Editor—Smith describes “disproportionate time and energy” being spent in “a battle over surgical services” in Dumfries and Galloway.1
In our rural practice of 2700 patients 32 cases of cancer were identified over 2.5 years. When travel to local services was excluded the 32 patients travelled on average 1479 km—over 20 hours by private car. Eleven died of their disease over that period and travelled an average of 1880 km, taking nearly 30 hours. No one chose ambulance transport, but six had to rely on it as their sole method of transport and three used a mixture of ambulance transport and private car. One 84 year old patient who was receiving radiotherapy described a 7.5 hour one way journey by the patient transport service from Edinburgh to Stranraer. Even by car this would have taken over three hours.
Patients who died survived an average 165 days, of which 22 days (13% of their remaining life) was spent travelling to or in remote (by rural perspective) hospitals.
One third of Scotland is regarded as rural. Proposed centralisation of cancer services2 places an extra burden on patients already frail from cancer or the effects of treatment. Will they benefit? Extrapolating our figures to the Wigtownshire district suggests that 482 800 km of patient travel occurs a year and 5800 inpatient days are spent in a cancer hospital more than three hours' travel from home. Four people from Stranraer have been killed in traffic accidents while visiting relatives in the past 15 years.
Solutions include developing and improving use of community resources; better personal communication and cooperation between specialists and general practitioners; block clinic bookings, allowing transport to be shared; and mobile facilities for imaging, investigations, or treatment. Patients travelled to Edinburgh rather than Glasgow for treatment (an extra 113 km) for reasons that did not seem to be patient centred. Telemedicine seems to have made little impact on travelling.3
Rural patients suffer the financial penalty of having to travel large distances. This is compounded by social and emotional deprivation caused by separation from home and friends. They have to balance spending 13% of their remaining life in a distant and lonely hospital against benefit from unpleasant and painful treatment. Visitors find the travel expensive and inconvenient.
Where cancer services are provided locally the uptake of treatment increases.4 If equity of access is important5 then where such barriers to treatment exist and services are made less, not more accessible, we have to strain to be optimistic.
References
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