Quality centralised care appears to narrow the survival gap between rural and urban patients with metastatic colorectal cancer in South Australia, according to research published in the Medical Journal of Australia.
Using data from the South Australian metastatic colorectal cancer (mCRC) clinical registry for patients registered between February 2006 and May 2012, the researchers found that: "Patterns of chemotherapy and surgical management of rural patients ... are equivalent to their metropolitan counterparts and lead to comparable overall survival."
Dr Christopher Hocking, a clinical research fellow at the Queen Elizabeth Hospital in Adelaide, and his coauthors wrote that most chemotherapy in South Australia had to be delivered in Adelaide because there were insufficient population numbers to sustain cancer treatment centres in rural areas.
Most evidence suggests that Australia's rural population experiences worse cancer outcomes than their urban equivalents because of "higher exposure to health hazards and poorer access to health services", the authors wrote. Less participation in cancer screening programs, delayed diagnosis, socioeconomic disadvantage and higher proportions of disadvantaged groups such as Indigenous Australians are some of the factors at play in rural areas.
However, the authors said their results confirmed that "optimal treatment" of rural patients resulted in equivalent outcomes to metropolitan patients, "irrespective of disadvantage".
"We consider that our findings highlight the positive outcomes achieved through high-quality, specialised care, rather than suggest that current regional services in Australia should also adopt a centralised approach [similar to South Australia's]", they wrote.
"[Our results suggest] previously demonstrated disparate outcomes may be due to factors such as higher incidence of colorectal cancer as a result of burden of risk factors and potentially reduced screening participation, rather than treatment factors once mCRC has been diagnosed.
"Targeting these factors is likely to provide the greatest impact on reducing the excess cancer burden for rural Australians."