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  • Cancer Control Domain
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  • Disease Site
    • Breast
      • Breast cancer screening
      • Screening in underserved populations
      • Breast cancer diagnosis wait time
      • Capture of stage
      • Stage distribution
      • Surgery
        • Breast cancer resections that are mastectomies
        • The use of breast-conserving surgery versus mastectomies for breast cancer resections
      • Radiation therapy
        • Post-operative radiation therapy for stage I or II breast cancer patients
      • Place of death
      • Adult clinical trial participation
      • Cancer research investment
      • Breast cancer screening outside recommended guidelines
      • Incidence and mortality rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Colorectal
      • Colorectal cancer screening
      • Geographic variation in colorectal cancer risk
      • Screening in underserved populations
      • Colorectal cancer diagnosis wait time
      • Capture of stage
      • Stage distribution
      • Surgery
        • Removal and examination of 12 or more lymph nodes in colon resections
        • Resection rates for stage II or III rectal cancer, stage III colon cancer and stage II or IIIA non-small cell lung cancer patients
      • Radiation therapy
        • Pre-operative radiation therapy for patients with stage II or III rectal cancer
      • Post-operative chemotherapy for stage III colon cancer patients
      • Place of death
      • Adult clinical trial participation
      • Cancer research investment
      • Incidence and mortality rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Lung
      • Capture of stage
      • Stage distribution
      • Geographic variation in lung cancer risk
      • Resection rates for stage II or IIIA Non-snmall cell lung cancer patients
      • Post-operative chemotherapy for stage II or IIIA non-small cell lung cancer patients
      • Place of death
      • Adult clinical trial participation
      • Cancer research investment
      • Incidence and mortality rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Prostate
      • PSA testing
      • Prostate risk profile
      • Capture of stage
      • Stage distribution
      • Prostate wait times for surgery
      • Prostate wait times for radiation therapy
      • Radical prostatectomy: open versus laparoscopic surgery
      • Prostate patterns of care: radiation and surgical treatment
      • Prostate access to palliative radiation
      • Prostate clinical trials participation
      • Adult clinical trial participation
      • Prostate cancer research investment
      • Cancer research investment
      • Incidence & Mortality Rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Cervical
      • Human papillomavirus (HPV) vaccination
      • Cervical cancer screening
      • Screening in underserved populations
    • Pancreas
      • Incidence and mortality rates
    • Stage Distribution
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  • 1. Prevention
  • 2. Screening
  • 3. Diagnosis
  • 4. Treatment
  • 5. Person-Centred Perspective
  • 6. Research
  • 7. Appropriateness
  • 8. Long-term outcomes
  • Smoking prevalence
  • Smoking behaviours in current cancer patients
  • Smoking cessation
  • Second-hand smoke exposure
  • Geographic variation in lung cancer risk
  • Alcohol consumption
  • Adult overweight and obesity
  • Active transportation
  • Physical inactivity
  • Human papillomavirus (HPV) vaccination
  • Fruit and vegetable consumption
  • Geographic variation in colorectal cancer risk
  • Cervical cancer screening
  • Breast cancer screening
  • Colorectal cancer screening
  • PSA testing
  • Screening in underserved populations
  • Breast cancer diagnosis wait times
  • Colorectal cancer diagnosis wait times
  • Capture of stage
  • Stage distribution
  • Prostate risk profile
  • Surgery
  • Radiation therapy
  • Systemic therapy
  • Removal and examination of 12 or more lymph nodes in colon resections
  • Resection rates for stage II or III rectal cancer, stage III colon cancer and stage II or IIIA non-small cell lung cancer patients
  • The use of breast-conserving surgery versus mastectomies for breast cancer resections
  • Breast cancer resections that are mastectomies
  • High-risk, resource-intensive surgeries for esophageal, pancreatic, liver, lung and ovarian cancers in Canada
  • Prostate wait times for surgery
  • Radical prostatectomy: open versus laparoscopic surgery
  • Radiation therapy wait times
  • Radiation therapy utilization and capacity
  • Pre-operative radiation therapy for patients with stage II or III rectal cancer
  • Post-operative radiation therapy for patients with stage I or II breast cancer
  • Prostate wait times for radiation therapy
  • Prostate patterns of care: radiation and surgical treatment
  • Post-operative chemotherapy for stage III colon cancer patients
  • Post-operative chemotherapy for patients with stage II or IIIA non-small cell lung cancer
  • Screening for distress
  • Patient satisfaction
  • Place of death
  • Prostate access to palliative radiation
  • Adult clinical trial participation
  • Prostate clinical trials participation
  • Pediatric clinical trial participation
  • Cancer research investment
  • Prostate cancer research investment
  • Breast cancer screening outside of guidelines
  • Breast cancer mastectomies done as day surgery
  • Intensive care use in the last two weeks of life
  • Breast cancer
  • Lung cancer
  • Colorectal cancer
  • Prostate cancer
  • Pancreatic cancer
  • Five-year net survival by income quintile for several cancers in Canada
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  • 5. Person-Centred Perspective
  • Screening for distress

Screening for distress

  • Charts and Tables

    Charts and Tables

    Table 5.1

    Current state of Patient Reported Outcomes implementation, by province, as of April 2017

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      Data Table

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    Province‡ Disease sites Data capture method Number of clinical sites using ESAS/number of sites providing cancer therapy Frequency of screening
    British Columbia — Paper (with electronic re-entry) 6/6 —
    Alberta All Paper (with electronic re-entry) 17/17 sites on paper (15/17 sites have electronic re-entry)
    • New patient oncology visit
    • Follow-up visits
    • Once per cycle of chemotherapy
    • Beginning, middle and end of radiation therapy
    Saskatchewan All Paper (with electronic re-entry) 18/18 (2 tertiary sites, 16 community oncology centres)
    • Once for every new patient at new patient consultation
    • Once for every patient referred to pain and symptom management clinic
    • Once for every radiation therapy patient while on radiation therapy
    Manitoba All but head & neck Paper (with electronic re-entry) 22 At every physician visit
    Ontario All except in-situ melanoma (malignant skin and malignant melanoma) Electronic (direct patient entry) 70/80 All visits
    Quebec All Electronic (direct patient entry) 2/92 At every physician visit
    New Brunswick  —  — — —
    Nova Scotia All Paper 9/11 Newly diagnosed patients and at specific transition points in cancer care
    Prince Edward Island All Paper 2/2
    • New patient oncology visits
    • Intravenous chemotherapy review appointments
    • End of treatment for all patients
    Newfoundland & Labrador  All Electronic (tertiary cancer treatment centre);
    paper (with electronic re-entry for all other clinics)
    13/17
    • New patient oncology visits
    • Some follow-up screening at identified points in treatment trajectory

    “—” Data not available

    ‡ All provinces that have implemented Patient Reported Outcomes tools (except BC) were a part of the Patient Reported Outcomes Initiative, led by the Canadian Partnership Against Cancer

    ESAS-r= Edmonton Symptom Assessment System – revised

    Data source: BC Cancer; Patient-Reported Outcomes Initiative Partners

    Figure 5.11

    Distribution of distress severity, by symptom, jurisdictions combined — October 2016–March 2017 

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    The percentage might not sum up to 100% due to rounding.

    BC, NB and NL were not included.

    Data source: Patient Reported Outcomes partners.

    Data Table

    SymptomLevel of distressNumber of cancer patientsProportion (%)Lower bound of 95% confidence intervalUpper bound of 95% confidence interval
    PainHigh level16,7686.06.06.1
    PainModerate level35,07712.612.512.8
    PainLow level87,88431.731.531.8
    PainNo symptoms137,88549.749.549.9
    FatigueHigh level33,91912.212.112.3
    FatigueModerate level62,28322.422.322.6
    FatigueLow level113,64740.940.741.1
    FatigueNo symptoms67,85224.424.324.6
    AnxietyHigh level18,5326.76.66.8
    AnxietyModerate level38,29213.813.713.9
    AnxietyLow level100,00336.135.936.2
    AnxietyNo symptoms120,55143.543.343.6
    DepressionHigh level13,2224.84.74.8
    DepressionModerate level30,11810.910.711.0
    DepressionLow level80,34529.028.829.1
    DepressionNo symptoms153,70355.455.255.6

    + Expand Table

    The percentage might not sum up to 100% due to rounding.

    BC, NB and NL were not included.

    Data source: Patient Reported Outcomes partners.

  • Data specifications

    Data specifications

    Definition: Proportion of patient self-assessments (ESAS-r) reporting no distress, low distress, moderate distress or high distress respectively by specific symptoms (i.e., pain, fatigue, anxiety and depression)

    Rationale for measurement: Routine screening of symptoms is important to identify cancer patients’ psychological, social, spiritual, practical or physical concerns that may negatively affect a person’s ability to cope with cancer and its treatment. One common self-report tool used to measure patient-reported outcomes is the Edmonton Symptom Assessment System (ESAS), which measures nine commonly reported symptoms (pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, lack of well-being and shortness of breath).

    Measurement timeframe: 1 October 2016 – 31 March 2017

    Denominator: Total number of questionnaires completed

    Numerator: Number of questionnaires reporting the level of distress by:

    • no distress
    • low
    • moderate
    • high level

    Exclusion criteria:

    1. Questionnaires with patients aged <18 were excluded
    2. Questionnaires with patients diagnosed with benign hematologic diseases were excluded
    3. Questionnaires with no response to each symptom and level of score were excluded respectively

    Data availability: AB, SK, MB, ON, QC, NS, PE

    Stratification: Data were pooled together by four symptoms of distress:

    • pain
    • fatigue
    • anxiety
    • depression

    Data source: Patient-Reported Outcome (PRO) Initiative partners

    Data retrieval date: October 2017

    Variables details: The questions on symptoms of distress varied by province. For each province, relevant questions were identified and included in the analysis.

    Notes from jurisdictions:

    • MB: Patients are screened for distress at every physician visit which includes new, on treatment and follow-up appointments. Inclusions: 1. Patient age ≥ 18 2. All cancers with the exception of Head and Neck cancer (including metastatic cases and benign hematological cases).
    • NS: We have defined Positive for Distress on this indicator as a score from 1-10 on the Distress Thermometer (DT). As noted above, 74.9% of patients who completed the DT from October 2016-March 2017, indicated some level of distress. We do not have the ability to report on this indicator (i.e., number of questionnaires positive for distress as defined by score of 1-10 for any symptom) on the ESAS-r at present. The denominator for this Indicator is different than the denominator for Indicator 2 because not all patients completed the Distress Thermometer on our Screening Tool (which consists of DT, CPC, and ESAS-r). There were 101 patients who completed the Screening Tool, but chose not to complete the Distress Thermometer item on the tool.
    • ON: All field on ESAS are mandatory using the ISAAC data capture system, so it is assumed that there are zero “no responses”. Any discrepancies are likely due to patients not completing all questions when completing ESAS via paper.

    Methodology notes:

    1. Data came from partners that participated in the Patient Reported Outcome (PRO) initiative survey
    2. Edmonton Symptom Assessment System-revised (ESAS-r), a self-assessment tool, was used to collect common symptoms in cancer patients during their treatment.
    3. Respondents scored the degree of symptoms using a scale of 0–10. These responses were grouped into four categories:
      • No distress: score 0
      • Low: scores 1–3
      • Moderate: scores 4–6
      • High: scores 7–10
    1. Each symptom has a  small number of no responses that are excluded: pain, 0.5%; fatigue, 0.4%; anxiety, 0.5%; depression, 0.5%.

    Changes to definition compared to previous years: Not applicable

  • Related indicators

    Related Indicators

    Patient satisfaction

    Percentage of patients reporting negative rating across dimensions of care and for overall quality of care, by province – from 2011 to 2013
    View this indicator
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