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Geographical distance and reduced access to palliative radiotherapy: Systematic review and meta-analysis

Chand, Chandini Parsan; Greenley, Sarah; Macleod, Una; Lind, Mike; Barton, Rachel; Kelly, Charlotte


Chandini Parsan Chand

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Professor Michael Lind
Foundation Professor of Oncology/ Head of the Joint Centre for Cancer Studies

Rachel Barton


Background: Palliative radiotherapy (PRT) is an effective way of reducing symptoms caused by advanced incurable cancer. Several studies have investigated factors that contribute to inequalities in access to PRT; distance to a radiotherapy centre has been identified as one potential barrier. Aim: To assess whether there is an association between distance to a radiotherapy centre and utilisation rates of PRT in adults with cancer. Methods: A systematic review and meta-analysis protocol was registered in the PROSPERO database (CRD42020190772). MEDLINE, EMBASE, CINAHL and APA-PsycINFO were searched for relevant papers up to 28 February 2021. Results: Twenty-one studies were included. Twelve studies focused on whether patients with incurable cancer received PRT, as part of their treatment package. Pooled results reported that living ≥50 km vs <50 km from the radiotherapy centre was associated with a reduced likelihood of receiving PRT (OR 0.84 (95%CI 0.80, 0.88)). Nine focused on distance from the radiotherapy centre and compared single-fraction (SF) versus multiple-fraction PRT, indicating that patients living further away were more likely to receive SF. Pooled results comparing ≥50 km versus <50 km showed increased odds of receiving SF for those living ≥50 km (OR 1.48 (95%CI 1.26,1.75)). Conclusion: Patients living further away from radiotherapy centres were less likely to receive PRT and those who received PRT were more likely to receive SF PRT, providing some evidence of inequalities in access to PRT treatment based on proximity to centres providing radiotherapy. Further research is needed to understand whether these inequalities are influenced by clinical referral patterns or by patients unwilling or unable to travel longer distances. PROSPERO registration number: CRD42020190772.


Chand, C. P., Greenley, S., Macleod, U., Lind, M., Barton, R., & Kelly, C. (2022). Geographical distance and reduced access to palliative radiotherapy: Systematic review and meta-analysis. BMJ supportive & palliative care,

Journal Article Type Review
Acceptance Date Jan 12, 2022
Online Publication Date Mar 15, 2022
Publication Date Jan 1, 2022
Deposit Date Apr 19, 2022
Publicly Available Date Apr 20, 2022
Journal BMJ Supportive and Palliative Care
Print ISSN 2045-435X
Electronic ISSN 2045-4368
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
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© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY.
Published by BMJ.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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