People living in remote NSW diagnosed with cancer are about 35 per cent more likely to die  over the ensuing 5 years than are people diagnosed with cancer living in areas with the greatest access to services, according to research published in the current issue of The Medical Journal of Australia.

Co-author of the report, Professor Bruce Armstrong, Head, School of Public Health, University of Sydney, says geographic isolation, poor transport links, shortage of healthcare providers, and more difficult access to healthcare are probably contributing factors, along with a higher proportion of Indigenous people and the generally lower socioeconomic status of residents of remote areas.

The research focused on a survival analysis of all patients with cancers diagnosed in NSW between 1 January 1992 and 31 December 1996. Survival was determined to 31 December 1999.

"We describe variation in cancer survival in New South Wales according to a measure of geographic accessibility and remoteness, without and with adjustment for a measure of stage at diagnosis," Professor Armstrong said.

The relative excess risk (RER) of death over 5 years was estimated for each geographic remoteness category relative to the highly accessible category for 20 cancer types adjusted for age, sex, years since diagnosis and, subsequently, stage of cancer diagnosis.

There were statistically significant differences in the RER of death across remoteness categories for cancers of the cervix and prostate and for all cancers. The RERs for the most remote categories (compared with the highly accessible category) before and after adjustment for stage were cervix 3.22 and 2.25; prostate, 3.38 and 2.53; and all cancers 1.35 and 1.25.

The authors say that some studies suggest that geographic variations in the quality of cancer treatment are more important determinants of survival than factors such as screening and early diagnosis.

"With the possible exception of prostate cancer, our findings of high RERs in less accessible areas for several cancers probably reflect variations in the nature of care received after diagnosis," Professor Armstrong said.

"In NSW, radiation oncology centres are typically located in the highly accessible areas along the middle of the NSW coast. Although many of these centres provide outreach services to larger towns in inland and northern parts of the state, the remote regions are quite distant even from these services.

Professor Armstrong said in countries like Australia, cost-effective cancer service delivery is complex. She said it is important to continue to explore ways in which effective consultation, diagnostic support and education can support the services available in all non-metropolitan areas.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT     Professor Bruce ARMSTRONG,                     0403 496 404
                  Judith   TOKLEY, AMA Public Affairs,            0408 824 306 / (02) 6270 5471

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Not necessarily "as a result of their cancer". This implies cause specific survival not relative survival.