The dilemma of distance: patients with kidney cancer from regional Australia present at a more advanced stage

Abstract

Objective To determine whether patients from regional areas undergoing surgery for kidney cancer present with more advanced disease as a result of geographic isolation. Patients and Methods Retrospective analysis of 221 patients undergoing surgery for renal cell carcinoma (RCC) from January 2004 to June 2012, from both a metropolitan centre and a large inner regional hospital. Data was collected on age, gender, presentation (incidental or symptomatic), clinical stage and pathological features. The Australian Standard Geographical Classification‐Remoteness Area (ASGC‐RA) is a system developed to allow quantitative comparisons between metropolitan and rural Australia. A score was assigned to each patient based on their location of residence at the time of surgery: metropolitan, RA1; inner regional, RA2; outer regional, RA3. Statistical significance was specified as P < 0.05 on Pearson's chi‐square tests. Results Patients in each ASGC‐RA group did not differ significantly in age, sex or mode of presentation. Pathological T stage on presentation increased with increasing ASGC‐RA and thus distance from tertiary centres (P = 0.004). The proportion of patients with ≥T3 disease rose from 30% of RA1 to 73% of RA3 patients (P = 0.016) treated at our tertiary centre. Similarly, our regional centre had a larger proportion of patients presenting with ≥T3 disease from RA3 (31% vs 5%, P = 0.003). When the 221 patients with RCC were analysed as a group, clinical T stage was significantly associated with ASGC‐RA (P < 0.001), symptomatic presentation (P < 0.001), N stage (P < 0.001), M stage (P < 0.001) and Fuhrman grade (P < 0.001). Conclusions Our data quantifies the detrimental effect of physical distance on the health outcomes of regional Australians with kidney cancer. Australia's unique geography and rural culture may preclude any attempts to centralise cancer care to specialised metropolitan units, as has occurred in other countries.

Distance as a Barrier to Cancer Diagnosis and Treatment: Review of the Literature

“…The role of travel burden influencing cancer stage at diagnosis was analyzed in 12 retrospective studies [1,9,[13][14][15][16][17][18][19][20][21][22], which involved 401,775 patients (Table 1). All but three of these studies were performed in the United States.…”

“…The distance from the hospital (i.e., travel burden) also influences the choice of appropriate treatment by cancer patients. Some studies found that patients living farther from a radiation treatment facility more often underwent mastectomy instead of BCS [23][24][25][27][28][29] or did not undergo radiotherapy after BCS [22,24]. The results reported by Schroen et al [23] suggest that a marked change in geographic access to radiotherapy by opening new facilities might correlate with an increase in the proportion of patients undergoing breast conservation therapy.Tracey et al [30] found that patients with localized NSCLC were most likely to not undergo potentially curative surgery if they lived far from a specialist hospital and only attended a general hospital for their care.…”

Survival from breast, colon, lung, ovarian and rectal cancer by geographical remoteness in New South Wales, Australia, 2000–2008

“…Such differences could be due to multiple reasons. For instance, living in rural and remote areas has been shown to be associated with a later stage of cancer at diagnosis . Access to specialist treatment might also be an issue, given that lower survival and higher mortality with increasing distance to treatment have been reported in numerous national settings and for different cancers .…”

Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns

“…Regionalization of diagnosis and treatment for STS at specialized centers has been advocated, but it would necessitate a greater travel burden for some patients [ 4 , 7 ]. In patients with carcinomas, travel burden has resulted in delays in diagnosis [ 8 , 11 , 13 , 17 , 26 – 30 ] and worse survival outcome [ 8 , 31 – 34 ]. To make this worthwhile, it is necessary to identify how the regionalized cases may differ from non-regionalized cases based on tumor stage or patient characteristics, how this translates into differences in patient survival, and if the effect is determined by care delivery by academic/specialized centers.…”