Research sheds light on healthcare disparities in cancer patients

Research has found that patients residing in the most deprived areas of England are less likely to receive surgery or chemotherapy than in affluent areas.

Addressing the divide

John, a resident of a less affluent coastal area, struggled to get to his hospital appointments. He didn’t have his own phone or transport, lived alone, and was diagnosed with bowel cancer that had spread to his lymph nodes.

He underwent surgery and may have benefited from chemotherapy to reduce the risk of recurrence. However, his circumstances made it too risky to have chemotherapy - he had no phone to call for help, no transport to get to follow-up appointments, and no one nearby to look after him. Unfortunately, John’s cancer returned.

The patient's name has been changed, but it was an encounter that influenced Dr Ben Pickwell-Smith, a Specialist Trainee in Oncology in Yorkshire, to research socioeconomic inequalities in the diagnosis and treatment of patients living with cancer.

Dr Ben Pickwell-Smith, a Specialist Trainee in Oncology in Yorkshire, whose research has found disparities in cancer care
Dr Ben Pickwell-Smith, a Specialist Trainee in Oncology in Yorkshire, whose research has found disparities in cancer care

Inspired by the experiences of his patient who faced significant barriers in accessing chemotherapy, Dr Pickwell-Smith embarked on a PhD at Hull York Medical School, funded by Yorkshire Cancer Research, to understand and address these inequalities.

"Some patients experience delays in diagnosis and treatment – or don’t receive treatment at all"
Dr Ben Pickwell-Smith

He said, “I'm very concerned about the inequalities in care within our healthcare system. It's disheartening to see how some patients, due to various factors, experience delays in diagnosis and treatment – or don’t receive treatment at all."

Specifically, Dr Pickwell-Smith has delved into the socioeconomic factors influencing the diagnosis and treatment of individuals with bowel and ovarian cancer.

He said, “It's a cause that resonates deeply with me, and I'm determined to contribute towards reducing inequalities and improving access to healthcare for all."

The Inequities in Cancer Care

The findings of Dr Pickwell-Smith’s research make for sobering reading.

His research found that patients residing in the most deprived areas of England are up to 30% less likely to receive surgery or chemotherapy than those in more affluent areas, depending on the underlying cancer and the type of treatment.

Moreover, there is a slight but statistically significant delay in diagnosis for individuals in deprived areas.

Dr Pickwell-Smith said, “Cancer incidences in the most deprived areas of England are higher than elsewhere in the country. Yet these are the people who often don't receive the same level of treatment compared to those in more affluent areas."

These findings have significant implications for healthcare policies and practices, highlighting the urgent need to address socioeconomic disparities in cancer care.

“We found People from the most deprived areas suffer the most”
Dr Ben Pickwell-Smith

Dr Pickwell-Smith emphasised the need for further research and qualitative studies to understand the underlying reasons for these disparities.

He said, “These disparities are due to several complex reasons – it could be due to access to healthcare, geographic location, language barriers, social support, and much more.”

While the exact reasons for these disparities remain unclear, Dr Pickwell-Smith believes that additional qualitative research and a comprehensive approach involving healthcare professionals, researchers, and policymakers are essential.

Driven by the desire to understand the underlying reasons behind these inequalities, Dr Pickwell-Smith has actively disseminated his research findings at national conferences and meetings with specialists in oncology.

By engaging with fellow healthcare professionals, researchers, and patient advocates, he aims to initiate a dialogue and gather insights to further explore and tackle the root causes of these disparities.

Addressing cancer inequalities

Dr Pickwell-Smith's research is part of a £4.9m project funded by Yorkshire Cancer Research called TRANSFORMing Cancer Outcomes in Yorkshire. This interdisciplinary initiative aims to drive transformative change in healthcare by exploring and addressing cancer inequalities and ultimately improve health outcomes across our region.

Dr Kathryn Scott, Chief Executive at Yorkshire Cancer Research said, “Knowledge from the TRANSFORMing Cancer Outcomes in Yorkshire programme will play an important role in finding new ways to address health inequalities in Yorkshire and beyond."

"Everyone in Yorkshire should have access to the best cancer prevention, diagnosis and treatment – whoever they are or wherever they live”
Dr Kathryn Scott, Chief Executive at Yorkshire Cancer Research

As a part of the TRANSFORM project, Dr Pickwell-Smith had exposure to cutting-edge research and best practices in the field.

The opportunity allowed him to draw from, and collaborate with, the collective expertise of the project's members.

This collaborative environment allowed for the exchange of ideas and the exploration of innovative approaches to tackling socioeconomic inequalities in cancer care. This environment also provided an opportunity to share his findings with his fellow researchers and professionals who shared his passion for addressing healthcare inequalities.

Respiratory equipment on a hospital ward

THE POWER OF COLLABORATION

Dr Pickwell-Smith attributes a significant portion of his success to the unwavering support from Hull York Medical School.

The Medical School’s commitment to fostering a nurturing and collaborative environment, and to tackling inequalities in patient care, played a vital role in enabling him to pursue his research.

Dr Pickwell-Smith’s PhD supervisors are Professor Una Macleod – a GP, national leader in cancer research, and Dean of Hull York Medical School – and Professor Mike Lind, a Professor in Oncology at Hull York Medical School and Consultant at Hull University Teaching Hospitals NHS Trust.

The data from Public Health England is stored securely in the data safe haven in the Hull Health Trials Unit – a collaboration with Hull York Medical School and the University of Hull – which Dr Pickwell-Smith describes this capability as being “a real strength of the Medical School.”

And Dr Pickwell-Smith acknowledges the invaluable support and input from the Patient and Public Involvement (PPI) group based at the University of Hull, which proved instrumental in his research journey.

The PPI group played a vital role in shaping the direction of the research and ensuring its relevance to the real needs of patients. Their unique insights, perspectives, and feedback helped Dr Pickwell-Smith refine his study design that could make a tangible difference in the lives of those affected by cancer.

CONTINUING THE QUEST FOR EQUITY IN CANCER CARE

Reflecting on the impact of his research, Dr Pickwell-Smith recalls his experience with John and the outcome that could have been different with better transport links and social support.

Dr Pickwell-Smith said, “I would dearly love to live in a fairer, more equitable society. I will continue this research to find ways to address the inequalities I have identified.”

As he continues his medical training and works toward becoming a consultant oncologist in the NHS, he plans to remain committed to his research, hoping to unravel the reasons behind the alarming statistics and develop interventions to mitigate them.

His dedication to combating socioeconomic inequalities in cancer care is a powerful reminder of the need for comprehensive, inclusive healthcare that leaves no patient behind.

If you are interested in finding out more about this research, please contact Dr Ben Pickwell-Smith or visit the Centre for Cancer Awareness, Diagnosis and Screening Pathways Research Group.