Provision of oncology services in remote rural areas: a Scottish perspective

Abstract

There is a paucity of research into rural health care services. In particular little is known about the provision of specialist cancer services for patients who live in remote rural areas of the UK. This study set out to investigate current models of medical and clinical oncology care in Scotland. A national survey with key health professionals was conducted to identify rural oncology schemes currently in operation. Detailed quantitative data about the schemes together with qualitative data on how health professionals view current models of care were collected by a computer-assisted telephone survey. Schemes that currently provide outpatient and chemotherapy oncology services for remote rural patients fell into three categories: central clinics (5); shared care outreach clinics with chemotherapy provision (11); and shared care outreach clinics without chemotherapy provision (7). All radiotherapy was conducted at central clinics (5). Widely varying practices in delivery of cancer care were found across the country. The main issues for professionals about current models of care involved expertise, travelling and accessibility (for patients), communication and expansion of the rural service. Nation-wide consistency in cancer care has still to be achieved. Travelling for treatment was seen to take its toll on all patients but particularly for the very remote, elderly and poor. Most professionals believe that an expansion of rural services would be of benefit to these patients. It is clear, however, that the proper infrastructure needs to be in place in terms of local expertise, ensured quality of care, and good communication links with cancer centres before this could happen.

A Literature Review of the Use of GIS-Based Measures of Access to Health Care Services

“…The increased public scrutiny of issues surrounding rural health as a result of, for example, the foot and mouth crisis in the UK in 2001 has also drawn attention to the impacts of (the lack of) access to health services in such contexts and the potential consequences for health outcomes (e.g., in relation to access to mental health services; [77]). Similar concerns have been expressed with regard to the provision of oncology services in remote rural areas (e.g., [88]). …”

Do cancer patients benefit from short-term contact with a general practitioner following cancer treatment? A randomised, controlled study

“…The number of excluded or, for other reasons, not included patients was high in this survey and left us with a group of patients who mostly were cured or had stable disease and thus may have had little need for increased GP attention at the time of inclusion. Finally, rural GPs in Norway are known to participate in cancer followup to a greater extent than their colleagues in this study who practice in the vicinity of a university hospital [1,11]. The high number of exclusions led to a loss of statistical power, but this may not have been important as differences were negligible.…”

Reply: Cancer care in rural areas

“…The abilities of Colomer et al to reach agreements between three centres and community hospitals are to be commended particularly in light of the polarised views that we reported (despite taking care not to exclude combinations of local and central delivery of chemotherapy in the wordings we used and by further qualitative analysis of opinions expressed during interviews). In Scotland, the divergent views of practitioners caring for patients with cancer are mirrored by those of patients (Bain et al, 2002), and appear to be responsible for substantial variations in provision even within rural locations (Smith and Campbell, 2004). This variation in practice stems from a real lack of evidence about the risks, benefits and costs of local chemotherapy provision, as well as uncertainty about how to balance uncommon but potentially serious risks against less easily measured effects on quality of life.…”