Inequalities in survival and care across social determinants of health in a cohort of advanced lung cancer patients in Quebec (Canada): A high‐resolution population‐level analysis

Qureshi, S.A.; Boily, Gino; Pagé, Élisabeth; Strumpf, Erin

doi:10.1002/cam4.5897

Cited by 5 publications

(4 citation statements)

References 43 publications

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“…A population-based retrospective study in Quebec investigated survival inequities in advanced lung cancer patients by income, education, material deprivation index, immigration, and geographic region, as well as variations in the use and delay of targeted therapy ( EGFR -TKI treatment). Patients residing in areas with low education, high material deprivation, minimal immigrant density, or in rural areas or urban centers other than Montreal, had shorter median survival times than patients from Montreal [ 19 ]. Data from the United Kingdom suggest that as the index of multiple deprivation (a measure of the general poverty of a geographic area) increases, the likelihood of patients receiving any novel anticancer therapy, any targeted therapy, or immunotherapy decreases [ 20 ].…”

Section: Why Is Timely Access To Molecular Testing Results An Imperat...mentioning

confidence: 99%

Barriers and Unequal Access to Timely Molecular Testing Results: Addressing the Inequities in Cancer Care Delays across Canada

Snow,

Brezden-Masley,

Carter

et al. 2024

Current Oncology

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Genomic medicine is a powerful tool to improve diagnosis and outcomes for cancer patients by facilitating the delivery of the right drug at the right dose at the right time for the right patient. In 2023, a Canadian conference brought together leaders with expertise in different tumor types. The objective was to identify challenges and opportunities for change in terms of equitable and timely access to biomarker testing and reporting at the education, delivery, laboratory, patient, and health-system levels in Canada. Challenges identified included: limited patient and clinician awareness of genomic medicine options with need for formal education strategies; failure by clinicians to discuss genomic medicine with patients; delays in or no access to hereditary testing; lack of timely reporting of results; intra- and inter-provincial disparities in access; lack of funding for patients to access testing and for laboratories to provide testing; lack of standardized testing; and impact of social determinants of health. Canada must standardize its approach to biomarker testing across the country, with a view to addressing current inequities, and prioritize access to advanced molecular testing to ensure systems are in place to quickly bring innovation and evidence-based treatments to Canadian cancer patients, regardless of their place of residence or socioeconomic status.

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Section: Why Is Timely Access To Molecular Testing Results An Imperat...mentioning

confidence: 99%

Barriers and Unequal Access to Timely Molecular Testing Results: Addressing the Inequities in Cancer Care Delays across Canada

Snow,

Brezden-Masley,

Carter

et al. 2024

Current Oncology

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“…For example, one study found that the percentage of individuals with survival <1 year after diagnosis in Black individuals and White individuals was 41.4% and 22.2% for lung cancer, 9.8% and 7.1% for colorectal cancer, and 2.9% and 0.7% for breast cancer, respectively (Cui and Finkelstein, 2022). Another study showed that patients with advanced lung cancer living in the most materially deprived areas had the shortest median survival time (Qureshi et al, 2023). Hamers et al (2020) found that, out of all patients diagnosed with stage IV colorectal cancer between 2008 and 2016 in the Netherlands Cancer Registry, OS improved only for those patients who were already doing well compared with others.…”

Section: Introductionmentioning

confidence: 99%

Quantifying the impact of novel metastatic cancer therapies on health inequalities in survival outcomes

Zebrowska,

Banuelos,

Rizzo

et al. 2023

Front. Pharmacol.

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Background: Novel therapies in metastatic cancers have contributed to improvements in survival outcomes, yet real-world data suggest that improvements may be mainly driven by those patient groups who already had the highest survival outcomes. This study aimed to develop and apply a framework for quantifying the impact of novel metastatic cancer therapies on health inequalities in survival outcomes based on published aggregate data.Methods: Nine (N = 9) novel therapies for metastatic breast cancer (mBC), metastatic colorectal cancer (mCRC), and metastatic non–small cell lung cancer (mNSCLC) were identified, 3 for each cancer type. Individual patient data (IPD) for overall survival (OS) and progression-free survival (PFS) were replicated from published Kaplan-Meier (KM) curves. For each cancer type, data were pooled for the novel therapies and comparators separately and weighted based on sample size to ensure equal contribution of each therapy in the analyses. Parametric (mixture) distributions were fitted to the weighted data to model and extrapolate survival. The inequality in survival was defined by the absolute difference between groups with the highest and lowest survival for 2 stratifications: one for which survival was stratified into 2 groups and one using 5 groups. Additionally, a linear regression model was fitted to survival estimates for the 5 groups, with the regression coefficient or slope considered as the inequality gradient (IG). The impact of the pooled novel therapies was subsequently defined as the change in survival inequality relative to the pooled comparator therapies. A probabilistic analysis was performed to quantify parameter uncertainty.Results: The analyses found that novel therapies were associated with significant increases in inequalities in survival outcomes relative to their comparators, except in terms of OS for mNSCLC. For mBC, the inequalities in OS increased by 13.9 (95% CI: 1.4; 26.6) months, or 25.0%, if OS was stratified in 5 groups. The IG for mBC increased by 3.2 (0.3; 6.1) months, or 24.7%. For mCRC, inequalities increased by 6.7 (3.0; 10.5) months, or 40.4%, for stratification based on 5 groups; the IG increased by 1.6 (0.7; 2.4) months, or 40.2%. For mNSCLC, inequalities decreased by 14.9 (−84.5; 19.0) months, or 12.2%, for the 5-group stratification; the IG decreased by 2.0 (−16.1; 5.1) months, or 5.5%. Results for the stratification based on 2 groups demonstrated significant increases in OS inequality for all cancer types. In terms of PFS, the increases in survival inequalities were larger in a relative sense compared with OS. For mBC, PFS inequalities increased by 8.7 (5.9; 11.6) months, or 71.7%, for stratification based on 5 groups; the IG increased by 2.0 (1.3; 2.6) months, or 67.6%. For mCRC, PFS inequalities increased by 5.4 (4.2; 6.6) months, or 147.6%, for the same stratification. The IG increased by 1.3 (1.1; 1.6) months, or 172.7%. For mNSCLC, inequalities increased by 18.2 (12.5; 24.4) months, or 93.8%, for the 5-group stratification; the IG increased by 4.0 (2.8; 5.4) months, or 88.1%. Results from the stratification based on 2 groups were similar.Conclusion: Novel therapies for mBC, mCRC, and mNSCLC are generally associated with significant increases in survival inequalities relative to their comparators in randomized controlled trials, though inequalities in OS for mNSCLC decreased nonsignificantly when stratified based on 5 groups. Although further research using real-world IPD is warranted to assess how, for example, social determinants of health affect the impact of therapies on health inequalities among patient groups, the proposed framework can provide important insights in the absence of such data.

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“… 2 With the development of medical technology, the terminal stage of advanced cancer patient life may be prolonged, but it has not significantly succeeded in improving the cure rate of cancer. 3 With the development of medical technology, the life of patients with advanced cancer is prolonged, but the physical function of patients is declining, the quality of life is decreasing, and the degree of dependence on the lives of caregivers is becoming stronger. At the same time, patient privacy is not protected, due to the lack of independent mobility, patients need to be cared for all the time, lack privacy space and time.…”

Section: Introductionmentioning

confidence: 99%

“…(2) refuse examination, diagnosis, and treatment of the primary disease. (3) The concept of receiving hospice care has the demand and willingness of hospice care. This study summarized the hospice care needs of patients with advanced cancer and the current situation of hospice care, and analyzed the influencing factors of hospice care needs in order to provide a reference for better clinical practice of hospice care.…”

Section: Introductionmentioning

confidence: 99%

A Review on the Application of Hospice Care in Patients with Advanced Cancer

Li,

Bai,

Liu

et al. 2023

PPA

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Hospice care is to improve the quality of life and help patients die comfortably, peacefully and dignified by controlling pain and discomfort symptoms and providing physical, psychological and spiritual care and humanistic care in the final stage of the patient’s life. Hospice care clients were primarily cancer patients at first and then slowly extended to other critically patients. Hospice care can alleviate the physical, psychosocial and mental problems of patients with advanced cancer, meet the diversified and multi-level health service needs of patients, improve the quality of life of patients and their families, and also save medical expenditure and improve the efficiency of medical resources. At present, there were few studies on hospice care for Chinese patients with advanced cancer. In this study, the needs of hospice care for patients with advanced cancer were reviewed from physical comfort and pain reduction, dignity maintenance, social support, and help calm death, and specific screening and evaluation tools for hospice care for patients with advanced cancer. And this study was summarized to review the influencing factors of hospice care in order to provide a reference for clinical hospice care practice for patients with advanced cancer in China.

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Inequalities in survival and care across social determinants of health in a cohort of advanced lung cancer patients in Quebec (Canada): A high‐resolution population‐level analysis

Cited by 5 publications

References 43 publications

Barriers and Unequal Access to Timely Molecular Testing Results: Addressing the Inequities in Cancer Care Delays across Canada

Barriers and Unequal Access to Timely Molecular Testing Results: Addressing the Inequities in Cancer Care Delays across Canada

Quantifying the impact of novel metastatic cancer therapies on health inequalities in survival outcomes

A Review on the Application of Hospice Care in Patients with Advanced Cancer

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