Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.
School of Psychology, University of Southern Queensland, Springfield Central, Queensland, Australia.
Eur J Cancer Care (Engl). 2019 May;28(3):e13072. doi: 10.1111/ecc.13072. Epub 2019 May 5.
Australia has one of the highest incidence rates of colorectal cancer (CRC) in the world. Residents in rural areas of Australia experience disadvantage in health care and outcomes. This review investigates whether patients with CRC in rural areas demonstrate poorer survival and more advanced stages of disease at diagnosis.
Systematic review of peer-reviewed articles and grey literature. Studies were included if they provided data on survival or stage of disease at diagnosis across multiple geographical locations; focused on CRC patients; and were conducted in Australia.
Twenty-six articles met inclusion criteria. Twenty-three studies examined survival, while five studies investigated stage at diagnosis. The evidence suggests that non-metropolitan patients are less likely to survive CRC for five years compared to patients living in metropolitan areas, yet there was limited evidence to suggest geographical disparity in stage of diagnosis.
While five-year survival disparities are apparent, these patterns appear to vary as a function of specific region and health jurisdiction, cancer type and year/s of data collection. Future research should examine current data using consistent and robust methods of reporting survival and classifying geographical location. The impact of population-level screening programmes on survival and stage at diagnosis also needs to be thoroughly explored.
澳大利亚是世界上结直肠癌（CRC）发病率最高的国家之一。澳大利亚农村地区的居民在医疗保健和结果方面处于不利地位。本综述调查了农村地区的 CRC 患者是否在生存和诊断时的疾病分期方面表现出较差的情况。
对同行评议的文章和灰色文献进行系统评价。如果研究提供了多个地理位置的生存或诊断时疾病分期的数据；聚焦于 CRC 患者；并在澳大利亚进行，则将其纳入研究。
有 26 篇文章符合纳入标准。23 项研究检查了生存率，而 5 项研究调查了诊断时的分期。有证据表明，与居住在大都市地区的患者相比，非大都市地区的患者五年内 CRC 生存率较低，但没有证据表明诊断时存在地理差异。
虽然五年生存率存在差异，但这些模式似乎因特定地区和卫生管辖区、癌症类型和数据收集年份而异。未来的研究应使用一致和可靠的报告生存率和分类地理位置的方法来检查现有数据。还需要彻底探讨人群筛查计划对生存和诊断时分期的影响。
