Poverty can lead to later diagnosis of cancer
A lack of access to cancer services makes the disease more devastating for people on low incomes who often face a later diagnosis, a new report has identified.
The report, Understanding the challenges of cancer and socio-economic inequality in Ireland, was published today by TASC, the independent economic and social think-thank.
It finds that social inequality affects patients all the way from pre-diagnosis to post-treatment.
A consistent theme noted in the report was "the financial burden which cancer placed on individual patients, their families and the patients’ wider social networks".
The report argues that if cancer outcomes are to significantly improve, the Irish state needs to systemically redesign cancer care services.
This includes strengthening the relationship between hospitals and community services and across cancer support services provided by different sectors.
It also includes state investment in amenities, such as parks and gyms, the use of which is actively encouraged by current
policy for the recovery and post-treatment stages of the cancer pathway
To reduce socio-economic inequalities in cancer care, TASC says services need to provide more financial and psychological support; develop better integration between hospital and primary care and build greater capacity in primary care in deprived areas.
This includes expanding cancer prevention and early diagnosis interventions (including using broader ways of screening); investing in localised and community facing services and fostering relationships between marginalised groups and local primary care.
A range of barriers that impact greater on disadvantaged and marginalised groups are identified, including: being less likely to have symptoms investigated, a cycle of behavioural self-blame and moving residence outside the catchment area or becoming homeless while on a waiting list.
Financial stress affects a wide range of people during cancer treatment including:
• those on low incomes
• higher numbers of older people on pensions
• middle to higher earners who lose income as a result of their diagnosis, subsequent treatment
and unforeseen costs
• parents of young children
• those who cannot afford private insurance and are not eligible for medical-card coverage
One doctor quoted in the report said: “Ireland’s extreme waiting lists will adversely affect the majority of low SES (socio-economic status) groups in how early a malignant cancerous tumour is found. Yet the impact of delayed diagnostic stage will be the greatest among the most vulnerable.”
Getting access to a diagnosis or referral can be delayed for communities lacking regular interaction with GPs.
Anyone with a low-income and no savings or with young children as well as the Traveller community and homeless people are among those at risk.
The report highlights obstacles including ambulance and emergency department fees for patients without insurance or medical cards, transport, car parks and accommodation.
The report recommends the introduction of prevention campaigns in schools which stress the detrimental health to young people of smoking and the funding of smoking cessation campaigns which are sensitive to people’s social circumstances and that provide non-judgemental peer groups.
It also recommends an acknowledgement of the inequality in disposable income available to patients for changing diets after surgery and understanding root causes of obesity rates among low SES populations.