Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Research article

A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia

Authors: Michael J. Ireland, Sonja March, Fiona Crawford-Williams, Mandy Cassimatis, Joanne F. Aitken, Melissa K. Hyde, Suzanne K. Chambers, Jiandong Sun, Jeff Dunn

Published in: BMC Cancer | Issue 1/2017

Login to get access

Abstract

Background

Australia and New Zealand have the highest incidence of colorectal cancer (CRC) in the world, presenting considerable health, economic, and societal burden. Over a third of the Australian population live in regional areas and research has shown they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. The extent to which geographical disparities exist in CRC management and outcomes has not been systematically explored. The present review aims to identify the nature of geographical disparities in CRC survival, clinical management, and psychosocial outcomes.

Methods

The review followed PRISMA guidelines and searches were undertaken using seven databases covering articles between 1 January 1990 and 20 April 2016 in an Australian setting. Inclusion criteria stipulated studies had to be peer-reviewed, in English, reporting data from Australia on CRC patients and relevant to one of fourteen questions examining geographical variations in a) survival outcomes, b) patient and cancer characteristics, c) diagnostic and treatment characteristics and d) psychosocial and quality of life outcomes.

Results

Thirty-eight quantitative, two qualitative, and three mixed-methods studies met review criteria. Twenty-seven studies were of high quality, sixteen studies were of moderate quality, and no studies were found to be low quality. Individuals with CRC living in regional, rural, and remote areas of Australia showed poorer survival and experienced less optimal clinical management. However, this effect is likely moderated by a range of other factors (e.g., SES, age, gender) and did appear to vary linearly with increasing distance from metropolitan centres. No studies examined differences in use of stoma, or support with stomas, by geographic location.

Conclusions

Overall, despite evidence of disparity in CRC survival and clinical management across geographic locations, the evidence was limited and at times inconsistent. Further, access to treatment and services may not be the main driver of disparities, with individual patient characteristics and type of region also playing an important role.
A better understanding of factors driving ongoing and significant geographical disparities in cancer related outcomes is required to inform the development of effective interventions to improve the health and welfare of regional Australians.
Literature
1.
AIHW. Australian cancer incidence and mortality (ACIM) books: colorectal cancer. Canberra: AIHW; 2016.
2.
3.
AIHW. Health system expenditure on cancer and other neoplasms in Australia 2008–09. Canberra: AIHW; 2013.
4.
Australian Bureau of Statistics. The ‘average’ Australian. In: 41020 - Australian Social Trends. Canberra: Australian Bureau of Statistics; 2013.
5.
AIHW. Rural, regional and remote health: Indicators of health status and determinants of health. In: Rural health series. Canberra: Australian Institute of Health and Welfare; 2008.
6.
Duckett S. Perils of place: identifying hotspots of health inequality. In: How a targeted approach could reduce our hotspots of health inequality. Melbourne: Grattan Institute; 2016.
7.
Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, Dash C, Giardiello FM, Glick S, Levin TR, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008. CA Cancer J Clin. 2008;58(3):130–60.CrossRefPubMed
8.
Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, James PD, Mangham CM. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348(9040):1472–7.CrossRefPubMed
9.
Kronborg O, Fenger C, Olsen J, Jørgensen OD, Søndergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348(9040):1467–71.CrossRefPubMed
10.
Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F. Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med. 1993;328(19):1365–71.CrossRefPubMed
11.
12.
AIHW. National bowel cancer screening program: monitoring report 2013–14. Canberra: AIHW; 2015.
13.
Lejeune C, Sassi F, Ellis L, Godward S, Mak V, Day M, Rachet B. Socio-economic disparities in access to treatment and their impact on colorectal cancer survival. Int J Epidemiol. 2010;39(3):710–7.CrossRefPubMed
14.
Veitch C, Crossland L, Steeghs M, Ho Y, Hanks H. Patients’ experiences of colorectal cancer and oncology services in north Queensland. Aust J Prim Health. 2008;14(3):93–100.
15.
Dunn J, Ng SK, Breitbart W, Aitken J, Youl P, Baade PD, Chambers SK. Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment. Health Qual Life Outcomes. 2013;11(1):46–53.CrossRefPubMedPubMedCentral
16.
Valery PC, Coory M, Stirling J, Green AC. Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: a matched cohort study. Lancet. 2006;367(9525):1842–8.CrossRefPubMed
17.
Cunningham J, Rumbold AR, Zhang X, Condon JR. Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncol. 2008;9(6):585–95.CrossRefPubMed
18.
Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007;7:16.CrossRefPubMedPubMedCentral
19.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRefPubMedPubMedCentral
20.
Youl P, Dasgupta P, Youlden D, Aitken J, Garvey G, Zorbas H, Chynoweth J, Wallington I, Baade P. A systematic review of inequalities in psychosocial outcomes for women with breast cancer according to residential location and Indigenous status in Australia. Psycho-Oncology. 2016;25(10):1157–67.CrossRefPubMed
21.
22.
Chambers SK, Dunn J, Occhipinti S, Hughes S, Baade P, Sinclair S, Aitken J, Youl P, O’Connell DL. A systematic review of the impact of stigma and nihilism on lung cancer outcomes. BMC Cancer. 2012;12(1):1–19.CrossRef
23.
National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for guideline developers. Canberra: NHMRC; 2009.
24.
Daly J, Willis K, Small R, Green J, Welch N, Kealy M, Hughes E. A hierarchy of evidence for assessing qualitative health research. J Clin Epidemiol. 2007;60(1):43–9.CrossRefPubMed
25.
26.
AIHW. Rural, regional and remote health: a study on mortality. Canberra: AIHW; 2007.
27.
AIHW. Cancer in Australia: an overview 2014. Canberra: AIHW; 2014.
28.
Baade PD, Dasgupta P, Aitken JF, Turrell G. Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in queensland. Med J Aust. 2011;195(6):350–4.CrossRefPubMed
29.
Baade PD, Dasgupta P, Aitken JF, Turrell G. Geographic remoteness, area-level socioeconomic disadvantage and inequalities in colorectal cancer survival in Queensland: a multilevel analysis. BMC Cancer. 2013;13:493.CrossRefPubMedPubMedCentral
30.
Beckmann KR, Bennett A, Young GP, Cole SR, Joshi R, Adams J, Singhal N, Karapetis C, Wattchow D, Roder D. Sociodemographic disparities in survival from colorectal cancer in South Australia: a population-wide data linkage study. BMC Health Serv Res. 2016;16(1):24.CrossRefPubMedPubMedCentral
31.
Chen TY, Morrell S, Thomson W, Baker DF, Walton R, Aranda S, Currow DC. Survival from breast, colon, lung, ovarian and rectal cancer by geographical remoteness in New South Wales, Australia, 2000–2008. Aust J Rural Health. 2015;23(1):49–56.CrossRefPubMed
32.
Coory M, Ho T, Jordan SJ. Australia is continuing to make progress against cancer, but the regional and remote disadvantage remains. Med J Aust. 2013;199(9):605–8.CrossRefPubMed
33.
Cramb SM, Mengersen KL, Turrell G, Baade PD. Spatial inequalities in colorectal and breast cancer survival: premature deaths and associated factors. Health Place. 2012;18(6):1412–21.CrossRefPubMed
34.
Jong KE, Smith DP, Yu XQ, O’Connell DL, Goldstein D, Armstrong BK. Remoteness of residence and survival from cancer in New South Wales. Med J Aust. 2004;180(12):618–22.PubMed
35.
Wilkinson D, Cameron K. Cancer and cancer risk in South Australia: what evidence for a rural-urban health differential? Aust J Rural Health. 2004;12(2):61–6.CrossRefPubMed
36.
Singla A, Broadbridge V, Mittinty M, Beeke C, Maddern GJ. Rural populations have equal surgical and survival outcomes in metastatic colorectal cancer. Aust J Rural Health. 2014;22(5):249–56.CrossRefPubMed
37.
38.
Martin HL, Ohara K, Chin W, Davidson A, Bayliss E, Redfern A, Khattak MA. Cancer services in Western Australia: a comparison of regional outcomes with metropolitan Perth. Aust J Rural Health. 2015;23(5):302–8.CrossRefPubMed
39.
Coory M, Thompson A, Ganguly I. Cancer among people living in rural and remote Indigenous communities in Queensland. Med J Aust. 2001;173(6):301–4.
40.
Homewood J, Coory M, Dinh B. Cancer among people living in rural and remote indigenous communities in Queensland: An update 1997–2002 Information Circular 2005;70.
41.
AIHW. Rural, regional, and remote health: indicators of health. Canberra: AIHW; 2005. cat. no. PHE 59.
42.
Armstrong K, O’Connell D, Leong D, Spigelman A, Armstrong BK. The New South Wales Colorectal Cancer Care Survey 2000 - Part 1 surgical management. In: The NSW Colorectal Cancer Care Survey. Kings Cross: The Cancer Council NSW; 2004.
43.
Baade PD, Dasgupta P, Aitken JF, Turrell G. Geographic remoteness and risk of advanced colorectal cancer at diagnosis in Queensland: a multilevel study. Br J Cancer. 2011;105(7):1039–41.CrossRefPubMedPubMedCentral
44.
Yu XQ, O’Connell DL, Gibberd RW, Armstrong BK. A population-based study from New South Wales, Australia 1996–2001: area variation in survival from colorectal cancer. Eur J Cancer. 2005;41(17):2715–21.CrossRefPubMed
45.
Javanparast S, Ward P, Cole S, Gill T, Matt M, Aylward P, Baratiny G, Jiwa M, Martini A, Misan G, et al. A cross-sectional analysis of participation in National Bowel Cancer Screening Program in Adelaide by age, gender and geographical location of residence. Australasian Med J. 2010;1(1):141–6.
46.
AIHW. National Bowel Cancer Screening Program: monitoring report 2016. Canberra: AIHW; 2016.
47.
Martini A, Javanparast S, Ward P, Baratiny G, Gill T, Cole S, Tsourtos G, Aylward P, Jiwa M, Misan G, et al. Colorectal cancer screening in rural and remote areas: analysis of the National Bowel Cancer Screening Program data for South Australia. Rural Remote Health. 2011;11:1648.PubMed
48.
Varlow M, Stacey I, Dunlop S, Young J, Kite J, Dessaix A, McAulay C. Self-reported participation and beliefs about bowel cancer screening in New South Wales, Australia. Health Promot J Austr. 2014;25:97–103.CrossRefPubMed
49.
Beckmann KR, Bennett A, Young GP, Roder DM. Treatment patterns among colorectal cancer patients in South Australia: a demonstration of the utility of population-based data linkage. J Eval Clin Pract. 2014;20(4):467–77.CrossRefPubMed
50.
Gilbar P, Lee A, Pokharel K: Why adjuvant chemotherapy for stage III colon cancer was not given: reasons for non-recommendation by clinicians or patient refusal. J Oncol Pharm Pract. 2015;epub ahead of print.
51.
Hocking C, Broadbridge VT, Karapetis C, Beeke C, Padbury R, Maddern GJ, Roder DM, Price TJ. Equivalence of outcomes for rural and metropolitan patients with metastatic colorectal cancer in South Australia. Med J Aust. 2014;201(8):462–6.CrossRefPubMed
52.
Hall SE, Holman CD, Platell C, Sheiner H, Threlfall T, Semmens J. Colorectal cancer surgical care and survival: do private health insurance, socioeconomic and locational status make a difference? ANZ J Surg. 2005;75(11):929–35.CrossRefPubMed
53.
Armstrong K, O’Connell D, Leong D, Spigelman A, Armstrong BK. The New South Wales Colorectal Cancer Care Survey 2000 - Part 2 chemotherapy management. Kings cross: The Cancer Council NSW; 2005.
54.
Armstrong K, O’Connell D, Leong D, Spigelman A, Armstrong BK. The New South Wales Colorectal Cancer Care Survey 2000 - Part 3 radiotherapy management. Kings cross: The Cancer Council NSW; 2007.
55.
Young JM, Leong DC, Armstrong K, O’Connell D, et al. Concordance with national guidelines for colorectal cancer care in New South Wales: a population-based patterns of care study. Med J Aust. 2007;186(6):292–5.PubMed
56.
Underhill C, Bartel R, Goldstein D, Snodgrass H, Begbie S, Yates P, White K, Jong K, Grogan P. Mapping oncology services in regional and rural Australia. Aust J Rural Health. 2009;17(6):321–9.CrossRefPubMed
57.
Morris M, Platell C, Fritschi L, Iacopetta B. Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients. Br J Cancer. 2007;96(5):701–7.CrossRefPubMedPubMedCentral
58.
Emery JD, Walter FM, Gray V, Sinclair C, Howting D, Bulsara M, Bulsara C, Webster A, Auret K, Saunders C, et al. Diagnosing cancer in the bush: a mixed methods study of GP and specialist diagnostic intervals in rural Western Australia. Fam Pract. 2013;30(5):541–50.CrossRefPubMed
59.
Pascoe SW, Veitch C, Crossland LJ, Beilby JJ, Spigelman A, Stubbs J, Harris MF. Patients’ experiences of referral for colorectal cancer. BMC Fam Pract. 2013;14(1):124.CrossRefPubMedPubMedCentral
60.
Goldsbury D, Harris MF, Pascoe S, Olver I, Barton M, Spigelman A, O’Connell D. Socio-demographic and other patient characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer: a retrospective cohort study. BMJ Open. 2012;2(3). http://​dx.​doi.​org/​10.​1136/​bmjopen-2012-001070.
61.
Fox P, Boyce A. Cancer health inequality persists in regional and remote Australia. Med J Aust. 2014;201(8):445–6.CrossRefPubMed
62.
Wichmann MW, Beukes E, Esufali ST, Plaumann L, Maddern G. Five-year results of surgical colorectal cancer treatment in rural Australia. ANZ J Surg. 2013;83(3):112–7.CrossRefPubMed
63.
Ieropoli SC, White VM, Jefford M, Akkerman D. What models of peer support do people with colorectal cancer prefer? Eur J Cancer Care. 2011;20(4):455–65.CrossRef
64.
Dunn J, Ng SK, Holland J, Aitken J, Youl P, Baade PD, Chambers SK. Trajectories of psychological distress after colorectal cancer. Psycho-Oncology. 2013;22(8):1759–65.CrossRefPubMed
65.
Mitry E, Rachet B. Prognosis of colorectal cancer and socio-economic inequalities. Gastroenterol Clin Biol. 2006;30(4):598–603.CrossRefPubMed
66.
Nur U, Rachet B, Parmar MKB, Sydes MR, Cooper N, Lepage C, Northover JMA, James R, Coleman MP. No socioeconomic inequalities in colorectal cancer survival within a randomised clinical trial. Br J Cancer. 2008;99(11):1923–8.CrossRefPubMedPubMedCentral
67.
Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT, Walters EE, Zaslavsky A. Short screening scales to monitor population prevalances and trends in nonspecific psychological distress. Psychol Med. 2002;32(6):959–76.CrossRefPubMed
68.
Tuinman MA, Gazendam-Donofrio SM, Hoekstra-Weebers JE. Screening and referral for psychosocial distress in oncologic practice: use of the Distress Thermometer. Cancer. 2008;113(4):870–8.CrossRefPubMed
69.
Roder D, Karapetis CS, Wattchow D, Moore J, Singhal N, Joshi R, Keefe D, Fusco K, Powell K, Eckert M, et al. Colorectal cancer treatment and survival: the experience of major public hospitals in South Australia over three decades. Asian-Pacific J Cancer Prev. 2015;16(6):2431–40.CrossRef
70.
Steffen A, Weber MF, Roder DM, Banks E. Colorectal cancer screening and subsequent incidence of colorectal cancer: results from the 45 and Up study. Med J Aust. 2014;201(9):523–7.CrossRefPubMed
71.
Tong S, Hughes K, Oldenburg B, Del Mar C, Kennedy B. Socio-demographic correlates of screening intention for colorectal cancer. Aust N Z J Public Health. 2000;24(6):610–4.CrossRefPubMed
72.
Ward P, Javanparast S, Matt M, Martini A, Tsourtos G, Cole S, Gill T, Aylward P, Baratiny G, Jiwa M, et al. Equity of colorectal cancer screening: cross-sectional analysis of National Bowel Cancer Screening Program data for South Australia. Aust N Z J Public Health. 2011;35(1):61–5.CrossRefPubMed
Metadata
Title
A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia
Authors
Michael J. Ireland
Sonja March
Fiona Crawford-Williams
Mandy Cassimatis
Joanne F. Aitken
Melissa K. Hyde
Suzanne K. Chambers
Jiandong Sun
Jeff Dunn
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3067-1

Other articles of this Issue 1/2017

BMC Cancer 1/2017 Go to the issue

Research article

Somatostatin and CXCR4 chemokine receptor expression in hepatocellular and cholangiocellular carcinomas: tumor capillaries as promising targets

Research article

Robot-assisted radical prostatectomy significantly reduced biochemical recurrence compared to retro pubic radical prostatectomy

Research article

Dickkopf-4 is frequently overexpressed in epithelial ovarian carcinoma and promotes tumor invasion

Research article

Cervical cytology and human papillomavirus among asymptomatic healthy volunteers in Vientiane, Lao PDR

Research article

YRNA expression predicts survival in bladder cancer patients

Research article

Long-term results of early adjuvant concurrent chemoradiotherapy for high-risk, early stage uterine cervical cancer patients after radical hysterectomy
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits