title: Does a centralized radiotherapy system provide adequate access to care?
abstract: OBJECTIVE
  In the Canadian province of Ontario, all radiotherapy is provided by a centrally managed provincial network of nine cancer centers. The primary goal of this study was to determine whether this highly centralized radiotherapy system provides adequate and equitable access to care for the province's dispersed population.
  
  
  METHODS
  The Ontario Cancer Registry (OCR) was used to identify 295,386 cases of invasive cancer, excluding nonmelanoma skin cancer, which were diagnosed in Ontario between 1984 and 1991. Electronic radiotherapy records from each of the province's radiotherapy centers were linked to the registry at the level of the individual case.
  
  
  RESULTS
  The proportion of incident cases treated with radiotherapy was 18.8% at 4 months after diagnosis, 23.7% at 1 year, 25.8% at 2 years, 28.2% at 5 years, and 29.1% at 8 years. These rates of radiotherapy use are much lower than the accepted national and international targets, and lower than rates reported from other jurisdictions. The rate of radiotherapy use at 1 year varied significantly from county to county across Ontario (range, 18.6% to 32.4%; P < 10(-6)), and the highest rates were recorded in communities close to radiotherapy centers. There was a common geographic pattern of rate variations among several disease groups, including breast cancer, lung cancer, the genitourinary malignancies, and the gastrointestinal malignancies.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Oncology, Queen's University, Canada. wmackillop@octrf.on.ca
authors.forename: W J
authors.initials: WJ
authors.lastname: Mackillop
authors.forename: P A
authors.initials: PA
authors.lastname: Groome
authors.forename: J
authors.initials: J
authors.lastname: Zhang-Solomons
authors.forename: Y
authors.initials: Y
authors.lastname: Zhou
authors.forename: D
authors.initials: D
authors.lastname: Feldman-Stewart
authors.forename: L
authors.initials: L
authors.lastname: Paszat
authors.forename: P
authors.initials: P
authors.lastname: Dixon
authors.forename: E J
authors.initials: EJ
authors.lastname: Holowaty
authors.forename: B J
authors.initials: BJ
authors.lastname: Cummings
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D009369:Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D009864:Ontario / Q000453:epidemiology; D012041:Regional Medical Programs / Q000706:statistics & numerical data*