Cancer survival by socio-economic group

Since the 1970s, there have been well-documented inequalities in cancer survival in England. The NHS Cancer Plan, which was published in September 2000, aimed to reduce inequalities in cancer survival between rich and poor.[1] This has now been superseded by the Improving Outcomes: A Strategy for Cancer, which was published in 2011.[2]

During the 1990s cancer survival improved significantly for almost all the common cancers. However, for many cancers, survival improved more for patients living in more affluent areas than for those in more deprived areas.[3]

Possible explanations for the lower survival in people living in more deprived areas include differences in:

• diagnosis (delays, advanced stage of disease);
• treatment (delays, poorer access to optimal care and lower compliance);
• worse general health (worse in more deprived) and type of disease (histological type or more aggressive disease).[1,4-12]

When one-year survival is high, as it is for malignant melanoma and cancers of the female breast, prostate and testis, then there is less room for improvement, especially in the people living in more affluent areas, in whom survival is highest. Most of the gains in survival are experienced in people living in the most deprived areas where there remains more scope for improvement. The increase in the survival gap between people living in the most affluent and most deprived areas for prostate cancer appears to be largely the result of socio-economic differences in access to prostate specific antigen (PSA) testing.[13]

One-year cancer survival for adults in England is generally lower among patients living in more deprived areas.[1] Overall, between 1996 and 2006, the deprivation gap in one-year survival narrowed for 8 cancers in men and 13 in women, but widened for 9 cancers in men and 5 in women. The largest observed deprivation gap increase between 1996 and 2006 was for female oesophageal cancer where the deprivation gap increased by 6.5 percentage points over this period. The largest decrease was observed for Hodgkin lymphoma in males where the deprivation gap decreased by 8.7 percentage points over the same period.

Deprivation Gap in One-Year Relative Survival (%) by Sex in 1996 and 2006

Three-year cancer survival for adults in England is also generally lower among patients living in more deprived areas.[1] Overall, between 1996 and 2000, a significant deficit in three-year survival among patients living in the more deprived areas was observed for 33 of the 35 cancer-sex combinations examined.[1] During 2001-2003 a deficit was observed for 26 of the 35, and during 2004-2006 it was observed for 24 of the 35 cancer-sex combinations examined. Brain cancers in men, where more deprived groups have higher survival, is the only site where the deprivation gap was consistently positive throughout the period 1996-2006.[1]

A 2011 study aimed to quantify the public health impact of inequalities in cancer survival between most and least deprived, by estimating the number of cancer-related deaths that would have been avoidable if all patients were to have the same cancer survival as those living in the most affluent areas.[1]

For patients diagnosed with one of 21 common cancers in England during 2004-2006, a total of 7,122 of the 64,940 excess (cancer-related) deaths a year would have been avoidable within three years since diagnosis if survival for all patients had been as high as in patients living in the most affluent areas.