The first nationwide study comparing urban and rural rates of receiving radiotherapy treatment for three major cancers highlighted significant locality and equity differences.
Led by the University of Otago – Ōtākou Whakaihu Waka, the study compared rates of rural Māori and non-Māori New Zealanders who received radiotherapy for breast, prostate and lung cancers, with their urban counterparts.
Dr Stephen Withington
Lead author Dr Stephen Withington, of Otago's Centre for Rural Health, says cancer is the leading cause of death in Aotearoa New Zealand, but accessing radiation therapy is a challenge for rural cancer patients.
"One third of people with cancer in New Zealand are treated with radiation, but radiation therapy centres and specialist oncology services are generally located in major urban centres, which adds the burden of travel and being treated away from whānau onto patients," he says.
Published in the Journal of Medical Imaging and Radiation Oncology, the study used the national database for radiotherapy, linked with the new Geographical Classification for Health, which Dr Withington says is a much better measure of rurality than was previously available.
"We found groups of people living at greater distance from radiation therapy centres who are receiving radiotherapy at lower rates than their urban counterparts."
Rates of receiving radiotherapy were lower for women with breast cancer aged over 75 living in small towns and for rural non-Māori women aged 45 to 64. Rural Māori aged 75 and over with lung cancer also received curative radiotherapy at a rate 66 per cent lower than their urban counterparts.
Surprisingly, some rural New Zealanders received radiotherapy at higher rates than their urban peers including rural men with prostate cancer (47 per cent higher) and rural men and women with lung cancer (both about 90 per cent higher).
"This may represent personal choice in the case of prostate cancer, or greater need from higher incidence of cancer and later diagnosis in the case of lung cancer, but more research is required," Dr Withington says.
The research also emphasised marked differences in receipt of radiotherapy for all three cancers between Māori and non-Māori within the same geographical zones.
"For lung cancer, for example, in almost every age group, for both males and females, and in every geographic region, Māori rates of radiotherapy for lung cancer were higher than non-Māori. This is in part attributable to known higher rates of lung cancer for Māori, but whether these increased rates fully match need is uncertain.
"By contrast, rates of receipt of radiotherapy for Māori women aged under 45 with breast cancer were lower than their non-Māori counterparts in the same geographical zone and age group, and this was especially true in the most remote areas where rates were 50 per cent lower."
What's more, lower radiotherapy rates in breast cancer generally correlate with higher rates of total mastectomy as opposed to breast conserving surgery which is generally accompanied by radiotherapy.
"This suggests that fewer rural women and fewer younger Māori women with breast cancer are having breast conserving surgery than their urban counterparts."
Dr Withington says practical measures which may help decrease gaps in access include improved, feedback-responsive provision of transport and accommodation; good communication with local teams; and engagement with communities to better understand patient social and cultural needs.
Technical initiatives, including appropriate use of hypofractionation and simulation-free radiation therapy, may also improve access for those living at a distance from main centre radiation oncology services.
"We need targeted strategies to reduce inequities between ethnicities. This includes policies to identify and mitigate gaps in access to diagnostic and treatment services for Māori and other groups that experience inequities, cultural safety programmes to address potential biases in the system and from providers, and increasing the Māori workforce in radiation therapy and other cancer services."
Rural Urban Differences in Receipt of Radiation Oncology Services for Breast, Prostate and Lung Cancer by Ethnicity in Aotearoa New Zealand
Stephen Withington, Gabrielle Davie, Sue Crengle, Melissa James, Benjamin Booker, Brandon de Graaf, Rory Miller, Ross Lawrenson, Garry Nixon
Journal of Medical Imaging and Radiation Oncology
https://onlinelibrary.wiley.com/doi/10.1111/1754-9485.70049
