A new nationwide University of Otago study has exposed significant geographic and ethnic differences in access to radiotherapy, raising fresh concerns that where cancer patients live — and whether they are Māori — can influence the treatment they receive.
The research, published in the Journal of Medical Imaging and Radiation Oncology, compared radiotherapy use among rural Māori and non-Māori patients with their urban counterparts across three major cancers — breast, prostate and lung cancer.
Led by Dr Stephen Withington from the University of Otago’s Centre for Rural Health, the study analysed national radiotherapy data from 2014 to 2020 using the Geographical Classification for Health to provide a more accurate picture of rural New Zealand.
The findings show the picture is complex, but some of the disparities are stark.
For Māori aged 75 and over with lung cancer, those living in the most rural communities received curative radiotherapy at a rate 66 percent lower than their urban counterparts.
For younger Māori women with breast cancer, another gap emerged.
Māori women under 45 received radiotherapy at lower rates than non-Māori women of the same age living within the same geographic areas. In the most remote communities, the difference reached 50 percent.
Researchers say lower radiotherapy rates for breast cancer are generally associated with higher rates of total mastectomy rather than breast-conserving surgery, which is typically accompanied by radiation treatment.
That raises the possibility that geography and ethnicity are influencing not only access to radiotherapy but the treatment pathways available to women diagnosed with breast cancer.
Distance adds another burden to cancer
Around one-third of New Zealanders diagnosed with cancer receive radiation treatment, but radiotherapy centres and specialist oncology services are largely concentrated in major urban centres.
For rural patients, treatment can therefore mean considerably more than turning up for an appointment.
It can require repeated long-distance travel, accommodation away from home and extended periods separated from whānau and support networks.
For patients already dealing with the physical, emotional and financial consequences of cancer, those additional demands can become another barrier to treatment.
The study did not, however, find a simple pattern where every rural population received less radiotherapy.
Rural men under 65 with prostate cancer had radiotherapy rates 47 percent higher than their urban counterparts, while rural men and women under 65 with lung cancer recorded rates around 90 percent higher. Researchers say those differences could reflect treatment choices, greater cancer incidence or later diagnosis, but further investigation is needed.
Māori differences run deeper than geography
The study also identified significant differences between Māori and non-Māori living within the same geographic areas.
For lung cancer, Māori generally recorded higher radiotherapy rates than non-Māori across age groups and locations, reflecting in part the higher incidence of lung cancer among Māori. Researchers caution, however, that it remains unclear whether those treatment rates fully correspond with the level of clinical need.
That distinction is critical.
A higher treatment rate does not automatically mean equitable treatment when one population carries a substantially greater burden of disease.
The research therefore points towards a combination of geography, ethnicity, age, cancer incidence and treatment pathways rather than one simple rural-versus-urban divide.
Researchers call for targeted action
The Otago team says reducing the gaps will require practical changes.
Those include better transport and accommodation support for patients forced to travel, stronger communication between specialist cancer centres and local health teams, and greater engagement with communities about their social and cultural needs.
Researchers also want targeted policies identifying gaps in Māori access to cancer diagnosis and treatment, stronger cultural safety programmes and growth in the Māori workforce across radiation therapy and cancer services.
New approaches to delivering radiotherapy could also help reduce the travel burden, including treatment techniques capable of reducing the number of visits some patients need to make to major centres.
The findings add weight to a longstanding challenge for the health system.
Having cancer treatment available somewhere in Aotearoa is not the same as making that treatment genuinely accessible to everyone who needs it.
For rural Māori, particularly kaumātua and whānau living significant distances from major hospitals, kilometres can become another barrier standing between diagnosis and treatment.
The Otago research makes clear there is no single solution.
But it also makes something else clear.
Cancer should determine the treatment a patient needs — not their ethnicity, their postcode, or how many hours they live from the nearest radiotherapy machine.
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