Incorporating socioeconomic measures in the Lebanese National Cancer Registry to enhance evidence on social inequalities in cancer

Background: Evidence on social determinants of cancer (SDC) in the United States and other high-income countries comes from registry data linked to individual or community level socioeconomic (SES) measures. In Lebanon, a middle-income country, the national cancer registry (LNCR) does not record SES on the forms, and census data are non-existent.  This paper describes the results of formative research conducted as part of a health promotion project to expand the use of LNCR data in SDC research.

Methodology: We conducted 20 semi-structured interviews with LNCR staff, oncologists, and pathologists to examine: 1) the process of, and challenges encountered in, registering cancer data; 2) Oncologists and pathologists’ understandings of SDC and views on recording SES data on registry forms. Data were analyzed using standard qualitative methods of open and thematic coding.

Results: One of the main challenges encountered in collecting SES data is the dual reporting system, whereby 2/3 of data are reported by pathologists who do not come in contact with patients and cannot collect SES data. On the other hand, oncologists agreed with the importance of SDC and held positive views of recording SES data on LNCR forms. In general, oncologists argued against income but believed that, in the context of Lebanon, education and region of residence are meaningful SES measures and can be feasibly collected.   

Discussion: The paper will present recommendations for incorporating education and region of residence into LNCR registration forms and a plan to achieve these recommendations in collaboration with the Lebanese Ministry of Health.