A 50% higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status

Louwman, Marieke W. J.; Aarts, Mieke J.; Houterman, Saskia; Lenthe, Frank J. van; Coebergh, Jan Willem; Janssen‐Heijnen, M.L.G.

doi:10.1038/sj.bjc.6605949

Cited by 128 publications

(111 citation statements)

References 39 publications

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“…Differences in the uptake of screening, 22 stage at diagnosis, 3 level of comorbidity 23,24 and access to optimal treatment 25 are all potential explanations for the difference in cancer survival between rich and poor patients. Whilst differences in stage at diagnosis and comorbidity have explained only a small proportion of the socioeconomic disparities in survival from colorectal cancer, 26 differential access to healthcare has been shown to strongly influence these inequalities in survival.…”

Section: Discussionmentioning

confidence: 99%

How many deaths would be avoidable if socioeconomic inequalities in cancer survival in England were eliminated? A national population-based study, 1996–2006

Ellis

Coleman

Rachet

2012

European Journal of Cancer

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Ellis, L; Coleman, MP; Rachet, B (2011) How many deaths would be avoidable if socioeconomic inequalities in cancer survival in England were eliminated? A national population-based study, 1996-2006. European journal of cancer (Oxford, England , 48 (2 This study aims to quantify the public health impact of these inequalities by estimating the number of cancer-related deaths that would be avoidable if all patients were to have the same survival as the most affluent patients. MethodsNational Cancer Registry data for all adults diagnosed with one of 21 common cancers in England were used to estimate relative survival. We estimated the number of excess (cancer-related) deaths that would be avoidable within three years after diagnosis if relative survival for patients in all deprivation groups were as high as the most affluent group. ResultsFor patients diagnosed during [2004][2005][2006] 7122 of the 64,940 excess deaths a year (11%) would have been avoidable if three-year survival for all patients had been as high as in the most affluent group. The annual number of avoidable deaths fell from 8435 (13%) a year for patients diagnosed during 1996-2000. Over 60% of the total number of avoidable deaths occurred within six months after diagnosis and approximately 70% occurred in the two most deprived groups. ConclusionThe downward trend in the annual number of avoidable deaths reflects more an improvement in survival in England overall, rather than a narrowing of the deficit in cancer survival between rich and poor. The lack of any substantial change in the percentage of avoidable excess deaths highlights the persistent nature of the deficit in survival between affluent and deprived groups.248 words

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Section: Discussionmentioning

confidence: 99%

How many deaths would be avoidable if socioeconomic inequalities in cancer survival in England were eliminated? A national population-based study, 1996–2006

Ellis

Coleman

Rachet

2012

European Journal of Cancer

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“…Extrapolating, this may indicate that differences between SES classes in lifestyle and access to care have been unchanged in patients with CRC over time. 29 Frederiksen et al 13 studied the role of SES in postoperative mortality after elective CRC surgery in a Danish cohort and found that low SES patients had an excess risk of death, which was mostly accounted for by comorbidity and lifestyle characteristics. The association of a low SES and a high prevalence of (multi) morbidity is also evident in the general population.…”

Section: Discussionmentioning

confidence: 99%

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Leersum

Janssen‐Heijnen

Wouters

et al. 2012

Intl Journal of Cancer

103

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Comorbidity has large impact on colorectal cancer (CRC) treatment and outcomes and may increase as the population ages. We aimed to evaluate the prevalence and time trends of comorbid diseases in patients with CRC from 1995 to 2010. The Eindhoven Cancer Registry registers comorbidity in all patients with primary CRC in the South of the Netherlands. We analyzed the prevalence of serious comorbid diseases in four time frames from 1995 to 2010. Thereby, we addressed its association with age, gender and socio-economic status (SES). The prevalence of comorbidity was registered in 27,339 patients with primary CRC. During the study period, the prevalence of comorbidity increased from 47% to 62%, multimorbidity increased from 20% to 37%. Hypertension and cardiovascular diseases were most prevalent and increased largely over time (respectively 16-29% and 12-24%). Pulmonary diseases increased in women, but remained stable in men. Average age at diagnosis increased from 68.3 to 69.5 years (p 5 0.004). A low SES and male gender were associated with a higher risk of comorbidity (not changing over time). This study indicates that comorbidity among patients with CRC is common, especially in males and patients with a low SES. The prevalence of comorbidity increased from 1995 to 2010, in particular in presumably nutritional diseases. Ageing, increased life expectancy and life style changes may contribute to more comorbid diseases. Also, improved awareness among health care providers on the importance of comorbidity may have resulted in better registration. The increasing burden of comorbidity in patients with CRC emphasizes the need for more focus on individualized medicine.Comorbidity composes a great challenge when treating patients with colorectal cancer (CRC). [1][2][3][4] In the Netherlands, CRC represents the second most frequent cancer in terms of incidence with more than 12,000 newly diagnosed patients annually and a lifetime risk of more than 5%. 5 As more than half of patients with CRC is aged older than 70 years, the diagnosis of CRC is often made amidst the presence of other chronic medical conditions. Treatment of patients with severe comorbidity is challenging because of polypharmacy and decreased compensating mechanisms, especially in older patients who also have normal age-related physiological changes. 6 The presence of a single or combination of chronic illnesses can affect both treatment effectiveness and tolerance, and is associated with worse short-and long-term outcomes after CRC surgery. [1][2][3][4][7][8][9][10][11] The prevalence of comorbidity is influenced by personal and environmental factors. Age, gender and socio-economic status (SES) have been described as interacting with the burden of specific comorbid ailments and influencing outcomes after CRC treatment. [12][13][14] Further, ageing, improved life expectancy and lifestyle habits in western countries will lead to a higher prevalence of (multiple) concomitant diseases among patients with CRC. 15,16 Objectifying increases in the burden of comorbi...

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“…Cancers in less-advantaged women might be diagnosed at a more advanced stage because of low screening uptake, delay in seeking health care, and poor access to specialist care (5,6). Furthermore, women with a lower socioeconomic position tend to have more comorbid conditions, which has also been associated with survival from cancer (4,7). This might either increase surveillance or, conversely, decrease individual resources, the attention to abnormal gynecologic symptoms and cause delayed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Position and Stage of Cervical Cancer in Danish Women Diagnosed 2005 to 2009

Ibfelt

Kjær

Johansen

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: To reduce social disparities in cervical cancer survival, it is important to understand the mechanisms by which social position influence cancer prognosis. We investigated the relations between socioeconomic factors, comorbidity, time since last Papanicolau smear, and stage at diagnosis in Danish women with cervical cancer. Results: The risk for advanced (stage II-IV) compared with early-stage cancer (stage I) was increased for women with short and medium education (OR ¼ 2.40; 1.67-3.45 and 1.76; 1.44-2.16), women living without a partner (OR ¼ 1.31; 1.10-1.55), and older women (OR ¼ 1.07; 1.06-1.08 increase per year). The relations between socioeconomic factors and cancer stage were partly mediated by time since last Pap smear test and to a lesser extent by comorbidity.Conclusions: Shorter education, living alone, and older age were related to advanced stage cervical cancer, due partly to Pap smear testing and less to comorbidity.Impact: It is relevant to further investigate how to decrease delay in cervical cancer diagnosis among disadvantaged groups. Cancer Epidemiol Biomarkers Prev; 21(5); 835-42. Ó2012 AACR.

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A 50% higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status

Cited by 128 publications

References 39 publications

How many deaths would be avoidable if socioeconomic inequalities in cancer survival in England were eliminated? A national population-based study, 1996–2006

How many deaths would be avoidable if socioeconomic inequalities in cancer survival in England were eliminated? A national population-based study, 1996–2006

Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010

Socioeconomic Position and Stage of Cervical Cancer in Danish Women Diagnosed 2005 to 2009

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