Jessica Chan1, Alfredo Polo2, Eduardo Zubizarreta2, Jean-Marc Bourque3, Timothy P Hanna4, Marc Gaudet5, Kristopher Dennis5, Michael Brundage4, Ben Slotman6, May Abdel-Wahab2. 1. Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Canada; Division of Human Health, International Atomic Energy Agency, Vienna, Austria; Department of Radiation Oncology, Amsterdam UMC - Vrije University Medical Center, The Netherlands. Electronic address: jchan207@uottawa.ca. 2. Division of Human Health, International Atomic Energy Agency, Vienna, Austria. 3. Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Canada; Division of Human Health, International Atomic Energy Agency, Vienna, Austria; Institute of Cancer Policy, Kings College London, United Kingdom. 4. Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Canada. 5. Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Canada. 6. Department of Radiation Oncology, Amsterdam UMC - Vrije University Medical Center, The Netherlands.
Abstract
BACKGROUND AND PURPOSE: Canada is a high-income country with universal healthcare. In international comparisons, its overall level of access to radiotherapy appears sufficient. However, challenges exist due to Canada's large geographic area and small population density. The association between access and cancer outcomes nationally has not yet been described. MATERIALS AND METHODS: We quantified geographic accessibility for 2012 using the linear distance from each Canadian health region centroid to the nearest radiotherapy center. We used geospatial analytic techniques to detect clusters of age-standardized all-cancer mortality-to-incidence ratios (MIRs) across health regions, from 2010-2012. Global ordinary least squares (OLS) and geographically-weighted regression (GWR) were conducted to examine relationships between distance and MIR, adjusting for sociodemographic factors. RESULTS: Median distance from health region centroid to nearest radiotherapy center was 101.73 km (range 1.14-2095.12). One cluster of worse outcomes (MIR range 0.45-0.88) involved most of northern Canada, with a second cluster of better outcomes (MIR range 0.40-0.41) in southern British Columbia. In both regression models, regions with longer distance to radiotherapy center (ß = 0.0001), increased smoking (ß = 0.002), and poorer food security (ß = -0.003) were significantly associated with worse outcomes (OLS R2 = 0.70, GWR R2 = 0.74). Distance remained independently associated with MIR for lung and colorectal cancer subgroups, but not breast and prostate. CONCLUSIONS: A clear north-south discordance in cancer outcomes exists in Canada, with poorer outcomes in the north, while radiotherapy centers are concentrated along the south. Increased distance to radiotherapy, along with other sociodemographic and health-system factors, are associated with poorer cancer outcomes. Our study could be replicated, particularly in other high-income countries, to help identify national patterns and regional disparities in access and outcomes.
BACKGROUND AND PURPOSE: Canada is a high-income country with universal healthcare. In international comparisons, its overall level of access to radiotherapy appears sufficient. However, challenges exist due to Canada's large geographic area and small population density. The association between access and cancer outcomes nationally has not yet been described. MATERIALS AND METHODS: We quantified geographic accessibility for 2012 using the linear distance from each Canadian health region centroid to the nearest radiotherapy center. We used geospatial analytic techniques to detect clusters of age-standardized all-cancer mortality-to-incidence ratios (MIRs) across health regions, from 2010-2012. Global ordinary least squares (OLS) and geographically-weighted regression (GWR) were conducted to examine relationships between distance and MIR, adjusting for sociodemographic factors. RESULTS: Median distance from health region centroid to nearest radiotherapy center was 101.73 km (range 1.14-2095.12). One cluster of worse outcomes (MIR range 0.45-0.88) involved most of northern Canada, with a second cluster of better outcomes (MIR range 0.40-0.41) in southern British Columbia. In both regression models, regions with longer distance to radiotherapy center (ß = 0.0001), increased smoking (ß = 0.002), and poorer food security (ß = -0.003) were significantly associated with worse outcomes (OLS R2 = 0.70, GWR R2 = 0.74). Distance remained independently associated with MIR for lung and colorectal cancer subgroups, but not breast and prostate. CONCLUSIONS: A clear north-south discordance in cancer outcomes exists in Canada, with poorer outcomes in the north, while radiotherapy centers are concentrated along the south. Increased distance to radiotherapy, along with other sociodemographic and health-system factors, are associated with poorer cancer outcomes. Our study could be replicated, particularly in other high-income countries, to help identify national patterns and regional disparities in access and outcomes.
Authors: Aba Anoa Scott; Alfredo Polo; Eduardo Zubizarreta; Charles Akoto-Aidoo; Clement Edusa; Ernest Osei-Bonsu; Joel Yarney; Bismark Dwobeng; Michael Milosevic; Danielle Rodin Journal: JAMA Netw Open Date: 2022-08-01
Authors: Luis Felipe Higuita-Gutiérrez; Diego Alejandro Estrada-Mesa; Jaiberth Antonio Cardona-Arias Journal: Patient Prefer Adherence Date: 2022-08-05 Impact factor: 2.314