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Waits for cancer biopsies not meeting targets: Auditor General

Last Updated Dec 6, 2017 at 7:01 pm EST

Long wait times for cancer biopsies, underuse of radiation therapy and millions of dollars paid to U.S. hospitals for stem cell transplants are some of the health-care issues highlighted in a report by Ontario’s auditor general.

The report, released Wednesday, looked at Ontario’s $1.6-billion annual cancer care system, concluding that while most patients are well-served, long waits for certain procedures and inefficiencies related to others remain in some areas of care.

“Our audit of cancer treatment services found that Ontarians needs were not fully being met in the areas of radiation treatment, … scans and wait times for some urgent cancer surgeries and diagnostic services,” Auditor General Bonnie Lysyk said.

The audit found that only 46 per cent of key biopsies to diagnose cancer are performed within the Ministry of Health’s 14-day target. It also found that a provincial target to provide radiation therapy in 48 per cent of cancer cases has not been met, with only 39 per cent of patients receiving the treatment in 2015-2016.

The report also noted that the government is spending millions to send cancer patients to the United States for stem cell transplants because of limited capacity to perform the procedure in Ontario. The cost to send a patent out of province for the treatment is $660,000 compared to $128,000 on average in the province.

The Ministry of Health paid $35 million to U.S. hospitals to perform the transplants on 53 patients between October 2015 and June 2017. Projections call for another 106 patients to be sent to the U.S. for transplants from July 2017 to the end of 2020-2021.

Only in 2016-2017 did the province approve capital projects to expand stem cell transplants in Ontario. Earlier planning could have mitigated many of those difficulties, Lysyk said.

“The province’s limited capacity to perform stem cell transplants was first identified as an issue in 2009,” she said. “In the next six years, this issue led to excessive wait times and costly out-of-country procedures.”

Health Minister Eric Hoskins said the province spent $31 million this year to bolster the health system’s ability to provide stem cell transplants for patients at home.

“We’ve changed the funding formula so I think we recognize more accurately the type of effort that goes into supporting an individual and a family that faces this challenge in life,” he said.

The report also says the full cost of cancer drugs is not covered for patients if they are not administered in hospital. In British Columbia, Alberta, Saskatchewan and Manitoba such drug coverage is provided regardless of where the drugs are taken.

More than 29,000 people died of cancer in Ontario in 2016, making it the leading cause of death in the province. The government estimates that about half of all Ontario residents will develop cancer in their lifetime and one in four will die from it.

Here are some highlights of the report:

– Nine coal and gas generators claimed as much as $260 million in ineligible expenses for items including thousands of dollars each year for raccoon traps, scuba gear, carpet cleaning and staff car washes.

– The Independent Electricity System Operator has not implemented some recommendations made by the Ontario Energy Board which could have saved ratepayers millions over the past 15 years.

– The report found long wait times for key biopsies to diagnose cancer, with only 46 per cent performed within the Ministry of Health’s 14-day target.

– The government is spending millions to send cancer patients to the United States for stem cell transplants because of limited capacity to perform the procedure in Ontario. A stem cell transplant costs $660,000 to perform in the United States, compared to the $128,000 average cost in Ontario.

– A provincial target to provide radiation therapy in 48 per cent of cancer cases has not been met, with 39 per cent of patients actually receiving the treatment in 2015-2016.

– There are more households on wait lists for social housing than actual people living in social housing in Ontario. The report found there are 185,000 households on the provincial wait list and 167,000 households who on average receive social housing annually.

– Sick days are up by 29 per cent over a five-year-period at 50 of Ontario’s public school boards _ from nine days to 11.6 days per average employee _ causing financial and resource allocation pressures.

– The increased cost of sick leave paid as a percentage of school board payroll rose from 4.2 per cent in 2011-2012 to 5.3 per cent in 2015-16. The change came after the last collective bargaining agreement stopped allowing teachers to bank their sick days.

– The province is not prepared for a large-scale emergency, the auditor found, and has not updated its emergency preparedness plan or provincial nuclear response plan since 2008 and 2009 respectively.

– Staffing and budget cuts at the province’s Emergency Management Office have limited its ability to respond to a prolonged event, with the report estimating it could not adequately respond to a disaster longer than two-weeks with current staffing levels.

– Government advertising spending was $58 million in 2016-17, a 10-year high, with what the auditor describes as 30 per cent of the ads appearing intended to help make the government look good.

– The government paid almost $19 million in 2016-17 to operate and maintain 812 vacant buildings across the province. Approximately 600 of them were unoccupied for an average of eight years.