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The socioeconomic status (SES), determined by factors such as income and education, plays a crucial role in shaping cancer-related outcomes. In the Netherlands, individuals with lower incomes live, on average, eight years shorter and experience poor health 21 years earlier than those with higher incomes. This group is also disproportionately affected by chronic conditions such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and depression. How these disparities manifest in the context of the cancer patient journey has long remained unclear. The Integraal Kankercentrum Nederland (The Netherlands Comprehensive Cancer Centre, IKNL), an independent knowledge institute for oncological and palliative care, investigated how SES influences the cancer journey in the Netherlands. Using data from the Nederlandse Kankerregistratie (Netherlands Cancer Registry, NKR) and other sources, IKNL aims to raise awareness of socioeconomic disparities in cancer care and outcomes.
The Netherlands Cancer Registry (NKR) systematically collects data on all patients diagnosed with cancer in the Netherlands. Patients are followed from diagnosis onward, providing essential insights into disease characteristics, treatment, and outcomes. For over 35 years, IKNL has monitored cancer care at a national level.
To complement registry data, IKNL analysed patient-reported outcomes using data from the Profiles (Patient Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship) Registry and examined the travel burden for patients through a nationwide flash mob study conducted by the Dutch Society for Medical Oncology.
A steering committee composed of internal and external experts guided the process, contributing to the content and providing feedback throughout the process. Additionally, external experts were invited to contribute to the writing of the texts.
The research culminated in a trilogy of reports illustrating how SES affects the cancer journey in the Netherlands:
- Part 1 focuses on how cancer incidence and stage at diagnosis vary by socioeconomic status. Similarly, lifestyle factors such as smoking, obesity, and physical inactivity were more common in lower SES groups, increasing cancer risk.
- Part 2 focuses on socioeconomic differences in cancer treatment and access to care, demonstrating that patients with lower SES are less likely to receive intensive or tumour-targeted treatments.
- Part 3 focuses on how socioeconomic status affects cancer outcomes, quality of life, and follow-up care, revealing that patients with lower SES experience worse survival rates and report more problems with quality of life, work, aftercare, follow-up and finances.
Covering diagnosis, treatment, survival, and quality of life, the findings of the report drew widespread attention to health inequalities and underscore the urgent need for targeted policies to reduce disparities and promote equitable cancer care across all socioeconomic groups. They also emphasise, that cancer is a disease that touches nearly every household and therefore affects the entire population.
To maximize reach and influence, IKNL implemented a comprehensive communication strategy that transformed insights into action. The trilogy of reports was widely disseminated through the IKNL website, targeted newsletters, social media campaigns and press releases, leading to extensive coverage in major media outlets. Furthermore, dedicated briefings and tailored summaries were provided to healthcare professionals, researchers, policy makers, and partners within the oncology field. Patients and citizens were informed through accessible online content and media coverage.
Not only did this strategic approach attract significant media attention, but its in-depth analyses and strong emphasis on socioeconomic disparities also drove change across multiple fields; Members of Parliament leveraged the evidence to raise critical questions and advocate for stronger policies aimed at improving the position of those in disadvantaged circumstances. For the first time, socioeconomic inequalities were structurally embedded in the Dutch Cancer Agenda, elevating health equity to a national priority. This breakthrough triggered targeted policy measures, new interventions to improve access for vulnerable populations, and accelerated research into socioeconomic determinants of cancer. Beyond policy and research, the reports exhilarated awareness among health care professionals, driving the development of more inclusive guidelines and care pathways, and marking a significant step toward equitable cancer care for all.
By engaging stakeholders across all levels, IKNL ensured that the report’s recommendations informed patients, healthcare professionals, researchers, government bodies, and partners. This ultimately helped drive collective action toward more equitable cancer care.
Enablers: A key enabler for the success of the trilogy was the availability of high-quality, reliable data. This included cancer incidence, treatment, and survival data from the Netherlands Cancer Registry; population-level data from Statistics Netherlands, including household income; and patient-reported outcomes from the Profiles Registry. Also, the availability of data at a detailed level from Statistics Netherlands (CBS microdata) enables more in-depth research (information).
Each release of the trilogy attracted significant media attention, which helped raise public awareness and prompted political engagement. To gain national visibility, the strong relationships between IKNL’s spokesperson and media representatives played a key role. The release of the three report sections was communicated to the press, resulting in widespread coverage across major outlets. Additionally, selected media parties were granted exclusives, further amplifying the reach and impact of the findings.
Following publication, IKNL organized a stakeholder meeting to translate findings into concrete actions. This led to a shared vision on health inequalities, developed by partners of the Dutch Cancer Collective (Dutch Cancer Society, Netherlands Federation of Cancer Patient Organizations, and IKNL), along with an overview of Dutch studies on cancer-related disparities. Actions are now being laid out in the scope of the Netherlands Cancer Agenda (where addressing inequalities is from 2026 a priority), via action plans and multi-stakeholder acceleration teams. The findings also prompted Members of Parliament to request a formal debate, seeking clarification from the Minister of Health.
Ultimately, the success of the project was supported by the active involvement of stakeholders throughout the entire process: Pharos, the Dutch centre of expertise on health inequalities, played a crucial role in interpreting the findings and ensuring that the nuances of health disparities were accurately understood. Clinicians were engaged to reflect on the medical implications and potential consequences of the findings, while the patient perspective was carefully considered to ensure that lived experiences were well represented.
Lessons learned: The inclusive approach used to generate these findings strengthened the relevance and impact of the research. Timely involvement of the right stakeholders was essential for accurate interpretation and contextualization of findings. Engaging professional associations early in the process significantly expanded the reach and relevance of the results. Their involvement ensured that the insights were not only scientifically sound but also practically applicable across the healthcare field. By fostering collaboration with key actors, including clinicians, researchers, and patients, the findings gained broader visibility and impact. This approach highlights the importance of inclusive dialogue and shared ownership in addressing complex issues such as health inequality. Bringing the evidence based on data on the table, also strengthens the foundation for translating evidence into actionable policy and practice.
Looking forward, it is necessary that healthcare professionals are encouraged to strengthen person-centred care and aftercare. Particular attention should be brought to psychosocial needs and practical support, especially for patients in vulnerable circumstances. This includes informing patients about supportive services such as travel cost reimbursement and promoting healthy lifestyle choices, including smoking cessation, while considering social and financial barriers. Researchers should conduct deeper analyses into the causes of disparities in survival, disease progression, and quality of life. Outcomes should be reported separately for different socioeconomic groups, and study populations should be representative. Furthermore, engaging with stakeholders is essential to ensure relevance and impact. Governments are urged to invest in reducing health inequalities by embedding health in all policies (Health in All Policies) and tailoring interventions to meet the needs of diverse population groups (Health Equity). Partners in the oncology field are invited to align with national initiatives such as the Dutch Delta Plan against Health Inequalities, contributing to a collective effort to improve cancer outcomes for all.
Health inequality is a complex societal challenge, making it difficult to reduce disparities through simple measures. However, progress is possible when all stakeholders, including patients, professionals, policymakers, and citizens, contribute in their own way, requiring a collective awareness of individual and institutional capacities to act.
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