Does a centralized radiotherapy system provide adequate access to care?

Mackillop, William J.; Groome, Patti A.; Zhang-Solomons, J; Zhou, Yunzheng; Feldman‐Stewart, Deb; Paszat, Lawrence; Dixon, Peter; Holowaty, Eric J.; Cummings, Bernard

doi:10.1200/jco.1997.15.3.1261

Cited by 110 publications

(57 citation statements)

References 11 publications

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“…Between January 1995 and January 2015, the number of cancer centres providing rt in Canada more than doubled, improving geographic access to rt. Building additional rt centres was motivated in part by long wait times for rt, and evidence that rt utilization declined with distance to the cancer centre and improved when access was more convenient 3,6,7,[11][12][13][14][15] . Improving geographic access by building cancer centres is one way to be patientcentred, because more convenient locations respond to a patient preference to access care closer to home.…”

Section: Figurementioning

confidence: 99%

Patient Preferences for Timing and Access to Radiation Therapy

et al. 2015

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Purpose Patient preferences for radiation therapy (rt) access were investigated. MethodsPatients completing a course of rt at 6 centres received a 17-item survey that rated preferences for time of day; day of week; actual, ideal, and reasonable travel times for rt; and actual, ideal, and reasonable times between referral and first oncologic consultation. Patients receiving single-fraction rt or brachytherapy alone were excluded. ResultsOf the respondents who returned surveys (n = 1053), 54% were women, and 74% had received more than 15 rt fractions. With respect to appointment times, 88% agreed or strongly agreed that rt between 08h00 and 16h30 was preferred; 14%-15% preferred 07h30-08h00 or 16h30-17h00; 10% preferred 17h00-18h00; and 6% or fewer preferred times before 07h30 or after 18h00. A preference not to receive rt before 07h30 or after 18h00 was expressed by 30% or more of the respondents. When days of the week were considered, 18% and 11% would have preferred to receive rt on a Saturday or Sunday respectively; 52% and 55% would have preferred not to receive rt on those days. A travel time of 1 hour or less for rt was reported by 82%, but 61% felt that a travel time of 1 hour or more was reasonable. A first consultation within 2 weeks of referral was felt to be ideal or reasonable by 88% and 73% of patients respectively.Conclusions An rt service designed to meet patient preferences would make most capacity available between 08h00 and 16h30 on weekdays and provide 10%-20% of rt capacity on weekends and during 07h30-08h00 and 16h30-18h00 on weekdays. Approximately 80%, but not all, of the responding patients preferred a 2-week or shorter interval between referral and first oncologic consultation.

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Section: Figurementioning

confidence: 99%

Patient Preferences for Timing and Access to Radiation Therapy

et al. 2015

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“…Like these there are other studies which show better outcomes and cost-effectiveness for RT treatments for different types of cancer and their stages. However, measured access to RT services has established that utilization rates are well below this optimal number (Mackillop et al, 1997;Barton 2000;Einhorn et al 1996;Athas et al, 2000) clearly demonstrating the existence of barriers to access existing RT services.…”

Section: Introductionmentioning

confidence: 99%

“…Since the proximity of RT facilities to home has been identified as a major factor enhancing accessibility to and utilization of RT services (Mackillop et al, 1997;, it is likely that remote and rural patients are facing limited accessibility to radiotherapy on the basis of inadequate transportation and lengthy travel. A literature review has highlighted travel as a perceived barrier to cancer treatment (Payne et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

An approach to plan and evaluate the location of radiotherapy services and its application in the New South Wales, Australia

Shukla

Wickramasuriya

Miller

et al. 2015

Computer Methods and Programs in Biomedicine

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“…Some authors have also suggested that, in addition to a negative emotional and psychological impact, oop costs may influence care-related decisions made by patients [6][7][8][9][10][11][12][13][14] . For example, researchers in Canada have suggested that high oop costs may have discouraged rural, low-income, and insurancedeprived patients from pursuing certain forms of treatment such as breast-conserving surgery [10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

“…For example, researchers in Canada have suggested that high oop costs may have discouraged rural, low-income, and insurancedeprived patients from pursuing certain forms of treatment such as breast-conserving surgery [10][11][12][13][14] . Using qualitative interviews with cancer care providers, researchers in Newfoundland and Labrador (hereinafter Newfoundland) suggested that patients may adopt care-compromising strategies (such as…”

Section: Introductionmentioning

confidence: 99%

Responses by Breast and Prostate Cancer Patients to Out-Of-Pocket Costs in Newfoundland and Labrador

et al. 2013

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Purpose: Cancer patients face substantial care-related out-of-pocket (oop) costs that may influence treatment decisions, attitudes, and use of drug- or appointment-related cost-saving strategies. We examined the relationship between oop costs and care-related responses by patients. Methods: We surveyed 170 prostate and 131 breast cancer patients presenting at clinics or support groups, or listed on the cancer registry in Newfoundland and Labrador. Results: In the 3-month period before the survey, 18.8% of prostate and 25.2% of breast cancer patients had oop costs greater than $500. Those oop costs consumed more than 7.5% of quarterly household income for 15.9% of prostate and 19.1% of breast cancer patients. Few patients (8.8% prostate, 15.3% breast) ever adopted any drug- or appointment-related cost-saving strategy. Few patients (7.2% prostate, 9.6% breast) said oop costs influenced treatment decisions, told their physicians about their oop costs (27.0% prostate, 21.1% breast), or were aware of available financial assistance programs (27.3% prostate, 36.9% breast). Compared with patients having low or moderate oop costs (22.9% prostate, 16.7% breast, and 25.7% prostate, 58.3% breast respectively), a larger proportion of prostate (56.0%) and breast (58.3%) cancer patients with high oop costs said that those costs created stress. Among prostate cancer patients, a larger proportion of those having high oop costs (compared with low or moderate costs) used drug-related (22.2% vs. 3.3% and 9.6% respectively) and appointment-related (11.1% vs. 1.1% and 3.8% respectively) cost-saving strategies, said oop costs created an unusual amount of stress (48.0% vs. 18.4% and 10.4%), and had difficulty paying those costs (29.2% vs. 6.2% and 10.4%). Conclusions: For a small group of breast and prostate cancer patients, oop costs are high, but rarely lead to the use of care-related cost-saving strategies or influence care decisions.

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Does a centralized radiotherapy system provide adequate access to care?

Abstract: The low and uneven rates of radiotherapy use across the province indicate that Ontario's centralized radiotherapy system does not, at present, provide adequate or equitable access to care.

Cited by 110 publications

References 11 publications

Patient Preferences for Timing and Access to Radiation Therapy

Patient Preferences for Timing and Access to Radiation Therapy

An approach to plan and evaluate the location of radiotherapy services and its application in the New South Wales, Australia

Responses by Breast and Prostate Cancer Patients to Out-Of-Pocket Costs in Newfoundland and Labrador

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