Item 15 - Cancer Inequalities
North Lanarkshire Council · 14 February 2023
Back to IJB Performance, Finance and Audit Committee — 14 February 2023 and its agenda
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1 REPORT Item No: 15 SUBJECT: Cancer Research UK Screening Inequalities Report TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer North HSCP DATE: 14th February 2023 1. PURPOSE OF REPORT This paper is coming to the Sub-Committee: For approval For endorsement To note 2. ROUTE TO THE IJB Sub-Committee This paper has been: Prepared Reviewed Endorsed 2.1 The paper was prepared by the Chief Officer and agreed by members of the Senior Leadership Team. 3. RECOMMENDATIONS 3.1 The Committee is asked to: Note the contents of the report; Note that NHS Lanarkshire’s Population Health Committee is coordinating an exercise to: o Form a baseline against all key themes outlined in this report o Research and understand the evidence around gold standard practice for each theme o Undertake a gap analysis to identify key actions for implementation through NHS Lanarkshire and wider partners. Request an update on the NHSL exercise once complete Embed cancer inequalities as a key theme in the 2023-26 Strategic Commissioning Plan. 4. VARIATIONS TO DIRECTIONS Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 In November 2022, Cancer Research UK published a report on Deprivation and Cancer Inequalities in Scotland. The report focuses on inequalities in relation to deprivation across the cancer pathway in Scotland, as it is one of the most influential factors in driving differences in cancer incidence, diagnosis and outcomes. 5.1.2 The report explores the levels of deprivation across Scotland and how this can impact on cancer incidence and outcomes, then focuses on three key areas of action: Prevention Early diagnosis Treatment 5.2 Deprivation in Scotland 5.2.1 Deprivation encompasses a wide range of different factors including income, employment, education, health, access to services, crime and housing. In Scotland, this is usually quantified using a relative measurement scale, the Scottish Index of Multiple Deprivation (SIMD). 5.2.2 Using the SIMD methodology, NHS Lanarkshire is the third most deprived Health Board in Scotland, with 28% of data zones in the most deprived quintile, behind NHS Ayrshire and Arran (31%) and NHS Greater Glasgow and Clyde (35%). 5.2.3 Cancer incidence is 33% higher in the most deprived populations in Scotland in comparison to the least deprived areas. It is estimated there are around 4,900 extra cancer cases every year in Scotland attributable to deprivation, with lung cancer contributing nearly half of these. 5.2.4 Cancer mortality is 74% higher in the most deprived population compared to the least deprived. This gap has narrowed slightly since the Covid-19 pandemic, which may relate to people from more deprived areas being more likely to die from Covid-19.
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3 5.2.5 Accordingly, cancer survival is lower in the most deprived groups – e.g. for bowel cancer, five year survival rates are 10% lower in the most deprived populations compared to the least deprived. 5.3 Prevention 5.3.1 Smoking remains the biggest cause of cancer in Scotland, responsible for 1 in 5 cases. While smoking prevalence continues to fall across Scotland, the rates in the most deprived population have consistently been much higher. In 2019, 32% of people in the most deprived quintile smoked, compared to 6% in the least deprived. 5.3.2 Overweight and obesity is the second highest risk factor for cancer in Scotland, causing nearly 7% of cancer cases each year. Unlike smoking, projections for adult obesity do not show a broad downward trajectory, with an increase from 36% in 2019 to 41% in 2040 projected for the most deprived and a modest decrease in the least deprived from 22% to 19% over the same timescale. Childhood obesity rates are twice as high in the most deprived areas compared to the least deprived. 5.4 Early Diagnosis 5.4.1 Cancer screening can help prevent cancers developing as well as detecting cancers at an early stage when treatment is more likely to be successful. Around 7% of all cancers in Scotland are detected through the breast, bowel and cervical
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4 screening programmes. For both breast and bowel screening, uptake is 20% lower in the most deprived populations compared to the least deprived and uptake is 11% lower for cervical screening. 5.4.2 Awareness of the signs and symptoms of cancer is lower in among more deprived populations. Health literacy is an important factor in inequalities, with identification of symptoms that could indicate cancer one of many factors that could support earlier diagnosis. People in the most deprived populations are between 50 and 75% less likely to recognise bruising, unspecified pain, changes in appearance of a mole, persistent cough or weight loss as potential symptoms of cancer. 5.4.3 Barriers to seeking help are more likely to exist for those living in more deprived communities. A range of difficulties such as getting access to an appointment, getting an appointment at a convenient time, being able to discuss health problems remotely, confidence to talk about symptoms or thinking symptoms were related to an existing condition are all significantly more prevalent in those from the most deprived communities (particularly around being able to access appointments with health professionals). 5.4.4 Consequently, those from more deprived areas are more likely to be diagnosed following an emergency referral and are more likely to be diagnosed at a later stage for some cancer sites. Data from other countries suggests that most deprived communities are 50% more likely to be diagnosed through an emergency presentation, with some evidence of this in Scotland, with 21% of patients in the West of Scotland diagnosed through emergency referral. Patients diagnosed at an early stage are more likely to survive their disease longer, with stage 1 and 2 diagnoses for breast and bowel cancer being around 5% lower in most deprived groups. 5.5 Treatment 5.5.1 NHS Scotland operates two targets for cancer waiting times: 62-day target from receipt of referral for an urgent suspected cancer to treatment 31-day target from decision to treat until first treatment begins for all cancers 5.5.2 There is no data available on cancer waiting times by deprivation level, however, the report does note declining Scottish performance against the 62-day target. NHS Lanarkshire currently sits above the Scottish average and 4th in Scotland for performance, but below target.
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5 5.6 Emergent themes 5.6.1 To conclude the report, Cancer Research UK sets out the importance of ensuring nobody is left behind in a shared mission to bear cancer. The following themes are noted: Need to roll out interventions that tackle the know drivers of inequalities, including smoking and obesity, which are cancer risk factors that disproportionately affect more deprived communities Need for bold action to diagnose cancers earlier and ensure everyone has equal access to the right treatment for them. Need to build a much stronger understanding of where inequalities exist and what is driving them through better data collection, infrastructure and access. The report calls for national agreement on data collection around patient characteristics, including age, gender, ethnicity, sexuality and deprivation. 5.7 Next steps 5.7.1 Given cancer is one of the leading causes of death in Scotland and NHS Lanarkshire’s significant deprivation profile, the contents of this report are highly concerning. 5.7.2 At the 18th January 2023 meeting of NHS Lanarkshire’s Population Health Committee, it was agreed: A scoping exercise be undertaken locally against all core elements outlined in this report, to provide a baseline for Lanarkshire. Research should be undertaken to better understand the evidence base and gold standard practice around each key element, to allow a gap analysis to be undertaken. Key actions be embedded within the Healthcare Strategy Our Health Together, but importantly embedded within partner plans, including IJB Strategic Commissioning Plans as well as those of the Community Planning Partnerships. 6. CONCLUSIONS
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6 6.1 The Cancer Research UK report Deprivation and Cancer Inequalities in Scotland highlights the significant impact of deprivation on cancer incidence, diagnosis and outcomes. With NHS Lanarkshire identified as the third most deprived Health Board in Scotland, the findings of the report are highly concerning. 6.2 It is recommended that cancer inequalities form a theme within the upcoming Strategic Commissioning Plan, 2023-26. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES 7.1.1 The programme impacts on all nine national health and wellbeing outcomes. 7.2 ASSOCIATED MEASURE(S) No further measures. 7.3 FINANCIAL 7.3.1 There are no direct financial implications identified to date, though small budgets may be required to support action across the Community Boards as the programme develops. 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4.1 There are no associated risks on the risk register at present. 7.5 PEOPLE 7.5.1 Through the NSS screening pilot, an extensive engagement programme was undertaken around screening inequalities and similar methodology could be utilised for other elements. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY 7.6.1 An EQIA is being developed to around the NSS screening pilot, which could potentially be extended. EQIA Completed: Yes No N/A 7.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. BACKGROUND PAPERS 9. APPENDICES Appendix 1: Cancer Research UK – Deprivation and Cancer Inequalities in Scotland report
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7 Cancer in the UK - Deprivation and Cancer Inequalities in Scotland (003).pdf ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 858 119