Ireland Michael J, March Sonja, Crawford-Williams Fiona, Cassimatis Mandy, Aitken Joanne F, Hyde Melissa K, Chambers Suzanne K, Sun Jiandong, Dunn Jeff
Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia.
School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia.
BMC Cancer. 2017 Feb 2;17(1):95. doi: 10.1186/s12885-017-3067-1.
Australia and New Zealand have the highest incidence of colorectal cancer (CRC) in the world, presenting considerable health, economic, and societal burden. Over a third of the Australian population live in regional areas and research has shown they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. The extent to which geographical disparities exist in CRC management and outcomes has not been systematically explored. The present review aims to identify the nature of geographical disparities in CRC survival, clinical management, and psychosocial outcomes.
The review followed PRISMA guidelines and searches were undertaken using seven databases covering articles between 1 January 1990 and 20 April 2016 in an Australian setting. Inclusion criteria stipulated studies had to be peer-reviewed, in English, reporting data from Australia on CRC patients and relevant to one of fourteen questions examining geographical variations in a) survival outcomes, b) patient and cancer characteristics, c) diagnostic and treatment characteristics and d) psychosocial and quality of life outcomes.
Thirty-eight quantitative, two qualitative, and three mixed-methods studies met review criteria. Twenty-seven studies were of high quality, sixteen studies were of moderate quality, and no studies were found to be low quality. Individuals with CRC living in regional, rural, and remote areas of Australia showed poorer survival and experienced less optimal clinical management. However, this effect is likely moderated by a range of other factors (e.g., SES, age, gender) and did appear to vary linearly with increasing distance from metropolitan centres. No studies examined differences in use of stoma, or support with stomas, by geographic location.
Overall, despite evidence of disparity in CRC survival and clinical management across geographic locations, the evidence was limited and at times inconsistent. Further, access to treatment and services may not be the main driver of disparities, with individual patient characteristics and type of region also playing an important role. A better understanding of factors driving ongoing and significant geographical disparities in cancer related outcomes is required to inform the development of effective interventions to improve the health and welfare of regional Australians.
澳大利亚和新西兰是全球结直肠癌（CRC）发病率最高的国家，带来了相当大的健康、经济和社会负担。超过三分之一的澳大利亚人口居住在偏远地区，研究表明他们面临一系列健康劣势，导致更高的疾病负担和更低的预期寿命。结直肠癌管理和治疗结果方面的地理差异程度尚未得到系统研究。本综述旨在确定结直肠癌生存率、临床管理和社会心理结果方面地理差异的本质。
本综述遵循PRISMA指南，使用七个数据库进行检索，涵盖1990年1月1日至2016年4月20日期间澳大利亚背景下的文章。纳入标准规定研究必须经过同行评审、英文撰写、报告来自澳大利亚的CRC患者数据，并与以下14个问题之一相关，这些问题考察了地理差异：a）生存结果；b）患者和癌症特征；c）诊断和治疗特征；d）社会心理和生活质量结果。
38项定量研究、2项定性研究和3项混合方法研究符合综述标准。27项研究质量高，16项研究质量中等，未发现质量低的研究。生活在澳大利亚偏远、农村和地区的CRC患者生存率较低，临床管理也不太理想。然而，这种影响可能受到一系列其他因素（如社会经济地位、年龄、性别）的调节，并且似乎并不随与大城市中心距离的增加而呈线性变化。没有研究考察地理位置对造口使用或造口支持的差异。
总体而言，尽管有证据表明不同地理位置的CRC生存率和临床管理存在差异，但证据有限且有时不一致。此外，获得治疗和服务可能不是差异的主要驱动因素，个体患者特征和地区类型也起着重要作用。需要更好地了解导致癌症相关结果持续存在且显著的地理差异的因素，以便为制定有效的干预措施提供信息，改善澳大利亚偏远地区居民的健康和福祉。
