Enduring inequalities in cancer care experience across England: a longitudinal analysis of NHS trusts, 2015-23.

BACKGROUND: Patient experience is a core indicator of cancer care quality in England, yet substantial variation persists across National Health Service (NHS) trusts. While waiting times and patient demographics are known to influence experience, it remains unclear whether these reflect changes within trusts over time or enduring inequalities betweenthem. METHODS: A nine-year panel dataset (2015-23) was constructed by linking Cancer Patient Experience Survey (CPES) scores with Cancer Waiting Times (CWT) metrics and patient demographics for over 140 NHS trusts. Associations were estimated using a hybrid within-between model, decomposing time-varying factors into within-trust and between-trust components. Sensitivity analyses tested alternative specifications. RESULTS: Differences in patient experience were predominantly associated with between-trust variation, which could reflect underlying structural disparities. Within-trust changes over time, including system shocks during COVID-19, had limited influence. Waiting time performance showed modest and inconsistent associations, whereas demographic composition exhibited stronger and more systematic relationships. Trusts serving more disadvantaged populations, particularly with higher proportions of ethnic minorities, reported poorer experience across multiple domains. CONCLUSIONS: Variation in cancer patient experience across NHS England largely reflects persistent disparities between trusts rather than short-term operational changes. Efforts to improve patient experience should prioritize addressing underlying population and system-level inequalities.