Socioeconomic inequalities in cancer survival in England after the NHS cancer plan.
BACKGROUND
Socioeconomic inequalities in survival were observed for many cancers in England during 1981-1999. The NHS Cancer Plan (2000) aimed to improve survival and reduce these inequalities. This study examines trends in the deprivation gap in cancer survival after implementation of the Plan.


METHODS
We examined relative survival among adults diagnosed with 1 of 21 common cancers in England during 1996-2006, followed up to 31 December 2007. Three periods were defined: 1996-2000 (before the Cancer Plan), 2001-2003 (initialisation) and 2004-2006 (implementation). We estimated the difference in survival between the most deprived and most affluent groups (deprivation gap) at 1 and 3 years after diagnosis, and the change in the deprivation gap both within and between these periods.


RESULTS
Survival improved for most cancers, but inequalities in survival were still wide for many cancers in 2006. Only the deprivation gap in 1-year survival narrowed slightly over time. A majority of the socioeconomic disparities in survival occurred soon after a cancer diagnosis, regardless of the cancer prognosis.


CONCLUSIONS
The recently observed reduction in the deprivation gap was minor and limited to 1-year survival, suggesting that, so far, the Cancer Plan has little effect on those inequalities. Our findings highlight that earlier diagnosis and rapid access to optimal treatment should be ensured for all socioeconomic groups.
Rachet
B
B
Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. bernard.rachet@lshtm.ac.uk
Ellis
L
L
Maringe
C
C
Chu
T
T
Nur
U
U
Quaresma
M
M
Shah
A
A
Walters
S
S
Woods
L
L
Forman
D
D
Coleman
M P
MP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D006285:Health Planning; D006291:Health Policy; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012959:Socioeconomic Factors; D013222:State Medicine; D016019:Survival Analysis; D055815:Young Adult