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.

 
 
 
 

What’s in Edinburgh’s 10 year transport masterplan?

Edinburgh. Image: Getty.

Edinburgh City Council has released a draft 10-year transport plan, and put it out to public consultation. The jauntily-named Edinburgh City Centre Transformation Proposed Strategy comes soon after a 20 mph zone was rolled out and the extension of the city's tram line was approved.

The council’s overriding aims are to make the city centre much friendlier to pedestrians and cyclists, and to get people out of cars and thus reduce air pollution. With the city forecast to grow larger than Glasgow within our lifetime, and with tourist numbers increasing with every year, it is encouraging that Edinburgh is making ambitious plans for a low carbon future. There is a surfeit of exciting ideas in the proposals, so even if half of them survive the consultation stage it would be a great achievement.

First off, yes there are going to be more trams. The council proposals include a a circular loop with trams going from Princes Street over the majestic North Bridge which connects the Old and New Towns. From there, it will continue over South Bridge, hook west through the University of Edinburgh area before linking back up with the current tram line at Haymarket railway station.

A summary of the plans: click to expand.

This is an exciting update to the tram network, which will provide services to the south of the city centre soon after the trams extend north through Leith. A free hop-on bus will also do a loop around the city centre, and will seek to emulate other cities, such as Talinn, which offer free transport.

North Bridge, which spans over Waverley station, will be closed to cars but will remain open to buses as this is a vital route. There will also be a new lift installed on the south side of Waverley station, to make it easier for people with prams, the elderly and the disabled to get from the platforms up to North Bridge: at present anyone doing this is required to take a lift to Princes Street, on the opposite side of the railway. Further lifts are planned to make it easier to get from the Grassmarket to Edinburgh Castle, from Market Street to The Mound, and from the Cowgate to George IV Bridge.


East of North Bridge there will be a brand new bridge for cyclists and pedestrians connecting the Old and New Towns. Although there is no crossing here at present, those with long memories will recall there was a pedestrian bridge here in the past, originally built as compensation for the fact the railway line had effectively split Edinburgh in half. However, British Rail “temporarily” closed the bridge from Jeffrey Street across the railway line to Calton Road in 1950, and never re-opened it again.

To the west of North Bridge lies Waverley Bridge, which is a lower-level crossing of the railway. At present this is open to all vehicles, and is where the bus to the airports departs from. The council’s plan is for this bridge, which runs from Princes Street to the bottom of the steep Cockburn Street, to be completely pedestrianised.

Actually, in a move that will prove popular with tourists, many streets in the historic Old Town will also be pedestrianised. The city has already began trials of this on the first Sunday of the month, allowing people to have access to Instagram-ready streets such as the winding Victoria Street, which leads to the Grassmarket, and Cockburn Street, which connects the Royal Mile with Waverley Bridge. A greater portion of the Royal Mile, the popular avenue for tourists which is packed during the Fringe, also looks set to be pedestrianised. The plan also promises more support for cyclists, with various segregated cycle lanes, such as one along a newly tree-lined Lothian Road to connect Princes Street with The Meadows.

The proposals for improved cycling access: click to expand.

Altogether, the 10 year vision is very ambitious and in Sir Humphrey-speak, “interesting”. There will surely be a lot of pressure from motorists and the Conservatives to scale back the plans, which aim to seriously reduce when and how car users can access the city centre, in favour of pedestrians and cyclists.

Motorists will lose crossings into the Old Town at North Bridge and Waverley Bridge, although they will still be able to drive from the middle of Princes Street up The Mound. Aside from that, car users wishing to enter the Old Town will be forced to either come in from the west via Lothian Road, or to take a long diversion around Abbeyhill to the east.

Of course the plans could still do with improvements such as re-opening the entirely complete suburban railway which circles Edinburgh and is only open to freight at present. Nonetheless, Edinburgh has been presented with an exciting low-carbon vision of the future. Hopefully it will act on it.

You can see the full plan here.

Pete Macleod tweets as @petemacleod84 and runs Pete’s Cheap Trains.