Are there socio-economic inequalities in utilisation of predictive biomarker tests and biological and precision therapies for cancer? A systematic review and meta-analysis


Session type:

Ruth Norris, Rosie Dew, Linda Sharp, Alastair Greystoke, Stephen Rice, Kristina Johnell, Adam Todd



Novel biological and precision therapies and their associated predictive biomarker tests offer opportunities for increased tumour response, reduced adverse effects and improved survival. This systematic review determined if there are socio-economic inequalities in utilisation of predictive biomarker tests and/or biological and precision cancer therapies.


MEDLINE, Embase, Scopus, CINAHL, Web of Science, PubMed and PsycINFO were searched for peer reviewed studies, published in English between January 1998 and December 2019. Observational studies reporting utilisation data for predictive biomarker tests and/or cancer biological and precision therapies by a measure of socio-economic status (SES) were eligible. Data was extracted from eligible studies. A modified ISPOR checklist for retrospective database studies was used to assess study quality. Meta-analyses were undertaken using a random-effects model, with sub-group analyses by cancer site and drug class. Unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed for each study. Pooled utilisation ORs for low versus high socio-economic groups were calculated for test and therapy receipt. 


Among 10,722 citations screened, 62 papers (58 studies; 8 test utilisation studies, 37 therapy utilisation studies, 3 studies on testing and therapy, 10 studies without denominator populations or which only reported mean socio-economic status) met the inclusion criteria. Studies reported on 7 cancers, 5 predictive biomarkers tests and 11 biological and precision therapies. 38 studies (including 1,036,125 patients) were eligible for inclusion in meta-analyses. Low socio-economic status was associated with modestly lower predictive biomarker test utilisation (OR 0.86, 95% CI 0.71-1.05; 10 studies) and significantly lower biological and precision therapy utilisation (OR 0.83, 95% CI 0.75-0.91; 30 studies). Associations with therapy utilisation were stronger in lung cancer (OR 0.71, 95% CI 0.51-1.00; 6 studies), than breast cancer (OR 0.93, 95% CI 0.78-1.10; 8 studies). 


These novel results indicate that there are socio-economic inequalities in predictive biomarker tests and biological and precision therapy utilisation. This requires further investigation to prevent differences in outcomes due to inequalities in treatment with biological and precision therapies.  

Impact statement

Future research needs to analyse UK big data in order to understand how to effectively personalise therapy whilst not compromising equitable treatment access to those patients most in need.