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Title: Geographic variations in access to cancer services and outcomes along the cancer care pathway
Author: Murage, Peninah
ISNI:       0000 0004 7231 8552
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2017
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The poorer cancer survival in England in comparison to countries of comparable wealth may be explained by variations in diagnostic and treatment practices, and in disease stage. This highlights the importance of General Practitioners (GPs) in facilitating earlier diagnosis and access to secondary care. Poor access to secondary care has been associated with poorer cancer outcomes. As GPs are the first point of contact with health services for most patients, it is possible that some problems associated with access in secondary care originate from poor GP access. Despite this, there is little evidence describing the relationship between access to GPs and cancer outcomes. This research examines the association between geographical accessibility and cancer outcomes along the cancer care pathway, with a focus on access to the GP. The research begins by reviewing policies on improving access to cancer services, and finds some trade-offs that result when meeting contrasting policy goals. For example, centralisation may improve efficiencies, but may increase inequities in access. One study found that cancer services in England may not be located according to need, but are more likely to be concentrated in urban areas where incidence rates are lower. The other studies examine how geographical access associates with outcomes related to primary care, secondary care and the interface between these two. These studies found that longer travel to primary care has an opposite association on outcomes in rural compared to urban areas, and, has important implications on the mode of cancer diagnosis in secondary care. Additionally, longer travel to both primary and secondary care, and living in an urban area is associated with worse survival, furthermore, times delays and disease stage may be important mediators for these associations. This research generates original evidence showing that geographical access to primary care for diagnosis may have important consequences for cancer outcomes. The findings suggests that rural areas may not necessarily experience poorer outcomes, warranting future research on access issues amongst patients living in urban areas.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available