Scotland's Cancer Strategy Evaluation: Experiences of patient access and engagement with cancer treatment and support in rural and island areas, and in areas with higher deprivation

References

1 Scottish Government (2023a). Cancer Strategy (2023-2033) and Cancer Action Plan (2023-2026): Monitoring and Evaluation Framework. (accessed 4 June 2026)

2 Scottish Government. (2022). Key Principles for Implementing Cancer Prehabilitation across Scotland 2022. (accessed 4 April 2026).

3 Scottish Government (2023b). Value Based Health and Care: Action Plan. (accessed 4 June 2026).

4 Scottish Government. (2020). Scottish Index of Multiple Deprivation 2020. (accessed 25 March 2026).

5 Scottish Government. (2023c). Cancer Strategy 2023 to 2033. (accessed 13 April 2026).

6 Scottish Government. (2023d). Cancer Action Plan 2023 to 2026. (accessed 13 April 2026).

7 Pawson, R., & Tilley, N. (1997). An introduction to scientific realist evaluation. In E. Chelimsky & W. R. Shadish (Eds.), Evaluation for the 21st Century: A Handbook (pp. 405–418). Sage Publications, Inc.

8 Michie, S., van Stralen, M.M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Sci 6, 42.

9 Scottish Government. (2025a). Health and Social Care Service Renewal Framework. (accessed 13 April 2026).

10 Australian Government. (2021). Stronger Rural Health Strategy. (accessed 13 April 2026).

11 Digital Health & Care Scotland. (undated). MyCare.scot – Our Digital Front Door. (accessed 14 April 2026).

12 UK Government (2010). Equality Act 2010: Guidance. (accessed 4 June 2026).

13 Public Health Scotland. (2023). Cancer Incidence Projections for Scotland.. (accessed: 13 April 2026).

14 Public Health Scotland. (2026). Cancer Mortality in Scotland: Annual Update to 2024. (accessed 13 April 2026).

15 Public Health Scotland. (2021). Cancer Mortality: Annual Update to 2021. (accessed 14 April 2026).

16 Turner, M., Carriere R., Fielding, S., Ramsay, G., Samuel, L., Maclaren, A., & Murchie, P. (2023). The impact of travel time to cancer treatment centre on post-diagnosis care and mortality among cancer patients in Scotland. Health & Place. 84, 103139.

17 Scottish Government. (undated). National Performance Framework. (accessed 25 March 2026).

18 Scottish Government. (2022). Scotland’s National Cancer Plan: A Report of Progress on Actions as at 31 August 2022. (accessed 13 April 2026).

19 Scottish Government. (undated). Scottish Cancer Patient Experience Survey: Results and Reports. (accessed 13 April 2026).

20 Snowden, A., Campbell K., Thompson, K., & Dicksit, D. (2024). Transforming Cancer Care: A National Rollout of the Macmillan Improving Cancer Journey. Edinburgh Napier University.

21 Healthcare Improvement Scotland. (2025). Improving Cancer Care with a Single Point of Contact: Scalability Assessment. (accessed 13 April 2026).

22 Scottish Government (2011). NHS Scotland Caldicott Guardians: Principles into Practice. (accessed 4 June 2026).

23 Scottish Government. (2024). Scottish Government Urban Rural Classification 2022. (accessed 13 April 2026).

24 Scottish Government. (2025). Ethnic and Racialised Inequalities in Cancer Services: Evidence Review. (accessed 13 April 2026).

25 Scottish Government (2023e). Island Communities Impact Assessment: New 10-year Cancer Strategy for Scotland. (accessed 13 April 2026).

26 Carriere, R., Adam, R., Fielding, S., Barlas, R., Ong, Y., & Murchie, P. (2018). Rural dwellers are less likely to survive cancer – an international review and meta-analysis. Health & Place, 53, 219-227.

27 Duncan, L., Murchie, P., Khor, W. L., Fielding, S., Evans, J., & Adam, R. (2023). Rural and urban patients' requirements and experiences of out-of-hours medical care after cancer (RUREO): a questionnaire study. BMJ Open, 13(7), e073392.

28 Maxwell, S., Pearce, C., Kynn, M., Anderson, L. A., Weller, D., & Murchie, P. (2023). The impact of rurality on patient experience and diagnostic pathway intervals in Scotland's cancer patients: further results from a national cancer diagnosis audit. Cancer Epidemiol, 86, 102414.

29 Murage, P.Bachmann, M. O., Crawford, S. M., McPhail, S., & Jones, A. (2018). Geographical access to GPs and modes of cancer diagnosis in England: a cross-sectional study. Fam. Practice, 36.

30 Maclaren, A. S., Locock, L., Skea, Z., Skatun, D., & Wilson, P. (2024). Rurality, healthcare and crises: investigating experiences, differences, and changes to medical care for people living in rural areas. Health & Place, 87, 103217.

31 Turner, M., Carriere, R., Fielding, S., Ramsay, G., Samuel, L., Maclaren, A., & Murchie, P. (2023). The impact of travel time to cancer treatment centre on post-diagnosis care and mortality among cancer patients in Scotland. Health & Place, 84, 103139.

32 The Scottish Parliament (2024). Remote and Rural Healthcare Inquiry. (accessed 13 April 2026).

33 Murchie, P., Falborg, A. Z., Turner, M., Vedsted, P., & Virgilsen, L. F. (2021). Geographic variation in diagnostic and treatment interval, cancer stage and mortality among colorectal patients - an international comparison between Denmark and Scotland using data-linked cohorts. Cancer Epidemiol, 74, 102004.

34 Murchie, P., McLernon, D., Murchie, A., Nelson, D., & Calanzani, N. (2025). Geographic variation in experiences of cancer care in Scotland: insights and policy implications from the Scottish Cancer Patient Experience Survey. Journal of Cancer, 46(10066), 3.

35 Bain, N. S., & Campbell, N. C. (2000). Treating patients with colorectal cancer in rural and urban areas: a qualitative study of the patients' perspective. Family Practice, 17(6), 475-479.

36 Stevenson, L., Campbell, N. C., & Kiehlmann, P. A. (2003). Providing cancer services to remote and rural areas: consensus study. Br J Cancer, 89(5), 821-827.

37 Campbell, N., Ritchie, L., Cassidy, J., & Little, J. (1999). Systematic review of cancer treatment programmes in remote and rural areas. British Journal of Cancer, 80(8), 1275-1280.

38 Dobson, C., Deane, J., Macdonald, S., Murchie, P., Ellwood, C., Angell, L., & Rubin, G. (2022). Barriers to early presentation amongst rural residents experiencing symptoms of colorectal cancer: a qualitative interview study. Cancers. 2023, 15(1), 274.

39 Smith, S. M., & Campbell, N. C. (2004). Provision of oncology services in remote rural areas: a Scottish perspective. Eur J Cancer Care (Engl), 13(2), 185-192.

40 Dobson, C., Rubin, G., Murchie, P., Macdonald, S., & Sharp, L. (2020). Reconceptualising rural cancer inequalities: time for a new research agenda. Int J Environ Res Public Health, 17(4).

41 Butow, P. N., Phillips, F., Schweder, J., White, K., Underhill, C., Goldstein, D., & Clinical Oncological Society of, A. (2012). Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support Care Cancer, 20(1), 1-22.

42 Hubbard, G., Venning, C., Walker, A., Scanlon, K., & Kyle, R. G. (2015). Supportive care needs of women with breast cancer in rural Scotland. Support Care Cancer, 23(6), 1523-1532.

43 van der Kruk, S. R., Butow, P., Mesters, I., Boyle, T., Olver, I., White, K., Sabesan, S., Zielinski, R., Chan, B. A., Spronk, K., Grimison, P., Underhill, C., Kirsten, L., Gunn, K. M., & Clinical Oncological Society of, A. (2022). Psychosocial well-being and supportive care needs of cancer patients and survivors living in rural or regional areas: a systematic review from 2010 to 2021. Support Care Cancer, 30(2), 1021-1064.

44 Cohen, A. (2021) The challenges of intersectionality in the lives of older adults living in rural areas with limited financial resources. Gerontology & Geriatric Medicine, 7, 1-9.

45 McInnerney, C., Quaife, S. L., Cooke, S., Pogson, Z., Ricketts, W., Januszewski, A., Lerner, A., Skinner, D., Civello, S., Kane, R., Harding-Bell, A., Calman, L., Selby, P., Peake, M. D., & Nelson, D. (2024). Understanding the impact of distance and disadvantage on lung cancer care and outcomes: a study protocol. BMC Cancer, 24, 942.

46 Specialist Cancer Charities Group (2024). From Lived Experience to National Policy: A citizens’ jury approach to improving cancer care. Specialist Cancer Charities Group. (accessed 13 April 2026).

47 Cancer Research UK (2022). Cancer in the UK: Deprivation and Cancer Inequalities in Scotland. Cancer Research UK. (accessed 13 April 2026).

48 Smith, S. M., & Campbell, N. C. (2004). Provision of oncology services in remote rural areas: a Scottish perspective. Eur J Cancer Care (Engl), 13(2), 185-192.

49 Richards, N., Quinn, S., Carduff, E., & Gott, M. (2024). Dying in the margins: Experiences of dying at home for people living with financial hardship and deprivation. Qualitative Research in Health, 5, 100414.

50 McCartney, G., and Hoggett, R. (2023). How well does the Scottish Index of Multiple Deprivation identify income and employment deprived individuals across the urban-rural spectrum and between local authorities? Public Health, Volume 217

51 Finke, I., Behrens, G., Weisser, L., Brenner, H., & Jansen, L. (2018). Socioeconomic differences and lung cancer survival - systematic review and meta-analysis. Front Oncol, 8, 536.

52 Pfizer (2024). Inequalities in Breast Cancer Care: Quantifying the Inequalities across the Breast Cancer pathway and their Impact on Health Outcomes in Scotland. Pfizer. (accessed 13 April 2026).

53 Poulton, T. E., Salih, T., Martin, P., Rojas-Garcia, A., Raine, R., & Moonesinghe, S. R. (2018). Systematic review of the influence of socioeconomic deprivation on mortality after colorectal surgery. British Journal of Surgery, 105(8), 959-970.

54 Afshar, N., English, D. R., & Milne, R. L. (2021). Factors explaining socio-economic inequalities in cancer survival: a systematic review. Cancer Control, 28, 10732748211011956.

55 Brown, D., Conway, D. I., McMahon, A. D., Dundas, R., & Leyland, A. H. (2021). Cancer mortality 1981-2016 and contribution of specific cancers to current socioeconomic inequalities in all cancer mortality: a population-based study. Cancer Epidemiology, 74, 102010.

56 Tweed, E. J., Allardice, G. M., McLoone, P., & Morrison, D. S. (2018). Socio-economic inequalities in the incidence of four common cancers: a population-based registry study. Public Health, 154, 1-10.

57 Chien, S., Shenoy, S., Petty, R., Lamb, P., & Glen, P. (2022). P103 Effect of deprivation on patients undergoing treatment for oesophagogastric cancer with curative intent in Scotland. Gut, 71(Suppl 1), A91-A91.

58 Holden, C., Wheelwright, S., Harle, A., & Wagland, R. (2021). The role of health literacy in cancer care: a mixed studies systematic review. PLoS One, 16(11).

59 Stormacq, C., Wosinski, J., Boillat, E., & Van den Broucke, S. (2020). Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI Evidence Synthesis, 18(7), 1389-1469.

60 Scottish Government (2022). Consultation Analysis: New Cancer Strategy. Scottish Government. (accessed 13 April 2026).

61 Herrera, D. J., van de Veerdonk, W., Berhe, N. M., Talboom, S., van Loo, M., Alejos, A. R., Ferrari, G., & Van Hal, G. (2023). Mixed-method systematic review and meta-analysis of shared decision-making tools for cancer screening. Cancers, 15(15), 3867.

62 Scottish Government (2023f). Cancer Strategy for Scotland 2023-33: Equality Impact Assessment Results. Scottish Government. (accessed 13 April 2026).

63 McCutchan, G., Wood, F., Smits, S., Edwards, A., & Brain, K. (2016). Barriers to cancer symptom presentation among people from low socioeconomic groups: a qualitative study. BMC Public Health, 16(1), 1052.

64 Adam, R., Nair, R., Duncan, L. F., Yeoh, E., Chan, J., Vilenskaya, V., & Gallacher, K. I. (2023). Treatment burden in individuals living with and beyond cancer: a systematic review of qualitative literature. PLoS One, 18(5), e0286308.