Geographical inequalities in cancer care, often termed the ‘postcode lottery’, have long affected patient access and outcomes across the UK. In Wales, radiotherapy services are concentrated within three specialist centres, meaning many patients must travel considerable distances for treatment, potentially extending the time between key steps in the pathway. This study examined whether distance from the South-West Wales Cancer Centre (SWWCC) influenced access to, or timing of, breast cancer radiotherapy and explored whether and how service developments have mitigated geographic inequity.

A retrospective cohort analysis was performed on 2,286 breast cancer patients treated at SWWCC between January 2018 and December 2023. Patients were grouped by travel time (≤60 min vs >60 min), transport type and treatment prescription. Statistical analyses, including Fisher’s exact and Kruskal-Wallis tests, assessed associations between travel distance, transport modality and treatment timing.

31% of patients lived more than 60 minutes away and were significantly more likely to require ambulance transport (16.8% vs 4.4%) or hostel accommodation (11.3% vs 0%) (p < .001). There was no statistically significant difference in time from booking to first treatment fraction (p = .676). Mean CT-to-plan-check intervals fell from 27 to <10 days, and the wait between booking and start of treatment fell from ∼60 to 25 days, reflecting efficiency gains linked to capacity release from adoption of hypofractionated regimens.

Treatment timeliness is equitable across South-West Wales. Five-fraction regimens have alleviated many postcode-related disparities, though differences in transport dependence and access to supportive services remain areas for improvement.