Instructions
Rollover the white buttons to reveal details of the patient journey.
Risk Factors and Prevention
Risk Factors
Age over 50, Family History, physical inactivity, and living with inflammatory bowel disease are all potential risk factors for colorectal cancer. 30% of our population is over age 50 and only half of adults in Ontario are active or moderately active.
Risk Factors and Prevention
Obesity
Too many people are obese – increasing the likelihood that they will get cancer.
Risk Factors and Prevention
Smoking
In 2005, the percent of adults who were current smokers decreased to 22%. Still a long way from the 5% Cancer 2020 target.
Screening
Fecal Occult Blood Test
The probability of curing this cancer is 90% when it is detected early. Fecal occult blood test (FOBT) is the recommended screening test for those who have average risk for colorectal cancer. In 2004-2005, the percent of the population screened with FOBT increased to 17%.
Screening
COLONOSCOPY
A positive FOBT test needs to be followed-up with a colonoscopy. A gastroenterologist (or other specialist) performs the colonoscopy and removes polyps or masses if present, then sends them to the lab to be analyzed.
In 2005/06, close to 300,000 colonoscopies were provided in Ontario, many of which were for colorectal cancer screening and surveillance. Over 20% of these colonoscopies involved the removal of a polyp.
Diagnosis
Pathology Reporting
Pathologists process the specimen to determine if it is cancerous and to help treatment planning.
Overall, 92% of cancer pathology reports include all of the information required by Ontario's new quality standards. This helps provide more accurate diagnosis and treatment.
Diagnosis
IMAGING
Part of the diagnostic period requires diagnostic scans such as x-ray, CT scan, and MRI. Images of these scans are read by radiologists and then sent to specialists to help plan treatment.
Diagnosis
STAGE CAPTURE
Determining the exact location, size, and spread of disease ("stage") of a patient’s cancer is essential for selecting the best treatment for that individual. However, only 33% of gastrointestinal cancers are being reported with stage data in Ontario.
It is recommend that, for adequate staging, at least 12 lymph nodes be removed and reported from patients having colon or rectum resection for cancer. 77% of colorectal cancer surgeries had 12 or more lymph nodes reported between September and October 2006. This is a statistically significant improvement from 70% in 2005.
Treatment
SURGERY
It is recommended that, for adequate staging, at least 12 lymph nodes be removed and reported from patients having colon or rectum resection for cancer. 77% of colorectal cancer surgeries had 12 or more lymph nodes reported between September and October 2006. This is a statistically significant improvement from 70% in 2005.
Surgical Wait Times: Surgery is most often the first point of entry into the cancer treatment system, so waits for surgery have an impact on the entire patient journey. About 80% of cancer patients will have surgery. 90% of gastrointestinal cancer patients receive their surgery in 47 days, well below the provincial target of 84 days.
Treatment
CHEMOTHERAPY
Chemotherapy Wait Times: Chemotherapy is an important part of cancer treatment as it slows or stops cancer cells from growing, multiplying or spreading to other parts of the body. For the past 3 years, half of colorectal patients waited less than five weeks from the time of their referral to a medical oncologist to the start of their treatment.
Drug Ordering: Errors can occur at any point from when a physician writes a prescription through to the pharmacist filling the order. Drug ordering software, that both alerts the physician or pharmacist to possible prescribing problems, and electronically transmits the order to a pharmacy, can prevent medical errors that can be associated with chemotherapy. There are plans to implement these Computerized Physician Order Entry systems at 3 new sites in 2007/08. This will result in a projected increase of 60% of chemotherapy drugs prescribed in Ontario being ordered electronically.
Treatment
RADIATION TREATMENT
Radiation treatment is an important part of cancer treatment, used to shrink a tumour, destroy cancer cells, or provide relief from cancer symptoms
Radiation treatment is usually only provided to rectal cancer patients. Half of these patients started their treatment within 30 days of their referral to a radiation oncologist. The provincial wait time has steadily improved over the past three years.
Treatment
PATIENT EXPERIENCE
Routinely monitoring patient satisfaction is essential to improving care and outcomes.
In 2006, over 70% of patients that reported mild to severe pain responded that staff did everything that they could to control their pain or discomfort.
Long-Term Survival / Monitoring and Follow-up
CANCER SURVIVAL
The proportion of colorectal patients alive five years after their diagnosis is approximately 60% and has improved from 54% 10 years ago.
Palliative End-of-life Care
END-OF-LIFE CARE
Understanding patterns in end-of-life care can provide valuable information about how patients dying of cancer are cared for in their last few months and also helps to make decisions about how healthcare should be structured to assist those in need of end-of-life care.
Research indicates that most patients prefer to die outside of hospital. The acute care setting is generally not designed to provide optimal palliative care for those dying of a terminal illness. However, the majority of patients who died of cancer, died in hospital.
