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Improved processes in Ontario lead to a more efficient cancer system

October 11, 2018

3 min read

Ontario’s cancer system continues to become more efficient according to the 2018 Cancer System Quality Index (CSQI), a quality improvement index that highlights where cancer service providers, including doctors and nurses, can advance the quality of care.


2018 Cancer System Quality Index highlights strengths and challenges of the provincial cancer system


Ontario’s cancer system continues to become more efficient according to the 2018 Cancer System Quality Index (CSQI), a quality improvement index that highlights where cancer service providers, including doctors and nurses, can advance the quality of care. The interactive web-based public reporting tool, released today by the Cancer Quality Council of Ontario (CQCO), indicates that Ontario’s cancer system has been performing well and that people in Ontario continue to receive safe and effective care based on the best evidence from across the care continuum.


“The CSQI allows us to monitor the performance of Ontario’s cancer system each year and make recommendations to improve the quality of care in the province,” said Virginia McLaughlin, Chair of the CQCO. “This year’s results demonstrate that Ontario continues to provide high-quality cancer care, but there is still work to be done to improve cancer care for all Ontarians.”


Measuring System Quality: 2018 CSQI

The CSQI found several improvements to efficiency, quality and effectiveness this year within the cancer system. These improvements show how the system is responding to the benchmarks that are set for each indicator:

  • Screening efficiency for colorectal cancer: Adults who have normal and complete colonoscopies should only be screened every 3 years. The percentage of colonoscopies that occur within 3 years of a normal and complete outpatient colonoscopy is an indicator that measures the appropriateness of colonoscopy and its potential overuse. Ontario is performing well when it comes to screening efficiency for colorectal cancer, based on the decrease in the percentage of Ontarians aged 53 and older who had a second colonoscopy within 36 months of a normal and complete outpatient colonoscopy.
  • Imaging efficiency for staging breast cancer: Practice guidelines do not recommend routine imaging to detect metastatic disease in patients with no symptoms. Ontario is improving when it comes to quality and efficiency for staging tests for breast cancer, based on fewer patients with stage 1 breast cancer who have received at least 1 imaging test to detect distant metastasis.
  • Effective surgical care: To provide the best care, hospitals must have the necessary specialized physical and human resources to provide safe, high-quality and effective surgical care. Some hospitals are designated as having specific resources to provide certain types of surgeries. The number of patients who had their head and neck or gynecologic oncology surgery at a designated centre for these treatments has increased during the 2016/2017 fiscal year and is approaching Cancer Care Ontario’s target of 90%.
  • Quality assurance for radiation therapy: Peer review is central to quality assurance in healthcare. In radiation therapy it is defined as the evaluation of the attending radiation oncologist’s treatment plan by a second radiation oncologist. The percentage of radiation therapy treatment plans that have been peer reviewed by radiation oncologists has increased in Ontario. The current rate is 88%, which is above the target of 75%.


The CQCO encourages Cancer Care Ontario to continue its leadership in driving evidence and quality improvement across the system. It recommends that Cancer Care Ontario prioritize responsive and integrated measures for future reporting by focusing on improvements to real-time measures of patient experience and outcomes, and improved coordination across transition points. Improving access to testing, screening and supportive services have also been identified as priorities for Cancer Care Ontario to address moving forward.


“We welcome the results of this year’s CSQI as it provides key information to help us further advance Ontario’s cancer system,” said Michael Sherar, President & CEO, CCO. “We are committed to working with our regional partners, patients and families, as well as First Nations, Inuit, Métis and urban Indigenous groups across the province to continue to drive quality improvement.”


The CSQI is a quality improvement tool which has been released annually since 2005 and identifies gaps in the cancer system, driving improvement through regional, provincial, national and international benchmarking. The CSQI evolves year-over-year, retiring indicators when performance reaches or surpasses targets, or when there is a more accurate way to measure the system. The CSQI informs Cancer Care Ontario’s overall action plan, helping to determine priorities and allocation of resources.


The 2018 CSQI reports on 31 indicators spanning the cancer care continuum from screening to survivorship, along with several measures related to cancer prevention. Visit to review all the indicators and this year’s interactive reporting tool.