Wait Times for Diagnostic Assessment Programs
Approximately half of Ontario patients who received a diagnosis of lung cancer in 2017 were diagnosed following assessment at one of Ontario’s 19 lung/thoracic Diagnostic Assessment Programs (DAPs). Fifty-nine percent (59%) of individuals suspected of having lung/thoracic cancer who had been assessed through one of Ontario’s lung/thoracic DAPs were diagnosed within the 28-day target following a referral from their primary care provider or other healthcare professional. After improvement in previous years, the percentage of patients diagnosed within the 28-day target remained relatively constant from 2016 to 2017, and it is near Cancer Care Ontario’s target of 65%.
While this is a report only on lung/thoracic patients seen in a DAP, Cancer Care Ontario continues to work with DAPs to improve wait times for diagnosis while also developing approaches to understand the experience of patients who are not served by a DAP.
Measure: Indicator: Percentage of lung/thoracic patients entering a Diagnostic Assessment Programs diagnosed within target (28 days) from referral to diagnosis
As of this Report:
What are Diagnostic Assessment Programs?
- Cancer Care Ontario has developed and supported the implementation of DAPs across the province for individuals suspected of having colorectal, lung/thoracic or prostate cancer. This was done to help improve (a) the experience in the diagnostic phase of the cancer journey for both patients and healthcare providers and (b) the efficiency and effectiveness of the overall healthcare system. Regions have also introduced additional programs for streamlined diagnostic assessment of other cancer types, based on local needs.
- There are currently 45 DAPs in Ontario, including 19 lung/thoracic DAPs associated with Ontario’s Regional Cancer Programs (RCPs) that specialize in the diagnosis and staging of lung/thoracic cancer. There also are 14 DAPs for colorectal cancer, 10 DAPs for prostate cancer and 2 DAPs for rectal cancer (Figure 1).
- In 2015, 44% of lung/thoracic cancer patients, 15% of colorectal cancer patients and 13% of prostate cancer patients in Ontario received their diagnosis through a DAP. The percentage of patients diagnosed with cancer who received their diagnosis through a DAP varies by region and type of cancer.
- DAPs may be physical or virtual programs, and they are characterized by facilitated access to coordinated diagnostic services, multidisciplinary consultation, patient information resources, symptom management and psychosocial supports .
- Patient navigators play a key role in DAPs, working as patient liaisons to help navigate appointments and providing psychosocial support and symptom management. They are specially trained in healthcare navigation through the cancer care continuum, and they work with all members of the healthcare team to identify and implement quality improvement initiatives that enhance the care and services provided to patients .
Diagnosing lung cancer
- In Ontario, lung cancer is the most commonly diagnosed cancer, and it is the leading cause of death from cancer for both men and women.
- Diagnosing lung cancer is a complex process that can be long and frustrating for people experiencing the relevant signs and symptoms. It requires several diagnostic tests and procedures to help the physician rule out other health problems and make a cancer diagnosis.
- Overall, the existing literature does not suggest a clear link between diagnostic wait time and patient survival outcomes [3, 4].
What do the results show?
The percentage of patients suspected of having lung/thoracic cancer seen in lung/thoracic Diagnostic Assessment Programs and diagnosed within 28 days of referral remains constant after improvement in previous years (Figure 2).
- Overall, the percentage of patients suspected of having lung/thoracic cancer diagnosed within 28 days of referral has increased from 50% in 2013 to 59% in 2017. The number of patients who were assessed in a DAP has risen from 7,066 in 2013 to 9,817 in 2017.
- There is regional variation in the percentage of patients suspected of having lung/thoracic cancer who are being diagnosed within 28 days of referral. Overall, 2 regions surpassed the target of 65% in 2017 – Erie St. Clair (70%) and Champlain (84%).
- Improvement from 2016 to 2017 in the percentage of patients diagnosed within 28 days of referral was observed in Erie St. Clair, Hamilton Niagara Haldimand Brant, Toronto Central South, North Simcoe Muskoka, and North West.
- Regional variability can be explained in part by differences in entry criteria when regional DAPs assess the eligibility of patients for enrolment in their program. For example, some regions enroll patients if they have an abnormal chest x-ray, while others may require a chest CT scan with the referral, which is likely to shorten the DAP wait times.
- Challenges meeting wait time targets in lung/thoracic DAPs still persist, and in some cases are worsening for a number of reasons. These include timely access to CT-guided biopsy and PET imaging, increased patient volumes in excess of capacity, and accommodation of patient scheduling preferences. Cancer Care Ontario is continuing to perform analyses to better understand the extent of the issue and the contributing factors.
- As the awareness of DAPs continues to increase among primary care providers, further increases in patient volumes can be expected.
- To address these challenges and improve wait times, Cancer Care Ontario is facilitating the sharing of best practices and successful strategies, both from regions that are meeting the target and from those making steady improvements. Individual regions are continuously developing and executing action plans to improve wait times.
- To promote equal access to lung/thoracic DAPs across the province, Cancer Care Ontario is supporting regional implementation of new recommended entry and transfer of care criteria for lung/thoracic DAPs.
Why is this important to Ontarians?
- Organized diagnostic assessment occurring within DAPs streamlines appropriate testing and ensures that patients are informed of the steps in the diagnostic process.
- The delay between patient referral and diagnosis can lead to increased stress and anxiety for patients and caregivers. Psychological distress intensifies as the waiting time for diagnosis gets longer .
- Emotional support is crucial to the overall patient experience and the quality of life for those undergoing testing for cancer. The uncertainty and fear associated with cancer suspicion often results in patient distress and anxiety, but navigational support can help patients cope with the emotional issues associated with testing for cancer .
- By monitoring wait time data, the province can more effectively and accurately distribute existing resources and plan for future services.
Find out more
- To learn more about Cancer Care Ontario’s DAPs, click here.
- Cancer Care Ontario’s Disease Pathway Management (DPM) has published several maps that outline the screening, diagnosis and treatment pathways for specific disease, including lung cancer. Individuals with signs and/or symptoms of lung cancer are typically referred directly to a lung/thoracic DAP by a family physician or other healthcare provider. To find out more about Cancer Care Ontario’s DPM program, click here.