Social Inequality Gap Still Exists for Common Cancers

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 examined.

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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.

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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.

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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.

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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.”

Source-BMJ
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