Rural patients shying away from best cancer care

People who live in the rural areas of Scotland may be putting their lives at risk by being too hesitant in approaching or returning to their doctors with symptoms of bowel cancer – according to research published this week by Cancer Research UK.

The new study – a collaboration between the charity and the Scottish Executive Department of Health – compared the views and behaviour of Scottish patients from the city and the countryside.

It showed that rural patients are reluctant to go or return to their GP and are less confident about demanding the quickest treatment than most of their more persistent urban counterparts.

While city patients were more likely to push for faster treatment after referral, rural patients were often less demanding. The charity’s experts believe this may contribute to the lower survival rates from bowel cancer among patients in the countryside¹.

Researchers questioned 95 patients and relatives of patients with the disease in the North, North East and Northern Isles of Scotland. They found that in general, delays in diagnosis and treatment were a major concern for both urban and rural patients.

Delays in approaching their doctor were more common in the rural patients questioned, who live in a very self-reliant way and seem not to like to be a “burden”.

One rural patient was reported as saying “I feel I have had this for about two years but, you know how it is, you don’t like to bother the doctors.”

This reluctance to be pro-active in seeking cancer care is very different to some of the attitudes of urban patients in the same situation. Dr Neil Campbell, a Cancer Research UK Fellow of Oncology, says of his findings: “Some city-dwellers did all they could to speed their progress through the system, probably because they are experienced at fighting to the front of the queue and are intolerant of delays.”

One urban patient said “Because my wife agitated and agitated I got in [for treatment] a month earlier.”

Dr Campbell adds: “It is quite alarming to see how hesitant some rural Scottish patients are in approaching their doctors when they have symptoms of bowel cancer. They seem to go to their doctor later and pursue their care less tenaciously than those who live in urban areas, which would go someway to explaining the poorer survival rates for some forms of cancer in rural patients in Scotland and elsewhere.*

“Add to this the difficulties they face in travelling for treatment and it is perhaps not surprising that where bowel cancer is concerned they come out worse.”

Former research carried out by Dr Campbell also demonstrated 52% of urban bowel cancer patients were in the early stages of the disease when they first approached their doctor compared with 39% of rural patients, showing again that they are more likely to approach their doctor earlier.²

This is important because late presentation is partially to blame for those in rural areas having more advanced disease, and therefore less chance of survival when they eventually do go to their doctors.

Lesley Walker, Director of Cancer Information at Cancer Research UK, says: “We have seen a decrease in the number of deaths from bowel cancer in Scotland over the last ten years, in part due to patients being more aware of symptoms and going to see their doctor earlier, but also due to improved treatments. This along with Dr Campbell’s research highlights the importance of being pushy when it comes to seeing your doctor.”

ENDS

1. ‘Rural factors and survival from cancer: analysis of Scottish cancer registrations’.
2. ‘Rural and urban differences in stage at diagnosis of colorectal and lung cancers’.

Note to Editors:

Bowel cancer is the third most common cancer in Scotland and patients’ chances of survival vary depending upon where they live.

The symptoms of bowel cancer include changes in bowel habit (new diarrhoea and/or constipation), rectal bleeding, passage of mucus and abdominal pain.

The difficulty (for patients and doctors) is that these symptoms are common and often caused by things other than bowel cancer, but they should be investigated if they persist for 4 weeks or more.

Socio-economically deprived and outlying patients have poorer survival and poverty is greater in rural areas than in the rest of Britain as a whole, so rural patients suffer on both counts.

In 1998 there were 3,362 cases of bowel cancer and 1,596 deaths in Scotland. The number of cases of bowel cancer in Scotland has risen by almost 10% in the last 3 years (1995-98) but thanks to better diagnosis and treatment the number of deaths has come down by 9%.