Inequity in access to cancer care: a review of the Canadian literature

Abstract

Despite the policy and research attention on ensuring equitable access--equal access for equal need--to health care, research continues to identify inequities in access to cancer services. We conducted a literature review to identify the current state of knowledge about inequity in access to cancer health services in Canada in terms of the continuum of care, disease sites, and dimensions of inequity (e.g., income). We searched MEDLINE, CINAHL, and Embase for studies published between 1990 and 2009. We retrieved 51 studies, which examine inequity in access to cancer services from screening to end-of-life care, for multiple cancer types, and a variety of socioeconomic, geographic, and demographic factors that may cause concern for inequity in Canada. This review demonstrates that income has the most consistent influence on inequity in access to screening, while age and geography are most influential for treatment services and end-of-life care, even after adjusting for patient need. Our review also reports on methods used in the literature and new techniques to explore. Equitable access to cancer care is vitally important in all health systems. Obtaining information on the current status of inequities in access to cancer care is a critical first step toward action.

Impact of referral letters on scheduling of hospital appointments: a randomised control trial

“…This exacerbates current inequities in the delivery of quality health care. 19,20 The RW GPs referred more patients than their control group counterparts. This finding should be interpreted with caution due to the potential for social desirability bias, 21 and/or novelty effects.…”

Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours

“…A recent review of Canadian literature on inequity in access to cancer services [81] suggested that among treatments and services, evidence of inequality is most consistent and convincing in radiation therapy and end of life care. Maddison and colleagues arrive at this conclusion from an assessment of the quality of the studies conducted (primarily focusing on whether results were adjusted for need) and consideration of the level of agreement in findings.…”

“…This finding is somewhat paradoxical. In a review of Canadian literature about access to cancer care, Maddison and colleagues [81] indicate that differences in patient selfadvocacy for care was one of two recurrent explanations offered by researchers for variations in access to cancer care in the Canadian context. That is, researchers speculated that people from advantaged group were more likely to be aware of their options, more demanding and better equipped to negotiate care.…”

“…Yet as noted earlier, the possibility that the advantaged group's actions are an explanation for variations in access to cancer care has indeed been raised by researchers in the field [81]. In other care settings, as well, researchers have commented that middle and upper class patients' greater familiarity and experience with moving institutional processes forward appears in at least some instances to secure more extensive, safer and swifter care [34].…”

Disparity in Cancer Care: A Canadian Perspective

“…Inequities in access to cancer services along the cancer care continuum, from screening to end-of-life care, are linked to a variety of socioeconomic, geographic, and demographic factors. The research on inequity in cancer care in Canada is sparse, and the quantity of research on access to care varies by point of service, equity determinates, and disease site 27 . Barriers to access can be sorted into 4 categories: availability of services, financial barriers, nonfinancial barriers to presentation of health care needs, and barriers to equitable treatment.…”