Despite the implementation of the NHS Cancer Plan, social
factors still strongly influence access to and the provision of care delivered
by NHS hospitals in England, concludes a study published on bmj.com today.
The NHS Cancer Plan was published in 2000 to improve
outcomes overall and to reduce health inequalities, in part through greater
equity of access to and provision of health care for all social groups. But the
extent to which access to health care has improved for all those in need
regardless of their socioeconomic circumstances, age, or sex has not been
So a team of researchers at University College London set
out to determine the extent to which type of hospital admission (emergency
compared with elective) and surgical procedure varied by socioeconomic
circumstances, age, sex, and year of admission for the three most common
cancers: colorectal, breast, and lung cancer.
Together these accounted for 64% of new cases diagnosed in
2006 and 40% of deaths from cancer in 2007.
Using hospital episode statistics, they identified 564,821
patients aged 50 and over admitted to an NHS hospital in England with a
diagnosis of colorectal, breast, or lung cancer. They then analysed the
proportion of patients admitted as emergencies and receiving the recommended
surgical treatment from 1999 to 2006 according to their socioeconomic
circumstances, age, sex, and year of admission.
During the study period, nearly a third of patients with
colorectal cancer were admitted as emergencies, and this proportion did not
improve over time. Over half of patients with lung cancer were also admitted as
emergencies, and this proportion increased over time.
In contrast, there was a downward trend in the proportion of
patients with breast cancer admitted as emergencies.
Patients from deprived areas, older people, and women were
more likely to be admitted as emergencies. Patients from deprived areas were
also less likely to receive preferred procedures for rectal, breast, and lung
cancer. These findings did not improve over time.
In terms of preferred surgical treatment, men were slightly
less likely to undergo the preferred surgical procedure for rectal cancer
(anterior resection) and resection for lung cancer.
Although older people were more likely to receive anterior
resection for rectal cancer, they were less likely to receive breast conserving
surgery and lung cancer resection
The authors conclude that reducing inequalities in survival
depends on improving timely presentation, early referral, and the application
of evidence based clinical guidelines among socially disadvantaged groups.
They also recommend audit of local surgical practice
and monitoring of sociodemographic variations in procedure use "to raise
standards and ensure best practice."