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The Contribution of Cancer Networks to reduce impact of ethnicity
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The Contribution of Cancer Networks
to reduce impact of ethnicity, age
and gender on inequalities in cancer
care
Mary Barnes
Director
ASWCS
Cancer Reform Strategy
One of the key aims of the Cancer Reform
Strategy (2007) is to reduce inequalities in
cancer incidence and increase access to
high quality cancer care and cancer
outcomes
Cancer Reform Strategy
Preventing cancer
• Over half of cancers could be prevented by changes to
lifestyle
• Smoking, obesity, alcohol, sun & sun beds, vaccination
Diagnosing cancer earlier
• Late diagnosis is the major factor contributing to poor
cancer survival rates in England
• Screening – cervical, breast, bowel
Reducing cancer inequalities
• Major inequalities in cancer incidence, access to
services and outcomes
Sources of inequality relating to
cancer
• Exposure to infections linked to cancer
• Genetic risk of developing cancer
• Awareness an attitude to lifestyle risk
factors
• Uptake of prevention and screening
services
• Access to diagnostic and treatment
services
• Provision of information and support
Risk groups within society
• Socio-economically deprived groups
• Black and minority ethnic groups
• Older or younger people
• Men and women
• People with disabilities
• People from particular religions
• Gays, lesbians or bisexuals
Race and Cancer
• The incidence varies between ethnic
groups;-
• Prostate cancer is higher in African
Caribbean men
• Mouth cancer is higher amongst south
Asians
• Liver cancer is higher among
Bangladeshis and Chinese
Patient experience surveys have
shown that BME groups, in general,
report a worse experience of
treatment and care
The National Cancer Equality
Initiative
• Advise on optimising data collection to enhance
understanding of inequalities that exist
• Advising on promoting research on how to fill
gaps in evidence
• Advising on how best to identify & spread good
practice
• Taking part in identifying & agreeing key work
streams
• Producing an action plan with key identifiable &
measurable goals to reduce inequalities in
cancer care
National BME Patient Programme
• In 2009 all 28 Networks and 111 trusts provided
information about services available for BME cancer
patients
• Aim:-
• Develop a baseline on spread of resources
• Share best practice
• Develop a BME specific commissioning check list
• Identify training to deliver culturally sensitive services
• Develop a culturally sensitive care information pathway
to be used alongside national information pathways
• Analysis underway
Age and Cancer
• Cancer predominantly affects older people
• 51% of all cancer diagnosed is in people
over 70 years
• ¾ of all cancer deaths occur in people
aged over 65 years
• Clinical trials focus on under 65’s
• However, teenagers are not offered the
same access to trials as adults
• Trend in fraction of pathologically verified lung cancers in the
South West Source: SWPHO
100
Percentage of path-verified cases (%)
80
60
40 Under 75 years
75 years and over
20
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year of diagnosis
Change in <75 Year Mortality from All Cancers*; Males.
South West Local Authorities, 1995/97 to 2005/07
Change in age standardised m ortality rate between 1995/97 and 2005/07
Age standardised m ortality rate 2005/07
England
South West
Plymouth
Christchurch
Weymouth and Portland
Bristol
Exeter
Penwith
Taunton Deane
Kerrier
Torbay
Bournemouth
Restormel
Carrick
Purbeck
Cheltenham
West Wiltshire
South Somerset
Sedgemoor
Mid Devon
Tewkesbury
Mendip
Gloucester
Caradon
Forest of Dean
Swindon
North Wiltshire
Poole
West Devon
South Gloucestershire
North Dorset
Cotswold
Kennet
South Hams
North Cornwall
North Somerset
Bath and North East Somerset
Teignbridge
North Devon
West Dorset
East Devon
East Dorset
Salisbury
Stroud
Torridge
West Somerset
80 100 120 140 160 180
Age Standardised Mortality Rate**
Source: NCHOD * ICD10 codes C00 - C97
** Rate per 100,000 m ales aged <75 per year, directly standardised to the
European Standard Population age structure.
Change in <75 Year Mortality from All Cancers*; Females.
South West Local Authorities, 1995/97 to 2005/07
Change in age standardised m ortality rate between 1995/97 and 2005/07
Age standardised m ortality rate 2005/07
England
South West
Kennet
Caradon
Forest of Dean
Kerrier
Exeter
Weymouth and Portland
Swindon
Gloucester
Sedgemoor
North Cornwall
Restormel
Purbeck
Bristol
Torridge
North Wiltshire
Torbay
Carrick
West Wiltshire
Tewkesbury
Plymouth
Teignbridge
South Hams
Cheltenham
North Dorset
North Devon
South Gloucestershire
Bournemouth
Penwith
Poole
Mendip
Christchurch
Cotswold
Bath and North East Somerset
Stroud
South Somerset
North Somerset
East Dorset
Taunton Deane
Salisbury
West Devon
West Dorset
Mid Devon
East Devon
West Somerset
70 80 90 100 110 120 130 140 150
Age Standardised Mortality Rate**
Source: NCHOD * ICD10 codes C00 - C97
** Rate per 100,000 f em ales aged <75 per year, directly standardised to the
European Standard Population age structure.
Target
Target
2005/07
OHN 2010
Source: NCHOD
West Somerset
Mid Devon
East Devon
Bournemouth
West Dorset
Cheltenham
South Somerset
Penwith
Bristol
North Somerset
Taunton Deane
Christchurch
West Devon
Bath and North East Somerset
Stroud
Salisbury
Teignbridge
Plymouth
North Cornwall
Mendip
Restormel
Gloucester
Weymouth and Portland
North Devon
Swindon
Poole
Cotswold
Torbay
South Hams
Kerrier
Exeter
South Gloucestershire
Sedgemoor
South West Local Authorities, 1995/97 to 2005/07
Purbeck
East Dorset
Change in <75 Year Mortality from All Cancers*; Females
Torridge
Tewkesbury
* ICD10 codes C00 - IC97
North Wiltshire
Kennet
Carrick
North Dorset
Caradon
European Standard Population age structure.
Forest of Dean
West Wiltshire
South West
England
0
10
20
30
40
-30
-20
-10
% Reduction in SMR**
** Rate per 100,000 females aged <75 per year, directly standardised to the
Target
Target
2005/07
OHN 2010
Source: NCHOD
West Somerset
Torridge
Forest of Dean
Swindon
South Hams
Stroud
West Dorset
Caradon
Bath and North East Somerset
Torbay
Gloucester
Sedgemoor
South Gloucestershire
Bristol
East Devon
Plymouth
Teignbridge
North Wiltshire
Kerrier
Bournemouth
Carrick
South West
England
North Cornwall
North Dorset
East Dorset
North Devon
Weymouth and Portland
Salisbury
West Wiltshire
North Somerset
Mendip
Penwith
South West Local Authorities, 1995/97 to 2005/07
Poole
Change in <75 Year Mortality from All Cancers*; Males
Restormel
Cheltenham
Kennet
* ICD10 codes C00 - IC97
Purbeck
West Devon
South Somerset
Taunton Deane
Mid Devon
European Standard Population age structure.
Cotswold
Exeter
Christchurch
Tewkesbury
0
10
20
30
40
-30
-20
-10
** Rate per 100,000 males aged <75 per year, directly standardised to the
% Reduction in SMR**
Age specific mortality rates for 2003-05
• The UK has a higher cancer death
rate in over 75’s than Western
Europe
• The Equality Bill sets out a clear
legal requirement to treat adults of
all ages equitably
• The ban on age discrimination will
make it unlawful to treat someone
less favourably because of age
• The ‘Achieving age Equality in
Health and Social Care’ report will
inform decisions related to
implementing the Equality Bill and
guide implementation of the
legislation
Age standardised mortality per 100,000 population
Men Women
Lung 55.8 28.4
Colorectal 24.0 14.7
Oesophagus 13.0 5.1
Stomach 10.9 4.3
Pancreas 9.6 7.3
Bladder 9.1 3.0
Non Hodgkins 7.5 4.7
Lymphoma
Leukaemia 6.8 4.3
Kidney 6.1 2.3
Melanoma 2.7 1.9
Excess Burden of Cancer in Men
Excess Burden of Cancer in Men
Factors involved in the
development of cancer in men
• Lifestyle
• Genetics
• Knowledge of genetic links within families
• Reduced uptake of available screening
• Help seeking behavior
• Knowledge of cancer
White, A, Thomson, C, Forman, D,(2009) The Excess burden of cancer in
men, NCIN, London
Top ten most common cancer cases for men, UK 2006
Top ten most common cancer deaths for men 2007
Life Expectancy at Birth (Years)
65
70
75
80
85
90
Bristol
Plymouth
Weymouth and Portland
Bournemouth
Source: ONS, NCHOD.
Gloucester
Swindon
Forest of Dean
Torbay
Exeter
Torridge
Restormel
North Devon
Penwith
North Cornwall
Sedgemoor
Kerrier
Teignbridge
North Somerset
Caradon
* Calculations based on data f or 2000-2002 (local authorities) and 1999-2003.
Taunton Deane
West Wiltshire
Cheltenham
Stroud
Mendip
West Dorset
South Somerset
Kennet
Male Life Expectancy at Birth;
East Devon
West Devon
North Wiltshire
Salisbury
Carrick
Bath and North East Somerset
Poole
South West Local Authorities and their Constituent Wards*
Mid Devon
South Gloucestershire
Cotswold
West Somerset
Tewkesbury
South Hams
Christchurch
North Dorset
Purbeck
East Dorset
Female Life Expectancy at Birth;
South West Local Authorities and their Constituent Wards*
95
90
)
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w y s e e o u K o M K a o e
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t
t g
t o
t m h
t n m u c
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l
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l h
t o o W W C
S n s d
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s P h
t s
i
P R r s d e r S
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w
t h o
t e e e e a S
o i S
t a r r
u G e n h o h h h
t e
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Source: ONS, NCHOD. B
* Calculations based on data f or 2000-2002 (local authorities) and 1999-2003.
Observations
• DH is interested in local variations
• Important that local targets are managed
by local health communities
• Support current efforts to look at outliers
and the potential underlying causes
• May need to focus on specific cancers e.g.
breast and colorectal
• New interventions may have an impact
e.g. public awareness and early diagnosis
National Awareness and Early
Diagnosis Initiative (NAEDI)
• Review of the evidence base on links between early
diagnosis and survival
• Measuring awareness of cancer symptoms
• Interventions to promote early presentation
• Interventions in primary care and understanding the
nature of primary care delay
• International benchmarking against countries with better
outcomes for selected cancers
• Prospective research to identify and fill gaps in the
knowledge base
• Key messages which use language consistently and
effectively
Awareness and Early Diagnosis
The Core Hypothesis
Key principles of equality working
• Interventions to reduce inequalities should
be undertaken where there is clear local
evidence that inequality exists
• Evidence from;
– local equality impact assessments
– Local health equity audits
– Joint strategic needs assessment
– Process mapping of patient pathways
– Use of NAEDI baseline Assessment
Baseline Assessments
ASWCS Plan
• The development of an ASWCS public health
strategy
• Developing an Implementation action plan
• Establishing a public health cancer leads
steering group
• Strengthening links with SWPHO
• Developing cancer awareness using the national
CAM toolkit
• Evaluation of the primary care NAEDI audit
