title: Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland.
abstract: OBJECTIVE
  To determine whether an association exists between distance from radiotherapy facilities and survival outcomes of people diagnosed with rectal cancer.
  
  
  METHODS
  Descriptive population-based study using data from the Queensland Cancer Registry.
  
  
  METHODS
  All patients aged 20-79 years (n = 6848) diagnosed with invasive rectal cancer between 1 January 1996 and 31 December 2006.
  
  
  METHODS
  Cause-specific survival.
  
  
  RESULTS
  The 5-year cause-specific survival was 62% (95% CI, 61%-64%); it was strongly influenced by stage at diagnosis (American Joint Committee on Cancer, Stages I-IV), ranging from 86% (Stage I) to 9% (Stage IV). After adjusting for age, sex, and stage at diagnosis, patients who lived 100-199 km, 200-399 km and 400 km or more from a radiotherapy facility were 16%, 30%, and 25%, respectively, more likely to die from rectal cancer than patients living within 50 km of such a facility. On average, there was a 6% increase in mortality risk (95% CI, 3%-8%; P < 0.001) for each 100 km increment in distance from the nearest radiotherapy facility. Shared frailty models showed that this association persisted after adjusting for the correlation between individual cancer patients living in the same remoteness or area-level socioeconomic status categories.
  
  
  CONCLUSIONS
  While centralisation of cancer treatment services has merit, our study provides evidence of a shorter survival for people with rectal cancer who live relatively far from radiotherapy facilities. It remains a priority to develop and implement policy, cultural and clinical measures to reduce the burden faced by rural and remote patients with rectal cancer.
authors.affiliation: Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD, Australia. peterbaade@ cancerqld.org.au
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
authors.forename: Paramita
authors.initials: P
authors.lastname: Dasgupta
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Aitken
authors.forename: Gavin
authors.initials: G
authors.lastname: Turrell
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016522:Oncology Service, Hospital; D011793:Queensland / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome