Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11036

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    P1.24-035 - Times to presentation and treatment : A prospective comparision of rural and urban lung cancer patients in North Queensland (ID 2500)

    09:30 - 16:30  |  Author(s): P. Beuttner
    • Abstract

    Background
    Disparities in cancer survival among rural and urban population is known. Time delay from symptom to presentation for medical attention and treatment in rural lung cancer population is partly responsible for lower survival rates in this population. Identification of specific barriers can help form strategies to improve survival. There are no prospective studies evaluating referral pathways and identifying barriers in lung cancer presentation in rural areas . This study's aim was to analyse time delays in management pathways of rural lung cancer patients and explore the influence of various demographic factors on these times.

    Methods
    Lung cancer patients presenting to Townsville Cancer Centre, Cairns Base Hospital and Mackay Base Hospital were prospectively recruited over a 36 month period from 2009 to 2012. As per ASGC (Australian Standard Geographical Classification) guidelines of remoteness patients were classified as regional or remote. Fisher’s test was used to identify differences between these two cohorts. Times along referral pathway were divided into symptoms to first presentation, symptoms to diagnosis, symptoms to specialist visit, specialist to treatment and symptoms to treatment. The influence of clinical and socio-demographic factors like gender, ethnic status, education level, income, remoteness of location and stage of disease on these times were analysed using Kruskal-Wallis and Mann-Whitney tests for statistical significance.

    Results
    A total of 252 lung cancer patients were eligible for recruitment. Of these 180 (71.4%) were classified as urban and rest remote. In remote compared to urban patients there were more males (73.6% vs 60%, p=0.046) and more Caucasians (96.2% vs 90%,p=0.068). Also level of secondary or higher education was significantly more in urban compared to remote cohort (88.5% vs62.7%). Tumour demographics like histology and stage were balanced between the two cohorts. Median time from symptoms to first presentation was significantly affected by ethnicity (indigenous vs non indigenous 92 vs 57 days, p=0.05), older age (<51yr vs >51yr 14 vs 45 days, p= 0.026) and lower level of education (primary/secondary vs tertiary/TAFE 61 vs 23 days, p=0.023). Median time between symptoms to specialist consultation were significantly higher for lower level of education ( primary / secondary vs tertiary/TAFE 140 vs 55 days, p=0.05) and remoteness of location (remote vs urban 113 vs 89 days, p=0.05). Specialist to treatment time was delayed by stage (III vs IV 34 vs 18 days, p=0.021). On multivariate analysis time between symptoms to first presentation was influenced by level of education (primary/secondary vs tertiary/TAFE, p=0.006). For rural compared to urban patients, time between first consultation to specialist visit (p=0.022) and time between symptoms to first treatment (p=0.015) were significantly longer.

    Conclusion
    The demographic profile of lung cancer patients from remote areas is quite smilar to their regional counterparts. In the five time zones from presentation to treatment, median time from symptoms to first presentation was the most susceptible. In the referral pathways, indigenous ethnicity, level of education, remoteness and stage of disease affected time delays but no impact was found for socio-economic status. On multivariate analysis level of education and remoteness of location emerged as significant barriers to presentation.