[State of knowledge: approach to managing access to cancer care: a review of the literature and practices]

Arsenault D, Boily G
Record ID 32018000979
Original Title: État des connaissances: modalité de gestion de l'accès aux soins en cancérologie: revue de la littérature et des pratiques
Authors' objectives: In 2012, the Ministère de la Santé et des Services sociaux established two cancer surgery access targets. These targets are independent of tumour site and disease severity: 90% of patients requiring oncologic surgery for suspected or confirmed cancer are to be operated on within 28 days or less (calendar days); 100% of these patients are to be operated on within 56 days or less (calendar days), and no patient is to wait for more than 56 days (calendar days). As at the end of period 5 of the year 2017-2018, the 28-day target had been achieved for 68.2% of patients, while the 56-day target had been achieved for 92.9% of cases. It was observed that some of the patients who were operated on after longer waits had less aggressive cancers. It was suggested that, for certain types of cancer, surgery could be delayed without adversely affecting patient survival. The Direction générale de cancérologie asked INESSS if it would be appropriate to institute maximum initial cancer treatment wait times that would be adjusted according to the tumour site. INESSS was also asked to conduct a review of practices at the national and international levels regarding standards for access to cancer treatment (surgery, radiotherapy and chemotherapy).
Authors' results and conclusions: RESULTS (IMPACT OF CANCER TREATMENT WAIT TIMES ON CLINICAL OUTCOMES BY TUMOUR SITE) Ontario and Saskatchewan have published reports on instituting tumour site-based standards for access to cancer surgery. Both of these Canadian provinces concluded that acceptable maximum tumour site-based cancer surgery wait times could not be determined because of the lack of evidence and the weakness of the scientific literature. An update of the scientific literature based on systematic and narrative reviews enabled us to identify the methodological limitations of the primary studies included in the reviews that make it difficult to interpret the results. The conclusions are contradictory and do not show a relationship between cancer treatment wait times and the risk of death. It is not possible to define a maximum wait time that needs to be respected so as not to cause any harm to cancer patients. (STANDARDS FOR ACCESS TO INITIAL CANCER TREATMENT) The standards for access to initial cancer treatment reported in the literature can be described in terms of four components: the indicator, the target population, the maximum wait time and the access target (%). The indicator is used to define the interval between two time points during the care trajectory. It varies according to the country or province. Two main categories of standards for access to initial cancer treatment were identified both at the Canadian and international levels. One category, without prioritization, is intended for an entire population regardless of disease severity. A second category, with prioritization, is intended for patient populations classified according to disease severity and the degree of treatment urgency. An complementary category involves standards for access to treatment in the form of clinical pathways that are specific to certain types of cancer. Time limits are proposed for each stage of patient management. (DESCRIPTION OF THE STANDARDS FOR ACCESS TO CANCER TREATMENT IN CANADA AND OTHER COUNTRIES) The examination of the available evidence showed that the standards for access to initial treatment instituted by the different government bodies are heterogeneous. Each province and country has adopted its own standards for access to cancer treatment. For the government bodies that have opted for access standards without prioritization, the maximum wait times established vary and are based mainly on expert opinions and recommendations. Certain countries and provinces have set access targets, an access target being a minimum percentage of patients who are to be treated within the prescribed time limit, which gives the medical team a certain amount of leeway for assessing the priority of a given case. A non-priority case might not be treated within the maximum wait time in order to give priority access to cases deemed urgent. For countries and provinces that have instituted standards with prioritization, the priority levels vary and are determined according to the medical team's judgment. Certain countries and provinces have defined clinical pathways specific to certain types of cancer in order to facilitate access to care and to ensure that patients are managed within an acceptable timeframe. Clinical pathways are based in part on clinical practice guidelines. However, few practice guidelines contain recommendations for maximum initial treatment wait times. CONCLUSION: It is important to implement strategies for ensuring access to cancer treatment within a reasonable timeframe. Because of the disparities between and the poor quality of the available studies, it is difficult to determine maximum tumour site-based wait times. Other strategies for managing access to cancer treatment have been developed. The review of the systems used by the different government bodies led to the identification of four components that need to be defined in order to establish standards for access to initial treatment: the indicator (or the measured time interval), the target population (with or without prioritization), the maximum wait time and the access target. However, because of the lack of uniformity in the definitions of indicators and the variability in the recommended maximum wait times, which are based on expert consensus, it cannot be shown that any particular system is superior.
Authors' methods: To determine the relevance of establishing tumour site-based initial cancer treatment wait times, we conducted a structured search of the scientific literature. The documentation sought included systematic reviews and narrative reviews concerning the impact of initial cancer treatment wait times on patient survival or progression towards more advanced stages. It also included health technology assessment reports, practice guidelines, and reports from government and parapublic bodies on indicators, targets and prioritization systems for initial cancer treatment wait times.
Project Status: Completed
Year Published: 2019
Requestor: Minister of Health
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Neoplasms
  • Time Factors
  • Waiting Lists
  • Time-to-Treatment
  • Patient Care Management
  • Referral and Consultation
  • Health Services Accessibility
  • Cancer treatment
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.