Cancer health inequality persists in regional and remote Australia

Fox, Peter; Boyce, Adam

doi:10.5694/mja14.01217

Cited by 80 publications

(92 citation statements)

References 9 publications

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“…The further away from a major centre the patient lives, the less likely he or she is to have access to specialised investigations, expertise and treatment . In Queensland, rectal cancer mortality increases by 6% for every 100 km that patients reside from the closest radiotherapy centre . Early breast cancer patients in rural New South Wales are more likely to receive suboptimal curative therapies, with an 84% higher breast cancer mortality .…”

Section: Discussionmentioning

confidence: 99%

“…Early breast cancer patients in rural New South Wales are more likely to receive suboptimal curative therapies, with an 84% higher breast cancer mortality . The cost of attending regional or tertiary centres for cancer treatment continues to remain a barrier to improved cancer survival rates . State‐based road travel subsidies for rural patients are as low as 16 cents per kilometre, which is significantly below the Australian Tax Office tax‐deductible rate of 65 cents per business kilometre.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical profile and treatment outcomes of advanced neuroendocrine tumours in rural and regional patients: a retrospective study from a regional cancer centre in North Queensland, Australia

Hafeez

Joshi

Bhatt

et al. 2017

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical profile and treatment outcomes of advanced neuroendocrine tumours in rural and regional patients: a retrospective study from a regional cancer centre in North Queensland, Australia

Hafeez

Joshi

Bhatt

et al. 2017

Internal Medicine Journal

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“…For example, rates of breast screening within the BreastScreen Australia services (Australia’s publically-funded screening program for women aged 50 to 74 years) are lowest for women living in remote and very remote areas of Australia and for Indigenous women [13]. Further, inequalities in timely access to diagnostic services have been reported in Australia [14], and elsewhere [15,16,17]. …”

Section: Introductionmentioning

confidence: 99%

The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population-Based Study of 3202 Women in Queensland, Australia

Youl

Aitken

Turrell

et al. 2016

IJERPH

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Delays in diagnosing breast cancer (BC) can lead to poorer outcomes. We investigated factors related to the diagnostic interval in a population-based cohort of 3202 women diagnosed with BC in Queensland, Australia. Interviews ascertained method of detection and dates of medical/procedural appointments, and clinical information was obtained from medical records. Time intervals were calculated from self-recognition of symptoms (symptom-detected) or mammogram (screen-detected) to diagnosis (diagnostic interval (DI)). The cohort included 1560 women with symptom-detected and 1642 with screen-detected BC. Symptom-detected women had higher odds of DI of >60 days if they were Indigenous (OR = 3.12, 95% CI = 1.40, 6.98); lived in outer regional (OR = 1.50, 95% CI = 1.09, 2.06) or remote locations (OR = 2.46, 95% CI = 1.39, 4.38); or presented with a "non-lump" symptom (OR = 1.84, 95% CI = 1.43, 2.36). For screen-detected BC, women who were Indigenous (OR = 2.36, 95% CI = 1.03, 5.80); lived in remote locations (OR = 2.35, 95% CI = 1.24, 4.44); or disadvantaged areas (OR = 1.69, 95% CI = 1.17, 2.43) and attended a public screening facility (OR = 2.10, 95% CI = 1.40, 3.17) had higher odds of DI > 30 days. Our study indicates a disadvantage in terms of DI for rural, disadvantaged and Indigenous women. Difficulties in accessing primary care and diagnostic services are evident. There is a need to identify and implement an efficient and effective model of care to minimize avoidable longer diagnostic intervals.

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“…This is due to a variety of reasons including lower availability of diagnostic or treatment services, late presentation and diagnosis, lower socioeconomic status, reduced rates of physical activity and a higher proportion of Aboriginal and Torres Strait Islander (ATSI) peoples 11, 12. The concept of treatment “quality” is also pertinent and has been addressed in the management of head and neck cancer, in which treatment outcomes have been shown to correlate to the volume of cases treated at a particular centre 13.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of post‐prostatectomy radiotherapy at a Regional Cancer Centre

Nicholls

Winter

Harwood

et al. 2017

J of Medical Radiation Sci

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IntroductionTo investigate the efficacy and toxicity of radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer at Radiation Oncology Centres, Toowoomba.MethodsThe electronic medical records of 130 consecutive patients with histologically proven prostate adenocarcinoma who underwent post‐prostatectomy RT between January 2008 and December 2014 were analysed. Primary endpoint was Biochemical Recurrence (BCR) after RT. BCR was defined by PSA > 0.2 ng/mL and BCR endpoints were analysed using Kaplan–Meier methods. The impact of RT technique and the rates of acute and late toxicities are also reported. Toxicities were graded according to Radiation Therapy Oncology Group (RTOG) criteria.ResultsMedian follow‐up time after RT (regardless of technique) was 28 months. BCR occurred in 32 of the 126 patients (25%) whose prostate specific antigen (PSA) levels have been monitored post‐RT. At 24 and 36 months, 85% and 75% of patients were BCR‐free, respectively. Patients with a pre‐RT PSA above 0.2 ng/mL had a higher probability of recurrence than patients with values below 0.2 ng/mL (P = 0.03). RT technique, pelvic nodal irradiation, androgen deprivation therapy, T staging or surgical margin did not significantly impact BCR results.No patient experienced acute toxicities greater than grade 2. Grade 1 or 2 late gastrointestinal (GI) toxicity occurred in 11% and 1 patient experienced a grade 3 event. 12% of patients developed grade 1 or 2 late genitourinary (GU) toxicity, with evidence of grade 3 severity in only 1 patient. Evidence of a trend in reduction in late GI toxicity with the use of intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) was apparent but not with late GU toxicity.ConclusionAt our regional centre, early RT (PSA < 0.2 ng/mL) was associated with significant improvement in BCR‐free survival. Rates of toxicity mirror those of landmark trials which suggest no detriment for our regional prostate cancer patients. The use of IMRT/VMAT techniques was associated with a trend towards reduced rates of GI toxicity.

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Cancer health inequality persists in regional and remote Australia

Cited by 80 publications

References 9 publications

Clinical profile and treatment outcomes of advanced neuroendocrine tumours in rural and regional patients: a retrospective study from a regional cancer centre in North Queensland, Australia

Clinical profile and treatment outcomes of advanced neuroendocrine tumours in rural and regional patients: a retrospective study from a regional cancer centre in North Queensland, Australia

The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population-Based Study of 3202 Women in Queensland, Australia

Outcomes of post‐prostatectomy radiotherapy at a Regional Cancer Centre

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