Rural factors and survival from cancer: analysis of Scottish cancer registrations

Abstract

More than 20% of the UK population live in rural areas (Cox, 1995) but there is little information on rural-urban patterns of cancer survival (Watt et al, 1993). Studies in other countries suggest that rural residence is associated with poorer survival, which could reflect more advanced stage at diagnosis and less adjuvant treatment (Bonett et al, 1990;Liff et al, 1991;Launoy et al, 1992). In the UK, the few studies of rural health in general have produced conflicting results but, overall, challenge the widespread belief that rural people have a health advantage over their urban counterparts (Phillimore and Reading, 1992;Watt et al, 1993; Cox, 1998).This study set out to investigate whether survival from cancer differed for patients resident in rural and urban areas. Two main rural indicators are associated with health: size of the local population and distance from health services (Weinert and Boik, 1995). In this paper, the hypotheses to be tested were that: (1) settlement size and (2) distance to the nearest cancer centre were associated with poorer survival. Excludes 3579 cases who died on the first day and 18 other cases who were followed up for less than 1 day.

Cancer of Unknown Primary: a Cancer Registry Study of Factors Affecting Access to Diagnosis

“…Table 2 gives the results from the logistic regression model, with the odds ratios for C80 compared to C20 for sex, age group, deprivation quartile and travel time to GP quartile. Travel time to GP showed a shallow gradient; odds ratios (ORs) (1.00, 1.09, 1.14) for quartiles [2][3][4] respectively, compared to the closest quartile 1, with p(trend)=0.007. Compared to C20, there was a significant protective effect against being classified as C80 in males, but this is partly an artefact of the high number of males in the C20 group which reflects the known sex ratio for rectal cancer.…”

“…A possible disadvantage of centralising services in this manner is that populations living further from specialist centres may have difficulties, including gaining transport to provide access to them for treatment, and such difficulties may consequently be associated with poorer disease prognosis [3,4]. Rural GPs have complained of the problems of gaining access to treatment for patients living in remoter areas far from cancer treatment centres [5] and a report from the Commission for Rural Communities has illustrated some adverse experiences of cancer sufferers and their carers living in rural England, with some patients facing round trips of 100 miles and the topography and quality of local roads further lengthening journey times [6].…”

“…Campbell et al [4] examined the relationship between survival and distance to cancer centres amongst 64,000 patients diagnosed with common cancers in Scotland between 1991 and 1995.…”

Access to specialist cancer care: is it equitable?

“…More indepth, qualitative studies are needed to understand why older patients and patients admitted to a 'non-cancer' hospital may be less likely to go on to receive specialist cancer care. Previous studies have shown patients living more remote from cities and cancer centres have more advanced cancer at diagnosis and poorer outcomes (Campbell 2000(Campbell , 2001). This must not be compounded by an inequity of access to specialist care.…”

“…Studies in the United States, France and Scotland have all shown that patients from rural areas are less likely to be treated in a specialist centre and to have poorer survival rates (Launoy et al, 1992;Howard et al, 1995;Greenberg et al, 1988). Campbell et al (2000) indicated that distance from a cancer centre might be a determining factor in survival. A more recent study showed that this is likely to be partly because patients living further from cities and associated cancer centres have more advanced disease at diagnosis (Campbell et al, 2001).…”