Outcomes of rural patients with metastatic colorectal cancer treated in a centralized system compared with their metropolitan counterparts.

Abstract

6598 Background: Significant geographical variation in survival after diagnosis of colorectal cancer (CRC) has been reported in Australia. Patients residing in rural locations have inferior survival time compared to metropolitan patients. Factors which have an impact on survival include local access to services (investigations, surgery and chemotherapy). Rural patients tend to present with more advanced disease. We analysed data from South Australia (SA) where cancer care has tended to be centralised to determine if rural patients in this setting have inferior outcomes to metropolitan patients. We examined survival of patients with stage 4 CRC. Methods: An analysis of the SA mCRC registry was performed to compare the oncological and surgical management and survival of city (metropolitan postcode) v rural (rest of state) patients. Overall Survival (OS) was calculated using the Kaplan-meier method. Results: Data from 2289 patient with mCRC since February 2006 were analysed. 27% of patients were rural. Patient characteristics did not differ between the 2 groups. There was no difference in chemotherapy use; City v rural, 1st, 2nd and 3rd line respectively-56%v58%, 23%v23%, 10%v9%. Choice of chemotherapy did not differ between city and rural; FU/Oxaliplatin 61%v60%, irinotecan+/-FU 9%v6%, FU alone 28%v31%. When an oxaliplatin doublet was chosen, oral capecitabine was used more frequently 32% in rural v 13% in city (P<0.001) Addition of bevacizumab/anti-EGFR to first line chemotherapy was equivalent: 19.7% v 14.3%/1.6% v 1.4%. Hepatic resection was also similar in 2 groups 14%v12%. Median OS did not differ; 23.4 months city v 23.5 months rural. These outcomes were similar for men and women. Conclusions: The patient characteristics, choice of chemotherapy (drug and single v doublet), hepatic resection rates and importantly, overall survival did not differ between city v rural patients. Oral chemotherapy used was higher in rural patients without affecting outcome.