Geographical Variations in the Clinical Management of Colorectal Cancer in Australia: A Systematic Review

Abstract

BackgroundIn Australia, cancer survival is significantly lower in non-metropolitan compared to metropolitan areas. Our objective was to evaluate the evidence on geographical variations in the clinical management and treatment of colorectal cancer (CRC).MethodsA systematic review of published and gray literature was conducted. Five databases (CINAHL, PubMed, Embase, ProQuest, and Informit) were searched for articles published in English from 1990 to 2018. Studies were included if they assessed differences in clinical management according to geographical location; focused on CRC patients; and were conducted in Australia. Included studies were critically appraised using a modified Newcastle–Ottawa Scale. PRISMA systematic review reporting methods were applied.Results17 articles met inclusion criteria. All were of high (53%) or moderate (47%) quality. The evidence available may suggest that patients in non-metropolitan areas are more likely to experience delays in surgery and are less likely to receive chemotherapy for stage III colon cancer and adjuvant radiotherapy for rectal cancer.ConclusionThe present review found limited information on clinical management across geographic regions in Australia and the synthesis highlights significant issues both for data collection and reporting at the population level, and for future research in the area of geographic variation. Where geographical disparities exist, these may be due to a combination of patient and system factors reflective of location. It is recommended that population-level data regarding clinical management of CRC be routinely collected to better understand geographical variations and inform future guidelines and policy.

Helicobacter pylori infection associated with an increased risk of colorectal adenomatous polyps in the Chinese population

“…20% of patients without any symptom at the time of diagnosis may present with contiguous invasion, transperitoneal spread, and lymphatic or hematogenous dissemination [4–6]. In the matter of geographic pattern, the prevalence has increased in Canada, Australia, and the United States, while India and China show a relatively low risk [4, 7, 8].…”

Effect of Gender and Age on the Correlation between Helicobacter pylori and Colorectal Adenomatous Polyps in a Chinese Urban Population: A Single Center Study

“…A previous study has shown that H. pylori infection can upregulate the expression of basal metalloproteinase [14], which may be involved not only in the occurrence of CAC in CAP but also in the invasion and metastasis of CAC [15]. According to other studies, infection by H. pylori may increase the release of gastrin, which acts on intestinal epithelial cells and stimulates the production of cox-2, a well-known player in the occurrence, development, invasion, and metastasis of CAC [16][17][18]. Meanwhile, serological response to Cag A (cytotoxin-associated gene A) and Vac A (vacuolating cytotoxin A) secreted by H. pylori is associated with a higher risk of CAP and/or CAC [19][20][21].…”

Grey areas and evidence gaps in the management of rectal cancer as revealed by comparing recommendations from clinical guidelines

“…Despite the routine adoption of an evidence-based decision-making approach and wide implementation of MDT-centered, integrated care pathways, variation in oncology clinical practice remains a well-established phenomenon for several tumours including rectal cancer [51][52][53][54]. This can be influenced by many factors such as availability of health care facilities and professional expertise for service provision, local reimbursement policies, institutional/network pathways, social pressure and cultural prejudices, physician attitude and patient preferences.…”