Poor access to general practitioners (GPs) may discourage early engagement with health services, resulting in an increased likelihood of emergency cancer presentations, according to research published in Family Practice.
The study by the University of East Anglia and the National Cancer Registration and Analysis Services used cancer registry data and hospital records of patients with a cancer diagnosis between 2006 and 2010 across 8 different cancer sites. Primary outcomes were defined as desirable routes to diagnosis (screen-detected and 2-week wait [TWW] referrals) and less desirable routes (emergency presentations and death certificate only [DCO]). Geographical access was measured as travel time in minutes from patients to their GPs.
Longer travel was associated with increased risk of diagnosis via emergency and DCO, but decreased risk of diagnosis via screening and TWW. Patients travelling more than 30 minutes had the highest risk of DCO diagnosis. The association was statistically significant for breast (relative risk ratio [RRR], 5.89; 95% CI, 3.45-10.05; P<.01), colorectal (RRR, 7.02; 95% CI, 4.33-11.37; P<.01), lung (RRR, 2.30; 95% CI, 1.28-4.11; P<.01), prostate (RRR, 4.75; 95% CI, 2.27-9.92; P<.01), stomach (RRR, 10.41; 95% CI, 4.29-25.26; P<.01) and ovarian (RRR, 3.51; 95% CI, 1.06-11.62; P=.04).
The authors say extra effort is needed to promote early diagnosis in more distant patients.
“Prolonged disengagement with primary care compounded by poor accessibility reduces the likelihood of seeking health care or of reporting symptoms that may be related to cancer. Although only 0.7 per cent of our sample travelled longer than 30 minutes to see their GP, the poor outcomes amongst these patients are concerning. The magnitude of apparent effect for risk of diagnosis at death is particularly alarming,” they say.
