Inequalities in cancer diagnostic outcomes for patients with a learning disability: a retrospective cohort study in...

The cancer diagnostic process may be more complicated for patients with a learning disability ('intellectual disability' outside of the UK) than for other patients. We aimed to investigate whether patients with a learning disability were more likely to experience disadvantage in cancer diagnostic pathways and outcomes.

A retrospective cohort study using routinely collected linked data across primary care and cancer registration.

1470 general practices in England.

277 050 participants who were aged 40+ years, had an incident cancer recorded in the cancer registration during 2012-2018 and were registered for at least 3 years at their general practice prior to diagnosis.

Emergency presentation route to diagnosis or urgent suspected cancer referral route to diagnosis, cancer stage at diagnosis (early vs advanced) and all-cause mortality within 30 days after diagnosis.

277 050 patients were included in the overall study, of which 211 423 were included in analyses with cancer stage as outcome. Learning disability was recorded for 796 (0.3%) patients. Patients with a learning disability were over twice as likely to be diagnosed via an emergency presentation (adjusted OR (aOR): 2.65, 95% CI 2.26 to 3.11, p<0.001) and half as likely to be diagnosed via an urgent suspected cancer referral (aOR: 0.51, 95% CI 0.43 to 0.60, p<0.001). They were also more likely to be diagnosed with advanced-stage cancer (aOR: 1.37, 95% CI 1.12 to 1.67, p=0.002), especially for breast cancer, and to die within 30 days of diagnosis (aOR: 3.77, 95% CI 3.10 to 4.59, p<0.001) than patients without a learning disability.

Patients with a learning disability experience marked inequalities in cancer diagnostic pathways and outcomes. The increased risk of advanced-stage breast cancer is of particular note. Improved support to access and navigate the health care system may be required to negate experienced difficulties during the diagnostic process.