Identifying, understanding and addressing inequalities in cancer treatment

Background. Cancer is a leading cause of mortality in the United Kingdom.

Chances for survival are improved when patients receive treatment (‘treatment receipt’), with further improvement when treatment is initiated early (shorter ‘time-to-treatment’).

Unfortunately, both are subject to inequalities, with people from marginalised groups being less likely to receive treatment / waiting longer to start treatment.

The evidence for these inequalities, however, is limited, with little-to-no research conducted for many cancers, treatments and marginalised groups, including most outlined in NHS England’s national framework for reducing health inequalities. Further, there is a lack of understanding as to why treatment inequalities exist, and how best to address them.

Aims.

The aims of this research, therefore, are to: 1. identify which marginalised groups experience inequalities in treatment receipt and time-to-treatment, for which treatments, in relation to which cancers (Study 1); 2. identify differences in cancer care experience (e.g. support from hospital staff), and the extent to which they mediate inequalities in treatment receipt and time-to-treatment (Study 2); 3. understand how differences in cancer care experience, and wider factors, lead to treatment inequalities (Study 3); 4. produce theory-based recommendations to inform the development of future interventions (Study 3).

Methods. Studies 1 and 2 will comprise a series of matched cohort studies.

In study 1, differences in treatment receipt and time-to-treatment will be compared, between marginalised groups and matched cohorts, using linked data from the Clinical Practice Research Datalink, the Cancer Registry and Hospital Episode Statistics.

In Study 2, differences in cancer care experience, and the extent to which they mediate treatment inequalities, will be examined using data from the National Cancer Patient Experience Survey.

Finally, in Study 3, the mechanisms by which differences in cancer care experience, and wider factors, lead to treatment inequalities, will be explored through interviews with patients and healthcare professionals. The data will be analysed using framework analysis, with findings mapped onto the Theoretical Domains Framework.

This will allow candidate behaviour change techniques to be identified, via the behaviour change technique taxonomy, and inform the development of future interventions. How the results will be used. The results will inform a future programme of research testing interventions to reduce treatment inequalities.

An online dashboard will also be developed, to support researchers to test their own interventions.

Further, the results will be used to co-create a CPD module and policy brief, which will be used to inform policy and improve service delivery.