Rural cancer survival rates lag behind city

CANCER patients in rural and remote Australian communities continue to be at increased risk of death compared with their urban-dwelling counterparts despite decreases in the number of cancer deaths overall, sparking calls for more investment in health-systems policy.

A study in the Medical Journal of Australia, co-authored by Dr Susan Jordan from QIMR Berghofer Medical Research Institute, analysed Australian Bureau of Statistics (ABS) data on cancer deaths between 2001-2010.

The authors, led by Dr Michael Coory, a public health physician with the Murdoch Childrens
Research Institute, looked at whether there had been an overall decrease in cancer deaths in the period, compared with 1997-2001 (deaths averted).

They found that although the percentage of Australians living in regional/remote areas remained stable at 27%-28%, for men, the relative disparity in mortality between regional/remote and metropolitan areas showed no evidence of improvement between 1997-2000 and 2006-2010. For women, the disparity actually increased.

There were 8878 excess cancer deaths in regional and remote areas – calculated by comparing mortality rates for metropolitan areas to corresponding populations for regional and remote areas – between 2001 and 2010. The largest numbers were for cancers of the lung, prostate, oesophagus and colorectum, and melanoma.

Although risk of cancer death across Australia decreased by 1% between 2001 and 2010, that decrease was almost twice as much in metropolitan areas as in the rural and regional areas (-1.1% vs -0.6%).

“We posit that at least part of the reason for the lack of progress is the lack of investment in health systems policy on how to organise cancer services so that they provide the most benefit to patients,” the authors wrote.

“Enough is already known about the causes of the regional and remote excess to start evaluating possible solutions.”

Those solutions may include more support for regional and remote patients to travel to
metropolitan centres and more funding for accommodation; managed referral
pathways; various forms of specialised outreach, such as telehealth, virtual multidisciplinary
teams, shared care and “fly-in, fly-out” services; and, building capacity in regional cancer centres.

“Research to guide service planning and budget decisions is not as prestigious as laboratory and clinical research to identify and test innovative diagnostic tests and treatments for cancer,” the authors concluded.

“However, such research is needed if all of the Australian community is to benefit from laboratory and clinical advances.”