Bergin, RJ;
Emery, J;
Bollard, RC;
Falborg, AZ;
Jensen, H;
Weller, D;
Menon, U;
... White, V; + view all
(2018)
Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer.
Cancer Epidemiology, Biomarkers & Prevention
, 27
(9)
pp. 1036-1046.
10.1158/1055-9965.EPI-18-0210.
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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 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.
| Type: | Article |
|---|---|
| Title: | Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1158/1055-9965.EPI-18-0210 |
| Publisher version: | https://doi.org/10.1158/1055-9965.EPI-18-0210 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | rural health, colorectal cancer, breast cancer, early diagnosis, time to treatment |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10052870 |
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