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Factors Affecting the Use of Palliative Radiotherapy in Ontario

From the Radiation Oncology Research Unit, Department of Oncology, Queen’s University, Kingston Regional Cancer Center, Kingston, Ontario, Canada.

Address reprint requests to William J. Mackillop, MD, Radiation Oncology Research Unit, Kingston General Hospital, Apps Level 4, Kingston, Ontario, K7L 2V7 Canada; email william.mackillop@ krcc.on.ca.

PURPOSE: To describe the use of palliative radiotherapy (PRT) and to identify factors associated with the use of PRT.

MATERIALS AND METHODS: The Ontario Cancer Registry was used to identify 193,253 adult patients who died of cancer between 1986 and 1995. Radiotherapy records from all Ontario cancer centers and the data on socioeconomic status (SES) from the Canadian Census were linked to the Ontario Cancer Registry data. The proportion of cases who received at least one course of PRT at any time within 2 years of death (PRT_2Y) was used as a primary measure of the use rate of PRT.

RESULTS: Overall, 26.4% of cases underwent at least one course of PRT. PRT_2Y remained relatively constant over the study period. PRT_2Y was disease-specific and ranged from 4% for pancreatic cancer to 41% for prostate cancer. Age was negatively associated with PRT_2Y (adjusted odds ratio [OR], 4.5 for the youngest group), and SES was positively associated with PRT_2Y (adjusted OR, 1.2 for patients from wealthy communities). Patients who were initially diagnosed in a hospital affiliated with a cancer center (adjusted OR, 1.4) or who lived in a county in which a cancer center is located (adjusted OR, 1.2), or who resided in certain regions (adjusted OR, 1.20 for Hamilton and 1.17 for Kingston), were more likely to be treated with PRT.

CONCLUSION: The use of PRT varied across the dispersed population in Ontario and was influenced by factors unrelated to the patient’s needs. An effort should be made to reduce barriers to access for disadvantaged groups.

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