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Wait Times for Diagnostic Assessment Programs

Key findings

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

 

Desired Direction:

 

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

 

As of this Report:

 

An image of an arrow pointing straight in a yellow box. This indicates that there has been no increase or decrease in performance over the previous periods identified and this action is below but approaching target or has notable regional variation.

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 [1].
  • 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 [2].

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].

Figure 1. Cancer Care Ontario Diagnostic Assessment Program locations across Ontario

 

Figure 2. Percentage of patients diagnosed in lung Diagnostic Assessment Programs within target (28 days), referral to diagnosis, by Regional Cancer Program (RCP), 2013 to 2017

More information regarding the methodology is available.

Report date: February 2018

Data source: DDUT and EPS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions
  2. † Values have been suppressed due to small cell counts

Data Table 1. Cancer Care Ontario Diagnostic Assessment Program locations across Ontario

DAP Site Name Windsor Regional Cancer Centre Windsor Regional Cancer Centre Windsor Regional Cancer Centre St. Joseph's Health Care London London Health Sciences Centre - Victoria Hospital St. Joseph's Health Care London Grey Bruce Health Services Grey Bruce Health Services Grand River Hospital Grand River Hospital St. Joseph's Hamilton Healthcare Niagara Health System Brant Community Health System General Hamilton Health Sciences William Osler Health System Trillium Health Partners - Credit Valley Hospital Trillium Health Partners - Credit Valley Hospital Trillium Health Partners - Credit Valley Hospital SunnybrookÊ Health Science Centre SunnybrookÊ Health Science Centre Michael Garron Hospital (previously Toronto East General Hospital) University Health Network - Toronto General Hospital University Health Network - Toronto Western Hospital Mount Sinai Hospital St. Michael's Hospital North York General Hospital Southlake Regional Health Centre Southlake Regional Health Centre Southlake Regional Health Centre Lakeridge Hospital Lakeridge Hospital Lakeridge Hospital Scarborough and Rouge Hospital Peterborough Regional Health Centre Hotel Dieu Hospital Kingston General Hospital The Ottawa Hospital The Ottawa Hospital The Ottawa Hospital Royal Victoria Regional Health Centre Royal Victoria Regional Health Centre Health Sciences North Health Sciences North Thunder Bay Regional Health Sciences Centre Thunder Bay Regional Health Sciences Centre
Address 2220 Kildare Rd. 2220 Kildare Rd. 2220 Kildare Rd. 268 Grosvenor St. 800 Commissioners Road East 268 Grosvenor St. 1800 8th Street East 1800 8th Street East 835 King St W 835 King St W 50 Charlton Ave. E. 1200 Fourth Avenue 200 Terrace Hill St 688 Concession St. 2100 Bovaird Drive East 2200 Eglinton Avenue West 2200 Eglinton Avenue West 2200 Eglinton Avenue West 2075 Bayview Ave 2075 Bayview Ave 825 Coxwell Ave 200 Elizabeth St 399 Bathurst Street 600 University Avenue 30 Bond Street 555 Finch Avenue West 596 Davis Dr 596 Davis Dr 596 Davis Dr 1 Hospital Ct 1 Hospital Ct 1 Hospital Ct 3030 Lawrence Avenue East 1 Hospital Drive 166 Brock St 76 Stuart St. 501 Smyth Road 501 Smyth Road 501 Smyth Road 201 Georgian Drive 201 Georgian Drive 41 Ramsey Lake Road 41 Ramsey Lake Road 980 Oliver Road 980 Oliver Road
City Windsor Windsor Windsor London London London Owen Sound Owen Sound Kitchner Kitchner Hamilton St. Catharines Brantford Hamilton Brampton Mississauga Mississauga Mississauga Toronto Toronto East York Toronto Toronto Toronto Toronto Toronto Newmarket Newmarket Newmarket Oshawa Oshawa Oshawa Scarborough Peterborough Kingston Kingston Ottawa Ottawa Ottawa Barrie Barrie Sudbury Sudbury Thunder Bay Thunder Bay
Province ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON
Postal Code N8W2X3 N8W2X3 N8W2X3 N6A4V2 N6A5W9 N6A4V2 N4K6M9 N4K6M9 N2G1G3 N2G1G3 L8N4A6 L2S0A9 N3R1G9 L8V4T1 L6R3J7 L5M2N1 L5M2N1 L5M2N1 M4N3M5 M4N3M5 M4C3E7 M5G2C4 M5T2S8 M5G1X5 M5B1W8 M2R1N5 L3Y2P9 L3Y2P9 L3Y2P9 L1G2B9 L1G2B9 L1G2B9 M1P 2T7 K9J 7C6 K7L5G2 K7L2V7 K1H8L6 K1H8L6 K1H8L6 L4M6M2 L4M6M2 P3E5J1 P3E5J1 P7B6V4 P7B6V4
Site Assess Colorectal Lung/Thoracic Prostate Colorectal Lung/Thoracic Prostate Lung/Thoracic Prostate Colorectal Lung/Thoracic Lung/Thoracic Lung/Thoracic Lung/Thoracic Colorectal Lung/Thoracic Lung/Thoracic Prostate Rectal Colorectal Lung/Thoracic Lung/Thoracic Lung/Thoracic Colorectal Colorectal Colorectal Prostate Colorectal Lung/Thoracic Prostate Lung/Thoracic Prostate Colorectal Prostate Prostate Colorectal Lung/Thoracic Colorectal Lung/Thoracic Prostate Rectal Lung/Thoracic Colorectal Lung/Thoracic Colorectal Lung/Thoracic

Data Table 2. Percentage of patients diagnosed in lung Diagnostic Assessment Programs within target (28 days), referral to diagnosis, by Regional Cancer Program (RCP), 2013 to 2017

RCP Percentage of patients diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2013 Number of cases diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2013 Total number of valid cases referred to lung Diagnostic Assessment Program in 2013 Lower confidence interval in 2013 Upper confidence interval in 2013 Percentage of patients diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2014 Number of cases diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2014 Total number of valid cases referred to lung Diagnostic Assessment Program in 2014 Lower confidence interval in 2014 Upper confidence interval in 2014 Percentage of patients diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2015 Number of cases diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2015 Total number of valid cases referred to lung Diagnostic Assessment Program in 2015 Lower confidence interval in 2015 Upper confidence interval in 2015 Percentage of patients diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2016 Number of cases diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2016 Total number of valid cases referred to lung Diagnostic Assessment Program in 2016 Lower confidence interval in 2016 Upper confidence interval in 2016 Percentage of patients diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2017 Number of cases diagnosed in lung Diagnostic Assessment Program within target (28 days) in 2017 Total number of valid cases referred to lung Diagnostic Assessment Program in 2017 Lower confidence interval in 2017 Upper confidence interval in 2017
Ontario 50.3% 2,211 4,394 48.8% 51.8% 54.9% 2,906 5,296 53.5% 56.2% 58.5% 3,361 5,748 57.2% 59.8% 61.2% 3,922 6,409 60.0% 62.4% 59.4% 3,850 6,478 58.2% 60.6%
Erie St. Clair 50.0% 93 186 42.5% 57.5% 40.3% 96 238 33.9% 46.8% 46.0% 110 239 39.5% 52.6% 59.4% 139 234 52.9% 65.9% 70.0% 147 210 63.6% 76.4%
South West 55.7% 262 470 51.1% 60.3% 59.8% 343 574 55.7% 63.9% 52.9% 327 618 48.9% 56.9% 52.7% 303 575 48.5% 56.9% 43.9% 247 563 39.7% 48.1%
Waterloo Wellington 64.1% 139 217 57.4% 70.7% 76.4% 159 208 70.4% 82.4% 69.3% 133 192 62.5% 76.1% 44.9% 110 245 38.5% 51.3% 41.7% 111 266 35.6% 47.8%
Hmltn-Ngr-Hldmnd-Brnt 44.7% 298 667 40.8% 48.5% 53.6% 444 828 50.2% 57.1% 55.8% 524 939 52.6% 59.0% 55.3% 534 966 52.1% 58.5% 61.5% 649 1,056 58.5% 64.4%
Mississauga Halton/Central West 63.4% 97 153 55.4% 71.4% 57.9% 151 261 51.7% 64.0% 63.2% 208 329 57.9% 68.6% 66.5% 339 510 62.3% 70.7% 59.0% 385 652 55.2% 62.9%
Toronto Central South 51.7% 137 265 45.5% 57.9% 53.8% 182 338 48.4% 59.3% 58.9% 206 350 53.6% 64.2% 53.6% 237 442 48.9% 58.4% 57.4% 243 423 52.6% 62.3%
Toronto Central North 61.6% 98 159 53.8% 69.5% 62.1% 133 214 55.4% 68.9% 70.6% 163 231 64.5% 76.7% 70.9% 195 275 65.4% 76.5% 59.4% 187 315 53.8% 64.9%
Central 46.8% 155 331 41.3% 52.4% 36.7% 155 422 32.0% 41.4% 48.3% 269 557 44.1% 52.5% 56.0% 353 630 52.1% 60.0% 48.1% 156 324 42.6% 53.7%
Central East 35.8% 200 559 31.7% 39.8% 46.0% 256 556 41.8% 50.3% 52.5% 345 657 48.6% 56.4% 52.8% 351 665 48.9% 56.7% 49.9% 308 617 45.9% 53.9%
South East 46.4% 90 194 39.1% 53.7% 49.3% 133 270 43.1% 55.4% 53.3% 120 225 46.6% 60.1% 59.0% 154 261 52.8% 65.2% 45.9% 150 327 40.3% 51.4%
Champlain 60.7% 455 749 57.2% 64.3% 64.5% 553 858 61.2% 67.7% 77.8% 624 802 74.9% 80.7% 86.4% 852 986 84.2% 88.6% 83.9% 882 1,051 81.7% 86.2%
North Simcoe Muskoka 46.8% 58 124 37.6% 56.0% 55.1% 81 147 46.7% 63.5% 33.6% 51 152 25.7% 41.4% 31.0% 48 155 23.4% 38.6% 40.6% 65 160 32.7% 48.5%
North East 38.0% 73 192 30.9% 45.1% 56.8% 150 264 50.7% 63.0% 64.1% 214 334 58.8% 69.4% 67.8% 246 363 62.8% 72.7% 62.4% 259 415 57.6% 67.2%
North West 43.8% 56 128 34.8% 52.7% 59.3% 70 118 50.0% 68.6% 54.5% 67 123 45.3% 63.7% 59.8% 61 102 49.8% 69.8% 61.6% 61 99 51.5% 71.7%

Report date: February 2018

Data source: DDUT and EPS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions
  2. † Values have been suppressed due to small cell counts

 

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 [5].
  • 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 [2].
  • 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.

Notes

  1. Brouwers M, Oliver TK, Crawford J, Ellison P, Evans WK, Gagliardi A, et al. Cancer diagnostic assessment programs: standard for the organization of care in Ontario. Curr Oncol. 2009;16(6):29–41.
  2. Cancer Care Ontario. Current state of diagnostic assessment programs: ESRS phase II report. Toronto: Cancer Care Ontario; 2013.
  3. Tørring ML, Frydenberg M, Hamilton W, Hansen RP, Lautrup MD, Vedsted P. Diagnostic interval and mortality in colorectal cancer: U-shaped association demonstrated for three different datasets. J Clin Epidemiol. 2012;65(6):669–678.
  4. National Cancer Intelligence Network. Routes to diagnosis: technical supplement. London (UK): National Cancer Research Institute; 2010.
  5. Risberg T, Sorbye SW, Norum J, Wist EA. Diagnostic delay causes more psychological distress in female than in male cancer patients. Anticancer Res. 1996;16(2):995–99.