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Equality
The Improving Outcomes: A Strategy for Cancer recognises that, as with many health conditions, there is a range of inequalities in the outcomes and experience of cancer patients. These can occur at every stage of the patient pathway, including in awareness, incidence, access to treatment and care, patient experience, survival and mortality. They can also affect a range of groups in society, including socio-economically disadvantaged groups and areas, black and minority ethnic groups, older or younger people, men or women, people with disabilities, people from particular religions or with particular beliefs and the lesbian, gay, bisexual and transgender (LGBT) community.
Tackling health inequalities in England is essential to improving outcomes and achieving cancer survival rates which match the best performing countries in the world. Equity and Excellence: Liberating the NHS makes clear the Government’s ambition to reduce health inequalities and improve the health of those with the poorest outcomes.
Incidence and mortality rates from cancer are higher in disadvantaged groups and areas, leading to worse outcomes and lowering overall performance. Therefore the greatest scope to make rapid improvements is by focussing activity on disadvantaged groups and areas.
The National Cancer Action Team is committed to addressing equality issues, and reducing inequalities across the care pathway.
National Cancer Equality Initiative
The National Cancer Equality Initiative (NCEI) was established in 2008. The NCEI Implementation Advisory Group meets three or four times a year and is chaired by Professor Sir Mike Richards and Joanne Rule. It brings together key stakeholders from the professions, voluntary sector, academia, and equality groups to develop research proposals on cancer inequalities, test interventions, and advise on the development of wider policy.
The role of the NCEI now is to advise the National Cancer Director and Ministers on the delivery of the actions to reduce inequalities set out in Improving Outcomes: A Strategy for Cancer.
An update of the work of the NCEI was disseminated at the recent Network Development Programme event at the end of March 2011. This can be downloaded from the document menu above.
Report on the impact of age on oncology decision making |
In partnership with the Pharmaceutical Oncology Initiative (POI), the National Cancer Equality Initiative (NCEI) has produced a report exploring the intent to which chronological age is a factor in decision making.
The study investigated the extent to which age is a factor in oncology treatment decision, looking at a number of cancer types, over a number of countries.
The results suggest that some clinicians may over rely on chronological age as a proxy for other factors which are often but not necessarily associated with age, e.g. co-morbidities, frailty.
It includes a number of suggestions for action for the clinical community and for both providers and commissioners of cancer services.
The report can be found in the document menu above.
Supporting commissioners to reduce inequalities in cancer
The National Cancer Equality Initiative and the National Cancer Action Team, have prepared a briefing paper about the practical steps cancer networks can take to support clinical commissioning groups (CCGs) and the NHS Commissioning Board in reducing inequalities in cancer care and treatment. This briefing comes ahead of the National Cancer Equality Initiative’s briefing on commissioning to reduce inequalities, which is expected shortly.
The briefing paper on practical action to reduce inequalities in cancer can be found in the document menu above.
'Evidence to March 2010 on Cancer Inequalities in England'
This report was originally published in March 2010 as an annex to the National Cancer Equalities Initiative (NCEI) report ‘Reducing cancer inequality: evidence, progress and making it happen’. It is republished as a summary of the National Cancer Intelligence Network’s work on cancer inequalities, supplemented where appropriate with references to other published work and the NCEI’s visioning events.
Please click here to see the report.
How to reduce excess mortality from cancer: Guide for Health and Well-being Boards and GP Commissioning Consortia
The Health Inequality National Support Team (HINST) has worked alongside NCAT, looking at how to reduce excess mortality from cancer.
The report; “How to reduce excess mortality from cancer: Guide for Health and Well-being Boards and GP Commissioning Consortia” is now available in the document section.
This concise guide describes how to improve outcomes for cancer by raising public awareness of the symptoms and promoting early diagnosis.
The report explains what data are available to help identify whether an area has more preventable deaths than other areas, what is causing the problem, and how to design interventions to address it.
The report draws on work by HINST and NCAT in the 60 areas with the worst health and highest levels of deprivation in England.
Older People
In partnership with the Pharmaceutical Oncology Initiative (POI), the National Cancer Equality Initiative (NCEI) has produced a report exploring the intent to which chronological age is a factor in decision making.
The study investigated the extent to which age is a factor in oncology treatment decision, looking at a number of cancer types, over a number of countries.
The results suggest that some clinicians may over rely on chronological age as a proxy for other factors which are often but not necessarily associated with age, e.g. co-morbidities, frailty.
It includes a number of suggestions for action for the clinical community and for both providers and commissioners of cancer services.
You can download a copy of the report from the document menu on the right.
Macmillan is working in partnership with the Department of Health and Age UK to address under treatment of older people with cancer. In May 2011, a number of pilot sites throughout England will begin to test new models of care for older people aged 70 and over, including:
1. testing new methods of clinical assessment of older people with a diagnosis of cancer
2. coordinating and delivering short-term practical support packages for older people undergoing treatment
3. promoting age equality to address age discriminatory behaviour in cancer services.
For more information, please visit the Macmillan website.
Breast Cancer in the Elderly
"Elderly breast cancer patients are less likely to receive surgical treatment or radiotherapy than younger patients." National Cancer Intelligence Network Data Briefing, Oct 2010
Please click here to see the data briefing in full.
Gender
Men and Cancer
The National Cancer Intelligence Network have produced a joint report with Cancer Research UK, The Centre for Men's Health at Leeds Metropolitan University and the Men's Health Forum. This publication presents analyses of the increased cancer incidence and mortality rates in males compared to females.
Please click here to see the report on the excess burden of cancer in men in the UK.
Blue September
NCAT is pleased to support Blue September, a nationwide awareness and fundraising initiative about all cancers that affect men - not just prostate and testicular cancer, but also bowel, lung, liver and other cancers.
The Blue September team visited NCAT in September and painted some faces blue. NCAT and NCIN then held Blue Friday with staff in blue attire, eating blue cakes, in an effort to raise money for the Men's Health Forum.
Click here to see an interview with Professor Sir Mike Richards.
'Men are at higher risk of developing a wide range of cancers than women. We need to encourage men to lead healthier lifestyles, to take up bowel screening when invited, and to present earlier when they have symptoms that could be due to cancer. Earlier diagnosis can undoubtedly save lives. I strongly support Blue September.' Professor Sir Mike Richards
For more information about Blue September, please visit their website: www.blueseptember.org.uk
Ethnicity
Ethnic Minority Cancer Awareness Week (EMCAW) 2012
This year EMCAW is running from 2nd – 8th July 2012. The National Cancer Action Team and Cancer Equality are funding a small grants programme to encourage and enable community organisations/charities to host an event during Ethnic Minority Cancer Awareness Week.
The aim of this year’s EMCAW Grant is to raise awareness about the cancer, it signs, symptoms and treatments, incorporating within this the importance of a healthy lifestyles. Events hosted by organisations need to reflect this.
The events should be aimed at black and minority ethnic communities. and held within the week. A small grant will be awarded of up to £250.
We hope the grant will support BME communities in their work to raise awareness within their localities.
The aims of the Grant Programme are:
- To improve quality of life and reduce health inequalities
- To increase awareness of the risk factors for developing cancer
- To support and encourage the adoption of healthy lifestyles
- To encourage patient-led and community-led activity
- To work with BME people and communities to raise awareness of cancer and improve access services
- To reduce stigma and taboo attached to cancer
- To encourage and promote the importance of national screening programmes
- To provide opportunities for BME communities to have a voice
Applying for an EMCAW grant
If you are interested in organising an event and applying for a grant please contact Cancer Equality
Email: info@cancerequality.org.uk or leave a message on 020 7735 7888
For more information about Ethnic Minority Cancer Awareness Week, click here
Within the Patient Experience Team at NCAT, a programme of work is focusing on raising awareness of cancer and improving cancer services for black and ethnic minority (BME) groups.
'Cancer does not discriminate' campaign
The 'cancer does not discriminate' campaign was launched on Wednesday 7th December 2011 in the House of Commons, hosted by David Lammy, MP for Tottenham. Health care professionals, patients and voluntary sector organisations met up to launch the cancer awareness campaign aimed at the black and minority ethnic (BME) community. For more information, please visit www.bmecancervoice.co.uk
Cancer Awareness Supplement
The Patient Experience Team have to date compiled three different cancer awareness supplements, aimed specifically at raising awareness of cancer in the African and Caribbean communities; the Irish community and the Asian community. These are all available in PDF format from the document section above. The supplements are available to order in hard copy for events and community groups, in batches of 100. To find out more, email us here.
BME Cancer Voice
The National Cancer Patient Survey in 2000 identified that minority ethnic patients, especially South Asian patients, were less likely to understand their diagnosis and treatment options and more recently, the 2010 Cancer Patient Experience Survey showed that in general, patients from black and minority ethnic (BME) groups report less favourably on their care.
We know that there is limited representation of black and minority ethnic patients in surveys, for e.g. only 2.8% of all respondents of the 2004 NAO Patient survey, were of BME origin, and less than 4% in the recent Cancer Patient Experience Survey (2010).
In response to this, the National Cancer Action Team (NCAT) has set up BME Cancer Voice to:
- Provide the NHS with information to help support and improve cancer services
- Give cancer patients and carers from a BME background a voice and an opportunity to share their experiences
We will be running three to four surveys a year to find out about various aspects of patients’ cancer journey (i.e. information, access and treatment). Members can either choose to be interviewed over the phone, by someone who speaks their first language, or answer questions online (in English).
Who can get involved? NCAT wants to hear from patients and carers from black or minority ethnic backgrounds (aged 16 years or older).
To be part of BME Cancer Voice,
- Either call this free phone number 0800 634 7382
- Visit the following website and complete a form online; http://www.bmecancerpanel.org.uk/
Further information can be found on the Patient Experience Team website: www.cancerinfo.nhs.uk
Materials are available in a number of languages. To order materials, please click here.
BME Baseline Audit
In 2009, NCAT contacted all NHS trusts and Cancer Networks in England asking them to take part in an audit to find out about their policy and services relating to BME communities.
All of the Cancer Networks in England and 111 Acute Trusts completed the survey. As a result of this audit, NCAT:
- developed a baseline of the current spread of services and resources across England
- shared best practice and resources with staff and where appropriate patients
- developed a BME commissioning 'checklist' to help commissioners commission for quality
- identified training and support needs for delivering culturally sensitive services
- developed culturally sensitive core Information Pathways to be used alongside the existing National Information Pathways.
The first stage analysis of this data is available for download from the document section above.
Cancer Ethnicity Resource Portal (CERP)
The Cancer and Ethnicity Resource Portal (CERP) contains a collection of grey literature about the experience of cancer in black and ethnic minority groups. The overall aim of the portal is to provide a facility that allows these resources to be made more widely available, in order to:
- help fill in the gaps in knowledge around cancer and ethnicity
- facilitate in the spread of information about potentially innovative and informative practices
- enable the sharing of good practices and learning experiences
- help share information about caring practices for BME patients that are appropriate and sensitive to their individual and cultural needs.
CERP users can search and download materials or access links to other resources relating to cancer and ethnicity.
The portal also provides a facility that allows users to submit details about their own work on cancer in black and minority ethnic groups. We would like to build upon this resource by inviting users to share this information with other portal users.
The CERP review panel will review any submitted materials before they become available in the portal.
Cancer Incidence and Survival By Major Ethnic Group
In collaboration with the Cancer Research UK Cancer Survival Group and the London School of Hygiene & Tropical Medicine, the National Cancer Intelligence Network (NCIN) has produced a report entitled "Cancer Incidence and Survival Cancer By Major Ethnic Group, England, 2002 - 2006"
It is the first national analysis for twenty-one different cancer sites or groups, presenting cancer incidence by ethnic group in England. This report also includes data on cancer survival by ethnic group for the four largest cancer sites
Plesae click here to see the report.
Breast Cancer : Ethnicity
"There are ethnic variations in the age, route of presentation and tumour characteristics of breast cancer patients in England. Patients known to be Black are younger, less likely to be screen-detected and have worse prognosis tumours." National Cancer Intelligence Network, Data Briefing, Oct 2010
Please click here to see the data briefing in full.
Sexuality
In 2009, Dr Julie Fish, of De Montfort University carried out a piece of research (funded by NCAT) into lesbian women and breast cancer entitled: Coming Out About Breast Cancer: Lesbian and Bisexual Women - Policy and Practice Implications for Cancer Services and Social Care Organisations”. This was published in 2010 and can be found here
Breast Cancer Care have just published “Lesbian and bisexual women and breast cancer: A policy briefing” which makes recommendations to healthcare professionals and commissioners of healthcare, cancer charities and policy makers. For more information please visit the Breast Cancer Care website.
Socio-Economic Deprivation
The Health Inequality National Support Team (HINST) has worked alongside NCAT, looking at how to reduce excess mortality from cancer.
The report, How to reduce excess mortality from cancer: Guide for Health and Well-being Boards and GP Commissioning Consortia” draws on work by HINST and NCAT in the 60 areas with the worst health and highest levels of deprivation in England. This is now available in the document section.
This concise guide describes how to improve outcomes for cancer by raising public awareness of the symptoms and promoting early diagnosis.
The report explains what data are available to help identify whether an area has more preventable deaths than other areas, what is causing the problem, and how to design interventions to address it.
Cancer Incidence by Deprivation
The National Cancer Intelligence Network has compiled a report looking at cancer incidence by deprivation. The report analyses twenty-four different cancer sites or groups and presents results showing the change in incidence rates between socio-economic quintiles, as well as estimating the excess cases caused by deprivation.
Please click here to see the report.
Breast Cancer: Deprivation
"Breast cancer patients are more likely to be affluent than deprived. Affluent patients are more likely to have a screen-detected breast cancer. The most deprived patients have a higher mastectomy rate and received less immediate reconstruction." National Cancer Intelligence Network, Data Briefing, Oct 2010.
Please click here to see the data briefing in full.
The Patient Experience Team is currently developing a cancer awareness supplement aimed at the Asian community and this will be available in early 2012.