Travel distance to cancer-diagnostic facilities and tumour stage

Specialisation and centralisation in healthcare systems increase patients' travel distance to cancer-diagnostic facilities but the impact of distance on tumour stage remains unclear. This study aimed to study the travel distance to cancer patient's GP and to the hospital of diagnosis and the association with tumour stage for 12 cancer types. A cohort study was conducted including cancer patients in Denmark diagnosed between 2005 and 2016 with rectum, malignant melanoma, breast, testis, oesophageal, colon, cervix, prostate, stomach, pancreatic, lung and ovary cancer (n = 256,663). Distance to each patient's GP and to the hospital of diagnosis were calculated using ArcGIS, Network Analyst. The results showed that for most easy-to-diagnose cancer types (rectum cancer, malignant melanoma, testis cancer) and cervix cancer, increasing travel distance to the hospital of diagnosis increased the odds of advanced disease at diagnosis. Contrary, increasing travel distance to the hospital was associated with decreased odds of being diagnosed with advanced disease stage among hard-to-diagnose cancer types (stomach, pancreatic, lung and ovarian cancer), and prostate cancer. Distance to the GP was overall not associated with tumour stage. The underlying mechanisms for these findings are multifaceted and might reflect differences in presentation, symptomologies and investigations used for diagnosis across cancer types.