How different is cancer control across Canada? Comparing performance indicators for prevention, screening, diagnosis, and treatment

Abstract

Meaningful performance measures are an important part of the toolkit for health system improvement. The Canadian Partnership Against Cancer has been reporting on pan-Canadian cancer system performance indicators since 2009-work that has led to the availability of standardized measures that can help to shed light on the extent of variation and opportunities for quality improvement across the country. Those measures include a core set of system indicators ranging from prevention and screening, through diagnosis and treatment, to survivorship and end-of-life care. Key indicators were calculated and graphed, showing the range from worst to best result for the provinces and territories included in the data. There were often significant differences in cancer system performance between provinces and territories. For example, smoking prevalence rates ranged from 14% to 62%. The 90th percentile wait times from an abnormal breast screen to resolution (without biopsy) ranged from 4 weeks to 8 weeks. The percentage of breast cancer resections that used breast-conserving surgery rather than mastectomy ranged from 38% to 75%. Clinical trial participation rates for adults ranged from 0.2% to 6.6%. Variations in performance indicators between Canadian jurisdictions suggest potential differences in the planning and delivery of cancer control services and in clinical practice patterns and patient outcomes. Understanding sources of variation can help to identify opportunities for improvements in the quality and outcomes of cancer control service delivery in each province and territory.

Keywords: Performance indicators.

FIGURE 1

Percentage of the population 12 or more years of age reporting daily or occasional smoking, 2014 reporting year. Source: Statistics Canada, Canadian Community Health Survey.

FIGURE 2

Percentage of the population 50–74 years of age who reported having had any or all of a fecal test in the preceding 2 years or sigmoidoscopy or colonoscopy in the preceding 5 years for any reason, 2014 reporting year. Source: Statistics Canada, Canadian Community Health Survey.

FIGURE 3

Median and 90th percentile wait times for resolution of an abnormal breast screen without tissue biopsy for asymptomatic women 50–69 years of age, 2013 screening year. Source: provincial breast cancer screening programs.

FIGURE 4

90th percentile wait times from ready to treat to start of radiation therapy, 2014 treatment year. Source: provincial cancer agencies and programs.

FIGURE 5

Percentage of colon resections with 12 or more lymph nodes removed and examined, 2009–2012 diagnosis years. Source: provincial cancer agencies and programs.

FIGURE 6

Percentage of breast cancer resections that were breast-conserving surgeries, 2009–2010 to 2013–2014 fiscal years combined. Source: Canadian Institute for Health Information, Discharge Abstract Database.

FIGURE 7

Percentage of breast cancer mastectomies performed as day surgery, 2008–2009 to 2013–2014 fiscal years combined. Source: Canadian Institute for Health Information, Discharge Abstract Database.

FIGURE 8

Ratio of adult patients enrolled in clinical trials to number of incident cases, by province, 2014 enrolment year. Source: provincial cancer agencies and programs.

FIGURE 9

Percentage of patients reporting negative rating for emotional support in the ambulatory oncology patient satisfaction survey (2011 to 2015) Source: Ambulatory Oncology Patient Satisfaction Survey