Verma Rishabh, Pathmanathan Shivanshan, Otty Zulfiquer A, Binder John, Vangaveti Venkat N, Buttner Petra, Sabesan Sabe S
College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
Department of Medical Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia.
Intern Med J. 2018 Oct;48(10):1228-1233. doi: 10.1111/imj.13934.
Despite advances in medical therapies, disparity in outcome between rural and urban patients remain in Australia and many Western countries.
To examine time delays in lung cancer referral pathways in North Queensland (NQ), Australia, and explore patients' perspective of factors causing these delays.
Prospective study of patients attending three cancer centres in Townsville, Cairns and Mackay in NQ from 2009 to 2012. Times along referral pathway were divided as follows: Onset of symptoms to treatment (T1), symptoms to general practitioner (GP) (T2), GP to specialist (T3) and Specialist to treatment (T4). Quantitative and qualitative methods were used for analysis.
In total, 252 patients were participated. T1 was influenced by remoteness (125 days in Townsville vs 170 days for remote, P = 0.01), T2 by level of education (91 days for primary education vs 61 days for secondary vs 23 days for tertiary/Technical and Further Education (TAFE), P = 0.006), and age group (14 days for 31-50 years, 61 days for 51-70 years, 45 days for >71 years, P = 0.026), T3 by remoteness (15 days for Townville and 29.5 days for remote, P = 0.02) and T4 by stage of disease (21 days for Stage I, 11 days for Stage II, 34 days for Stage III 18 days for Stage IV, P = 0.041). Competing priorities of family and work and cost and inconvenience of travel were perceived as rural barriers.
Remoteness, age and level of education were related to delays in various time lines in lung cancer referral pathways in NQ. Provision of specialist services closer to home may decrease delays by alleviating burden of cost and inconvenience of travel.
尽管医学治疗取得了进展，但在澳大利亚和许多西方国家，农村和城市患者的治疗结果仍存在差异。
研究澳大利亚北昆士兰（NQ）肺癌转诊途径中的时间延迟，并探讨患者对导致这些延迟的因素的看法。
对2009年至2012年在NQ汤斯维尔、凯恩斯和麦凯的三个癌症中心就诊的患者进行前瞻性研究。转诊途径中的时间分为以下几个阶段：症状出现到治疗（T1）、症状出现到全科医生（GP）（T2）、全科医生到专科医生（T3）以及专科医生到治疗（T4）。采用定量和定性方法进行分析。
共有252名患者参与。T1受偏远程度影响（汤斯维尔为125天，偏远地区为170天，P = 0.01），T2受教育程度影响（小学学历为91天，初中学历为61天，大专/技术与继续教育（TAFE）学历为23天，P = 0.006）以及年龄组影响（31 - 50岁为14天，51 - 70岁为61天，>71岁为45天，P = 0.026），T3受偏远程度影响（汤斯维尔为15天，偏远地区为29.5天，P = 0.02），T4受疾病阶段影响（I期为21天，II期为11天，III期为34天，IV期为18天，P = 0.041）。家庭和工作的竞争优先级以及旅行成本和不便被视为农村地区的障碍。
偏远程度、年龄和教育程度与NQ肺癌转诊途径中不同时间阶段的延迟有关。在离家更近的地方提供专科服务可能通过减轻旅行成本和不便的负担来减少延迟。
