Background

Evidence shows that cancer patients living in rural Australia suffer inferior outcomes. Putative reasons include delayed diagnosis, referral processes, and difficulty with access to treatment services. We wanted to compare access to care between patients living in rural and urban areas. We chose a cohort of rectal cancer patients treated with LCCRT at the Royal Brisbane and Women’s Hospital as this cohort require multi-disciplinary team (MDT) discussion and multi-modality treatment.

Methods

Eligible patients treated with concurrent 5-fluorouracil and radiation from January 2011 to December 2013 were identified using electronic chemotherapy prescribing software. Dates were retrospectively determined for diagnostic biopsy, commencement of CRT, MDT discussion. Metropolitan was defined as including Brisbane, Ipswich, Sunshine Coast and Gold Coast. All other areas were considered rural.

Results

131 patients were identified. 62 (47%) were rural. The median time from diagnostic biopsy to commencement of treatment for the rural and the metropolitan populations were 65 (95% CI 56-74) and 58 (95% CI 50-65) days respectively (p=0.2). Median time from MDT discussion to treatment commencement was 33 days for both patient groups.

Conclusion

We found no difference in time from diagnosis to treatment among rural versus metropolitan patients. However, our analysis does not exclude the possibility that a lower percentage of rural patients access a treatment centre or that these patients present later in the course of their disease. Access to diagnostic services such as colonoscopy has been postulated as a factor and is being looked into by others. Nevertheless, once diagnosed, our data suggests many rural patients do not wait longer than urban patients to commence therapy. Assessment of an earlier cohort would be useful to determine to what extent, if any, this has improved over time. Looking at long term outcomes for these patients will also be helpful to determine any differences.