A cancer geography paradox? Poorer cancer outcomes with longer travelling times to healthcare facilities despite prompter diagnosis and treatment: a data-linkage study

Melanie Turner, Shona Fielding, Yuhan Ong, Chris Dibben, Zhiqianq Feng, David H. Brewster, Corri Black, Amanda Lee, Peter Murchie

Research output: Contribution to journalArticle

6 Citations (Scopus)
30 Downloads (Pure)

Abstract

Background: Rurality and distance from cancer treatment centres have been shown to negatively impact cancer outcomes, but the mechanisms remain obscure. 
Method: We analysed the impact of travel time to key healthcare facilities and mainland/island residency on the cancer diagnostic pathway (treatment within 62 days of referral, and within 31 days of diagnosis) and one-year mortality using a data linkage study with 12 339 patients. 
Results: After controlling for important confounders, mainland patients with more than 60 minutes travelling time to their cancer treatment centre [OR 1.42; CI 1.25 to 1.61] and island dwellers [OR 1.32; CI 1.09 to 1.59] were more likely to commence cancer treatment within 62 days of GP referral and within 31 days of their cancer diagnosis compared to those living within 15 minutes. Island-dwellers patients were more likely to have their diagnosis and treatment started on the same or next day [OR 1.72; 95%CI 1.31 to 2.25]. Increased travelling time to a cancer treatment centre was associated with increased mortality to one year (30-59 minutes [HR 1.21; 95%CI 1.05 to 1.41], >60 minutes [HR 1.18; 95%CI 1.03 to 1.36], island-dweller [HR 1.17; 95%CI 0.97 to 1.41]. 
Conclusions: Island-dwelling and greater mainland travel burden was associated with more rapid cancer diagnosis and treatment following GP referral even after adjustment for advanced disease, however these patients also experienced a survival disadvantage compared to those living nearer. Cancer services may need to be better configured to suit the different needs of dispersed populations.
Original languageEnglish
Pages (from-to)439-449
Number of pages11
JournalBritish Journal of Cancer
Volume117
Issue number3
Early online date22 Jun 2017
DOIs
Publication statusPublished - 25 Jul 2017

Fingerprint

Geography
Information Storage and Retrieval
Delivery of Health Care
Islands
Neoplasms
Therapeutics
Referral and Consultation
Mortality
Internship and Residency
Survival

Keywords

  • diagnosis
  • treatment
  • travel
  • mortality
  • healthcare facilities

Cite this

@article{4a5f70bd1e49434bb6dbb1afa350f335,
title = "A cancer geography paradox? Poorer cancer outcomes with longer travelling times to healthcare facilities despite prompter diagnosis and treatment: a data-linkage study",
abstract = "Background: Rurality and distance from cancer treatment centres have been shown to negatively impact cancer outcomes, but the mechanisms remain obscure. Method: We analysed the impact of travel time to key healthcare facilities and mainland/island residency on the cancer diagnostic pathway (treatment within 62 days of referral, and within 31 days of diagnosis) and one-year mortality using a data linkage study with 12 339 patients. Results: After controlling for important confounders, mainland patients with more than 60 minutes travelling time to their cancer treatment centre [OR 1.42; CI 1.25 to 1.61] and island dwellers [OR 1.32; CI 1.09 to 1.59] were more likely to commence cancer treatment within 62 days of GP referral and within 31 days of their cancer diagnosis compared to those living within 15 minutes. Island-dwellers patients were more likely to have their diagnosis and treatment started on the same or next day [OR 1.72; 95{\%}CI 1.31 to 2.25]. Increased travelling time to a cancer treatment centre was associated with increased mortality to one year (30-59 minutes [HR 1.21; 95{\%}CI 1.05 to 1.41], >60 minutes [HR 1.18; 95{\%}CI 1.03 to 1.36], island-dweller [HR 1.17; 95{\%}CI 0.97 to 1.41]. Conclusions: Island-dwelling and greater mainland travel burden was associated with more rapid cancer diagnosis and treatment following GP referral even after adjustment for advanced disease, however these patients also experienced a survival disadvantage compared to those living nearer. Cancer services may need to be better configured to suit the different needs of dispersed populations.",
keywords = "diagnosis, treatment, travel, mortality, healthcare facilities",
author = "Melanie Turner and Shona Fielding and Yuhan Ong and Chris Dibben and Zhiqianq Feng and Brewster, {David H.} and Corri Black and Amanda Lee and Peter Murchie",
note = "This study was funded by Cancer Research UK (Grant number = C10673/A17593). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. All authors are independent of Cancer Research UK.",
year = "2017",
month = "7",
day = "25",
doi = "10.1038/bjc.2017.180",
language = "English",
volume = "117",
pages = "439--449",
journal = "British Journal of Cancer",
issn = "0007-0920",
publisher = "Nature Publishing Group",
number = "3",

}

TY - JOUR

T1 - A cancer geography paradox? Poorer cancer outcomes with longer travelling times to healthcare facilities despite prompter diagnosis and treatment

T2 - a data-linkage study

AU - Turner, Melanie

AU - Fielding, Shona

AU - Ong, Yuhan

AU - Dibben, Chris

AU - Feng, Zhiqianq

AU - Brewster, David H.

AU - Black, Corri

AU - Lee, Amanda

AU - Murchie, Peter

N1 - This study was funded by Cancer Research UK (Grant number = C10673/A17593). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. All authors are independent of Cancer Research UK.

PY - 2017/7/25

Y1 - 2017/7/25

N2 - Background: Rurality and distance from cancer treatment centres have been shown to negatively impact cancer outcomes, but the mechanisms remain obscure. Method: We analysed the impact of travel time to key healthcare facilities and mainland/island residency on the cancer diagnostic pathway (treatment within 62 days of referral, and within 31 days of diagnosis) and one-year mortality using a data linkage study with 12 339 patients. Results: After controlling for important confounders, mainland patients with more than 60 minutes travelling time to their cancer treatment centre [OR 1.42; CI 1.25 to 1.61] and island dwellers [OR 1.32; CI 1.09 to 1.59] were more likely to commence cancer treatment within 62 days of GP referral and within 31 days of their cancer diagnosis compared to those living within 15 minutes. Island-dwellers patients were more likely to have their diagnosis and treatment started on the same or next day [OR 1.72; 95%CI 1.31 to 2.25]. Increased travelling time to a cancer treatment centre was associated with increased mortality to one year (30-59 minutes [HR 1.21; 95%CI 1.05 to 1.41], >60 minutes [HR 1.18; 95%CI 1.03 to 1.36], island-dweller [HR 1.17; 95%CI 0.97 to 1.41]. Conclusions: Island-dwelling and greater mainland travel burden was associated with more rapid cancer diagnosis and treatment following GP referral even after adjustment for advanced disease, however these patients also experienced a survival disadvantage compared to those living nearer. Cancer services may need to be better configured to suit the different needs of dispersed populations.

AB - Background: Rurality and distance from cancer treatment centres have been shown to negatively impact cancer outcomes, but the mechanisms remain obscure. Method: We analysed the impact of travel time to key healthcare facilities and mainland/island residency on the cancer diagnostic pathway (treatment within 62 days of referral, and within 31 days of diagnosis) and one-year mortality using a data linkage study with 12 339 patients. Results: After controlling for important confounders, mainland patients with more than 60 minutes travelling time to their cancer treatment centre [OR 1.42; CI 1.25 to 1.61] and island dwellers [OR 1.32; CI 1.09 to 1.59] were more likely to commence cancer treatment within 62 days of GP referral and within 31 days of their cancer diagnosis compared to those living within 15 minutes. Island-dwellers patients were more likely to have their diagnosis and treatment started on the same or next day [OR 1.72; 95%CI 1.31 to 2.25]. Increased travelling time to a cancer treatment centre was associated with increased mortality to one year (30-59 minutes [HR 1.21; 95%CI 1.05 to 1.41], >60 minutes [HR 1.18; 95%CI 1.03 to 1.36], island-dweller [HR 1.17; 95%CI 0.97 to 1.41]. Conclusions: Island-dwelling and greater mainland travel burden was associated with more rapid cancer diagnosis and treatment following GP referral even after adjustment for advanced disease, however these patients also experienced a survival disadvantage compared to those living nearer. Cancer services may need to be better configured to suit the different needs of dispersed populations.

KW - diagnosis

KW - treatment

KW - travel

KW - mortality

KW - healthcare facilities

U2 - 10.1038/bjc.2017.180

DO - 10.1038/bjc.2017.180

M3 - Article

VL - 117

SP - 439

EP - 449

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

IS - 3

ER -