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Wong Shee A, Donaldson A, Clapham RP, Aitken JC, Ananthapavan J, Ugalde A, Versace VL, Mc Namara K. Identifying health and healthcare priorities in rural areas: A concept mapping study informed by consumers, health professionals and researchers. Health Res Policy Syst 2024; 22:105. [PMID: 39135114 PMCID: PMC11320881 DOI: 10.1186/s12961-024-01163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/20/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND It is vital that health service delivery and health interventions address patients' needs or preferences, are relevant for practice and can be implemented. Involving those who will use or deliver healthcare in priority-setting can lead to health service delivery and research that is more meaningful and impactful. This is particularly crucial in rural communities, where limited resources and disparities in healthcare and health outcomes are often more pronounced. The aim of this study was to determine the health and healthcare priorities in rural communities using a region-wide community engagement approach. METHODS This multi-methods study was conducted in five rural communities in the Grampians region, Western Victoria, Australia. It involved six concept mapping steps: (1) preparation, (2) generation (brainstorming statements and identifying rating criteria), (3) structuring statements (sorting and rating statements), (4) representation of statements, (5) interpretation of the concept map and (6) utilization. Community forums, surveys and stakeholder consultations with community members and health professionals were used in Step 2. An innovative online group concept mapping platform, involving consumers, health professionals and researchers was used in Step 3. RESULTS Overall, 117 community members and 70 health professionals identified 400 health and healthcare issues. Six stakeholder consultation sessions (with 16 community members and 16 health professionals) identified three key values for prioritizing health issues: equal access for equal need, effectiveness and impact (number of people affected). Actionable priorities for healthcare delivery were largely related to access issues, such as the challenges navigating the healthcare system, particularly for people with mental health issues; the lack of sufficient general practitioners and other health providers; the high travel costs; and poor internet coverage often impacting technology-based interventions for people in rural areas. CONCLUSIONS This study identified actionable health and healthcare priorities from the perspective of healthcare service users and providers in rural communities in Western Victoria. Issues related to access, such as the inequities in healthcare costs, the perceived lack of quality and availability of services, particularly in mental health and disability, were identified as priorities. These insights can guide future research, policy-making and resource allocation efforts to improve healthcare access, quality and equity in rural communities.
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Affiliation(s)
- Anna Wong Shee
- Grampians Health, 102 Ascot St Sth, Ballarat, VIC, 3350, Australia.
- Deakin Rural Health, Deakin University, Warrnambool, Australia.
| | | | - Renee P Clapham
- Deakin Rural Health, Deakin University, Warrnambool, Australia
- Ballarat Health Services, Ballarat, Australia
| | | | | | | | - Vincent L Versace
- Grampians Health, 102 Ascot St Sth, Ballarat, VIC, 3350, Australia
- Deakin Rural Health, Deakin University, Warrnambool, Australia
| | - Kevin Mc Namara
- Grampians Health, 102 Ascot St Sth, Ballarat, VIC, 3350, Australia
- Deakin Rural Health, Deakin University, Warrnambool, Australia
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Paynter J, Qin KR, Brennan J, Hunter-Smith DJ, Rozen WM. The provision of general surgery in rural Australia: a narrative review. Med J Aust 2024; 220:258-263. [PMID: 38357826 DOI: 10.5694/mja2.52232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia. The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes. Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes. To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural-facing generalist curriculum. Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres. Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery.
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Affiliation(s)
- Jessica Paynter
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Kirby R Qin
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Janelle Brennan
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
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Bammert P, Schüttig W, Novelli A, Iashchenko I, Spallek J, Blume M, Diehl K, Moor I, Dragano N, Sundmacher L. The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review. Int J Equity Health 2024; 23:37. [PMID: 38395914 PMCID: PMC10885500 DOI: 10.1186/s12939-024-02122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. METHODS We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. RESULTS Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. CONCLUSIONS Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.
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Affiliation(s)
- Philip Bammert
- Chair of Health Economics, Technical University of Munich, Munich, Germany.
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Iryna Iashchenko
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Lausitz Center for Digital Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Irene Moor
- Institute of Medical Sociology, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
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Beks H, Wood SM, Clark RA, Vincent VL. Spatial methods for measuring access to health care. Eur J Cardiovasc Nurs 2023; 22:832-840. [PMID: 37590972 DOI: 10.1093/eurjcn/zvad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
Access to health care is a universal human right and key indicator of health system performance. Spatial access encompasses geographic factors mediating with the accessibility and availability of health services. Equity of health service access is a global issue, which includes access to the specialized nursing workforce. Nursing research applying spatial methods is in its infancy. Given the use of spatial methods in health research is a rapidly developing field, it is timely to provide guidance to inspire greater application in cardiovascular research. Therefore, the objective of this methods paper is to provide an overview of spatial analysis methods to measure the accessibility and availability of health services, when to consider applying spatial methods, and steps to consider for application in cardiovascular nursing research.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
| | - Sarah M Wood
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
| | - Robyn A Clark
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Versace L Vincent
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
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Bartholomew K, Ghafel M, Tin Tin S, Aye PS, Elwood JM, Hardie C, Scott N, Kidd J, Ramsaroop R, Campbell I. Receipt of mastectomy and adjuvant radiotherapy following breast conserving surgery (BCS) in New Zealand women with BCS-eligible breast cancer, 2010-2015: an observational study focusing on ethnic differences. BMC Cancer 2023; 23:766. [PMID: 37592208 PMCID: PMC10436661 DOI: 10.1186/s12885-023-11248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Women with early breast cancer who meet guideline-based criteria should be offered breast conserving surgery (BCS) with adjuvant radiotherapy as an alternative to mastectomy. New Zealand (NZ) has documented ethnic disparities in screening access and in breast cancer treatment pathways. This study aimed to determine whether, among BCS-eligible women, rates of receipt of mastectomy or radiotherapy differed by ethnicity and other factors. METHODS The study assessed management of women with early breast cancer (ductal carcinoma in situ [DCIS] and invasive stages I-IIIA) registered between 2010 and 2015, extracted from the recently consolidated New Zealand Breast Cancer Registry (now Te Rēhita Mate Ūtaetae NZBCF National Breast Cancer Register). Specific criteria were applied to determine women eligible for BCS. Uni- and multivariable analyses were undertaken to examine differences by demographic and clinicopathological factors with a primary focus on ethnicity (Māori, Pacific, Asian, and Other; the latter is defined as NZ European, Other European, and Middle Eastern Latin American and African). RESULTS Overall 22.2% of 5520 BCS-eligible women were treated with mastectomy, and 91.1% of 3807 women who undertook BCS received adjuvant radiotherapy (93.5% for invasive cancer, and 78.3% for DCIS). Asian ethnicity was associated with a higher mastectomy rate in the invasive cancer group (OR 2.18; 95%CI 1.72-2.75), compared to Other ethnicity, along with older age, symptomatic diagnosis, advanced stage, larger tumour, HER2-positive, and hormone receptor-negative groups. Pacific ethnicity was associated with a lower adjuvant radiotherapy rate, compared to Other ethnicity, in both invasive and DCIS groups, along with older age, symptomatic diagnosis, and lower grade tumour in the invasive group. Both mastectomy and adjuvant radiotherapy rates decreased over time. For those who did not receive radiotherapy, non-referral by a clinician was the most common documented reason (8%), followed by patient decline after being referred (5%). CONCLUSION Rates of radiotherapy use are high by international standards. Further research is required to understand differences by ethnicity in both rates of mastectomy and lower rates of radiotherapy after BCS for Pacific women, and the reasons for non-referral by clinicians.
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MESH Headings
- Female
- Humans
- Breast Neoplasms/epidemiology
- Breast Neoplasms/ethnology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/ethnology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Maori People/statistics & numerical data
- Mastectomy/statistics & numerical data
- Mastectomy, Segmental/statistics & numerical data
- New Zealand/epidemiology
- Radiotherapy, Adjuvant/statistics & numerical data
- Pacific Island People/statistics & numerical data
- Asian/statistics & numerical data
- European People/statistics & numerical data
- Middle Eastern People/statistics & numerical data
- African People/statistics & numerical data
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Affiliation(s)
- Karen Bartholomew
- Te Whatu Ora Waitematā, Auckland, New Zealand
- Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Mazin Ghafel
- Te Whatu Ora Waitematā, Auckland, New Zealand
- Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Phyu S Aye
- Te Whatu Ora Waitematā, Auckland, New Zealand.
- University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - J Mark Elwood
- University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Claire Hardie
- Te Whatu Ora MidCentral, Palmerston North, New Zealand
| | - Nina Scott
- University of Auckland, Waikato Campus, Hamilton, New Zealand
| | - Jacquie Kidd
- Auckland University of Technology, Auckland, New Zealand
| | | | - Ian Campbell
- University of Auckland, Waikato Campus, Hamilton, New Zealand
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Trends in surgery and adjuvant treatment for early-stage breast cancer: a population-based study in Queensland, Australia. Breast Cancer Res Treat 2022; 193:175-185. [PMID: 35254604 DOI: 10.1007/s10549-022-06551-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/18/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Our aim was to describe variations in the treatment of early-stage breast cancer and to examine factors associated with disease-specific survival (DSS). METHODS The study used linked data for 24,190 women with a T1 (≤ 20 mm) breast cancer who underwent surgery from 2005 to 2019. Multivariate logistic regression was used to model predictors of receiving breast-conserving surgery (BCS) compared to mastectomy and a multinomial model was used to examine factors associated with type(s) of treatment received. RESULTS Overall, 70.3% had BCS, with a reduced likelihood of BCS observed for younger women (p < 0.001), rural residence, (p < 0.001), socioeconomic disadvantage (p = 0.004), higher tumour grade (p < 0.001) and surgery in a public versus private hospital (p < 0.001). Compared to women who received BCS and radiation therapy (RT), those having mastectomy alone or mastectomy plus RT were more likely to be younger (p < 0.001), live in a rural area (p < 0.001), have higher-grade tumours (p < 0.001) and positive lymph nodes (p < 0.001). Overall 5-year survival was 95.3% and breast cancer-specific survival was 98.3%. Highest survival was observed for women having BCS and RT and lowest for those having mastectomy and RT (p < 0.001). CONCLUSION Our results indicate some variation in the management of early-stage breast cancer. Lower rates of BCS were observed for rural and disadvantaged women and for those treated in a public or low-volume hospital. Whilst survival was high for this cohort, differences in tumour biology likely explain the differences in survival according to treatment type.
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George M, Smith A, Ranmuthugula G, Sabesan S. Barriers to Accessing, Commencing and Completing Cancer Treatment Among Geriatric Patients in Rural Australia: A Qualitative Perspective. Int J Gen Med 2022; 15:1583-1594. [PMID: 35210830 PMCID: PMC8859537 DOI: 10.2147/ijgm.s338128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore patients’, caregivers’, and health professionals’ perspectives on barriers and challenges to accessing, commencing and completing cancer therapy, with a focus on geriatric patients and the impacts of comorbidities and rurality. Patients and Methods A qualitative sub-study using focus group discussions was conducted in a regional cancer center and one of its outreach clinics in rural New South Wales, Australia. Five discussions with three distinct cohorts were undertaken, including: 1) geriatric cancer patients (two discussions); 2) caregivers (two discussions); and 3) health professionals (one discussion). Each focus group comprised eight to ten participants. A question guide was used to elicit participants’ experiences of receiving/providing cancer care and support during cancer treatment in a rural setting. Iterative thematic analysis was undertaken, with transcripts coded using NVivo software. Results Participants identified travel to larger regional centers and/or metropolitan areas and related arrangements as primary challenges to accessing diagnostic tests, surgeries, some treatments, and follow-up tests. Financial stress, and a lack of knowledge regarding available support services and mechanisms, was also a key issue for most patients and caregivers. Differences in availability of specific testing equipment, such as PET-CT, further complicated patients’ and caregivers’ experience of seeking diagnosis and management of cancer. While all interview cohorts identified positive rapport between clinicians and patients as a key characteristic of their experience of cancer management in rural and regional areas, difficulty in retaining clinical staff and related staffing levels at some health services were understood to negatively impact patients’ and caregivers’ experiences. Conclusion Overall, the study highlights the effects of geographical, social, and informational isolation on patients’ and caregivers’ experience of cancer diagnosis and management, and suggests several implications for further research and practice improvement.
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Affiliation(s)
- Mathew George
- Department of Medical Oncology, North West Cancer Centre, Tamworth, NSW, Australia
- School of Rural Medicine, University of New England, Armidale, NSW, Australia
- Correspondence: Mathew George Tel +61 2 6767 7760Fax +61 2 6766 9173 Email
| | - Alexandra Smith
- Department of Medical Oncology, North West Cancer Centre, Tamworth, NSW, Australia
| | - Geetha Ranmuthugula
- School of Rural Medicine, University of New England, Armidale, NSW, Australia
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville University Hospital, Townsville, QLD, Australia
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Yahya N, Sukiman NK, Suhaimi NA, Azmi NA, Manan HA. How many roads must a Malaysian walk down? Mapping the accessibility of radiotherapy facilities in Malaysia. PLoS One 2019; 14:e0213583. [PMID: 30897166 PMCID: PMC6428267 DOI: 10.1371/journal.pone.0213583] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/25/2019] [Indexed: 12/18/2022] Open
Abstract
Background The accessibility to radiotherapy facilities may affect the willingness to undergo treatment. We sought to quantify the distance and travel time of Malaysian population to the closest radiotherapy centre and to estimate the megavoltage unit (MV)/million population based on the regions. Materials & methods Data for subdistricts in Malaysia and radiotherapy services were extracted from Department of Statistics Malaysia and Directory of Radiotherapy Centres (DIRAC). Data from DIRAC were validated by direct communication with centres. Locations of radiotherapy centres, distance and travel time to the nearest radiotherapy were estimated using web mapping service, Google Map. Results The average distance and travel time from Malaysian population to the closest radiotherapy centre were 82.5km and 83.4mins, respectively. The average distance and travel were not homogenous; East Malaysia (228.1km, 236.1mins), Central (14.4km, 20.1mins), East Coast (124.2km, 108.8mins), Northern (42.9km, 42.8mins) and Southern (36.0km, 39.8mins). The MV/million population for the country is 2.47, East Malaysia (1.76), Central (4.19), East Coast (0.54), Northern (2.40), Southern (2.36). About 25% of the population needs to travel >100 km to get to the closest radiotherapy facility. Conclusion On average, Malaysians need to travel far and long to reach radiotherapy facilities. The accessibility to radiotherapy facilities is not equitable. The disparity may be reduced by adding centres in East Malaysia and the East Coast.
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Affiliation(s)
- Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Nur Khalis Sukiman
- Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nani Adilah Suhaimi
- Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nor Aniza Azmi
- Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Hanani A. Manan
- Department of Radiology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Dasgupta P, Baade PD, Youlden DR, Garvey G, Aitken JF, Wallington I, Chynoweth J, Zorbas H, Youl PH. Variations in outcomes by residential location for women with breast cancer: a systematic review. BMJ Open 2018; 8:e019050. [PMID: 29706597 PMCID: PMC5935167 DOI: 10.1136/bmjopen-2017-019050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To systematically assess the evidence for variations in outcomes at each step along the breast cancer continuum of care for Australian women by residential location. DESIGN Systematic review. METHODS Systematic searches of peer-reviewed articles in English published from 1 January 1990 to 24 November 2017 using PubMed, EMBASE, CINAHL and Informit databases. Inclusion criteria were: population was adult female patients with breast cancer; Australian setting; outcome measure was survival, patient or tumour characteristics, screening rates or frequencies, clinical management, patterns of initial care or post-treatment follow-up with analysis by residential location or studies involving non-metropolitan women only. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. RESULTS Seventy-four quantitative studies met the inclusion criteria. Around 59% were considered high quality, 34% moderate and 7% low. No eligible studies examining treatment choices or post-treatment follow-up were identified. Non-metropolitan women consistently had poorer survival, with most of this differential being attributed to more advanced disease at diagnosis, treatment-related factors and socioeconomic disadvantage. Compared with metropolitan women, non-metropolitan women were more likely to live in disadvantaged areas and had differing clinical management and patterns of care. However, findings regarding geographical variations in tumour characteristics or diagnostic outcomes were inconsistent. CONCLUSIONS A general pattern of poorer survival and variations in clinical management for Australian female patients with breast cancer from non-metropolitan areas was evident. However, the wide variability in data sources, measures, study quality, time periods and geographical classification made direct comparisons across studies challenging. The review highlighted the need to promote standardisation of geographical classifications and increased comparability of data systems. It also identified key gaps in the existing literature including a lack of studies on advanced breast cancer, geographical variations in treatment choices from the perspective of patients and post-treatment follow-up.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danny R Youlden
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | | | - Helen Zorbas
- Cancer Australia, Sydney, New South Wales, Australia
| | - Philippa H Youl
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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