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…
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 ( )
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.