Characteristics of interventions aimed at reducing inequalities along the cancer continuum: A scoping review

Cancer inequalities are wide and enduring, within countries between socio-demographic groups and between countries. These are generated and sustained throughout the key phases of the cancer pathway, from investigation, clinical assessment, decision and access to treatment, and follow-up care. We aimed to describe the characteristics of implemented interventions, evaluated in published controlled experiments in the medical literature, specifically designed to target reductions in inequalities along the cancer pathway. We searched the Ovid Medline and Embase databases from January 2005 to April 2024 for controlled experiments reporting on interventions tackling inequalities. We extracted information on the publication, the aim and type of intervention, its setting, the characteristics of the sample and of the interventions, and summarised their results and limitations. We identified 56 articles reporting on 57 interventions. Of these, 51 (89.5%) focused on access to screening; 56 (98.2%) focused on colorectal, breast, and cervical cancers; 37 (64.9%) concentrated on ethnic inequalities and 48 (84.2%) were based in the USA. In addition, the majority of interventions sought to change individual knowledge, beliefs, and behaviour rather than issues at the system-level. The importance of addressing how healthcare is delivered equitably to all individuals is widely recognised, and there is evidence that individual factors account for only a small part of cancer pathway inequalities. Yet, this scoping review reports a lack of diversity in the implementation of interventions addressing cancer inequalities, and a minority of them target health system issues.