Effect of social and spatial isolation among cancer patients on treatment receipt and survival

This study aims to:

[a] investigate how aspects of social and spatial isolation among cancer patients influence treatment receipt and survival; and

[b] identify factors which, if modified, could improve equity and translate into better patient outcomes.

The study is investigating relationships between measures of social and spatial isolation—e.g., age, living alone, geographical isolation, access to transport, distance to health services and low mobility—and treatment receipt and survival/mortality in patients diagnosed with colorectal cancer or non-Hodgkin’s lymphoma between 2004-2008.

Data sources for the project include:

[1] demographic, cancer and treatment data from the National Cancer Registry;

[2] 2006 census data on distance to hospital, density of general practitioners, deprivation, mobility, accessibility and living alone linked, through address mapping, to patients’ area of residence (using a new classification which includes 18,488 areas); and

[3] measures of co-morbidity derived from hospital in-patient episodes (HIPE) linked to individual cancer patients.

Outcome measures will be

[i] types of treatments received within the first year after diagnosis (e.g., cancer-directed surgery, radiotherapy, chemotherapy; analysed individually and in combination); and

[ii] relative and cause-specific survival. Analyses will incorporate variables measured at the individual (e.g., age, marital status, distance), consultant (e.g., caseload), hospital (e.g., public/private; cancer centre or not) and area-level (e.g., deprivation), using sophisticated multi-level modelling techniques. The study will identify modifiable elements of isolation (e.g., advocacy, transport, home care) which, if addressed, could potentially improve equity and, hence, patient outcomes.