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. 2010 Aug 10;103(4):446-53.
doi: 10.1038/sj.bjc.6605752. Epub 2010 Jun 29.

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

B Rachet  1 , L Ellis, C Maringe, T Chu, U Nur, M Quaresma, A Shah, S Walters, L Woods, D Forman, M P Coleman
Affiliations

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

B Rachet et al. Br J Cancer. .

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.

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Figures

Figure 1
Figure 1
One-year relative survival for rectal cancer for the most deprived and most affluent groups, by sex, England 1996–2006. Lines are the regression plots fitted in a single model, which comprises every survival estimate by deprivation and calendar year (see text); dashed line: most deprived group; plain line: most affluent group.
Figure 2
Figure 2
(A) Trends in 1-year relative survival for the most deprived and most affluent groups, by cancer prognosis, England 1996–2006. Lines are the regression plots fitted in a single model, which comprises every survival estimate by deprivation and calendar year (see text); dashed line: most deprived group; plain line: most affluent group. (B) Trends in deprivation gap in 1-year relative survival, by cancer prognosis, England 1996–2006. Deprivation gap is the simple difference in 1-year relative survival between the most deprived group and the most affluent group. Lines are the regression plots fitted in a single model, which comprises every survival estimate by deprivation and calendar year (see text).
Figure 3
Figure 3
Excess hazard of death for the most deprived and most affluent groups, by cancer prognosis, England 1996–2006.
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