Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand

In New Zealand, there are known disparities between the Indigenous Maori and the majority non-Indigenous European populations in access to cancer treatment, with resulting disparities in cancer survival. There is international evidence of ethnic disparities in the distance travelled to access cancer treatment; and as such, the aim of this paper was to examine the distance and time travelled to access surgical care between Maori and European liver and stomach cancer patients. We used national-level data and Geographic Information Systems (GIS) analysis to describe the distance travelled by patients to receive their first primary surgery for liver or stomach cancer, as well as the estimated time to travel this distance by road, and the surgical volume of hospitals performing these procedures. All cases of liver (ICD-10-AM 3rd edition code: C22) and stomach (C16) cancer that occurred in New Zealand (2007-2019) were drawn from the New Zealand Cancer Registry (liver cancer: 866 Maori, 2,460 European; stomach cancer: 953 Maori, 3,192 European), and linked to national inpatient hospitalisation records to examine access to surgery. We found that Maori on average travel 120km for liver cancer surgery, compared to around 60km for Europeans, while a substantial minority of both Maori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Maori (36% vs 29%; adj. OR 1.48, 95% CI 1.09-2.01). No such disparities were observed for stomach cancer. This contrast between cancers is likely driven by the centralisation of liver cancer surgery relative to stomach cancer. In order to support Maori to access liver cancer care, we recommend that additional support is provided to Maori patients (including prospective financial support), and that efforts are made to remotely provide those clinical services that can be decentralised.