Title: Ethnic inequality in diagnosis and outcomes of cancer
Funder: Cancer Research UK

Abstract: Background Minimising ethnic inequalities is key to achieving world-class cancer outcomes in the UK. However, efforts to address this issue are often buried within wider plans of improving cancer outcomes, whereas targeted interventions may have a greater impact in ethnic minority population. Aims This fellowship will investigate ethnic differences in patients’ cancer journeys, from the first primary care consultation to definitive diagnosis, and eventual outcomes. Specifically, it will examine ethnic variation in: i) symptoms profile and primary care consultation before diagnosis, ii) the intervals between first primary care consultation and diagnosis, iii) the routes to diagnosis iv) cancer stage at diagnosis and survival rates. Furthermore, the fellowship will include two separate systematically reviews: i) to examine the evidence regarding ethnic inequalities in cancer diagnosis and outcomes, and ii) to examine the evidence on good practice and interventions to tackle ethnic inequalities in cancer. Methods The first four broad objectives will be based on statistical analyses of multiple clinical databases with the Clinical Practice Research Datalink (CPRD) at the core. Participants will include patients diagnosed with common cancers between 2006 and 2017. Chi-squared tests will be used to investigate ethnic differences in the recorded symptoms for each cancer type. Poisson and Cox regression models will be fitted to examine ethnic differences in consultation rates and diagnostic intervals respectively, by cancer types. Logistic regression models will be used to investigate ethnic differences in the route to diagnosis, and staging at diagnosis by tumour types. Finally, net survival models will be fitted to investigate ethnic variation in survival for each cancer type. The systematic reviews will involve searching through five bibliographic databases (Medline, EMBASE, Web of Science, PsycINFO, CINAHL, and the COCHRANE) and grey literature archives. Results will be summarised using a narrative empirical synthesis and the reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework. How the results of this research will be used This fellowship is the first to investigate ethnic inequalities in diagnosis and outcomes of cancer using the CPRD with linkage to secondary care data, and examining multiple cancer types. The fellowship will provide a strong evidence base to inform policy, awareness campaign and clinical practice. It will identify areas where existing interventions would have optimum impact in addition to identifying new interventions for future trial.

Lay abstract: Background Minimising ethnic inequalities is key to achieving world-class cancer outcomes in the UK. However, efforts to address this issue are often buried within wider plans of improving cancer outcomes, whereas targeted interventions may have a greater impact in ethnic minority population. Aims This fellowship will investigate ethnic differences in patients’ cancer journeys, from the first primary care consultation to definitive diagnosis, and eventual outcomes. Specifically, it will examine ethnic variation in: i) symptoms profile and primary care consultation before diagnosis, ii) the intervals between first primary care consultation and diagnosis, iii) the routes to diagnosis iv) cancer stage at diagnosis and survival rates. Furthermore, the fellowship will include two separate systematically reviews: i) to examine the evidence regarding ethnic inequalities in cancer diagnosis and outcomes, and ii) to examine the evidence on good practice and interventions to tackle ethnic inequalities in cancer. Methods The first four broad objectives will be based on statistical analyses of multiple clinical databases with the Clinical Practice Research Datalink (CPRD) at the core. Participants will include patients diagnosed with common cancers between 2006 and 2017. Chi-squared tests will be used to investigate ethnic differences in the recorded symptoms for each cancer type. Poisson and Cox regression models will be fitted to examine ethnic differences in consultation rates and diagnostic intervals respectively, by cancer types. Logistic regression models will be used to investigate ethnic differences in the route to diagnosis, and staging at diagnosis by tumour types. Finally, net survival models will be fitted to investigate ethnic variation in survival for each cancer type. The systematic reviews will involve searching through five bibliographic databases (Medline, EMBASE, Web of Science, PsycINFO, CINAHL, and the COCHRANE) and grey literature archives. Results will be summarised using a narrative empirical synthesis and the reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework. How the results of this research will be used This fellowship is the first to investigate ethnic inequalities in diagnosis and outcomes of cancer using the CPRD with linkage to secondary care data, and examining multiple cancer types. The fellowship will provide a strong evidence base to inform policy, awareness campaign and clinical practice. It will identify areas where existing interventions would have optimum impact in addition to identifying new interventions for future trial.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION;4.5 RESOURCES AND INFRASTRUCTURE (DETECTION)
Health categories: CANCER AND NEOPLASMS