title: Cancer services in Western Australia: A comparison of regional outcomes with metropolitan Perth.
abstract: OBJECTIVE
  To investigate whether any survival differences existed between advanced cancer patients treated in metropolitan Perth and those treated in regional Western Australia (WA).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Advanced cancer patients treated through medical oncology clinics at Royal Perth Hospital and regional cancer centres (Kalgoorlie, Albany, Geraldton and Northam).
  
  
  METHODS
  Patients diagnosed with advanced melanoma, breast, colorectal, gastro-oesophageal, prostate, lung and pancreatic cancers between 1 January 2007 and 31 December 2011.
  
  
  METHODS
  Nil.
  
  
  METHODS
  Median survival.
  
  
  RESULTS
  Data were available for 1581 patients with 75% living in a metropolitan setting and 25% in rural WA. Median overall survival was 8.3 months for metropolitan patients and 7.6 months for regional patients (P = 0.06, HR 0.89; 95% CI, 0.78-1.01). There was no statistically significant difference in median survival for different tumour types except pancreatic cancer: breast 22.1 months versus 21.3 months, colorectal 13.1 months versus 16.4 months, lung 5.1 months versus 3.1 months, upper GI 5.6 months versus 7.2 months, pancreatic 4.5 months versus 3 months (P = 0.02, HR 0.57; 95% CI, 0.32-0.99), melanoma 10.4 months versus 10.5 months, prostate 28.6 months versus 15.3 months. Rural cancer patients with breast and pancreatic cancers received fewer lines of anti-cancer therapy compared to metropolitan patients. The three-year survival rates for metropolitan compared to rural breast cancer patients were 34 and 23%, respectively (not statistically significant).
  
  
  CONCLUSIONS
  Our findings suggest a trend towards inferior survival for regional cancer patients in WA compared with metropolitan-based patients.
authors.affiliation: Department of Medical Oncology, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Hilary L
authors.initials: HL
authors.lastname: Martin
authors.affiliation: Department of Medical Oncology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Kanako
authors.initials: K
authors.lastname: Ohara
authors.affiliation: Department of Medical Oncology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Wee
authors.initials: W
authors.lastname: Chin
authors.affiliation: Department of Medical Oncology, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davidson
authors.affiliation: Department of Medical Oncology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Evan
authors.initials: E
authors.lastname: Bayliss
authors.affiliation: Department of Medical Oncology, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Redfern
authors.affiliation: Department of Medical Oncology, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Muhammad Adnan
authors.initials: MA
authors.lastname: Khattak
mesh_terms: D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D012424:Rural Population / Q000706:statistics & numerical data*; D016019:Survival Analysis; D014505:Urban Population / Q000706:statistics & numerical data*; D014904:Western Australia / Q000453:epidemiology
keywords: health service evaluation; health services access; oncology; rural health; rural medicine