How does socio-economic disadvantage influence the timeliness of lung cancer diagnosis? A systematic review and synthesis of published qualitative studies

Abstract

Objectives: Lung cancer has a social gradient in survival and mortality. This review aimed to identify and synthesise qualitative evidence evaluating the role of low socio-economic status on the factors and experiences that lead to delays in lung cancer diagnosis in high-income countries.

Study design: A qualitative systematic review.

Methods: This review identified and synthesised published qualitative evidence evaluating the role of low socio-economic status on factors affecting lung cancer diagnosis in high-income countries. MEDLINE, EMBASE, PsycINFO, CINAHL, and SCOPUS were searched from inception to 21/04/2023 to identify relevant qualitative studies including socio-economically disadvantaged individuals at high risk of, or with, lung cancer (or their family members); or healthcare professionals managing these groups. No language restrictions were applied. Study quality was assessed using the CASP Qualitative Checklist. Iterative thematic analysis was undertaken to create themes and concepts.

Results: The 12 eligible studies assessed multiple perspectives including lung cancer patients, those at high-risk of lung cancer, and healthcare professionals. Synthesis resulted in nine themes: knowledge, health beliefs and behaviours, psychological barriers, competing priorities, social influences, societal and community barriers, public health messages, structural barriers to help-seeking, and structural barriers to a formal diagnosis. Within these themes, there were 20 concepts, some of which fell into multiple themes. Emotional delays, lung cancer awareness, and excusing symptoms were the most commonly recurring concepts.

Conclusions: This review identified multiple barriers that should be addressed to reduce lung cancer inequalities. This information can be used to inform future public health policies and interventions.

Keywords: Health inequalities; Lung cancer; Socioeconomic status.