New and Revised Definitions A Quick Summary Wait Times Measurement Toolkit

Wait Time Project: Definitions Specialist Referral Date –The date on which a request for consultation with a specialist (Rad Onc, Med Onc) is received at the ICP (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. –Example: Date on the fax Date of the phone call

Wait Time Project: Definitions Decision-to-Treat (DTT ) –The date on which sufficient pre-treatment testing is completed that the physician can reasonably assume that the patient will be treated, and the patient has agreed to the treatment. Ready-to-Treat (RTT) –The date when any planned delay is over, and the patient is ready to begin treatment from both a social/ personal and medical perspective. Planned Delay –Other cancer treatment first –Patient choice (e.g., vacation or other personal business) –Physician choice (e.g., for medical reasons)

Decision-to-Treat and Ready-to-Treat Dates The intent is to separate resource-based waits from planned waits, to appropriately reflect wait times on public and CCO intranet sites, and for System Administrators and Managers –In order to achieve this, it is essential to document key dates and identify patients requiring other cancer treatments prior so they are included in the appropriate wait time interval.

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

Decision-to-Treat Date If the physician is waiting for diagnostic tests, e.g. CT, to determine if the radiation or systemic treatment is appropriate, then DTT is after the test results are available. The wait for CT will be reflected in the “referral to consult or decision to treat to treatment” time frames. If there is no planned delay, the DTT and RTT dates for treatment are the same.

Ready-to-Treat Date This newly defined event is the date on which any planned delay is over, and the patient is ready to begin treatment from both a social/personal and medical perspective. The RTT date is the same as the DTT date unless there is a planned delay. If the patient is not proceeding straight to radiation or systemic treatment, but has a planned delay (other cancer treatment first, patient choice or physician choice) then “Ready to Treat” date MUST be specified.

Ready-to-Treat Date The RTT must be specified by the treating Oncologist. It is not necessarily connected to the treatment start date or a treatment planning event. DTT and RTT are Mandatory. RTT can be updated, if original estimate is incorrect.

No Planned Delay DTT and RTT date Consult Date Start of Treatment Date RTT to Start of Treatment If there is no planned delay, the RTT date = the DTT date Consult to DTT

With Planned Delay DTT date Consult Date Start of Treatment Date RTT to Start of Treatment With planned Delay, the DTT does not equal the RTT. The planned delay is not reported as part of the wait time. RTT date Planned delay Consult to DTT Other cancer Tx, Patient or Physician choice

Ready-to-Treat Date: “Other Cancer Treatment First” Patient receiving chemotherapy first, then proceeding to radiation; DTT = decision to treat w rads, and does not equal RTT for rads; RTT = expected date of recovery following completion of chemo. Patient receiving hormone therapy prior to radiation; same as above, RTT = when hormone therapy completed and the patient recovered enough to start Radiation Treatment. Patient requiring surgery prior to radiation or systemic treatment; RTT = after surgery recovery date.

Ready-to-Treat Date: “Patient Choice Example” Patient decides to delay radiation or systemic treatment; RTT is after DTT, when patient is ready to proceed.

Ready-to-Treat Date: “Physician Choice Example” Physician decides to delay radiation or systemic treatment until the patient is physically and emotionally ready; RTT is after DTT, when patient is ready to proceed.

DTT and RTT: “Radiation Examples” Patient requires gold seed implants prior to external beam radiation; DTT = RTT; RTT is NOT changed to reflect wait for implant; this is considered part of the treatment planning process. Patient requires dental extraction prior to radiation, DTT = RTT; RTT is NOT changed to reflect wait for dentist. Patient receiving HDR prior to external beam – this is part of treatment plan; DTT = RTT and is the date decided to proceed with entire treatment plan.

DTT and RTT: Examples cont… If imaging, e.g. CT, or other procedures are required to assist in developing a treatment plan for a patient, these are considered part of the treatment planning process; DTT = RTT If patient requires a PICC insertion to assist with chemo drug administration, this is not considered a planned delay; DTT = RTT