Beyond rurality: Regional and service-system variation in cancer patient experience in Scotland

Previous analysis of the Scottish Cancer Patient Experience Survey showed that rural-dwelling cancer patients experience greater travel burden and fewer opportunities to participate in research, while reporting similar overall care experience. However, urban-rural classification captures only one dimension of geography and does not directly reflect how cancer services are organized, accessed or delivered across regional systems.

This study aimed to explore whether cancer patient experience in Scotland varies across regional and service-system geographies, and whether these patterns provide policy-relevant information beyond urban-rural classification alone.

We conducted an exploratory descriptive analysis of publicly available aggregated SCPES 2024 data, comparing patient experience responses across NHS Board of residence, NHS Board of treatment, regional cancer network and deprivation quintile. We interpreted these patterns alongside previously reported urban-rural variation. We examined deprivation gradients using SIMD (Scottish Index of Multiple Deprivation) quintiles. Chi-square tests and Cramér's V assessed both presence and magnitude of variation across key domains of the cancer care pathway.

Associations between experience and geography differed across organizational levels. Early diagnosis showed little variation, while reported treatment receipt, particularly radiotherapy, varied substantially by NHS Board and persisted at cancer network level. Travel burden and reported distance to services showed the strongest geographic effects. Deprivation gradients were present but generally modest compared with regional variation.

Findings suggest geography in cancer patient experience is multi-layered. Urban-rural classification remains important, but analysis by NHS Board, treatment location and cancer network may reveal additional service-system variation relevant to cancer policy, access and planning.

Geographic variation in cancer patient experience should be evaluated not only by urban-rural classification or deprivation, but also by NHS Board, treatment location and cancer network. This may help identify service-system variation relevant to treatment access, travel burden and cancer service planning.