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

Jon Emery, Victoria Gray, Fiona Walter, Shelley Cheetham, E.J. Croager, T. Slevin, Christobel Saunders, T. Threlfall, Kirsten Auret, Anna Nowak, Elizabeth Geelhoed, Mahesh Bulsara, D'Arcy Holman

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Introduction
While overall survival for most common cancers in Australia is improving, the rural–urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA).

Methods and analysis
The community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness.

Ethics and dissemination
Ethics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA.

Results
Results of this trial will be reported in peer-reviewed publications and in conference presentations.

Original languageEnglish
Pages (from-to)1-10
JournalBMJ Open
Volume4
Issue number9
DOIs
Publication statusPublished - 17 Sep 2014

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Western Australia
Randomized Controlled Trials
Neoplasms
Early Detection of Cancer
Ethics
General Practice
Colorectal Neoplasms
Lung Neoplasms
Prostatic Neoplasms
Breast Neoplasms
Delivery of Health Care
Symptom Assessment
Delayed Diagnosis
Sample Size
Disease-Free Survival
Cost-Benefit Analysis
Publications
Primary Health Care
Referral and Consultation
Survival

Cite this

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title = "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",
abstract = "Introduction While overall survival for most common cancers in Australia is improving, the rural–urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA). Methods and analysis The community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness. Ethics and dissemination Ethics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA. Results Results of this trial will be reported in peer-reviewed publications and in conference presentations.",
author = "Jon Emery and Victoria Gray and Fiona Walter and Shelley Cheetham and E.J. Croager and T. Slevin and Christobel Saunders and T. Threlfall and Kirsten Auret and Anna Nowak and Elizabeth Geelhoed and Mahesh Bulsara and D'Arcy Holman",
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T1 - 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

AU - Emery, Jon

AU - Gray, Victoria

AU - Walter, Fiona

AU - Cheetham, Shelley

AU - Croager, E.J.

AU - Slevin, T.

AU - Saunders, Christobel

AU - Threlfall, T.

AU - Auret, Kirsten

AU - Nowak, Anna

AU - Geelhoed, Elizabeth

AU - Bulsara, Mahesh

AU - Holman, D'Arcy

PY - 2014/9/17

Y1 - 2014/9/17

N2 - Introduction While overall survival for most common cancers in Australia is improving, the rural–urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA). Methods and analysis The community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness. Ethics and dissemination Ethics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA. Results Results of this trial will be reported in peer-reviewed publications and in conference presentations.

AB - Introduction While overall survival for most common cancers in Australia is improving, the rural–urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA). Methods and analysis The community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness. Ethics and dissemination Ethics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA. Results Results of this trial will be reported in peer-reviewed publications and in conference presentations.

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