Exploring ethnic differences in diagnostic intervals of cancer

What is the problem

The British Asian and Black minority groups have poorer survival of breast and prostate cancer and often report less positive care experiences - including care at the GP surgeries and cancer care. The reasons for these differences are uncertain considering the NHS is free at the point of delivery. From the patient’s perspective, research shows that part of this may be due to poorer awareness of cancer signs and symptoms and lower uptake of screening among Asian and Black groups. Another possible reason is that patients of Black ethnic backgrounds often develop fast-growing subtypes of breast and prostate cancer when compared to the White group. While these factors are may lead to poorer cancer survival, our recent research shows that patients of Asian and Black ethnic backgrounds with cancers of the blood, prostate, bowel, oesophagus, and stomach have a longer time to diagnosis than their British White counterparts. Longer time to cancer diagnosis may result in late-stage cancer and poor experience of care. However, we are uncertain whether these differences in time to diagnosis resulted from delays within GP surgeries or delays occurring afterward (e.g., due to difficulties booking or attending hospital appointments). Studying these aspects will help us identify possible solutions to address ethnic inequalities in cancer and determine whether such solutions should be applied in GP surgeries or hospitals.

Our plan

In this study, we will use patient information gathered from GP surgeries, hospitals, and cancer registries in England to study differences by ethnicity in the time to cancer diagnosis. We will analyse information of patients aged at least 40 years diagnosed with one of eight most common cancers (lung, breast, bowel, prostate, stomach, ovarian, oesophageal, and myeloma) between 2006 and 2021. We will categorise patients’ ethnicity as Black, White, Asian, Mixed, or Other group, in line with the UK census. The time to cancer diagnosis will be separated into four important time points in patients’ cancer journeys: a) the time between first visit at the GP surgery with a cancer symptom and referral to hospital for investigation, b) the time between GP referral and first hospital visit, c) the time from first hospital visit and cancer diagnosis, and d) the total time to diagnosis from first visit at the GP surgery. We will use statistical analysis to determine whether there are differences across ethnic groups in these timelines and whether the differences have clinical relevance.

Potential impacts

The NHS Long-Term Plan for cancer includes a commitment to tackle inequalities, although this Plan omitted specific strategies to address ethnic inequalities. Findings from the proposed study will feed into those from our other ongoing projects to determine aspects of cancer diagnosis where ethnic minorities are experiencing suboptimal care. In the next phase of our work, we will use findings from this project, our ongoing programme of work and other contemporary evidence to develop targeted interventions to address ethnic inequalities in cancer diagnosis. Such interventions will improve care experiences and outcomes of cancer in ethnic minority groups while fostering a more equitable NHS.

Amount Awarded: £58,441