Health inequalities are complex and far reaching, hence collecting data on health inequalities at both community and individual patient level is essential, writes Dr Neal Navani.
The covid-19 pandemic, together with the current cost of living crisis, have shone a light on the huge health disparities and deep inequalities running through our society, not least in UK lung cancer.
Lung cancer remains the UK’s biggest cancer killer, with nearly 35,000 deaths per year, and has the widest deprivation gap compared to other cancers. Yet almost 80 per cent of lung cancer cases are preventable.
A new report published on 3 November 2022 by the UK Lung Cancer Coalition states if we address health inequalities successfully in lung cancer, we will have a significant impact on overall UK cancer outcomes. It recommends comprehensive approach to data collection in health inequalities - to bridge gaps in current knowledge, improve outcomes and ensure people who have, or who are at high risk of lung cancer have equitable access to diagnosis, treatment, and care.
The National Lung Cancer Audit is extremely well-placed to assist in this endeavour. Since 2004, when it was established, the NLCA’s quality data and reporting has played an instrumental role in helping the NHS to make steady progress in improving the quality of care and outcomes for lung cancer patients in England and Wales, and more latterly also in Jersey and Guernsey.
Commissioned by the Healthcare Quality Improvement Partnership and now run and managed by the Royal College of Surgeons, the NLCA takes clinical data from hospital trusts and the cancer registry, case mix adjusts, benchmarks and reports back to trusts with recommendations. Year on year it has demonstrated unwarranted variations in practice and has acted as a driver in reducing them.
In its latest 2022 audit analyses, the NLCA has sharply revealed the impact of the pandemic. Using the rapid cancer registration data for the first time, it has shown that compared with 2019, lung cancer patients diagnosed in England in 2020 had worse performance status, were more likely to be diagnosed via emergency presentation and less likely to have a pathological diagnosis. Curative treatment rates fell from 81 per cent in 2019 to 73 per cent in 2020 with a drop-in surgical resection rate from 20 per cent to 15 per cent. These factors may contribute to worse survival in 2020.
Tackling inequalities has been a health service ambition for some time, but we need more progress.
The UKLCC report recommends combining this kind of outcomes data from the NLCA, with data on health inequalities. While there is a vast amount of data on deprivation and lung cancer, there is limited data on other health inequality factors, such as ethnicity, lesbian, gay, bisexual, transgender, queer, and other health inequality factors such as gender, religion, disability, distance from health service, and homelessness. Resourcing would be required to pool existing NLCA data in ethnicity, for example, to make it more statistically powerful – but it is wholly achievable.
Extending the remit of the NLCA would therefore be a powerful way of measuring success of mitigating actions in lung cancer. It would also improve our understanding of what, and how, health inequalities affect groups not studied before. This could also be achieved by mandating trusts and boards to complete information on inequalities and encouraging the cancer registry in each nation to collect data on inequalities.
Health inequalities are complex and far reaching, so collecting data on health inequalities at both community and individual patient level will also be essential. For example, relatively small changes to holistic needs assessments could allow information to be recorded regarding health inequalities, together with the patient’s personal treatment and care plan.
While it’s vital we collect more robust quality data, we do have enough evidence to know that governments can play a crucial role in reducing health inequalities. Following the positive recommendation of the UK National Screening Programme, the four UK governments must now act to establish targeted lung cancer screening programmes, which will have an immediate impact on health inequalities. Targeted disease awareness and smoking cessation campaigns in those areas of most need should also be fully funded.
Tackling inequalities has been a health service ambition for some time, but we need more progress. Putting pressure on governments, and a co-ordinated effort by the lung cancer community, can help to ensure that no one is disadvantaged because of their background or where they live.
No comments yet