A COMPARISON OF DELAYS IN THE TREATMENT OF CANCER WITH RADIATION IN CANADA AND THE UNITED-STATES
A COMPARISON OF DELAYS IN THE TREATMENT OF CANCER WITH RADIATION IN CANADA AND THE UNITED-STATES
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DOI：
10.1016/0360-3016(94)00662-5
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发表时间：
1995-05-15
影响因子：
7
通讯作者：
QUIRT, CF
中科院分区：
文献类型：
--
作者：
MACKILLOP, WJ;ZHOU, YZ;QUIRT, CF
目的：加拿大的医疗保健等候名单一直被用作反对美国医疗保健改革单一付款人选择的论据，但这两个医疗保健系统中没有直接比较。本研究的目的是比较加拿大和美国癌症患者等待放疗的时间。方法和材料：国际抗癌联盟（UICC）在加拿大和美国列出的所有癌症中心的放射肿瘤学负责人都收到了一份问卷，询问他们的患者等待放疗的时间，以及他们认为患者等待多长时间是可以接受的，结果：97个合格中心中有92个有反应（95%）。开始放射治疗的中位等待时间如下：（T2，N 0，M0），加拿大29天，美国10天;肺癌（IIIb期，鳞状），加拿大34天，美国9天;前列腺癌（B2期），加拿大40天，美国11天;乳腺癌（T2，N 0，M0）在乳房肿瘤切除术后1个月转诊，加拿大为43天，美国为10天;前列腺癌伴疼痛性骨转移，加拿大为17天，美国为5天;前列腺癌伴脊髓压迫，加拿大< 1天，美国< 1天。加拿大和美国之间的等待时间差异都具有统计学意义（p < 0.0001），除了脐带压迫的紧急治疗。大多数的放射肿瘤学家在加拿大和美国的加拿大部门报告的延迟为medically unacceptable.Conclusions：几乎在加拿大各地的患者等待放疗的时间比他们几乎在美国的任何地方。
Purpose: Waiting lists for medical care in Canada have been used as an argument against the single-payer option for health care reform in the United States, but there have been no direct comparisons of access to care in these two health care systems. The objective of this study was to compare how long cancer patients wait far radiotherapy in Canada and the USA.Methods and Materials: Heads of radiation oncology at all cancer centers listed by the International Union Against Cancer (UICC) in Canada and the United States were sent a questionnaire that asked how long their patients waited for radiotherapy, and how long they thought it was acceptable for patients to wait, in six clinical situations.Results: Ninety-two of 97 eligible centers responded (95%). Median waiting times to start of radiotherapy were as follows: carcinoma of the larynx (T2,N0,M0), 29 days in Canada, 10 days in the USA; carcinoma of the lung (Stage IIIb, squamous), 34 days in Canada, 9 days in the USA; carcinoma of the prostate (Stage B2), 40 days in Canada, 11 days in the USA; carcinoma of the breast (T2,N0,M0) referred 1 month after lumpectomy, 43 days in Canada, 10 days in the USA; carcinoma of the prostate with painful bone metastases, 17 days in Canada, 5 days in the USA; carcinoma of the prostate with spinal cord compression, < 1 day in Canada, < 1 day in the USA. The differences in waiting times between Canada and the USA were all statistically significant (p < 0.0001), except in the case of emergency treatment for cord compression. The majority of radiation oncologists in both Canada and the USA regarded the delays reported by Canadian departments as medically unacceptable.Conclusions: Patients almost everywhere in Canada wait longer for radiotherapy than they do almost anywhere in the United States.