Mapping Healthcare Access: A Primary Exploration of the Spatial Accessibility of Breast Reconstruction Services in Scotland

Abstract

Breast reconstruction (BR) is an important step in the recovery of many breast cancer patients, with multiple studies citing BR as being valuable to patient mental and physical wellbeing. Two primary types of BR are available through NHS Scotland; implant/prosthesis-based reconstruction (IPR) and ‘free-flap’/free tissue reconstruction (FFR). In the context of the NHS, all patients have access to BR services, but may not necessarily be able to gain access to them. Due to the specialist nature of FFR, these procedures are available only in larger hospitals, generally in the central belt of Scotland. As such, varying accessibility is likely to be experienced by patients who wish to avail of these services, especially if they originate in rural or island areas. This research used service area analysis to calculate the estimated journey times and estimated financial cost of travel from Scottish data zone (DZ) population weighted centroids (PWC) to their allocated BR service hospital. IPR and FFR accessibility were compared with mastectomy (MT) accessibility, to contrast the current availability of a recognised part of cancer treatment with the accessibility of BR; a service which is generally considered ‘optional’, and not a part of true cancer treatment. This research found that large variations in spatial accessibility to BR services exist in Scotland, for both journey times and financial costs. As such, these services are not equally accessible to all patients in Scotland who may wish to access them. Increased journey times and financial costs are potential barriers to access which may discourage patients from pursuing breast reconstruction. Revision of NHS Scotland health board area boundaries are advised to improve BR service accessibility and make BR more equally available to all breast cancer patients in Scotland.