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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
  1. Jon D Emery1,2,
  2. Victoria Gray3,4,5,
  3. Fiona M Walter6,
  4. Shelley Cheetham3,
  5. Emma J Croager5,7,
  6. Terry Slevin5,7,
  7. Christobel Saunders8,
  8. Tim Threlfall9,
  9. Kirsten Auret10,
  10. Anna K Nowak11,
  11. Elizabeth Geelhoed4,
  12. Max Bulsara13,
  13. C D'Arcy J Holman4
  1. 1General Practice and Primary Health Care Academic Centre, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
  2. 2School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Australia
  3. 3School of Primary, Aboriginal and Rural Health Cancer, The University of Western Australia, Crawley, Australia
  4. 4School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
  5. 5Education and Research Division, Cancer Council Western Australia, Perth, Western Australia, Australia
  6. 6The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
  7. 7Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Western Australia, Australia
  8. 8School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
  9. 9The Department of Health of Western Australia, Western Australia Cancer Registry, Australia
  10. 10Rural Clinical School of WA, The University of Western Australia, Perth, Western Australia, Australia
  11. 11School of Medicine and Pharmacology, The University of Western Australia, Crawley, Australia
  12. 12Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  13. 13Institute of Health and Rehabilitation Research, Notre Dame University, Freemantle, Australia
  1. Correspondence to Professor Jon D Emery; jon.emery{at}


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.

Trial registration number Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12610000872033.


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