Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2012

Open Access 01-12-2012 | Research

Barriers to accessing radiation therapy in Canada: a systematic review

Authors: Caitlin Gillan, Kaleigh Briggs, Alejandro Goytisolo Pazos, Melanie Maurus, Nicole Harnett, Pamela Catton, David Wiljer

Published in: Radiation Oncology | Issue 1/2012

Login to get access

Abstract

Introduction

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.
Appendix
Available only for authorised users
Literature
1.
Zhang-Salomons J, Mackillop WJ: Estimating the lifetime utilization rate of radiotherapy in cancer patients: the Multicohort Current Utilization Table (MCUT) method. Comput Methods Programs Biomed 2008, 92: 99-108. 10.1016/j.cmpb.2008.06.011CrossRefPubMed
2.
3.
Delaney G, Jacob S, Featherstone C, Barton M: The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer 2005, 104: 1129-1137. 10.1002/cncr.21324CrossRefPubMed
4.
Scottish Executive Health Dept Radiotherapy Activity Planning Group: Cancer in Scotland: Radiotherapy Activity Planning for Scotland 2011–2015. Scotland: NHS; 2005.
5.
Canadian Partnership Against Cancer (CPAC): System Performance Report. Toronto: CPAC; 2010.
6.
7.
Cooke AL, Appell R, Suderman K, Fradette K, Latosinsky S: Radiation treatment waiting times for breast cancer patients in Manitoba, 2001 and 2005. Curr Oncol 2009, 16: 58-64.PubMedCentralCrossRefPubMed
8.
Reed AD, Williams RJ, Wall PA, Hasselback P: Waiting time for breast cancer treatment in Alberta. Can J Public Health 2004, 95: 341-345.PubMed
9.
Yavari P, Barroetavena MC, Hislop TG, Bajdik CD: Breast cancer treatment and ethnicity in British Columbia, Canada. BMC Cancer 2010, 10: 154. 10.1186/1471-2407-10-154PubMedCentralCrossRefPubMed
10.
French J, McGahan C, Duncan G, Lengoc S, Soo J, Cannon J: How gender, age, and geography influence the utilization of radiation therapy in the management of malignant melanoma. Int J Radiat Oncol Biol Phys 2006, 66: 1056-1063. 10.1016/j.ijrobp.2006.06.051CrossRefPubMed
11.
Ludbrook JJS, Truong PT, MacNeil MV, Lesperance M, Webber A, Joe H, Martins H, Lim J: Do age and comorbidity impact treatment allocation and outcomes in limited stage small-cell lung cancer? A community-based population analysis. Int J Radiat Oncol Biol Phys 2003, 55: 1321-1330. 10.1016/S0360-3016(02)04576-5CrossRefPubMed
12.
Truong PT, Kader HA, Lacy B, Lesperance M, MacNeil MV, Berthelet E, McMurtrie E, Alexander S: The effects of age and comorbidity on treatment and outcomes in women with endometrial cancer. Am J Clin Oncol 2005, 28: 157-164. 10.1097/01.coc.0000143049.05090.12CrossRefPubMed
13.
Samant RS, Fitzgibbon E, Meng J, Graham ID: Family physicians' perspectives regarding palliative radiotherapy. Radiother Oncol 2006, 78: 101-106. 10.1016/j.radonc.2005.11.008CrossRefPubMed
14.
15.
Turnock B: Public Health: what it is and how it works. 4th edition. Sudbury, MA: Jones and Bartlett Publishers; 2009.
16.
Morris AM, Rhoads KF, Stain SC, Birkmeyer JD: Understanding racial disparities in cancer treatment and outcomes. J Am Coll Surg 2010, 211: 105-113. 10.1016/j.jamcollsurg.2010.02.051CrossRefPubMed
17.
Barnes EA, et al.: Palliative radiotherapy for patients with bone metastases: Survey of primary care physicians. Radiother Oncol 2003,67(2):221-223. 10.1016/S0167-8140(02)00366-3CrossRefPubMed
18.
Chow E, et al.: Referring physicians' satisfaction with the rapid response radiotherapy programme: Survey results at the Toronto-Sunnybrook Regional Cancer Centre. Support Care Cancer 2000,8(5):405-409. 10.1007/s005200050009CrossRefPubMed
19.
Chuah TK, et al.: Management of primary rectal cancer by surgeons in Atlantic Canada: Results of a regional survey. Can J Surg 2010,53(6):396-402.PubMedCentralPubMed
20.
Danielson B, et al.: Palliative Radiotherapy for Women with Breast Cancer. Clin Oncol 2008,20(7):506-512. 10.1016/j.clon.2008.04.013CrossRef
21.
Dunscombe P, Roberts G: Radiotherapy service delivery models for a dispersed patient population. Clin Oncol 2001,13(1):29-37.
22.
Fitch MI, et al.: Travelling for radiation cancer treatment: patient satisfaction. Can Oncol Nurs J 2005,15(2):107-112.CrossRefPubMed
23.
Fortin B, Goldberg MS, et al.: Waiting time for radiation therapy in breast cancer patients in Quebec from 1992 to 1998: a study of surgically treated breast cancer patients in Quebec documents and helps to explain increased waiting times for radiation therapy. Healthcare Policy = Politiques de sante 2006,1(2):152-167.PubMedCentralCrossRefPubMed
24.
French J, et al.: Inequities in Access: How Utilization of Palliative Radiation Therapy in British Columbia Varies with Geography. J Med Imag Radiat Sci 2008,39(2):75-80. 10.1016/j.jmir.2008.04.011CrossRef
25.
Gray RE, et al.: A consultation with Canadian rural women with breast cancer. Health Expect 2004,7(1):40-50. 10.1046/j.1369-6513.2003.00248.xCrossRefPubMed
26.
Hebert-Croteau N, et al.: A population-based study of the impact of delaying radiotherapy after conservative surgery for breast cancer. Breast Cancer Res Treat 2004,88(2):187-196. 10.1007/s10549-004-0594-7CrossRefPubMed
27.
Huang J, et al.: Factors affecting the use of palliative radiotherapy in Ontario. J Clin Oncol 2001,19(1):137-144.PubMed
28.
Johnston GM, et al.: Radiotherapy wait times for patients with a diagnosis of invasive cancer, 1992–2000. Clin Invest Med 2004,27(3):142-156.PubMed
29.
Kerba M, et al.: Defining the Need for Prostate Cancer Radiotherapy in the general population: a Criterion-based Benchmarking Approach. Clin Oncol 2010,22(10):801-809. 10.1016/j.clon.2010.07.006CrossRef
30.
Lavergne MR, et al.: Variation in the use of palliative radiotherapy at end of life: Examining demographic, clinical, health service, and geographic factors in a population-based study. Palliat Med 2011,25(2):101-110. 10.1177/0269216310384900PubMedCentralCrossRefPubMed
31.
Li X, Butts C, et al.: Utilization of oncology services and receipt of treatment: a comparison between patients with breast, colon, and rectal, or lung cancer. Ann Oncol 2010,22(8):1902-1909.CrossRef
32.
Maddison AR, Asada Y, Urquhart R: Inequity in access to cancer care: A review of the Canadian literature. Cancer Causes Control 2011,22(3):359-366. 10.1007/s10552-010-9722-3CrossRefPubMed
33.
Sutton DS, et al.: The use of palliative radiotherapy for bone metastasis. Radiother Oncol 2010,97(3):548-553. 10.1016/j.radonc.2010.09.015CrossRefPubMed
34.
Szumacher E, et al.: Improving access to radiotherapy services in the Simcoe-Muskoka region of Ontario: needs assessment study. Can J Med Radiat Technol 2007,38(3):7-16. 10.1016/S0820-5930(09)60205-XCrossRef
35.
Taussky D, et al.: Factors influencing treatment decisions in patients with low risk prostate cancer referred to a brachytherapy clinic. Can J Urol 2008,15(6):4415-4420.PubMed
36.
Tyldesley S, McGahan C: Utilisation of Radiotherapy in Rural and Urban Areas in British Columbia Compared with Evidence-based Estimates of Radiotherapy Needs for Patients with Breast, Prostate and Lung Cancer. Clin Oncol 2010,22(7):526-532. 10.1016/j.clon.2010.06.006CrossRef
37.
Johnston GM, et al.: Variation in delivery of palliative radiotherapy to persons dying of cancer in Nova Scotia, 1994 to 1998. J Clin Oncol 2001,19(14):3323-3332.PubMed
38.
Wu JS, et al.: Patterns of practice in palliative radiotherapy for painful bone metastases: impact of a regional rapid access clinic on access to care. Int J Radiat Oncol Biol Phys 2010,78(2):533-538. 10.1016/j.ijrobp.2009.07.1716CrossRefPubMed
39.
Bairati I, et al.: Women's perceptions of events impeding or facilitating the detection, investigation and treatment of breast cancer. Eur J Cancer Care 2006,15(2):183-193. 10.1111/j.1365-2354.2005.00635.xCrossRef
40.
Belyea J, et al.: Wait times for head and neck cancer patients in the Maritime provinces. J Otolaryngol Head Neck Surg 2011,40(4):318-322.PubMed
41.
Chan K, et al.: Investigating patient wait times for daily outpatient radiotherapy appointments (a single-centre study). J Med Imag Radiat Sci 2010,41(3):145-151. 10.1016/j.jmir.2010.06.001CrossRef
42.
Cromwell IA, Johnson A, Mackillop W: The cost of waiting: Economic benefit of reducing waiting times for early breast cancer radiotherapy. Value Health 2009,12(3):A48-A49.CrossRef
43.
44.
Goldstein D, et al.: Wait times in the diagnosis and treatment of head and neck cancer: Comparison between wait times in 1995 and 2005 - A prospective study. J Otolaryngol 2007,36(6):336-343.PubMed
45.
Groome PA, et al.: Laryngeal Cancer Treatment and Survival Differences across Regional Cancer Centres in Ontario, Canada. Clin Oncol 2011,23(1):19-28. 10.1016/j.clon.2010.08.027CrossRef
46.
Groome PA, et al.: Explaining Socioeconomic Status Effects in Laryngeal Cancer. Clin Oncol 2006,18(4):283-292. 10.1016/j.clon.2005.12.010CrossRef
47.
Kavanagh AG, Lee JC, Donnelly B: Time to treatment of prostate cancer through the Calgary Prostate Institute rapid access clinic. Can J Urol 2008,15(2):3975-3979.PubMed
48.
Keyes M, et al.: Health-related quality of life in patients on radiotherapy waiting lists (multiple letters) [2]. Clin Oncol 2002,14(4):329-330.CrossRef
49.
Rayson D, et al.: Comparison of elapsed times from breast cancer detection to first adjuvant therapy in Nova Scotia in 1999/2000 and 2003/04. Cmaj 2007,176(3):327-332. 10.1503/cmaj.060825PubMedCentralCrossRefPubMed
50.
Samant RS, et al.: Barriers to palliative radiotherapy referral: a Canadian perspective. Acta Oncol 2007,46(5):659-663. 10.1080/02841860600979005CrossRefPubMed
51.
Stevens C, Bondy SJ, Loblaw DA: Wait times in prostate cancer diagnosis and radiation treatment. Can Urol Assoc J 2010,4(4):243-248. 10.5489/cuaj.09122PubMedCentralCrossRefPubMed
52.
53.
French J, McGahan C: Measuring patient satisfaction with radiation therapy service delivery. Healthc Manage Forum 2009,22(4):40-50. 10.1016/S0840-4704(10)60141-XCrossRefPubMed
54.
Barbera L, et al.: Defining the need for radiotherapy for lung cancer in the general population: a criterion-based, benchmarking approach. Med Care 2003,41(9):1074-1085. 10.1097/01.MLR.0000083742.29541.BCCrossRefPubMed
55.
Choo R, et al.: Survey of radiation oncologists: practice patterns of the management of stage I seminoma of testis in Canada and a selected group in the United States. Can J Urol 2002,9(2):1479-1485.CrossRefPubMed
56.
De Sa E, et al.: Continued success of the rapid response radiotherapy program: A review of 2004–2008. Support Care Cancer 2009,17(7):757-762. 10.1007/s00520-009-0585-7CrossRefPubMed
57.
Danjoux C, et al.: An innovative rapid response radiotherapy program to reduce waiting time for palliative radiotherapy. Support Care Cancer 2006,14(1):38-43. 10.1007/s00520-005-0822-7CrossRefPubMed
58.
Dayes IS, et al.: Cross-border referral for early breast cancer: An analysis of radiation fractionation patterns. Curr Oncol 2006,13(4):124-129.PubMedCentralPubMed
59.
Giddings A: Treatment interruptions in radiation therapy for head-and-neck cancer: rates and causes. J Med Imag Radiat Sci 2010,41(4):222-229. 10.1016/j.jmir.2010.08.002CrossRef
60.
Gorey KM, et al.: Income and long-term breast cancer survival: comparisons of vulnerable urban places in Ontario and California. Breast J 2010,16(4):416-419.PubMedCentralPubMed
61.
Kollmannsberger C, et al.: Evolution in management of testicular seminoma: Population-based outcomes with selective utilization of active therapies. Ann Oncol 2011,22(4):808-814. 10.1093/annonc/mdq466CrossRefPubMed
62.
Kwon JS, et al.: Patterns of practice and outcomes in intermediate- and high-risk stage I and II endometrial cancer: a population-based study. Int J Gynecol Cancer 2007,17(2):433-440. 10.1111/j.1525-1438.2007.00812.xCrossRefPubMed
63.
Randal J: Canada faces shortage of radiation therapists. J Natl Cancer Inst 2000,92(3):186-188. 10.1093/jnci/92.3.186CrossRefPubMed
64.
Gorey KM, et al.: Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: greater socioeconomic inequity in America. Clin Invest Med 2009,32(3):E239-E249.PubMedCentralPubMed
65.
Bagnell S, et al.: Practice patterns of Canadian urologists in the management of stage I testicular seminoma. Can J Urol 2004,11(2):2194-2199.PubMed
66.
Chua B, et al.: Original article increased use of adjuvant regional radiotherapy for node-positive breast cancer in British Columbia. Breast J 2004,10(1):38-44. 10.1111/j.1524-4741.2004.09605.xCrossRefPubMed
67.
Elit L, et al.: Patterns of care in the initial management of women with vulvar cancers in Ontario. Eur J Gynaecol Oncol 2009,30(5):503-505.PubMed
68.
Elit L, et al.: Patterns of care for the initial management of cervical cancer in Ontario. Eur J Gynaecol Oncol 2009,30(5):493-496.PubMed
69.
Gorey KM, et al.: Breast cancer care in the Canada and the United States: Ecological comparisons of extremely impoverished and affluent urban neighborhoods. Health Place 2010,16(1):156-163. 10.1016/j.healthplace.2009.09.011PubMedCentralCrossRefPubMed
70.
Ng A, et al.: An examination of utilization of adjuvant and salvage radiosurgery for the treatment of brain metastasis. Int J Radiat Oncol Biol Phys 2010, 1: S285.CrossRef
71.
Puts MTE, et al.: Characteristics of older newly diagnosed cancer patients refusing cancer treatments. Support Care Cancer 2010,18(8):969-974. 10.1007/s00520-010-0883-0CrossRefPubMed
72.
Schwartz KL, et al.: Continued undertreatment of older men with localized prostate cancer. Urology 2003,62(5):860-865. 10.1016/S0090-4295(03)00690-3CrossRefPubMed
73.
Clavel S, et al.: Adjuvant regional irradiation after breast-conserving therapy for early stage breast cancer: a survey of Canadian radiation oncologists. Clin Oncol (R Coll Radiol) 2010,22(1):39-45. 10.1016/j.clon.2009.09.026CrossRef
74.
French J: Introduction to the principles of bioethics. Can J Med Radiat Technol 2006,37(1):31-38. 10.1016/S0820-5930(09)60115-8CrossRef
75.
Hislop TG, et al.: Local and regional therapy for women with breast cancer in British Columbia. Breast J 2003,9(3):192-199. 10.1046/j.1524-4741.2003.09310.xCrossRefPubMed
76.
Kerba M, et al.: Defining the Need for Breast Cancer Radiotherapy in the General Population: a Criterion-based Benchmarking Approach. Clin Oncol 2007,19(7):481-489. 10.1016/j.clon.2007.03.013CrossRef
77.
78.
Tyldesley S, et al.: Association between age and the utilization of radiotherapy in Ontario. Int J Radiat Oncol Biol Phys 2000,47(2):469-480. 10.1016/S0360-3016(00)00440-5CrossRefPubMed
79.
Fitzgibbon EJ, et al.: Awareness and use of the Rapid Palliative Radiotherapy Program by family physicians in Eastern Ontario: A survey. Curr Oncol 2006, 13: 27-32.PubMedCentralPubMed
80.
Tucker TL, Fitzgibbon E, Samant R: A national survey of Canadian pediatric oncologists of barriers in the delivery of palliative radiotherapy to children with cancer. J Palliat Care 2006,22(3):236.
81.
Tyldesley S, Roques TW, Erridge S: General practitioner assessment of stage and performance status in lung cancer patients at a population level: Implications for prognosis and radiotherapy needs analyses. Lung Cancer 2007,57(3):381-388. 10.1016/j.lungcan.2007.03.024CrossRefPubMed
82.
Fairchild A, Ghosh S: Referring practitioners' self-rated versus actual knowledge about Palliative radiotherapy. Support Care Cancer 2009,17(7):965.
83.
Gorey KM, et al.: The supply of physicians and care for breast cancer in Ontario and California, 1998 to 2006. Can J Rural Med 2011,16(2):47-54.PubMedCentralPubMed
84.
Barbera L, et al.: Defining the need for radiotherapy for lung cancer in the general population: a criterion-based, benchmarking approach. Medical Care 2003,41(9):1074-1085. 10.1097/01.MLR.0000083742.29541.BCCrossRefPubMed
85.
Barnes EA, et al.: Involvement of family physicians in the care of cancer patients seen in the palliative Rapid Response Radiotherapy Program. J Clin Oncol 2007,25(36):5758-5762. 10.1200/JCO.2007.13.3082CrossRefPubMed
86.
87.
Kumar S, et al.: Influence of patient's perceptions, beliefs and knowledge about cancer on treatment decision making in Pakistan. Asian Pac J Cancer Prev 2010,11(1):251-255.PubMed
88.
Chen YP, et al.: Causes of interruption of radiotherapy in nasopharyngeal carcinoma patients in Taiwan. Jpn J Clin Oncol 2000,30(5):230-234. 10.1093/jjco/hyd059CrossRefPubMed
89.
Bickell NA, et al.: Underuse of breast cancer adjuvant treatment: patient knowledge, beliefs, and medical mistrust. J Clin Oncol 2009,27(31):5160-5167. 10.1200/JCO.2009.22.9773PubMedCentralCrossRefPubMed
90.
Halkett GK, Kristjanson LJ, Lobb EA: 'If we get too close to your bones they'll go brittle': women's initial fears about radiotherapy for early breast cancer. Psychooncology 2008,17(9):877-884. 10.1002/pon.1298CrossRefPubMed
Metadata
Title
Barriers to accessing radiation therapy in Canada: a systematic review
Authors
Caitlin Gillan
Kaleigh Briggs
Alejandro Goytisolo Pazos
Melanie Maurus
Nicole Harnett
Pamela Catton
David Wiljer
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-7-167

Other articles of this Issue 1/2012

Radiation Oncology 1/2012 Go to the issue

Research

64Cu-ATSM and 18FDG PET uptake and 64Cu-ATSM autoradiography in spontaneous canine tumors: comparison with pimonidazole hypoxia immunohistochemistry

Research

Seminal vesicle interfraction displacement and margins in image guided radiotherapy for prostate cancer

Research

Detection of local recurrent prostate cancer after radical prostatectomy in terms of salvage radiotherapy using dynamic contrast enhanced-MRI without endorectal coil

Research

Higher toxicity with 42 Gy in 10 fractions as a total dose for 3D-conformal accelerated partial breast irradiation: results from a dose escalation phase II trial

Research

A dosimetric comparison of 3D conformal vs intensity modulated vs volumetric arc radiation therapy for muscle invasive bladder cancer

Research

Exposure to ionizing radiation induced persistent gene expression changes in mouse mammary gland