Waiting times for cancer care in Canadian children: Impact of distance, clinical, and demographic factors

Klein-Geltink, Julia E; Pogany, Lisa; Barr, Ronald D.; Greenberg, Mark; Mery, Les

doi:10.1002/pbc.20156

Cited by 59 publications

(88 citation statements)

References 14 publications

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“…Studies from countries with large land areas have suggested that delay is associated with the nature of the first healthcare contact, independent of distance from treatment centers [1,7,15], but our findings suggest this association could also be mediated by decision processes in the healthcare consult. Detection of symptoms and suspicion of malignancy may vary with clinical practice, making one healthcare provider more or less likely to detect and investigate for cancer.…”

Section: Discussioncontrasting

confidence: 68%

“…This association may be explained by the varying mass effect of different tumors depending on site and age, making one tumor more or less easily detected. Older children may have their health-related issues monitored less closely by parents, and may be more reluctant to disclose symptoms [7,12,13]. In addition, biologic factors may vary with age, resulting in differences in intrinsic tumor behavior [14].…”

Section: Discussionmentioning

confidence: 99%

“…Healthcare staff may detect worrying symptoms that parents and patients may otherwise miss at earlier stages. Pediatric emergency physicians may be more likely to receive cases with acute symptoms, and hence shorter diagnostic delay times; they may be more familiar with pediatric malignancies, and have more ready access to pediatric oncological specialty care [7,14]. Our study setting's small geographical area minimized physical barriers to healthcare access, and may have uncovered this underlying effect of individual clinical practice differences on diagnostic delay.…”

Section: Discussionmentioning

confidence: 99%

“…Patient-and disease-related factors may play a greater role in diagnostic delays in the childhood cancer. Socio-economic and geographical barriers to healthcare negatively influence the diagnostic process only to a limited extent [6,7]. The confounding effects of geographical distance, waiting time, and financial restrictions may be controlled to a greater extent in the context of our small urban island-state, and may facilitate the more accurate identification of social demographic factors that affect diagnostic delay.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic delay in pediatric solid tumors: A population based study on determinants and impact on outcomes

Loh¹,

Aung²,

Ha³

et al. 2011

Pediatric Blood & Cancer

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BackgroundDespite socioeconomic and clinical progress, pediatric tumors continue to present in advanced stage, and may be due to delays in diagnosis. This study aimed to identify factors associated with diagnostic delay (time between symptom onset and diagnosis) in pediatric tumors in a population‐based study, and to assess the impact of delay on subsequent outcome.ProcedureNatural logarithm of delay was retrospectively described for 390 newly diagnosed tumors reported to the Singapore Childhood Cancer Registry from 1997 to 2007. Delay was correlated with socio‐demographic, disease and healthcare‐system factors using multivariate linear regression, and with event‐free survival (EFS) using Cox regression analysis.ResultsTotal median delay was 5.3 weeks (range 0.1–283.1). Shorter delay was independently associated with younger patient age (P = 0.006), abdominal and pelvic sites (P < 0.001 and P = 0.036, respectively), incidental diagnoses by healthcare staff (P = 0.002), and when pediatric emergency units were the first contacted healthcare facilities and the first to raise suspicion of malignancy (P = 0.034, and P = 0.018, respectively). These factors explained only a small percentage of variance in delay times (21%). Delay was not associated with EFS and disease stage, with 24% of tumors presenting in stage 4.ConclusionsDiagnostic delay was independently associated with age and site of presentation, and points of first symptom detection, first healthcare contact, and first suspicion of malignancy. The broad range of clinical variables analyzed could only account in a small way for differences in delay times observed. While overall delay times were short, they did not influence disease stage at presentation and eventual outcome. Pediatr Blood Cancer 2012; 58: 561–565. © 2011 Wiley Periodicals, Inc.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic delay in pediatric solid tumors: A population based study on determinants and impact on outcomes

Loh¹,

Aung²,

Ha³

et al. 2011

Pediatric Blood & Cancer

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“…, and survival 24,[26][27][28][29] , there is some evidence that these socioeconomic disparities also reflect poor spatial access to screening, diagnosis, and treatment 6,7,24,[30][31][32][33] . In order to provide more geographically equitable access to treatment in British Columbia (BC), Canada, the British Columbia Cancer Agency has established five new comprehensive cancer treatment centers since 1995, in addition to the original BC Cancer Centre in the city of Vancouver.…”

mentioning

confidence: 99%

Socioeconomic disparities in head and neck cancer patients’ access to cancer treatment centers

Walker

Schuurman

Auluck³

et al. 2017

Rural Remote Health

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Introduction: Both socioeconomic status and travel time to cancer treatment have been associated with treatment choice and patient outcomes. An improved understanding of the relationship between these two dimensions of access may enable cancer control experts to better target patients with poor access, particularly in isolated suburban and rural communities. Methods: Using geographical information systems, head and neck cancer patients across British Columbia, Canada from 1981 to 2009, were mapped and their travel times to the nearest treatment center at their time of diagnosis were modelled. Patients' travel times were analysed by urban, suburban, and rural neighborhood types and an index of multiple socioeconomic deprivation was used to assess the role of socioeconomic status in patients' spatial access. Results: Significant associations between socioeconomic deprivation and spatial access to treatment were identified, with the most deprived quintiles of patients experiencing nearly twice the travel time as the least deprived quintile. The sharpest disparities were observed among the most deprived patient populations in suburban and rural areas. However, the establishment of new treatment centers has decreased overall travel times by 28% in recent decades. Conclusions: Residence in a neighborhood with high socioeconomic deprivation is strongly associated with head and neck cancer patients' spatial access to cancer treatment centers. Patients residing in the most socioeconomically deprived neighborhoods consistently have longer travel times in urban, suburban, and rural communities in the study area.Key words: cancer treatment, socioeconomic status, deprivation, head and neck cancers, spatial access, geographic information systems, Canada.© BB Walker, N Schuurman, A Auluck, SA Lear, M Rosin 2017. A Licence to publish this material has been given to James Cook University, http://www.jcu.edu.au 2 IntroductionWith an estimated 525 000 new cases in 2012, head and neck cancers are the eighth most common non-melanoma cancers globally 1. This number is expected to grow significantly in the coming decades, resulting in increased demand for treatment 2 .To maximize efficiency, comprehensive cancer treatment facilities are most commonly located in areas where they service the largest proportion of the patient population, generally in large urban centers. This results in a geographical inequity, such that individuals living farther from a cancer treatment center experience a greater travel burden in order to attend their treatment, particularly those living in rural and remote areas , and survival 14. The time required for patients to travel from the home to a cancer treatment center is therefore an important factor throughout the continuum of care, and may inform more efficient and equitable cancer control programs and policy.The travel time required for an individual to reach a treatment center provides a quantitative measure of access 15 . However, an individual's access to a health service may also be measured as the ...

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Wired for Innovation: How Information Technology is Reshaping the Economy

Sawyer

2010

J. Am. Soc. Inf. Sci.

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Waiting times for cancer care in Canadian children: Impact of distance, clinical, and demographic factors

Abstract: Distance to treating center had no significant impact on waiting times for important diagnostic and treatment events, when adjusted for age at diagnosis, diagnosis, region, and first health care professional seen.

Cited by 59 publications

References 14 publications

Diagnostic delay in pediatric solid tumors: A population based study on determinants and impact on outcomes

Diagnostic delay in pediatric solid tumors: A population based study on determinants and impact on outcomes

Socioeconomic disparities in head and neck cancer patients’ access to cancer treatment centers

Wired for Innovation: How Information Technology is Reshaping the Economy

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