Comparing Pathways to Diagnosis and Treatment for Rural and Urban Patients With Colorectal or Breast Cancer: A Qualitative Study

Colorectal cancer patients living in rural areas have poorer outcomes than their urban counterparts, but such disparities are not found for breast cancer. Few studies have examined patient experiences to understand how and why delays may occur. Through 43 semi-structured interviews with colorectal and breast cancer patients, this study compared rural and urban patient experiences of pathways to colorectal or breast cancer diagnosis and treatment in Victoria, Australia. Rural and urban patients showed similar attitudes and reasons for lengthy symptom appraisal and delay in help-seeking. However, some rural patients reported long waiting times to see a Primary Care Practitioner (PCP) and perceived greater barrier to access diagnostic services. Furthermore, patient perceptions of the urgency of the PCP referral could impact their behavior, such as waiting longer to book appointments. More so, waiting time for colonoscopies could be long, but mammograms were quickly arranged. Colorectal cancer patients also reported more varying symptoms,  diverse presentation routes and reduced sense of urgency. These findings demonstrate that pathway to diagnosis differed more between colorectal cancer and breast cancer patients, than between rural and urban patients. Having said so, future research should investigate the impact of diagnostic service accessibility on PCP referral behavior to further understand rural-urban disparities.

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