Background: With oesophagectomy the predominant curative option for oesophageal cancer, access to health services is vital. This study aimed to investigate variation in the definitive surgical management and mortality of oesophageal carcinoma by urban/rural place of residence and disadvantage in urban-dwelling patients, in New South Wales (NSW), Australia.
Methods: The study was a population-based retrospective cohort of patients diagnosed with primary oesophageal carcinoma between 1 January 2001 and 31 December 2007, using data from the NSW Central Cancer Registry, probabilistically linked with hospital and death data. Logistic regression and Cox-regression were used to identify factors associated with surgery and mortality respectively. Factors investigated included age at diagnosis, sex, country of birth, year of diagnosis, disease stage, diagnostic group and co-morbidities.
Results: Among 1,412 patients with loco-regional oesophageal carcinoma, 24% (n=339) received definitive surgery. Of these, 3.5% died within 30 days after surgery, the median length of stay for surgery was 17 days, and 27% of patients experienced a respiratory complication. Median survival was 10 months, and 5 year survival was 19.1% (95% Confidence Interval [CI]: 16.5-21.9%). Reduced uptake of definitive surgery was associated with living in a rural location (adjusted Odds Ratio: 0.40; 95% CI: 0.23-0.70) or a more disadvantaged urban area (P-trend: < 0.001). Patients who had definitive surgery had a lower risk of dying (adjusted Hazard Ratio [aHR]: 0.33; 95% CI: 0.27-0.40), as did patients living in rural areas (aHR: 0.70; 95% CI: 0.55-0.89).
Conclusions: Patterns of surgical management differ for patients living in rural and more disadvantaged urban areas. While this may be offset partly by treatment with chemotherapy or radiotherapy, it is important to conduct further research to fully understand the role of patient access to health services, referral and clinical assessment practices, and patient choice in the curative treatment of oesophageal carcinoma in NSW and Australia.