Cancer diagnosis in people with disability: a multi-methods international project on diagnostic pathways and cancer outcomes

Background Under the UK Equality Act 2010, a disabled person is "someone who has a physical or mental impairment that has a 'substantial' and 'long-term' negative effect on their ability to do normal daily activities”.

People with disability can face barriers in accessing timely cancer diagnosis, with worse outcomes, as also highlighted by the COVID-19 pandemic. Population-based evidence on cancer diagnosis by disability is scant, and mostly referring to North America.

Research on disability and cancer in the UK and Europe is primarily based on small qualitative studies, and a few quantitative studies on mental health or learning disability and screening.

Population-based evidence is needed on diagnostic pathways and cancer outcomes for patients with different disability types, identifying where delays occur and characterizing groups at higher risk of delays.

Aims We aim to investigate variations in cancer care among individuals with psychiatric, intellectual, neurological and sensory disability for improving cancer diagnosis and outcomes.

Specific objectives:1) identify where delays occur along cancer diagnostic pathways, 2) characterize patient groups at higher risk of delays and poorer outcomes, 3) identify possible areas for improvement, and 4) consider international comparative analyses.

Methods Utilizing a multi-methods approach, we will analyze population-based linked primary care, secondary care and cancer registration data, and we will conduct qualitative interviews with patients/carers and healthcare providers. The study will include patients diagnosed with breast, cervical, colorectal, and lung cancer between 2011 and 2020.

Data sources will include the Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics, diagnostic imaging, Cancer Waiting Times and cancer registration data in the UK.

Linked electronic health records and cancer registration data from ATS-Milan, Northern Italy will allow to perform international comparative analyses.

Additionally, qualitative interviews with patients/carers and healthcare providers (GPs, mental health and cancer specialists) will be examined using thematic analysis, exploring experiences and challenges in cancer diagnosis. We will collaborate with UK charities and the Disabled Advanced Medical Assistance (DAMA) in Italy.

How the results of this research will be used The findings will provide novel population-based evidence on variations in cancer care by disability status.

By identifying where delays occur along diagnostic pathways and characterizing patient groups at higher risk of delays, the findings will highlight specific areas where healthcare delivery can be improved.

The results will be used to inform future larger projects and international collaborations aimed at developing targeted interventions. The findings will support equitable access to timely