Do people with disabilities experience disparities in cancer care? A systematic review

Abstract

Background: Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that patients with disabilities might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. Methods: A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of patients with disabilities and a sample without disabilities were included. Studies were evaluated for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. Results: Thirty-one studies were included in the systematic review. Compared to people without disabilities, people with disabilities had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that people with disabilities received poorer quality cancer care, including: lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. Discussion: Limitations of this work include results from high-income countries only, exclusion of qualitative research, no meta-analysis and high risk of bias in 15% of included studies. In spite of these limitations, our results show that people with disabilities often experience severe disparities in cancer care: barriers at different levels must be eliminated to ensure that they receive equitable treatment.

Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study

“…Therefore, the care experience of these groups relative to axes of power remains unknown ('intersectional invisibility' (Purdie-Vaughns and Eibach, 2008)). Population health research has identified inequities in care experience among cancer patients living with disability (Tosetti and Kuper, 2023) and comorbidity (Fowler et al, 2020). Therefore, high quality routine data collection is necessary to understand the needs of these often overlooked groups in research (Ginsburg et al, 2023).…”