Access to cancer care in northwestern Ontario-a population-based study using administrative data

Background Despite universal access to health care in Canada, there are disparities relating to social determinants of health that contribute to discrepancies between rural and urban areas in cancer incidence and outcomes. Given that Canada has one of the highest-quality national population-based cancer registry systems in the world and that little information is available about cancer statistics specific to northwestern Ontario, the purpose of the present study was to estimate the percentage of cancer patients without documentation of a specialist consultation (medical or radiation oncology consultation) and to determine factors that affect access to specialist consultation in northwestern Ontario. Methods This population-based retrospective study used administrative data obtained through the Ontario Cancer Data Linkage Project. For each index case, a timeline was constructed of all Ontario Health Insurance Plan billing codes and associated service dates, starting with the primary cancer diagnosis and ending with death. Specific factors affecting access to specialist consultation were assessed. Results Within the 6-year study period (2010-2016), 2583 index cases were identified. Most (n = 2007, 78%) received a specialist consultation. Factors associated with not receiving a specialist consultation included older age [p < 0.0001; odds ratio (OR): 0.29; 95% confidence interval (CI): 0.19 to 0.44] and rural residence (p < 0.0001; OR: 0.48; 95% CI: 0.48 to 0.72). Factors associated with receiving a specialist consultation included a longer timeline (p < 0.0001; OR: 1.32; 95% CI: 1.19 to 1.46), a diagnosis of breast cancer (p < 0.0001; OR: 2.51; 95% CI: 1.43 to 4.42), and a diagnosis of lung cancer (p < 0.0001; OR: 1.77; 95% CI: 1.38 to 2.26). Conclusions This study is the first to look at care access in northwestern Ontario. The complexity and multidisciplinary nature of cancer care makes the provision of appropriate care a challenge; a one-size-fits-all disease prevention and treatment strategy might not be appropriate.