title: Access to oncology consultation in a cancer cohort in northeastern Ontario.
abstract: BACKGROUND
  To enhance cancer symptom management for residents of Sudbury-Manitoulin District, an ambulatory palliative clinic (pac) was established at the Northeast Cancer Centre of Health Sciences North. The pac is accessed from a medical or radiation oncology consultation. The primary purpose of the present population-based retrospective study was to estimate the percentage of cancer patients who died without ever having a medical or radiation oncology consultation. A secondary purpose was to determine factors associated with never having received one of those specialized consultations.
  
  
  METHODS
  Administrative data was obtained through the Ontario Cancer Data Linkage Project. For each index case, we constructed a timeline, in days, of all Ontario Health Insurance Plan billing codes and associated service dates starting with the primary cancer diagnosis and ending with death.
  
  
  RESULTS
  Within the 5-year study period (2004-2008), 6683 people in the area of interest with a valid record of primary cancer diagnosis died from any cause. Most (n = 5988, 89.6%) had 1 primary cancer diagnosis. For that subgroup, excluding those with a disease duration of 0 days (n = 67), about 18.4% (n = 1088) never had a consultation with a medical or radiation oncologist throughout their disease trajectory. Patients who were older or who resided in a rural area were significantly less likely to have had a consultation.
  
  
  CONCLUSIONS
  Specific strategies directed toward older and rural patients might help to address this important access-to-care issue.
authors.affiliation: Epidemiology, Outcomes and Evaluation Research, Northeast Cancer Centre, Sudbury, ON. ; Northeast Cancer Centre, Health Sciences North, Sudbury, ON. ; Laurentian University, Sudbury, ON. ; Northern Ontario School of Medicine, Sudbury, ON.
authors.forename: M
authors.initials: M
authors.lastname: Conlon
authors.affiliation: Northeast Cancer Centre, Health Sciences North, Sudbury, ON. ; Cancer Care Ontario, Toronto, ON.
authors.forename: M
authors.initials: M
authors.lastname: Hartman
authors.affiliation: Northeast Cancer Centre, Health Sciences North, Sudbury, ON. ; Systemic Therapy Program, Northeast Cancer Centre, Sudbury, ON. ; Cambrian College, Sudbury, ON.
authors.forename: B
authors.initials: B
authors.lastname: Ballantyne
authors.affiliation: Northeast Cancer Centre, Health Sciences North, Sudbury, ON.
authors.forename: N
authors.initials: N
authors.lastname: Aubin
authors.affiliation: Epidemiology, Outcomes and Evaluation Research, Northeast Cancer Centre, Sudbury, ON. ; Northeast Cancer Centre, Health Sciences North, Sudbury, ON.
authors.forename: M
authors.initials: M
authors.lastname: Meigs
authors.affiliation: Northeast Cancer Centre, Health Sciences North, Sudbury, ON. ; Northern Ontario School of Medicine, Sudbury, ON. ; Cancer Care Ontario, Toronto, ON. ; Systemic Therapy Program, Northeast Cancer Centre, Sudbury, ON.
authors.forename: A
authors.initials: A
authors.lastname: Knight
keywords: Health services accessibility; medical records; palliative care; referral and consultation; rural health services