title: Does geography influence the treatment and outcomes of colorectal cancer? A population-based analysis.
abstract: BACKGROUND
  The Canadian province of Manitoba covers a large geographical area but only has one major urban center, Winnipeg. We sought to determine if regional differences existed in the quality of colorectal cancer care in a publicly funded health care system.
  
  
  METHODS
  This was a population-based historical cohort analysis of the treatment and outcomes of Manitobans diagnosed with colorectal cancer between 2004 and 2006. Administrative databases were utilized to assess quality of care using published quality indicators.
  
  
  RESULTS
  A total of 2,086 patients were diagnosed with stage I to IV colorectal cancer and 42.2% lived outside of Winnipeg. Patients from North Manitoba had a lower odds of undergoing major surgery after controlling for other confounders (odds ratio (OR): 0.48, 95% confidence interval (CI): 0.26 to 0.90). No geographic differences existed in the quality measures of 30-day operative mortality, consultations with oncologists, surveillance colonoscopy, and 5-year survival. However, there was a trend towards lower survival in North Manitoba.
  
  
  CONCLUSIONS
  We found minimal differences by geography. However, overall compliance with quality measures is low and there are concerning trends in North Manitoba. This study is one of the few to evaluate population-based benchmarks for colorectal cancer therapy in Canada.
authors.affiliation: Department of Surgery, University of Manitoba, AE101-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada.
authors.forename: Ramzi M
authors.initials: RM
authors.lastname: Helewa
authors.forename: Donna
authors.initials: D
authors.lastname: Turner
authors.forename: Debrah
authors.initials: D
authors.lastname: Wirtzfeld
authors.forename: Jason
authors.initials: J
authors.lastname: Park
authors.forename: David
authors.initials: D
authors.lastname: Hochman
authors.forename: Piotr
authors.initials: P
authors.lastname: Czaykowski
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.forename: Emma
authors.initials: E
authors.lastname: Shu
authors.forename: Lin
authors.initials: L
authors.lastname: Xue
authors.forename: Andrew
authors.initials: A
authors.lastname: McKay
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005843:Geography; D006801:Humans; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult