Safari Wende C, Gravenhorst Katja, Leyrat Clemence, Shimizu Koki, Smith Matthew J, Aggarwal Ajay, Maringe Camille
Inequalities in Cancer Outcomes Network, Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK.
Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK.
Int J Cancer. 2025 Sep 15;157(6):1043-1054. doi: 10.1002/ijc.35478. Epub 2025 May 26.
Cancer inequalities are wide and enduring, within countries between socio-demographic groups and between countries. These are generated and sustained throughout the key phases of the cancer pathway, from investigation, clinical assessment, decision and access to treatment, and follow-up care. We aimed to describe the characteristics of implemented interventions, evaluated in published controlled experiments in the medical literature, specifically designed to target reductions in inequalities along the cancer pathway. We searched the Ovid Medline and Embase databases from January 2005 to April 2024 for controlled experiments reporting on interventions tackling inequalities. We extracted information on the publication, the aim and type of intervention, its setting, the characteristics of the sample and of the interventions, and summarised their results and limitations. We identified 56 articles reporting on 57 interventions. Of these, 51 (89.5%) focused on access to screening; 56 (98.2%) focused on colorectal, breast, and cervical cancers; 37 (64.9%) concentrated on ethnic inequalities and 48 (84.2%) were based in the USA. In addition, the majority of interventions sought to change individual knowledge, beliefs, and behaviour rather than issues at the system-level. The importance of addressing how healthcare is delivered equitably to all individuals is widely recognised, and there is evidence that individual factors account for only a small part of cancer pathway inequalities. Yet, this scoping review reports a lack of diversity in the implementation of interventions addressing cancer inequalities, and a minority of them target health system issues.
癌症不平等现象广泛且持久，存在于国家内部不同社会人口群体之间以及国家之间。这些不平等现象在癌症诊疗路径的关键阶段产生并持续存在，涵盖从检查、临床评估、治疗决策与获取，到后续护理等各个环节。我们旨在描述已实施干预措施的特征，这些干预措施是在医学文献中已发表的对照实验中进行评估的，专门旨在减少癌症诊疗路径中的不平等现象。我们检索了2005年1月至2024年4月的Ovid Medline和Embase数据库，以查找关于解决不平等问题的干预措施的对照实验。我们提取了有关出版物、干预措施的目的和类型、其实施背景、样本特征以及干预措施的特征等信息，并总结了它们的结果和局限性。我们确定了56篇报告57项干预措施的文章。其中，51项（89.5%）关注筛查的可及性；56项（98.2%）关注结直肠癌、乳腺癌和宫颈癌；37项（64.9%）集中在种族不平等方面，48项（84.2%）以美国为研究基地。此外，大多数干预措施旨在改变个人的知识、信念和行为，而非系统层面的问题。人们广泛认识到公平地为所有个体提供医疗服务的重要性，并且有证据表明个体因素仅占癌症诊疗路径不平等现象的一小部分。然而，这项范围综述报告称，在解决癌症不平等问题的干预措施实施方面缺乏多样性，其中少数措施针对卫生系统问题。
