Significant inequalities in cancer care persist around the UK, according to a new review by Dr Emily Scott, Clinical Research Fellow with the East of England Cancer Alliance
The report, published by medical journal the Lancet’s eClinicalMedicine, highlights disparities in cancer incidence, outcomes and healthcare access among different groups. It sets out how these are influenced by factors such as health awareness, ethnicity, socioeconomic status, age, gender, geography, screening practices, healthcare access and lifestyle choices.
The report calls for:
- more focus on public awareness and education through culturally sensitive campaigns tailored to diverse ethnic groups, tackling stigma and fatalistic beliefs about cancer
- work in schools to make young people more aware of symptoms and cancer prevention
- support groups and counselling services for patients and families to address fears and emotional barriers
“The next largest impact can stem from strengthened community engagement between Integrated Care Systems, local authorities and local leaders to promote cancer awareness and screening in minority populations,” says Dr Scott, recommending culturally appropriate screening invitations, translation services and healthcare navigators to support understanding and access among those with language barriers, plus financial help and transport services for those on low incomes, in remote areas, or with physical difficulties.
“The healthcare system needs to improve training and awareness about learning, physical and mental health difficulties and its impact on patients in the NHS, and to mandate cultural competency training.”
People from more deprived backgrounds often experience higher cancer incidence and worse outcomes, due to limited access to preventative measures, delayed diagnosis and reduced access to high quality treatment.
Age-related barriers, such as physical frailty, cognitive decline and mobility challenges can impede timely access to healthcare services for older people, who can also face “ageist attitudes” within the healthcare system.
Regional disparities in cancer rates and outcomes also persist, along with differences in access to services between rural, urban and coastal areas.
“Lifestyle related factors such as smoking, diet, alcohol consumption and level of physical activity contribute significantly to variations in cancer rates, with socioeconomic challenges, like poverty and debt, exacerbating unhealthy behaviours.”
Ethnicity and cultural factors play a significant role in shaping attitudes and behaviours related to cancer, says the report. Delayed diagnoses are compounded by pessimism, fear, embarrassment, or cultural nuances, with some people lacking confidence in healthcare services or having “fatalistic” beliefs.
Bias in doctor-patient interactions can also contribute to delays in cancer diagnosis “often stemming from sub conscious stereotypes or assumptions related to a patient’s ethnicity, gender or socioeconomic status,” says the report.
“Such biases may cause doctors to minimise or dismiss symptoms presented by marginalised groups, delaying necessary tests or referrals. Additionally, linguistic and cultural communication barriers can exacerbate misunderstandings.”
Addressing these challenges requires initiatives aimed at improving health awareness, implementing culturally sensitive screening approaches and enhancing access to both primary and secondary care services, the report states.
It also makes recommendations for:
- More work on how cancer prevention and screening campaigns can target the specific challenges faced by deprived populations and ethnic minorities
- Research to understand the unique challenges of marginalised groups such as rough sleepers, migrants, people with substance abuse issues and those involved in the justice system – and develop tailored approaches to meet their specific needs
- Healthcare systems to improve data collection and ensure that cancer care disparities are accurately identified across all minority and marginalised groups
- Further investigation into the determinants of disparities for LGBTQ+ individuals and people with disabilities.
It concludes: “While progress has been made in cancer care, significant disparities remain, especially among deprived and marginalised populations.
“Addressing these inequities requires culturally sensitive care, targeted interventions and improved data collection to guide policy and practice.
“Ongoing research is essential to close these gaps and ensure equitable access to cancer services for all individuals, regardless of their background or circumstances.”
The full report, Health Inequalities in Cancer Care: A Literature Review of Pathways to Diagnosis in the United Kingdom, is available: Health inequalities in cancer care: a literature review of pathways to diagnosis in the United Kingdom - eClinicalMedicine (thelancet.com)
https://authors.elsevier.com/sd/article/S2589537024004437
It was co-authored by Professor Peter Hoskin, Clinical Director at the East of England Cancer Alliance.
He said: “This work brings together many of the issues the Cancer Alliance is seeking to address in achieving equal access to cancer diagnosis for all.
“It provides an important guide to those areas which need to be targeted as we address the difficulties faced by those who are least well represented in our current system of health care.”
Dr Emily Scott works as an Oncology Registrar at Mount Vernon Cancer Centre in Northwood, Middlesex, and with the East of England Cancer Alliance on reducing health inequalities in cancer care. She has contributed to various initiatives aimed at improving cancer care in the region, such as identifying barriers to earlier diagnosis of cancer after an emergency presentation, and Genomic testing.
She said: “I hope this report will shed light on the wide range of health inequalities that affect people with cancer – people who are often already disadvantaged in other ways.”
“I hope this review sparks more discussions on this important subject and leads to collaborative work to tackle it for the benefit of everyone in the East of England and more widely.”
Dr Emily Scott, Clinical Research Fellow with the East of England Cancer Alliance