A 20-Year Review of the Ontario Radiation Therapy Access to Care Crisis: Lessons Applied to the COVID-19 Pandemic

PURPOSE/OBJECTIVE(S): Cancer systems across Canada are struggling with an acute access to care crisis resulting from the COVID-19 pandemic. Policies are being considered and applied across the country to address the backlog of patients needing access to cancer services, including radiation therapy (RT). The purpose of this research was to assess the impact of central (provincial health ministry and cancer agency) and regional (cancer center) policies on access to RT in Ontario between 1997 and 2017, and consider their relevance to today's challenges. MATERIALS/METHODS: The research design was a case study with multiple embedded units. The case was Cancer Care Ontario. The embedded units were four diverse regional cancer centers representing the 14 different Ontario cancer centers. Methods included a document review, longitudinal quantitative data collection, and 43 key informant interviews. The theoretical underpinning was an extension of Kingdon's Multiple Streams Framework, to examine the ‘problem’, ‘policy’ solutions and ‘politics’ surrounding the crisis. RESULTS: The access to RT problem started as a wait time issue in the 1990s caused by inadequate RT facility capacity and a shortage of RT specialized staff, and evolved into a shortfall in RT utilization. Thirty-seven policies were identified and categorized as: improving existing RT capacity (n=5), system planning (n=7), performance management (n=6), human resources (HR, n=12), and building new RT capacities (n=7). Ten of the HR policies implemented to address recruitment and retention had mixed success because of implementation and political context issues. Many of these same policies are now being applied across Canada to address access to cancer services during the COVID-19 pandemic. CONCLUSION: A 20-year case study of the Ontario RT access crisis in the 1990s, and the post-crisis periods, offer many useful learnings that can be applied to current policy challenges in access to care due to the ongoing pandemic.