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Golemiec B, Robertson M, Poon V, Foley M, Parker CM, McGann C, O'Callaghan N, Digby GC. Improving Access to Care, Patient Costs, and Environmental Impact Through a Community Outreach Lung Cancer Rapid Assessment Clinic. JCO Oncol Pract 2024; 20:1123-1131. [PMID: 38696740 PMCID: PMC11368164 DOI: 10.1200/op.23.00657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
PURPOSE In Southeastern Ontario, increased patient distance from the regional lung cancer diagnostic assessment program (LDAP) is associated with a lower likelihood of patient care via LDAP while receiving care via LDAP is associated with improved survival. We implemented an LDAP outreach clinic to provide specialist assessment for patients with suspected lung cancer at a regional community hospital and assessed the impact on timeliness and accessibility of care. MATERIALS AND METHODS The Kingston Health Sciences Centre LDAP team engaged with community hospital partners to develop and launch the LDAP outreach clinic. We performed a retrospective chart review of LDAP patients (N = 1,070) before (August-November 2021; n = 234) and after implementation of the outreach clinic (November 2021-October 2022; n = 836). Descriptive data are reported as No. (%). Unpaired t tests and statistical process control charts assess for significance. A cost analysis of out-of-pocket patient costs related to travel and parking is presented in 2022 Canadian dollars (CAD). RESULTS Compared with a 3-month matched time period before (August-October 2021) and after outreach clinic (August-October 2022), the mean time from referral to assessment and time from referral to diagnosis decreased from 20.3 to 14.4 days (P = .0019) and 40.0 to 28.9 days (P = .0007), respectively. Over 12 months, the total patient travel was reduced by 8,856 km, which combined with parking cost-savings, resulted in patient out-of-pocket savings of CAD $5,755.60 (CAD $47.60/patient). Accounting for physician travel, the total travel saved was 5,688 km, corresponding to reduced CO2 emissions by 1.9 tCO2. CONCLUSION Implementation of a lung cancer outreach clinic led to improved timeliness of care, patient cost-savings, and reduced carbon footprint while serving patients in their community.
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Affiliation(s)
- Breanne Golemiec
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, Queen's University, Kingston, ON, Canada
| | - Madison Robertson
- Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Vincent Poon
- Department of Medicine, Division of Medical Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Mary Foley
- Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Christopher M. Parker
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, Queen's University, Kingston, ON, Canada
| | - Craig McGann
- Division of Respirology, Queen's University, Kingston, ON, Canada
| | - Nicole O'Callaghan
- Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Geneviève C. Digby
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
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Characterizing Regional Variability in Lung Cancer Outcomes across Ontario-A Population-Based Analysis. Curr Oncol 2022; 29:9640-9659. [PMID: 36547171 PMCID: PMC9777041 DOI: 10.3390/curroncol29120757] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Lung cancer (LC) is the leading cause of cancer-related mortality. In Ontario, Canada, there are significant survival differences for patients with newly diagnosed LC across the 14 provincial regions. Methods: A population-based retrospective cohort study using ICES databases from 01/2007-12/2017 identified patients with newly diagnosed LC through the Ontario Cancer Registry and those with LC as the cause of death. Descriptive data included patient, disease, and system characteristics. The primary outcome was 5-year survival by region. Results: 178,202 patient records were identified; 101,263 met inclusion criteria. LC incidence varied by region (5.6-14.6/10,000), as did histologic subtype (adenocarcinoma: 27.3-46.1%). Five-year cancer-specific survival was impacted by age, rurality, pathologic subtype, stage at diagnosis, and income quintile. Timely care was inversely related to survival (fastest quintile: HR 3.22, p < 0.0001). Adjusted 5-year cancer-specific survival varied across regions (24.1%, HR 1.12; 34.0%, HR 0.89, p < 0.001). Conclusions: When adjusting for confounders, differences in survival by health region persisted, suggesting a complex interplay between patient, disease, and system factors. A single approach to improving patient care is likely to be ineffective across different systems. Quality improvement initiatives to improve patient outcomes require different approaches amongst health regions to address local disparities in care.
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Webber C, Brundage M, Hanna TP, Booth CM, Kennedy E, Kong W, Peng Y, Whitehead M, Groome PA. Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort study. BMJ Open 2022; 12:e059597. [PMID: 36123112 PMCID: PMC9486232 DOI: 10.1136/bmjopen-2021-059597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Regional variation in cancer survival is an important health system performance measurement. We evaluated if regional variation in colon cancer survival may be driven by differences in the patient population, their health and healthcare utilisation, and/or cancer care delivery. DESIGN Population-based retrospective cohort study using routinely collected linked health administrative data. SETTING Ontario, Canada. PARTICIPANTS Patients with colon cancer diagnosed between 1 January 2009 and 31 December 2012. OUTCOME Cancer-specific survival was compared across the province's 14 health regions. Using accelerated failure time models, we assessed whether regional survival variations were mediated through differences in case mix, including age, sex, comorbidities, stage at diagnosis and colon subsite, potential marginalisation and/or prediagnosis healthcare. RESULTS The study population included 16 895 patients with colon cancer. There was statistically significant regional variation in cancer-specific survival. Three regions had cancer-specific survival that was between 30% (95% CI 1.03 to 1.65) and 39% (95% CI 1.13 to 1.71) longer and one region had cancer-specific survival that was 26% shorter (95% CI 0.58 to 0.93) than the reference region. For three of these regions, case mix explained between 26% and 56% of the survival variation. Further adjustment for rurality explained 22% of the remaining survival variation in one region. Adjustment for continuity of primary care and the diagnostic interval length explained 10% and 11% of the remaining survival variation in two other regions. Socioeconomic marginalisation, recent immigration and colonoscopy history did not explain colon cancer survival variation. CONCLUSIONS Case mix accounted for much of the regional variation in colon cancer survival, indicating that efforts to monitor the quality of cancer care through survival metrics should consider case mix when reporting regional survival differences. Future work should repeat this approach in other settings and other cancer sites considering a broad range of potential mediators.
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Affiliation(s)
- Colleen Webber
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Brundage
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Timothy P Hanna
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Erin Kennedy
- University of Toronto, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Weidong Kong
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Yingwei Peng
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
- Department of Mathematics and Statistics, Queen's University, Kingston, Ontario, Canada
| | | | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
- ICES, Kingston, Ontario, Canada
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Patel S, McClintock C, Booth C, Merchant S, Heneghan C, Bankhead C. Variations in Care and Real World Outcomes in those with Rectal Cancer: A protocol for the Ontario Rectal Cancer Cohort (OntaReCC) (Preprint). JMIR Res Protoc 2022; 11:e38874. [PMID: 35930352 PMCID: PMC9391972 DOI: 10.2196/38874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with rectal cancer require a number of pretreatment investigations, often require multidisciplinary treatment, and require ongoing follow-ups after treatment is completed. Due to the complexity of treatments, large variations in practice patterns and outcomes have been identified. At present, few comprehensive, population-level data sets are available for assessing interventions and outcomes in this group. Objective Our study aims to create a comprehensive database of individuals with rectal cancer who have been treated in a single-payer, universal health care system. This database will provide an excellent resource that investigators can use to study variations in the delivery of care to and real-world outcomes of this population. Methods The Ontario Rectal Cancer Cohort database will include comprehensive details about the management and outcomes of individuals with rectal cancer who have been diagnosed in Ontario, Canada (population: 14.6 million), between 2010 and 2019. Linked administrative data sets will be used to construct this comprehensive database. Individual and care provider characteristics, investigations, treatments, follow-ups, and outcomes will be derived and linked. Surgical pathology details, including the stage of disease, histopathology characteristics, and the quality of surgical excision, will be included. Ethics approval for this study was obtained through the Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board. Results Approximately 20,000 individuals who meet the inclusion criteria for this study have been identified. Data analysis is ongoing, with an expected completion date of March 2023. This study was funded through the Canadian Institute of Health Research Operating Grant. Conclusions The Ontario Rectal Cancer Cohort will include a comprehensive data set of individuals with rectal cancer who received care within a single-payer, universal health care system. This cohort will be used to determine factors associated with regional variability and adherence to recommended care, and it will allow for an assessment of a number of understudied areas within the delivery of rectal cancer treatment. International Registered Report Identifier (IRRID) RR1-10.2196/38874
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Affiliation(s)
- Sunil Patel
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Chad McClintock
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Shaila Merchant
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Carl Heneghan
- Centre for Evidence Medicine, University of Oxford, Oxford, United Kingdom
| | - Clare Bankhead
- Centre for Evidence Medicine, University of Oxford, Oxford, United Kingdom
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