Assessing the impact of rurality on oesophagogastric cancer survival in the North-East of Scotland- a prospective population cohort study |
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| Institution: | 1. Department of General Surgery, Aberdeen Royal Infirmary, United Kingdom;2. Centre of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom;3. Cancer Audit Team, NHS Grampain, United Kingdom;4. Health Services Research Unit, University of Aberdeen, United Kingdom;1. Department of Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar;2. Department of Surgery, Hamad Medical Corporation, Doha, Qatar;3. College of Medicine, Qatar University, Doha, Qatar;4. College of Medicine, University of Glasgow, Glasgow, UK;1. Department of Hepatobiliary and Transplant Surgery, St. Vincent''s University Hospital, Elm Park, Dublin 4, Ireland;2. Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland;3. Department of Pathology, St. Vincent''s University Hospital, Elm Park, Dublin, Ireland;1. Department of Orthopedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52064, Aachen, Germany;2. Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy;3. Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG London, England, UK;4. School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB Stoke on Trent, England, UK;5. Department of Orthopaedics and Trauma Surgery, University Medical Centre Mannheim of the University Heidelberg, 68167 Mannheim, Germany;1. Department of Surgery, The Chinese University of Hong Kong, Hong Kong;2. Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong;3. Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong |
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| Abstract: | IntroductionDespite advances in oncology therapies and surgical techniques, survival from oesophagogastric cancer remains low. Poorer cancer outcomes and survival for rural dwellers is documented worldwide and has been an area of focus in Scotland since 2007 when changes to suspected cancer national referral guidelines and governmental mandates on delivering remote and rural healthcare occurred. Whether these changes in clinical practice has impacted upon upper gastrointestinal cancer remains unclear.MethodsA prospective, single-centre observation study was performed. Data from the regional oesophagogastric cancer MDT between 2013 and 2019 were included. The Scottish Index of Multiple Deprivation 2020 tool provided a rurality code (1 or 2) based on patient postcode at time of referral. Survival outcomes for urban and rural patients were compared across demographic factors, disease factors and stage at presentation.ResultsA total of 1038 patients were included in this study. There was no significant difference between rural and urban groups in terms of sex of patient, age at diagnosis, cancer location, or tumour stage. Furthermore, no difference was identified between those commenced on a radical therapy with other treatment plans. Despite this, rurality predicted for an improved outcome on survival analysis (p = 0.012) and this was independent of other factors on multivariable analysis (HR = 0.78, 95%CI 0.66–0.98; p = 0.032).DiscussionThe difference in survival demonstrated here between urban and rural groups is not easily explained but may represent improvements to rural access to healthcare delivered as a result of Scottish Government reports. |
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| Keywords: | Oesophageal cancer Gastric cancer Oesophagogastric cancer Rurality |
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