The 2015 Cancer System Performance Report

(1)

The 2015 Cancer System

Performance Report

June 2015

(2)

1.

Prevention

Smoking

prevalence

Definition:Percentageofpopulationaged12yearsandolderineachspecifiedgroup–daily,occasional, formerorneversmokers

Numerator:Numberofdaily,occasional,former,orneversmokers,aged12yearsandolder

Denominator:Totalpopulationaged12yearsandolder

DataSource:CanadianCommunityHealthSurvey

Measurementtimeframe:2013

CCHSvariables:1.Inyourlifetime,haveyousmokedatotalof100ormorecigarettes(about4packs)? 2.Haveyoueversmokedawholecigarette?3.Atthepresenttime,doyousmokecigarettesdaily, occasionallyornotatall? 4.Haveyoueversmokedcigarettesdaily?

Stratificationvariables:Province/territory,Sex

Provinces/territorieswithdataavailable:AB,BC,MB,NB,NL,NS,NT,ON,PE,QC,SK,NU,YT

Notes:CCHSdataarebasedonarepresentativesamplewhichisthenextrapolatedtotheoverall population.

Human

papillomavirus

(HPV)

vaccination

Definition:Theproportionoffemalesinthetargetedcohorttoreceivethefirstof3dosesoftheHPV vaccination

Numerator:NumberoffemaleswhohavereceivedthefirstdoseoftheHPVvaccinationthroughthe provincially/territoriallyorganizedprogram

Denominator:Numberoffemalesinthetargetgrade/agegroupinschoolswheretheprovincialHPV vaccinationprogramhasbeenoffered.Itdoesnotnecessarilyrepresenttheentirefemalepopulation withinthetargetagerangefortheprovince.

DataSource:Pan‐CanadianCervicalScreeningNetwork,PrinceEdwardIslandChiefPublicHealth Office

Measurementtimeframe:2012/2013or2013/2014schoolyear,dependingontheprovinceandas indicatedinTable1.1(approximatelySeptember1sttoAugust31st)

Stratificationvariables:Province/territory

Provincespecificnotes:NB:Dataarefor3rddoseofHPVvaccine.NT:Datareportedarebasedon estimates.ON:Dataarefor3rddoseofHPVvaccine.PE:Dataarefor3rddoseofHPVvaccine.

Generalnotes:1.Thetargetgradeandagegroupvariesbyprovince/territory;2.Itwasnotpossibleto collectstandardizeddatafromallprovincesandterritories.Provincialandterritorialprogramshave differenttargetpopulations,implementationplansandphasesforvaccination.Withbettercollection ofstandardizeddataandcontinuedroll‐outofHPVvaccination,itisexpectedthatthepercentages willincreaseandinter‐provincial/territorialvariationwilldecrease.

Physical

activity ‐

Active

transportation

Definition:Percentageofadultsaged18andolderwhoreportengaginginphysicalactivityaspartof transportationinthepast3months

Numerator:Numberofindividualsaged18andolderwhowalk/biketoschoolorworkinthepast3 months

(3)

DataSource:CanadianCommunityHealthSurvey

CCHSvariables:1.Wasthereanytime*inthepast3monthswhenyouwalkedtoandfromworkor school?2. Wasthereanytime*inthepast3monthswhenyoubikedtoandfromworkorschool?

*Forthosewhoansweredyestowalkingorbikingforleisure,thebeginningofthequestionswere phrasedasfollows:1.Otherthanthe(X)timesyoualreadyreportedwalkingforexercisewasthereany othertime…";2.Otherthanthe(X)timesyoualreadyreportedbicyclingwasthereanyothertime…”

Stratificationvariables:Province/territory,agegroup

Notes:CCHSdataarebasedonarepresentativesamplewhichisthenextrapolatedtotheoverall population.

(4)

2.

Screening

Cervical

cancer

screening:

self‐reported

Definition:Age‐standardized(2011standardpopulation)percentageofwomenaged18–69whohadat leastonePapanicolau(Pap)smearinthepast3years

Numerator:Totalnumberofwomenaged18–69reportinghavinghadatleastonePaptestinthepast3 years

Denominator:Totalnumberofwomenaged18–69(excludingwomenwhohavehadahysterectomy)

Datasource:CanadianCommunityHealthSurvey

Measurementtimeframe:2012,2013

CCHSvariables:1.HaveyoueverhadaPAPsmeartest?2.Whenwasthelasttime?3.Haveyouhada hysterectomy?

Stratificationvariables:Province/territory,householdincome,immigrationstatus

Provinces/territorieswithdataavailable:Allfor2012;NB,PE,NL,YT,NT,NUfor2013

Notes:1.CCHSdataisbasedonarepresentativesamplewhichisthenextrapolatedtotheoverall population.2.CervicalcancerscreeningwasoptionalcontentinCCHS2013.

Breast

cancer

screening:

self‐reported

Definition:Percentageofasymptomaticfemalesaged50‐69receivingamammogramwithinthepast 2years,whereasymptomaticisdefinedasrespondentswhoindicatedgoingforamammogramfor anyofthefollowingreasons:1.Familyhistory;Routinescreen/check‐up;2.Age;3.Hormone replacementtherapy(HRT).Mammogramsreceivedforanyofthefollowingreasonswereexcluded: lump;breastproblem;follow‐uptobreastcancertreatment;other.

Numerator:Asymptomaticfemalesaged50 ‐69whoindicatedgoingforamammogramwithinthe past2years

Denominator:Totalnumberofasymptomaticfemalesaged50 ‐69

CCHSvariables:1.Haveyoueverhadamammogramthatis,abreastx‐ray?2.Whydidyouhaveit? (markallthatapply):familyhistory;partofregularcheck‐up/routinescreening;age;HRT;lump;follow‐

uptobreastcancertreatment;breastproblem;other;3.Whenwasthelasttime?

Stratificationvariables:Province/territory,householdincomequintile,immigrantstatus

Provinces/territorieswithdataavailable:Allprovincesandterritoriesfor2012;AB,NB,NS,NTfor 2013.

Notes:1.CCHSdataisbasedonarepresentativesamplewhichisthenextrapolatedtotheoverall population.2.BreastcancerscreeningwasoptionalcontentinCCHS2013.

Colorectal

cancer

screening:

self‐reported

Definition:Percentageofasymptomaticindividualsaged50 ‐74whoareup‐to‐datewiththeir

colorectalcancerscreening.Up‐to‐dateisdefinedashavinghadascreeningfecaltest(FOBT)inthepast 2yearsand/orsigmoidoscopy/colonoscopyinthepast5years,andasymptomaticisdefinedas

respondentswhoreportedhavingaCRCscreeningtestforanyofthefollowingreasons: familyhistory; regularcheck‐up/routinescreening;age;race.Colorectalscreeningreceivedforanyofthefollowing reasonswereexcluded:follow‐upofproblem;follow‐upofcolorectalcancertreatment;other.

(5)

Numerator:Numberofasymptomaticindividualsaged50 ‐74reportinghavinghadanFOBTwithinthe past2yearsand/oracolonoscopy/sigmoidoscopywithinthepast5years

Denominator:Totalnumberofasymptomaticindividualsaged50 ‐74

CCHSvariables:1.HaveyoueverhadanFOBTtest?Whenwasthelasttime?Whydidyouhaveit?2. Haveyoueverhadacolonoscopyorsigmoidoscopy?Whenwasthelasttime?Whydidyouhaveit?

Stratificationvariables:Province/territory,agegroup,sex,householdincomequintile,immigrantstatus

Provinces/territorieswithdataavailable:Allprovincesandterritoriesfor2012;AB,MB,QC,NB,PE, NL,YT,NTfor2013

Notes: 1.CCHSdataisbasedonarepresentativesamplewhichisthenextrapolatedtotheoverall population.2.ColorectalcancerscreeningwasoptionalcontentinCCHS2013.

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3.

Diagnosis

Breast

cancer

diagnosis

wait

time:

from

abnormal

breast

screen

to

resolution

Definition:1.Themedianand90thpercentileelapsedtime(inweeks)fromabnormalbreastscreento resolution(testdateofdefinitivediagnosis)2.Thepercentageofwomenforwhichtheabovewaittime waswithintargettimeframes

Population:Womenaged50–69participatingintheorganizedbreastscreeningprogramwithan abnormalbreastscreenresult(mammogramorclinicalbreastexamination);1.Requiringatissuebiopsy 2.Notrequiringatissuebiopsy

Datasource:Provincialbreastcancerscreeningprograms

Datareported:BC,AB,SK,MB,ON,QC,NB,NS,PE,NL,NT

Provincespecificnotes:AB:WaittimedatawerebasedonthescreeningmammogramsdonebyScreen Test,whichispartofAlbertaBreastCancerScreeningPrograms(accountingforabout10%ofscreening mammogramsinAlberta).

SK:Participationrateincludedpatientswhohavehadbreastcancerinthepastwhoareallowedtore‐

screenwiththescreeningProgramforbreastcancer.

ON:Medianandpercentilearenotavailablefrom2009onward.

QC:Dataarenotavailablefor2004,2009and2011.

NT:2011waittimedataincludedonesite(Stanton)only.

Generalnotes:

1.Indicatorexcludestestsbeyond6monthspostscreen.

2.Timetodiagnosisisbasedonthedateofthefirstpathologicalbiopsyresultofbreastcancer (excludesfineneedleaspirationandallinconclusiveprocedures)orthedateofthelastbenigntestor pathologicalbiopsy.

3.Definitivediagnosisofcanceristhefirstcoreoropensurgicalbiopsythatconfirmscancer.Inrare occasions,fineneedleaspiration(FNA)biopsymayalsobeusedasadefinitivediagnosisofcancer. Definitivediagnosisofbenigncasesisthelastbenigntestupto6monthsfollowinganabnormalscreen. 4.Tissuebiopsyincludesopenandcoreneedlebiopsy.

Colorectal

cancer

diagnosis

wait

time:

from

abnormal

fecal

test

to

colonoscopy

Definition:Time(indays)betweenanabnormalcolorectalcancerscreeningfecaltestresultanda follow‐upscreeningcolonoscopyprocedure

Population:Individualswithanabnormalfecaltest(forCRCscreening)whowentontoreceivea colonoscopywithin180daysofthefecaltestresult

Measures:1.Median2.90thpercentile3.Numberofindividualshavingafollow‐upcolonoscopywithin 180days

DataSource:ReportedbytheprovincialcolorectalscreeningprogramsthroughtheNationalColorectal CancerScreeningNetwork

MeasurementTimeframe:First‐roundscreeningtestsconductedbetweenJanuary1,2011and December31,2012

DataReported:SK,MB,NS,NL,andPE

(7)

NL:Referralsforcolonoscopyoccuraftertheindividualhasbeencontactedbythescreeningprogram regardingtheabnormalfecaltestandahealthassessmentcompleted. Thismayinfluencemedianand 90thpercentileforwaittimefromabnormalfecaltesttofollow‐upcolonoscopy.

PE:FTgwasdiscontinuedbyJuneof2012aftertransitiontoFTi. FTiwasimplementedinearly2012.

GeneralNotes:

1.Thisindicatordoesnotincludepatientswhoreceivedacolonoscopymorethan6monthsfollowing anabnormalfecaltest.

2.ThecolonoscopymayhavebeenperformedinsideoroutsidetheProgrambutonlyincludesindividuals whoseabnormalfecaltestwasperformedinthescreeningProgram.

Use

of

PET

scans

among

patients

diagnosed

with

non‐small

cell

lung

cancer

Definition:Percentageofpatientsdiagnosedasnon‐smallcelllungcancer(NSCLC),receivingatleast onePETscanwithinthreemonthsbeforeanduptooneyearafterdiagnosis

Numerator:Numberofpatientswhodiagnosedasnon‐smallcelllungcancerandreceivedatleastone PETscanwiththreemonthsbeforeanduptooneyearafterdiagnosis

Denominator:Numberofpatientswhowerediagnosedasnon‐smallcelllungcancer

Datasources:Provincialcanceragencies

Measurementtimeframe:2009to2011diagnosisyear

Stratificationvariables:province,sex,agegroupandcancerstage

Provincessubmittingdata:BC,AB,MB,ON,NB,NS

Provincespecificnotes:

BC:DatawereonlyforNSCLCpatientsdiagnosedin2010and2011,sincestagedatawerenotavailable for2009.Datamaynotbecompleteandcomparablewithotherprovincesduetolackofinformation aboutsurgeryforthediagnosisyears2010and2011,whichwereusedtodeterminethetreatment modality.CaseswithStageIIIdiseasewerestagedupwardtoStageIIIA.

AB:Theclassificationofcancerstagefor2009werebasedonAJCC6th,for2010and2011werebased onAJCC7th.CaseswithDeathCertificateOnly(DCO)orconfirmedbyautopsyonlywereexcluded. CaseswithstageIIIwerecategorizedasstageIIIB.

MB:CaseswithstageIIIwerecategorizedasstageIIIB.

NS: CaseswithstageIIIwerecategorizedasstageIIIB.

Generalnotes:

1.Datawerecollectedbytreatmentmodalityandstage.Resultsfromtreatmentmodalitywere combinedforreporting. Provinceswithnotreatmentdataavailable(i.e.BCandNB)werepartially excludedfromtheanalysis.

2.InvasiveNon‐SmallCellLungcancer(NSCLC)incidencecasesweredefinedasC34withbehaviorcode 3,excludinghematopoietichistology(M‐95toM‐98),smallcell,neuroendocrinecarcinomaandsarcoma codesusingInternationalClassificationofDiseasesforOncology,ThirdEdition(ICD‐O‐3).

3.Onlypatientswithageatdiagnosis>=18wereincluded,whoweredividedtotwogroups:18‐69and 70+.

4.IncidencecasesthroughDeathCertificateonly(DCO)wereexcluded.

5.Treatmentmodalitywasclassifiedintothreegroups:firstsurgery,firstradiationtherapyandnoany treatment.

Distribution

of

diagnostic

PET

scans

by

stage

for

non‐small

cell

lung

cancer

cases

Definition:PercentageofdiagnosticPETscanbystagefornon‐smallcelllungcancercases(NSCLC).

Numerator:NumberofdiagnosticPETscanfornon‐smallcelllungcancercasesforaspecificstage.

(8)

Datasources:Provincialcanceragencies

Measurementtimeframe:2009to2011diagnosisyear

Stratificationvariables:province,sex,agegroupandcancerstage

Provincessubmittingdata:BC,AB,MB,ON,NB,NS

Provincespecificnotes:

BC:DatawereonlyforNSCLCcasesdiagnosedin20010and2011,sincestagedatawasnotavailablefor 2009.Datamaynotbecompleteandcomparablewithotherprovincesduetolackofinformationabout surgeryforthediagnosisyears2010and2011,whichwereusedtodetermineifPETscanswerefor diagnosis.CaseswithStageIIIdiseasewerestagedupwardtoStageIIIA.

AB:Theclassificationofcancerstagefor2009werebasedonAJCC6th_,_for₂₀₁₀_and₂₀₁₁_were_based_on

AJCC7th_._Cases_with_Death_Certificate_Only_(DCO)_or_confirmed_by_autopsy_only_were_excluded._Cases

withstageIIIwerecategorizedasstageIIIB.

MB:CaseswithstageIIIwerecategorizedasstageIIIB.

NS: CaseswithstageIIIwerecategorizedasstageIIIB.

NB: Datawerenotcompleteandcomparableduetolackofradiationtherapyinformationforthe diagnosisyears,whichwereusedtodetermineifPETscanswerefordiagnosis.

Generalnotes:

1.Datawerecollectedbytreatmentmodalityandstage.Resultsfromtreatmentmodalitywere combinedforreporting. Provinceswithnotreatmentdataavailable(i.e.BCandNB)werepartially excludedfromtheanalysis.

2.InvasiveNon‐SmallCellLungcancer(NSCLC)incidencecasesweredefinedasC34withbehaviorcode 3,excludinghematopoietichistology(M‐95toM‐98),smallcell,neuroendocrinecarcinomaandsarcoma codesusingInternationalClassificationofDiseasesforOncology,ThirdEdition(ICD‐O‐3).

3.Onlypatientswithageatdiagnosis>=18wereincluded,whoweredividedtotwogroups:18‐69and 70+.

4.IncidencecasesthroughDeathCertificateonly(DCO)wereexcluded.

5.DiagnosticPETscanswasdeterminedbythedateinwhichPETscansoccurredandthefirstdateof surgeryand/orradiationtherapy.ThereweretwoscenariostodetermineifPETscanswerefor diagnosticpurpose:

a. Forthecases,therewerenosurgeryorradiationtherapywithinoneyearofdiagnosis,any PETscanshappenedbetween3monthspre‐diagnosisand4monthspostdiagnosiswere consideredasdiagnostic.

b. Forthecases,thereweresurgeryorradiationtherapywithinoneyearofdiagnosis,anyPET scanshappenedbetween3monthspre‐diagnosisandthefirstsurgeryorthefirstradiation therapywereconsideredasdiagnostic.

(9)

4.

Treatment

4.1 Surgery

Removal

and

examination

of

12

or

more

lymph

nodes

in

colon

resections

Definition:Theproportionofcoloncancerresectionsforwhich12ormorelymphnodeswereremoved andexamined

Numerator:Coloncancercasesdiagnosedduringtheyearandresectedwithin1yearofdiagnosisfor which12ormorelymphnodeswereremovedandexamined

Denominator:Allcoloncancercasesdiagnosedintheprovinceduringtheyearandresectedwithin12 monthsofdiagnosis

Datasource:Provincialcanceragencies

Measurementtimeframe:2008,2009,2010and2011diagnosisyears

Stratificationvariables:Province,agegroup,sex

Provincessubmittingdata:AB,SK,MB,ON,NB,NS,PE,NL

Provincespecificnotes:AB:For2011,treatmentinformationisbasedoninitiallyplannedtreatmentto primarysite(ACRdata). ExcludesC18.1Appendix. CCIcodesarenotidentifiedintheACR,assuchall codedsurgerieswereincludedforcompletecolonresection. Ifmorethanonesurgicalprocedureis performed;themostdefinitiveprocedureisdocumented.Thedefinitionofdefinitiveisthesurgical procedurewiththeintenttocure. Throughqualityassurance,wenoticedthatanumberofthecases codedassurgeryontheACRhadCCIcodesorBillingcodesotherthantheoneslisted. Themajorityof thesecasesappeartobecasesinwhichthebillingdatabasehad60.5otherresectionoftherectumeven thoughthepatientonlyhadC18.7sigmoidcolon. However,therearealsosomecasesinwhichtheACR codessurgeryforpolypectomyandhencethesehavealsobeenincluded. ON: CasesforAppendix C18.1wereexcluded.NS:For2011,collaborativestagevariableusedtoidentifythosehavinga resection.Resectionsdatesmanuallyreviewedfromchartreview.PE:For2011,casesforAppendix C18.1wereexcluded.

Generalnotes:

1. Caseswithunknownnumberofnodesremovedandexaminedwereexcludedfromboth numeratoranddenominator.

2. Casesforpatientsunder18yearsofage(atdiagnosis)wereexcluded. 3. ColoncasesdefinedasICDO3codes:C18.0toC18.9withbehaviorcode3.

4. ExcludelymphomaCodesM‐95toM‐98.From2010onwarddataalsoexcludesarcomacodes, neuroendocrinecarcinoma,squamouscellcarcinoma.

5. ColonresectionsidentifiedasCCIcodes:1NM87or1NM89or1NM91ordescriptorslistedinTable 1.

6. Allresectedcaseswereincluded,regardlessofmarginstatus(duetodatalimitations). 7. Includedcaseswhichlastresectiondate(ifmultiple)–diagnosisdate<=365days.

Breast

cancer

resections

that

are

mastectomies

Definition:Thepercentageofsurgicalresectionsamongwomenwithunilateralinvasivebreastcancer thataremastectomies.

(10)

Numerator:Womeninthedenominatorwhoreceivedamastectomyfirstaswellaswomenwho receivedbreastconservingsurgery(BCS)firstfollowedbyamastectomywithinoneyear

Denominator:Womenwithunilateralinvasivebreastcancerwhoreceivedbreastconservingsurgery and/oramastectomy

Datasource:HospitalMorbidityDatabase,CanadianInstituteforHealthInformation(CIHI);National AmbulatoryCareReportingSystem,CIHI;FichierdeshospitalisationsMED‐ÉCHO,ministèredela Santé etdesServices sociauxduQuébec;AlbertaAmbulatoryCareReporting System,AlbertaHealthand Wellness

Measurementtimeframe:2007‐08to2011‐12

Provincessubmittingdata:BC,AB,SK,MB,ON,QC,NB,NS,PE,NLandTerritories

Generalnotes:

1.Thefollowingsurgicalanddiagnostic codes,asdocumentedinhospitalpatientrecordsandreported toCIHI,wereusedtoidentifydiagnosesandproceduresperthefollowing:

a. Inordertoidentifyabreastcancerdiagnosis,thefollowingICD‐10‐CAcodeswereused: C50.00, C50.01,C50.09,C50.10,C50.11,C50.19,C50.20,C50.21,C50.29,C50.30,C50.31,C50.39,C50.40, C50.41,C50.49,C50.50,C50.51,C50.59,C50.60,C50.61,C50.69,C50.80,C50.81,C50.89,C50.90, C50.91,C50.99.Womenwithunilateralinvasivebreastcancerwerethefocusofthisanalysis (comprising98%ofwomenwithinvasivebreastcancer).

b. Inordertoidentifyamastectomy,thefollowingsurgicalcodeswereusedaccordingtoCCI: 1.YM.89to1.YM.92.

c. ThefollowingCCIcodeswereusedtoidentifyabreastconservingsurgery: 1.YM.87,1.YM.88.

4.2 Radiation Therapy

Radiation

therapy

wait

time:

from

ready‐to‐treat

to

start

of

treatment

Definition:1.Themedianand90thpercentileelapsedtimefromreadytotreattostartofradiation therapy,measuredindays;2.Thepercentageofradiationtherapycasesforwhichtheabovewaittime waswithintargettimeframes

Measurementtimeframe:2013treatmentyear

Stratificationvariables:Province,bydiseasesite(allcancers,breast,colorectal,lung,prostate)

Provincessubmittingdata:BC,AB,SK,MB,ON,NB,NS,PE,NL

Provincespecificnotes:AB:For2013,dataincludedallcaseswhohadradiationtherapyataCancer ControlAlbertaFacilitywiththeirfirsttreatmentbetweenJan1,2013 ‐Dec31,2013;itincludesthose whowerelivinginanotherprovinceattimeofdiagnosisbutreceivingradiationtherapyinAlberta. Tumorgroupclassificationforthisindicatorisbasedonreferraltumorgroups. SK: For2013,data werereportedbytreatmentsite,anyRTtreatmentmodalitywasincluded. NS:For2013,waittime werecomputedusingthesamerulesforproducingwaittimeforNSDepartmentofHealthandWellness. Assuch,waittimewerebasedonpatientfirstcoursesoftreatmentintheperiodofinterest. PE:For 2013,datawerebasedonnewtreatmentstartswithinthetimeframeof2013.Individualcancerpatients couldhavemorethanonetreatmentstartinthetimeframeandcouldthereforebecountedmorethan once.

(11)

Generalnotes:

1.Allbehaviorcodesareincluded.

2.Caseswithtreatmentdonein2013areincluded.

3.Toidentifybreast,colorectal,lung,prostatecancerandallcancers,pleaseincludethemorphology codesthatarecurrentlyusedwithinyourregistry.

4.Ofnoteforbreastcancerdata,iftheprovinceobtainsthisdatafromawaittimedatabaseas opposedtoaregistry,thenbreastcancercasesweretobeincludedperthedatabasedefinition. 5.Thereareknowndiscrepanciesinthewaysinwhichdifferentprovincesmeasurewaittimes.Oneof thekeysourcesofvariationisthewaythe“ReadytoTreat”timeframeisdefined.Effortsareunderway tostandardizethesedefinitions.Thefollowingsectionoutlinesthedefinitionsusedbythedifferent provinces.

Provincialdefinitions:

AB:Thedatewhenthepatientisphysicallyreadytocommencetreatment.BC:Thedateatwhichboth oncologistandpatientagreethattreatmentcancommence.Beingreadytotreatrequiresthatall diagnostictestsandproceduresrequiredtoassesstheappropriatenessof,indicationsfor,andfitness toundergoradiationtherapyarecomplete.MB:Thedatewhenadecisionhasbeenmadebythe radiationoncologistandisagreedtobythepatientthatradiationtherapyisappropriateandshould commenceANDthepatientismedicallyreadytostarttreatmentANDthepatientiswillingtostart treatment.NB:Thedatewhenanyplanneddelayisoverandthepatientisreadytobegintreatment frombothasocial/personalandmedicalperspective.NL:Thedatewhenallpre‐treatment

investigationsandanyplanneddelayareover,andthepatientisreadytobeginthetreatmentprocess frombothasocial/personalandmedicalperspective.NS:Thedatewhenallpre‐treatment

investigationsandanyplanneddelayareover,andthepatientisreadytobeginthetreatmentprocess frombothasocial/personalandmedicalperspective.NovaScotiadidnothaveareadytotreatdate untilFebruary2010;aproxydatewasusedpriortothistime.ON:Thetimefromwhenthespecialistis confidentthatthepatientisreadytobegintreatmenttothetimethepatientreceivestreatment.PE:

Thedatewhenallpre‐treatmentinvestigationsandanyplanneddelayareover,andthepatientis readytobeginthetreatmentprocessfrombothasocial/personalandmedicalperspective.QC:At consultation,theradiationoncologistentersthedateatwhichthepatientwillbereadytotreatona formularyrequestingtreatment.SK:Thedatewhenthepatientisreadytoreceivetreatment,taking intoaccountclinicalfactorsandpatientpreference.Inthecaseofradiationtherapy,anypreparatory activities(e.g.,simulation,treatmentplanning,dentalwork)donotdelaythereadytotreatdate.

Pre‐operative

radiation

therapy

for

stage

II

or

III

rectal

cancer

patients

Definition:PercentageofresectedstageIIandIIIrectalcancercasesreceivingpre‐operative(neo‐

adjuvant)radiationtherapy

Numerator:StageIIandIIIrectalcancercasesdiagnosedduringtheyearreceivingpre‐operative radiationtherapyupto120daysbeforeresection

Denominator:StageIIandIIIrectalcancercasesdiagnosedintheprovinceduringtheyearandhavinga rectalresectionwithinoneyearofdiagnosis

Measurementtimeframe:2008,2009,2010and2011diagnosisyear

(12)

Provincespecificnotes:AB:For2011,treatmentinformationwasbasedoninitiallyplannedtreatment toprimarysite.CCIcodesarenotidentifiedintheACR,assuchallcodedsurgerieswereincludedfor completerectumresection.Ifmorethanonesurgicalprocedureisperformed,theACRcodesthemost definitiveproceduresisdocumented.Thedefinitionofdefinitiveisthesurgicalprocedurewiththe intenttocure.Caseswithradiationtherapyaftersurgerywereexcluded.

Generalnotes:

1.RectalcasesdefinedasICDO3codes:C19.9orC20.9,excludelymphomacodes(M‐95toM‐98).2010 dataalsoexcludesarcomacodes–8800/3,neuroendocrinecarcinomaandsquamouscellcarcinoma. 2.IncludedAJCCGroupStageatDiagnosis=IIorIII.

3.Casesforpatientsunder18yearsofage(atdiagnosis)wereexcluded.

4.RectalresectionsdefinedasCCIcodes1NQ59or1NQ87or1NQ89orseelistofdescriptorslistedin Table2.

5.Allresectedcaseswereincludedregardlessofmarginstatus(duetodatalimitations).

6.Includedcaseswhich1stresectiondate(ifmultiple)–diagnosisdate<=365days.1st _resection_date_–

radiationtherapystartdate<=120days.

4.3 Systemic

Therapy

Post‐operative

chemotherapy

for

stage

II

or

IIIA

non‐small

cell

lung

cancer

patients

Definition:PercentageofstageIIandIIIAnon‐smallcelllungcancercasesreceivingchemotherapy followingsurgicalresection

Numerator:StageIIandIIIAnon‐smallcelllungcancercasesdiagnosedduringtheyear,resected withinoneyearofdiagnosisandstartingadjuvantchemotherapywithin120daysofsurgery

Denominator:StageIIandIIIAnon‐smallcelllungcancercasesdiagnosedintheprovinceduringthe yearandhavingalungresectionwithinoneyearofdiagnosis

Measurementtimeframe:2009,2010and2011diagnosisyears

Provincessubmittingdata:AB,SK,MB,ON,NS,PE

Provincespecificnotes:AB: For2011,Treatmentinformationisbasedoninitiallyplannedtreatmentto theprimarysite(ACRdata).CCIcodesarenotidentifiedintheACR,assuchallcodedsurgerieswere includedforcompletelungresection.Ifmorethanonesurgicalprocedureisperformed;themost definitiveprocedureisdocumented.Thedefinitionofdefinitiveisthesurgicalprocedurewiththeintent tocure.SCCwereexcluded. Allcodedsurgerieswereincludedascompletelungresection. SK:Data includedSCCin2011. NS:For2011,collaborativestagevariableswereusedtoidentifythosehaving resections.Individualchartwerereviewedtoobtainresectiondate.PE:For2011,dataincluded squamouscellcarcinomacases.

Generalnotes:

1.Casesforpatientsunder18yearsofage(atdiagnosis)wereexcluded.

2.Non‐smallcelllungcasesweredefinedasC34.0toC34.9,withbehaviorcode3,usingInternational ClassificationofDiseasesofOncology,ThirdEdition(ICD‐O‐3).HistologycodesforlymphomaM‐95to M‐98,andhistologycodesforsmallcell:8002,8041,8043,8044,8045,8073and8803wereexcluded.

(13)

3.For2010,dataexcludedsarcomacodes,neuroendocrinecarcinoma,andsquamouscellcarcinoma.For 2011,dataexcludedsarcomacodes,neuroendocrinecarcinoma.

4.IncludedAJCCGroupStageIIandIIIAatDiagnosis.

5.ResectionsdefinedasCCIcodes:1GR87,1GR89,1GR91,1GT59,1GT87,1GT89or1GT91ordescriptors listedinTable2below.

6.Allresectedcasesareincludedregardlessofmarginstatus(duetodatalimitations).

7.IncludedcaseswhichLastresectiondate(ifmultiple)–diagnosisdate<=365days.Chemotherapystart date–lastresectiondate(ifmultiple)<=120days.

8.Chemotherapyincludesoral(asavailableindata)andIVchemotherapy.

9.Nofilterfortreatmentintentwasused,unlessotherwisespecifiedbyprovince.

Table1:ProcedureCodes

Procedure Codes Diagnostic codes

Specific Cohort CCP CCI ICD‐9‐CM ICD‐10

Coloncancer 57.5*,57.6* 1.NM.87.^^,1.NM.89.^^, Onlycolorectalcancercodes

resections 1.NM.91.^^ 153*,154.0, 154.1 154.2,154.3. 154.8 C18,C19,C20 C21 Rectalcancer resections 60.2,60.24, 60.4,60.5, 60.51,60.52, 60.53,60.55, 60.59 1.NQ.87.LA,1.NQ.87.DA, 1.NQ.87.PF,1.NQ.87.RD, 1.NQ.87.DF,1.NQ.89.^^

Onlycolorectalcancercodes

153*,154.0, 154.1 154.2,154.3. 154.8 C18,C19,C20 C21

Table2:ClinicalDescriptors

ClinicaldescriptorsforColonCancer ClinicaldescriptorsforRectalCancer

righthemicolectomy, lefthemicolectomy segmentalcolectomy partialcolectomy transversecolectomy subtotalcoloectomy

anteriorresection(noteoverlapwithrectal cancerbelow)

anteriorresection(overlapwithcoloncancer above)

lowanteriorresection abdominoperinealresection segmentalresectionrectum Harmannprocedure totalproctectomy

(14)

5.

Person Centred‐Perspective

Screening

for

distress

Definition:Extenttowhichprovincesandtheircancerprogramshaveimplementedstandardizedtools toscreenforpatient‐reportedsymptomssuchasemotionalandphysicaldistress(includingpain)

ExtentofImplementation:1.Provincewideimplementation*standardizedsymptomscreening undertakenforatleastaportionofpatientsateachprovincialcancercentreanddatacollected centrally;2.Partialimplementation*standardizedsymptomscreeningundertakenforatleastaportion ofpatientsatselectedprovincialcancercentres;3.Notprovinciallycoordinated(somelocaluse possible)*provinciallymanagedimplementationofsymptomscreeningdoesnotexist;however,some individualcentres/regionsmayuseascreeningtoolbutdonotreportdataataprovinciallevel

Datasource:Provincialcanceragenciesandprograms

(15)

6.

Research

Adult

clinical

trial

participation

Definition:Theratioofthetotalnumberofallpatients(≥19years)newlyenrolledincancer‐related therapeutictrialsorclinicalresearchstudiesin2013totheprojectednumberofnewcancercases(all ages)in2013

Numerator:Numberofcancerpatients(≥19years)newlyenrolledincancer‐relatedtherapeuticclinical trialsorclinicalresearchatprovincialcancercentresin2013.Forpatientenrolledinmultipleclinical trials,countalloccurrences.

Denominator:Projectednumberofnewinvasivecancercases(allages)in2013.

Datasource:NumeratorswerereportedbyprovincialcanceragenciesorequivalenttotheCanadian PartnershipAgainstCancer.Denominatorswereretrievedfrom“CanadianCancerStatistics2013”– StatisticsCanada.

Stratificationvariables:Province,diseasesite:1.Allinvasivecancers2.Breast3.Colorectal4.Lung;5. Prostate

Provincessubmittingdata:Allinvasivecancers:BC,AB,SK,MB,ON,NB,NS,PE,NL.

Bycancertype:BC,AB,SK,MB,NB,NS,PE,NL.

Provincespecificnotes:AB:For2013,thetotalnumberofaccrualsforcancerpatients(>=19years) includednewlyenrolledincancerrelatedtherapeutictrialsorclinicalresearchwhowereonthe AlbertaCancerClinicalTrials(ACCT)database. Ifapatientwentonmultipleclinicaltrialaccrualsinthe givenyear,apatientwouldbecountedforeachaccrual.TheACCTdatabasealsoincludespatientswho werelivingoutsideofAlberta,aslongastheywereonaclinicaltrialinAlberta.TheACCTdatabase includesbothfemalesandmalesintheBreastTumorGroupandmayincludeclinicaltrialsfornon‐

melanomaskinpatients.

Generalnote:

(16)

7.

Appropriateness

Breast

cancer

screening

within

and

outside

recommended

guidelines

Definition:Percentageofasymptomaticfemalesaged35+receivingamammogramwithinthepast2 years,whereasymptomaticisdefinedas:Respondentswhoindicatedgoingforamammogramforany ofthefollowingreasons:Familyhistory;Routinescreen/check‐up;Age;HRT;andNOTforanyofthe followingreasons:Lump;Breastproblem;Follow‐uptobreastcancertreatment;Other.

Numerator:Asymptomaticfemalesaged35+whoindicatedgoingforamammogramwithinthepast2 years

Denominator:Totalnumberofasymptomaticfemalesaged35+receivingamammogramwithinthe past2years

CCHSVariable:1.Everhadamammogram;2.Reasonsforhavingmammogram(markallthatapply): Familyhistory;Routinescreen;Age;HRT;Lump;Follow‐uptobreastcancertreatment;Breastproblem; Other;3.Lasttimerespondenthadundergoneamammogram

Provincessubmittingdata:Allprovincesandterritories

GeneralNotes:CCHSdataarebasedonarepresentativesamplewhichisthenextrapolatedtothe overallpopulation.

Breast

cancer

mastectomies

performed

as

day

surgery

Definition:Percentageofbreastcancermastectomiesdoneasdaysurgeries,byprovince/territory

Numerator:Mastectomiesperformedasdaysurgery

Denominator:Totalmastectomies

Exclusion:Potentialduplicaterecordsareremovedfromtheanalysis.Potentialduplicaterecordsare identifiedasdischargeswithidenticalvaluesinthefollowingdataelements:

1.ForHMDB:Institution,healthcardnumber,admissiondate,admissiontime,dischargedate,discharge time,healthcardprovince3,birthdate,gender,postalcode,MRDx/mainproblem,principalCCI/main intervention

2.ForAlbertaAmbulatoryCaredata:INSTHEALTH_CARD_ENCRYPT_NUMSTDATESTHOURENDDATE

ENDHOURDOBSEXPOSTCODEMDIAGMINT

3.InvalidHealthCardNumber(“000000000000”). 4.HealthCardProvinceCode=’CA’.

5.Invalidpostalcode.

6.Procedurescodedasabandoned.

7.Newborns,stillbirthsandcadavericdonors. 8.Invalidepisodedate(i.e.,01JAN9999).

Datasource:HospitalMorbidityDatabase,NationalAmbulatoryCareReportingSystem,Canadian InstituteforHealthInformation;AlbertaAmbulatoryCareReportingSystem,AlbertaHealthand Wellness

Measurementtimeframe:2007/08to2011/12combinedfiscalyears

Provincessubmittingdata:AllprovincesandTerritories

(17)

recordcontainingthesurgicalepisodeassociatedwiththepatient’sfirstbreastresectionareconsidered mastectomycases

(18)

8.

Long‐Term Outcomes

Age‐standardized

incidence

rates

Definition:Theincidenceratethatwouldhaveoccurrediftheagedistributioninthepopulationof interestwasthesameasthatofthestandard,whereincidencerateisdefinedasthenumberofcases ofcancer(malignantneoplasms)newlydiagnosedduringayear,per100,000peopleatrisk

Numerator:Numberofnewcancercases(allages):1.Breast(female)2.Colorectal3.Lung4.Prostate (male)5.Pancreas

Denominator:1.Annualfemalepopulationestimateinhundredsofthousands;2,3,5.Annual populationestimatesinhundredsofthousands4.Annualmalepopulationestimateinhundredsof thousands

Agestandardization:Directmethodusingthe2011CanadianCensuspopulation

Datasources:CanadianCancerRegistry(CCR)Database–cancerincidencedata;DemographyDivision ofStatisticsCanada–populationestimates

Measurementtimeframe:Foroveralltrends,Canada–1992to2010.Byprovince:3‐yearcombined (2008–2010)

Stratificationvariables:Province,sex

Generalnotes:

1.WorldHealthOrganization,InternationalClassificationofDiseasesforOncology,ThirdEdition(ICD‐

O‐3)andtheInternationalAgencyforResearchonCancer(IARC)rulesfordeterminingmultiple primariessiteswereused:colorectal(ICD‐O‐3:C18.0toC18.9,C19.9,C20.9,C26.0),lungandbronchus (ICD‐O‐3:C34.0toC34.9),femalebreast(ICD‐O‐3:C50.0toC50.9),prostate(ICD‐O‐3:C61.9),pancreas (ICD‐O‐3:C25.0‐C25.9)

2.JoinpointRegressionProgram4.1.1forWindowswasusedtoanalyzelineartrendsacrossyears. The softwaretakestrenddataandfitsthesimplestjoinpointmodelthatthedataallow. Theprogramstarts withtheminimumnumberofjoinpoints(e.g.0joinpoints,whichisastraightline)andtestswhether morejoinpointsarestatisticallysignificantandmustbeaddedtothemodel(uptothatmaximum number).Thisenablestheusertotestwhetheranapparentchangeintrendisstatisticallysignificant. ThetestsofsignificanceuseaMonteCarloPermutationmethod. AnnualPercentChange(APC)was reportedtocharacterizetrendsincancerratesovertime. APCassumesthatcancerratesarechanging ataconstantpercentageoftherateofthepreviousyear. Theminimumandmaximumnumberof joinpointsusedinthisanalysiswere0and4respectively. Forfurtherdetails,refertotheJoinpoint RegressionProgramdocumentation(http://surveillance.cancer.gov/joinpoint/).

Age‐standardized

incidence

rates

by

stage

Definition:Thestage‐specificincidenceratethatwouldhaveoccurrediftheagedistributioninthe populationofinterestwasthesameasthatofthestandard,whereincidencerateisdefinedasthe numberofcasesofcancer(malignantneoplasms)newlydiagnosedduringaspecifictimeperiod,per 100,000peopleatrisk.

Numerator:Numberofnewcancercasesforeachstageduringthegiventimeperiod.

Denominator:Totalpopulation(person‐time)atriskforaspecificsexduringthegiventimeperiod.

Measurementtimeframe:2010to2012combined

Stratificationvariables:Province,stage(includingstageI,II,IIIandIV)

(19)

Agestandardization:Directmethodusingthe2011CanadianCensuspopulationasstandardweights

Provincespecificnotes:AB:Hematology,sarcomaandmelanomamorphologieswereremovedfrom thesite‐specificcancers.

Generalnotes:

O‐3)andtheInternationalAgencyforResearchonCancer(IARC)rulesfordeterminingmultiple primariessiteswereused:colorectal(ICD‐O‐3:C18.0,C18.2toC18.9,C19.9,C20.9,C26.0),lungand bronchus(ICD‐O‐3:C34.0toC34.9),breast(ICD‐O‐3:C50.0toC50.9),prostate(ICD‐O‐3:C61.9). 2.AppendixC18.1wasexcludedfromcolorectalcancer.

3.SiteswithhistologycodesforlymphomaM‐95toM‐98,sarcomacodes–8800/3wereexcluded. 4.Casesforpatientswithageunder18(notincluded)atdiagnosiswereexcluded.

5.AmericanJointCommitteeonCancer7edition(AJCC7)wasusedtoclassifycancergroupstage.

Age‐standardized

mortality

rates

Definition:Themortalityratethatwouldhaveoccurrediftheagedistributioninthepopulationof interestwasthesameasthatofthestandard,wheremortalityrateisdefinedasthenumberofdeaths duetocancer(malignantneoplasms)inayearper100,000peopleatrisk

Numerator:Numberofdeathsfromcancer(allages):1.Breast(female);2.Colorectal;3.Lung;4. Prostate(male);5.Pancreas

Denominator:1.Annualfemalepopulationestimateinhundredsofthousands2,3,5Annual populationestimatesinhundredsofthousands;2.Annualmalepopulationestimateinhundredsof thousands

Agestandardization:Directmethodusingthe2011CanadianCensuspopulation

Datasources:CanadianVitalStatistics–DeathDatabase–cancermortalitydata;DemographyDivision ofStatisticsCanada–populationestimates

Measurementtimeframe:Foroveralltrends,Canada–1992to2011.Byprovince:3‐yearcombined (2009–2011).

Stratificationvariables:Province

Generalnotes:

1. Uptotheyear1999,causesofdeathwerecodedaccordingtoWorldHealthOrganization(WHO), InternationalClassificationofDiseases,NinthRevision(ICD‐9):Colorectal(ICD‐9153‐154),lung (ICD‐9:162),femalebreast(ICD‐9:174),prostate(ICD‐9:185),pancreas(ICD‐9:157)2.Afterthe year1999,causesofdeathwerecodedaccordingtotheWorldHealthOrganization(WHO), InternationalStatisticalClassificationofDiseasesandRelatedHealthProblems,TenthRevision (ICD‐10): Colorectal(ICD‐10:C18‐C20,C26.0),lung(ICD‐10:C34),femalebreast(ICD‐10:C50), prostate(ICD‐10:C61),pancreas(ICD‐10:C25)

2. JoinpointRegressionProgram4.1.1forWindowswasusedtoanalyzelineartrendsacrossyears. Thesoftwaretakestrenddataandfitsthesimplestjoinpointmodelthatthedataallow. The programstartswiththeminimumnumberofjoinpoints(e.g.0joinpoints,whichisastraightline) andtestswhethermorejoinpointsarestatisticallysignificantandmustbeaddedtothemodel(up tothatmaximumnumber).Thisenablestheusertotestwhetheranapparentchangeintrendis statisticallysignificant.ThetestsofsignificanceuseaMonteCarloPermutationmethod. Annual PercentChange(APC)wasreportedtocharacterizetrendsincancerratesovertime. APCassumes thatcancerratesarechangingataconstantpercentageoftherateofthepreviousyear. The minimumandmaximumnumberofjoinpointsusedinthisanalysiswere0and4respectively. For furtherdetails,refertotheJoinpointRegressionProgramdocumentation

(20)

Age‐standardized

relative

survival

ratios

Definition:Relativesurvivalratio(RSR)istheratiooftheobservedsurvivalforagroupofcancer patients(malignantneoplasms)totheexpectedsurvivalformembersofthegeneralpopulationwho havethesamemainfactorsaffectingsurvival(sex,age,placeofresidence)asthecancerpatients.The age‐standardizedRSRisthatrelativesurvivalthatwouldhaveoccurrediftheagedistributionofthe cancerpatientsunderstudyhadbeenthesameasthatofthestandardpopulation

Numerator:Forperiodanalysismethod(2006‐2008):Observedcumulativesurvivalprobabilitiesof cancerpatientsafterdiagnosiswithfollow‐upin2006to2008forbreast,lungandcolorectal;2005to 2007forpancreas.Forcohortanalysismethod(1992‐1994):Observedcumulativesurvivalprobabilities ofcancerpatientswhowerediagnosedduring1992‐1994:1.Breast;2.Colorectal;3.Lung;4.Pancreas

Denominator:Expectedsurvivalofcomparisonpopulationthatwasalivefor5yearsforpatientswith follow‐upin2006to2008forbreast,lungandcolorectal;2005to2007forpancreas.

Age‐standardized:Forbreast,lungandcolorectal:age‐standardizedtopeoplediagnosedwiththat cancerinCanadabetween1992and2001. Forpancreas,age‐standardizedtopopulationdiagnosed withpancreaticcancerinCanadabetween2001and2005

Datasources:Breast,lungandcolorectal:CanadianCancerStatistics2013;Pancreas:Canadian CancerRegistry(annualfile,releasedate2011);Provinciallifetables(providedfromStatisticsCanada, 2012)

Measurementtimeframe:Forperiodanalysismethod,patientswithfollow‐upduring2006to2008for breast,lungandcolorectal;2005to2007forpancreas.Forcohortanalysismethod,patientsdiagnosed during1992to1994

Stratificationvariables:Province

Generalnotes:

O‐3)andtheInternationalAgencyforResearchonCancer(IARC)rulesfordeterminingallprimaries siteswereused:colorectal(ICD‐O‐3C18.0toC18.9,C19.9,C20.9,C26.0),lungandbronchus(ICD‐O‐3 C34.0toC34.9),breast(ICD‐O‐3C50.0toC50.9),pancreas(ICD‐O‐3:C25.0‐C25.9)

2.“Canada”representsallprovincesandterritories,exceptQuebec.DatafromQuebechavebeen excluded,inpart,becausethemethodofascertainingthedateofcancerdiagnosisdiffersfromthe methodusedbyotherregistriesandbecauseofissuesincorrectlyascertainingthevitalstatusofcases. 3.Theanalysiswasconductedusingbothcohortandperiodanalysismethods(Reference:BrennerH, GefellerO.Analternativeapproachtomonitoringcancerpatientsurvival.Cancer.1996;78:2004–10). 4.Expectedsurvivalproportionswerederivedfromsex‐specificcompleteprovinciallifetables

producedbyStatisticsCanada,usingtheEdererIIapproach.(Reference:EdererF,HeiseH.Theeffectof eliminatingdeathsfromcancerongeneralpopulationsurvivalrates(methodologicalnote11,End ResultsEvaluationsection).NationalCancerInstitute;August1959)

5. Periodanalysis was used to estimate the survival for the cases diagnosed 2006 – 2008 for breast, lung andcolorectal;2005–2007forpancreas.Relativesurvivalratiosfor1992to1994werecalculated usingcohortanalysis.Forbreast,lungandcolorectal,thesedataarebasedonpeopleaged15–99years atdiagnosis.SurvivalratiosforNewfoundlandandLabradorarenotshownastheyareartificiallyhigh. Forpancreas,thesedataarebasedonpeopleaged15‐74,MB,NBandPEhassparsedatainsomeofthe agegroups,therefore,resultswerenotpresentedsincetheestimatewouldbeunstable.

(http://surveillance.cancer.gov/joinpoint