title: Waiting times for cancer care in Canadian children: impact of distance, clinical, and demographic factors.
abstract: BACKGROUND
  The objective of this study was to evaluate the impact of distance from residence to pediatric oncology centers on waiting times to diagnostic assessment and treatment in Canadian children with cancer.
  
  
  METHODS
  Two thousand three hundred sixteen children (< 15 years of age) captured by the Canadian Childhood Cancer Surveillance and Control Program's (CCCSCP) Treatment and Outcome Surveillance (TOS) system were included in the analysis. The number of days between onset of symptoms and first anti-cancer therapy was compared for those living less than 25, 25-99, and more than 100 kilometers from their treating center. For each time period, the adjusted odds of falling into the longest time quartiles were estimated using logistic regression analysis.
  
  
  RESULTS
  Thirty-four percent (n = 786) of children lived more than 100 kilometers from their treating center. There were no significant differences in age at diagnosis (P = 0.33), sex (P = 0.68), or ICCC diagnosis (P = 0.02) by distance from center, though there was a significant difference in region of residence (P < 0.01) and the first health care professional contacted (P < 0.01). Except for waiting time from first health care contact to first assessment by treating oncologist which increased with increasing distance (P < 0.01), there were no significant differences in waiting times by distance. When adjusted for important demographic and clinical characteristics, distance to center did not affect the odds of waiting longer for any event.
  
  
  CONCLUSIONS
  Distance to treating center had no significant impact on waiting times for important diagnostic and treatment events, when adjusted for age at diagnosis, diagnosis, region, and first health care professional seen.
authors.affiliation: Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada, Ottawa, Ontario, Canada. julia_klein-geltink@hc-sc.gc.ca
authors.forename: Julia E
authors.initials: JE
authors.lastname: Klein-Geltink
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Pogany
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Barr
authors.forename: Mark L
authors.initials: ML
authors.lastname: Greenberg
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Mery
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002170:Canada; D002648:Child; D002675:Child, Preschool; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D012111:Residence Characteristics; D013997:Time Factors; D014850:Waiting Lists