Delays in access to cancer diagnoses and treatment leads to poorer survival outcomes.1 Poor communication from healthcare providers can stem from delays, and people with cancer may have unaddressed anxieties or feel uncertainty. All of these factors can negatively affect the mental wellbeing of those living with cancer.2 3 In 2008, Cancer Care Ontario implemented the Diagnostic Assessment Programs (DAPs) as part of their Ontario Cancer Plan.4 DAPs were developed for lung, colorectal and prostate cancers, and aimed to decrease waiting times for diagnosis and treatment, while also improving the coordination and communication of care to better the patient experience.5 DAPs also included the use of an electronic pathway solution (EPS) to facilitate communication between healthcare providers and people living with cancer.6 The implementation of DAPs was found to improve the efficiency and effectiveness of cancer diagnoses, while the inclusion of an EPS was found to reduce patient anxieties during the diagnostic process.5 7


For those with a suspicion of cancer, the period between the point of suspicion and diagnosis is complex; it can be difficult to navigate this stage, particularly alongside anxieties about a possible cancer diagnosis. The number of tests and consultations that a person has to undergo, as well as the lack of comprehensive and informative communication from healthcare professionals, can be intimidating and leave people confused and worried, affecting their mental .3 Over 50% of have emotional concerns upon a cancer diagnosis but are not referred to support services.2

A delay in the time to diagnosis can also cause poorer outcomes for people with cancer.8 Diagnosing colorectal cancer at an early stage increases the chance of survival eight-fold, while an early diagnosis for lung cancer increases the chance of survival five-fold.1

Even after cancer is diagnosed, there are also delays in the time to commence treatment. Again, this is a mentally and emotionally taxing time for people with cancer, who may experience further uncertainty, anxiety and confusion. A delay in treatment after diagnosis also has an impact on clinical outcomes. People whose treatment for cancer is delayed by one month have a 6–13% higher risk of dying; this rate continues to rise the longer treatment is delayed.9


Between 2008 and 2019, Cancer Care Ontario ran the Diagnostic Assessment Programs (DAPs) as part of their Ontario Cancer Plan.4 5 The programmes aimed to improve the experience of people with cancer during the diagnostic phase of the cancer care continuum. DAPs sought to do this by providing people with shorter waiting times to diagnosis and treatment and enhancing coordination of care.10 DAPs were developed for lung, colorectal and prostate cancers.4 Their primary purpose was to:4 10

  • Improve the quality and accessibility of diagnostic care for people with cancer by providing a single point of access for all diagnostic services
  • Advance a person-centred approach in diagnostic care by providing timely information and support throughout the process
  • Streamline scheduling and coordination of tests and consultations by driving integrated-care delivery among services and providers
  • Maximise the value of the care delivered by reducing waiting times and costs.

When a person presented at the point of suspicion of cancer, they were referred to their relevant DAP which then provided access to a multidisciplinary care team (MDT).5 The MDT consisted of a range of healthcare professionals, including pathologists, oncologists, psychologists, radiographers and oncology researchers. The MDT engages, educates and assists people living with cancer, and their loved ones, families or carers, in overcoming barriers to accessing healthcare. The MDT also included a nurse navigator who was the main point of contact for the person with cancer. The nurse navigator was responsible for coordinating all testing and consultations throughout the diagnostic journey, as well as providing psychosocial support and enhancing the availability of resources for people living with cancer.5 10

DAPs also included an electronic pathway solution (EPS) to improve the level of communication and information received by people living with cancer, and to help them navigate the cancer care continuum. EPS also ensures better patient management, increased productivity and a more streamlined workflow for healthcare providers.6 7

What has been achieved?

An evaluation of DAPs showed that they improved the efficiency and effectiveness of cancer diagnoses, and the quality and experience of care for people with suspected cancer.5 DAPs did this by offering streamlined access to an integrated MDT which led to earlier-stage diagnosis. Earlier diagnosis has been shown to improve clinical outcomes in people with lung and colorectal cancer.1 11 12 The inclusion of a nurse navigator as part of the MDT was shown to improve times to early referral, diagnosis, staging and treatment in people with lung cancer.13

An EPS was shown to compliment DAPs, with 72% of the people surveyed saying it helped them to understand their health problems, and 78% saying it helped to improve their knowledge of their own health.7 The people surveyed also said that the EPS made them feel more at ease while waiting for diagnosis or treatment, as the information was easily accessible, allowing them to take ownership over their personal schedules.7

Next steps

DAPs are still in operation after the completion of the pilot programme in 2019, with the funding for DAPs now being built into regional operational budgets.14 Other jurisdictions in Canada are also interested in the care model and the lessons learnt from the development of the existing DAPs are being shared to enable the implementation across Canada.14

DAPs are expected to be included as a priority in Ontario’s next provincial cancer plan in March 2024. There is also a possibility that the plan may be expanded to include symptom assessment programmes.14


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