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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.

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Acknowledgments

The authors would like to thank Dr. Fredrick Burge, Dr. Geoff Porter, Dr. Grace Johnston, and Dr. Jeremiah Hurley for helpful comments of the earlier versions of this manuscript. This work is part of AM’s Master’s thesis at the Department of Community Health and Epidemiology Dalhousie University and supported by ACCESS (CIHR/CCNS Team in Access to Colorectal Cancer Services in Nova Scotia) and NELS-ICE (Network for End of Life Studies Interdisciplinary Capacity Enhancement) funded by the Canadian Institutes of Health Research (CIHR). ACCESS also receives funds from Cancer Care Nova Scotia (CCNS), Nova Scotia Department of Health, Capital District Health Authority, Dalhousie Medical Research Foundation, and Dalhousie University’s Faculty of Medicine. YA is a recipient of the CIHR New Investigator Salary Award.

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Correspondence to André R. Maddison.

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Maddison, A.R., Asada, Y. & Urquhart, R. Inequity in access to cancer care: a review of the Canadian literature. Cancer Causes Control 22, 359–366 (2011). https://doi.org/10.1007/s10552-010-9722-3

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Keywords

  • Inequity
  • Access
  • Cancer
  • Continuum of care
  • Canada
  • Income
  • Geography
  • Age