Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

The Improving Rural Cancer Outcomes (IRCO) Trial: a factorial cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural cancer patients in Western Australia. (#67)

Jon Emery 1 , Victoria Gray 2 , Fiona M Walter 3 , Shelley Cheetham 2 , Terry Slevin 4 , Christobel Saunders 5 , Timothy Threlfall 6 , Kirsten Auret 7 , Anna Nowak 8 , Elizabeth Geelhoed 9 , Max Bulsara 10 , D'Arcy Holman 9
  1. General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, VIC, Australia
  2. General Practice, University of Western Australia, Perth, WA
  3. Department of Primary Care, University of Cambridge, Cambridge, UK
  4. Cancer Council WA, Perth, WA
  5. Department of Surgery, University of Western Australia, Perth, WA
  6. WA Cancer Registry, Perth, WA
  7. Rural Clinical School of WA, University of Western Australia, Perth, WA
  8. Dept of Medicine and Pharmacology, University of Western Australia, Perth, WA
  9. School of Population Health, University of Western Australia, Perth, WA
  10. Notre Dame University, Fremantle, WA, Australia

Aims:

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).

Methods:

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. 

Findings:

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.

Conclusion:

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.

  1. Emery JD, Gray V, Walter FM, Cheetham S, Croager EJ, Slevin T, Saunders C, Threlfall T, Auret K, Nowak AK, Geelhoed E, Bulsara M, Holman CJD. (2014). The Improving Rural Cancer Outcomes (IRCO) Trial: a factorial cluster randomised controlled trial of a complex intervention to reduce time to diagnosis in rural patients with cancer in Western Australia: a study protocol. BMJ Open, 4:e006156. DOI:10.1136/bmjopen-2014-006156