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2012 Cancer System Quality Index Erie St.

Clair (ESC) LHIN Performance Highlights

Performing Better than Ontario Average % of women aged 50 -69 who received a screening mammogram within a two year interval % of cancer surgery cases completed within Wait Time targets % of patients seeing a Systemic Oncologist within 14 days of referral % of cancer patients who were screened at least once per month for symptom severity (ESAS) % of patients who said their health care team took into account their ESAS scores % of pathology reports received in synoptic format

ESC LHIN (%) 69.2 85.0 60.1 76.6 94.9 93.0

Ontario (%) 66.8 78.2 44.6 50.5 91.4 87.9

Early detection of cancer by screening increases treatment options for patients and reduces death rates from the disease. ESC continues to implement multiple strategies aimed at increasing cancer screening rates and boasts one of the highest breast cancer screening rates in the province. ESC is one of five successful regions to pilot a focused initiative to improve screening rates among First Nations & Metis people living on and off reserve. Prolonged wait times cause considerable anxiety and frustration for patients and their families and may impact treatment outcomes. ESC has consistently maintained some of the shortest waits for cancer surgery and access to systemic treatment in the province. Patients identifying the severity of symptoms they are experiencing from either their disease or treatment, ensures their experience is quickly brought to the attention of care providers so strategies can be implemented to help them better manage their symptoms. Synoptic pathology reporting represents a significant pathology quality improvement with pathology reports now being submitted in a standardized electronic format. 1|Page

Performing the Same as the Ontario Average Estimated incidence age-standardized rates for female breast cancer Age standardized 5-year relative survival ratio for Colon and rectum cancer % aged 50 -74 completed a fecal occult blood test (FOBT) within a two year interval % of cancer patients who visited the emergency department in the last two weeks of life

ESC LHIN (%) 100.6 63.1 27.7 39.5

Ontario (%) 101.2 65.2 27.4 40.8

Providing opportunities for physicians across all disciplines to review cases and develop the best care plan for individual patients (Multidisciplinary Cancer Conferencing) along with adherence to evidence-based treatment guidelines improves patient survival rates. Even though colon cancer screening with the use of Fecal Occult Blood Test (FOBT) is comparable to the provincial performance, it remains far too low more than 70% of the eligible population is not being screened with a FOBT. There are several responsive regional strategies underway a key one being a Primary Care resource kit to support Primary Care providers as they work to have their patients participate in colon cancer screening. Early identification and control of patient pain and other symptoms may prevent their escalating to a crisis situation requiring an ED visit. Multiple provider education sessions have been held across ESC focusing on the implementation of Cancer Care Ontarios new pain & symptom management guidelines. The potential of a pain and symptom dedicated clinic for patients needing immediate help is also being explored. An enhanced Palliative Medicine program is working to improve the coordination of care and supporting resources for palliative patients within the community.

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Performing Worse than the Ontario Average Age standardized 5-year survival ratio for prostate cancer % of patients who had a colonoscopy within the 8 week benchmark after an abnormal FOBT % of women (aged 20 69) who had a Pap test within a three-year time interval % of women (aged 20 -69) with high grade abnormality on Pap test who received a colposcopy within 6 months after receiving an abnormal Pap test % of patients seeing a Radiation Oncologist within 14 days of referral

ESC LHIN (%) 94.1 67.4 67.5 75.9 46.3

Ontario (%) 97.4 73.0 72.4 83.3 71.1

A regional Prostate Diagnostic Assessment Program (DAP) has recently been implemented with a goal of early identification of patients at suspicion for prostate cancer so they can be assessed in a timely and coordinated fashion. Within the DAP is a unique shared Urologist and Oncologist clinic where patients receive information about their full scope of treatment options so they can make an informed decision about the care they wish to receive. With early diagnosis and treatment decisions, it is expected that survival rates will also be improved. Prompt follow up of abnormal screening results are critical to prevention of disease and early treatment interventions as needed. Screening programs have reduced impact if timely work up of abnormalities does not occur. Newly implemented Colorectal Diagnostic Assessment Programs will assist with data collection and process improvements for colorectal cancer. Radiation wait times have been aggressively attacked by the Cancer Program at Windsor Regional Hospital. Increased capacity and process improvements have been highly successful. Currently 96% of patients see a Radiation Oncologist within 14 days of being referred. This high performance has been sustained for 4 months across all disease sites.

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