Patients who live
further away from cancer centres are likely to receive different care and
experience worse outcomes than those who live closer according to new research
on patients in the north-east of Scotland and the Northern Isles. This is
despite patients from further away being referred and diagnosed as quickly as
people close to the centre.
The study, which
was funded by NHS Grampian Charity and published in the journal Health
& Place, calls for ‘better configuration of cancer services’ across
Scotland to address disparities in cancer care.
Professor Peter
Murchie, Clinical Chair in Academic Primary Care at the University, who led the
research alongside colleagues from NHS Grampian, 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.
The team found
that those living in Orkney and Shetland spent more time in hospital
and attended fewer oncology outpatient appointments. 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.
Dr Melanie
Turner, Advanced Research Fellow at the University, analysed data from the
NASCAR database collected from more than seventeen thousand patients diagnosed
with one of eight solid cancer types over ten years, 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 percent 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.
Dr Turner
explains: “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.
“
Dr Leslie Samuel,
Consultant Oncologist in NHS Grampian and Honorary Clinical Senior Lecturer at
the University explains: “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.
“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.”
Dr Kirsty
Brightwell, NHS Shetland 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.
“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.”
Dr Louise Wilson,
Director of Public Health at NHS Orkney 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. More therapies
are becoming available locally and we will work with NHS Grampian to get the
best possible outcomes for our patients.”
Professor Peter
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.”