Just over half of the surgeries done on patients with highly aggressive cancers in early 2024 were performed in the recommended time frame
EDITOR’S NOTE: This article originally appeared on The Trillium, a new Village Media website devoted to covering provincial politics at Queen’s Park.
The percentage of cancer surgeries done in Ontario within the recommended time was “still low” early last year, according to the agency overseeing the province’s health-care system.
From January to March last year, 79 per cent of cancer surgeries met the province’s wait-time target.
While this marked a “slight increase” from the first quarter of 2023, when 74 per cent of cancer surgeries were completed within the recommended time, “the percentage of surgeries within target is still low,” according to Ontario Health’s recently tabled 2023–24 annual report.
“To ensure equitable system recovery, focus has been on urgent cancer surgeries which have been consistently prioritized; however, overall volume of surgeries is below target as of Q4,” the agency wrote.
When broken down by priority level, the greater the urgency, the lower the percentage of surgeries completed within the recommended time frame.
The report didn’t include data on Priority 1 surgeries, which are recommended to take place within 24 hours. The other priority levels were included: Priority 2, where the aim is to operate within 14 days; Priority 3, where the goal is 28 days; and Priority 4, where the target is within 84 days.
During the first three months of 2024, 52 per cent of Priority 2 surgeries — performed on what are considered highly aggressive cancers — were completed within the target time of 14 days. Over the first three months of 2023, about 55 per cent of these surgeries were done in the recommended time.
For surgeries clinically characterized as Priority 3, about 72 per cent were performed within the recommended four-week target — up from the prior year’s 66 per cent.
Ninety-three per cent of Priority 4 surgeries were done within the target time, up slightly from 91 per cent the year before.
The Trillium reported earlier this year that between 2020 to the end of August 2024, at least 10 per cent of patients with highly aggressive cancers waited more than 36 days for surgery that the province recommends should be done within 14 days.
Since 2020, the percentage of Priority 2 cancer surgeries completed within the target time each calendar year ranged between 53 per cent and 65 per cent, according to government data The Trillium obtained through the freedom-of-information process.
Dr. David Urbach, professor of surgery at the University of Toronto and head of the Department of Surgery at Women’s College Hospital, told The Trillium at the time that it isn’t surprising to see fewer than 60 per cent of Priority 2 cases done within 14 days as it can be difficult to get a patient ready for surgery within two weeks due to people’s availability or the availability of an operating room.
“Very few operations that aren’t emergencies that don’t need to be done today need to be done within two weeks,” he said at the end of January. “It’s probably fine to be done in 21 days, or 28 days, or even 40 days. It’s not like someone’s on their way out dying … that’s Priority 1, and those patients are in hospital.”
Asked during the recent provincial election campaign if he would guarantee that all Ontarians needing a surgery would get one within the recommended time frame if re-elected, Doug Ford promised “better health care.”
“We’re going to put more money into the system. We’re going to have more doctors because we put more medical seats in universities,” Ford said before being re-elected in February. “We’re going to make sure we put every single penny we can to have a better health-care system and also connect the people … to family physicians.”
Hillary Buchan-Terrell, advocacy manager at the Canadian Cancer Society, said that while there’s been some progress in cancer care since the pandemic, “important gaps remain,” including in reducing surgical wait times for cancer patients.
She said Ontario Health’s report shows wait times in Ontario are “consistent,” but that many people across Canada are still reporting long waits for care.
“Delays are distressing to people with cancer and may result in worse outcomes like later stage at diagnosis, disease progression and poorer survival,” Buchan-Terrell said in a statement to The Trillium.
“Everyone in Ontario deserves timely access to cancer care. That’s why we’re calling on all governments, including Ontario, to work together to establish reasonable, Canada-wide benchmarks for cancer care wait times across the cancer care continuum, set targets for these benchmarks and report annually on progress,” she said.
Buchan-Terrell also called on the province to invest more in the health-care workforce “to support cancer surgeries” impacted by the “health-care crisis.”
Mammograms, fecal test volumes ‘on track’
The Ontario Health report also included data on cancer screening tests, with the number of fecal tests and mammograms completed during the first three months of 2024 surpassing pre-pandemic volumes — which is how the agency measures system performance — and the number of Pap tests falling short.
The target for these screen tests was 105 per cent of pre-pandemic volumes.
In the fourth quarter of 2023-24, there were 227,608 fecal tests done — a 130 per cent increase over the 175,286 tests performed during the fourth quarter of 2019-20 — with Ontario Health writing in its report that “increased access to testing shows improvement in post-pandemic recovery.” These were also more than the 184,575 fecal tests completed during the same period in 2022-23.
The number of mammograms increased by 122 per cent early last year (198,179 tests) compared to pre-pandemic levels (162,536 tests) and during the same quarter the previous year (176,247).
Meanwhile, Pap tests during the fourth quarter of 2023-24 — 183,549 tests — were down, reaching just 78.5 per cent of the pre-pandemic volume (233,840 tests in the fourth quarter of 2018-19).
Ontario Health described this as a “major deviation,” saying in its report that there has been a decline in Pap tests following guideline updates in 2021 that changed the age for starting screening from 21 to 25.
Routine cancer screening through Ontario’s screening programs was paused during the pandemic as the province tried to increase capacity within the health-care system to deal with the rise in COVID-19 cases.
Buchan-Terrell said while it was “encouraging to see that some cancer screening programs are recovering,” the decline in Pap tests was “concerning, especially with rates of cervical cancer rising in recent years.”
“Ontario is now transitioning from Pap tests to HPV testing, which is a more accurate way to screen for cervical cancer,” she said. “As this change happens, it is important to ensure that all Ontarians, and especially those in underserved communities, have equitable access to testing — including self-sampling options.”
Neither Ontario Health nor Health Minister Sylvia Jones’ office responded to questions or requests for more recent data before publication.