TY - JOUR
T1 - Rural-urban disparities in time to diagnosis and treatment for colorectal and breast cancer
AU - Bergin, Rebecca J.
AU - Emery, Jon
AU - Bollard, Ruth C.
AU - Falborg, Alina Zalounina
AU - Jensen, Henry
AU - Weller, David
AU - Menon, Usha
AU - Vedsted, Peter
AU - Thomas, Robert J.
AU - Whitfield, Kathryn
AU - White, Victoria
N1 - Funding Information:
R.J. Bergin's PhD scholarship was supported by the Victorian Government Department of Health and Human Services and Australian Government Research Training Program Scholarship. PhD host institutions were Cancer Council Victoria and the University of Melbourne. The International Cancer Benchmarking Partnership Module 4 in Victoria was supported by the Victorian Government Department of Health and Human Services. J. Emery is supported by an NHMRC Practitioner Fellowship.
Publisher Copyright:
© 2018 American Association for Cancer Research.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/9
Y1 - 2018/9
N2 - 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 6 months of diagnosis), primary care physicians (PCPs), 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 socioeconomic status. Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 PCPs, and 370 specialists participated. Compared with urban patients, patients with symptomatic colorectal cancer 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 postpresentation. Impact: Interventions targeting time from presentation to diagnosis may help reduce colorectal cancer rural-urban disparities.
AB - 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 6 months of diagnosis), primary care physicians (PCPs), 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 socioeconomic status. Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 PCPs, and 370 specialists participated. Compared with urban patients, patients with symptomatic colorectal cancer 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 postpresentation. Impact: Interventions targeting time from presentation to diagnosis may help reduce colorectal cancer rural-urban disparities.
UR - http://www.scopus.com/inward/record.url?scp=85053069835&partnerID=8YFLogxK
U2 - 10.1158/1055-9965.EPI-18-0210
DO - 10.1158/1055-9965.EPI-18-0210
M3 - Journal article
C2 - 29987098
AN - SCOPUS:85053069835
SN - 1055-9965
VL - 27
SP - 1036
EP - 1046
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
IS - 9
ER -