Cancer Mortality in Individuals with a Learning Disability: A Mixed-Methods Systematic Review

Abstract

Background: Cancer is a leading cause of morbidity and mortality worldwide, with survival outcomes improving in the general population over recent decades. However, evidence suggests that individuals with a learning disability experience poorer cancer-related outcomes, potentially due to delayed diagnosis, barriers to screening, disparities in treatment, and differences in healthcare access. While studies have examined this disparity, the extent of the differences and the factors contributing to them remain unclear.

Objective: This mixed-methods systematic review aims to synthesise quantitative evidence on cancer-specific mortality and overall survival following diagnosis in people with a learning disability, and to integrate qualitative insights into the barriers and facilitators affecting cancer diagnosis, treatment, and end-of-life care in this population.

Methods: A comprehensive search will be conducted in Medline, CINAHL, PsycINFO, Embase, and Scopus, supplemented by Google searches. Eligible studies will include quantitative observational designs and qualitative research published between 2000 and 2025. Two reviewers will independently conduct screening, data extraction, and risk of bias assessment using Joanna Briggs Institute critical appraisal tools. Quantitative data will be synthesised using random-effects meta-analysis where possible; qualitative data will undergo thematic analysis using Braun and Clarke’s framework. The JBI convergent segregated approach will be used to integrate quantitative and qualitative findings.

Expected outcomes: The review will provide an up-to-date, integrated synthesis of evidence on cancer mortality in people with a learning disability, identifying disparities in survival outcomes and the key factors driving these differences. Findings will inform clinical guidelines, healthcare policy, and targeted interventions to promote equitable cancer care.

Registration: This review protocol is registered with PROSPERO.