Despite the implementation of a national cancer plan, social factors still strongly influence access to and the provision of care delivered by NHS hospitals in England, a new study has found.
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 healthcare for all social groups. But the extent to which access to healthcare has improved for all those in need regardless of their socio-economic circumstances, age or sex has not been examined.
So a team of researchers at University College London set out to determine the extent to which type of hospital admission 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 three cancers accounted for 64 per cent of all new cancer cases diagnosed in 2006 and 40 per cent of deaths from cancer in 2007 in England.
Using hospital episode statistics, the researchers 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 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
From the findings, the study’s authors concluded 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 recommended audit of local surgical practice and monitoring of sociodemographic variations in procedure use “to raise standards and ensure best practice”.
BMJ Online: http://www.bmj.com/cgi/doi/10.1136/bmj.b5479