New lung health equity framework covers lung cancer and COPD
A new report sets out a framework to help countries identify and address inequalities in lung cancer and chronic obstructive pulmonary disease (COPD).
Addressing Inequalities in COPD and Lung Cancer: A Framework for Action looks at the full pathway. This includes risk factors, prevention, diagnosis, treatment and outcomes.
The report was produced by LCP Health, the specialist health team within Lane Clark & Peacock. Its work includes health economics, policy and data analysis.
AstraZeneca initiated and funded the project. Experts at LSE Health, part of the London School of Economics and Political Science, conducted a supplementary evidence review.
What is the Lung Health Equity Framework?
The Lung Health Equity Framework is a set of measures that countries and health systems can use to find inequalities in lung cancer and COPD care.
It covers six areas:
factors that affect lung health, such as tobacco, air pollution, housing and working conditions;
prevention;
incidence and prevalence;
detection and diagnosis;
treatment and management; and
outcomes.
The researchers screened 5,124 studies and included 399 in their review. The lung cancer evidence covered 32 countries. The COPD evidence covered 54 countries.
The framework is designed for use at national and regional levels. Countries can adapt it to their health systems, available data and local populations.
Where do inequalities affect lung cancer care?
The report finds that inequalities can occur at several points in a person’s care.
People on lower incomes, people living in rural areas and some ethnic minority groups can face repeated barriers. These barriers can build over time and lead to later diagnosis, reduced access to treatment and poorer outcomes.
For lung cancer, the framework includes measures for:
access to screening;
stage and route of diagnosis;
time to diagnosis;
biomarker testing;
time from diagnosis to treatment;
access to surgery and radiotherapy;
access to treatments recommended in clinical guidelines;
receipt of biomarker-matched treatment;
access to multidisciplinary teams; and
survival and patient-reported outcomes.
The report also covers patient navigation, early palliative care, follow-up after treatment and access to clinical trials.
A service may be available without being accessible to everyone who needs it. The report therefore recommends looking at who uses each service and who benefits from it.
Better data can reveal hidden inequalities
National figures can hide large differences between groups.
The report recommends analysing data by factors such as income, sex, ethnicity and location. This can show whether some groups are less likely to take part in screening, receive biomarker testing, start treatment promptly or receive care recommended in clinical guidelines.
The framework also links different parts of the pathway. This can help identify communities where greater exposure to risk is combined with later diagnosis, less access to treatment and worse outcomes.
How can countries use the lung health equity framework?
The report proposes four steps:
Measure the burden of lung cancer and COPD and the main risk factors.
Use detailed data to identify populations that face barriers.
Find where inequalities occur at several points in the pathway.
Direct services and funding towards these gaps, then measure whether they reduce.
The report says countries should set clear lung health equity targets. Named organisations should be responsible for delivering them and reporting progress.
It also calls for action outside healthcare. Housing, employment, education, transport and the environment can all affect lung health and access to care.
Which lung cancer programmes are included?
The report includes examples of programmes that aim to reduce inequalities.
England’s lung cancer screening programme uses targeted invitations, community engagement and mobile scanners to reach people in areas with high levels of deprivation.
Australia’s national programme was developed with Aboriginal and Torres Strait Islander communities. It includes community-led support and mobile screening for people in rural and remote areas.
The European EPROPA programme provides comprehensive genomic testing for people with advanced non-small cell lung cancer. It can also connect eligible people with targeted treatments and clinical trials.
These examples show how services can be designed around the barriers faced by different populations.
How did Lung Cancer Europe contribute?
Lung Cancer Europe President Debra Montague was a member of the international Steering Committee.
The committee included clinicians, patient advocates, health economists and health policy experts. Its members helped identify and rank the measures included in the framework. They also reviewed the evidence and advised on barriers affecting different populations.
Lung Cancer Europe provided further feedback on the draft report. This helped strengthen its coverage of lung cancer screening, biomarker testing, precision medicine and treatment.
AstraZeneca did not select or rank the measures or interpret the evidence. Final editorial control remained with the report’s authors.
Read the Lung Health Equity Project report
The report is the first phase of the Lung Health Equity Project. Later phases will use national and regional data to show where risk factors and gaps in care occur together.
Read Addressing Inequalities in COPD and Lung Cancer: A Framework for Action