Barriers to accessing radiation therapy in Canada: a systematic review.
BACKGROUND
Radiation therapy (RT) is effective treatment for curing and palliating cancer, yet concern exists that not all Canadians for whom RT is indicated receive it. Many factors may contribute to suboptimal use of RT. A review of recent Canadian literature was undertaken to identify such barriers.


METHODS
MEDLINE, CINAHL, and EMBase databases were used to search keywords relating to barriers to accessing or utilizing RT in Canada. Collected abstracts were reviewed independently. Barriers identified in relevant articles were categorized as relating to the health systems, patient socio-demographic, patient factors, or provider factors contexts and thematic analysis performed for each context.


RESULTS
535 unique abstracts were collected. 75 met inclusion criteria. 46 (61.3%) addressed multiple themes. The most cited barriers to accessing RT when indicated were patient age (n = 26, 34.7%), distance to treatment centre (n = 23, 30.7%), wait times (n = 22, 29.3%), and lack of physician understanding about the use of RT (n = 16, 21.6%).


CONCLUSIONS
Barriers to RT are reported in many areas. The role of provider factors and the lack of attention to patient fears and mistrust as potential barriers were unexpected findings demanding further attention. Solutions should be sought to overcome identified barriers facilitating more effective cancer care for Canadians.
Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada. caitlin.gillan@rmp.uhn.on.ca
Caitlin
C
Gillan
Kaleigh
K
Briggs
Alejandro
A
Goytisolo Pazos
Melanie
M
Maurus
Nicole
N
Harnett
Pamela
P
Catton
David
D
Wiljer
D001294:Attitude to Health; D002170:Canada; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000706:statistics & numerical data*; D012923:Social Class; D013997:Time Factors