Mackillop W J, Groome P A, Zhang-Solomons J, Zhou Y, Feldman-Stewart D, Paszat L, Dixon P, Holowaty E J, Cummings B J
Department of Oncology, Queen's University, Canada.
J Clin Oncol. 1997 Mar;15(3):1261-71. doi: 10.1200/JCO.1997.15.3.1261.
In the Canadian province of Ontario, all radiotherapy is provided by a centrally managed provincial network of nine cancer centers. The primary goal of this study was to determine whether this highly centralized radiotherapy system provides adequate and equitable access to care for the province's dispersed population.
The Ontario Cancer Registry (OCR) was used to identify 295,386 cases of invasive cancer, excluding nonmelanoma skin cancer, which were diagnosed in Ontario between 1984 and 1991. Electronic radiotherapy records from each of the province's radiotherapy centers were linked to the registry at the level of the individual case.
The proportion of incident cases treated with radiotherapy was 18.8% at 4 months after diagnosis, 23.7% at 1 year, 25.8% at 2 years, 28.2% at 5 years, and 29.1% at 8 years. These rates of radiotherapy use are much lower than the accepted national and international targets, and lower than rates reported from other jurisdictions. The rate of radiotherapy use at 1 year varied significantly from county to county across Ontario (range, 18.6% to 32.4%; P < 10(-6)), and the highest rates were recorded in communities close to radiotherapy centers. There was a common geographic pattern of rate variations among several disease groups, including breast cancer, lung cancer, the genitourinary malignancies, and the gastrointestinal malignancies.
The low and uneven rates of radiotherapy use across the province indicate that Ontario's centralized radiotherapy system does not, at present, provide adequate or equitable access to care.
在加拿大安大略省，所有放射治疗均由一个由九个癌症中心组成的省级中央管理网络提供。本研究的主要目标是确定这种高度集中的放射治疗系统是否能为该省分散的人口提供充足且公平的医疗服务。
利用安大略癌症登记处（OCR）识别出1984年至1991年间在安大略省诊断出的2953个月时接受放射治疗的新发病例比例为18.8%，1年时为23.7%，2年时为25.8%，5年时为28.2%，8年时为29.1%。这些放射治疗使用率远低于公认的国内和国际目标，也低于其他司法管辖区报告的比率。安大略省各郡之间1年时的放射治疗使用率差异显著（范围为18.6%至32.4%；P < 10⁻⁶），最高使用率出现在靠近放射治疗中心的社区。包括乳腺癌、肺癌、泌尿生殖系统恶性肿瘤和胃肠道恶性肿瘤在内的几个疾病组中，存在共同的地理使用率变化模式。
全省放射治疗使用率低且不均衡，表明安大略省目前的集中放射治疗系统未能提供充足或公平的医疗服务。 例，不包括非黑色素瘤皮肤癌。该省各放射治疗中心的电子放射治疗记录在个体病例层面与登记处相链接。
诊断后4个月时接受放射治疗的新发病例比例为18.8%，1年时为23.7%，2年时为25.8%，5年时为28.2%，8年时为29.1%。这些放射治疗使用率远低于公认的国内和国际目标，也低于其他司法管辖区报告的比率。安大略省各郡之间1年时的放射治疗使用率差异显著（范围为18.6%至32.4%；P < 10⁻⁶），最高使用率出现在靠近放射治疗中心的社区。包括乳腺癌、肺癌、泌尿生殖系统恶性肿瘤和胃肠道恶性肿瘤在内的几个疾病组中，存在共同的地理使用率变化模式。
全省放射治疗使用率低且不均衡，表明安大略省目前的集中放射治疗系统未能提供充足或公平的医疗服务。
