Geographical access to GPs and modes of cancer diagnosis in England

This cross-sectional study investigated the extent to which access to GPs determines the route that patients take to obtain a cancer diagnosis. A linked dataset of cancer registry and hospital records of patients with a diagnosis between 2006 and 2010 was used. Routes to diagnosis such as screen-detected and 2-week wait (TWW) referrals were defined as ‘desirable routes’, where as emergency presentations and death certificate only (DCO) were defined as ‘less desirable routes’. All other routes (GP referral, inpatient elective and other outpatient) were specified as the reference category. Longer travel was associated with increased risk of diagnosis via emergency and DCO, but decreased risk of diagnosis via screening and TWW. Patients travelling over 30 minutes had the highest risk of a DCO diagnosis, compared with patients with travel times ≤10 minutes. These results show that poor access to GPs may deter early engagement with health services, decreasing the likelihood of screening uptake and increasing the likelihood of emergency presentations. Future work should involve targeted campaigns for these at-risk groups.

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