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The distance that islanders need to travel for their cancer care could make a difference to their recovery, or even their survival, according to a study reported by the University of Aberdeen on Wednesday (21 February).

The study, titled ‘the impact of travel time to cancer treatment centre on post-diagnosis care and mortality among cancer patients in Scotland,’ was funded by NHS Grampian Charity and published in the journal Health & Place,

In it, researchers call for ‘better configuration of cancer services’ across Scotland, after finding that people from Orkney and Shetland can experience worse outcomes than those who live closer to the cancer treatment centre of Northeast Scotland.

A spokesperson for NHS Western Isles gave a cautious welcome to some of the findings of the study but said: “While we may have some things in common as island communities, it would be inaccurate to assume we have enough in common that the findings of the study might also apply to us.”

The Aberdeen study found that patients who lived remotely were more likely to die within the first year following an emergency cancer admission, receive different care and experience worse outcomes than those who live closer.

Professor Peter Murchie and research colleagues found that those living in Orkney and Shetland spent more time in hospital and attended fewer oncology outpatient appointments.

This was associated with a higher risk of death within a year of diagnosis compared to their mainland dwelling counterparts.  

In contrast, 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.  

The data also showed that when patients who lived remotely had an emergency cancer admission, they were more likely to die within the first year.   

Data from more than 17,000 cancer diagnosis patients was studied over ten years to 2017 to reach the results, with patients coming from NHS Grampian, NHS Orkney and NHS Shetland health board areas.

Researchers said: “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. “ 

And they spoke of ‘time toxicity’ for those patients with advanced disease and a higher travel burden. Professor Murchie said: “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.” 

NHS Shetland’s medical director is former Western Isles GP Dr Kirsty Brightwell. She commented on the research findings, saying: “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.”

That’s something with which Dr Brightwell’s former colleagues at NHS Western Isles agree. They told “The date range for the survey is pre-COVID and cancer care has since changed significantly. This means that some of the questions and issues that the survey is addressing may not be relevant to today's healthcare systems.

“The study bases 'contact time' on what appears to be face-to-face outpatients, (which is) old data as Near Me is commonly used now and plays a significant part.”

NHS Western Isles professionals also highlighted a range of other variables which would affect how applicable the study’s findings are to Western Isles patients.

They said: “The patient pathway for patients in the Western Isles is very different to that of patients in Orkney and Shetland, in terms of where patients are referred to for different cancer treatments.

“It is difficult to comment on the specific associations found with respect to travel time and secondary cancer care contacts in this study, without specific data on Western Isles, alongside other potential population factors that would be important to consider.

“It would be important also to assess whether the configuration of post-diagnostic cancer support in Orkney and Shetland is similar to that in the Western Isles particularly with respect to local provision. 

“Taking the example of the other islands' level of outpatient oncology time at regional centres, this will vary depending on whether each cancer type is outpatient-led and on the availability of locally provided post-diagnostic services such as chemotherapy (as takes place in the Western Isles).

“Indeed, the role of secondary care generally will vary according to cancer type, severity and symptoms experienced by individual patients, and so it is difficult to make broad associations with travel time across cancer types and stages. Establishing a causal link is complex and would require further study.

“NHS Western Isles takes a person-centred approach to support all individuals needing to travel to the mainland for specialist treatment.”

The issue of how geography affects cancer care is, nevertheless, of interest to health professionals in the Western Isles.  

The NHSWI spokesperson said: “Acknowledging that the Western Isles population was not included in this research, it is useful, albeit somewhat concerning, to have further intelligence on the challenge of remoteness and possible associations with health outcomes such as cancer survival.

“It is widely recognised that remoteness has an impact across a range of health outcomes, reflected in travel time being included within the Scottish Government's SIMD measure of deprivation (which is) used to assess health inequalities in Scotland and included as factor in this study.”

The pictures show chemotherapy in progress (Beatson West of Scotland Cancer Centre) and Dr Kirsty Brightwell, medical director of NHS Shetland, who says ‘a lot has changed’ since the study was completed (NHS Shetland).