Socioeconomic inequalities in cancer survival in England after the NHS cancer plan

Abstract

Background:Socioeconomic inequalities in survival were observed for many cancers in England during 1981–1999. The NHS Cancer Plan (2000) aimed to improve survival and reduce these inequalities. This study examines trends in the deprivation gap in cancer survival after implementation of the Plan.Materials and method:We examined relative survival among adults diagnosed with 1 of 21 common cancers in England during 1996–2006, followed up to 31 December 2007. Three periods were defined: 1996–2000 (before the Cancer Plan), 2001–2003 (initialisation) and 2004–2006 (implementation). We estimated the difference in survival between the most deprived and most affluent groups (deprivation gap) at 1 and 3 years after diagnosis, and the change in the deprivation gap both within and between these periods.Results:Survival improved for most cancers, but inequalities in survival were still wide for many cancers in 2006. Only the deprivation gap in 1-year survival narrowed slightly over time. A majority of the socioeconomic disparities in survival occurred soon after a cancer diagnosis, regardless of the cancer prognosis.Conclusion:The recently observed reduction in the deprivation gap was minor and limited to 1-year survival, suggesting that, so far, the Cancer Plan has little effect on those inequalities. Our findings highlight that earlier diagnosis and rapid access to optimal treatment should be ensured for all socioeconomic groups.

How many deaths would be avoidable if socioeconomic inequalities in cancer survival in England were eliminated? A national population-based study, 1996–2006

“…4 Socioeconomic inequalities in survival persist for most adult cancers in England, and the NHS Cancer Plan has, so far, had little effect on reducing the deficit in survival between rich and poor. 2 The number of deaths among cancer patients within three years of diagnosis that would have been avoidable if inequalities in survival did not exist helps to quantify its public health importance. It provides insight into how much the excess cancer mortality could be reduced if the levels of survival attained by the most affluent patients could be achieved in all patients, after adjusting for the differences in background mortality between socioeconomic groups.…”

“…Despite differential trends in lung cancer incidence in men and women, 19 examination of avoidable deaths by sex revealed only small differences because relative survival and the 'deprivation gap' in survival are similar for both sexes and have been for several decades. 2,20 One of the most rapid falls in the annual number of avoidable deaths was among men diagnosed with prostate cancer, and this was despite a substantial increase in the number of patients diagnosed over the period 1996-2006. An explanation for these phenomena may be an equalisation in the uptake of PSA testing among affluent and deprived men.…”

“…8 To estimate the number of avoidable deaths, we first produced estimates of relative survival: the method is described in detail elsewhere. 2 Briefly, we used National Cancer Registry data on all adults (15-99 years) diagnosed with one of 21 common primary malignant neoplasms in England during the 11 years 1996-2006 and followed up to the end of 2009. These 21 common cancers represent 90.7% of all cancers.…”

“…1,2 The origins of these disparities in survival are still not fully understood, but factors such as stage at diagnosis and access to optimal treatment have been implicated. 3 Such observations suggest that deprived patients do not benefit equally from health-care services in the UK, despite a universal health-care system that is free to all at the point of use.…”

“…5 However, there is little evidence that the Cancer Plan has been effective in reducing socioeconomic inequalities in short-term survival in the period up to 2006. 2 Inequalities in short-term survival between rich and poor were still large for many cancers among patients diagnosed in 2006.…”