Prostate wait times for radiation therapy

Data and measurement considerations

• 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 90^th 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 90^th 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

• Definition:
  1. Median and 90^th percentile radiation therapy wait time from ready-to-treat to start of radiation therapy, measured in days
  2. 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.

• Measures:
  1. Wait time
     1. Median wait time (days)
     2. 90^th percentile wait time (days)
  2. 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.
• General notes:
  1. All behaviour codes are included.
  2. Radiation therapy to the primary site only.
  3. 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.
  4. 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.