Radiation Therapy Wait Times

  • Charts and Tables

    Charts and Tables

    Figure 4.10

    Median and 90th percentile wait times for radiation therapy, all cancers, by province — 2014 treatment year

    "–" Data not available.
    BC, AB: Brachytherapy was not included for 2014 treatment year but was included in the previous submissions.
    ON: Data include the percent of patients treated with radiation therapy within 14 days (CARO target) from February – December 2014.
    The CARO target is that 90% of patients receive radiation therapy within 14 days of being ready to treat.
    The Canadian Institute for Health Information defines ready-to-treat as the time when the referring physician makes the referral to start radiation therapy. Considerable effort has gone into developing and adopting standardized definitions for this term, but interprovincial variations may persist.
    Data source: Provincial cancer agencies.

    Data Table

    ProvinceMedian of wait time90th percentile of wait timeNumber of casesPercent below the target (%)Lower bound of 95% confidence intervalUpper bound of 95% confidence interval
    BC82211,13195.995.596.2
    AB7227,16496.696.297.0
    SK––––––
    MB7222,46099.999.7100.0
    ON–––90.0-–
    QC–––99.0-–
    NB7191,75697.096.297.8
    NS––––––
    PE142745092.289.894.6
    NL6201,37598.698.099.2

    "–" Data not available.
    BC, AB: Brachytherapy was not included for 2014 treatment year but was included in the previous submissions.
    ON: Data include the percent of patients treated with radiation therapy within 14 days (CARO target) from February – December 2014.
    The CARO target is that 90% of patients receive radiation therapy within 14 days of being ready to treat.
    The Canadian Institute for Health Information defines ready-to-treat as the time when the referring physician makes the referral to start radiation therapy. Considerable effort has gone into developing and adopting standardized definitions for this term, but interprovincial variations may persist.
    Data source: Provincial cancer agencies.

    Figure 4.11

    90th percentile wait times for radiation therapy, by disease site and by province — 2014 treatment year

    “—” Data not available.
    AB: Brachytherapy was not included for the 2014 treatment year but was included in previous years.
    The current national target is that 90% of patients receive radiation therapy within 28 days of being ready to treat.
    The CARO target is that 90% of patients receive radiation therapy within 14 days of being ready to treat.
    The Canadian Institute for Health Information defines ready-to-treat as the time when the referring physician makes the referral to start radiation therapy. Considerable effort has gone into developing and adopting standardized definitions for this term, but interprovincial variations may persist.
    Data source: Provincial cancer agencies.

    Data Table

    ProvinceDisease siteWait time (Days)Number of casesPercent below the target (%)Lower bound of 95% confidence intervalUpper bound of 95% confidence interval
    BCAll cancers2211,13195.995.596.2
    BCLung192,14697.997.498.5
    BCProstate261,34492.991.694.3
    BCColorectal2170897.396.198.4
    BCBreast212,82896.595.897.1
    ABAll cancers227,16496.696.297.0
    ABLung211,32697.396.498.1
    ABProstate2472694.292.595.8
    ABColorectal2444697.696.299.0
    ABBreast231,86696.495.697.3
    SKAll cancers–––––
    SKLung–––––
    SKProstate–––––
    SKColorectal–––––
    SKBreast–––––
    MBAll cancers222,46099.999.7100.0
    MBLung2332199.799.1100.0
    MBProstate2822599.698.7100.0
    MBColorectal21151100.0100.0100.0
    MBBreast22560100.0100.0100.0
    ONAll cancers–––––
    ONLung–––––
    ONProstate–––––
    ONColorectal–––––
    ONBreast–––––
    QCAll cancers–––––
    QCLung–––––
    QCProstate–––––
    QCColorectal–––––
    QCBreast–––––
    NBAll cancers191,75697.096.297.8
    NBLung1240598.597.499.7
    NBProstate3020588.784.792.8
    NBColorectal2110299.097.1100.0
    NBBreast1846696.995.398.4
    NSAll cancers–––––
    NSLung2648392.590.394.8
    NSProstate–––––
    NSColorectal2816991.487.395.4
    NSBreast–––––
    PEAll cancers2745092.289.894.6
    PELung–––––
    PEProstate–––––
    PEColorectal–––––
    PEBreast–––––
    NLAll cancers201,37598.698.099.2
    NLLung1825899.698.9100.0
    NLProstate2813992.788.596.8
    NLColorectal1410399.097.2100.0
    NLBreast2121898.296.499.9

    “—” Data not available.
    AB: Brachytherapy was not included for the 2014 treatment year but was included in previous years.
    The current national target is that 90% of patients receive radiation therapy within 28 days of being ready to treat.
    The CARO target is that 90% of patients receive radiation therapy within 14 days of being ready to treat.
    The Canadian Institute for Health Information defines ready-to-treat as the time when the referring physician makes the referral to start radiation therapy. Considerable effort has gone into developing and adopting standardized definitions for this term, but interprovincial variations may persist.
    Data source: Provincial cancer agencies.

  • About this indicator

    About this indicator

    Key message

    Over 90% of cancer patients started radiation therapy within the national wait time target of 28 days from ready-to-treat.

    Indicator definition

    The median and 90th percentile radiation therapy wait times from ready-to-treat to start of radiation for patients treated for all types of cancer and for the four most common cancers in 2014. Results are presented by province and disease site.

    Target

    The national wait time target is that 90% of patients should receive radiation therapy within 28 days of being ready to treat.

    The Canadian Association of Radiation Oncologists (CARO) wait time target is that patients should receive radiation therapy within 14 days of being ready to treat.

    Measured since

    The 2009 Cancer System Performance Report.

    Why measure this?

    Timely access to radiation therapy is a key component of a high-quality cancer control system; it can reduce anxiety for patients and their families and ensure prompt treatment for patients who need it. Reducing radiation therapy wait times is a national health care priority.1 A national wait time target has been set and provincial initiatives have been implemented to reduce wait times. Reporting on radiation therapy wait times is an important step to understanding the health care system’s ability to meet the needs of patients with cancer.

    What are the key findings?

    • In the 2014 treatment year, 90th percentile radiation therapy wait times ranged from 19 days in New Brunswick to 27 days in Prince Edward Island. All six reporting provinces achieved the target of 90% of patients treated within 28 days of being ready to treat (Feature 4.10).
    • The percentage of cancer patients treated within the wait time target ranged from 92.2% in Prince Edward Island to 99.9% in Manitoba (Feature 4.10).
    • The 90th percentile wait time decreased slightly in four of the six reporting provinces (British Columbia, New Brunswick, Prince Edward Island and Newfoundland and Labrador) from 2013 to 2014 (data not shown).
    • Of the four most common disease sites—breast, colorectal, lung and prostate—prostate cancer patients continue to have the longest 90th percentile radiation therapy wait times, ranging from 24 days in Alberta to 30 days in New Brunswick (Feature 4.11). However, compared with 2013, radiation therapy wait times for prostate cancer are improving in four of the five provinces that reported data (data not shown).

    Why do these findings matter?

    All reporting provinces achieved the national target of 90% of patients receiving radiation therapy within 28 days of being ready to treat. Ensuring patients receive timely access to radiation therapy has positive implications for patient experience, such as reduced anxiety. Patients with prostate cancer continue to wait slightly longer for radiation therapy than patients with breast, colorectal or lung cancer. It is important to note that longer wait times for prostate cancer may be expected given the nature of the disease. Many prostate cancers are slow growing, so treatment may be considered less urgent for prostate cancer than for other cancers.

    References

    1. Health Canada. A 10-Year Plan to Strengthen Health Care [Internet]. Ottawa (ON): Health Canada; 2004 [updated 2006 Sep 5; cited 2015 Dec 10]. Available from: http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2004-fmm-rpm/bg-fi-eng.php.

     

  • Data specifications

    Data specifications

    Definition:

    1. The median and 90th percentile radiation therapy wait time (days) from ready-to-treat to start of radiation for patients treated for all types of cancer and for the four most common cancers.
    2. The percentage of radiation therapy cases for which the above wait time was within target timeframes

    Population: All cancer patients receiving radiation therapy in 2014 who have wait time data collected as consistent with the specifications of this indicator.

    Data source: Provincial cancer agencies

    Measurement timeframe: 2014 treatment year

    Stratification variables: Province, disease site (all cancers, breast, colorectal, lung, prostate)

    Provinces submitting data: BC, AB, MB, ON, QC, NB, NS, PE, NL

    Province specific notes:

    • BC: Brachytherapy was not included.
    • AB: data include all cases who had radiation therapy at a Cancer Control Alberta Facility with their first treatment between January 2, 2014 – December 31, 2014; 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. Brachytherapy was not included.
    • ON: Only provided the percentage of radiation therapy cases for which the wait time was within target < 14 days from February to December 2014. QC: Only provided the percentage of radiation therapy cases for which the wait time was within target timeframes.
    • NS: Patients with more than one treated disease may have contributed to more than one wait time. Procedures around specifying ready-to-treat date have not accurately captured the relevant date for prostate and breast patients, so the wait times for these two cancers are not reported.
    • PE: Could not provide site-specific wait times.

    Provincial definitions of “Ready to Treat”:

    • 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.
    • AB: The date when the patient is physically ready to commence 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.
    • 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.
    • ON: The time from when the specialist is confident that the patient is ready to begin treatment to the time the patient receives treatment.
    • QC: At consultation, the radiation oncologist enters the date at which the patient will be ready to treat on a formulary requesting 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.
    • 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.
    • 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.
    • 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.

    Notes:

    1. All behavior codes are included.
    2. To identify breast, colorectal, lung, prostate cancer and all cancers, provinces included the morphology codes that are used within their registry.
    3. Only cases with external beam radiation therapy (EBRT) done in 2014 are included.
    4. Of note for breast cancer data, if the province obtains this data from a wait time database as opposed to a registry, then breast cancer cases were to be included per the database definition.
    5. There are known discrepancies in the ways in which different provinces measure wait times. One of the key sources of variation is the way the “ready-to-treat” timeframe is defined. Efforts are underway to standardize these definitions. The following section outlines the definitions used by the different provinces.
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