Results: The number of excess cancer deaths in regional and remote areas from 2001 to 2010 was 8878 (95% CI, 8187–9572). For men, the age-standardised mortality ratios (comparing regional and remote areas with metropolitan areas) showed no evidence of improvement, from 1.08 in 1997–2000 to 1.11 in 2006–2010. For women, they increased from 1.01 in 1997–2000 to 1.07 in 2006–2010. The age-standardised cancer death rate in regional and remote areas (annual percentage change [APC], − 0.6%; 95% CI, − 0.8% to − 0.4%) is decreasing more slowly than in metropolitan areas (APC, − 1.1%; 95% CI, − 1.3% to − 1.0%).
Conclusions: The regional and remote disadvantage for cancer deaths has been recognised as a problem for more than two decades, yet we have made little progress. This is not surprising — we have not invested in research into solutions. The benefits of laboratory and clinical research to identify innovative cancer treatments will not be fully realised across the entire Australian population unless we also invest in health systems and policy research.
- 1. Australian Institute of Health and Welfare. Cancer in Australia 2010: an overview. Canberra: AIHW, 2010. (AIHW Cat. No. CAN 56; Cancer Series No. 60.) http://www.aihw.gov.au/publication-detail/?id=6442472459 (accessed Jun 2013).
- 2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012; 62: 10-29.
- 3. King NB, Harper S, Young ME. Use of relative and absolute effect measures in reporting health inequalities: structured review. BMJ 2012; 345: e5774.
- 4. Australian Institute of Health and Welfare. Rural, regional and remote health: indicators of health system performance. Canberra: AIHW, 2008. (AIHW Cat. No. PHE 103.) http://www.aihw.gov.au/publication-detail/?id=6442468150 (accessed Jun 2013).
- 5. Australian Bureau of Statistics. Statistical geography volume 1. Australian Standard Geographic Classification (ASCG), Jul 2006. Canberra: ABS, 2006. (ABS Cat. No. 1216.0.) http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/BD1B52D132D130E7CA 2573630012F67B?opendocument (accessed Jun 2013).
- 6. Jong KE, Vale PJ, Armstrong BK. Rural inequalities in cancer care and outcome [editorial]. Med J Aust 2005; 182: 13-14. <MJA full text>
- 7. Underhill CR, Goldstein D, Grogan PB. Inequity in rural cancer survival in Australia is not an insurmountable problem [editorial]. Med J Aust 2006; 185: 479-480. <MJA full text>
- 8. Heathcote K, Armstrong B. Disparities in cancer outcomes in regional and rural Australia. Cancer Forum 2007; 31: 70-74. http://cancerforum.org. au/Issues/2007/July/Forum/Disparities_cancer_outcomes_regional_rural_Australia.htm (accessed Jun 2013).
- 9. Moore SP, O’Rourke PK, Mallitt KA, et al. Cancer incidence and mortality in Indigenous Australians in Queensland, 1997-2006. Med J Aust 2010; 193: 590-593. <MJA full text>
- 10. Cancer Institute New South Wales. New evidence reveals inexperience in complex cancer surgeries costs lives [media release]. 10 Sep 2012. http://www.cancerinstitute.org.au/news/i/new-evidence-reveals-inexperience-in-complex-cancer-surgeries-costs-lives (accessed Dec 2012).
- 11. Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH. Workload and surgeon’s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev 2012; (3): CD005391.
- 12. Wouters MW, Gooiker GA, van Sandick JW, Tollenaar RA. The volume-outcome relation in the surgical treatment of esophageal cancer: a systematic review and meta-analysis. Cancer 2012; 118: 1754-1763.
- 13. Morris M, Platell C, Fritschi L, Iacopetta B. Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients. Br J Cancer 2007; 96: 701-707.
- 14. Adams P, Hardwick J, Embree V, et al. Literature review: models of cancer services for rural and remote communities. Sydney: Cancer Institute NSW, 2009. http://www.cancerinstitute.org.au/publications/i/literature-review-models-of-cancer-services-for-rural-and-remote-communities (accessed Jun 2013).
- 15. Smith-Merry J, Gillespie J, Leeder SR. A pathway to a stronger research culture in health policy. Aust New Zealand Health Policy 2007; 4: 19.
- 16. Pickstone JV. The rule of ignorance: a polemic on medicine, English health service policy, and history. BMJ 2011; 342: d997.
- 17. Department of Health and Ageing. Deliverying regional cancer centres [media release]. 7 Apr 2010. http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr059.htm (accessed Dec 2012).
- 18. Cartwright N. A philosopher’s view of the long road from RCTs to effectiveness. Lancet 2011; 377: 1400-1401.
- 19. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer survival in Australia 1992–1997: geographic categories and socioeconomic status. Canberra: AIHW, 2003. (AIHW Cat. No. CAN 17; Cancer Series No. 22.) http://www.aihw.gov.au/publication-detail/?id=6442467451 (accessed Jun 2013).
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