Exploring associations between travel burden, clinical features, and outcomes from head and neck cancer in Scotland,...

Geographic inequalities in cancer outcomes are reported internationally, but little is known about associations between geography and head and neck cancer (HNC) in Scotland. We explored how travelling times to health services influences clinical characteristics, stage at diagnosis, treatment, and one-year mortality for HNC in Scotland.

We conducted a national, population-based, retrospective cohort study using linked administrative and clinical data covering all individuals diagnosed with HNC in Scotland between 2014 and 2019. We calculated and categorised their travelling times to key healthcare facilities and explored associations with key outcomes - HPV-status, stage at diagnosis, treatment received, and one-year mortality. Multivariable regression models adjusted for key confounders.

6692 patients were included. Patients with the longest travelling time (≥ 60 min or island) were less likely to present with advanced-stage disease (OR 0.73, 95 % CI: 0.54-0.98) and were significantly less likely to die within one year (HR 0.64, 95 % CI: 0.46-0.88). No difference was observed in proportion of HPV-positive cancers across travel time categories. There were also no significant differences in proportions receiving surgery or treated within 31 days of diagnosis.

The association between geography and HNC in Scotland is complex and differs from previous studies in other cancers. Patients with the longest travel time had lower risk of advanced stage at presentation and reduced one-year mortality with no apparent difference in HPV-prevalence or treatment access. In context these findings suggest that travelling time disadvantage is not uniform across cancer types and highlights the need for cancer site-specific approaches to monitoring and reducing inequalities. This large, population-based analysis provides the most comprehensive assessment of HNC and geography in Scotland to date. Findings challenge assumptions of consistent travel time disadvantage and can inform policy on equitable cancer care delivery in the pre-pandemic era.