Cancer Diagnostic Delays and Travel Distance to Health Services: A Nationwide Cohort Study in Denmark

Background: This study aims to investigate the association between distance to health services and intervals in the cancer diagnostic pathway, and explore whether the diagnostic difficulty of the cancer influences this association.

Method: A nationwide cohort study was conducted based on data from both questionnaires and registries. Danish cancer patients diagnosed in 2005-2016 and their general practitioner (GP) were included if enrolled in the Danish Cancer in Primary Care (CaP) cohort (n = 37,872). The CaP cohorts provided data on intervals assessed by patients and GPs. The Geographical Information System (GIS) was used to calculate travel distances from the residence of the patient to their GP surgery and to the hospital of diagnosis.

Results: Longer travel distance to the hospital of diagnosis was associated with longer diagnostic interval. This association was strongest in the period before the implementation of Cancer Patient Pathways (CPP) in 2010. Patients with a cancer categorised as ´hard to diagnose´ contributed mostly to the association. Longer travel distance to the GP was associated with shorter patient interval and primary care interval for patients diagnosed with cancer types ´intermediate to diagnose´.

Conclusion: Travel distance to cancer diagnostic health care services was associated with interval length in the diagnostic pathway. This association was less pronounced in the period after introducing CPPs and also strongly depending of the underlying cancer type and symptomatology.