Does Patients' Place of Residence Affect the Type of Physician Performing Primary Excision of Cutaneous Melanoma in Northern Scotland? : Melanoma Excision in Northern Scotland

The aim was to examine the effect of geographical access to treatment services on cancer treatment patterns. Records for patients in northern England with breast, colon, rectal, lung, ovary and prostate tumours were augmented with estimates of travel time to the nearest hospital providing surgery, chemotherapy or radiotherapy. Using logistic regression to adjust for age, sex, tumour stage, selected tumour pathology characteristics and deprivation of place of residence, the likelihood of receiving radiotherapy was reduced for all sites studied with increasing travel time to the nearest radiotherapy hospital. Lung cancer patients living further from a thoracic surgery hospital were less likely to receive surgery, and both lung cancer and rectal cancer patients were less likely to receive chemotherapy if they lived distant from these services. Services provided in only a few specialised centres, involving longer than average patient journeys, all showed an inverse association between travel time and treatment take-up.

In this survival study 63 976 patients diagnosed with one of six common cancers in Scotland were followed up. Increasing distance from a cancer centre was associated with less chance of diagnosis before death for stomach, breast and colorectal cancers and poorer survival after diagnosis for prostate and lung cancers. © 2000 Cancer Research Campaign