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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