Remoteness of residence and survival from cancer in New South Wales

Objective: To analyse cancer survival in New South Wales by geographic remoteness. Design, setting and participants: A survival analysis of all patients with cancers diagnosed in NSW between 1 January 1992 and 31 December 1996. Survival was determined to 31 December 1999. Main outcome measures: The relative excess risk (RER) of death over 5 years was estimated for each geographic remoteness category relative to the highly accessible category for 20 cancer types adjusted for age, sex, years since diagnosis and, subsequently, stage of cancer at diagnosis. Results: There were statistically significant differences in the RER of death across remoteness categories (P<0.001) for cancers of the cervix and prostate and for all cancers. The RERs for the most remote categories (compared with the highly accessible category) before and after adjustment for stage were cervix, 3.22 (95% Cl, 1.54-6.75) and 2.25 (95% Cl, 1.06-4.77); prostate, 3.38 (95% Cl, 2.21-5.16) and 2.53 (95% Cl, 1.60-4.01); all cancers, 1.35 (95% Cl, 1.20-1.51) and 1.25 (95% Cl, 1.11-1.41). In addition, there were significant variations in RER of death by remoteness for head and neck, lung and colon cancers and cutaneous melanoma. Conclusion: Cancer survival varies by remoteness of residence in NSW for all cancers together and some cancers individually. Access to screening or early diagnosis probably contributes to this variation, but persistence after adjustment for stage suggests that treatment variation is also important.