Christopher Hocking1, Vy Tuong Broadbridge2, Christos Karapetis3, Carol Beeke4, Robert Padbury4, Guy J Maddern5, David M Roder6, Timothy J Price2. 1. Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA, Australia. christopher.hocking@health.sa.gov.au. 2. Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA, Australia. 3. Flinders Cancer Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia. 4. Division of Surgery, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia. 5. Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia. 6. School of Population Health, University of South Australia, Adelaide, SA, Australia.
Abstract
OBJECTIVE: To compare the management and outcome of rural and metropolitan patients with metastatic colorectal cancer (mCRC) in South Australia. DESIGN, SETTING AND PATIENTS: Retrospective cohort study of patients with mCRC submitted to the South Australian mCRC registry between 2 February 2006 and a cut-off date of 28 May 2012. MAIN OUTCOME MEASURES: Differences in oncological and surgical management and overall survival (calculated using the Kaplan-Meier method) between city and rural patients. RESULTS: Of 2289 patients, 624 (27.3%) were rural. There was a higher proportion of male patients in the rural cohort, but other patient characteristics did not significantly differ between the cohorts. Equivalent rates of chemotherapy administration between city and rural patients were observed across each line of treatment (first line: 56.0% v 58.3%, P = 0.32; second line: 23.3% v 22.5%, P = 0.78; and third line: 10.1% v 9.3%, P = 0.69). A higher proportion of city patients received combination chemotherapy in the first-line setting (67.4% v 59.9%; P = 0.01). When an oxaliplatin combination was prescribed, oral capecitabine was used more frequently in rural patients (22.9% v 8.4%; P < 0.001). No significant difference was seen in rates of hepatic resection or other non-chemotherapy treatments between cohorts. Median overall survival was equivalent between city and rural patients (14.6 v 14.9 months, P = 0.18). CONCLUSION: Patterns of chemotherapy and surgical management of rural patients with mCRC in SA are equivalent to their metropolitan counterparts and lead to comparable overall survival. The centralised model of oncological care in SA may ensure rural patients gain access to optimal care.
OBJECTIVE: To compare the management and outcome of rural and metropolitan patients with metastatic colorectal cancer (mCRC) in South Australia. DESIGN, SETTING AND PATIENTS: Retrospective cohort study of patients with mCRC submitted to the South Australian mCRC registry between 2 February 2006 and a cut-off date of 28 May 2012. MAIN OUTCOME MEASURES: Differences in oncological and surgical management and overall survival (calculated using the Kaplan-Meier method) between city and rural patients. RESULTS: Of 2289 patients, 624 (27.3%) were rural. There was a higher proportion of male patients in the rural cohort, but other patient characteristics did not significantly differ between the cohorts. Equivalent rates of chemotherapy administration between city and rural patients were observed across each line of treatment (first line: 56.0% v 58.3%, P = 0.32; second line: 23.3% v 22.5%, P = 0.78; and third line: 10.1% v 9.3%, P = 0.69). A higher proportion of city patients received combination chemotherapy in the first-line setting (67.4% v 59.9%; P = 0.01). When an oxaliplatin combination was prescribed, oral capecitabine was used more frequently in rural patients (22.9% v 8.4%; P < 0.001). No significant difference was seen in rates of hepatic resection or other non-chemotherapy treatments between cohorts. Median overall survival was equivalent between city and rural patients (14.6 v 14.9 months, P = 0.18). CONCLUSION: Patterns of chemotherapy and surgical management of rural patients with mCRC in SA are equivalent to their metropolitan counterparts and lead to comparable overall survival. The centralised model of oncological care in SA may ensure rural patients gain access to optimal care.
Authors: Rittal Mehta; Kota Sahara; Katiuscha Merath; J Madison Hyer; Diamantis I Tsilimigras; Anghela Z Paredes; Aslam Ejaz; Jordan M Cloyd; Mary Dillhoff; Allan Tsung; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2019-06-13 Impact factor: 3.452
Authors: Michael J Ireland; Sonja March; Fiona Crawford-Williams; Mandy Cassimatis; Joanne F Aitken; Melissa K Hyde; Suzanne K Chambers; Jiandong Sun; Jeff Dunn Journal: BMC Cancer Date: 2017-02-02 Impact factor: 4.430
Authors: Fiona Crawford-Williams; Sonja March; Michael J Ireland; Arlen Rowe; Belinda Goodwin; Melissa K Hyde; Suzanne K Chambers; Joanne F Aitken; Jeff Dunn Journal: Front Oncol Date: 2018-05-16 Impact factor: 6.244