[Missing Credit]University of Otago Centre for Rural Health researcher Dr Stephen Withington. Photo: Supplied Some lung cancer patients living in country areas, are up to 66% less likely to get radiotherapy treatment than those in urban areas, because oncology centres are too challenging to get to. New Zealand’s first nationwide study, led by University of Otago Centre for Rural Health researcher Dr Stephen Withington, investigated rates of rural Māori and non-Māori who received radiotherapy for breast, prostate and lung cancers and compared them with their urban counterparts. He said Radiation Oncology Collection radiation treatment data from 2014-2020 was used, along with resident population estimates from StatsNZ, and each patient’s rurality was assigned using the Geographical Classification for Health (GCH). “One third of people with cancer in New Zealand are treated with radiation, but radiation therapy centres and specialist oncology services are generally located in major urban centres, which adds the burden of travel and being treated away from whānau, on to patients.” Dr Withington said the research found accessing radiation therapy was “a challenge” for rural cancer patients. “We found groups of people living at greater distance from radiation therapy centres, who are receiving radiotherapy at lower rates than their urban counterparts.” For all females with breast cancer, receipt of radiotherapy was lower for those over the age of 75 living in small towns, and for non-Māori aged 45–64 living rurally. Rural Māori with lung cancer, aged 75 and over, also received curative radiotherapy at a rate 66% lower than their urban counterparts. Surprisingly, for prostate cancer, there was higher receipt of radiotherapy by rurality in those under 65, he said. For lung cancer, radiotherapy rates were higher in rural patients under 65 — particularly females and non-Māori — but lower receipt of curative radiotherapy was observed for the most rural Māori females and males over 75. Irrespective of rurality, Dr Withington said Māori receipt of radiotherapy was lower than non-Māori in the youngest age groups for breast and prostate cancer. However, Māori aged 45–74 with breast cancer, and Māori females and males with lung cancer in almost all age groups and GCH categories, had higher rates of radiotherapy than their non-Māori counterparts. “This study observed some rural–urban differences in receipt of radiation therapy for the three cancers studied, though with evidence of variability by age group and cancer type, and significant differences between Māori and non-Māori,” he said. “This may represent personal choice in the case of prostate cancer, or greater need from higher incidence of cancer and later diagnosis in the case of lung cancer, but more research is required.” Dr Withington said practical measures which may help decrease gaps in access included improved feedback-responsive provision of transport and accommodation; good communication with local teams; and engagement with communities to better understand patient social and cultural needs. Technical initiatives, including appropriate use of hypofractionation (less radiotherapy treatments with higher doses of radiation) and simulation-free radiation therapy using existing diagnostic scans, may also improve access for those living at a distance from radiation oncology services, he said. “We need targeted strategies to reduce inequities between ethnicities.” john.lewis@odt.co.nz
