Social inequalities in treatment receipt for childhood cancers in Ireland: A population‐based analysis

Abstract

Treatment advances over the past five decades have resulted in significant improvements in survival from childhood cancer. Although survival rates are relatively high, social disparities in outcomes have been sometimes observed. In a population-based study, we investigated social inequalities by sex and deprivation in treatment receipt in childhood cancer in Ireland. Cancers incident in people aged 0 to 19 during 1994 to 2012 and treatments received were abstracted from the National Cancer Registry Ireland. Multivariable modified Poisson regression with robust error variance (adjusting for age, and year) was used to assess associations between sex and deprivation category of area of residence at diagnosis and receipt of cancer-directed surgery, chemotherapy or radiotherapy. Three thousand seven hundred and four childhood cancers were included. Girls were significantly less likely than boys to receive radiotherapy for leukemia overall (relative risk [RR] = 0.70; 95% confidence interval [CI] = 0.50-0.98), and acute lymphoblastic leukemia specifically (RR = 0.54; 95% CI = 0.36-0.79), and surgery for central nervous system (CNS) overall (RR = 0.83; 95% CI = 0.74-0.93) and other CNS (RR = 0.76; 95% CI = 0.60-0.96).Girls were slightly less likely to receive chemotherapy for non-Hodgkin lymphoma and surgery for Hodgkin lymphoma (HL), but these results were not statistically significant. Children residing in more deprived areas were significantly less likely to receive chemotherapy for acute myeloid leukemia or surgery for lymphoma overall and HL, but more likely to receive chemotherapy for medulloblastoma. These results may suggest social inequalities in treatment receipt for childhood cancers. Further research is warranted to explore whether similar patterns are evident in other childhood cancer populations and to better understand the reasons for the findings.

Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study

“…Furthermore, our results suggest a lower prevalence or the underdiagnosis of certain conditions among deprived children, such as scoliosis, diseases of the ear and mastoiditis, and neoplasms. There may be many explanations for this observation, such as, for example, lower incidence, less access to healthcare or fewer visits to specialists, for whom the density decreases across deprivation quintiles, and less treatment or higher mortality for tumours [ 32 ]. Our study also highlights a more marked association of mental disorders with deprivation based on the income level of the family (CMUc).…”

“…Importantly, certain LTDs are not classified as a LTD in France. Definitions have been proposed to group children with medically complex or chronic conditions [29][30][31], with a prevalence estimated to be between 13 and 18% and who also show healthcare inequities [31,32]. Several studies have provided data on specific chronic diseases or not are more affected by socioeconomic positions based on and other diseases [4].…”

Alert regarding “Social inequalities in treatment receipt for childhood cancers in Ireland: A population‐based analysis. Michal Molcho, Audrey A. Thomas, Paul M. Walsh, Roderick Skinner, Linda Sharp. Int J Cancer 2022 Mar 15;150(6):941–951. https://doi.org/10.1002/ijc.33856”

“…We would like to draw the attention of the reader to some correspondence about this article published as Letters to the Editor 1,2 in the International Journal of Cancer.…”