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Peter Vedsted

Rural-urban disparities in time to diagnosis and treatment for colorectal and breast cancer

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Rebecca J Bergin, Centre for Behavioural Research in Cancer, Cancer Council Victoria rebecca.bergin@cancervic.org.au.
  • ,
  • Jon Emery, General Practice and Centre for Cancer Research, University of Melbourne.
  • ,
  • Ruth C Bollard, Division of Surgery, Ballarat Health Services.
  • ,
  • Alina Zalounina Falborg
  • Henry Jensen
  • David Weller, University of Edinburgh
  • ,
  • Usha Menon, Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London.
  • ,
  • Peter Vedsted
  • Robert J Thomas, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne
  • ,
  • Kathryn Whitfield, Department of Health and Human Services, Victorian Government.
  • ,
  • Victoria White, School of Psychology, Deakin University.

BACKGROUND: Longer cancer pathways may contribute to rural-urban survival disparities, but research in this area is lacking. We investigated time to diagnosis and treatment for rural and urban patients with colorectal or breast cancer in Victoria, Australia.

METHODS: Population-based surveys (2013-2014) of patients (aged ≥40, approached within six months of diagnosis), primary care physicians (PCP), and specialists were collected as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were examined: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment) and total interval (symptom/screening to treatment). Rural and urban intervals were compared using quantile regression including age, sex, insurance and socio-economic status.

RESULTS: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 PCPs and 370 specialists participated. Compared to urban patients, symptomatic colorectal cancer patients from rural areas had significantly longer total intervals at the 50th (18 days longer, 95% Confidence Interval (CI): 9-27), 75th (53, 95% CI: 47-59) and 90th percentiles (44, 95% CI: 40-48). These patients also had longer diagnostic and health system intervals (6-85 days longer). Breast cancer intervals were similar by area of residence, except the patient interval, which was shorter for rural patients with either cancer in the higher percentiles.

CONCLUSIONS: Rural residence was associated with longer total intervals for colorectal but not breast cancer; with most disparities post-presentation.

IMPACT: Interventions targeting time from presentation to diagnosis may help reduce colorectal cancer rural-urban disparities.

TidsskriftCancer Epidemiology, Biomarkers & Prevention
Sider (fra-til)1036-1046
StatusUdgivet - 9 jul. 2018

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