Article Text


Cancer survival
036 Socio-economic inequalities in cancer survival in England after the NHS cancer plan
  1. L Ellis,
  2. B Rachet,
  3. C Maringe,
  4. M P Coleman
  1. Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK


Objectives Socio-economic inequalities in survival have been reported for most adult cancers in England. The NHS Cancer Plan (2000) aimed to improve cancer patient survival, and tackle inequalities in survival between people from deprived and affluent backgrounds. Recent observations suggest some improvements in survival have accelerated since implementation of the Cancer Plan. This study investigates the efficacy of the Cancer Plan in tackling inequalities in cancer survival.

Design We examined data for all adults registered in the National Cancer Registry and diagnosed with one of 21 common cancers in England during 1996–2006 and followed up to 31 December 2007. We defined a priori three calendar periods of diagnosis in relation to the NHS Cancer Plan: 1996–2000 (before the Cancer Plan), 2001–03 (initialisation) and 2004–06 (implementation).

Main outcome measures One-year relative survival by sex and socio-economic group for each of the 11 calendar years was estimated using a maximum-likelihood approach. Life tables by age, sex, calendar year, deprivation category and Government Office Region were used to control for the variability in background mortality. The “deprivation gap” (quantified as the difference between survival in the most deprived and most affluent groups) was estimated with variance-weighted linear regression. Changes in the deprivation gap within and between the three successive calendar periods were also examined.

Results For patients diagnosed during 1996, 1-year survival in the most deprived group was lower than the most affluent group for 34 of the 35 cancer-sex combinations examined (27 significant at 5%). The figure was almost identical a decade later, in 2006, with lower survival in the most deprived group for 32 of the 35 cancer-sex combinations (23 significant at 5%). Although trends in the deprivation gap fluctuated between calendar periods, overall, between 1996 and 2006, the deprivation gap widened for 14 cancer-sex combinations (increasing by more than 2% for 3 cancers in women and 5 cancers in men), and narrowed for 21 (decreasing by more 2% for 6 cancers in women and 1 cancer in men).

Conclusion For most cancers, the deprivation gap in survival has changed very little since the introduction of the NHS Cancer Plan. Despite small reductions in the deprivation gap for some cancers, there was no obvious acceleration in the reduction since the NHS Cancer Plan. Inequalities in cancer survival were still large for many cancers in 2006.

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