Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand

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Gurney J, Whitehead J, Kerrison C, Stanley J, Sarfati D, Koea J. Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand. PLoS One. 2022 Aug 11;17(8):e0269593. doi: 10.1371/journal.pone.0269593. PMID: 35951652; PMCID: PMC9371338.

OPEN ACCESS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9371338/

This recent study focuses on travel required for patients to access surgery for liver or stomach cancer in New Zealand, particularly for Māori. Gurney et al. find that that Māori on average travel twice as far for cancer surgery compared to Europeans. A substantial minority of both Māori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Māori. This research has important implications for rural communities – which have a higher proportion of Māori residents than urban areas – and there are likely to be similar situations with other essential health services. To help address these inequitable travel barriers to access cancer care, it is recommended that additional support is provided to Māori patients, including financial support, and that Te Whatu Ora consider localising as much service provision as possible. (J.Whitehead)

 

Abstract

In New Zealand, there are known disparities between the Indigenous Māori and the majority non-Indigenous European populations in access to cancer treatment, with resulting disparities in cancer survival. There is international evidence of ethnic disparities in the distance travelled to access cancer treatment; and as such, the aim of this paper was to examine the distance and time travelled to access surgical care between Māori and European liver and stomach cancer patients. We used national-level data and Geographic Information Systems (GIS) analysis to describe the distance travelled by patients to receive their first primary surgery for liver or stomach cancer, as well as the estimated time to travel this distance by road, and the surgical volume of hospitals performing these procedures. All cases of liver (ICD-10-AM 3rd edition code: C22) and stomach (C16) cancer that occurred in New Zealand (2007-2019) were drawn from the New Zealand Cancer Registry (liver cancer: 866 Māori, 2,460 European; stomach cancer: 953 Māori, 3,192 European), and linked to national inpatient hospitalisation records to examine access to surgery. We found that Māori on average travel 120km for liver cancer surgery, compared to around 60km for Europeans, while a substantial minority of both Māori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Māori (36% vs 29%; adj. OR 1.48, 95% CI 1.09-2.01). No such disparities were observed for stomach cancer. This contrast between cancers is likely driven by the centralisation of liver cancer surgery relative to stomach cancer. In order to support Māori to access liver cancer care, we recommend that additional support is provided to Māori patients (including prospective financial support), and that efforts are made to remotely provide those clinical services that can be decentralised.

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