guideline concordance - PowerPoint PPT Presentation

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Use of Population Stage Data 2

ONTARIO 13 Million Larger than France and Spain Combined The Stage- Path Project provides a rich dataset of cancer information for Ontario

Stage Project goal is to expand to population based stage data capture Final 90% of all cancer cases are staged Target Target -- 74% stage capture (2009) Actual -- 47% stage capture (2008) -- 33% stage capture Baseline (2007) Ontario

90% of Ontario pathology reports completed in January 2011, were synoptic - January 2011 5 !

Stage Distribution, Breast, Colorectal, Lung, Prostate Cancer 2008

Indicators for screening

20% Colorectal Cancer IV

75% Lung Cancer III or IV

Indicators for resourses

Lung Cancer by Region The distribution of stage IV cancer ranges from 43% to 54%

Stage Distribution and Regional Variation • The health care needs of the region for treatment costs, palliative care costs may be higher in regions were there is more stage IV cancer than others

Indicators for resection rates by stage

Region Variation in treatment - Surgery

Region Variation in treatment - Surgery • The rate of surgical resection in non small cell lung cancer in Ontario varies from 13% to 28% • This could be explained by more early cases in the LHIN with the higher rate • Linking surgical treatment to stage show that in one region 54% of stage I patients have surgery compared to 78% in another LHIN • Other explanations must be looked for

Indicators of treatment rates by stage

The percentage of stage II and IIIA resected cell lung cancer treated with chemotherapy or radiation therapy or both

Regional Variation in Treatment Guideline Concordance • Ontario has a mature program in Evidence-Based Care • Adjuvant platinum based chemotherapy is recommended in completely resected stage II and III non small cell lung cancer • Compliance overall is 56% but varies from 32-66% • The reasons for this can be investigated and further physician education is required

Indicators of survival rates by stage

The one year relative survival by stage at diagnosis by LHIN and Ontario for non small cell lung cancer

Regional Variation in Survival • Survival by stage and region can be determined • One year survival in patients with stage IV cancer varies by region from 15%- 31% • Reasons for this require further investigation

Conclusions • Adding stage data to other data collected by a cancer program greatly enhances that data • It can be used to measure the effectiveness of screening programs, determine health care needs by region and determine variations in treatment practice • Further communication and investigation of data quality and clinical practice is needed to assist with better understanding the variations detected