Rich benefit most from improved treatment of cancer, study claims

Sarah Boseley, The Guardian, March 10, 2004

Rich people are more likely to survive cancer than poor people in England
and Wales, and the gulf in their life chances has been steadily widening,
according to research released yesterday.

The prognosis for most cancers has been improving but an international team
of researchers backed by Cancer Research UK revealed yesterday that it is
the affluent who are profiting the most from today's faster diagnosis and
better treatment, while the prospects for the poor lag years behind. If all
cancer patients were equal, an extra 3,000 lives could be saved every five
years, they estimate.

Their analysis of data from the English and Welsh cancer registries,
published yesterday in the British Journal of Cancer, reveals the
seriousness of the health divide. While the government pointed out that its
national cancer plan was published just after the period for which we have
survival figures, the widening of the socio-economic gulf over the previous
15 years, in spite of initiatives to address health inequalities, bodes
ill.

Most shocking was the disparity in the survival rates of men five years
after a diagnosis at some point between 1996 and 1999 of cancer of the
larynx. The gap between rich and poor was 17.2%. For men diagnosed with
cancer of the rectum, the gap was 9.4% and for women 8.3%, for women with
cancer of the colon it was 7.3% and for women with myeloma it was 7.7%.

"We have evidence of trends in survival which are, generally speaking, very
good news," said Michel Coleman, professor of epidemiology at the London
School of Hygiene and Tropical Medicine and leader of the team, "but for 28
of those 33 cancers [16 were studied in men and 17 in women] there is a
substantial difference between rich and poor and it has been getting
worse."

It appeared from their data on 2.2 million adult patients that trends in
deprivation were linked to trends in survival. "Where survival is
increasing, deprivation is also increasing," said Professor Coleman. In
men, he said, "a 5% gain in survival is on average associated with a 1.5%
worsening in the deprivation gap". In women, the gap appeared to increase
at the slightly slower rate of 1% for every 5% improvement in survival
overall.

The reason for the lower survival rates of poorer people are not to do with
less access to newer, more expensive drugs, say the researchers. Nor is it
to do with access to a particular hospital, since all see a mixture of
classes. They do not know exactly what is happening, but speculate that the
worst off are not getting diagnosed as fast or treated as well as the
affluent.

Rich people are quicker to go to the doctor when they suspect something is
wrong and know how to demand attention.

"We don't have hard evidence that the issue of stridency, or if you like
communication and demanding approaches to doctors, underpins differences in
survival, but there is evidence the rich and poor do get diagnosed at
slightly different stages of disease," Professor Coleman said.

"Maybe the firmness with which patients address the healthcare system does
have an impact."

========================
Trends and socioeconomic inequalities in cancer survival in England and
Wales up to 2001

M P Coleman, B Rachet, L M Woods, E Mitry, M Riga, N Cooper, M J Quinn, H
Brenner, J Estève. British Journal of Cancer advance online publication 9
March 2004.

Correspondence to: Dr MP Coleman, Head of Cancer and Public Health Unit,
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E
7HT, UK. E-mail: [log in to unmask]

We examined national trends and socioeconomic inequalities in cancer
survival in England and Wales during the 1990s, using population-based data
on 2.2 million patients who were diagnosed with one of the 20 most common
cancers between 1986 and 1999 and followed up to 2001. Patients were
assigned to one of five deprivation categories (from 'affluent' to
'deprived') using characteristics of their electoral ward of residence at
diagnosis. We estimated relative survival up to 5 years after diagnosis,
adjusting separately in each deprivation category for background mortality
by age, sex and calendar period. We estimated trends in survival and in the
difference in survival between deprivation categories ('deprivation gap')
over the periods 1986-90, 1991-95 and 1996-99. We used period analysis to
examine likely survival rates in the near future. Survival improved for
most cancers in both sexes during the 1990s, and appears likely to continue
improving for most cancers in the near future. The deprivation gap in
survival between rich and poor was wider for patients diagnosed in the late
1990s than in the late 1980s. Increases in cancer survival in England and
Wales during the 1990s are shown to be significantly associated with a
widening deprivation gap in survival.

http://www.nature.com/cgi-taf/DynaPage.taf?file=/bjc/journal/vaop/ncurrent/abs/6601696a.html

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