Appendix 1.33 - Wait Times Definitions

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Table 1: Urgency Categories by Modality
(Urgency Category numbers revised March 2006)

Urgency Category

Surgery

Radiation Treatment

Systemic Therapy

1

Patients with immediately life-threatening conditions (e.g., airway obstruction, hemorrhage, neurological compromise).

Patients who have an immediately life-threatening condition (e.g., neurological compromise with cord compression, superior vena caval syndrome), which is expected to be treated on an emergent basis.

Patients who have an immediately life-threatening condition (e.g., acute leukemia), which is expected to be treated on an emergent basis.

2

Patients diagnosed with very aggressive tumours, such as central nervous system (CNS) cancer.

Patients who are not considered emergent, but, in the opinion of the treating physician,[1] the treatment should start within one week.  This category would include, for example, very aggressive tumours and some palliative cases. 

Patients who are not considered emergent, but, in the opinion of the treating physician,1 the treatment should start within one week. 

3

All patients with known or suspected invasive cancer that does not meet the criteria of urgency category 2 or 4.

All patients who, in the opinion of the treating physician, do not meet the criteria of category 1 or 2.

All patients who, in the opinion of the treating physician, do not meet the criteria of category 1 or 2.

4

Patients diagnosed with indolent tumours.

N/A

N/A

Table 2: Common Definitions for Wait-Time Events

Wait-time Event

Definition

Comment

Specialist Referral Date

Date on which a request for consultation with a specialist is received in the specialist office.

If the specialist does not accept the referral at this time (e.g., referral form incomplete, workup not complete), this date does not change.

Patients/disease may have multiple specialist referral dates.
One per specialist type.

Specialist Consult Date

First date on which a patient sees the specialist for consultation regarding this specific problem. 

Mandatory for treated patients.
One per patient/disease per specialist type.
Should be linked to a referral date.

Decision to Treat (DTT) Date

Date on which sufficient pre-treatment testing is complete, the physician can reasonably assume that patient will be treated, and the patient has agreed to the treatment.

If the patient is not proceeding straight to that modality of treatment but has a planned delay (other treatment first, patient choice or physician choice) then “Ready to Treat” date needs to be specified.  Otherwise, the DTT date is the same as the RTT date.

For radiation, the decision-to-treat date is when the patient is ready to proceed to planning. 

Mandatory for treated patients.
One per patient/disease/modality/ treatment intent combination.

Patients who are undergoing "watchful waiting" may have a lengthy time interval between the DTT date and the RTT date.

Ready to Treat (RTT) Date

Date on which all pre-treatment testing is complete (for radiation treatment and systemic therapy– when any planned delay is over), and the patient is ready to begin treatment from both a social/personal and medical perspective.  

Mandatory for treated patients.
One per patient/disease/modality/ treatment intent combination

For patients with no planned delay (other treatment first, patient choice or physician choice), the RTT date is equal to the DTT date.

Patients who are undergoing "watchful waiting" may have a lengthy time interval between the DTT date and the RTT date.

Start of Treatment Date

Date of treatment.  This includes date of any therapeutic service or procedure (e.g., surgery, operation, endoscopy, first treatment with radiation treatment or systemic therapy).

Mandatory for treated patients.
One per patient/disease/modality/ treatment intent combination.

Table D-2: Wait-time Definitions Unique to Radiation Treatment

Wait-time Event

Definition

Comment

Radiation Treatment Planning Start Date

Date of first planning event with patient present (i.e., first mould room procedure, first simulator, CT simulator or clinical markup).

Radiation treated patients only.
One for each time radiation treatment is planned for a given patient/disease/ intent combination.

Radiation Treatment Planning End Date

Date of completion of the planning process when all the treatment planning information is ready for the patient to commence radiotherapy, as determined by local procedure

Radiation treated patients only.
One for each time radiation treatment is planned for a given patient/ disease/ intent combination

 

 


[1] This category will include cases that, in the oncologist’s opinion, should be treated within a shorter period than seven days (e.g., within one or two days).  Seven days is simply the upper limit to identify cases for this more urgent category.  These categories will not be used to schedule cases, although the assignment to these categories should be consistent with the urgency category used to triage cases at the centre.

 

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