title: Clinical profile and treatment outcomes of advanced neuroendocrine tumours in rural and regional patients: a retrospective study from a regional cancer centre in North Queensland, Australia.
abstract: BACKGROUND
  Neuroendocrine tumours (NET) arise from neuroendocrine cells, which are widely distributed throughout the body. However, diagnosing NET is difficult due to nonspecific symptoms and the paucity of experience among health professionals. This retrospective study was carried out to improve our understanding about NET. This knowledge can be used for optimal utilisation and distribution of limited resources.
  
  
  OBJECTIVE
  To study the clinical profile, treatment and survival outcomes for advanced NET patients in Australian regional and remote settings.
  
  
  METHODS
  We reviewed all adult patients who were diagnosed with NET between 1994 and 2012. Patients' data were extracted from electronic databases of The Townsville Cancer Centre. Remoteness was based on postcodes, with patients stratified as regional or rural North Queensland according to Australian Standard Geographical Classification (ASGC). Overall survival was studied using survival analysis.
  
  
  RESULTS
  Data from 79 patients were included in the study. The median age at diagnosis was 60 years. A total of 48 patients (60.8%) was male and 31 (39.2%) female. The majority of the patients lived in rural areas (51, 64%) as compared to residing in regional areas (28, 36%). There were 34 deaths at the study cut-off point. Median overall survival of NET patients in rural areas is significantly less than those living in regional areas (1613 days vs. 2935 days, respectively), P = 0.03.
  
  
  CONCLUSIONS
  Remoteness has an adverse impact on overall survival of NET patients. This outcome may be because of varied access to health services and/or lack of access to specialised scans and medical and surgical expertise.
authors.affiliation: Department of Medical Oncology, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Umbreen
authors.initials: U
authors.lastname: Hafeez
authors.affiliation: Department of Medical Oncology, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Department of Nuclear Medicine, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Manoj
authors.initials: M
authors.lastname: Bhatt
authors.affiliation: College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Department of Medical Oncology, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Sabe
authors.initials: S
authors.lastname: Sabesan
authors.affiliation: College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
authors.forename: Venkat
authors.initials: V
authors.lastname: Vangaveti
mesh_terms: D000368:Aged; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: neuroendocrine tumour; regional; remote; rural; survival