Access to Oncology Consultation in a Cancer Cohort in Northeastern Ontario

Abstract

BackgroundTo enhance cancer symptom management for residents of Sudbury–Manitoulin District, an ambulatory palliative clinic (pac) was established at the Northeast Cancer Centre of Health Sciences North. The pac is accessed from a medical or radiation oncology consultation. The primary purpose of the present population-based retrospective study was to estimate the percentage of cancer patients who died without ever having a medical or radiation oncology consultation. A secondary purpose was to determine factors associated with never having received one of those specialized consultations.MethodsAdministrative data was obtained through the Ontario Cancer Data Linkage Project. For each index case, we constructed a timeline, in days, of all Ontario Health Insurance Plan billing codes and associated service dates starting with the primary cancer diagnosis and ending with death.ResultsWithin the 5-year study period (2004–2008), 6683 people in the area of interest with a valid record of primary cancer diagnosis died from any cause. Most (n = 5988, 89.6%) had 1 primary cancer diagnosis. For that subgroup, excluding those with a disease duration of 0 days (n = 67), about 18.4% (n = 1088) never had a consultation with a medical or radiation oncologist throughout their disease trajectory. Patients who were older or who resided in a rural area were significantly less likely to have had a consultation.ConclusionsSpecific strategies directed toward older and rural patients might help to address this important access-to-care issue.

Material deprivation and access to cancer care in a universal health care system

“…Frequency of medical oncology consultation differs by cancer site and geographic region and ranges from 65% for advanced pancreatic cancer to 78% for colon cancer 12,31,32 . Only 1 other study examined the effect of income on the receipt of cancer consultation in a universal health care setting, and it found similar results 33 . Our observations are also in line with studies in private and public health systems identifying income as a barrier to chemotherapy 32,34 .…”

Access to Palliative Care for Cancer Patients Living in a Northern and Rural Environment in Ontario, Canada: The Effects of Geographic Region and Rurality on End-of-Life Care in a Population-Based Decedent Cancer Cohort

“…Rural residents, however, did not demonstrate higher use of chemotherapy or ICU admissions. Some authors report that cancer patients in rural areas of Ontario are less likely to have access to cancer care resources, 17,44,45 which could contribute to rural residents being more likely to have aggressive end-of-life care. 6,7 In addition, high use of ED and hospital resources by rural residents may have occurred as a result of resource access or availability in rural areas-where EDs are being used for situations that may be addressed within ambulatory settings in urban areas.…”

“…10 Previously published research references inequity issues of access to resources, lengthy travel to urban centers to obtain palliative services, as well as a lack of available health care professionals and health care resources. [11][12][13][14][15][16][17] Furthermore, many rural residents often wish to receive care in their community with their families to avoid travel-related issues and costs. 18 Some additional barriers to accessing palliative care in rural areas also included lower socioeconomic status, a misunderstanding of what palliative care treatment is, and health care providers feeling ill-equipped to manage the care needs of patients nearing their end of life.…”

A Comparison Between the Rates of Radiation Oncologist and Urologist Consultations in Men Diagnosed With Prostate Cancer in Northern Ontario, Canada

“… 10 Recent findings demonstrated that rurality was one of the variables associated with lower oncology consultations in a decedent cancer cohort. 11 Furthermore, a rural geographic location was also associated with reduced access to palliative care services. 12 Of note, these studies both examined access to these health care services in Northeastern Ontario, Canada, a geographic area classified, in general, as more rural.…”

“…Health care regions in Ontario are categorized into 14 Local Health Integrated Networks (LHINs), and the North East LHIN (region 13) has a land mass that covers approximately 400,000 square kilometers, providing health care to approximately 565,000 residents (2017 estimate), with 30.2% of the population residing in rural regions. 11 , 13 , 14 When taken together the population of northern Ontario (both northeast and northwest combined) comprises approximately 6% of the total population in Ontario 11 , 12 , 13 and is characterized by less proximity to necessary health care resources, with patients usually incurring greater travel times and undertaking greater personal expenses to receive these services. 10 , 13…”