Cancer patients living furthest from hospital can have worse survival rates and differences in care
Patients who live further away from cancer centres are likely to receive different care and experience worse outcomes than those who live closer to them. This is despite patients from further away being referred and diagnosed as quickly as people close to the centre.
These findings emerged from a study that was funded by NHS Grampian Charity and appeared in the journal Health & Place at the end of last year. The article’s first author is Melanie Turner, from the Institute of Applied Health Sciences at the University of Aberdeen.
Peter Murchie, clinical chair in Academic Primary Care at the university led the research alongside colleagues from NHS Grampian. The study was conducted among patients in north east Scotland and the Northern Isles.
Professor Murchie and his colleagues call for a ‘better configuration of cancer services’ across Scotland to address disparities in cancer care. They investigated the relationship between distance to travel to the main cancer centre with hospital appointments and admissions, and the patients’ survival one-year after diagnosis.
Orkney and Shetland dwellers faced longer hospital stays
People living in Orkney and Shetland spent more time in hospital and attended fewer oncology outpatient appointments, they found. This was associated with a higher risk of death within a year of diagnosis compared to their mainland dwelling counterparts.
In contrast, patients on the mainland who had longer travelling times also spent more time in hospital but had more oncology outpatient appointments, and in their case, there was no increased risk of death within a year of diagnosis.
The data also showed that when patients who lived remotely had an emergency cancer admission, they were more likely to die within the first year. However, longer travelling times or living on an island did not increase the likelihood of emergency admission for cancer or affect the length of time to first emergency cancer admission.
Key findings from the study
- some people from Orkney and Shetland experienced worse outcomes than those who live closer to the cancer centre
- patients who lived remotely were more likely to die within the first year following an emergency cancer admission
- this was despite patients from further away being referred and diagnosed as quickly as people who live close to the cancer treatment centre
Dr Turner analysed data from the NASCAR database collected from more than 17,000 patients diagnosed with one of eight solid cancer types from 2007-2017. The patients lived in north-east Scotland – an area covered by NHS Grampian, NHS Orkney and NHS Shetland health boards. Island patients made up 8 per cent of the patients in the study.
Further analysis of factors that may influence survival found that it cannot be explained by age, type of treatment, socioeconomic status, non-cancer related co-morbidities or metastatic cancer. They did find a trend towards a positive effect of involvement of the oncology team where more oncology outpatient appointments reduced the risk. The team are now working to establish whether there is a difference in the treatment choices made by people living in the islands.
Research giving a better understanding of why these differences occur should enable the health service to not only review how cancer services are organised ... [and] the 'time toxicity' for those patients with advanced disease and a higher travel burden [Leslie Samuel, Aberdeen University]
Dr Turner said: ‘The aim of this and future research is to ensure that decisions on cancer treatment and care following diagnosis are not based on difficulties in accessing healthcare facilities due to a high travel burden for patients.'
'Time toxicity' factor needs attention
Leslie Samuel, a consultant oncologist in NHS Grampian and honorary clinical senior lecturer at Aberdeen University noted: ‘We already know that there is a difference in outcomes between urban and rural patients in north east Scotland, one marked difference being the paradox that while rural patients, with longer travelling times, tend to get a diagnosis and start treatment more promptly, their one year survival rate tends to be poorer.'
Dr Samuel added: ‘Research giving a better understanding of why these differences occur should enable the health service to not only review how cancer services are organised but also how this affects decisions patients make about treatment. In particular, the “time toxicity” for those patients with advanced disease and a higher travel burden.’
Kirsty Brightwell, NHS Shetland’s medical director added: ‘NHS Shetland welcomes any research that shines a light on the issues for our population. This study looks at data from 2007-2017 and a lot has changed since then, not least of all the changes put in place during the pandemic.
Dr Brightwell added: ‘We continue to work closely with colleagues in NHS Grampian to improve services and deliver as much as we can as close to people’s homes as possible whilst maintaining the quality of their experience and outcomes.’
'More therapies are becoming available locally'
Louise Wilson, NHS Orkney’s director of public health said: ‘Our cancer care is delivered in partnership with the specialists in NHS Grampian and supporting patients to make the best treatment choice for their situation is important. Dr Wilson noted: ‘More therapies are becoming available locally and we will work with NHS Grampian to get the best possible outcomes for our patients.’
Professor Murchie concluded: ‘It is essential that we continue to ensure equitable cancer care across all of Scotland’s geography. This research is a good step forward in beginning to unpick the complex mechanisms underlying poorer outcomes for our rural cancer patients.’
To see the full version of the article – titled The impact of travel time to cancer treatment centre on post-diagnosis care and mortality among cancer patients in Scotland – click
Author: I A McMillan
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