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Cancer Epidemiol Biomarkers Prev. 2018 Sep;27(9):1036-1046. doi: 10.1158/1055-9965.EPI-18-0210. Epub 2018 Jul 9.

Rural-Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer.

Author information

1
Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia. Rebecca.bergin@cancervic.org.au.
2
Department of General Practice and Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia.
3
Division of Surgery, Ballarat Health Services, Ballarat, Australia.
4
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
5
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
6
Gynaecological Cancer Research Centre, London, United Kingdom.
7
Department of Health and Human Services Victoria, Victorian Government, Melbourne, Australia.
8
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
9
Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.
10
School of Psychology, Deakin University, Burwood, Australia.

Abstract

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. Cancer Epidemiol Biomarkers Prev; 27(9); 1036-46. ©2018 AACR.

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