Inequalities in reported cancer patient experience by socio-demographic characteristic and cancer site: evidence from respondents to the English Cancer Patient Experience Survey

Abstract

Patient experience is a critical dimension of cancer care quality. Understanding variation in experience among patients with different cancers and characteristics is an important first step for designing targeted improvement interventions. We analysed data from the 2011/2012 English Cancer Patient Experience Survey (n = 69,086) using logistic regression to explore inequalities in care experience across 64 survey questions. We additionally calculated a summary measure of variation in patient experience by cancer, and explored inequalities between patients with cancers treated by the same specialist teams. We found that younger and very old, ethnic minority patients and women consistently reported worse experiences across questions. Patients with small intestine/rarer lower gastrointestinal, multiple myeloma and hepatobiliary cancers were most likely to report negative experiences whereas patients with breast, melanoma and testicular cancer were least likely (top-to-bottom odds ratio = 1.91, P < 0.0001). There were also inequalities in experience among patients with cancers treated by the same specialty for five of nine services (P < 0.0001). Specifically, patients with ovarian, multiple myeloma, anal, hepatobiliary and renal cancer reported notably worse experiences than patients with other gynaecological, haematological, gastrointestinal and urological malignancies respectively. Initiatives to improve cancer patient experience across oncology services may be suitably targeted on patients at higher risk of poorer experience.

Keywords: healthcare inequalities; hospital; neoplasms; oncology service; patient satisfaction; quality of health care.

Figure 1

Association between cancer diagnosis and overall patient experience (average) across the survey/patient journey. Results are compared with the experience of patients with rectal cancer as a baseline, with a lower odds ratio indicating more positive experiences. Ophthalmic and rarer CNS, ophthalmic and rarer central nervous system; Gynaecological NOS, gynaecological not otherwise specified.

Figure 2

Association between cancer diagnosis and overall patient experience across the patient journey. Results are presented making comparisons in experience among cancer diagnoses within cancer specialty group. A lower odds ratio indicates more positive experiences. P-values are presented, and are a Wald test of whether odds ratios vary within cancer specialty group. Ophthalmic and rarer CNS, ophthalmic and rarer central nervous system; Gynaecological NOS, gynaecological not otherwise specified.