Low-income cancer patients less likely to survive

TORONTO — Lower-income cancer patients are less likely to survive the disease, according to new research from the Canadian Partnership Against Cancer’s annual Cancer System Performance report, suggesting they may not receive the same care as wealthier patients.

For the first time, researchers were able to analyze cancer survival rates for breast, lung, colorectal and prostate cancers while removing the effect of other health risks.

The difference in survival rates – a 10% relative change in the case of colorectal cancer – suggests lower-income patients are not receiving equitable care. Lower-income individuals may not be screened for cancer, have symptoms recognized early or receive the most effective treatment.

For colorectal cancer, the probability of being alive five years after being diagnosed is 65% for patients in the top income ranges compared to 59% for patients in the lowest income range. For breast cancer, almost 88% of patients in the highest income range would have survived for at least five years after their diagnosis, compared to nearly 83% for the lowest income range.

For lung cancer, there was a relative change of nearly 18% in survival between higher- and lower-income patients.

Further study is required to understand barriers to lower-income individuals being screened for cancer and whether symptoms are being recognized early enough to provide the most effective treatment. To help drive screening participation, the Partnership has established a Screening in Underserved Populations to Expand Reach (SUPER) initiative that will explore opportunities to engage immigrants, low income or rural and remote residents in breast, cervical and colorectal cancer screening.

Previous Canadian and international research has shown that lower-income populations are:

• less likely to have their cancer symptoms recognized and investigated early, resulting in a more advanced stage at diagnosis, when treatment is less effective and, ultimately, prospects for survival are poorer
• likely to have longer wait times between an abnormal screening result or the detection of symptoms and receipt of follow-up care or treatment
• less likely to have a regular family doctor who can refer them to screening or identify and investigate possible symptoms of cancer early when the chance for cure is higher

The survival by income findings are part of the CONCORD-2 study, the most comprehensive study to date on international comparisons of population-based cancer survival. The Partnership funded the Canadian survival by income portion of the study.

The 2016 Cancer System Performance Report also shows:

• Expanding uptake of colorectal cancer screening, increasing clinical trial participation, wider collection of patient feedback on physical and emotional symptoms, increasing rates of breast-conserving therapy and better harmony with colorectal cancer treatment guidelines. All of these improvements translate to better care and outcomes for patients, as can be seen in decreasing death rates for many cancers.
• There is still wide variability in the percentage of mastectomies performed as day surgeries and differing rates of HPV vaccination uptake, which indicates that there is more to be done to develop a pan-Canadian approach.
• While participation in colorectal cancer screening has improved in the relatively short time programs have been in place, it remains low while wait times for receiving colorectal cancer screening results remain high.

Quotes

“In a country with universal access to timely, high-quality health-care, this is surprising. We need greater understanding of what’s causing these differences so that they can be systematically addressed,” said Dr. Heather Bryant, Vice President of Cancer Control at the Partnership.

“Hard to reach communities are just that – they’re hard to reach. That means we need to work harder to understand and overcome the barriers that are preventing low-income patients from receiving equitable cancer care,” said Dr. Kathleen Decker, Epidemiologist at Cancer Care Manitoba and Chair of the Pan-Canadian Cervical Cancer Screening Network.

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Karen Palmer
Canadian Partnership Against Cancer
(647) 388-9647

About the Canadian Partnership Against Cancer

The Canadian Partnership Against Cancer works with Canada’s cancer community to reduce the burden of cancer on Canadians. Grounded in and informed by the experiences of those affected by cancer, the organization works with partners to support multi-jurisdictional uptake of evidence that will help to optimize cancer control planning and drive improvements in quality of practice across Canada. Through sustained effort and a focus on the cancer continuum, the organization supports the work of the collective cancer community in achieving long-term population outcomes: reduced incidence of cancer, less likelihood of Canadians dying from cancer, and an enhanced quality of life of those affected by cancer.