At least 10 per cent of patients with highly aggressive cancers waited more than double the province’s recommended time for surgery during the past several years, according to provincial government data.
From 2020 to the end of August last year, these patients waited more than 36 days for a surgery that the province recommends should be done within 14 days, Ontario Health data obtained by The Trillium shows.
While some doctors offered some caution when interpreting the data, they also said the health system could be improved. Leaders of the province's political parties have spoken while on the campaign trail about ways they'd try to do that.
Ontario Health's data breaks down cancer surgery wait times according to priority levels. These include Priority 2 (urgent), where the aim is to operate within 14 days; Priority 3 (semi-urgent), where the goal is 28 days; and Priority 4 (elective), where the target is within 84 days. Priority 1 refers to emergency cases where surgeries are recommended to take place within 24 hours.
The data — which doesn’t include emergency cases, diagnostic, palliative and reconstructive cancer surgeries, or skin surgeries — also shows fewer urgent surgeries are done within the target time than less urgent ones.
From January to the end of August last year, 58 per cent of Priority 2 cancer surgeries, considered highly aggressive, were done within the target of 14 days, compared to 93 per cent of Priority 4 cases. The latter was the same in 2019, but more Priority 2 cancer surgeries — 76 per cent — were done within the recommended time that year, according to the data.
Since 2020, the percentage of Priority 2 cancer surgeries completed within the target time ranged between 53 per cent and 65 per cent.
Asked on Monday at a press conference in Oakville about the cancer surgery wait times outlined in the Ontario Health data, Progressive Conservative Leader Doug Ford said the issue is one he can relate to.
“That's close to my heart and probably close to everyone's heart in this place,” Ford said. “My brother died of cancer, my mother died of cancer, my father died of cancer.”
He said the province, under his PC government, boosted health spending by billions and has been “pouring money” into cancer research and supporting those with cancer.
Ford then steered to the focus of his campaign, protecting the economy in the face of U.S. President Donald Trump’s tariff threats, saying these health investments can’t be made without a strong economy.
A spokesperson for the PC Party later added that the province has increased its capacity since 2018 for “publicly funded, same-day hip and knee surgeries by 4,260 per cent and 5,840 per cent, respectively.”
The party spokesperson said that in addition to boosting access to diagnostic imaging, there’s been a reduction in the number of people waiting beyond the recommended time for a surgery, with “81 per cent of surgeries completed within the targeted window—an 11 per cent improvement over the past three years.”
Asked if he would guarantee that all Ontarians needing a surgery would get one within the recommended time frame if he’s re-elected, Ford wouldn’t say.
“What my promise is — we're going to have 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,” the PC leader said. “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.”
Last week, NDP Leader Marit Stiles promised as part of her party’s health-care platform to implement a centralized referral system for specialist treatment. Asked what more she’d do to cut surgical waitlists, Stiles said Monday that connecting people to a primary care team and establishing “safe nurse-to-patient staffing ratios” are “critical components” to get people the care they need.
Liberal Leader Bonnie Crombie also talked about recruiting more family doctors — with her party promising to connect every Ontarian to one within four years.
“That will get that diagnosis done and people into treatment as quickly as possible,” Crombie said. “We know that over 11,000 people died waiting for care and waiting for treatment. We know that 2,000 people each and every day get treated in a hallway or in an auditorium or in a doorway, and that's completely unacceptable.”
However, some health-care experts said it's not necessarily bad news when patients miss the target time frame for their cancer surgeries.
Dr. David Urbach, professor of surgery at the University of Toronto and head of the Department of Surgery at Women's College Hospital, said that 90 per cent of Priority 2 patients having surgery within 36 days for most of last year is “not at all bad.”
Just 58 per cent of Priority 2 cases being done within 14 days during the same period last year was “not at all surprising,” Urbach said, because it’s often difficult to get a patient ready for surgery within two weeks due to people’s availability or the availability of an operating room.
He said even with unlimited operating room time or money, it’s unlikely those surgeries would all get done within 14 days “just because somebody would want their mother to come from the Philippines or somebody would want to just tell their work another week,” he said, adding that patients might also want to do additional tests or repeat blood tests. “We're not talking about somebody who's dying of a heart attack, who needs to have surgery right away.”
“Very few operations that aren't emergencies that don't need to be done today need to be done within two weeks,” Urbach said. “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.”
He said 14 days in most cases is probably an “overestimate of how urgently the surgery has to happen,” and that he doesn’t think a few extra days or weeks would threaten patients’ survival.
“Cancer evolves and progresses and spreads over the course of many years,” Urbach said.
Another thing to keep in mind, he said, is the “random error” in the priority level that surgical cases are assigned, noting that some Priority 2 cases are really Priority 3 cases.
Even so, Urbach said there are ways to improve the surgical system, both cancer and non-cancer surgeries, including through “central intake” models and team-based care where surgeons work together through a “next available” approach.
Dr. David Gomez, a general surgeon and associate professor of surgery at the University of Toronto, said 56 per cent of Priority 2 surgeries being completed within target wait times in 2023 is “not ideal,” but added that the data doesn’t tell the whole story, including the specific types of cancer.
“Cancers are dramatically heterogeneous … and delays or not completing something within target can have different effects,” Gomez said.
“(The data) shows that for low priority things, the system remains unchanged, and even in the thick of the pandemic, was able to provide over 80 per cent timely care for priority three and four, which is, I think, part of a good news story,” he said.
“But there appeared to be some challenges in the most recent data with the most urgent cases, and that requires further investigation as to what diseases we're looking at, is this homogeneous across the province, or are there some regions that are the drivers of this?” he said.
Like Urbach, Gomez also said there are ways to improve the system, including “strengthening” primary care so people don’t face delays in getting referrals for initial diagnostic tests and ensuring timely access to diagnostics and surgeries.
Gomez disagreed with the Progressive Conservatives’ recent push to expand surgical capacity in private clinics.
“This does not lead to equitable care," he said. "It will lead to a higher volume of procedures performed in a faster way for those that have the capacity to pay, but will not overall improve the capacity for the vast majority of people that live in these areas."
Gomez said he’d like surgical capacity expanded “in a model that already exists,” adding that many hospital operating rooms “sit idle after 3 p.m.” or on weekends because they’re not funded for additional hours.
Dr. Dominik Nowak, president of the Ontario Medical Association, said Ontarians are “experiencing severe waits” in the health-care system, including when trying to find a family doctor.
“Because of that, people are getting diagnosed later with serious conditions, including cancers,” Nowak said, adding that when people are diagnosed with more severe cancers and have to wait for treatment, “it would mean that the cancers that they have end up being less treatable and more expensive to treat.”
Nowak said Ontarians, especially those with serious conditions like cancer, “deserve to get treatment for it rapidly and effectively and close to home, and for too many people right now, that's just not happening.”
“We need a health-care system that the government gets back on track, including getting everybody a family doctor, but then also making sure that the waitlists, especially for serious conditions … are acceptable and acknowledge that the wait actually has a big impact on prognosis,” he added.
Jasmine Brown, advocacy manager of cancer care systems at the Canadian Cancer Society, echoed this. Her organization continues to hear concerns about longer wait times for cancer care, she said.
“This can cause anxiety as any delay in cancer care may result in worse outcomes, including disease progression and an increased risk of death,” Brown said in a statement.
“All Ontarians deserve timely access to care. Our health-care system must be equipped to prioritize and sustain timely and equitable access to cancer care, and we urge decision-makers to prioritize the needs of people who are impacted by cancer,” she said. “Addressing the human resources crisis ultimately leads to a more resilient and effective health-care system and ensures that patients can access health-care services when they need to.”
The Trillium requested an interview with an Ontario Health official but instead got an email noting that since 2022, more cancer surgeries had been performed than before the pandemic and that breast and colorectal cancer screening rates were also higher than they previously were.
-With files from Charlie Pinkerton and data visualizations by Jessica Smith Cross
