Research from the University of Aberdeen has revealed that people in Orkney and Shetland experience worse outcomes a year after their diagnosis of cancer than those who live closer to the cancer centre.

Alongside colleagues from NHS Grampian, Professor Peter Murchie, Clinical Chair in Academic Primary Care in Aberdeen and project lead, investigated the relationship between travel time to cancer centres with outpatient appointments, admissions and the patients’ one-year survival after diagnosis.

The Aberdeen team found that patients who lived in rural and remote areas were more likely to die within the first year following an emergency cancer admission.

An earlier study between 2012-2017 found that more than a third of cancer diagnoses were made after emergency care attendance in Scotland.

Funded by NHS Grampian Charity, the study calls for ‘better configuration of cancer services’ across Scotland to tackle disparities in cancer care.

Researchers found that patients who live further away from cancer centres are likely to receive different care and then experience worse outcomes than those who live closer.

This is despite patients from the north-east and the Northern Isles being referred and diagnosed just as quickly as those closer to cancer centres.

Dr Leslie Samuel, Consultant Oncologist in NHS Grampian and Honorary Clinical Senior Lecturer at the university, explained:

“We already know that there is a difference in outcomes between urban and rural patients in North East Scotland, one marked difference being the paradox that while rural patients, with longer travelling times, tend to get a diagnosis and start treatment more promptly, their one year survival rate tends to be poorer.  

“Research giving a better understanding of why these differences occur should enable the health service to not only review how cancer services are organised but also how this affects decisions patients make about treatment.

“In particular the ‘time toxicity’ for those patients with advanced disease and a higher travel burden.” 

The team found that those living in Orkney and Shetland spent more time in hospital and attended fewer oncology outpatient appointments – both of which are associated with a higher risk of death within a year.

Dr Melanie Turner, Advanced Research Fellow at the University of Aberdeen, analysed data collected from more than 17,000 patients from areas covered by NHS Grampian, NHS Orkney and NHS Shetland diagnosed with one of eight solid cancer types over ten years, from 2007-2017.

Dr Turner said future research will work to improve post-diagnosis cancer treatment and care:

“The aim of this and future research is to ensure that decisions on cancer treatment and care following diagnosis are not based on difficulties in accessing healthcare facilities due to a high travel burden for patients.”

The team are now working to establish whether there is a difference in the treatment choices made by people living in Shetland or Orkney. 

Responding to the study, Dr Kirsty Brightwell, NHS Shetland Medical Director said:

“NHS Shetland welcomes any research that shines a light on the issues for our population. This study looks at data from 2007-2017 and a lot has changed since then, not least of all the changes put in place during the pandemic.  

“We continue to work closely with colleagues in NHS Grampian to improve services and deliver as much as we can as close to people’s homes as possible whilst maintaining the quality of their experience and outcomes.” 

Public Health Scotland has reported that fewer cancer cases were spotted during the pandemic and more diagnoses were made at advanced stages of cancers, negatively impacting outcomes across Scotland.

However, longer travelling times or living on an island did not increase the likelihood of emergency admission for cancer or affect the length of time to first emergency cancer admission. 

Patients on the mainland who had longer travelling times also spent more time in hospital but had more oncology outpatient appointments, and in their case, there was no increased risk of death within a year of diagnosis.

Further analysis of factors that may influence survival found that it cannot be explained by age, type of treatment, socioeconomic status, non-cancer related co-morbidities or metastatic cancer.

Dr Louise Wilson, Director of Public Health at NHS Orkney, said:

“Our cancer care is delivered in partnership with the specialists in NHS Grampian and supporting patients to make the best treatment choice for their situation is important.

“More therapies are becoming available locally and we will work with NHS Grampian to get the best possible outcomes for our patients.” 

Project lead Professor Murchie added:

“It is essential that we continue to ensure equitable cancer care across all of Scotland’s geography. This research is a good step forward in beginning to unpick the complex mechanisms underlying poorer outcomes for our rural cancer patients.”

Read more: Making cervical cancer a ‘rare disease'; All cancer patients to access extra support by 2024; Biomarkers can improve melanoma patient care; ‘Weaknesses' found in Scotland's cervical screening; Microwaves offer less invasive cervical cancer therapy; Pandemic impact on cancer incidence in Scotland

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