The dilemma of distance: patients with kidney cancer from regional A ustralia present at a more advanced stage

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Abstract
Objective: To determine whether patients from regional areas undergoing surgery for kidney cancer present with more advanced disease as a result of geographic isolation. Patients and Methods: Retrospective analysis of 221 patients undergoing surgery for renal cell carcinoma ( RCC ) from J anuary 2004 to J une 2012, from both a metropolitan centre and a large inner regional hospital. Data was collected on age, gender, presentation (incidental or symptomatic), clinical stage and pathological features. The A ustralian S tandard G eographical C lassification‐ R emoteness A rea ( ASGC‐RA ) is a system developed to allow quantitative comparisons between metropolitan and rural A ustralia. A score was assigned to each patient based on their location of residence at the time of surgery: metropolitan, RA 1; inner regional, RA 2; outer regional, RA 3. Statistical significance was specified as P < 0.05 on P earson's chi‐square tests. Results: Patients in each ASGC‐RA group did not differ significantly in age, sex or mode of presentation. Pathological T stage on presentation increased with increasing ASGC‐RA and thus distance from tertiary centres ( P = 0.004). The proportion of patients with ≥ T 3 disease rose from 30% of RA 1 to 73% of RA 3 patients ( P = 0.016) treated at our tertiary centre. Similarly, our regional centre had a larger proportion of patients presenting with ≥ T 3 disease from RA 3 (31% vs 5%, P = 0.003). When the 221 patients with RCC were analysed as a group, clinical T stage was significantly associated with ASGC‐RA ( P < 0.001), symptomatic presentation ( P < 0.001), N stage ( P < 0.001), M stage ( P < 0.001) and F uhrman grade ( P < 0.001). Conclusions: Our data quantifies the detrimental effect of physical distance on the health outcomes of regional A ustralians with kidney cancer. Australia's unique geography and rural culture may preclude any attempts to centralise cancer care to specialised metropolitan units, as has occurred in other countries.

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