Surviving cancer: Money no cure-all, but poverty limits chances

Are you old, not well off and living in a city?

If so, you have drawn the short straw when it comes to developing and surviving cancer. This is the blunt and uncompromising message in the latest report from the National Cancer Registry Ireland (NCRI).

"The patterns seen – in particular, in relation to variation in cancer risk by deprivation status, variation in survival by deprivation and by age and variation in treatment by age – do point up striking inequalities that need to be targeted for improvement," said Dr Harry Comber, director of the registry.

While money is not the answer to all of life’s problems, being poor limits your chances.

If you are brought up in a mainly working class area, the housing you occupy is likely to indirectly affect your health.

Preventive health

The educational opportunities available to you are limited, which negatively affects your attitude to and knowledge of preventive health. Even your transport options, because they are limited, go against your future health status.

The NCRI report shows the incidence of cancer in the most deprived 20 per cent of the population is 10 per cent greater for men, and 4 per cent higher for women, when compared with the best-off 20 per cent segment of the population.

However, the gap is even more striking when it comes to lung, stomach and cervical cancer. The incidence of cervical cancer is 120 per cent higher in the most deprived section of the population compared to the most affluent, 60 per cent higher for lung cancer and 40 per cent higher for stomach cancer.

Whether it is cardiovascular disease, cancer or infant mortality, we know that if you are unemployed or work at a manual job, you are more likely to die prematurely than if you are a professional.

It is also well documented that the wider the gap between socio-economic groups in terms of health indices, the poorer the health of that nation as a whole.

A 2004 report from the Public Health Alliance of Ireland, Health in Ireland – An Unequal State, found that death rates for all cancers are more than three times greater in the lowest socio-economic group compared to the highest.

It showed that death from lung cancer is four times greater for people in the lowest occupational class, while death from stroke is three times greater.

Cancer inequalities

The latest report digs more deeply into cancer inequalities. It is a complex area, with unanswered questions about how causative factors interact.

Take the findings on age as an example: patients aged over 75 years when they were diagnosed were four times more likely to die from their cancer than those aged 45-54 years.

An initial reaction might be that this represents ageism, in the form of health professionals declining to treat older people’s cancer purely on the basis of their age. But other factors come into play: older people tend to have multiple illnesses other than cancer, and this co-morbidity could mean they are not medically fit enough to undergo rigorous cancer treatment.

Alternatively, a person might quite reasonably say “no thank you” to cancer treatment, having considered the pros and cons. As Dr Comber noted: “Survival variation may not simply be explained by some patient groups presenting at a later stage or receiving less treatment.”

Complexity, however, is not an excuse for inaction over these findings. An analysis by the Institute of Public Health showed that eliminating socio-economic mortality differentials in Ireland would mean more than 13.5 million extra years of life for Irish people.

A good starting point would be to carry out an independent review of health inequalities, which would help to identify the most effective evidence-based strategies for reducing health inequalities here.

Implementation of these strategies will not just benefit people with cancer – it will level the treatment playing field across a whole range of diseases.