Letters
Cancer
Volume 195 - Issue 11

Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland

Authors:  Peter D Baade, Paramita Dasgupta, Joanne F Aitken and Gavin Turrell

Med J Aust 2011; 195 (11): 661-662. || doi: 10.5694/mja11.11310
Published online: 12 December 2011
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In reply: We thank Bydder and Spry for their comments, although we suggest that they have misunderstood our study and its conclusions. We appreciate the opportunity to clarify our results.

Our study provides clear evidence that, after rectal cancer diagnosis, differences in survival are directly correlated with how far patients live from radiotherapy facilities.1 We did not conclude, as stated by Bydder and Spry, that “the apparent poorer outcomes were due to a failure to receive radiotherapy”. This explanation would be simplistic and ignores the many, varied and complex factors (demographic, socioeconomic, geographical and clinical) that together contribute to poorer survival in regional and rural communities.

Cause-of-death codes were based on case reviews by specialised coders using clinical information, in addition to the death certificate. Information on clinical stage is not available in population-based cancer registries and, for some cancers (including colorectal cancer), staging based on pathology reports has been shown to be a reliable substitute.2 Population-based data on radiation treatment are not available in Queensland.

Finally, whether or not distance from radiotherapy facilities has a direct impact on access to radiation treatment, while outside the scope of our study, is an important question and, with our clinical collaborators, is indeed one focus of the next phase of our work.

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