Abstract
Background: In Scotland 17% of the population reside rurally and previous research has demonstrated worse cancer outcomes in this group. The underlying reason for this is unclear. This study aims to determine whether patient presenting factors, GP consultation factors or the diagnostic pathways
differ between urban and rural patients within Scotland.
Methods: This study combined two Scottish National Cancer Diagnosis Audits. Participating GPs collected data on the diagnostic pathway from primary to secondary care for cancer patients diagnosed during the audit period. Using the Scottish Government Urban Rural Classification, patients were designated as rural or urban dwellers and compared in descriptive analyses. Key cancer intervals (primary, diagnostic, secondary and treatment interval) were compared between urban and rural dwellers with an additional adjusted analysis for the main cancer sites.
Results: A total of 4309 cancer diagnoses were included in the study; 22% were in patients from rural locations. Rural patients had significantly more consultations and investigations prior to referral than
their urban counterparts. There was no difference in prolonged cancer pathways between the two
groups except in lung cancer patients where rural patients had a significantly increased odds of a
diagnostic interval of >90 days.
Conclusion: Our findings suggest differences in the interaction between patients and GPs prior to
referral in urban and rural settings. However, this does not appear to lead to prolonged patient
pathways, except in lung cancer. Further research is needed to determine whether this delay is
clinically significant and contributing to poorer outcomes in Scottish rural dwellers with lung cancer.
differ between urban and rural patients within Scotland.
Methods: This study combined two Scottish National Cancer Diagnosis Audits. Participating GPs collected data on the diagnostic pathway from primary to secondary care for cancer patients diagnosed during the audit period. Using the Scottish Government Urban Rural Classification, patients were designated as rural or urban dwellers and compared in descriptive analyses. Key cancer intervals (primary, diagnostic, secondary and treatment interval) were compared between urban and rural dwellers with an additional adjusted analysis for the main cancer sites.
Results: A total of 4309 cancer diagnoses were included in the study; 22% were in patients from rural locations. Rural patients had significantly more consultations and investigations prior to referral than
their urban counterparts. There was no difference in prolonged cancer pathways between the two
groups except in lung cancer patients where rural patients had a significantly increased odds of a
diagnostic interval of >90 days.
Conclusion: Our findings suggest differences in the interaction between patients and GPs prior to
referral in urban and rural settings. However, this does not appear to lead to prolonged patient
pathways, except in lung cancer. Further research is needed to determine whether this delay is
clinically significant and contributing to poorer outcomes in Scottish rural dwellers with lung cancer.
| Original language | English |
|---|---|
| Article number | 102414 |
| Number of pages | 9 |
| Journal | Cancer Epidemiology |
| Volume | 86 |
| Early online date | 25 Jul 2023 |
| DOIs | |
| Publication status | Published - 1 Oct 2023 |
Bibliographical note
FUNDINGThe National Cancer Diagnosis Audit (NCDA) in Scotland received enabling support from Cancer Research UK and the Scottish Government.
ACKNOWLEDGEMENTS
This audit used data provided by patients and collected by NHS as part of their care and support. The authors would like to thank all GPs and health professionals who participated in the NCDA in Scotland, the members of the NCDA Steering Group, as well as contributing staff at Cancer Research UK; Information Services Division (NHS Scotland); National Centre for Sustainable Delivery; the Royal College of General Practitioners; and Macmillan Cancer Support.
Data Availability Statement
In full compliance with all regulatory and legal requirements data were stored, accessed and analysed within the National Data Safe Haven maintained by NHS National Services Scotland. Outputs were subject to disclosure checks by members of the Electronic Data Research and Innovation (eDRIS) team of the Information and Statistics Division, Scotland prior to release to the research team for inclusion in this manuscript.Keywords
- cancer
- clinical audit
- diagnosis
- delay
- primary care
- Rurality
Access to Document
- Maxwell_etal_CE_The_Impact_of_Rurality_VOR
/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).