This indicator measures wait times, starting from the time men with prostate cancer are ready to be treated with radiation therapy to the actual start of treatment (for 2013). This measure is expressed as the percentage of prostate cancer patients treated within the national target wait time (28 days) as well as the 90th percentile wait times in days. The indicator also examines the median and 90th percentile wait times in days by patient risk category (as per the GUROC Canadian Consensus definition).
A prolonged delay between cancer suspicion and treatment is stressful and can lead to excess anxiety for patients and their family members.1,2 National wait time targets have been set and provincial initiatives to reduce wait times have been implemented.3
Radiation is one of the primary treatment modalities for men with low-, intermediate- and high-risk prostate cancer as per evidence-based guidelines. It is commonly used post-operatively (adjuvant therapy) to reduce risk of recurrence and when pathology reports indicate positive surgical margins (i.e., cancer cells were found at the edges of the removed tumour).4
Many studies have demonstrated that prostate cancer patients wait longer for radiation therapy compared to patients with other types of cancer.2 Longer wait times may be expected due to the nature of prostate cancer; in many men, prostate cancer is slow-growing so treatment may be considered less urgent for prostate cancer than for other cancers.
Analyzing radiation therapy wait times by prostate cancer risk profile may help to identify whether delays exist. This in turn may help efforts aimed at optimizing wait times for treatment. It is important to note that not all patients need to receive radiation therapy with the same urgency.
What are the results?
Prostate cancer patients waited longer for radiation therapy than patients with breast, colorectal or lung cancers in all reporting provinces (data not shown).
In the 2013 treatment year, Ontario’s 90th percentile wait time for radiation therapy (18 days) to treat prostate cancer was the shortest in the country; the 90th percentile wait time in British Columbia was the longest (40 days) (Figure 4.19).
The percentage of prostate cancer patients treated within the national wait time benchmark (28 days from ready-to-treat) ranged from 82.4% to 99.4%. Three of the eight reporting provinces achieved the target wait time (Table 3.1).
British Columbia’s 90th percentile wait times showed timing of radiation therapy may be prioritized based on patients’ risk levels: higher-risk patients waited less time for radiation therapy to start compared to patients deemed to be at lower-risk (Figure 4.20). However, of the five reporting provinces, British Columbia had the longest 90th percentile wait times for intermediate- and low-risk patients; Saskatchewan had the shortest.
What do the results mean?
Examining wait times interprovincially can help identify potential benchmarks. Only three of eight reporting provinces achieved the target of 90% of patients receiving radiation therapy within the national wait time benchmark of 28 days from ready-to-treat.
Urgency of treatment seems to be a key factor in wait times. A study was undertaken to identify delays in the process from diagnosis to radiation treatment among prostate cancer patients who received curative radiation therapy treatment at the Odette Cancer Centre in Toronto, Ontario.2 This study found that the time interval between diagnosis and delivery of a first fraction of radiation therapy was appropriately shorter for intermediate- and high-risk patients (124 days) compared to wait times for low-risk patients in the group (178 days).
Dale W, Bilir P, Han M, Meltzer D. The role of anxiety in prostate carcinoma: a structured review of the literature. Cancer. 2005 Aug 1;104(3):467-78.
Stevens C, Bondy SJ, Loblaw DA. Wait times in prostate cancer diagnosis and radiation treatment. Can Urol Assoc J. 2010 Aug;4(4):243-8.
Health Canada. Final Report of the Federal Advisor on Wait Times. Ottawa (ON): Health Canada; 2006. 76 p.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer Version 2.2014. Chicago (IL): American Joint Committee on Cancer; 2014. 98 p.
The criteria for assigning risk based on the GUROC Canadian Consensus definition include non-metastatic patients only. This means that metastatic patients were excluded from the analysis showing wait times by risk category (Figure 4.20). For other analyses of radiation therapy wait times, all prostate cancer patients (non-metastatic and metastatic) were included (Figure 4.19).
The indicator examining the median and 90th percentile wait times by risk category includes data on patients who received treatment to the primary cancer site only (the prostate gland) (Figure 4.20). Indicator data on the 90th percentile wait times (not by risk category) are consistent with provincial wait times definition, which means that waits could be reported by primary site (prostate gland) or by the site receiving treatment (i.e., metastatic site) (Figure 4.19).
“Ready-to-treat” is the starting point for the wait time measurement. While considerable effort has gone into developing and adopting a standardized definition for this term, interprovincial variations may persist.
Radiation therapy wait times include wait times for external beam radiation therapy (EBRT) or brachytherapy where available.
The Canadian Association of Radiation Oncology (CARO) has set a target of 10 working days (14 calendar days) from the day of consultation or requisition to the start of radiation therapy for all cancer patients.554 This target is shown in the figures along with the national target of 28 days.
Wait times for radiation therapy
Median and 90th percentile radiation therapy wait time from ready-to-treat to start of radiation therapy, measured in days
The percentage of cases treated with radiation therapy within 4 weeks from ready-to-treat
The population includes prostate cancer cases (men aged 35 and older) receiving radiation therapy in 2013 that have wait time data collected.
Median wait time (days)
90th percentile wait time (days)
Percentage of patients starting treatment within target timeframe (4 weeks after being deemed ‘ready-to-treat’)
Numerator: Of the denominator, the total number of prostate cancer cases (men aged = 35) starting radiation therapy within 4 weeks of being ‘ready-to-treat’
Denominator: Total number of prostate cancer cases receiving radiation therapy within 2013
Data source: Provincial cancer agencies
Measurement timeframe: 2013 treatment year
Stratification variables: Province, risk category* (low, intermediate, high)
*Refer to ‘Age-standardized incidence rates by risk category’ under ‘2. Diagnosis’ section for detail.
Provinces submitting data: BC, AB, SK, MB, ON, NB, NS, PE, NL
Province specific notes: AB: For 2013, data included all cases who had radiation therapy at a Cancer Control Alberta Facility with their first treatment between Jan 1, 2013 – Dec 31, 2013; it includes those who were living in another province at time of diagnosis but receiving radiation therapy in Alberta. Tumor group classification for this indicator is based on referral tumor groups. Data by risk category were not available since risk category could not be assigned for more than 55% of patients. SK: For 2013, data were reported by treatment site, any RT treatment modality was included. NS: For 2013, wait time were computed using the same rules for producing wait time for NS Department of Health and Wellness. As such, wait time were based on patient first courses of treatment in the period of interest. Data by risk category were not available due to incomplete disease information for 2013 cases. PE: For 2013, data were based on new treatment starts within the timeframe of 2013. Individual cancer patients could have more than one treatment start in the timeframe and could therefore be counted more than once.
All behaviour codes are included.
Radiation therapy to the primary site only.
Disease Site and Morphology Codes: In order to identify prostate cancer, the provinces used whatever disease site and morphology codes they typically use within their provincial registry for reporting incident cases by disease site.
There are known discrepancies in the ways in which different provinces measure wait times. One of the key sources of variation is how “ready-to-treat” is defined. Efforts are underway to standardize these definitions. The following section outlines the definitions used by the different provinces, collected in 2013:
Provincial definitions: AB: The date when the patient is physically ready to commence treatment. BC: The date at which both oncologist and patient agree that treatment can commence. Being ready to treat requires that all diagnostic tests and procedures required to assess the appropriateness of, indications for, and fitness to undergo radiation therapy are complete. MB: The date when a decision has been made by the radiation oncologist and is agreed to by the patient that radiation therapy is appropriate and should commence AND the patient is medically ready to start treatment AND the patient is willing to start treatment. NB: The date when any planned delay is over and the patient is ready to begin treatment from both a social/personal and medical perspective. NL: The date when all pre-treatment investigations and any planned delay are over, and the patient is ready to begin the treatment process from both a social/ personal and medical perspective. NS: The date when all pre-treatment investigations and any planned delay are over, and the patient is ready to begin the treatment process from both asocial/personal and medical perspective. Nova Scotia did not have a ready to treat date until February 2010; a proxy date was used prior to this time. ON: The time from when the specialist is confident that the patient is ready to begin treatment to the time the patient receives treatment. PE: The date when all pre-treatment investigations and any planned delay are over, and the patient is ready to begin the treatment process from both a social/personal and medical perspective. QC: At consultation, the radiation oncologist enters the date at which the patient will be ready to treat on a formulary requesting treatment. SK: The date when the patient is ready to receive treatment, taking into account clinical factors and patient preference. In the case of radiation therapy, any preparatory activities (e.g., simulation, treatment planning, dental work) do not delay the ready to treat date.