title: How gender, age, and geography influence the utilization of radiation therapy in the management of malignant melanoma.
abstract: OBJECTIVE
  Comparing radiation therapy utilization rates (RTUR) to those predicted by best evidence is a useful measure of the equity and accessibility of service delivery. In this study the RTUR for melanoma was established for British Columbia, Canada, and compared with the rate suggested by the evidence. Demographic variables, specifically age, gender, and geography that influenced the RTUR were examined with a view to identifying methods of improving underutilization.
  
  
  METHODS
  The RTUR in the management of malignant melanoma was taken from British Columbia Cancer registry data for 1986 to 1998. Variations in utilization based on age, gender, health authority, stage of disease, and referral patterns were analyzed.
  
  
  RESULTS
  An RTUR of 11% was identified. This was consistent over time. Referral rates decreased between 1986 and 1998. RT is used mostly for later stage disease. Males were more likely to receive RT than females, related to later stage of disease in men. Referral rates decreased, but RTUR for referred cases increased, in health authorities that did not have a cancer center.
  
  
  CONCLUSIONS
  Use of RT is influenced by age and by stage of disease. Overall RTUR in British Columbia is lower than suggested by best evidence. Referral patterns are influenced by geography. RTUR was higher in males, consistent with a different pattern of disease in males compared with females.
authors.affiliation: Radiation Therapy, British Columbia Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada. jfrench@bccancer.bc.ca
authors.forename: John
authors.initials: J
authors.lastname: French
authors.forename: Colleen
authors.initials: C
authors.lastname: McGahan
authors.forename: Graeme
authors.initials: G
authors.lastname: Duncan
authors.forename: Sonca
authors.initials: S
authors.lastname: Lengoc
authors.forename: Jenny
authors.initials: J
authors.lastname: Soo
authors.forename: Jerry
authors.initials: J
authors.lastname: Cannon
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000532:radiotherapy*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011878:Radiotherapy / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy*