Access to a GP can make a huge difference in curing lung cancer – and that’s a Māori problem

Surviving lung cancer in Aotearoa Modern Zealand may depend on whether you have access to a GP, raising questions about equity in the country’s healthcare system.

Our new research examines the outcomes of patients diagnosed with lung cancer by their family doctor compared with patients diagnosed with lung cancer in the emergency department (ED).

Analyzing 2,400 lung cancer cases in the Waikato between 2011 and 2021, we found that people diagnosed with lung cancer after ED visits tended to have later stage disease and worse outcomes compared to people diagnosed after referral to a GP.

We also found that diagnosis after an ED visit was 27% higher for Māori than non-Māori and 22% higher for men than women.

These results raise vital questions about health inequalities in Modern Zealand and highlight the need to ensure everyone has access to early cancer diagnosis.

Constrained access to everyday health care

Currently half of all general practices have closed their books to fresh patients, leaving 290,000 patients unregistered and dependent on emergency departments for healthcare.

As of 2019, approximately 80% of practices closed their books to fresh patients at some point.

For people registered for an internship, waiting time for appointments are often such that the only option is to go to the emergency room for lend a hand.

This is especially true in rural areas, where the hospital may become the default route to diagnosis.

Lung cancer is the most common cause of cancer death in Modern Zealand – there are over 1,800 per year. About 80% of people diagnosed with lung cancer have advanced disease and have a very needy chance of survival.

It is also the cancer causing the largest capital gap. The mortality rate for Māori people with lung cancer is three to four times higher than for people of European descent.

While much of this disparity is due to differences in smoking rates among ethnic groups, it also exists evidence delays in diagnosis and poorer access to surgery also have a major impact on survival.

Identification of lung cancer

Lung cancer usually begins in the tissue lining the airways, and symptoms may initially be relatively minor – shortness of breath when exercising, a nasty cough, or piercing pains when breathing.

Patients with these types of symptoms will usually go to their GP to see if it is something that requires further investigation.

However, if someone cannot make an appointment or does not consider the symptoms to be earnest, they are likely to delay taking action.

Advanced symptoms of lung cancer include coughing up blood or lumps in the neck due to the lymphatic spread of the cancer. People with these disturbing symptoms usually go to hospital for treatment.

Our study confirms previous findings that people diagnosed in the emergency department include:

• more vulnerable to advanced disease
• A more aggressive type of cancer is more common (so-called small cell carcinoma), I
• they have a much lower chance of survival.

The median survival for those who never presented to the ED was 13.6 months, while the median survival for those who had one ED visit was only three months.

That said, there are some benefits to visiting the emergency department. These include seeing a doctor within hours, instant access to X-rays and, in our major hospitals, access to the ultimate diagnostic tool for lung cancer – computed tomography (CT).

Our study found that 25% of cases presented to the emergency department two or more times in the two weeks before diagnosis. This was particularly true for people going to one of the rural hospitals in the Waikato, where it was more likely that a second or third visit was required before a diagnosis could be made.

Barriers to care

It is clear that there are still several barriers to access to primary healthcare in Modern Zealand. This has led to an over-reliance on emergency departments to diagnose cancer, despite the lengthy process faster cancer treatment goals.

The situation is unlikely to improve. Access to primary care physicians is deteriorating, in part because increasing fees.

Māori and Pacific patients had lung cancer less likely than other ethnic groups who were enrolled in a primary care organization at the time of diagnosis. They were also less likely to visit their GP in the three months before diagnosis.

Making visiting your family doctor easier

Increasing access to overall care is the most effective way to eliminate inequities in our lung cancer statistics.

Currently Modern Zealand only has 74 general practitioners per 100,000 inhabitants people compared to 110 in Australia.

It is clear that we need to significantly augment the number of general practitioners. This is a long-term project, but it must be a strategic goal for the health sector.

In the meantime, we need to augment access to primary care by increasing patient subsidies and reducing the direct costs of doctor visits. At the same time, we need to better equip primary care physicians with access to diagnostic facilities, including in our rural hospitals.