Health inequalities leave those in deprived regions most at risk of cancer
Financial and health inequalities are seeing cancer care in the most deprived regions of the UK fall behind – so how can we level up prevention, diagnosis, and treatment?
Over the last two years, COVID-19 has placed huge pressure on all parts of the NHS, particularly cancer screening and treatment. Thousands have faced delays to their care, while clinical trials and other vital research have also been impacted. And the long-term effects are still to be felt; backlogs in diagnosis and care, the financial impact on funders of cancer research, and worsening inequalities.
Even before the pandemic, the most deprived regions of the UK faced around 20,000 extra cases a year. In Greater Manchester, healthcare inequalities and socioeconomic deprivation overlap, leaving people from the most disadvantaged backgrounds facing worse outcomes across the whole cancer care pathway. Those from poorer areas are less likely to attend cancer screening tests – while simultaneously facing a higher risk of cancer due to the lifestyle choices available to them – with the knock-on effect that they are then diagnosed later in the disease’s progression.
Figures in the new On Cancer report, published by The University of Manchester’s policy engagement institute, Policy@Manchester, show that 49% of the most deprived patients have an early stage diagnosis, compared to 58% for the least deprived. In its starkest terms, those who are most disadvantaged in life to begin with are also most likely to be affected by cancer.
So how do we start to close the gap in health inequalities? Academics from the University believe one starting point is to make screening and diagnosis services more easily available, which means moving them out of the hospital, and in to the community. The Lung Health Check (LHC), pioneered by researchers at the University with partners from across Manchester, took mobile screening units to public spaces around the region.
It offered an opportunity to engage with health professionals in a much more informal setting, and the results were soon clear; 79% of those who were diagnosed with lung cancer through the LHC were stage one, compared to a national average of just under 20% of those diagnosed in a clinical setting. Not only is treatment significantly more accessible at this stage, it also reduces the cost to the NHS of late diagnosis, while reaching disadvantaged communities. The LHC is now being deployed on a national scale, funded by NHS England.
In Greater Manchester, healthcare inequalities and socioeconomic deprivation overlap, leaving people from the most disadvantaged backgrounds facing worse outcomes across the whole cancer care pathway.
Also in Manchester, the University’s digital Experimental Cancer Medicine Team (digital ECMT) is working on moving monitoring services for cancer patients undergoing treatment into their homes. These proof of concept studies could pave the way for in-home analysis, allowing for earlier interventions, as well as potentially increasing the length of time a patient can stay on treatment. In On Cancer, the academics leading these studies call for policymakers and regulators to develop and deploy new ideas and technology in an ethical way, with the needs of patients – particularly the most disadvantaged – first and foremost.
Another key recommendation in On Cancer is to set minimum acceptable standards around the construction and use of AI, algorithms, and data in cancer care pathways. These technologies promise to speed up cancer diagnosis by cutting waiting times and improving the accuracy of results. But there are currently very few algorithms successfully deployed in healthcare, with trust and transparency two major barriers. Policymakers have a role in creating and enforcing minimum standards to support the deployment of new technologies.
The solutions are not just in frontline treatment. The North of England – particularly Manchester, Barnsley, Sheffield, and Darlington – possesses all of the research and industrial infrastructure to become a global hub for advanced cell and gene cancer therapies. The UK as a whole, despite being less than 1% of the world’s population, conducts 12% of gene therapy trials.
This is a distinctive edge for the UK’s life sciences sector, but underinvestment in domestic bioproduction facilities leaves us at risk of falling behind. Funding for a cell production facility in the North West would not only join up this infrastructure and enhance our national research capacity, but also deliver on the levelling-up promise made at the 2019 General Election. It would create highly skilled jobs, shorten supply chains, and stimulate private investment in the region.
A final way to boost our health and economy, argues the On Cancer report, is to invest in international collaborations. The Manchester Cancer Research Centre has partnered with Kenyan health authorities and researchers to improve clinical services for cancer in Kenya, by deploying successful models of care developed in Manchester.
Relationships like these provide opportunities for export, training, and investment both locally and internationally, while boosting the UK’s global profile. Policymakers have a role to play in agreeing mutual standards on issues like ethical approval and sharing of research data, and to develop reciprocal agreements around training overseas healthcare workers, that benefit both the NHS and overseas partners.
COVID-19 has put enormous pressure on every part of our health and care system, and cancer services are no exception. But as we emerge from the pandemic, we have an opportunity to implement new approaches to cancer prevention, diagnosis, and treatment; moving services out of the hospital, integrating data and AI into healthcare, and seizing international opportunities in life sciences and cancer care.
On Cancer was distributed with the latest edition of The House magazine. You can find out more about the publication, and read it here.
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