Where are the inequalities in ovarian cancer care in a country with universal healthcare? A systematic review and narrative synthesis

Pickwell-Smith, Benjamin; Greenley, Sarah; Lind, Michael; Macleod, Una

Abstract

Introduction: Patients diagnosed with ovarian cancer from more deprived areas may face barriers to accessing timely, quality healthcare. We evaluated the literature for any association between socioeconomic group, treatments received and hospital delay among patients diagnosed with ovarian cancer in the United Kingdom, a country with universal healthcare. Methods: We searched MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED, PsycINFO and HMIC from inception to January 2023. Forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts, and full-text articles. UK-based studies were included if they reported socioeconomic measures and an association with either treatments received or hospital delay. The inclusion of studies from one country ensured greater comparability. Risk of bias was assessed using the QUIPS tool, and a narrative synthesis was conducted. The review is reported to PRISMA 2020 and registered with PROSPERO [CRD42022332071]. Results: Out of 2876 references screened, ten were included. Eight studies evaluated treatments received, and two evaluated hospital delays. We consistently observed socioeconomic inequalities in the likelihood of surgery (range of odds ratios 0.24–0.99) and chemotherapy (range of odds ratios 0.70–0.99) among patients from the most, compared with the least, deprived areas. There were no associations between socioeconomic groups and hospital delay. Policy summary: Ovarian cancer treatments differed between socioeconomic groups despite the availability of universal healthcare. Further research is needed to understand why, though suggested reasons include patient choice, health literacy, and financial and employment factors. Qualitative research would provide a rich understanding of the complex factors that drive these inequalities.

Citation

Pickwell-Smith, B., Greenley, S., Lind, M., & Macleod, U. (2024). Where are the inequalities in ovarian cancer care in a country with universal healthcare? A systematic review and narrative synthesis. Journal of Cancer Policy, 39, Article 100458. https://doi.org/10.1016/j.jcpo.2023.100458

• Journal Article Type: Review
• Acceptance Date: Nov 18, 2023
• Online Publication Date: Nov 25, 2023
• Publication Date: Mar 1, 2024
• Deposit Date: Jul 30, 2025
• Publicly Available Date: Jul 31, 2025
• Journal: Journal of Cancer Policy
• Electronic ISSN: 2213-5383
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 39
• Article Number: 100458
• DOI: https://doi.org/10.1016/j.jcpo.2023.100458
• Public URL: https://hull-repository.worktribe.com/output/4484820