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Working towards equal cancer care for everyone

Ian Walker
by Ian Walker | Opinion

2 August 2023

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Three people walking along a road
Credit: Kerry Harrison

Tackling inequalities in healthcare is something that I’ve always been passionate about.  

I am, and always have been a proud Yorkshireman – I grew up in Barnsley and most of my family still live there. But my upbringing there made me very much aware of the impact that socioeconomic deprivation can have on the health outcomes within communities. 

And now, as Executive Director of Policy, Information and Communications at Cancer Research UK, I’m highly motivated to ensure that as a charity we are doing everything we can to ensure that where you are born, or the colour of your skin, has no impact on your likelihood of getting and dying from cancer. 

In 2020, Cancer Research UK produced a report showing that more than 30,000 extra cases of cancer in the UK each year are attributable to socio-economic variation and survival is worse for the most deprived groups. 

This is unacceptable, and there is clearly still much work that needs to be done in this area.  

And it is one of the many reasons why, in 2021, we launched our first Equality, Diversity and Inclusion (EDI) strategy 

As Iain Foulkes covered in our last article, we have made much progress in increasing diversity in our research workforce and portfolio since then. 

And so, in this article I would like to take the time to highlight some of the changes we’ve implemented across the Policy, Information and Communications directorate at Cancer Research UK, and how we hope these changes might impact cancer inequalities in the future.  

Helping to build evidence 

Of course, we have a number of fantastic researchers funded by Cancer Research UK focused on understanding and addressing the impacts of differences and inequalities on cancer outcomes. For example, we recently announced a new funded study led by Dr Toral Gathani, which aims to shed light on the variation in breast cancer across different ethnic minority groups. 

But within our Policy, Information and Communications directorate, we are also directly building the evidence base on health and cancer inequalities. 

We have been studying how personal circumstances and distance from the location of specialist services intersect and impact on access to optimal lung cancer care and therefore best outcomes for patients with lung cancer. 

Our cancer intelligence team are constantly monitoring trends in cancer incidence and mortality for 40 different cancer sites and groups. This allows us to collect important data that can give further insights on cancer inequalities. For example, we recently published a paper showing differences in cancer incidence by broad ethnic group in England. 

The front cover of our Deprivation and cancer inequalities in Scotland report

Last year, we published our report on Deprivation and Cancer Inequalities in Scotland. This landmark report highlights that the burden of cancer is not felt equally across Scotland, and that those living in more deprived areas are more likely to get cancer and are, sadly, more likely to die from the disease than those in less deprived areas. It’s through important new data, such as that highlighted in this report, that we can continue to influence governments to make a change.  

Cancer Research UK are also hosting the International Cancer Benchmarking Partnership (ICBP) research programme. This is a unique and innovative collaboration that brings together clinicians, policymakers, researchers and data experts across the world. It aims to measure international variation in cancer survival, incidence and mortality, as well as identify factors that might be driving these differences.  

Findings from ICBP research have already had considerable impact on policy and practice internationally. In England, the ICBP contributed evidence in the early stages of forming the Accelerate, Coordinate, Evaluate (ACE) programme, an early diagnosis programme that supports the NHS outcome of ‘preventing people from dying prematurely.’ 

Ensuring all our information is accessible   

Of course, one of our big functions as a charity, and particularly in my directorate, is to provide information to those who have experienced a diagnosis or are worried about cancer. But not everyone is equally able to access or understand this information, so we know that it’s important for us to take steps to ensure that our outputs are accessible to all.  

Our About Cancer pages are a huge source of information, and help people understand cancer or take action to improve their health, with over 19 million people accessing the pages this year. We have worked to ensure that all of the content on About Cancer is written in plain English for a reading age of 9-11 to make it as accessible as possible.  

We’ve also been working to create content in different formats to meet different audience needs, such as video content and infographics on our About Cancer pages; easy read versions of key publications for primary care; and posters and short animations for GP surgeries to meet the needs of users who are digitally excluded.  

Furthermore, to ensure our information feels relevant for all, we plan diversity and representation into our video and image content. 

We want to make sure that all of our information can reach the people that need it. So, working with Public Health Wales, we are also piloting translation of a bowel screening video into Urdu, Arabic, Somali and Bengali.  

We are also collaborating with other teams across the charity to scope new window displays across our 600 shops to share health information. We aim to target areas disproportionately affected by cancer inequalities, starting with smoking in around 180 shops located in areas where smoking rates are higher.  

Engaging communities 

We have also been working to proactively engage different communities in our work.  

We continue to deliver a range of targeted cancer awareness activity, with 96% of our audiences reporting having a better understanding of ways to help their health.  

Three people sitting and talking
Credit: Michael Pilkington 2019

In 2022 the Cancer Awareness Roadshow campaign reached 70% of the highest-need areas in England and all highest-need areas in Scotland, with face-to-face engagement on health and cancer. We engaged nearly 50,000 visitors in total, with our nurses signposting 10,081 people to the GP, stop smoking, weight management and other services.  

Our Talk Cancer workshops equip participants with the skills and confidence to have conversations about cancer and health with people in their communities. In 2022/23 we delivered them to over 800 trainees, helping to reduce the stigma around talking openly about cancer and break down barriers people may have in seeking help.  

Talk Cancer aims to help reduce health inequalities by prioritising training in locations where more people are affected by cancer. We were a RSPH award finalists for our interpreted workshop pilot with Bradford District and Craven Health Care Partnership delivering interpreted workshops in Punjabi and Urdu to the South Asian community. The Talk Cancer workshop in any language is now a permanent offering to help reach groups who face additional barriers to accessing accurate health information. 

What a fabulous training session. Really enjoyed it. I was impressed with the way the nurses and interpreters delivered the training. They put it across in a way that we could understand. It wasn’t too much to digest. The workshop has given me knowledge and awareness of cancer. I now feel confident talking about cancer to others. I will encourage others to look out for early signs and take actions before it’s too late.

- Talk Cancer interpreted workshop trainee

We’ve also been empowering people in the workplace to take positive action for their health with our Cancer Awareness in the Workplace (CAW) programme. We worked with 11 corporate partners and clients in 22/23, directly engaging over 7,500 employees across the UK, with focus on reaching underserved groups with our cancer prevention and early diagnosis information.   

Working with health professionals 

Another important activity in our directorate is working closely with health professionals and key opinion leaders to raise awareness and spread best practice.  

This includes working as a key partner in the development of the Scottish Equity in Screening Strategy and undertaking our regular GP Omnibus survey to assess awareness, attitudes and behaviours of prevention and early diagnosis of cancer and delivery of primary care.  

A Black man speaks to his doctor
Credit: Kerry Harrison

The Tackling Neighbourhood Health inequalities specification requires primary care networks (PCNs) to identify a population within the PCN experiencing inequality in health provision and/or outcomes, and to develop a plan to tackle the unmet needs of that population. We help them do this by providing information on smoking, one of the biggest drivers of health inequalities, as well as cancer screening. 

We know the importance of our continued engagement with healthcare organisations and professionals, so that’s why we’re working on our new Health Systems Engagement strategy. This forms the basis of our future work with healthcare systems, and we’re hoping that this will help to drive deeper impact, encourage better adoption of innovations, reduce variation in practice and ultimately drive better cancer outcomes across the UK.  

Next steps 

While we’re really pleased with some of the progress we’ve made towards our EDI strategy over the past few years, we know there is still a long way to go.  

In our directorate, we’re currently developing a Cancer Inequalities Strategy which will focus on the inequalities within cancer outcomes in the UK and will have an aligned implementation plan.  

We’ve recognised that improving collaboration between the different directorates of the charity has led to more opportunities to drive impact, and we know that this is just the start. We’re incredibly motivated to keep up the pace to drive even more change.