Can community pharmacies help to reduce health inequalities in early cancer detection?

Problem

One in two people in the United Kingdom will be diagnosed with cancer during their life The key to cancer treatment success and better clinical outcomes is early detection. Most commonly, patients present to general practice with cancer symptoms, however, they may present to other healthcare providers, such as community pharmacies. Community pharmacies are accessible healthcare providers, who can contribute to the prevention, screening and early diagnosis of cancer.Patients in deprived areas, compared to those who live in more affluent areas, experience a higher disease burden of cancer and their experience of accessing general practice services is less favourable. Therefore, we aim to explore approaches or interventions to early cancer detection in community pharmacies, and whether there is a difference between deprived and more affluent areas in i) the nature of the approaches being offered, ii) clinical outcomes, iii) the perceived barriers and facilitators to the delivery of such approaches, and iv) service users’ and stakeholders’ experiences.

Approach

We are undertaking a systematic review; the protocol is registered with PROSPERO. We are searching MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases. Relevant UK websites such as the Pharmaceutical Journal or Cancer Research UK will also be searched. We are including articles published from 2015 onwards, without language restriction, that report any interventions or programs in community pharmacies to aid early cancer detection. Inclusion criteria are intentionally broad, without restriction by study design. Quality is being assessed with the Mixed Methods Appraisal Tool. Two independent reviewers are screening titles and abstracts, then reviewing included full texts using Covidence (Veritas Health Innovation, Melbourne, Australia) and extracting data to an Excel data extraction form. Extracted data will vary by type of included paper but includes: setting (country and socio-economic status), study characteristics, methods, and clinical and behavioural outcomes.We are adopting a narrative approach to data synthesis. If suitable numerical outcome data such as referral or detection rates emerge, we will undertake meta-analysis where appropriate. Due to the anticipated heterogeneity of study methods and settings, analyses will a priori be conducted using random effects meta-analyses. We aim to undertake subgroup analyses, as the data permit, to compare outcomes from pharmacies serving affluent and deprived populations.The review will be reported according to the PRISMA statement, with narrative findings reported according to the ENTREQ guidance.

Findings

We will present review findings to the conference.

Consequences

This review will inform the future design of a trial targeting early cancer detection in community pharmacies, tailored to the needs of local populations, with the aim of reducing health inequalities and contributing to an improvement of population health.