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Investigating the ‘postcode lottery’ for breast cancer patients undergoing radical radiotherapy in South-West Wales

Joe Purden Orcid Logo, Douglas Etheridge, Christopher Rose Orcid Logo, Genotan Reggian Orcid Logo, Andrea Tales Orcid Logo, Ryan Lewis

Journal of Radiotherapy in Practice, Volume: 25

Swansea University Authors: Joe Purden Orcid Logo, Douglas Etheridge, Andrea Tales Orcid Logo, Ryan Lewis

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DOI (Published version): 10.1017/s1460396926100429

Abstract

Background:Geographical inequalities in cancer care, often termed the ‘postcode lottery’, have long affected patient access and outcomes across the UK. In Wales, radiotherapy services are concentrated within three specialist centres, meaning many patients must travel considerable distances for treat...

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Published in: Journal of Radiotherapy in Practice
ISSN: 1460-3969 1467-1131
Published: Cambridge University Press (CUP) 2026
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URI: https://cronfa.swan.ac.uk/Record/cronfa71440
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In Wales, radiotherapy services are concentrated within three specialist centres, meaning many patients must travel considerable distances for treatment, potentially extending the time between key steps in the pathway. This study examined whether distance from the South-West Wales Cancer Centre (SWWCC) influenced access to, or timing of, breast cancer radiotherapy and explored whether and how service developments have mitigated geographic inequity.Methods:A retrospective cohort analysis was performed on 2,286 breast cancer patients treated at SWWCC between January 2018 and December 2023. Patients were grouped by travel time (&#x2264;60 min vs &gt;60 min), transport type and treatment prescription. Statistical analyses, including Fisher&#x2019;s exact and Kruskal-Wallis tests, assessed associations between travel distance, transport modality and treatment timing.Results:31% of patients lived more than 60 minutes away and were significantly more likely to require ambulance transport (16.8% vs 4.4%) or hostel accommodation (11.3% vs 0%) (p &lt; .001). There was no statistically significant difference in time from booking to first treatment fraction (p = .676). Mean CT-to-plan-check intervals fell from 27 to &lt;10 days, and the wait between booking and start of treatment fell from &#x223C;60 to 25 days, reflecting efficiency gains linked to capacity release from adoption of hypofractionated regimens.Conclusions:Treatment timeliness is equitable across South-West Wales. Five-fraction regimens have alleviated many postcode-related disparities, though differences in transport dependence and access to supportive services remain areas for improvement.</abstract><type>Journal Article</type><journal>Journal of Radiotherapy in Practice</journal><volume>25</volume><journalNumber/><paginationStart/><paginationEnd/><publisher>Cambridge University Press (CUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1460-3969</issnPrint><issnElectronic>1467-1131</issnElectronic><keywords>access; burden; postcode lottery; radiotherapy; travel</keywords><publishedDay>11</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2026</publishedYear><publishedDate>2026-03-11</publishedDate><doi>10.1017/s1460396926100429</doi><url/><notes/><college>COLLEGE NANME</college><department>Health and Social Care School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HSOC</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>This research received no specific grant from any funding agency, commercial or not-for-profit sectors.</funders><projectreference/><lastEdited>2026-03-16T16:23:29.7770277</lastEdited><Created>2026-02-17T09:29:31.2456227</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Healthcare Science</level></path><authors><author><firstname>Joe</firstname><surname>Purden</surname><orcid>0000-0002-4441-8113</orcid><order>1</order></author><author><firstname>Douglas</firstname><surname>Etheridge</surname><order>2</order></author><author><firstname>Christopher</firstname><surname>Rose</surname><orcid>0009-0008-1864-9031</orcid><order>3</order></author><author><firstname>Genotan</firstname><surname>Reggian</surname><orcid>0009-0000-0822-2538</orcid><order>4</order></author><author><firstname>Andrea</firstname><surname>Tales</surname><orcid>0000-0003-4825-4555</orcid><order>5</order></author><author><firstname>Ryan</firstname><surname>Lewis</surname><order>6</order></author></authors><documents><document><filename>71440__36426__2fe056132e96496f8e3b48bc95eaf1f1.pdf</filename><originalFilename>71440.VoR.pdf</originalFilename><uploaded>2026-03-16T16:19:21.9021949</uploaded><type>Output</type><contentLength>2171732</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s), 2026. 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spelling 2026-03-16T16:23:29.7770277 v2 71440 2026-02-17 Investigating the ‘postcode lottery’ for breast cancer patients undergoing radical radiotherapy in South-West Wales 5460500136e327b41f17c548057ffab1 0000-0002-4441-8113 Joe Purden Joe Purden true false b8041596898e6ff822ee4a1f709d8a32 Douglas Etheridge Douglas Etheridge true false 9b53a866ddacb566c38ee336706aef5f 0000-0003-4825-4555 Andrea Tales Andrea Tales true false 7456b1f7fb096b1475698df28aea6a0c Ryan Lewis Ryan Lewis true false 2026-02-17 HSOC Background:Geographical inequalities in cancer care, often termed the ‘postcode lottery’, have long affected patient access and outcomes across the UK. In Wales, radiotherapy services are concentrated within three specialist centres, meaning many patients must travel considerable distances for treatment, potentially extending the time between key steps in the pathway. This study examined whether distance from the South-West Wales Cancer Centre (SWWCC) influenced access to, or timing of, breast cancer radiotherapy and explored whether and how service developments have mitigated geographic inequity.Methods:A retrospective cohort analysis was performed on 2,286 breast cancer patients treated at SWWCC between January 2018 and December 2023. Patients were grouped by travel time (≤60 min vs >60 min), transport type and treatment prescription. Statistical analyses, including Fisher’s exact and Kruskal-Wallis tests, assessed associations between travel distance, transport modality and treatment timing.Results:31% of patients lived more than 60 minutes away and were significantly more likely to require ambulance transport (16.8% vs 4.4%) or hostel accommodation (11.3% vs 0%) (p < .001). There was no statistically significant difference in time from booking to first treatment fraction (p = .676). Mean CT-to-plan-check intervals fell from 27 to <10 days, and the wait between booking and start of treatment fell from ∼60 to 25 days, reflecting efficiency gains linked to capacity release from adoption of hypofractionated regimens.Conclusions:Treatment timeliness is equitable across South-West Wales. Five-fraction regimens have alleviated many postcode-related disparities, though differences in transport dependence and access to supportive services remain areas for improvement. Journal Article Journal of Radiotherapy in Practice 25 Cambridge University Press (CUP) 1460-3969 1467-1131 access; burden; postcode lottery; radiotherapy; travel 11 3 2026 2026-03-11 10.1017/s1460396926100429 COLLEGE NANME Health and Social Care School COLLEGE CODE HSOC Swansea University SU Library paid the OA fee (TA Institutional Deal) This research received no specific grant from any funding agency, commercial or not-for-profit sectors. 2026-03-16T16:23:29.7770277 2026-02-17T09:29:31.2456227 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Healthcare Science Joe Purden 0000-0002-4441-8113 1 Douglas Etheridge 2 Christopher Rose 0009-0008-1864-9031 3 Genotan Reggian 0009-0000-0822-2538 4 Andrea Tales 0000-0003-4825-4555 5 Ryan Lewis 6 71440__36426__2fe056132e96496f8e3b48bc95eaf1f1.pdf 71440.VoR.pdf 2026-03-16T16:19:21.9021949 Output 2171732 application/pdf Version of Record true © The Author(s), 2026. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. true eng https://creativecommons.org/licenses/by/4.0/
title Investigating the ‘postcode lottery’ for breast cancer patients undergoing radical radiotherapy in South-West Wales
spellingShingle Investigating the ‘postcode lottery’ for breast cancer patients undergoing radical radiotherapy in South-West Wales
Joe Purden
Douglas Etheridge
Andrea Tales
Ryan Lewis
title_short Investigating the ‘postcode lottery’ for breast cancer patients undergoing radical radiotherapy in South-West Wales
title_full Investigating the ‘postcode lottery’ for breast cancer patients undergoing radical radiotherapy in South-West Wales
title_fullStr Investigating the ‘postcode lottery’ for breast cancer patients undergoing radical radiotherapy in South-West Wales
title_full_unstemmed Investigating the ‘postcode lottery’ for breast cancer patients undergoing radical radiotherapy in South-West Wales
title_sort Investigating the ‘postcode lottery’ for breast cancer patients undergoing radical radiotherapy in South-West Wales
author_id_str_mv 5460500136e327b41f17c548057ffab1
b8041596898e6ff822ee4a1f709d8a32
9b53a866ddacb566c38ee336706aef5f
7456b1f7fb096b1475698df28aea6a0c
author_id_fullname_str_mv 5460500136e327b41f17c548057ffab1_***_Joe Purden
b8041596898e6ff822ee4a1f709d8a32_***_Douglas Etheridge
9b53a866ddacb566c38ee336706aef5f_***_Andrea Tales
7456b1f7fb096b1475698df28aea6a0c_***_Ryan Lewis
author Joe Purden
Douglas Etheridge
Andrea Tales
Ryan Lewis
author2 Joe Purden
Douglas Etheridge
Christopher Rose
Genotan Reggian
Andrea Tales
Ryan Lewis
format Journal article
container_title Journal of Radiotherapy in Practice
container_volume 25
publishDate 2026
institution Swansea University
issn 1460-3969
1467-1131
doi_str_mv 10.1017/s1460396926100429
publisher Cambridge University Press (CUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Healthcare Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Healthcare Science
document_store_str 1
active_str 0
description Background:Geographical inequalities in cancer care, often termed the ‘postcode lottery’, have long affected patient access and outcomes across the UK. In Wales, radiotherapy services are concentrated within three specialist centres, meaning many patients must travel considerable distances for treatment, potentially extending the time between key steps in the pathway. This study examined whether distance from the South-West Wales Cancer Centre (SWWCC) influenced access to, or timing of, breast cancer radiotherapy and explored whether and how service developments have mitigated geographic inequity.Methods:A retrospective cohort analysis was performed on 2,286 breast cancer patients treated at SWWCC between January 2018 and December 2023. Patients were grouped by travel time (≤60 min vs >60 min), transport type and treatment prescription. Statistical analyses, including Fisher’s exact and Kruskal-Wallis tests, assessed associations between travel distance, transport modality and treatment timing.Results:31% of patients lived more than 60 minutes away and were significantly more likely to require ambulance transport (16.8% vs 4.4%) or hostel accommodation (11.3% vs 0%) (p < .001). There was no statistically significant difference in time from booking to first treatment fraction (p = .676). Mean CT-to-plan-check intervals fell from 27 to <10 days, and the wait between booking and start of treatment fell from ∼60 to 25 days, reflecting efficiency gains linked to capacity release from adoption of hypofractionated regimens.Conclusions:Treatment timeliness is equitable across South-West Wales. Five-fraction regimens have alleviated many postcode-related disparities, though differences in transport dependence and access to supportive services remain areas for improvement.
published_date 2026-03-11T05:34:16Z
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