Geographic variation in experiences of cancer care in Scotland: insights and policy implications from the Scottish Cancer Patient Experience Survey

Background: Rural residence is associated with reduced cancer survival but research linking geography to patient experience is limited. Evidence from Scotland suggests rural patients experience cancer care differently. The Scottish Cancer Patient Experience Survey (SCPES) provides nationally representative, patient-reported datasets capturing experiences across the cancer care pathway, offering a unique opportunity to examine geographic variation in care.
Methods: SCPES 2024 responses from 4,540 adults were analysed. Data were weighted to account for non-response bias and structured for analysis by Scottish Government six-fold Urban-Rural classification. From 102 SCPES items, 32 were selected by two researchers independently (percentage agreement and Cohen’s kappa were calculated) based on relevance to cancer pathway stages, travel burden or rural-urban disparities. Analyses were conducted in three blocks: (1) pathway-relevant questions (n=15), (2) distance to care components (n=7), and (3) specific travel difficulties (n=10). Cross-tabulations employed weighted counts, with χ² tests and linear-by-linear trend analyses for ordinal responses. Bonferroni correction was applied within each block.
Results: Rural-dwelling respondents reported significantly longer journeys to access aspects of their cancer care and were more likely to report specific travel difficulties. Rural-dwellers were significantly less-likely to be given the chance to participate in research. Despite this, rural-dwelling cancer patients were as likely as urban-dwellers to report that their cancer experience was positive overall.
Conclusion: Satisfaction with cancer care in Scotland is positive irrespective of geography. Further research should focus on sustainably reducing travel-burden for rural-dwelling cancer patients and ensuring equal opportunities for them to participate in qualitative and quantitative research.
Policy summary: Efficient and meaningful analysis of publicly available cancer data should be encouraged. Future UK policy should support sustainable access to care for rural patients. Equal opportunities for research participation among rural patients should also be promoted. The SCPES should continue, and an additional question on overall support would be a useful addition.