Background/significance:
The Australian Standard Geographical Classification - Remoteness Area (ASGC-RA) is a classification system developed by the Australian Bureau of Statistics to allow quantitative comparisons between metropolitan and rural Australia.

Objectives:
We applied the ASGC-RA to a cohort of patients undergoing cystectomy for bladder cancer, with the aim of determining whether patients from regional areas undergo surgery at a more advanced stage of disease.

Methods:
160 patients undergoing cystectomy for bladder cancer were identified retrospectively from Jan 1989 to Aug 2012. An ASGC-RA was attributed to each patient based on their location of residence at the time of surgery: metropolitan = RA1, inner regional = RA2, outer regional = RA3 and remote = RA4. Data was collected with regard to age, gender, pathological features and overall survival (OS). Statistical significance was specified as p < 0.05 on Pearson’s Chi-square tests.

Results:
There were 113 patients from RA1, 34 patients from RA2, 12 patients from RA3 and 1 from RA4. The mean age of patients from each region was 70 years, 67 years,74 years and 64 years respectively, with a total of 123 male and 37 female patients. There was a significant association between increasing ASGC-RA and pathological T-stage (p = 0.004). The proportion of pT2 cancer fell from 38% of RA1 patients to 17% of RA3 patients. Conversely the proportion of pT3+ disease rose from 50% of RA1 to 66% of RA3. Survival data was available for 137 patients. Increasing ASGC-RA was associated with poorer overall survival at 1 year and 3 years. At 1 year 80% of patients from RA1 were alive, compared with 76% from RA2 and 14% from RA3 (p < 0.001). At 3 years, only 48% of patients from RA1 were alive, compared with 52% from RA2 and none from RA3 (p = 0.04). Three-year OS was strongly associated with pathological t-stage (p = 0.003), pathological n-stage (p = 0.015) and the presence of lymphatic invasion (p = 0.05) and vascular invasion (p = 0.008).

Conclusion:
Our data suggests that patients from regional areas present later and have poorer outcomes than their metropolitan counterparts. This disparity is particularly noticeable between inner and outer regional areas. Whilst determining the exact cause of this variation is beyond the scope of this paper, we hypothesise that it may be related to poorer access to primary care physicians and specialist referral.