title: A prospective comparison of times to presentation and treatment of regional and remote head and neck patients in North Queensland, Australia.
abstract: OBJECTIVE
  This study aims to examine differences between outer regional (OR) and remote/very remote (RVR) patients in northern Queensland, Australia in the times taken to receive various aspects of head and neck cancer management.
  
  
  METHODS
  Our study prospectively recruited head and neck cancer patients presenting to three North Queensland regional hospitals from January 2009 to January 2011. Data on demographic and cancer-specific details, comorbidities and timing of presentation to various services, were collected using a self-administered questionnaire that included two questions in relation to possible reason for delays to health services. Multivariate linear regression analyses were conducted to assess the effects of various demographic characteristics on time delays. Survival and disease recurrence data were analysed in 2014.
  
  
  RESULTS
  One hundred and fifty-eight patients participated. RVR patients had significantly longer median times between diagnosis and first treatment compared with OR patients (P = 0.015). Indigenous patients had significant delays from diagnosis to first treatment (P = 0.013) and visit to first specialist and treatment (P = 0.031) compared to non-Indigenous patients. Longer median times between symptoms and first treatment was associated with low income (P = 0.03) and lower education level (P = 0.04). Disease recurrence was higher for RVR patients compared with OR patients (P = 0.04), without significant differences in overall survival. Possible reasons for delays included patient and professional factors.
  
  
  CONCLUSIONS
  Significant delays in various aspects of head and neck cancer management were associated with remoteness, Indigenous and socioeconomic status. While patient and professional factors could be addressed at local levels, sustainable improvement in outcomes requires a state and national level approach.
authors.affiliation: Department of Medical Oncology, Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.|Cancer Care Services, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: J Y-A
authors.initials: JY
authors.lastname: Tan
authors.affiliation: Cancer Care Services, The Townsville Hospital, Townsville, Queensland, Australia.|College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Otty
authors.affiliation: College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
authors.forename: V N
authors.initials: VN
authors.lastname: Vangaveti
authors.affiliation: College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.|Tropical Health Solutions Pty Ltd, Townsville, Queensland, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Buttner
authors.affiliation: Cancer Care Services, The Townsville Hospital, Townsville, Queensland, Australia.|College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
authors.forename: S C
authors.initials: SC
authors.lastname: Varma
authors.affiliation: Cancer Care Services, The Townsville Hospital, Townsville, Queensland, Australia.|College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Joshi
authors.affiliation: College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.|Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Cancer Care Services, The Townsville Hospital, Townsville, Queensland, Australia.|College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Collins
authors.affiliation: Cancer Care Services, The Townsville Hospital, Townsville, Queensland, Australia.|College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
authors.forename: S S
authors.initials: SS
authors.lastname: Sabesan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D006761:Hospitals; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011446:Prospective Studies; D011793:Queensland; D012017:Referral and Consultation; D012423:Rural Health; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: diagnosis delay; head and neck cancer; rural health; treatment delay