Cancer services need to be systematically redesigned to take into account the impact of social inequality on patients’ experience of the disease, according to a new report.
Less well-off patients face more delays, psychological barriers such as self-blame and stigma and financial stress, notes the report by social change think tank Tasc.
Differences in the economic and social resources available to different cancer patients fundamentally determine their experience when ill with cancer, including incidence and outcomes for some types of the disease, it says.
“The barriers created by social inequality affect their experience from pre-diagnosis through to post-treatment.”
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Among the barriers faced by disadvantaged patients are delays accessing primary services, fewer GPs in deprived areas and the direct and indirect financial costs of treatment, including transport expenses and loss of income.
The report says the coronavirus pandemic has aggravated many of the barriers that were already in place. “Patients, for example, have delayed reporting cancer symptoms for fear of contracting the virus while visiting GPs and existing cancer patients have been fearful of contracting Covid and then losing their jobs.”
Early diagnosis
It calls for targeted investment to reach those most at risk, including greater capacity in primary care in deprived areas and investment in localised and community-facing services aimed at disadvantaged and marginalised groups.
Expansion of cancer prevention and early diagnosis interventions, including a new approach to promotion of healthier lifestyles and access to amenities by disadvantaged groups during post-treatment recovery, is proposed.
Tasc director Shana Cohen said the report “highlights a plethora of crisscrossing gaps and deficiencies that make cancer a more devastating disease for less well-off individuals and families. Disadvantaged patients also experience self-blame and stigma, which may be made worse by current public ‘healthy lifestyle’ messaging. The psychological impact for such cancer cases requires attention.”
If cancer outcomes are to significantly improve, strengthening of relationships between hospitals, community services and cancer support services is required, the report says.
Ms Cohen cited the example of facilities such as parks and gyms which are encouraged for recovery from cancer and should be supported publicly, particularly for deprived communities.
People from the most deprived fifth of the population have a seven percentage-point greater rate of stage IV stomach cancer than those from the least deprived fifth of the population, according to a figure quoted in the report, though this dates from 2012 and earlier.
The report was commissioned and funded by Merck Sharp Dohme, but Tasc said the pharmaceutical company had no editorial influence on it.
Separately, the Marie Keating Foundation has called on the Government to introduce a national screening programme for lung cancer. The cancer charity warned that lung cancer rates are set to more than double over the next 20 years.
