Wait Times from Diagnosis to Radiation Treatment
Measure: Wait times (in days) from diagnosis to start of treatment for head and neck cancer patients receiving radiation treatment
As of this Report:
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
As of this Report:
- 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 .
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.
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 .
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 .
- 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 .