Access to radiotherapy and its association with cancer outcomes in a high-income country: Addressing the inequity in Canada

Jessica Chan, Alfredo Polo, Eduardo Zubizarreta, Jean-Marc Bourque, Timothy P. Hanna, Marc Gaudet, Kristopher Dennis, Michael Brundage, Ben Slotman, May Abdel-Wahab

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
JournalRadiotherapy and Oncology
DOIs
Publication statusPublished - 2019

Cite this

Chan, Jessica ; Polo, Alfredo ; Zubizarreta, Eduardo ; Bourque, Jean-Marc ; Hanna, Timothy P. ; Gaudet, Marc ; Dennis, Kristopher ; Brundage, Michael ; Slotman, Ben ; Abdel-Wahab, May. / Access to radiotherapy and its association with cancer outcomes in a high-income country: Addressing the inequity in Canada. In: Radiotherapy and Oncology. 2019.
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title = "Access to radiotherapy and its association with cancer outcomes in a high-income country: Addressing the inequity in Canada",
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.",
author = "Jessica Chan and Alfredo Polo and Eduardo Zubizarreta and Jean-Marc Bourque and Hanna, {Timothy P.} and Marc Gaudet and Kristopher Dennis and Michael Brundage and Ben Slotman and May Abdel-Wahab",
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Access to radiotherapy and its association with cancer outcomes in a high-income country: Addressing the inequity in Canada. / Chan, Jessica; Polo, Alfredo; Zubizarreta, Eduardo; Bourque, Jean-Marc; Hanna, Timothy P.; Gaudet, Marc; Dennis, Kristopher; Brundage, Michael; Slotman, Ben; Abdel-Wahab, May.

In: Radiotherapy and Oncology, 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Access to radiotherapy and its association with cancer outcomes in a high-income country: Addressing the inequity in Canada

AU - Chan, Jessica

AU - Polo, Alfredo

AU - Zubizarreta, Eduardo

AU - Bourque, Jean-Marc

AU - Hanna, Timothy P.

AU - Gaudet, Marc

AU - Dennis, Kristopher

AU - Brundage, Michael

AU - Slotman, Ben

AU - Abdel-Wahab, May

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

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U2 - 10.1016/j.radonc.2019.09.009

DO - 10.1016/j.radonc.2019.09.009

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JO - Radiotherapy and Oncology

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