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10.1038/bjc.2017.180

http://scihub22266oqcxt.onion/10.1038/bjc.2017.180
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suck abstract from ncbi


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pmid28641316      Br+J+Cancer 2017 ; 117 (3): 439-49
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  • A cancer geography paradox? Poorer cancer outcomes with longer travelling times to healthcare facilities despite prompter diagnosis and treatment: a data-linkage study #MMPMID28641316
  • Turner M; Fielding S; Ong Y; Dibben C; Feng Z; Brewster DH; Black C; Lee A; Murchie P
  • Br J Cancer 2017[Jul]; 117 (3): 439-49 PMID28641316show ga
  • Background:: Rurality and distance from cancer treatment centres have been shown to negatively impact cancer outcomes, but the mechanisms remain obscure. Methods:: 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 1-year mortality using a data-linkage study with 12?339 patients. Results:: After controlling for important confounders, mainland patients with more than 60?min of travelling time to their cancer treatment centre ((OR 1.42; 95% CI 1.25?1.61) and island dwellers (OR 1.32; 95% CI 1.09?1.59) were more likely to commence cancer treatment within 62 days of general practitioner (GP) referral and within 31 days of their cancer diagnosis compared with those living within 15?min. Island-dweller patients were more likely to have their diagnosis and treatment started on the same or next day (OR 1.72; 95% CI 1.31?2.25). Increased travelling time to a cancer treatment centre was associated with increased mortality to 1 year (30?59?min (HR 1.21; 95% CI 1.05?1.41), >60?min (HR 1.18; 95% CI 1.03?1.36), island dweller (HR 1.17; 95% CI 0.97?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 with those living nearer. Cancer services may need to be better configured to suit the different needs of dispersed populations.
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