Are there gender inequalities between ethnic groups in primary care cancer referrals?

Problem

Longer cancer diagnostic intervals, from as little as 14 days, are associated with more advanced cancer. Women and individuals from ethnic minorities tend to experience longer times to diagnosis, and therefore poorer prognosis, compared with their counterparts for various cancers. The reasons for longer intervals include differences in healthcare seeking behaviour and clinician factors including referral times,for example. In countries with a gatekeeper healthcare system, such as UK, most cancers are diagnosed following primary care initiated referrals.Our objective is to synthesise evidence on the relationship between primary care initiated cancer referrals and cancer outcomes by gender and ethnicity. This is the first review to examine the concept of gender inequalities in primary care initiated cancer referrals . Our review question is,“When primary care referral is the route to diagnosis of various cancers (such as GP referral pathway and two-week-wait pathway in the UK or similar routes in other countries), across various ethnic groups:1. Are time intervals to diagnosis of cancer longer in women than in men?2. Are emergency presentations more likely in women than in men?3. Are stage and/or survival for cancers worse in women than in men?”

Approach

This scoping review will use the Joanna Briggs Institute methodology and PRISMA-ScR. Sources searched include electronic databases-Medline(Ovid), CINAHL,Embase(Ovid) and CENTRAL-and private collections of the team members. Based on participants, concept and context framework, this review will consider studies after 2000 that explored the relationship between gender, across various ethnic groups, and cancer outcomes following primary care cancer referral pathways in countries with gatekeeper healthcare systems. Two independent reviewers are carrying out the study selection followed by data extraction using a template. The results will be presented as a narrative analysis. For this study there is ongoing partnership with public collaborators from the Peninsula Public Engagement Group and the Exeter Collaboration for Academic Primary Care patient and public involvement group who helped develop the research question and review protocol.

Findings

Out of 14,375 studies, titles and abstracts of 10,693 were screened and 216 have been included in the ongoing full text screening. The results will provide an overview of the discrepancies in primary care cancer referrals based on gender across ethnic groups and will be presented in full at the meeting.

Consequences

The results will be used to understand the extent of peer-reviewed literature available on this topic and help identify and analyse knowledge gaps allowing for development of future research initiatives. Synthesising this evidence may also influence policy by allowing the identification of appropriate strategies and interventions to address gender and ethnic inequalities when using cancer referral pathways which could impact the timely identification and management of cancer, making care safer and improving prognosis, resulting in an impact on population health.