Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care

Peninah Murage, Peter Murchie, Max Bachmann, Michael Crawford, Andy Jones

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Abstract

Background: Several studies have reported a survival disadvantage for rural dwellers who develop colorectal cancer, but the underlying mechanisms remain obscure. Delayed presentation to general practitioners (GPs) maybe a contributory factor but evidence is lacking. Aim: To examine the association between rurality and travel time on diagnosis and survival from colorectal cancer in a cohort from Northeast Scotland. Design and setting: We used a database linking GP records to routine data for patients diagnosed between 1997/98, and followed up to 2011. Method: Primary outcomes were alarm symptoms, emergency admissions, stage and survival. Travel time in minutes from patients to GP was estimated. Logistic and Cox regression were used to model outcomes. Interaction terms were used to determine if travelling time impacted differently on urban versus rural patients. Results: Rural patients and patients travelling farther to the GP had better three-year survival. When the travel - outcomes association were explored using interaction terms, the associations differed between rural and urban areas. Longer travel in urban areas significantly reduced the odds of emergency admissions (OR 0.62, p<0.05), and increased survival (HR 0.75, p<0.05). Longer travel also increased the odds of presenting with alarm symptoms in urban areas, this was nearly significant (OR 1.34, p=0.06). Presence of alarm symptoms reduced the likelihood of emergency admissions (OR 0.36, p<0.01). Conclusions: Living in a rural area, and travelling farther to GP in urban areas may reduce the likelihood of emergency admissions and poor survival. This may be related to how patients present with alarm symptoms.
Original languageEnglish
Pages (from-to)460-466
Number of pages7
JournalThe British Journal of General Practice
Volume67
Issue number660
Early online date29 Jun 2017
DOIs
Publication statusPublished - Jul 2017

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Colorectal Neoplasms
Primary Health Care
Cohort Studies
General Practitioners
Cross-Sectional Studies
Survival
Emergencies
Scotland
Logistic Models
Databases

Keywords

  • access
  • cancer systems
  • early diagnosis
  • geography
  • primary care
  • rurality

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Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer : a cross-sectional cohort study in primary care. / Murage, Peninah ; Murchie, Peter; Bachmann, Max; Crawford, Michael; Jones, Andy.

In: The British Journal of General Practice, Vol. 67, No. 660, 07.2017, p. 460-466.

Research output: Contribution to journalArticle

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title = "Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care",
abstract = "Background: Several studies have reported a survival disadvantage for rural dwellers who develop colorectal cancer, but the underlying mechanisms remain obscure. Delayed presentation to general practitioners (GPs) maybe a contributory factor but evidence is lacking. Aim: To examine the association between rurality and travel time on diagnosis and survival from colorectal cancer in a cohort from Northeast Scotland. Design and setting: We used a database linking GP records to routine data for patients diagnosed between 1997/98, and followed up to 2011. Method: Primary outcomes were alarm symptoms, emergency admissions, stage and survival. Travel time in minutes from patients to GP was estimated. Logistic and Cox regression were used to model outcomes. Interaction terms were used to determine if travelling time impacted differently on urban versus rural patients. Results: Rural patients and patients travelling farther to the GP had better three-year survival. When the travel - outcomes association were explored using interaction terms, the associations differed between rural and urban areas. Longer travel in urban areas significantly reduced the odds of emergency admissions (OR 0.62, p<0.05), and increased survival (HR 0.75, p<0.05). Longer travel also increased the odds of presenting with alarm symptoms in urban areas, this was nearly significant (OR 1.34, p=0.06). Presence of alarm symptoms reduced the likelihood of emergency admissions (OR 0.36, p<0.01). Conclusions: Living in a rural area, and travelling farther to GP in urban areas may reduce the likelihood of emergency admissions and poor survival. This may be related to how patients present with alarm symptoms.",
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author = "Peninah Murage and Peter Murchie and Max Bachmann and Michael Crawford and Andy Jones",
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AU - Murchie, Peter

AU - Bachmann, Max

AU - Crawford, Michael

AU - Jones, Andy

N1 - The authors are grateful to Professor Willie Hamilton of the University of Exeter Medical School for his advice on grouping colorectal cancer symptoms, and would also like to thank colleagues at the University of Aberdeen for providing the CRUX dataset.

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N2 - Background: Several studies have reported a survival disadvantage for rural dwellers who develop colorectal cancer, but the underlying mechanisms remain obscure. Delayed presentation to general practitioners (GPs) maybe a contributory factor but evidence is lacking. Aim: To examine the association between rurality and travel time on diagnosis and survival from colorectal cancer in a cohort from Northeast Scotland. Design and setting: We used a database linking GP records to routine data for patients diagnosed between 1997/98, and followed up to 2011. Method: Primary outcomes were alarm symptoms, emergency admissions, stage and survival. Travel time in minutes from patients to GP was estimated. Logistic and Cox regression were used to model outcomes. Interaction terms were used to determine if travelling time impacted differently on urban versus rural patients. Results: Rural patients and patients travelling farther to the GP had better three-year survival. When the travel - outcomes association were explored using interaction terms, the associations differed between rural and urban areas. Longer travel in urban areas significantly reduced the odds of emergency admissions (OR 0.62, p<0.05), and increased survival (HR 0.75, p<0.05). Longer travel also increased the odds of presenting with alarm symptoms in urban areas, this was nearly significant (OR 1.34, p=0.06). Presence of alarm symptoms reduced the likelihood of emergency admissions (OR 0.36, p<0.01). Conclusions: Living in a rural area, and travelling farther to GP in urban areas may reduce the likelihood of emergency admissions and poor survival. This may be related to how patients present with alarm symptoms.

AB - Background: Several studies have reported a survival disadvantage for rural dwellers who develop colorectal cancer, but the underlying mechanisms remain obscure. Delayed presentation to general practitioners (GPs) maybe a contributory factor but evidence is lacking. Aim: To examine the association between rurality and travel time on diagnosis and survival from colorectal cancer in a cohort from Northeast Scotland. Design and setting: We used a database linking GP records to routine data for patients diagnosed between 1997/98, and followed up to 2011. Method: Primary outcomes were alarm symptoms, emergency admissions, stage and survival. Travel time in minutes from patients to GP was estimated. Logistic and Cox regression were used to model outcomes. Interaction terms were used to determine if travelling time impacted differently on urban versus rural patients. Results: Rural patients and patients travelling farther to the GP had better three-year survival. When the travel - outcomes association were explored using interaction terms, the associations differed between rural and urban areas. Longer travel in urban areas significantly reduced the odds of emergency admissions (OR 0.62, p<0.05), and increased survival (HR 0.75, p<0.05). Longer travel also increased the odds of presenting with alarm symptoms in urban areas, this was nearly significant (OR 1.34, p=0.06). Presence of alarm symptoms reduced the likelihood of emergency admissions (OR 0.36, p<0.01). Conclusions: Living in a rural area, and travelling farther to GP in urban areas may reduce the likelihood of emergency admissions and poor survival. This may be related to how patients present with alarm symptoms.

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