Rural and urban differences in stage at diagnosis of colorectal and lung cancers

Abstract

SummaryThere is evidence that patients living in outlying areas have poorer survival from cancer. This study set out to investigate whether they have more advanced disease at diagnosis. Case notes of 1323 patients in north and northeast Scotland who were diagnosed with lung or colorectal cancer in 1995 or 1996 were reviewed. Of patients with lung cancer, 42% (69/164) living 58 km or more from a cancer centre had disseminated disease at diagnosis compared to 33% (71/215) living within 5 km. For colorectal cancer the respective figures were 24% (38/161) and 16% (31/193). For both cancers combined, the adjusted odds ratio for disseminated disease at diagnosis in furthest group compared to the closest group was 1.59 (P = 0.037). Of 198 patients with non-small-cell lung cancer in the closest group, 56 (28%) had limited disease (stage I or II) at diagnosis compared to 23 of 165 (14%) of the furthest group (P = 0.002). The respective figures for Dukes A and B colorectal cancer were 101 of 196 (52%) and 67 of 172 (39%) (P = 0.025). These findings suggest that patients who live remote from cities and the associated cancer centres have poorer chances of survival from lung or colorectal cancer because of more advanced disease at diagnosis. This needs to be taken into account when planning investigation and treatment services.

The influence of socio-economic and locational disadvantage on patterns of surgical care for lung cancer in Western Australia 1982-2001

“…The evidence concerning a relationship between residential location and stage has been mixed with one population-based study from the southern US finding that distance to the nearest hospital predicted a later stage of lung cancer, although, rurality of residence did not (Silverstein et al, 2002). Other studies have shown an association between location of residence and advanced lung cancer stage (Campbell et al, 2001, Liff et al, 1991, Jong et al, 2002. Another US study, by Smith et al (1995), found that living in an urban area reduced the likelihood of treatment in older patients with a similar stage of disease.…”

Investigating urban–rural disparities in tuberculosis treatment outcome in England and Wales

“…Previous studies have used place of residence and distance from treatment centre as a proxy measures of access to care [8][9][10][11]. Neither of these, however, may be an appropriate indicator.…”

Access to specialist cancer care: is it equitable?

“…More indepth, qualitative studies are needed to understand why older patients and patients admitted to a 'non-cancer' hospital may be less likely to go on to receive specialist cancer care. Previous studies have shown patients living more remote from cities and cancer centres have more advanced cancer at diagnosis and poorer outcomes (Campbell 2000(Campbell , 2001). This must not be compounded by an inequity of access to specialist care.…”

“…Campbell et al (2000) indicated that distance from a cancer centre might be a determining factor in survival. A more recent study showed that this is likely to be partly because patients living further from cities and associated cancer centres have more advanced disease at diagnosis (Campbell et al, 2001). It is therefore crucial that any increase in physical distance from specialised services does not exacerbate inequalities in uptake of specialist care.…”