Is intensive chemotherapy safe for rural cancer patients?

• Published in: Internal medicine journal 2013-06, Vol.43 (6), p.643-649
• Main Authors: Pathmanathan, S., Burgher, B., Sabesan, S.
• Format: Article
• Language: English
• Subjects: Adult; adverse event; Aged; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Cancer; chemotherapy; Clinical support; Colonic Neoplasms - drug therapy; Colonic Neoplasms - epidemiology; Colorectal cancer; Diarrhea - chemically induced; Diarrhea - epidemiology; dose intensity; Drugs (Pharmaceuticals); Female; Humans; Male; Middle Aged; Retrospective Studies; rural; Rural conditions; Rural Population; Safety; Townsville (Qld); Vomiting - chemically induced; Vomiting - epidemiology
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.12083

Background To provide equality of cancer care to rural patients, Townsville Cancer Centre administers intensive chemotherapy regimens to rural patients with node‐positive breast and metastatic colorectal cancers at the same doses as urban patients. Side‐effects were usually managed by rural general practitioners locally. Aim The aim is to determine the safety of this practice by comparing the profile of serious adverse events and dose intensities between urban and rural patients at the Townsville Cancer Centre. Method A retrospective audit was conducted in patients with metastatic colorectal and node‐positive breast cancers during a 24‐month period. Fisher's exact test was used for analysis. Rurality was determined as per rural, remote and metropolitan classification. Results Of the 121 patients included, 70 and 51 patients had breast and colon cancers respectively. The urban versus rural patient split among all patients, breast and colorectal cancer subgroups was 68 versus 53, 43 versus 27 and 25 versus 26 respectively. A total of 421 cycles was given with dose intensity of >95% for breast cancer in both groups (P > 0.05). Rate of febrile neutropenia was 9.3% versus 7.4% (P = 0.56). For XELOX, rate of diarrhoea was 20% versus 19% (P = 0.66) and rate of vomiting was 20% versus 11% (P = 0.11). Only two patients were transferred to Townsville for admission. No toxic death occurred in either group. Conclusion It appears safe to administer intensive chemotherapy regimens at standard doses to rural patients without increased morbidity or mortality. Support for general practitioners through phone or videoconferencing may reduce the safety concerns.