Alice Nennecke1, Karla Geiss2, Stefan Hentschel3, Eik Vettorazzi4, Lina Jansen5, Andrea Eberle6, Bernd Holleczek7, Adam Gondos5, Hermann Brenner5. 1. Hamburg Cancer Registry, Authority for Health and Consumer Protection, Hamburg, Germany. Electronic address: Alice.Nennecke@bgv.hamburg.de. 2. Population Based Cancer Registry Bavaria, Registry Office, Erlangen, Germany. 3. Hamburg Cancer Registry, Authority for Health and Consumer Protection, Hamburg, Germany. 4. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. 6. Cancer Registry of Bremen, BIPS - Institute for Epidemiology and Prevention Research, Bremen, Germany. 7. Saarland Cancer Registry, Saarbrücken, Germany.
Abstract
BACKGROUND: Cancer care services including cancer prevention activities are predominantly localised in central cities, potentially causing a heterogeneous geographic access to cancer care. The question of an association between residence in either urban or rural areas and cancer survival has been analysed in other parts of the world with inconsistent results. This study aims at a comparison of age-standardised 5-year survival of cancer patients resident in German urban and rural regions using data from 11 population-based cancer registries covering a population of 33 million people. MATERIAL AND METHODS: Patients diagnosed with cancers of the most frequent and of some rare sites in 1997-2006 were included in the analyses. Places of residence were assigned to rural and urban areas according to administrative district types of settlement structure. Period analysis and district type specific population life tables were used to calculate overall age-standardised 5-year relative survival estimates for the period 2002-2006. Poisson regression models for excess mortality (relative survival) were used to test for statistical significance. RESULTS: The 5-year relative survival estimates varied little among district types for most of the common sites with no consistent trend. Significant differences were found for female breast cancer patients and male malignant melanoma patients resident in city core regions with slightly better survival compared to all other district types, particularly for patients aged 65 years and older. CONCLUSION: With regard to residence in urban or rural areas, the results of our study indicate that there are no severe differences concerning quality and accessibility of oncological care in Germany among different district types of settlement.
BACKGROUND:Cancer care services including cancer prevention activities are predominantly localised in central cities, potentially causing a heterogeneous geographic access to cancer care. The question of an association between residence in either urban or rural areas and cancer survival has been analysed in other parts of the world with inconsistent results. This study aims at a comparison of age-standardised 5-year survival of cancerpatients resident in German urban and rural regions using data from 11 population-based cancer registries covering a population of 33 million people. MATERIAL AND METHODS:Patients diagnosed with cancers of the most frequent and of some rare sites in 1997-2006 were included in the analyses. Places of residence were assigned to rural and urban areas according to administrative district types of settlement structure. Period analysis and district type specific population life tables were used to calculate overall age-standardised 5-year relative survival estimates for the period 2002-2006. Poisson regression models for excess mortality (relative survival) were used to test for statistical significance. RESULTS: The 5-year relative survival estimates varied little among district types for most of the common sites with no consistent trend. Significant differences were found for female breast cancerpatients and male malignant melanomapatients resident in city core regions with slightly better survival compared to all other district types, particularly for patients aged 65 years and older. CONCLUSION: With regard to residence in urban or rural areas, the results of our study indicate that there are no severe differences concerning quality and accessibility of oncological care in Germany among different district types of settlement.
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