Geographic variations in access to cancer services and outcomes along the cancer care pathway

Murage, Peninah (2017) Geographic variations in access to cancer services and outcomes along the cancer care pathway. Doctoral thesis, University of East Anglia.

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    The poorer cancer survival in England in comparison to countries of comparable wealth may
    be explained by variations in diagnostic and treatment practices, and in disease stage. This
    highlights the importance of General Practitioners (GPs) in facilitating earlier diagnosis and
    access to secondary care. Poor access to secondary care has been associated with poorer cancer
    outcomes. As GPs are the first point of contact with health services for most patients, it is
    possible that some problems associated with access in secondary care originate from poor GP
    access. Despite this, there is little evidence describing the relationship between access to GPs
    and cancer outcomes. This research examines the association between geographical
    accessibility and cancer outcomes along the cancer care pathway, with a focus on access to the
    The research begins by reviewing policies on improving access to cancer services, and finds
    some trade-offs that result when meeting contrasting policy goals. For example, centralisation
    may improve efficiencies, but may increase inequities in access. One study found that cancer
    services in England may not be located according to need, but are more likely to be
    concentrated in urban areas where incidence rates are lower. The other studies examine how
    geographical access associates with outcomes related to primary care, secondary care and the
    interface between these two. These studies found that longer travel to primary care has an
    opposite association on outcomes in rural compared to urban areas, and, has important
    implications on the mode of cancer diagnosis in secondary care. Additionally, longer travel to
    both primary and secondary care, and living in an urban area is associated with worse survival,
    furthermore, times delays and disease stage may be important mediators for these associations.
    This research generates original evidence showing that geographical access to primary care for
    diagnosis may have important consequences for cancer outcomes. The findings suggests that
    rural areas may not necessarily experience poorer outcomes, warranting future research on
    access issues amongst patients living in urban areas.

    Item Type: Thesis (Doctoral)
    Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
    Depositing User: Stacey Armes
    Date Deposited: 23 Mar 2018 16:17
    Last Modified: 23 Mar 2018 16:17

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