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Cancer strategies failed to improve one-year survival

And no evidence that they reduced socioeconomic inequalities in cancer survival in England

Louise Prime

Thursday, 15 March 2018

Increasing cancer survival and reducing inequalities in survival have been among the main targets of national cancer policy initiatives implemented in England since 2000 – yet despite this, there is little evidence of a direct impact of these strategies on one-year survival, and no evidence for a reduction in socioeconomic inequalities in survival, according to research* published today in the BMJ. The authors of an accompanying commentary** said the study shows that the goals of the NHS Cancer Plan to save lives and to ensure that these gains were evenly shared remain critical, and that the methods to achieve them need more work.

A research team from the Cancer Survival Group at the London School of Hygiene and Tropical Medicine conducted a population cohort study to assess the effectiveness of the NHS Cancer Plan (2000) and subsequent national cancer policy initiatives in improving cancer survival and reducing socioeconomic inequalities in survival in England. They analysed data for more than 3.5 million registered patients aged 15-99 with a diagnosis of one of the 24 most common primary, malignant, invasive neoplasms between 1996 and 2013, and calculated age-standardised net survival estimates by cancer, sex, year, and deprivation group.

They reported that one-year net survival improved steadily from 1996 for 26 of the 41 sex-cancer combinations that they studied, and only from 2001 or 2006 for four cancers. Trends in survival accelerated after 2006 for five cancers.

They found that the ‘deprivation gap’ observed for all 41 sex-cancer combinations among patients with a diagnosis in 1996 persisted until 2013. However, the gap slightly decreased for six cancers among men for which one-year survival was more than 65% in 1996, and for cervical and uterine cancers, for which survival was more than 75% in 1996. Furthermore, the deprivation gap widened notably for brain tumours in men and for lung cancer in women.

The authors of the study acknowledge that its limitations included that it might be too early to detect the full impact of recently implemented cancer initiatives – but as it is based on almost all cancer cases registered in England over 18 years, it allows for more accurate estimates of trends.

They concluded: “Little evidence was found of a direct impact of national cancer strategies on one-year survival, and no evidence for a reduction in socioeconomic inequalities in cancer survival. These findings emphasise that socioeconomic inequalities in survival remain a major public health problem for a healthcare system founded on equity.”

In their commentary, experts from the University of Otago in New Zealand pointed out that drivers of social disparities in cancer outcomes are complex, making it difficult to establish cause and effect. They said genuine improvements might 'require a more comprehensive approach than the NHS reforms', as people’s ability to access care can also depend on factors such as employment stability, geographical isolation and family support.

They concluded: “To reduce the incidence and impact of cancer we must continue to be ambitious. The goals of the NHS Cancer Plan were to save lives and to ensure that the gains were evenly shared. These goals remain critical. The methods to achieve them need more work.”

*Exarchakou A, Rachet B, Belot A, et al. Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study. BMJ 2018; 360: k764. http://dx.doi.org/10.1136/bmj.k764.

**Sarfati D, Jackson C. Editorial: Cancer inequalities endure despite NHS Reforms. BMJ 2018; 360: k989 doi: 10.1136/bmj.k989.

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