Remoteness of residence and survival from cancer in New South Wales

Abstract

Objective: To analyse cancer survival in New South Wales by geographic remoteness. Design, setting and participants: A survival analysis of all patients with cancers diagnosed in NSW between 1 January 1992 and 31 December 1996. Survival was determined to 31 December 1999. Main outcome measures: The relative excess risk (RER) of death over 5 years was estimated for each geographic remoteness category relative to the highly accessible category for 20 cancer types adjusted for age, sex, years since diagnosis and, subsequently, stage of cancer at diagnosis. Results: There were statistically significant differences in the RER of death across remoteness categories (P < 0.001) for cancers of the cervix and prostate and for all cancers. The RERs for the most remote categories (compared with the highly accessible category) before and after adjustment for stage were cervix, 3.22 (95% CI, 1.54–6.75) and 2.25 (95% CI, 1.06–4.77); prostate, 3.38 (95% CI, 2.21–5.16) and 2.53 (95% CI, 1.60–4.01); all cancers, 1.35 (95% CI, 1.20–1.51) and 1.25 (95% CI, 1.11–1.41). In addition, there were significant variations in RER of death by remoteness for head and neck, lung and colon cancers and cutaneous melanoma. Conclusion: Cancer survival varies by remoteness of residence in NSW for all cancers together and some cancers individually. Access to screening or early diagnosis probably contributes to this variation, but persistence after adjustment for stage suggests that treatment variation is also important.

Quality or equality? The Norwegian experience with medical monopolies

“…In the Nordic countries and other countries with a scattered population, geographical maldistribution has been the main focus [9]. Such a focus seems to be substantiated by the results of the present study.…”

Functional imaging equivalence and proof of concept for image-guided adaptive radiotherapy with fixed gantry and rotating couch

“…Lack of appropriately tailored (or any) radiotherapy services affect healthcare systems through increased patient morbidity and mortality, longer and more complicated hospitalizations, expensive medicines, 13 and unnecessary surgeries such as mastectomy and prostatectomy 10, 14, 15. In Australia, for example, mortality rates are 35% higher for patients with cancer in rural areas10, 16 compared with mortality rates for patients with rectal cancer, which rise by 6% for every extra 100 km patients live from a radiotherapy clinic 17 . Indigenous patients with cancer suffer mortality rates that are 30% higher 18, 19…”

Cancer care in Australia

“…People with cancer living in remote and rural areas are diagnosed at a later stage than their city counterparts [52], and moreover, are more likely to die from cancers such as lung, cervix, and uterine malignancies the further they are located from city centres [53]. Specific indicators of reduced access to cancer care services in remote and rural areas include poorer state-of-the-art diagnostic tests, staging and treatment of prostate cancer [54], less breast-conserving surgery [55], and lower probability of completing external beam radiotherapy when referred for treatment of rectal cancer [56].…”