Abstract 4141: Access to medical or radiation oncology consultation in patients who died from cancer in the Sudbury-Manitoulin District of Northeastern Ontario, Canada
Authors: Conlon Michael , Hartman Mark , Ballantyne Barbara , Bewick Mary , Meigs Margaret , Aubin Natalie , Knight Andrew 
Published: May 2015

Abstract
Sudbury-Manitoulin district is located in Northeastern Ontario, Canada, and resident cancer patients often receive care at the Northeast Cancer Centre (NECC), a Cancer Care Ontario regional cancer program located at Health Sciences North in Sudbury. In 2008, as part of enhancing services in this district, the NECC established an ambulatory Palliative Clinic. Presently, referral to this clinic occurs subsequent to a patient consultation with a medical or radiation oncology specialist. Using administrative data, the primary purpose of this population-based retrospective study was to estimate the percentage of patients who died from cancer without having had the opportunity to access this clinic through a prior documented medical or radiation oncology consultation during the interval of 2004-2008. A secondary purpose was to determine factors associated with never having received this specialized medical consult. Data was obtained through The Ontario Cancer Data Linkage Project (`cd-link') an initiative of the Ontario Institute for Cancer Research/Cancer Care Ontario Health Services Research Program. For each index case, we constructed a timeline (days) of all Ontario Health Insurance Plan (OHIP) billing codes and associated service dates, from primary cancer diagnosis through to cancer death. Our main outcome variable, consultation with a medical or radiation oncologist, was dichotomized as “ever” or “never”. A total of 6,683 individuals with a valid primary cancer diagnosis record died from any cancer cause in the Sudbury-Manitoulin District within the 5 year period from 2004-2008. Most (n=5988, 89.6%) had one primary cancer diagnoses. For this subgroup, and excluding those with a disease duration of 0 days (n=67), about 18.4% (n=1088/5921) never consulted a medical or radiation oncologist through their disease trajectory. Multivariable logistic regression identified three significant and independent predictors of having never received a consultation. Older age and rural residence were associated with increased risk of “never consultation”, with adjusted Odds Ratio (OR)s of 7.13 (95% Confidence Interval (CI) 3.68-13.81) and 1.77 (95% CI 1.51-2.06) for residents 80 years and older, or living in a rural residence, respectively. A longer duration of disease was associated with a decreased risk, with an OR of 0.99 (95% CI 0.99-0.99). While there are limitations to using administrative data, we estimate that 18.4% of the residents in this area did not benefit from a specialized consultation about their cancer care, which could also have included suitability and timing of referral to the palliative care clinic. Specific strategies directed towards older and rural patients may help to address this important access to care issue.
Citation Format: Michael Conlon, Mark Hartman, Barbara Ballantyne, Mary Bewick, Margaret Meigs, Natalie Aubin, Andrew Knight. Access to medical or radiation oncology consultation in patients who died from cancer in the Sudbury-Manitoulin District of Northeastern Ontario, Canada. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4141. doi:10.1158/1538-7445.AM2014-4141