Ontario needs to improve the way it cares for breast and colon cancer patients taking protective chemotherapy, nearly half of whom are making unplanned visits to overburdened emergency rooms, according to a new evaluation of cancer care in Canada's most populous province.
The Cancer System Quality Index, released Tuesday, shows that 46 per cent of colon cancer patients and 43 per cent of breast cancer patients who received chemotherapy after surgery turned to ERs at least once, an outcome that suggests oncologists and family doctors are not doing enough to help patients cope with the toxic side effects of their therapy.
Unplanned hospital visits are just one of the measures included in the annual report, which looks at Ontario's performance on every step of the cancer journey, from prevention and screening to end-of-life care. The report compares Ontario with a handful of other provinces and Western countries and finds it generally stacks up favourably, especially when it comes to caring for patients after they are diagnosed with the disease.
"In principle, we do well internationally and nationally. But the intent of the index itself is not necessarily to measure nationally or internationally, but rather to drive quality improvement in Ontario," said Virginia McLaughlin, chair of the Cancer Quality Council of Ontario, an arms-length body that advises Cancer Care Ontario and the Ministry of Health and Long-Term Care.
The index gives Ontario high marks for the effectiveness of its cancer system, meaning patients are receiving treatment based on the best possible evidence. The report also judged accessibility as "good."
But it awarded the system grades of "fair" for safety, responsiveness, equitability, integration and efficiency, lukewarm rankings that suggest there is room for improvement in battling the country's number one killer.
Preventing unplanned hospital visits is one place to start, said Michael Sherar, the CEO of Cancer Care Ontario, the provincial agency that co-ordinates cancer care.
"We feel that there is an opportunity for improvement here," he said. "These patients, some of them require hospitalization. They need to go to the emergency room. But we feel that number is too high currently. Many of these patients could be better managed through better supports for primary care."
The report looked specifically at breast and colon cancer patients taking adjuvant chemotherapy – a precautionary measure for people whose tumours have been removed before the cancer has spread – in 2012. The province now funds a suite of chemo drugs that are more effective but more toxic, leading some patients to race to the emergency room with worrying side effects like fevers and potential infections.
For example, of the 3,243 women receiving adjuvant chemotherapy for breast cancer in 2012, 1,387 or 43 per cent went to the emergency department at least once within four weeks of treatment; some went as many as five times.
The unplanned hospital visits measure has not improved since last year's report.
However, Dr. Sherar said Ontario is working to keep patients on chemo out of the emergency room by surveying them about their symptoms and supporting primary-care providers.
"We're now seeing evidence that when that information is collected … and when providers respond to that information about patient symptoms that the the number of visits to emergency rooms goes down and it goes down significantly," he said.
On the safety front, the report found that perforations during colonoscopies continue to decline, and that the percentage of cancer centres using automated chemotherapy ordering systems was expected to reach 90 per cent in 2013, up from 46 per cent in 2004.
Computerized ordering helps cut down on errors in delivering complex drug therapies, Dr. Sherar said. However, it was an unrelated shortcoming that led to last year's diluted chemotherapy scandal, in which more than 1,200 patients at four hospitals in Ontario and one in New Brunswick received lower-than-prescribed doses of two drugs commonly used to combat cancers of the breast and lymphatic system.
Dr. Sherar said "good progress is being made" on implementing the recommendations of last summer's investigation into the watered-down chemotherapy, which was a result of miscommunication between the company that premixed the drugs and the hospitals that administered it.