Rural Australians have poorer cancer survival due partially to later presentation and diagnosis. We aimed to measure the effect of community-based symptom awareness and general practice-based educational interventions on time to diagnosis in rural cancer patients in Western Australia (WA).
2x2 factorial cluster randomised controlled trial. Community Intervention: symptom awareness campaign tailored for rural Australians. GP intervention: symptom risk assessment charts and local referral pathways implemented through academic detailing visits. Participants were eligible if diagnosed with breast, colorectal, lung or prostate cancer and resided in rural WA. Primary outcome: Total Diagnostic Interval (TDI i.e. duration from first symptom or date of screening test to cancer diagnosis). Interventions were delivered over two years and participants recruited during that period and for a further three months.
1,358 people were recruited (52.4% of potentially eligible population; accrual target 850). A TDI could be calculated for 1,314 (96.8%) participants for the Community Intervention and for 1,136 (83.7%) participants for the GP Intervention. There were no significant differences in median or ln mean TDI at a Community or GP intervention level (Community intervention vs control: median TDI 107.5 vs 92 days; ln mean difference 0.08 95% CI -0.06- 0.23 p=0.27; GP intervention vs control: median TDI 97 vs 96.5 days; ln mean difference 0.004 95% CI -0.18 – 0.19 p=0.99). There were no significant differences in the TDI when analysed by factorial design, tumour group or sub-intervals of the TDI.
This is the first randomised trial to test the combined effects of community and GP level interventions on time to cancer diagnosis. We found no effect of either the community campaign or GP interventions. This may reflect limited dose of the interventions, or limited duration of follow-up. Alternatively, these interventions do not have a measurable effect on time to cancer diagnosis.