Article

Geographic remoteness and risk of advanced colorectal cancer at diagnosis in Queensland: a multilevel study

Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Brisbane, QLD 4004, Australia.
British Journal of Cancer (Impact Factor: 4.82). 09/2011; 105(7):1039-41. DOI: 10.1038/bjc.2011.356
Source: PubMed

ABSTRACT We examine the relationships between geographic remoteness, area disadvantage and risk of advanced colorectal cancer.
Multilevel models were used to assess the area- and individual-level contributions to the risk of advanced disease among people aged 20-79 years diagnosed with colorectal cancer in Queensland, Australia between 1997 and 2007 (n=18,561).
Multilevel analysis showed that colorectal cancer patients living in inner regional (OR=1.09, 1.01-1.19) and outer regional (OR=1.11, 1.01-1.22) areas were significantly more likely to be diagnosed with advanced cancer than those in major cities (P=0.045) after adjusting for individual-level variables. The best-fitting final model did not include area disadvantage. Stratified analysis suggested this remoteness effect was limited to people diagnosed with colon cancer (P=0.048) and not significant for rectal cancer patients (P=0.873).
Given the relationship between stage and survival outcomes, it is imperative that the reasons for these rurality inequities in advanced disease be identified and addressed.

0 Followers
 · 
144 Views
  • Source
    • "Studies from other western countries have provided only limited and inconsistent findings (Coughlin et al., 2006; Clegg et al., 2009; Donnelly and Gavin, 2011). However, numerous studies have suggested that disadvantaged individuals and/or those living far from a reference cancer centre or in remote areas could have poorer access to CRC screening and to specialized healthcare, or could be more prone to an advanced stage at diagnosis leading to a worse prognosis (Dejardin et al., 2005; Blais et al., 2006; Parikh-Patel et al., 2006; Dejardin et al., 2008; Von Wagner et al., 2009; Jambon et al., 2010; Lejeune et al., 2010; Baade et al., 2011; Hines et al., 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to assess the impact of area deprivation and primary care facilities on colorectal adenoma detection and on colorectal cancer (CRC) incidence in a French well-defined population before mass screening implementation. The study population included all patients aged 20 years or more living in Côte d'Or (France) with either colorectal adenoma or invasive CRC first diagnosed between 1995 and 2002 and who were identified from the Burgundy Digestive Cancer Registry and the Côte d'Or Polyp Registry. Area deprivation was assessed using the European deprivation index on the basis of the smallest French area available (Ilots Regroupés pour l'Information Statistique). Healthcare access was assessed using medical density of general practitioners (GPs) and road distance to the nearest GP and gastroenterologist. Bayesian regression analyses were used to estimate influential covariates on adenoma detection and CRC incidence rates. The results were expressed as relative risks (RRs) with their 95% credibility interval. In total, 5399 patients were diagnosed with at least one colorectal adenoma and 2125 with invasive incident CRC during the study period. Remoteness from GP [RR=0.71 (0.61-0.83)] and area deprivation [RR=0.98 (0.96-1.00)] independently reduced the probability of adenoma detection. CRC incidence was only slightly affected by GP medical density [RR=1.05 (1.01-1.08)] without any area deprivation effect [RR=0.99 (0.96-1.02)]. Distance to gastroenterologist had no impact on the rates of adenoma detection or CRC incidence. This study highlighted the prominent role of access to GPs in the detection of both colorectal adenomas and overall cancers. Deprivation had an impact only on adenoma detection.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 06/2015; DOI:10.1097/CEJ.0000000000000175 · 2.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In Australia, breast cancer is the most common cancer affecting Australian women. Inequalities in clinical and psychosocial outcomes have existed for some time, affecting particularly women from rural areas and from areas of disadvantage. We have a limited understanding of how individual and area-level factors are related to each other, and their associations with survival and other clinical and psychosocial outcomes. This study will examine associations between breast cancer recurrence, survival and psychosocial outcomes (e.g. distress, unmet supportive care needs, quality of life). The study will use an innovative multilevel approach using area-level factors simultaneously with detailed individual-level factors to assess the relative importance of remoteness, socioeconomic and demographic factors, diagnostic and treatment pathways and processes, and supportive care utilization to clinical and psychosocial outcomes. The study will use telephone and self-administered questionnaires to collect individual-level data from approximately 3, 300 women ascertained from the Queensland Cancer Registry diagnosed with invasive breast cancer residing in 478 Statistical Local Areas Queensland in 2011 and 2012. Area-level data will be sourced from the Australian Bureau of Statistics census data. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to diagnostic and treatment centres. Data analysis will include a combination of standard empirical procedures and multilevel modelling. The study will address the critical question of: what are the individual- or area-level factors associated with inequalities in outcomes from breast cancer? The findings will provide health care providers and policy makers with targeted information to improve the management of women with breast cancer, and inform the development of strategies to improve psychosocial care for women with breast cancer.
    BMC Cancer 09/2011; 11:415. DOI:10.1186/1471-2407-11-415 · 3.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To quantify the demographic and clinical factors associated with an increased risk of multiple primary cancers (MPCs) among colorectal cancer survivors. Standardized incidence ratios for MPCs were calculated for residents of Queensland, Australia, who were diagnosed with a first primary colorectal cancer between 1996 and 2005 and survived for at least 2 months. Relative risk ratios were calculated for all MPCs combined and selected individual sites using multivariate Poisson models. A total of 1,615 MPCs were observed among 15,755 study patients. The cohort had a significant excess risk of developing subsequent colorectal (SIR = 1.47, 95 % CI 1.30-1.66) or non-colorectal (SIR = 1.24, 95 % CI 1.18-1.31) cancers relative to the incidence of cancer in the general population. Age at initial diagnosis, follow-up time, initial colorectal subsite, and surgical treatment were independently associated (p < 0.01) with the overall risk of developing MPCs after adjustment. The relative risk ratio was 1.23 (95 % CI 1.07-1.41) for those aged 20-59 years compared with the 70-79 age group and 0.82 (95 % CI 0.72-0.92) for 1-5-year follow-up relative to the first year. The likelihood of being diagnosed with a MPC was 33 % higher (95 % CI 1.12-1.56) for surgically treated patients and 45 % higher (95 % CI 1.29-1.64) after proximal colon cancers relative to rectal cancer. While these population-based results do not incorporate all possible risk factors, they form an important foundation from which to further investigate the etiological causes that result in the development of MPCs among colorectal cancer survivors.
    Cancer Causes and Control 05/2012; 23(8):1387-98. DOI:10.1007/s10552-012-9990-1 · 2.96 Impact Factor
Show more

Preview

Download
4 Downloads
Available from