Impact of age and diagnosis on waiting times between important healthcare events among children 0 to 19 years cared for in pediatric units: the Canadian Childhood Cancer Surveillance and Control Program.

BACKGROUND: The objectives were to describe and compare waiting times to diagnosis and treatment of children and adolescents who accessed pediatric oncology centers in Canada for healthcare, and to assess the effects and relative contributions of age, sex, and diagnosis to waiting times. METHODS: Waiting times were assessed for 2,365 children (0 to 14 y) and 375 adolescents (15 to 19 y) diagnosed with cancer between 1995 and 2000 inclusive and followed by the Treatment and Outcome Surveillance system of the Canadian Children's Cancer Surveillance and Control Program. Differences were assessed using the chi2 test, Fisher exact test, and Wilcoxon test statistic. RESULTS: Median waiting times between first assessment by treating oncologist or surgeon and definitive diagnostic procedure, and the subsequent interval to first therapeutic event, were 2 days each. Significant variation existed in both periods when stratified by age and diagnosis but not sex. The most significant differences between age groups were eliminated when stratified by diagnosis. INTERPRETATION: This analysis suggests that once they enter the healthcare system, children and adolescents treated in pediatric centers in Canada experience short waiting times to key diagnostic and treatment events. Differences in wait times between the 2 age groups are not clinically significant and can be attributed to the differences in the types of cancer experienced by adolescents compared with children.

Multiple exposures to smoking, alcohol, physical inactivity and overweight: Prevalences according to the Canadian Community Health Survey Cycle 1.1.

The objective of this study was to calculate the prevalence of multiple exposures to four modifiable risk factors (smoking, alcohol, physical inactivity and overweight) and to establish whether there are more Canadians with multiple risk factor exposures than those with singular ones. Weighted estimates of the prevalence of mutually exclusive risk factor clusters were calculated according to the Canadian Community Health Survey, Cycle 1.1 (2000). Confidence limits were estimated by bootstrap techniques. Findings indicate that 21.0 percent of Canadians have no risk factor exposures, 53.5 percent are physically inactive, 21.5 percent currently smoke, 44.8 percent are overweight, and 6.0 percent are high-risk drinkers. Compared to females, males are less physically inactive but more likely to smoke, have high alcohol intake and be overweight, across all age groups. At least one risk factor was present in 79.0 percent of Canadians and 39.0 percent have at least two coexistent exposures. The distribution of risk factor prevalences differed significantly by age, most peaking among those between age 35 and 64, with the exception of physical inactivity. Those who smoke and are physically inactive account for the highest proportion of the population with two or more coexistent risk factors. Canadians who are free of the four risk factors for chronic disease examined in this paper constitute the minority. Future studies are recommended to examine other risk factors, as well as interactions of multiple exposures in association with chronic disease.

Waiting times for cancer care in Canadian children: impact of distance, clinical, and demographic factors.

BACKGROUND: The objective of this study was to evaluate the impact of distance from residence to pediatric oncology centers on waiting times to diagnostic assessment and treatment in Canadian children with cancer. PROCEDURE: Two thousand three hundred sixteen children (< 15 years of age) captured by the Canadian Childhood Cancer Surveillance and Control Program's (CCCSCP) Treatment and Outcome Surveillance (TOS) system were included in the analysis. The number of days between onset of symptoms and first anti-cancer therapy was compared for those living less than 25, 25-99, and more than 100 kilometers from their treating center. For each time period, the adjusted odds of falling into the longest time quartiles were estimated using logistic regression analysis. RESULTS: Thirty-four percent (n = 786) of children lived more than 100 kilometers from their treating center. There were no significant differences in age at diagnosis (P = 0.33), sex (P = 0.68), or ICCC diagnosis (P = 0.02) by distance from center, though there was a significant difference in region of residence (P < 0.01) and the first health care professional contacted (P < 0.01). Except for waiting time from first health care contact to first assessment by treating oncologist which increased with increasing distance (P < 0.01), there were no significant differences in waiting times by distance. When adjusted for important demographic and clinical characteristics, distance to center did not affect the odds of waiting longer for any event. CONCLUSIONS: Distance to treating center had no significant impact on waiting times for important diagnostic and treatment events, when adjusted for age at diagnosis, diagnosis, region, and first health care professional seen.