with cervical cancer, diagnosed from 2011 to 2016, by Regional Cancer Program (RCP) of treatment

RCP Median wait time (in days) from diagnosis to start of treatment, diagnosed 2011 to 2012 Case volume, diagnosed 2011 to 2012 Median wait time (in days) from diagnosis to start of treatment, diagnosed 2013 to 2014 Case volume, diagnosed 2013 to 2014 Median wait time (in days) from diagnosis to start of treatment, diagnosed 2015 to 2016 Case volume, diagnosed 2015 to 2016
Ontario 55 53 55 383
Erie St. Clair 64 15 50 14 67 21
South West 48 45 48 43 51 30
Waterloo Wellington 58 6 64 9 60 12
Hamilton Niagara Haldimand Brant 54 55 47 46 51 56
Mississauga Halton/Central West 102 80 14 56 36
Toronto Central South 60 68 61 74 58 47
Toronto Central North 48 88 48 71 60 66
Central East 68 17 43 8 34 16
South East 66 18 33 15 53 13
Champlain 55 34 42 34 45 30
North Simcoe Muskoka - - 40 41 22
North East 44 22 48 21 53 24
North West 28 46 59 10

Report date: January 2018

Data source: OCR, ALR, DAD, NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for inclusions/exclusions.
  2. Centres with low volumes are not shown.
  3. † Values have been suppressed due to small cell counts.
  4. Diagnosis date in OCR is based on the earliest date from all the source records associated with the incident case of interest (i.e., DAD: the admission date, NACRS: the registration date; ALR: the diagnosis date on the disease record; pathology: the specimen collection date).

Figure 1. Median wait times (in days) from diagnosis-to-referral, referral-to-consult, and consult-to-treatment for patients with head and neck cancer (diagnosed 2015 to 2016)

The figure is a large arrow with text above, within, and below the arrow.

The arrow is a visual to illustrate the text that describes the median time a patient with head and neck cancer waited at specific intervals from diagnosis to the start of treatment at a regional cancer centre in Ontario.

The text above the arrow defines the radiation therapy wait time indicator as the median wait times (in days) from diagnosis to referral, referral to consult, and consult to start of radiation treatment for patients diagnosed with head and neck cancer in 2015 and 2016 in Ontario.

Four boxes with text in between lies on top of the arrow and visually illustrates the text: the median (or 50th percentile) wait time between diagnosis and referral is 14 days, the median wait time between referral and consult is 7 days, and the median wait time between consult and the start of radiation treatment is 21 days. This means that 50 % of patients with head and neck cancer received a referral within 14 days of receiving their diagnosis, had a consultation with a radiation oncologist within 7 days of receiving a referral, and started radiation treatment within 21 days of having a consultation with a radiation oncologist.

The text below the arrow states the current result of the indicator: the median wait time from diagnosis to radiation treatment for patients with head and neck cancer is 47 days.

Additional text further below the arrow states that the overall median wait times for the entire patient journey (diagnosis to treatment) cannot be compared to the summation of the individual parts of the journey (diagnosis to referral, referral to consult, and consult to treatment).

Figure 3. Median wait times (in days) from diagnosis to start of treatment for patients with head and neck cancer, diagnosed from 2011 to 2016, by Regional Cancer Program (RCP) of treatment

The figure is a large arrow with text above, within, and below the arrow.

The arrow is a visual to illustrate the text that describes the median time a patient with cervical cancer waited at specific intervals from diagnosis to the start of treatment at a regional cancer centre in Ontario.

The text above the arrow defines the radiation therapy wait time indicator as the median wait times (in days) from diagnosis to referral, referral to consult, and consult to start of radiation treatment for patients diagnosed with cervical cancer in 2015 and 2016 in Ontario.

Four boxes with text in between lies on top of the arrow and visually illustrates the text: the median (or 50th percentile) wait time between diagnosis and referral is 23 days, the median wait time between referral and consult is 6 days, the median wait time between consult and the start of radiation treatment is 19 days. This means that 50 % of patients with cervical cancer received a referral within 23 days of receiving their diagnosis, had a consultation with a radiation oncologist within 6 days of receiving a referral, and started radiation treatment within 19 days of having a consultation with a radiation oncologist.

The text below the arrow states the current result of the indicator: the median wait time from diagnosis to radiation treatment for patients with cervical cancer is 55 days.

Additional text further below the arrow states that the overall median wait times for the entire patient journey (diagnosis to treatment) cannot be compared to the summation of the individual parts of the journey (diagnosis to referral, referral to consult, and consult to treatment).

What do the results show?

Head and neck cancer patients diagnosed from 2015 to 2016 had a median wait time of 47 days from diagnosis to start of treatment (Figures 1, 2 and 3).

  • The median wait time of 47 days from diagnosis to start of treatment for HN cancer patients diagnosed from 2015 to 2016 is lower than the median wait time from last year (i.e., for patients diagnosed from 2014 to 2015).
  • The diagnosis-to-referral median is 14 days, which indicates that 50% of patients are not referred more than 2 weeks after being diagnosed. Variation seen across regions suggests room for improvement.
  • The referral-to-consult median is 7 days (Figures 1 and 2).
  • The median number of days from consult-to-treatment is 21 days,  indicating that 50% of patients start treatment just over 3 weeks after having a consult with a radiation oncologist.
  • Overall, trends in wait time trends continue to remain consistent, with the exception of diagnosis to start of treatment and consult-to-treatment, each showing a slight decrease over time (Figure 2).
  • Considerable variation exists in the wait time measure for consult-to-treatment, despite provincial targets for the ready-to-treat to start of radiation treatment interval being met. This variation again suggests room for improvement, presumably in the staging workup of patients and the coordination of care with other related disciplines (e.g., medical oncology, surgery or dental).

Cervical cancer patients diagnosed from 2015 to 2016 had a median wait time of 55 days from diagnosis to start of treatment (Figures 4, 5 and 6).

  • The median wait time in Ontario from diagnosis to referral for patients who were diagnosed with cervical cancer from 2015 to 2016 was 23 days. The referral-to-consult median wait time was 6 days and consult-to-treatment median wait time was 19 days.
  • Differences in the interpretation of the diagnosis date can affect the length of wait times from diagnosis to treatment.
  • Evidence suggests that patients with cervical cancer who complete their radiation treatment (first external beam to end of brachytherapy) in fewer than 56 days have better outcomes [2].

Why is this important to patient care?

Measuring wait times is a person-centred measure.

  • Measuring the time from diagnosis to start of treatment captures a larger section of the patient journey. This may be more relevant from a patient perspective than other wait time intervals.
  • Having relevant integrated measures such as those discussed here addresses the importance of coordination of care for patients in the cancer system <<link to write-up on Patient Experience >>. 

Shorter wait times result in better outcomes and reduced stress.

  • Radiation treatment shrinks tumours, destroys cancer cells and provides relief from cancer symptoms. This includes use for palliative reasons in end-of-life care.
  • To ensure the best outcomes from radiation treatment and to minimize undue stress, the wait time should be as short as reasonably possible [3].
  • Unavoidable delays contribute to a percentage of patients who do not meet the target for the referral-to-consult interval.
  • Wait times serve as a gauge of how well the cancer system is working. They provide valuable insight when distributing existing resources and planning for future services. They also are important for identifying aspects of treatment or processes that add to wait times and affect access to care [4].

Notes

  1. Ontario Wait Times [Internet]. Toronto: Ontario Ministry of Health and Long-Term Care; c2013 [updated 2015 Nov 2; cited 2014 Mar 7]. Available from: here.
  2. Song S, Rudra S, Hasselle MD, Dorn PL, Mell LK, Mundt AJ, et al. The effect of treatment time in locally advanced cervical cancer in the era of concurrent chemoradiotherapy. Cancer. 2013;119:325–32.
  3. Chen Z, King W, Pearcey R, Kerba M, Mackillop WJ. The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review of the literature. Radiother Oncol. 2008;87:3–16.
  4. Saint-Jacques N, Rayson D, Al-Fayea T, Virik K, Morzychi W, Younis T. Waiting times in early-stage non-small cell lung cancer. J Thorac Oncol. 2008;3(8):865–870.