Access to specialist cancer care: is it equitable?

Abstract

The first principle of the Calman -Hine report's recommendations on cancer services was that all patients should have access to a uniformly high quality of care wherever they may live. This study aimed to assess whether the uptake of chemotherapy for colorectal cancer varied by hospital type in Scotland. Hospitals were classified according to cancer specialisation rather than volume of patients. To indicate cancer specialisation, hospitals were classified as 'cancer centres', 'cancer units' and 'noncancer' hospitals. Colorectal cancer cases were obtained from cancer registrations linked to hospital discharge data for the period January 1992 to December 1996. Multilevel logistic regression was used to model the binary outcome, namely whether or not a patient received chemotherapy within 6 months of first admission to any hospital. The results showed that patients admitted first to a 'non-cancer' hospital were less than half as likely to go on to receive chemotherapy as those first admitted to a cancer unit or centre (OR=0.28). This result was not explained by distance between hospital of first admission and nearest cancer centre, nor by increasing age or severity of illness. The study covers the period immediately preceding the introduction of the Calman -Hine report in Scotland and should serve as a baseline for future monitoring of access to specialist care.

Inequity in colorectal cancer treatment and outcomes: a population-based study

“…Our frequency of 78% undergoing resection was lower than that in US studies (90 -92%; Ciccolallo et al, 2005) but close to figures for European community practice (Gatta et al, 2000;Pitchforth et al, 2002). The differences may be partly a result of variations in stage distribution between populations, but are more likely to be due to lack of consensus regarding resection of the primary tumour in stage IV patients (Rosen et al, 2000;Sarela et al, 2001;Ruo et al, 2003).…”

“…Two small studies have reported poorer outcomes in smokers following colorectal cancer surgery (Jadallah et al, 1999;Munro et al, 2006). Although the result could be due to confounding by another prognostic factor such as deprivation (Bouchardy et al, 2001;Pitchforth et al, 2002;Wrigley et al, 2003), there are several potential mechanisms by which smoking might adversely affect survival. These include effects on immune function (O'Byrne et al, 2000), inflammatory response (Yanbaeva et al, 2007), metabolism of chemotherapy drugs (van der Bol et al, 2007), and genetic damage and repair capacity (Fracasso et al, 2006).…”

Spatial Analyses Identify the Geographic Source of Patients at a National Cancer Institute Comprehensive Cancer Center

“…Care may be ambulatory care sensitive (15,30), for detection and treatment, as uptake of chemo is greater when in-area and a "cancer hospital" (35). Women less likely to travel (31).…”

Patterns of Colorectal Cancer Care in Europe, Australia, and New Zealand

“…Chemotherapy receipt was less likely among both women and patients with lower socioeconomic status in one study (61). Several studies also highlighted variation in chemotherapy rates by hospital setting (eg, general vs university; private vs public), hospital volume, and emergency room admissions (29,40,54,61,68,77).…”