2010 Quality Index Reports on Ontario's Cancer System

CANCER CARE ONTARIOMay 28 2010

2010 Quality Index Reports on Ontario's Cancer System

Wait times for cancer radiation treatment continued their decline across Ontario during 2009, despite a more than 10 per cent increase in the number of patients receiving treatment, according to the 2010 Cancer System Quality Index report issued today.

Across the province, the report found that:

- The number of patients who receive radiation treatment within Ontario's target for the time between being ready to treat and receiving treatment increased from 53 per cent in 2007 to 73 per cent in 2009, a total increase of more than 40 per cent. - The number of patients who are seen by a radiation specialist within 14 days of referral increased from 57 per cent to 68 per cent from 2007 to 2009. - For the period April-September 2009, 96 per cent of Ontario patients started radiation treatment within the Provincial-Territorial benchmark of 28 days from the time when a patient is considered ready to treat to the time the patient begins receiving treatment.

"The gains we are seeing in radiation treatment wait times shows what can happen when, a comprehensive strategy, long-term planning, appropriate resources and collaboration among the government, hospitals and clinicians comes together," said Dr. Robert Bell, Chair, Cancer Quality Council of Ontario. "With the increasing demands being placed on the system we need to apply these approaches to improving quality and access for cancer surgery and chemotherapy."

The Cancer System Quality Index report says Ontario's radiation wait times now are at an acceptable level and the province should turn its attention to substantially increasing the utilization of radiation therapy (currently at 36 per cent) to the provincial target of 48 per cent in order to meet international benchmarks.

In other areas, the report noted that wait times for cancer surgery were unchanged in the past year with 76 per cent of surgeries meeting target wait times. Wait times for more common, low-complexity cases - such as breast and colorectal cancer surgery - have decreased, but Ontario faces an increasing challenge in meeting its wait time targets for highly complex and more urgent priority cases. Despite growing demand, wait times for chemotherapy remained the same during the past year.

"The Index is a snapshot of how the cancer system is performing and highlights successes and opportunities for improvement," said Terrence Sullivan, President and CEO, Cancer Care Ontario. "For the first time, international comparators are posted for the public to see. This will drive the province towards regular benchmarking against international best practices."

During 2009, the quality of pathology reporting improved substantially with most (76 per cent) pathology reports now being submitted in standardized electronic format according to international standards. A U.S. study has shown that standardized pathology reporting enhances patient care by improving the efficiency of clinical processes. As well, efforts to implement electronic reporting are making it easier for physicians to review reports more quickly, and share and analyze data, all of which is essential for ensuring high quality pathology reporting and improved patient care.

"The work of the Cancer Quality Council of Ontario exemplifies the principles articulated in the government's proposed Excellent Care for All Act to drive quality improvements and accountability of the health care system for Ontario's patients," said Deb Matthews, Minister of Health and Long-Term Care. "The Index is an excellent barometer of how well the cancer care system is performing. It provides valuable data, information and analysis to guide the government, Cancer Care Ontario and our regional partners in our work to ensure we are preventing cancer, detecting it early, and meeting the needs of patients."

To meet the increasing demand for cancer services Ontario's cancer care system has begun looking at new ways to organize and provide care to improve the quality for patients as well as efficiency. For example:

- More than 50 per cent of Ontario hospitals now report holding at least one regularly scheduled, multidisciplinary case conference (MCC) in which healthcare providers from different disciplines make recommendations on the care of individual cancer patients. - Eighty-three per cent of thoracic operations were completed at a designated centre that meets the minimum surgical volumes and other standards. Thoracic surgery is very complex and successful outcomes are linked to the number of surgeries performed, and the availability of specialized surgical training and hospital resources.

Other Cancer System Quality Index highlights:

- The Index compares Ontario's performance to other provinces and international jurisdictions. Looking at cancer mortality rates, Ontario is generally on-par with - or better than - the best performers in Canada, but is in the mid-range internationally. - The anti-smoking message is getting through, with half to three- quarters of Ontarians - depending on age and sex - reporting they tried to quit smoking in the past year. - Participation among eligible adults in colorectal cancer screening using the fecal occult blood test (FOBT) has risen by 50 per cent since the last reporting period but still falls short of the provincial target of 40 per cent. Ontario has one of the highest rates of colorectal cancer in the world. - Participation in clinical trials is decreasing. In 2009, approximately 4,300 cancer patients (9 per cent) were enrolled in treatment-based clinical trials down from 5,500 in 2007. - In 2009, 97 per cent of cancer patients treated in hospital reported a high degree of satisfaction with most aspects of their care. However, patient satisfaction related to emotional support remained low at 46 to 59 per cent depending on location.