Exarchakou Aimilia, Rachet Bernard, Belot Aurélien, Maringe Camille, Coleman Michel P
Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
BMJ. 2018 Mar 14;360:k764. doi: 10.1136/bmj.k764.
To assess the effectiveness of the NHS Cancer Plan (2000) and subsequent national cancer policy initiatives in improving cancer survival and reducing socioeconomic inequalities in survival in England.
Population based cohort study.
England.
More than 3.5 million registered patients aged 15-99 with a diagnosis of one of the 24 most common primary, malignant, invasive neoplasms between 1996 and 2013.
Age standardised net survival estimates by cancer, sex, year, and deprivation group. These estimates were modelled using regression model with splines to explore changes in the cancer survival trends and in the socioeconomic inequalities in survival.
One year net survival improved steadily from 1996 for 26 of 41 sex-cancer combinations studied, and only from 2001 or 2006 for four cancers. Trends in survival accelerated after 2006 for five cancers. The deprivation gap observed for all 41 sex-cancer combinations among patients with a diagnosis in 1996 persisted until 2013. However, the gap slightly decreased for six cancers among men for which one year survival was more than 65% in 1996, and for cervical and uterine cancers, for which survival was more than 75% in 1996. The deprivation gap widened notably for brain tumours in men and for lung cancer in women.
Little evidence was found of a direct impact of national cancer strategies on one year survival, and no evidence for a reduction in socioeconomic inequalities in cancer survival. These findings emphasise that socioeconomic inequalities in survival remain a major public health problem for a healthcare system founded on equity.
评估英国国民医疗服务体系癌症计划（2000年）及随后的国家癌症政策举措在提高英格兰癌症生存率和减少生存方面的社会经济不平等方面的有效性。
基于人群的队列研究。
英格兰。
1996年至2013年间超过350万年龄在15 - 99岁之间、被诊断患有24种最常见原发性恶性侵袭性肿瘤之一的注册患者。
按癌症、性别、年份和贫困组划分的年龄标准化净生存估计值。这些估计值使用带样条的回归模型进行建模，以探讨癌症生存趋势和生存方面的社会经济不平等的变化。
在所研究的41种性别 - 癌症组合中，有26种组合的一年净生存率自1996年起稳步提高，另外4种癌症仅从2001年或2006年起生存率有所提高。2006年后，有5种癌症的生存趋势加速。1996年确诊的所有41种性别 - 癌症组合患者中观察到的贫困差距一直持续到2013年。然而，对于1996年一年生存率超过65%的男性中的6种癌症，以及1996年生存率超过75%的宫颈癌和子宫癌，贫困差距略有缩小。男性脑肿瘤和女性肺癌的贫困差距显著扩大。
几乎没有证据表明国家癌症战略对一年生存率有直接影响，也没有证据表明癌症生存方面的社会经济不平等有所减少。这些发现强调，对于一个建立在公平基础上的医疗体系而言，生存方面的社会经济不平等仍然是一个主要的公共卫生问题。
