Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study

Abstract

ContextThe European Deprivation Index (EDI), is a new ecological estimate for Socio-Economic Status (SES). This study postulates that Time-To-Treatment could be used as a cancer quality-of -care surrogate in order to identify the association between cancer patient's SES and quality of care in a French comprehensive cancer center.Methodsretrospective mono-centered cohort study. All consecutive incoming adult patients diagnosed for breast cancer(BC), prostate cancer(PC), colorectal cancer (CRC), lung cancer(LC) or sarcoma(S) were included between January 2013 and December 2013. The association of EDI and Time-To-Diagnosis(TTD), as well as Time-To-Treatment(TTT) was analyzed using a cox regression, and a strata analysis per tumor site was performed.Results969 patients were included. Primitive tumor site was 505 BC(52%), 169 PC(17%), 145 LC(15%), 116 CRC(12%), and 34 S(4%). Median TTD was 1.41 months (Q1-Q3 0.5 to 3.5 months). Median TTT was 0.9 months (0.4 - 1.4). In a multivariate analysis, we identified the tumor site as a predictive factor to influence TTD, shorter for BC (0.75months, [0.30- 1.9]) than PC (4.69 months [1.6-29.7]), HR 0.27 95%CI= [0.22-0.34], p < 0.001. TTT was also shorter for BC (0.75months [0.4-1.1]) than PC (2.02 [0.9-3.2]), HR 0.32 95%CI= [0.27-0.39], p < 0.001. EDI quintiles were not found associated with either TTT or TTD.ConclusionsDeprivation estimated by the EDI does not appear to be related to an extension of the Time-to-Diagnosis or Time-to-Treatment in our real-life population. Further research should be done to identify other frailty-sensitive factors that could be responsible for delays in care.

What might explain deprivation-specific differences in the excess hazard of breast cancer death amongst screen-detected women? Analysis of patients diagnosed in the West Midlands region of England from 1989 to 2011

“…Surprisingly, surgical treatment received did not further explain differences in the excess hazard in either group, where previously this has been shown to be influential [8]. Additionally, time to surgery was not found here to improve the fit of any of the models for the screen-detected group, similar to the findings of a recent smaller study [25]. However, the measure available was not very discriminatory, partly because almost all women had surgery, but also because information on hormone therapy, chemotherapy and radiotherapy were too incomplete to use.…”

Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence

“…No studies were found on the relationships between SES and surgical outcomes, post-surgical complications, length of stay and waiting times in diagnosis and treatment stages which are used as surrogates for the quality of treatment received. These issues have been reported internationally [ 3 , 86 , 95 ] and need to be explored further.…”

Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care

“…Furthermore, for the first time in Italy, we linked population-based data with information on care and treatment to the census tract DI database [ 33 ], in order to attribute to each cancer case a SES category. A limitation of our study regards the use of a census tract DI rather than an individual DI because, as argued by Moriceau et al [ 34 ], the association between SES and cancer survival, where it exists, was stronger when SES was assessed individually [ 35 ] than according to the census tracts [ 36 ]. Indeed, people can live in a deprived area without being deprived themselves.…”