ENQUIRE – Using routine health data to undErstaNd eQUIty in canceR carE: A quantitative study with embedded stakeholder engagement

Description

Half of people in the UK will develop cancer but our outcomes are not as good as those in other similar countries. Outcomes are worse for people from poorer areas but we don’t fully understand why. This could be due to having more advanced cancer at diagnosis, other medical conditions or receiving different care.

Reducing inequalities is a high priority but without understanding what the causes are it’s difficult for policymakers to know what to do. We need information that spans the whole cancer pathway and that recognises the cost of doing things differently. 

Health economic analyses help to make sure the NHS gets the best outcomes possible from its limited budget. Often in cancer care, people think this means whether new, high-cost drugs offer value for money but we can do much more to understand if the £6 billion spent on ‘day-to-day’ cancer care offers value for money and if it is shared fairly. 

In this project we want to understand how money is spent on cancer care in the NHS. We will find out what, where and on who money is spent to understand if this is fair for all people with cancer. We can then find out if the differences in spending are leading to worse survival for people from poorer areas. Working with NHS leaders and the public we can then find ways to reduce cancer inequalities. This will help to ensure that all patients get the right care and have the best chance of surviving cancer, no matter where they live.

This project includes three main parts:

1)    We will use complex, linked, real world data from patients treated for four common cancers (lung, bowel, oesophageal and diffuse large B-cell lymphoma) to find out how much NHS cancer treatment costs and how what we spend varies between people. For example, because they come from poorer parts of the country or are treated at different hospitals. We will use causal inference methods to see if these differences are leading to worse cancer outcomes or if these are due to other things (like advanced stage or comorbidities).

2)    Working with patients, doctors, local and national NHS leaders we will create a map (called a theory of change) for how we might be able to use health policy to reduce cancer inequalities. By combining the routine data analysis with this map we will identify which policies can have the biggest impact.

3)    Finally, we will work with a citizen’s jury to see if the policies we identify are acceptable to the public. This can help to ensure that NHS leaders have confidence that a policy can be implemented in practise to reduce inequalities.

Impact

This project will help to identify and inform policies that can reduce the deprivation gap in cancer survival. Developing the theory of change with NHS leaders and aptients will help to ensure that we have a shared understanding of the problemand the mechanisms that can address it. This will mean that the findings from our rsearch can influence policy and make sure that all people with cancer have the best chance possible of surviving.

We are starting the process of informing policy by contributing to the National cancer Plan, which will be published in late 2025. 

Publications and outputs

https://github.com/KatieSpencer72/ENQUIRE

Project website

https://eprints.whiterose.ac.uk/id/eprint/195768/3/Editorial_V1.5%20%281%29.pdf