Access to cancer care in northwestern Ontario—a population-based study using administrative data
Background: Despite universal access to health care in Canada, disparities exist relating to social determinants of health, which contribute to discrepancies in cancer incidence and outcomes between rural and urban areas. Given that Canada has one of the highest-quality national population-based cancer registry systems in the world and there is little information regarding cancer statistics specific to northwestern Ontario, the purpose of this study was to estimate the percentage of cancer patients without documentation of a specialist consultation (medical or radiation oncology consultation) and to determine factors that affect access to specialist consultation in northwestern Ontario.
Methods: This was a population-based retrospective study using administrative data. Administration data was obtained through the Ontario Cancer Data Linkage Project. For each index case, a timeline was constructed of all Ontario Health Insurance Plan billing codes and associated service dates starting with primary cancer diagnosis and ending with death. Specific factors affecting access to specialist consultation were assessed.
Results: Within the 6 year study period (2010-2016), 2583 index cases were identified. Most (n=2007, 78%) received a specialist consultation. Factors associated with not receiving a specialist consultation included older age (p<0.0001, OR 0.29; 95% CI 0.19-0.44) and rural residence (p<0.0001, OR 0.48; 95% CI 0.48-0.72). Factors associated with receiving a specialist consultation included increased duration of disease (p< 0.0001, OR 1.32; 95% CI 1.19-1.46), a diagnosis of breast cancer (p < 0.0001, OR 2.51; 95% CI 1.43-4.42), and a diagnosis of lung cancer (p< 0.0001, OR 1.77; 95% CI 1.38-2.26).
Conclusions: These findings are consistent with the other studies assessing access to care barriers, but is the first to look at care access in northwestern Ontario. Further research is needed to examine gaps in care relating to access to primary referral services, symptom recognition, cancer screening, and travel associated burdens specific to northwestern Ontario.