Abstract
In Australia, cancer survival is significantly lower in non-metropolitan compared to metropolitan areas. Our objective was to evaluate the evidence on geographical variations in the clinical management and treatment of colorectal cancer (CRC). A systematic review of published and gray literature was conducted. Five databases (CINAHL, PubMed, Embase, ProQuest, and Informit) were searched for articles published in English from 1990 to 2018. Studies were included if they assessed differences in clinical management according to geographical location; focused on CRC patients; and were conducted in Australia. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. PRISMA systematic review reporting methods were applied. 17 articles met inclusion criteria. All were of high (53%) or moderate (47%) quality. The evidence available may suggest that patients in non-metropolitan areas are more likely to experience delays in surgery and are less likely to receive chemotherapy for stage III colon cancer and adjuvant radiotherapy for rectal cancer. The present review found limited information on clinical management across geographic regions in Australia and the synthesis highlights significant issues both for data collection and reporting at the population level, and for future research in the area of geographic variation. Where geographical disparities exist, these may be due to a combination of patient and system factors reflective of location. It is recommended that population-level data regarding clinical management of CRC be routinely collected to better understand geographical variations and inform future guidelines and policy.
Highlights
Australia and New Zealand have the highest incidence rates of colorectal cancer (CRC) in the world, and it is the second leading cause of cancer death in Australia [1, 2]
Studies were included if the data were from cohorts of Australian individuals with CRC; reflected outcomes pertaining to clinical management; and compared non-metropolitan vs metropolitan patients
The current review found inconsistent evidence relating to geographical disparities in clinical management of CRC in Australia
Summary
Australia and New Zealand have the highest incidence rates of colorectal cancer (CRC) in the world, and it is the second leading cause of cancer death in Australia [1, 2]. The Australian National Health and Medical Research Council and Cancer Australia have developed evidence-based guidelines for optimal care in the clinical management of CRC [4, 5]. These guidelines recommend that patients should receive site- and stage-specific care including preoperative assessment, surgery, and adjuvant therapy where appropriate. The guidelines recommend less than 30 days between diagnosis and surgery, and receipt of treatment in specialist cancer centers or from specialist surgeons [5] To date, it is unclear whether these guidelines are adhered to uniformly across Australia. Our objective was to evaluate the evidence on geographical variations in the clinical management and treatment of colorectal cancer (CRC)
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