A1 – Surgical wait times for cancer patients

Key Messages

•   Rossy Cancer Network (RCN) partner hospitals perform below the provincial target for surgical wait time.

•   Not all hospitals perform surgeries for all cancers. Lung cancer patients are operated on uniquely at the MUHC and prostate cancer patients can be operated on at the MUHC or JGH. Breast and colorectal cancer surgeries are performed at all three RCN partner hospitals.

•   Of the three RCN  partner hospitals, SMHC is closest to achieving provincial targets, with 79% of cancer patients having their cancer surgery performed within 28 days of surgery request in 2017-2018. This hospital also performs significantly less cancer surgery than the MUHC and JGH.  

•   The surgical wait time is longest for more indolent (slow-growing) cancers such as prostate cancer. At the MUHC and the JGH,  20% and 12% of prostate cancer patients have their surgery performed within 28 days of request. 

Background

Surgical delays can affect outcomes and can cause anxiety for the patient.

For system managers and healthcare planners, having reliable surgical wait times data is crucial for assessing system capacity and demand, and for managing the use of resources.

Surgical wait time is measured by tracking the time the patient waits for a surgical procedure after they have met with their surgeon and the decision to perform surgery has been made. It is calculated from the time the procedure is requested by the surgeon to the time surgery is performed. If another treatment is initiated before the surgery, the delay excludes this period.

The Quebec government target for surgical wait time for patients with cancer is that 90% of patients should have their surgery performed within 28 days of the surgeon requesting the surgery, no matter what the severity of the disease or the level of priority of the surgery, and that 100% of patients should have their surgery within 56 days of the request.

Charts + Tables

What Do the Results Mean?

RCN partner hospitals are below the provincial target for surgical wait time, similar to other centers in the Montreal region.¹ Of the three RCN partner hospitals, SMHC is closest to achieving provincial targets, with 79% of cancer patients having their cancer surgery performed within 28 days of surgery request in 2017-18. SMHC has smaller surgical volumes when compared to the MUHC and JGH and does not perform all types of cancer surgery, including that for prostate and lung cancers.

Differences in surgical wait times across the partner institutions of the RCN are also seen by tumour type. Neither the JGH nor the MUHC meet the target of 90% of patients having their surgery performed in 28 days for the four most common cancers. Improvements in delays are noted for breast and colorectal cancer surgeries at the JGH in 2017-18.

Differences in wait times can be explained by many factors, including:

• The total surgical volume of the hospital
• Surgeon-specific delays related to volume of referrals and how operating room time is allocated within their hospital
• The allocated funding for operating rooms, support staff and recovery beds
• Efficiency of operating room processes

Surgeons also prioritize their cases depending on the cancer type. Some cancers are more indolent (slow-growing) and do not require immediate treatment. Thyroid cancer and most cases of prostate cancer are examples of slow-growing tumours. Other cancers are more aggressive and will have greater priority.

Across the RCN, the surgical wait time is longest for prostate cancer. At the MUHC and the JGH, 35% and 14% of prostate cancer patients respectively have their surgery performed within 28 days of request. Because of the slow-growing nature of localized prostate cancer, prostate cancer surgeries tend to be booked further out. While there is no Canadian target for cancer surgical wait times, other provinces have set different priority levels depending on the urgency of the surgery.2 In Ontario, the recommended maximum wait time for patients diagnosed with slow-growing malignancies, such as low risk prostate cancer is ≤ 90 days, for intermediate risk prostate cancer it is ≤ 60 days and for high risk prostate cancer, it is ≤ 28 days.² 

Efforts in this Area

Improving surgical delays for cancer patients is a priority of the RCN partner hospitals and of the Ministry of Health and Social Services. Active steps have been taken in the current year to reduce surgical wait time. It is expected that both the MUHC and JGH will be closer to achieving provincial targets in the next report.

Within the RCN, we continue to:

• refine and apply priority standards for surgical treatment
• contribute to discussions regarding the allocation of resources for cancer surgeries
• monitor the impact of additional funding support both overall and on high priority surgeries.

This information helps us to prioritize improvement efforts.

Notes