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Variation in Delivery of Palliative Radiotherapy to Persons Dying of Cancer in Nova Scotia, 1994 to 1998

From the Nova Scotia Cancer Registry and Nova Scotia Cancer Centre of Queen Elizabeth II Health Sciences Centre, and School of Health Services Administration, Dalhousie University, Halifax, Nova Scotia, Canada.

Address reprint requests to Grace M. Johnston, MHSA, PhD, School of Health Services Administration, 5599 Fenwick St, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1R2; email: grace.johnston{at}dal.ca

PURPOSE: To examine sociodemographic and clinical variables associated with provision of palliative radiotherapy (RT) to persons dying of cancer.

METHODS: The Nova Scotia Cancer Registry was used to identify 9,978 adults who were dying of cancer between 1994 and 1998 in the Canadian province of Nova Scotia. RT records from between April 1992 and December 1998 were obtained from the provincial treatment database. Multivariate analysis identified factors associated with two sequential decisions determining provision of palliative RT in the last 9 months of life: likelihood of receiving an RT consultation with a radiation oncologist and, given a consultation, likelihood of being treated with palliative RT.

RESULTS: The likelihood of having a consultation decreased with age (20 to 59 years v 80+ years: odds ratio [OR], 4.43 [95% confidence interval, 3.80 to 5.15]), increased with community median household income (> $50,000 v < $20,000: OR, 1.31 [1.02 to 1.70]), was higher for residents closer to the cancer center (< 25 km v 200+ km: OR, 2.47 [2.16 to 2.83]), increased between 1994 and 1998 (OR, 1.34 [1.16 to 1.56]), varied by cause of death (relative to thoracic cancers, head and neck: OR, 1.75 [1.31 to 2.33]; gynecologic: OR, 0.35 [0.27 to 0.44]), and was greater for those who had prior RT (OR, 2.20 [1.89 to 2.56]). Similar associations were observed when outcome was the provision of palliative RT given a consult, with one notable exception: prior RT was associated with a lower likelihood of receiving palliative RT (OR, 0.48 [0.40 to 0.58]).

CONCLUSION: Variations observed in delivery of palliative RT should prompt further investigation into equity of access to clinically appropriate, palliative radiation consultation and treatment.

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