Coastal cancer care: A blueprint to address the unmet needs through place-based research and policy approaches

A substantial gap persists in our understanding of specific cancer prevention, diagnosis and care needs of coastal communities. Despite growing policy attention to coastal inequalities, the current evidence-base is limited, with insufficient explanation of how and why cancer-related needs and outcomes vary across coastal geographies. Treating coastal areas as homogenous, or subsuming them within broader rural or urban categories, risks obscuring place-specific mechanisms that may contribute to inequalities, while also overlooking opportunities for targeted, place-sensitive interventions to improve cancer outcomes. This gap is increasingly salient considering recent policy developments. The new National Cancer Plan for England recognises that patients from deprived areas, particularly those in coastal and rural locations, distant from large academic centres, are less likely to be offered certain cancer-related care opportunities. The plan also commits to rebalancing cancer diagnostic and medical training places towards remote, rural and coastal areas, targeting investment in cancer nurse specialists and medical specialists in areas with greater need, and adopting more holistic approaches that involve non-clinical interventions to tackle inequalities. However, these ambitions have yet to be underpinned by a robust, conceptually grounded evidence-base specific to coastal cancer care. In response to the National Cancer Plan, our multidisciplinary team propose a conceptual framework for "coastal cancer care" relevant to both the UK and internationally. We identify key domains where a coastal context may influence cancer prevention, diagnosis, care, and survivorship, and present guiding principles to stimulate debate and inform future research and policy aimed at understanding and reducing inequalities in coastal settings.