Socioeconomic variation in cancer survival in the Southeastern Netherlands, 1980-1989

Abstract

Background. The survival rates of patients with cancer by socioeconomic status (SES) has never been investigated in the Netherlands, a country characterized by good general access to health care services. The association between socioeconomic status and survival from cancer of the lung (n = 4591), breast (n = 3928), colorectum (n = 3558), prostate (n = 1484), and stomach (n = 1455) was studied, and the impact of some prognostic factors (stage at diagnosis, histologic type, and treatment) on this association was assessed. Methods. Subjects were patients who were diagnosed from 1980 to 1989 and included in the population‐based Eindhoven Cancer Registry in the Southeastern Netherlands. The patients were classified by socioeconomic status based on their postal code of residence at the time of diagnosis (3 or 5 categories). The follow‐up ended July 1, 1991, at which time relative survival rates and hazard ratios were calculated. Results. A more favorable relative survival for patients living in high SES areas was found for those with cancer of the lung, breast, colorectum, and prostate, whereas for those with stomach cancer, lower survival was found for patients living in high SES areas. For cancer of the lung, colorectum, and prostate, the socioeconomic variation in survival could not be explained by the distribution of the prognostic factors stage, histologic type, and treatment. For patients with breast and stomach cancer, the socioeconomic variation in survival could be ascribed mainly to differences in the percentage of patients diagnosed with a metastasis. Conclusions. Socioeconomic variation in survival from a number of common cancer sites exists in the Netherlands, despite the fairly equal access to health care services for different socioeconomic groups. Most of the variation could not be explained by the differential distribution of stage, histologic type, and treatment across SES categories. Cancer 1995;75:2946–53.

Social class is an important and independent prognostic factor of breast cancer mortality

“…3,[32][33][34] Other studies in European countries reported a cancer overmortality of 25 to 50% among breast cancer patients of low SES. 3,10,[35][36][37] The number of cancer deaths in Europe that could potentially be avoided by eliminating social variation in cancer survival appeared particularly important for breast cancer. 38 Even though Switzerland has one of the best equipped healthcare systems in Europe, this study shows that breast cancer patients of low SES have a 2.4-fold increased risk of dying of breast cancer compared with the risk for breast cancer patients of high SES.…”

Socioeconomic inequalities in cancer survival in Scotland 1986–2000

“…Socioeconomic differences in cancer survival have been observed in many countries (Kogevinas and Porta, 1997;Ward et al, 2004), including the Netherlands (Schrijvers et al, 1995a), Canada (Mackillop et al, 1997), England and Wales (Coleman et al, 1999), Scotland (Scottish Cancer Intelligence Unit, 2000) and the United States (Singh et al, 2003). In England and Wales, recent improvements in survival have been more marked in affluent groups, actually widening the socioeconomic inequality in survival (Coleman et al, 2004).…”

“…Socioeconomic gradients in colorectal cancer survival may be explained by differences in treatment (Faivre-Finn et al, 2002;Guyot et al, 2005;Yu et al, 2005), stage at diagnosis (Singh et al, 2003) or comorbidity (Schrijvers et al, 1995a;Wrigley et al, 2005), although such differences are not consistent (Ionescu et al, 1998;Brewster et al, 2001;Wrigley et al, 2005). In Scotland, deprived and affluent patients diagnosed during 1991 -1994 had similar curative resection rates, but survival was lower among deprived patients, even after adjusting for stage at diagnosis and type of operation (Hole and McArdle, 2002).…”

Identical chemotherapy schedules given on and off trial protocol in small cell lung cancer response and survival results

“…We have no data on non clinical prognostic factors which could be important such as socio-economic status. Lung cancer patients living in better socio-economic areas are known to have more favourable survival compared to patients living in the lower socio-economic areas of the southeastern part of the Netherlands (Schrijvers et al, 1995). This observation was confirmed by the Cancer and Leukaemia Group B, which reported that small cell lung cancer patients with a lower annual income and lower educational level had a shorter survival than those with higher income or education Experimental Therapeutics No significant difference P50.13 for any of the parameters for the off and on trial groups.…”