Diffuse large B-cell lymphoma: impact of socio-demographic and geographical factors on routes to diagnosis, disease presentation and outcomes of patients in the Haematological Malignancy Research Network

Background
An association between travel to healthcare and subsequent route to diagnosis (RTD), treatment and survival has not been previously reported for diffuse large B-cell lymphoma (DLBCL) patients in the UK. This thesis aims to address this gap using data from the Haematological Malignancy Research Network (HMRN).

Methods
Firstly, a literature review was conducted which showed a lack of research investigating the impact of travel time to healthcare on outcomes of cancer patients in the UK, particularly those with haematological malignancies, and informed the methods used in this thesis. RTDs were assigned using Hospital Episode Statistics and travel distances and times were calculated for journeys by car and public transport between the patient’s home postcode at diagnosis and healthcare facilities (registered GP and diagnostic hospital) using TRACC (Basemap). Hospital activity in the two-years leading up to diagnosis was also calculated and compared to background rates using a nested case-control study. Associations with RTD and treatment were examined using logistic regression and survival was compared using standard time-to-event analyses.

Results
Journeys to healthcare across HMRN were generally short, with a median time to hospital by car of 10.8 minutes, however, corresponding journeys by public transport were four times longer, at 43.1 minutes. A total of 1292 patients (31.4%) were diagnosed following an EP, suggesting that many patients experience diagnostic delay and this result was supported by the hospital activity analysis which showed that patients with DLBCL had elevated hospital activity for two years before diagnosis compared to their matched controls. No statistically significant associations between travel to healthcare and RTD, treatment intent or survival were detected.

Conclusions
These findings reassuringly suggest that in the HMRN region, travel to healthcare does not influence RTD or survival of DLBCL and that patients receive equitable care from the NHS regardless of how close they live to healthcare services.