People who live in the country are less likely to survive cancer

Bad for your health, this. Image: Getty.

It is easy to romanticise about escaping to the country, with its clean air, green space, and idyllic views. But our latest research, a review of 39 studies from around the world, suggests the need for a bit of an adjustment: it turns out that people living in rural locations are less likely to survive cancer.

We previously found that people in the northeast of Scotland who live more than an hour away from a cancer treatment centre are more likely to die within the first year after their diagnosis. We were interested in whether studies from other parts of the world also found differences between urban and rural cancer survival. We also wanted to understand reasons why people living rurally might be disadvantaged.

We examined studies that observed people with cancer over time. The studies calculated the risk of a person dying from cancer depending on whether they lived in urban or rural locations. One of the things that can complicate research comparing urban and rural living is that pockets of poverty can exist geographically, and poverty negatively affects cancer survival. For this reason, we only included studies that accounted for deprivation levels.

The 39 relevant studies that we found were all from developed countries, mostly the US, Canada, the UK and Australia/New Zealand. They covered a large variety of different cancer types and involved more than 2m people. Thirty of these studies found a clear survival disadvantage for rural people compared to their urban counterparts.

We wanted to find out exactly how much of a disadvantage rural patients had and we were able to aggregate the results of 11 of the studies. This led us to conclude that rural people are 5 per cent less likely to survive cancer than those living in urban areas.

Understanding why

The authors of the original studies suggested reasons why people living rurally might do worse after a cancer diagnosis. It is possible that they behave differently to city dwellers. They might be more likely to smoke or consume more alcohol, for example. It is also possible that rural people are more stoical, and might put off seeking help for symptoms.

The transport situation. Image: Sam Burriss/creative commons.

Access to services is also likely to be important. Most developed countries centralise their specialist cancer services within major cities, and this could potentially lead to disadvantages for rural people.

Some studies suggest that patients who live far away from specialist centres might be treated differently – not receiving radiotherapy, for example. Travel burden, transport infrastructure, and the way that cancer services are organised are important considerations. It might be, for example, that people in rural areas are more likely to avoid long journeys to city hospitals for treatments that will only make small improvements to their life expectancy.


Whatever the case, more research is needed to determine exactly which factors are at play, and which are the most important. Equally, it raises questions about survival rates for other illnesses in people living in the countryside.

There are many advantages to living in rural areas, and we are certainly not suggesting that everyone should move to the city. The big question is what we could do to improve cancer outcomes in people who live far away from cancer centres. Recognising that there is a problem is a good starting point, and research to build a deeper understanding of the problem could be coupled with innovative strategies to reduce rural cancer inequality.

One area of promise is digital/communications technology, such as getting people to communicate with clinicians via the internet. Possibilities would include everything from more automated appointment reminders to apps that help people to examine themselves online. On the whole, however, we need to better understand the problem better before we start proposing solutions. Having established that there is a definite disadvantage to living in the countryside if you have cancer, we now need to get to the bottom of it.

The Conversation

Rosalind Adam, Clinical Lecturer, University of Aberdeen; Peter Murchie, Professor of Primary Care, University of Aberdeen, and Romi Carriere, Doctoral Researcher, Epidemiology, University of Aberdeen.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 
 
 
 

“You don’t look like a train buff”: on sexism in the trainspotting community

A female guard on London’s former Metropolitan Railway. Image: Getty.

I am a railway enthusiast. I like looking at trains, I like travelling by train and I like the quirks of the vast number of different train units, transit maps and train operating companies.

I get goosebumps standing on a platform watching my train approach, eyeballing the names of the destinations on the dot matrix display over and over again, straining to hear the tinny departure announcements on the tannoy.  I’m fortunate enough to work on the site of a former railway station that not only houses beautiful old goods sheds, but still has an active railway line running alongside it. You can imagine my colleagues’ elation as I exclaim: “Wow! Look at that one!” for the sixth time that day, as another brilliantly gaudy freight train trundles past.

I am also a woman in my twenties. A few weeks my request to join a railway-related Facebook group was declined because I – and I quote here – “don’t look like a train buff”.

After posting about this exchange on Twitter, my outrage was widely shared. “They should be thrilled to have you!” said one. “What does a train buff look like?!” many others asked.

The answer, of course, is a middle-aged white man with an anorak and notebook. Supposedly, anyway. That’s the ancient stereotype of a “trainspotter”, which sadly shows no sign of waning.

I’m not alone in feeling marginalised in the railway community. Sarah, a railway enthusiast from Bournemouth, says she is used to funny looks when she tells people that she is not only into trains, but an engineer.

She speaks of her annoyance at seeing a poster bearing the phrase: “Beware Rail Enthusiasts Disease: Highly Infectious To Males Of All Ages”. “That did bug me,” she says, “because women can enjoy trains just as much as men.”


Vicki Pipe is best known as being one half of the YouTube sensation All The Stations, which saw her and her partner Geoff Marshall spend 2017 visiting every railway station in Great Britain.

“During our 2017 adventure I was often asked ‘How did your boyfriend persuade you to come along?’” she says. “I think some found it unusual that a woman might be independently interested or excited enough about the railways to spend sixteen weeks travelling to every station on the network.”

Pipe, who earlier this year travelled to all the stations in Ireland and Northern Ireland, is passionate about changing the way in which people think of the railways, including the perception of women in the industry.

“For me it’s the people that make the railways such an exciting place to explore – and many of these are women,” she explains. “Women have historically and continue to play an important part in the railway industry – throughout our journey we met female train drivers, conductors, station staff, signallers and engineers. I feel it is important that more female voices are heard so that women of the future recognise the railways as a place they too can be part of.”

Despite the progress being made, it’s clear there is still a long way to go in challenging stereotypes and proving that girls can like trains, too.

I’m appalled that in 2019 our life choices are still subjected to critique. This is why I want to encourage women to embrace their interests and aspirations – however “nerdy”, or unusual, or untraditionally “female” they may be – and to speak up for things that I was worried to speak about for so long.

We might not change the world by doing so but, one by one, we’ll let others know that we’ll do what we want – because we can.