Cancer inequity: what is the care gap?

Written by: Rosie Lobley and Ben Caldwell

The concerning facts included in the quiz above highlight the glaring differences that exist in cancer outcomes and access to care across regions and socioeconomic groups. These inequalities amount to a ‘gap’ in cancer care. This year’s World Cancer Day launched its ‘close the care gap’ programme, a three-year campaign to combat inequality in cancer treatment, diagnosis and access to care.

As part of our year-long focus on cancer, we’re taking an in-depth multi-part look at the cancer care gap – how it manifests, what are its causes and impacts, and how it can be alleviated. In this piece, we provide a stark illustration of the magnitude of the care gap.

Inequality of outcomes

The image above demonstrates the fundamental divide between high- and low-income countries in terms of cancer survival rates.1 Even within individual countries, the so-called ‘deprivation gap’2 means that patients from more deprived areas have worse cancer outcomes than those from wealthier areas. Indeed, low socioeconomic status in childhood is associated with a heightened risk of cancer in adulthood,3 and low socioeconomic status as a whole is linked with lowered survival rates in cancer patients.4

Poverty and location are both significant factors in cancer incidence and outcomes, but they are by no means the only contributors to the care gap. Minority ethnic patients commonly experience poorer cancer outcomes than white patients.5 Rates of cancer incidence and mortality both increase with age6 – advanced age is itself a risk factor for cancer7 – and older patients are more likely to present with complicating comorbidities.6 Worldwide, the incidence and mortality of cancer are both higher in men than women;8 and cancer outcomes are poorer among patients with physical9 and intellectual disabilities.10

The cancer care gap across the world

Inequalities in cancer care are felt throughout the world in a multitude of diverse and intersecting ways. To illustrate the range and scope of the care gap, we have captured a selection of country- and region-specific examples in the below graphic.

cancer care gap

This article demonstrates that unequal cancer outcomes are affected by a diverse and interconnected array of environmental, medical, geographical and socioeconomic factors, many of which feed into and exacerbate one another. In the next article in this series, we’ll examine the interplay between the various vectors of inequality and highlight how they tie into disparities in access to cancer care.

References
    1. World Health Organization. World Cancer Day: closing the care gap. 2022. Available at: https://bit.ly/3uWsPSu [Accessed April 2022].
    2. Nuñez O, Rodríguez Barranco M, Fernández-Navarro P et al. Deprivation gap in colorectal cancer survival attributable to stage at diagnosis: a population-based study in Spain. Cancer Epidemiol. 2020;68:101794. https://doi.org/10.1016/j.canep.2020.101794
    3. Vohra J, Marmot MG, Bauld L et al. Socioeconomic position in childhood and cancer in adulthood: a rapid-review. J Epidemiol Community Health 2016;70:629-634.
    4. Redondo-Sánchez D, Petrova D, Rodríguez-Barranco M, Fernández-Navarro P et al. Socio-economic inequalities in lung cancer outcomes: an overview of systematic reviews. Cancers. 2022;14(2):398. https://doi.org/10.3390/cancers14020398
    5. Zavala VA, Bracci PM, Carethers JM et al. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 2021;124:315–332. https://doi.org/10.1038/s41416-020-01038-6
    6. Walsh PM, McDevitt J, Deady S, O’Brien K, Comber H. Cancer inequalities in Ireland by deprivation, urban/rural status and age: a report by the National Cancer Registry. 2016. Available at: https://bit.ly/378lozA [Accessed April 2022].
    7. Schroyen S, Adam S, Jerusalem G, Missotten P. Ageism and its clinical impact in oncogeriatry: state of knowledge and therapeutic leads. Clin Interv Aging 2015;10:117-125. https://doi.org/10.2147/CIA.S70942
    8. Global Burden of Disease Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol 2019;5(12):1749–1768. https://doi.org/10.1001/jamaoncol.2019.2996
    9. Choi JY, Yeob KE, Hong SH et al. Disparities in the diagnosis, treatment, and survival rate of cervical cancer among women with and without disabilities. Cancer Control 2021;28. https://doi.org/10.1177/10732748211055268
    10. Liu Q, Adami HO, Reichenberg A, Kolevzon A, Fang F et al. Cancer risk in individuals with intellectual disability in Sweden: A population-based cohort study. PLOS Med 2021;18(10):e1003840. https://doi.org/10.1371/journal.pmed.1003840