Medical papers published or on-line should legally be obliged to reveal which journals refused publication..

An interesting headline in the Times ( and in NetDoctor ) says “Want to beat cancer? Move to the country and get to know your GP”. Most of the papers covered this but the research is questionable to say the least. The numbers are small, so the power is low, and the confounding factors of social class and education probably account for the observed differences. Was the paper presented to the BMJ or the Lancet before the Journal of the RCGP? Legislation is needed to make explicit who has rejected any paper. It may be that the right conclusion is the one drawn by the media, but there is no real evidence to support this. Training GPs in rural areas is good for their independence and broad based clinical skills. More of this training, rather than less please…

Image result for health rurality cartoon

The paper: Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care by Peninah Murage, Peter Murchie, Max Bachmann, Michael Crawford and Andy Jones ()

Chris Smyth in The Times reports: Rural patients less likely to die from cancer under the headline “Want to beat cancer? Move to the country and get to know your GP”.

Move to the countryside if you want to beat cancer | Daily Mail Online

Jenny Cook of NetDoctor reports: How living in the countryside could reduce your risk of dying from cancer – According to a couple of studies

Abstract of  Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer in the JRCGP

Background Several studies have reported a survival disadvantage for rural dwellers who develop colorectal cancer, but the underlying mechanisms remain obscure. Delayed presentation to GPs may be a contributory factor, but evidence is lacking.

Aim To examine the association between rurality and travel time on diagnosis and survival of colorectal cancer in a cohort from northeast Scotland.

Design and setting The authors used a database linking GP records to routine data for patients diagnosed between 1997 and 1998, and followed up to 2011.

Method Primary outcomes were alarm symptoms, emergency admissions, stage, and survival. Travel time in minutes from patients to GP was estimated. Logistic and Cox regression were used to model outcomes. Interaction terms were used to determine if travelling time impacted differently on urban versus rural patients.

Results Rural patients and patients travelling farther to the GP had better 3-year survival. When the travel outcome associations were explored using interaction terms, the associations differed between rural and urban areas. Longer travel in urban areas significantly reduced the odds of emergency admissions (odds ratio [OR] 0.62, P<0.05), and increased survival (hazard ratio 0.75, P<0.05). Longer travel also increased the odds of presenting with alarm symptoms in urban areas; this was nearly significant (OR 1.34, P = 0.06). Presence of alarm symptoms reduced the likelihood of emergency admissions (OR 0.36, P<0.01).

Conclusion Living in a rural area, and travelling farther to a GP in urban areas, may reduce the likelihood of emergency admissions and poor survival. This may be related to how patients present with alarm symptoms.

Image result for health rurality cartoon

This entry was posted in A Personal View, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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