Cancer Inequalities in Wales
Wales suffers from some of the worst cancer outcomes in Europe, but the burden of cancer is not shared equally across Wales. In fact, there are large disparities between different groups of people, depending on who they are, where they live and their financial situations.
The Senedd Cross-Party Group on Cancer last month published its report into cancer inequalities in Wales, which lays bare the unacceptable truth that the chances of getting cancer and the likelihood of surviving it are not the same for everyone in Wales. In this two-part blog series, we will look into some of the report’s findings and the areas where inequalities exist, as well as discuss some of the measures that Cancer Research Wales suggested to the Cross-Party Group to begin to address these disparities.
Across Wales, the distribution of wealth, services and opportunities is very uneven. This is true even at a relatively local level – as can be seen on the above map, areas of affluence can often be found close to areas of high deprivation. A clear example of this is cited in the report, wherein Swansea Bay University Health Board (UHB) contains around a quarter of the most deprived areas in Wales, but also a quarter of the least deprived areas.
These stark discrepancies are sadly reflected in cancer statistics as well.
Shockingly, people from the most deprived areas of Wales have an almost 20% higher incidence of cancer compared with those from the least deprived areas. Across the 7 different health boards in Wales, there is also wide variation – in fact, if the national cancer incidence matched the lowest rate (in Hywel Dda UHB) there would be around 1300 fewer cancer cases each year.
It is not just the incidence of cancer that is affected by the area in which people live, but the chances of survival differ significantly as well. The proportion of patients who survive 5 years after their diagnosis is a remarkable 17% lower (50% vs 67%) in the most deprived areas compared to the least deprived, while the mortality rate is an even more alarming 55% higher in the most deprived areas. Similar to cancer incidence, if the cancer mortality rate in the best performing health board (Hywel Dda UHB) could be replicated across Wales, around 600 fewer lives would be lost each year.
The above statistics show the shocking disparities between areas of high and low deprivation in Wales with regards to cancer. However, inequalities also exist between these communities when it comes to healthcare services and accessing the right care at the right time. Earlier diagnosis is vitally important for improving cancer survival, but deprived areas often do not have the same access to the necessary services.
A large majority of cancer patients initially visit their GP before their cancer is diagnosed, following concerns about their health. Therefore, primary care has a vital role to play in ensuring patients can be referred to the correct cancer pathway as soon as possible. Unfortunately, access to primary care services is not consistent across Wales.
The most recent figures available show that in the most deprived areas of Wales GP practices have fewer fully qualified GPs, fewer practice nurses and fewer administrative staff, compared to less deprived areas. These issues make it more difficult to obtain primary care appointments and leads to delays in patients receiving the right care in areas where the burden of cancer is highest. Significant investment to recruit and retain primary care staff in deprived areas is required to tackle this inequality.
Furthermore, the lack of staffing and subsequent pressures in primary care settings can lead to inadequate follow-up of people who visit their GP, with patients consequently ‘falling through the cracks’. The Cancer Research Wales funded ThinkCancer! project created a training workshop for both clinical and non-clinical staff in primary care, including the generation of a bespoke safety netting plan for each practice to improve patient follow-up. In a pilot of the workshop, a number of GP practices found shortcomings in their safety netting processes and immediately invoked beneficial changes. Cancer Research Wales calls for a designated safety netting process/policy to be implemented in every primary care practice, with a fully trained appointed safety netting champion responsible for the delivery of the safety netting process.
Cancer Research Wales previously funded the WICKED study, which investigated the knowledge and attitudes around cancer of primary care staff. It was found GPs’ confidence in their ability to recognise cancer symptoms, particularly non-specific vague symptoms, varied greatly – this was compounded by the finding that the National Institute for Health and Care Excellence (NICE) NG12 guidelines for cancer referral were not being used uniformly by GPs across Wales. To improve the consistency of primary care and reduce differences between practices, Cancer Research Wales calls for the uniform use of the NG12 guidelines by all GPs across Wales, along with the rollout of cancer training for primary care staff such as the ThinkCancer! workshops.
The Cross-Party Group on Cancer’s report really shines a spotlight on the unacceptable disparities across Wales with regards to the chances of developing cancer and the likelihood of surviving it. Although the underlying causes of these discrepancies are complex, relatively simple steps, such as those Cancer Research Wales have suggested, could be taken in the short term to start bringing about positive change.
However, there is more to this topic than just cancer statistics and primary care concerns. Look out for our next blog, where we will discuss some of the other areas where inequalities exist and other measures to begin to tackle the issues.