Key findings
More than three quarters of cancer patients in Ontario who have thoracic (lung and esophageal) surgery receive care at a designated centre. The percentage has increased in the past year.
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Goal |
As of this report |
| Thoracic surgery standards |
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What are thoracic cancer surgery and the thoracic cancer surgery standards?
Lung cancer is treated with a lung resection - a surgical procedure to remove a damaged or diseased portion of a lung (lobectomy), or a whole lung (pneumonectomy). Thoracic surgery is very complex, with successful outcomes linked to the number of surgeries performed as well as to surgical training and hospital resources. This indicator reports on the percentage of thoracic surgeries in Ontario that are performed in a hospital that is designated as a thoracic centre by the Regional Cancer Program.
What is a designated centre?
A designated centre is a hospital that either meets or is committed to meeting the requirements set out in the thoracic cancer surgery standards. A centre can be designated as level 1 or level 2 depending on the number of surgeries performed (level 2 centres are in Thunder Bay and Kingston only).
What’s new this year?
This report presents new data for 2007-2008.
 Figure 1: Percentage of thoracic (lung and esophageal) surgeries performed in designated thoracic surgery centres, Ontario, April 1 2006 to March 31, 2008
 Figure 2: Percentage of thoracic cancer surgeries performed in a designated centre, by LHIN, April 2007 to March 2008
 Figure 3: Number of lung cancer surgeries performed, by hospital, 2006-2007 and 2007-2008
 Figure 4: Number of esophageal cancer surgeries by hospital, 2006-2007 and 2007-2008
 Figure 5: Designated thoracic surgery facilities in Ontario
What do the results show?
The number of thoracic cancer surgeries being performed in designated centres is increasing
The percentage of esophageal cancer surgeries performed in a designated thoracic surgery centre has increased from 79% in 2006-2007 to 82% in 2007-2008, an increase of 3%.
The percentage of lung cancer surgeries performed in a designated thoracic surgery centre has increased from 77% in 2006-2007 to 78% in 2007-2008, an increase of 1%.
These increases represent an exciting trend toward having all thoracic cancer surgeries performed in a designated thoracic surgery centre.
Most thoracic cancer surgeries are performed in designated centres
Overall, 78% of thoracic operations in Ontario were completed at a designated centre that either meets or is committed to meeting the requirements set out in the provincial standards. The rate is slightly higher for esophageal surgeries than for lung surgeries (Figure 2).
Designation status varies across the province
The Thoracic Surgery Oncology Standards, details the best system for delivering cancer-related thoracic surgery in Ontario. The recommendations are based on evidence and expert consensus and include surgeon criteria, hospital criteria and expected minimum number of surgeries performed. (See Thoracic Surgical Oncology Standards)
The criteria include:
- Number of surgical procedures – A level 1 centre should perform at least 150 lung cancer operations and at least 20 esophageal cancer surgeries, while a level 2 centre should perform at least 50 lung and at least 7 esophageal cancer surgeries.
- Surgeons should have advanced training in thoracic surgery.
- To provide the best care, hospitals must have the necessary physical resources, human resources and an affiliation with a Regional Cancer Program.
Five level 1 and two level 2 centres are currently meeting volume requirements for the standards (Figure 3). Cancer Care Ontario is working with the remaining designated centres to help them reach the threshold volumes (minimum number of surgeries). Although the percentage of thoracic surgeries performed in a non-designated centre has decreased in 2007-2008, the number of lung surgeries performed at non-designated centres has increased to 505 in the past year. This is coincident with an overall increase in lung cancer surgery. On the other side, the number of esophageal surgeries has decreased at non-designated centres. This decrease is especially pronounced for a number of hospitals that had low esophageal surgical volumes in 2006-2007 and are no longer performing the surgery in 2007-2008 (Figure 4). In total, there are 14 designated thoracic surgery hospitals across the province (Figure 5).
Why is this important to patient care?
Evidence and expert consensus point to need for a standard
More people die from lung cancer each year than from breast, prostate and colorectal cancer combined 1. In 2005, Cancer Care Ontario released the Thoracic Surgical Oncology Standards, which detail the best system for delivering cancer-related thoracic surgery in Ontario. The standards are based on evidence and expert consensus, and include surgeon criteria, hospital criteria and expected minimum number of surgeries performed.
Higher volumes of thoracic cancer surgery improve outcomes
There is a consistent relationship reported in the literature between the number of thoracic surgeries performed in a center and improved patient outcomes 2. As a result, Cancer Care Ontario is working with its regional partners to centralize thoracic surgeries in those centres that meet the minimum surgical volumes and other requirements of the standards. While access to care close to home is important for patients, this must be balanced by the need for high-quality and expert care.
How does Ontario compare?
There are no current comparable data from other jurisdictions.
What is being done?
Implementing the Thoracic Surgical Oncology Standards
Cancer Care Ontario is working with Regional Cancer Programs, thoracic surgeons, hospitals and Local Health Integration Network (LHIN) CEOs to implement the thoracic surgery standards across Ontario.
Embracing the thoracic surgery standards in hospitals
Hospitals receiving additional funds to carry out cancer operations under the Wait Time Strategy have agreed to be accountable for quality and reporting standards as part of the Cancer Surgery Agreement. This includes the implementation of the thoracic surgery standards.
Designated centres to work with each other
It is required that level 2 centres have a formal relationship with a level 1 centre to which a thoracic surgeon may refer complex cases. The North Simcoe Muskoka LHIN is partnering with a level 1 centre outside of the LHIN as there are not enough volumes for a level 1 centre in the LHIN.
Linking adherence to the thoracic surgery standards to outcomes
Implementation of the thoracic surgery standards is aimed at improving patient safety and outcomes, including lower death rates. Post-surgical mortality (deaths after surgery) is reported every two years in the CSQI. See 2008 report Deaths Following Cancer Surgery. In future CSQIs, patient outcomes following the implementation of the thoracic surgery standards will be reported.
Notes
1 Quan ML, Hodgson N, Przybysz R, Gunraj N, Schultz SE, Baxter N, Urbach DR, Simunovic M. Surgery for Breast Cancer. In: Urbach DR, Simunovic M & Schultz SE, editors. Cancer Surgeryin Ontario: ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences, 2008.
2 Sundaresan S, Langer B, Oliver T, Schwartz F, Brouwers M, Stern H and the Expert Panel on Thoracic Surgical Oncology. Standards for Thoracic Surgical Oncology in a Single-Payer Healthcare System. Annals of Thoracic Surgery 8, 693-701.
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