People in rural areas are 5% less likely to survive cancer than people living in urban areas. A study at Newcastle University, funded by Yorkshire Cancer Research, has been exploring why.
Find out more about the RURALLY study in this blog from Principal Investigator Christina Dobson.
The grass isn’t always greener
When we think about rural living we often think about an idyllic, ‘healthy’ life, filled with clean air, country walks, local produce and village fêtes. The countryside is not somewhere we would automatically think of when we think about health inequalities. When it comes to cancer though, living in a rural area, surprisingly, puts people at a disadvantage.
People in rural areas have more advanced cancer when they are diagnosed and are 5% less likely to survive it than people living in urban areas. This may be because people living in rural areas take longer to seek help about symptoms of cancer, or it may take longer for their GPs to refer them to hospital for specialist assessment.
Exploring health inequalities in rural communities
We recently undertook a study, funded by Yorkshire Cancer Research, to try to understand what may be causing these rural cancer inequalities. We recruited patients from four diverse GP surgeries across rural North Yorkshire and asked them to complete a survey about any recent bowel symptoms they had experienced, as well as asking them their thoughts about visiting doctors more generally. It was important that we undertook this research with people from different areas, as rural communities are very diverse in terms of economies, size and the characteristics of the local population.
We also interviewed 40 of these participants, to get a more detailed understanding of how people in rural areas may feel about, and respond to, symptoms of bowel cancer.
The importance of a good GP-patient relationship
What we found through the interviews and survey was really interesting. People in rural areas are very self-reliant in life generally, including being stoic about health and illness. Living in a rural area brings with it unique time pressures, which often influence whether or not people go to their GP about symptoms. Many people in rural areas are self-employed and going to the doctors can mean loss of earnings and/or impact on progress of work, which is particularly problematic for people whose work is very seasonal, for instance people working in farming. Living in a rural area often presents additional challenges when it comes to getting to the doctors, because of long travel times and poor public transport.
People in all areas reported these ‘barriers’ to consulting the GP about symptoms, but what was interesting was that the relationship between patients and their GP could either help someone overcome these barriers, or heighten them, and make them less inclined to consult.
When there were good relationships between GPs and patients, people were happy to consult about their symptoms. However, when people felt that their GP didn’t know them very well (both in relation to their medical history and their broader family context), or when they felt that they didn’t know their GP very well, they were often reluctant to visit about new symptoms, or re-consult about symptoms that hadn’t improved. People who reported ‘poor’ relationships between themselves and their GP often felt like they were “just a number” and that their GP didn’t have time for them or was unlikely to “fix” their problem. They felt it was not worth wasting their time by going to see the GP.
What are our next steps?
We have been working with people in rural North Yorkshire to think of ways to support people in rural areas to go to the doctors early when they have symptoms of cancer. Early diagnosis of cancer is crucial for improving people’s chances of surviving cancer. Developing ways to make sure people in rural areas are diagnosed with cancer as early as possible, will not only improve their experiences, but also increase their chances of survival.
Find out more
Christina Dobson is a Senior Research Associate at Newcastle University’s Population Health Sciences Institute and Principal Investigator on the Yorkshire Cancer Research-funded study RURALLY (Recognition, Understandings of, and Responses to colorectal symptoms Among people Living in rural Localities of Yorkshire).
Christina’s research focuses on the early diagnosis of cancer and delays in the diagnostic pathways of cancer patients, and she is particularly interested in people's experiences of symptoms and help-seeking, as well as inequalities in the diagnosis of cancer.
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