DISCUSSION
There is a north-south geographic/spatial gradient when considering cancer outcomes that is significant. This indicates there is something that these regions have in common being where they are located that influence the disease distribution. 
 Areas of highest population density are where RT centers are located.
Reasons that drive high MIR - stage, screening, biology of cancer - 
RT utilization relationship with travel time differs by disease site (Liu) - should look at this by disease site next
Positive impact of opening new centre on RT use (Liu) - we did not have the data to look at cancer outcomes past 2010-2012, with 2 new centers (?) opened after this, likely improved things. However, evidence to suggest that even with opening of new rural centers, patients may not use them (Thompson)
large geographic area, low population density; high income country issues; not unique to Canada. Urban/rural... this is a global problem, need to explore other countries, collaboration to determine how best to serve these populations.
 
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Research in context panel
Evidence before this study: This section should include a description of all the evidence that the authors considered before undertaking this study. Authors should briefly state: the sources (databases, journal or book reference lists, etc) searched; the criteria used to include or exclude studies (including the exact start and end dates of the search), which should not be limited to English language publications; the search terms used; the quality (risk of bias) of that evidence; and the pooled estimate derived from metaanalysis of the evidence, if appropriate.
Added value of this study: Authors should describe here how their findings add value to the existing evidence.
Implications of all the available evidence: Authors should state the implications for practice or policy and future research of their study combined with existing evidence. Research in context panels should not contain references; key studies mentioned here should be referenced in the main text.