title: A comparison of delays in the treatment of cancer with radiation in Canada and the United States.
abstract: OBJECTIVE
  Waiting lists for medical care in Canada have been used as an argument against the single-payer option for health care reform in the United States, but there have been no direct comparisons of access to care in these two health care systems. The objective of this study was to compare how long cancer patients wait for radiotherapy in Canada and the USA.
  
  
  METHODS
  Heads of radiation oncology at all cancer centers listed by the International Union Against Cancer (UICC) in Canada and the United States were sent a questionnaire that asked how long their patients waited for radiotherapy, and how long they though it was acceptable for patients to wait, in six clinical situations.
  
  
  RESULTS
  Ninety-two of 97 eligible centers responded (95%). Median waiting times to start of radiotherapy were as follows: carcinoma of the larynx (T2,N0,M0), 29 days in Canada, 10 days in the USA; carcinoma of the lung (Stage IIIb, squamous), 34 days in Canada, 9 days in the USA; carcinoma of the prostate (Stage B2), 40 days in Canada, 11 days in the USA; carcinoma of the breast (T2,N0,M0) referred 1 month after lumpectomy, 43 days in Canada, 10 days in the USA; carcinoma of the prostate with painful bone metastases, 17 days in Canada, 5 days in the USA; carcinoma of the prostate with spinal cord compression, < 1 day in Canada, < 1 day in the USA. The differences in waiting times between Canada and the USA were all statistically significant (p < 0.0001), except in the case of emergency treatment for cord compression. The majority of radiation oncologists in both Canada and the USA regarded the delays reported by Canadian departments as medically unacceptable.
  
  
  CONCLUSIONS
  Patients almost everywhere in Canada wait longer for radiotherapy than they do almost anywhere in the United States.
authors.affiliation: Department of Oncology, Queen's University, Kingston Regional Cancer Centre, Ontario, Canada.
authors.forename: W J
authors.initials: WJ
authors.lastname: Mackillop
authors.forename: Y
authors.initials: Y
authors.lastname: Zhou
authors.forename: C F
authors.initials: CF
authors.lastname: Quirt
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D009369:Neoplasms / Q000532:radiotherapy*; D015397:Program Evaluation; D013125:Spinal Neoplasms / Q000532:radiotherapy; D013997:Time Factors; D014481:United States; D014850:Waiting Lists; D016526:Workload