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Renna Junior NL, Azevedo E Silva GD. Socioeconomic status and cancer survival in Brazil: Analysis of population data from the municipalities of Aracaju and Curitiba, 1996-2012. Cancer Epidemiol 2023; 85:102394. [PMID: 37419053 DOI: 10.1016/j.canep.2023.102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION The association between socioeconomic status and cancer prognosis has been demonstrated in several countries. Despite the existence of indirect evidence of this phenomenon in Brazil, few studies in this regard are available. OBJECTIVES The objective of the present study is to analyse socioeconomic related survival gaps for patients diagnosed with breast, cervical, lung, prostate, and colorectal cancer in the cities of Aracaju (SE) and Curitiba (PR). METHODS Using population-based data, we estimated net survival by tumour site, year of diagnosis, socioeconomic status and local of residence. Net survival estimation was done with multilevel parametric model allowing flexible spline functions do estimate excess mortality hazards. RESULTS 28,005 cases were included in survival analysis. Five-year net survival showed positive association with SES. Intermunicipal survival gaps favouring Aracaju where prominent for breast (reaching 16,1% in 5 years) OBJECTIVES: Study the impact of socioeconomic factors on cancer survival in two Brazilian capitals. METHODS Survival analysis using population-based cancer data including patients diagnosed with breast, lung, prostate, cervical and colorectal cancer between 1996 and 2012 in Aracaju and Curitiba. Outcomes were excessive mortality hazard (EMH) and 5- and 8-years net survival (NS). The association of race/skin color and socioeconomic level (SES) with EMH and net survival were analyzed using a multilevel regression model with flexible splines. RESULTS 28,005 cases were included, 6636 from Aracaju and 21,369 from Curitiba. NS for all diseases studied increased more prominently for Curitiba population. We observed NS gap between the populations of Aracaju and Curitiba that increased or remained stable during the study period, with emphasis on the growth of the difference in NS of lung and colon cancer (among men). Only for cervical cancer and prostate cancer there was a reduction in the intermunicipal gaps. 5-year NS for breast cancer in Aracaju ranged from 55.2% to 73.4% according to SES. In Curitiba this variation was from 66.5% to 83.8%. CONCLUSION The results of the present study suggests widening of socioeconomic and regional inequalities in the survival of patients with colorectal, breast, cervical, lung and prostate cancers in Brazil during the 1990 s and 2000 s.
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Stuart GW, Chamberlain JA, te Marvelde L. The contribution of prognostic factors to socio-demographic inequalities in breast cancer survival in Victoria, Australia. Cancer Med 2023; 12:15371-15383. [PMID: 37458115 PMCID: PMC10417162 DOI: 10.1002/cam4.6092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Breast cancer survival in Australia varies according to socio-economic status (SES) and between rural and urban places of residence. Part of this disparity may be due to differences in prognostic factors at the time of diagnosis. METHODS Women with invasive breast cancer diagnosed from 2008 until 2012 (n = 14,165) were identified from the Victorian Cancer Registry and followed up for 5 years, with death from breast cancer or other causes recorded. A prognostic score, based on stage at diagnosis, cancer grade, whether the cancer was detected via screening, reported comorbidities and age at diagnosis, was constructed for use in a mediation analysis. RESULTS Five-year breast cancer mortality for women with breast cancer who were in the lowest quintile of SES (10.3%) was almost double that of those in the highest quintile (5.7%). There was a small survival advantage (1.7% on average, within each socio-economic quintile) of living in inner-regional areas compared with major cities. About half of the socio-economic disparity was mediated by prognostic factors, particularly stage at diagnosis and the presence of comorbidities. The inner-regional survival advantage was not due to differences in prognostic factors. CONCLUSIONS Part of the socio-economic disparity in breast cancer survival could be addressed by earlier detection in, and improved general health for, more disadvantaged women. Further research is required to identify additional causes of socio-economic disparities as well as the observed inner-regional survival advantage.
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Affiliation(s)
- Geoffrey W. Stuart
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- School of Psychological Sciences, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneVictoriaMelbourneAustralia
| | | | - Luc te Marvelde
- Victorian Cancer RegistryCancer Council VictoriaMelbourneVictoriaAustralia
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Tron L, Remontet L, Fauvernier M, Rachet B, Belot A, Launay L, Merville O, Molinié F, Dejardin O, Launoy G. Is the Social Gradient in Net Survival Observed in France the Result of Inequalities in Cancer-Specific Mortality or Inequalities in General Mortality? Cancers (Basel) 2023; 15:659. [PMID: 36765616 PMCID: PMC9913401 DOI: 10.3390/cancers15030659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In cancer net survival analyses, if life tables (LT) are not stratified based on socio-demographic characteristics, then the social gradient in mortality in the general population is ignored. Consequently, the social gradient estimated on cancer-related excess mortality might be inaccurate. We aimed to evaluate whether the social gradient in cancer net survival observed in France could be attributable to inaccurate LT. METHODS Deprivation-specific LT were simulated, applying the social gradient in the background mortality due to external sources to the original French LT. Cancer registries' data from a previous French study were re-analyzed using the simulated LT. Deprivation was assessed according to the European Deprivation Index (EDI). Net survival was estimated by the Pohar-Perme method and flexible excess mortality hazard models by using multidimensional penalized splines. RESULTS A reduction in net survival among patients living in the most-deprived areas was attenuated with simulated LT, but trends in the social gradient remained, except for prostate cancer, for which the social gradient reversed. Flexible modelling additionally showed a loss of effect of EDI upon the excess mortality hazard of esophagus, bladder and kidney cancers in men and bladder cancer in women using simulated LT. CONCLUSIONS For most cancers the results were similar using simulated LT. However, inconsistent results, particularly for prostate cancer, highlight the need for deprivation-specific LT in order to produce accurate results.
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Affiliation(s)
- Laure Tron
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
| | - Laurent Remontet
- Service de Biostatistique—Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France
- University of Lyon, 69000 Lyon, France
- University of Lyon 1, 69100 Villeurbanne, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Mathieu Fauvernier
- Service de Biostatistique—Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France
- University of Lyon, 69000 Lyon, France
- University of Lyon 1, 69100 Villeurbanne, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Ludivine Launay
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
| | - Ophélie Merville
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
| | - Florence Molinié
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Loire-Atlantique-Vendée Cancer Registry, 44000 Nantes, France
- Centre d’Epidémiologie et de Recherche en santé des POPulations (CERPOP) UMR1295, Université de Toulouse Paul Sabatier, Inserm, 31000 Toulouse, France
| | - Olivier Dejardin
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
- Research Department, Caen University Hospital Centre, 14000 Caen, France
| | - Francim Group
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
| | - Guy Launoy
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Research Department, Caen University Hospital Centre, 14000 Caen, France
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Long-term benefits for lower socioeconomic groups by improving bowel screening participation in South Australia: A modelling study. PLoS One 2022; 17:e0279177. [PMID: 36542644 PMCID: PMC9770333 DOI: 10.1371/journal.pone.0279177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The gap in bowel cancer screening participation rates between the lowest socioeconomic position (SEP) groups and the highest in Australia is widening. This study estimates the long-term health impacts and healthcare costs at current colorectal cancer (CRC) screening participation rates by SEP in South Australia (SA). METHODS A Markov microsimulation model for each socioeconomic quintile in SA estimated health outcomes over the lifetime of a population aged 50-74 years (total n = 513,000). The model simulated the development of CRC, considering participation rates in the National Bowel Cancer Screening Program and estimated numbers of cases of CRC, CRC deaths, adenomas detected, mean costs of screening and treatment, and quality adjusted life years. Screened status, stage of diagnosis and survival were obtained for patients diagnosed with CRC in 2006-2013 using data linked to the SA Cancer Registry. RESULTS We predict 10915 cases of CRC (95%CI: 8017─13812) in the lowest quintile (Q1), 17% more than the highest quintile (Q5) and 3265 CRC deaths (95%CI: 2120─4410) in Q1, 24% more than Q5. Average costs per person, were 29% higher in Q1 at $11997 ($8754─$15240) compared to Q5 $9281 ($6555─$12007). When substituting Q1 screening and diagnostic testing rates with Q5's, 17% more colonoscopies occur and adenomas and cancers detected increase by 102% in Q1. CONCLUSION Inequalities were evident in CRC cases and deaths, as well as adenomas and cancers that could be detected earlier. Implementing programs to increase screening uptake and follow-up tests for lower socioeconomic groups is critical to improve the health of these priority population groups.
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Disparities in the survival of endometrial cancer patients in a public healthcare system: A population-based cohort study. Gynecol Oncol 2022; 167:532-539. [PMID: 36192238 DOI: 10.1016/j.ygyno.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Social determinants of health (SDH) have been shown to correlate with adverse cancer outcomes. It is unclear if their impact goes beyond behavioral risk or healthcare access. We aimed to evaluate the association of SDH with endometrial cancer outcomes in a public healthcare system. METHODS A retrospective cohort study of endometrial cancer patients diagnosed between 2009 and 2017 in Ontario, Canada. Clinical and sociodemographic variables were extracted from administrative databases. Validated multifactorial marginalization scores for domains of material deprivation, residential instability and ethnic concentration were used. Associations between marginalization and survival were evaluated using log-rank testing and Cox proportional hazards regression. RESULTS 20228 women with endometrial cancer were identified. Fewer patients in marginalized communities presented with early disease (70% vs. 76%, p < 0.001) and received surgery (89% vs. 93%, p < 0.001). Overall survival was shorter among marginalized patients (p < 0.001). On multivariable analysis adjusted for patient and disease factors, overall marginalization (HR = 1.22, 95% CI 1.03-1.08), material deprivation (HR = 1.22, 95% CI 1.10-1.35) and residential instability (HR = 1.32, 95% CI 1.19-1.46) were associated with increased risk of death (p < 0.001). CONCLUSIONS Socioeconomic marginalization is associated with an increased risk of death in endometrial cancer patients. Targetable events in the cancer care pathway should be identified to improve health equity. FUNDING This study was supported by a grant (#RD-196) from the Hamilton Health Sciences Juravinski Hospital and Cancer Center Foundation.
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Tham NL, Skandarajah A, Hayes IP. Socioeconomic disadvantage and its impact on colorectal cancer in Australia: a scoping review. ANZ J Surg 2022; 92:2808-2815. [PMID: 36189982 PMCID: PMC9828090 DOI: 10.1111/ans.18081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Social disparities in cancer survival have been demonstrated in Australia despite a universal healthcare insurance system. Colorectal cancer is common, and reasons for survival disparities related to socioeconomic status need to be investigated and addressed. The aim is to evaluate the current Australian literature concerning the impact of socioeconomic status on colorectal cancer survival and stage at presentation. METHODS A systematic search of PUBMED, EMBASE, SCOPUS and Clarivate Web of Science databases from January 2010 to March 2022 was performed. Studies investigating the impact of socioeconomic status on colorectal stage at presentation or survival in Australia were included. Data were extracted on author, year of publication, state or territory of origin, patient population, other exposure variables, outcomes and findings and adjustments made. RESULTS Of the 14 articles included, the patient populations examined varied in size from 207 to 100 000+ cases. Evidence that socioeconomic disadvantage was associated with poorer survival was demonstrated in eight of 12 studies. Evidence of effect on late stage at presentation was demonstrated in two of seven studies. Area-level measures were commonly used to assess socioeconomic status, with varying indices utilized. CONCLUSION There is limited evidence that socioeconomic status is associated with late-stage at presentation. More studies provide evidence of an association between socioeconomic disadvantage and poorer survival, especially larger studies utilizing less clinically-detailed cancer registry data. Further investigation is required to analyse why socioeconomic disadvantage may be associated with poorer survival.
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Affiliation(s)
- Nicole Li Tham
- Colorectal Surgical UnitThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of General Surgical SpecialtiesThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of SurgeryThe University of MelbourneMelbourneVictoriaAustralia
| | - Anita Skandarajah
- Department of General Surgical SpecialtiesThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of SurgeryThe University of MelbourneMelbourneVictoriaAustralia
| | - Ian Paul Hayes
- Colorectal Surgical UnitThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of General Surgical SpecialtiesThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of SurgeryThe University of MelbourneMelbourneVictoriaAustralia
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Venchiarutti RL, Pho L, Clark JR, Palme CE, Young JM. A qualitative exploration of the facilitators and barriers to early diagnosis and treatment of head and neck cancer: Perceptions of patients and carers. Eur J Cancer Care (Engl) 2022; 31:e13718. [PMID: 36178016 PMCID: PMC9788178 DOI: 10.1111/ecc.13718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this study to explore experiences of patients and carers of the pathway to diagnosis and treatment of head and neck cancer (HNC), focusing on differences based on remoteness of residence. METHODS Patients ≥6 months post-treatment completion, and their carers, were recruited. Semi-structured interviews, guided by the Model of Pathways to Treatment as the theoretical framework, were conducted to examine pathways to treatment of HNC and facilitators and barriers to early diagnosis and treatment. Thematic analysis with an iterative and data-driven approach was used to identify themes. RESULTS A total of 39 patients and 17 carers participated in the interviews. Facilitators of timely diagnosis and treatment included a sense of urgency from health care professionals (HCPs), advocacy by the HCP or carers, and leveraging social capital. Distance to services, financial costs, and a perceived lack of emotional investment by HCPs arose as barriers to timely diagnosis and treatment. Participants were often able to rationalise that not all delays were negative, depending causes and expected impact on cancer management. CONCLUSION The findings highlight the complex nature of factors facilitating and impeding early HNC diagnosis and treatment that may be targeted in interventions to support patients and meet important benchmarks for high-quality cancer care.
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Affiliation(s)
- Rebecca L. Venchiarutti
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia,Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia
| | - Lily Pho
- Sydney Local Health District Nursing and Midwifery Executive UnitSydney Local Health DistrictCamperdownNew South WalesAustralia
| | - Jonathan R. Clark
- Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia,Royal Prince Alfred Institute of Academic SurgerySydney Local Health DistrictCamperdownNew South WalesAustralia,Central Clinical School, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Carsten E. Palme
- Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia,Royal Prince Alfred Institute of Academic SurgerySydney Local Health DistrictCamperdownNew South WalesAustralia,Central Clinical School, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Jane M. Young
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia,The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
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Brunetto Neto A, Oliveira AMD, Rocha CR, Tavares LP, Caldas MFB. Aumento da Incidência de Recidiva Bioquímica após Prostatectomia Radical em Centro de Formação em Urologia Oncológica no Brasil: Doenças mais Avançadas estão sendo submetidas à Cirurgia? REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Introdução: O câncer de próstata e a neoplasia maligna mais incidente em homens, representando 29% dos diagnósticos da doença no Brasil, segundo o Instituto Nacional de câncer Jose Alencar Gomes da Silva (INCA). Esse câncer e suspeito em alterações do toque retal e/ou do nível sérico do antígeno prostático especifico (PSA) total, sendo o diagnóstico definitivo feito por estudo histopatológico. Objetivo: Verificar a associação entre parâmetros clínicos e anatomopatológicos após prostatectómica radical com recidiva bioquímica ao longo do seguimento. Método: Estudo retrospectivo observacional dos parâmetros clínicos (idade, PSA inicial, toque retal, classificação histopatológica da International Society of Urological Pathology (ISUP), escala de D’Amico e estádio clínico) e anatomopatológicos (grau ISUP da peça cirúrgica, margens cirúrgicas, extensão extracapsular tumoral e presença de linfonodos acometidos), de 177 pacientes submetidos a prostatectomia radical em serviço de uro-oncologia de junho/2010-maio/2018. Resultados: A recidiva bioquímica ocorreu em 44,1% dos casos no tempo de seguimento médio de 34,9 meses. A análise univariada demonstrou PSA inicial >9 ng/mL, toque retal alterado, classificação patológica ISUP 4 e 5, risco D’Amico alto e estagio clinico TNM T3 como fatores diretamente associados a recidiva bioquímica. As margens cirúrgicas foram positivas em 46,3%; em 47,7%, identificou-se extensão extraprostática tumoral. Linfonodos positivos em 10,9% e vesículas seminais comprometidas ocorreram em 21,8%. Conclusão: Fatores clinico-patológicos podem ser preditores de recidiva bioquímica. Nesses casos, foi identificado padrão clinico pré-tratamento supostamente mais agressivo em comparação a literatura em geral. Além disso, deve-se considerar a curva de aprendizado dos cirurgiões em formação no serviço, o que pode resultar em maiores taxas de margens cirúrgicas positivas.
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Gallagher BD, Coughlin EC, Nair-Shalliker V, McCaffery K, Smith DP. Socioeconomic differences in prostate cancer treatment: A systematic review and meta-analysis. Cancer Epidemiol 2022; 79:102164. [DOI: 10.1016/j.canep.2022.102164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/18/2022] [Accepted: 04/16/2022] [Indexed: 11/02/2022]
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Lal A, McCaffrey N, Gold L, Roder D, Buckley E. Variations in utilisation of colorectal cancer services in South Australia indicated by MBS/PBS benefits: a benefit incidence analysis. Aust N Z J Public Health 2022; 46:237-242. [PMID: 35174927 DOI: 10.1111/1753-6405.13197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study investigated variations in healthcare expenditure for colorectal cancer (CRC) patients in South Australia by socioeconomic position (SEP) and remoteness area. METHODS Benefits incidence analysis (BIA) was used to examine healthcare expenditure and utilisation in relation to CRC patients by SEP and remoteness areas. Utilisation data was obtained for patients diagnosed with CRC in 2003-2013 from a dataset linked to a population-based cancer registry, Medicare Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS), hospital and death data. Concentration indices estimated the distribution of health expenditure on MBS, MBS palliative care, PBS and general practitioners. Costs of claims data and length of stay in hospital were used as indicators of healthcare utilisation. RESULTS The results indicated that MBS palliative healthcare services utilisation favoured the more advantaged groups for both SEP and remoteness area (Concentration index (CI)= 0.1681, t-value=54.42 (SEP) and CI=0.1546, t-value=41.64). MBS expenditure was also favourable to the more advantaged groups (CI: 0.0785 and 0.0493).PBS and MBS general practitioner expenditure were equal (-0.0093 to 0.0250). CONCLUSION Overall MBS and PBS healthcare expenditure for CRC patients was close to equality, however utilisation of MBS-funded palliative healthcare services was less concentrated in low SEP and more remote areas. Implications for public health: Whether the differences in palliative healthcare utilisation supplied by private providers are offset by other services requires investigation to determine if there is a need for initiatives to improve equality and give greater support to those who choose to die at home.
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Affiliation(s)
- Anita Lal
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria
| | - Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria
| | - Lisa Gold
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria
| | - David Roder
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia
| | - Elizabeth Buckley
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia
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Yu XQ, Yap ML, Cheng ES, Ngo PJ, Vaneckova P, Karikios D, Canfell K, Weber MF. Evaluating prognostic factors for sex differences in lung cancer survival: findings from a large Australian cohort. J Thorac Oncol 2022; 17:688-699. [DOI: 10.1016/j.jtho.2022.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
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Yu XQ, Goldsbury D, Feletto E, Koh CE, Canfell K, O'Connell DL. Socioeconomic disparities in colorectal cancer survival: contributions of prognostic factors in a large Australian cohort. J Cancer Res Clin Oncol 2021; 148:2971-2984. [PMID: 34822016 PMCID: PMC8614213 DOI: 10.1007/s00432-021-03856-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022]
Abstract
Purpose We quantified the contributions of prognostic factors to socioeconomic disparities in colorectal cancer survival in a large Australian cohort. Methods The sample comprised 45 and Up Study participants (recruited 2006–2009) who were subsequently diagnosed with colorectal cancer. Both individual (education attained) and neighbourhood socioeconomic measures were used. Questionnaire responses were linked with cancer registrations (to December 2013), records for hospital inpatient stays, emergency department presentations, death information (to December 2015), and Medicare and Pharmaceutical Benefits claims for subsidised procedures and medicines. Proportions of socioeconomic survival differences explained by prognostic factors were quantified using multiple Cox proportional hazards regression. Results 1720 eligible participants were diagnosed with colorectal cancer after recruitment: 1174 colon and 546 rectal cancers. Significant colon cancer survival differences were only observed for neighbourhood socioeconomic measure (p = 0.033): HR = 1.55; 95% CI 1.09–2.19 for lowest versus highest quartile, and disease-related factors explained 95% of this difference. For rectal cancer, patient- and disease-related factors were the main drivers of neighbourhood survival differences (28–36%), while these factors and treatment-related factors explained 24–41% of individual socioeconomic differences. However, differences remained significant for rectal cancer after adjusting for all these factors. Conclusion In this large contemporary Australian cohort, we identified several drivers of socioeconomic disparities in colorectal cancer survival. Understanding of the role these contributors play remains incomplete, but these findings suggest that improving access to optimal care may significantly reduce these survival disparities.
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Affiliation(s)
- Xue Qin Yu
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia.
| | - David Goldsbury
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
| | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
| | - Cherry E Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Discipline of Surgery, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Tron L, Fauvernier M, Bouvier AM, Robaszkiewicz M, Bouvier V, Cariou M, Jooste V, Dejardin O, Remontet L, Alves A, Molinié F, Launoy G. Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study. Cancers (Basel) 2021; 13:cancers13205156. [PMID: 34680305 PMCID: PMC8533795 DOI: 10.3390/cancers13205156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022] Open
Abstract
Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006-2009, collected through the French network of cancer registries, were included (end of follow-up 30 June 2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.
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Affiliation(s)
- Laure Tron
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Correspondence:
| | - Mathieu Fauvernier
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France; (M.F.); (L.R.)
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, University of Lyon 1, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, INSERM UMR 1231, University of Burgundy, 21079 Dijon, France; (A.-M.B.); (V.J.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
| | - Michel Robaszkiewicz
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Tumors Registry of Finistère, EA SPURBO 7479, CHRU Morvan, 29200 Brest, France
| | - Véronique Bouvier
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Cancer Registry of Calvados, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| | - Mélanie Cariou
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Tumors Registry of Finistère, EA SPURBO 7479, CHRU Morvan, 29200 Brest, France
| | - Valérie Jooste
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, INSERM UMR 1231, University of Burgundy, 21079 Dijon, France; (A.-M.B.); (V.J.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
| | - Olivier Dejardin
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| | - Laurent Remontet
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France; (M.F.); (L.R.)
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, University of Lyon 1, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Arnaud Alves
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
- Department of Digestive Surgery, University Hospital of Caen, 14000 Caen, France
| | | | - Florence Molinié
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Loire-Atlantique/Vendée Cancer Registry, 44000 Nantes, France
- CERPOP, Université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - Guy Launoy
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
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Poiseuil M, Tron L, Woronoff AS, Trétarre B, Dabakuyo-Yonli TS, Fauvernier M, Roche L, Dejardin O, Molinié F, Launoy G. How do age and social environment affect the dynamics of death hazard and survival in patients with breast or gynecological cancer in France? Int J Cancer 2021; 150:253-262. [PMID: 34520579 DOI: 10.1002/ijc.33803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022]
Abstract
Several studies have investigated the association between net survival (NS) and social inequalities in people with cancer, highlighting a varying influence of deprivation depending on the type of cancer studied. However, few of these studies have accounted for the effect of social inequalities over the follow-up period, and/or according to the age of the patients. Thus, using recent and more relevant statistical models, we investigated the effect of social environment on NS in women with breast or gynecological cancer in France. The data were derived from population-based cancer registries, and women diagnosed with breast or gynecological cancer between 2006 and 2009 were included. We used the European deprivation index (EDI), an aggregated index, to define the social environment of the women included. Multidimensional penalized splines were used to model excess mortality hazard. We observed a significant effect of the EDI on NS in women with breast cancer throughout the follow-up period, and especially at 1.5 years of follow-up in women with cervical cancer. Regarding corpus uteri and ovarian cancer patients, the effect of deprivation on NS was less pronounced. These results highlight the impact of social environment on NS in women with breast or gynecological cancer in France thanks to a relevant statistical approach, and identify the follow-up periods during which the social environment may have a particular influence. These findings could help investigate targeted actions for each cancer type, particularly in the most deprived areas, at the time of diagnosis and during follow-up.
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Affiliation(s)
- Marie Poiseuil
- Univ. Bordeaux, Gironde General Cancer Registry, Bordeaux, France.,Inserm, Bordeaux Population Health, Research Center U1219, Team EPICENE, Bordeaux, France
| | - Laure Tron
- 'ANTICIPE' U1086 INSERM-UCN, Normandie Université UNICAEN, Centre François Baclesse, Caen, France
| | - Anne-Sophie Woronoff
- Doubs Cancer Registry, Besançon University Hospital, Besançon, France.,Research Unit EA3181, University of Burgundy Franche-Comté, Besançon, France.,French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Brigitte Trétarre
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Hérault Cancer Registry, Montpellier, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Breast and Gynecologic Cancer Registry of Côte d'Or, Georges Francois Leclerc Comprehensive Cancer Centre, Dijon, France.,Epidemiology and Quality of Life Research Unit, INSERM U1231, Dijon, France
| | - Mathieu Fauvernier
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique - Bioinformatique, Lyon, France.,Lyon University, Lyon 1 University, CNRS, UMR 5558, Biometrics and Evolutionary Biology Laboratory, Biostatistics and Health Team, Villeurbanne, France
| | - Laurent Roche
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique - Bioinformatique, Lyon, France.,Lyon University, Lyon 1 University, CNRS, UMR 5558, Biometrics and Evolutionary Biology Laboratory, Biostatistics and Health Team, Villeurbanne, France
| | - Olivier Dejardin
- 'ANTICIPE' U1086 INSERM-UCN, Normandie Université UNICAEN, Centre François Baclesse, Caen, France.,Research Department, Caen University Hospital Centre, Caen, France
| | - Florence Molinié
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Loire-Atlantique/Vendée Cancer Registry, Nantes, France.,SIRIC-ILIAD, INCA-DGOS-Inserm_12558, CHU Nantes, Nantes, France
| | - Guy Launoy
- 'ANTICIPE' U1086 INSERM-UCN, Normandie Université UNICAEN, Centre François Baclesse, Caen, France.,French Network of Cancer Registries (FRANCIM), Toulouse, France.,Research Department, Caen University Hospital Centre, Caen, France
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15
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MacDermid E, Pasch J, Fok KY, Pasch L, Premaratne C, Kotecha K, Barto W, El Khoury T. The effect of socioeconomic deprivation on presentation stage and long-term outcomes in patients undergoing colorectal cancer resection in Western Sydney. ANZ J Surg 2021; 91:1563-1568. [PMID: 34224200 DOI: 10.1111/ans.17048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND While socioeconomic deprivation has been shown to affect survival in colorectal cancer, other factors such as global region of birth and ethnicity also exert an effect. We wished to ascertain the influence of socioeconomic deprivation on stage of presentation and cancer survival in an ethnically diverse Australian population. METHODS Cases from a database of resections in Western Sydney (n = 1596) were stratified into cohorts of socioeconomic quintiles. Univariate analysis was used to compare demographics, AJCC stage and histopathological details between the least and most socioeconomically deprived groups. Kaplan-Meier analysis and log-rank testing were used to compare cancer-specific and all-cause 5-year survival between the most deprived quintile and all others, after case-control matching for age and overseas birth. RESULTS A total of 322 (20.2%) patients from the most socioeconomically deprived centile, and 275 (17.2%) from the least were compared. The most deprived were significantly more likely to be aged under 70 (54.1% vs. 44.4%, p = 0.019), born overseas (54.3% vs. 38.6%, p = 0.003), present with stage III disease (37.4% vs. 26.7%, p = 0.005), perforated (12.5% vs. 5.3%, p = 0.005) or circumferential tumours (37% vs. 24.3%, p = 0.043). There was no significant difference in proportions presenting with metastatic disease, or 5-year survival between the most deprived quintile and all others after correction for age and foreign birth. CONCLUSIONS Socioeconomic deprivation is associated with unfavourable colorectal cancer presentation stage but not poorer 5-year survival in our Western Sydney population. The reasons for this are unclear and demand further attention.
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Affiliation(s)
- Ewan MacDermid
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | - James Pasch
- Department of Surgery, Northern Beaches Hospital, Sydney, New South Wales, Australia
| | - Kar Yin Fok
- Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | - Lachlan Pasch
- School of Midwifery and Nursing, University of Western Sydney, Sydney, New South Wales, Australia
| | - Chatika Premaratne
- Department of Surgery, John Hunter Hospital, Sydney, New South Wales, Australia
| | - Krishna Kotecha
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Walid Barto
- Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | - Toufic El Khoury
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
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16
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Palliative care among adult cancer survivors: Knowledge, attitudes, and correlates. Palliat Support Care 2021; 20:342-347. [PMID: 34154694 DOI: 10.1017/s1478951521000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Palliative care (PC) is patient and family-centered supportive care intended to improve symptom management, reduce caregiver burden, coordinate care, and improve quality of life for patients diagnosed with serious illness. Optimally, PC is begun close to initial diagnosis and delivered in synchrony with disease-specific treatment until symptom relief or patient death. The purpose of this study was to examine cancer survivors' knowledge and perceptions of PC using a nationally representative sample of US adults from the Health Information National Trends Survey (HINTS). METHOD A total of 593 HINTS respondents reported a personal history of cancer and were included in the sample (55.56% female; mean age of 65.88 years, SD = 18.21; mean time from diagnosis 13.83 years, SD = 18.21). Weighted logistic regression models were conducted to identify correlates of PC knowledge. RESULTS Of the 593 cancer survivors in the sample, 66% (N = 378) reported that they had never heard of PC, 18% (N = 112) reported knowing a little bit about PC, and 17% (N = 95) reported knowing what PC is and could explain it to someone else. In multivariable analysis, survivors of color (Hispanic/Latino, Black, Asian, American Indian, and Pacific Islander), males, and those less educated were significantly less likely to report knowledge of PC. Among survivors who did report knowledge of PC, a lack of distinction between differing modes of supportive care exists. SIGNIFICANCE OF RESULTS These findings suggest a need to increase PC knowledge among cancer survivors with the ultimate goal of addressing disparities in PC acceptance and utilization.
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17
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Finke I, Behrens G, Maier W, Schwettmann L, Pritzkuleit R, Holleczek B, Kajüter H, Gerken M, Mattutat J, Emrich K, Jansen L, Brenner H. Small-area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany. Int J Cancer 2021; 149:561-572. [PMID: 33751564 DOI: 10.1002/ijc.33553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/27/2020] [Accepted: 01/28/2021] [Indexed: 11/12/2022]
Abstract
Socioeconomic inequalities in cancer survival have been reported in various countries but it is uncertain to what extent they persist in countries with relatively comprehensive health insurance coverage such as Germany. We investigated the association between area-based socioeconomic deprivation on municipality level and cancer survival for 25 cancer sites in Germany. We used data from seven population-based cancer registries (covering 32 million inhabitants). Patients diagnosed in 1998 to 2014 with one of 25 most common cancer sites were included. Area-based socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation (GIMD) on municipality level. We estimated 3-month, 1-year, 5-year and 5-year conditional on 1-year age-standardized relative survival using period approach for 2012 to 2014. Trend analyses were conducted for periods between 2003-2005 and 2012-2014. Model-based period analysis was used to calculate relative excess risks (RER) adjusted for age and stage. In total, 2 333 547 cases were included. For all cancers combined, 5-year survival rates by GIMD quintile were 61.6% in Q1 (least deprived), 61.2% in Q2, 60.4% in Q3, 59.9% in Q4 and 59.0% in Q5 (most deprived). For most cancer sites, the most deprived quintile had lower 5-year survival compared to the least deprived quintile even after adjusting for stage (all cancer sites combined, RER 1.16, 95% confidence interval 1.14-1.19). For some cancer sites, this association was stronger during short-term follow-up. Trend analyses showed improved survival from earlier to recent periods but persisting deprivation differences. The underlying reasons for these persisting survival inequalities and strategies to overcome them should be further investigated.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Werner Maier
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ron Pritzkuleit
- Institute for Cancer Epidemiology at the University of Lübeck, Cancer Registry Schleswig-Holstein, Lübeck, Germany
| | | | | | - Michael Gerken
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Johann Mattutat
- Institute for Cancer Epidemiology at the University of Lübeck, Cancer Registry Schleswig-Holstein, Lübeck, Germany
| | | | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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18
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Pham DX, Ho TQH, Bui TD, Ho-Pham LT, Nguyen TV. Trends in breast cancer incidence in Ho Chi Minh City 1996-2015: A registry-based study. PLoS One 2021; 16:e0246800. [PMID: 33566857 PMCID: PMC7875422 DOI: 10.1371/journal.pone.0246800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/26/2021] [Indexed: 12/09/2022] Open
Abstract
The burden of breast cancer in Vietnam has not been documented. This study sought to estimate the incidence of breast cancer in Ho Chi Minh City, the largest economic center of Vietnam, from 1996 to 2015. This was a population-based study using the Ho Chi Minh City Cancer Registry as a source of data (coverage period: 1996-2015). The Registry adopted the International Classification of Diseases for Oncology, 3rd Edition for the classification of primary sites and morphology, and guidelines from the International Agency for Research on Cancer and the International Association of Cancer Registries. Using the population statistics from census data of Ho Chi Minh City, the point incidence of breast cancer for 5-year period was estimated. Based on the national population, we calculated the age-standardized rate (ASR) of breast cancer between 1996 and 2015. Overall 14,222 new cases of breast cancer (13,948 women, or 98%) had been registered during the 1996-2015 period; among whom, just over half (52%) were in the 2nd stage and 26% in the 3rd and 4th stages. In women, the median age at diagnosis was 50 years and there was a slight increase over time. The ASR of breast cancer during the 2011-2015 period was 107.4 cases per 100,000 women, representing an increase of 70% compared to the rate during the 1996-2000 period. In men, there was also a significant increase in the ASR: from 1.13 during the 1996-2001 period to 2.32 per 100,000 men during the 2011-2015 period. These very first data from Vietnam suggest that although the incidence of breast cancer in Vietnam remains relatively low, it has increased over time.
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Affiliation(s)
- Dung X. Pham
- Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
- Department of Oncology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thao-Quyen H. Ho
- Department of Training and Scientific Research, University Medical Center, Ho Chi Minh City, Vietnam
| | - Tung D. Bui
- Department of Healthcare Directions, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Lan T. Ho-Pham
- BioMedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Bone and Muscle Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- * E-mail:
| | - Tuan V. Nguyen
- Bone and Muscle Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia
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19
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Kou K, Dasgupta P, Aitken JF, Baade PD. Impact of area-level socioeconomic status and accessibility to treatment on life expectancy after a cancer diagnosis in Queensland, Australia. Cancer Epidemiol 2020; 69:101803. [PMID: 32927295 DOI: 10.1016/j.canep.2020.101803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
AIMS This study quantifies geographic inequities in loss of life expectancy (LOLE) by area-level socioeconomic status (SES) and accessibility to treatment. METHODS Analysis was conducted using a population-based cancer-registry cohort (n = 371,570) of Queensland (Australia) residents aged 50-89 years, diagnosed between 1997-2016. Flexible parametric survival models were used to estimate LOLE by area-level SES and accessibility for all invasive cancers and the five leading cancers. The gain in life years that could be achieved if all cancer patients experienced the same relative survival as those in the least disadvantaged-high accessibility category was estimated for the 2016 cohort. RESULTS For all invasive cancers, men living in the most disadvantaged areas lost 34 % of life expectancy due to their cancer diagnosis, while those from the least disadvantaged areas lost 25 %. The corresponding percentages for women were 33 % and 23 %. Accessibility had a lower impact on LOLE than SES, with patients from low accessibility areas losing 0-4 % more life expectancy than those from high accessibility areas. For cancer patients diagnosed in 2016 (n = 24,423), an estimated 101,387 life years will be lost. This would be reduced by 19 % if all patients experienced the same relative survival as those from the least disadvantaged-high accessibility areas. CONCLUSION The impact of a cancer diagnosis on remaining life expectancy varies by geographical area. Establishing reasons why area disadvantage impacts on life expectancy is crucial to inform subsequent interventions that could increase the life expectancy of cancer patients from more disadvantaged areas.
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Affiliation(s)
- Kou Kou
- Cancer Council Queensland, Brisbane, Australia
| | | | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia; School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia.
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20
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Bower A, Hsu FC, Weaver KE, Yelton C, Merrill R, Wicks R, Soike M, Hutchinson A, McTyre E, Laxton A, Tatter S, Cramer C, Chan M, Lesser G, Strowd RE. Community economic factors influence outcomes for patients with primary malignant glioma. Neurooncol Pract 2020; 7:453-460. [PMID: 32765895 DOI: 10.1093/nop/npaa010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Community economics and other social health determinants influence outcomes in oncologic patient populations. We sought to explore their impact on presentation, treatment, and survival in glioma patients. Methods A retrospective cohort of patients with glioma (World Health Organization grades III-IV) diagnosed between 1999 and 2017 was assembled with data abstracted from medical record review. Patient factors included race, primary care provider (PCP) identified, marital status, insurance status, and employment status. Median household income based on zip code was used to classify patients as residing in high-income communities (HICs; ie, above the median state income) or low-income communities (LICs; ie, below the median state income). The Kaplan-Meier method was used to assess overall survival (OS); Cox proportional hazards regression was used to explore associations with OS. Results Included were 312 patients, 73% from LICs. Survivors residing in LICs and HICs did not differ by age, sex, race, tumor grade, having a PCP, employment status, insurance, time to presentation, or baseline performance status. Median OS was 4.1 months shorter for LIC patients (19.7 vs 15.6 mo; hazard ratio [HR], 0.75; 95% CI: 0.56-0.98, P = 0.04); this difference persisted with 1-year survival of 66% for HICs versus 61% for LICs at 1 year, 34% versus 24% at 3 years, and 29% versus 17% at 5 years. Multivariable analysis controlling for age, grade, and chemotherapy treatment showed a 25% lower risk of death for HIC patients (HR, 0.75; 95% CI: 0.57-0.99, P < 0.05). Conclusions The economic status of a glioma patient's community may influence survival. Future efforts should investigate potential mechanisms such as health care access, stress, treatment adherence, and social support.
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Affiliation(s)
- Aaron Bower
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Departments of Social Sciences and Health Policy and Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caleb Yelton
- Wake Forest Baptist Medical Center Department of Neurology, Winston-Salem, North Carolina
| | - Rebecca Merrill
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert Wicks
- Wake Forest Baptist Medical Center Department of Neurosurgery, Winston-Salem, North Carolina
| | - Mike Soike
- Wake Forest Baptist Medical Center Department of Radiation Oncology, Winston-Salem, North Carolina
| | - Angelica Hutchinson
- Wake Forest Baptist Medical Center Department of Social Sciences and Health Policy, Winston-Salem, North Carolina
| | - Emory McTyre
- Wake Forest Baptist Medical Center Department of Radiation Oncology, Winston-Salem, North Carolina
| | - Adrian Laxton
- Wake Forest Baptist Medical Center Department of Neurosurgery, Winston-Salem, North Carolina
| | - Stephen Tatter
- Wake Forest Baptist Medical Center Department of Neurosurgery, Winston-Salem, North Carolina
| | - Christina Cramer
- Wake Forest Baptist Medical Center Department of Radiation Oncology, Winston-Salem, North Carolina
| | - Michael Chan
- Wake Forest Baptist Medical Center Department of Radiation Oncology, Winston-Salem, North Carolina
| | - Glenn Lesser
- Wake Forest Baptist Medical Center Department of Neurology, Winston-Salem, North Carolina
| | - Roy E Strowd
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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Wright CM, Nowak AK, Halkett G, Moorin RE. Incorporating competing risk theory into evaluations of changes in cancer survival: making the most of cause of death and routinely linked sociodemographic data. BMC Public Health 2020; 20:1002. [PMID: 32586298 PMCID: PMC7318745 DOI: 10.1186/s12889-020-09084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Relative survival is the most common method used for measuring survival from population-based registries. However, the relative survival concept of ‘survival as far as the cancer is concerned’ can be biased due to differing non-cancer risk of death in the population with cancer (competing risks). Furthermore, while relative survival can be stratified or standardised, for example by sex or age, adjustment for a broad range of sociodemographic variables potentially influencing survival is not possible. In this paper we propose Fine and Gray competing risks multivariable regression as a method that can assess the probability of death from cancer, incorporating competing risks and adjusting for sociodemographic confounders. Methods We used whole of population, person-level routinely linked Western Australian cancer registry and mortality data for individuals diagnosed from 1983 to 2011 for major cancer types combined, female breast, colorectal, prostate, lung and pancreatic cancers, and grade IV glioma. The probability of death from the index cancer (cancer death) was evaluated using Fine and Gray competing risks regression, adjusting for age, sex, Indigenous status, socio-economic status, accessibility to services, time sub-period and (for all cancers combined) cancer type. Results When comparing diagnoses in 2008–2011 to 1983–1987, we observed substantial decreases in the rate of cancer death for major cancer types combined (N = 192,641, − 31%), female breast (− 37%), prostate (− 76%) and colorectal cancers (− 37%). In contrast, improvements in pancreatic (− 15%) and lung cancers (− 9%), and grade IV glioma (− 24%) were less and the cumulative probability of cancer death for these cancer types remained high. Conclusion Considering the justifiable expectation for confounder adjustment in observational epidemiological studies, standard methods for tracking population-level changes in cancer survival are simplistic. This study demonstrates how competing risks and sociodemographic covariates can be incorporated using readily available software. While cancer has been focused on here, this technique has potential utility in survival analysis for other disease states.
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Affiliation(s)
- Cameron M Wright
- Health Economics and Data Analytics, Faculty of Health Sciences, School of Public Health, Curtin University, Kent St, Bentley, 6102, Western Australia. .,School of Medicine, College of Health & Medicine, University of Tasmania, Churchill Avenue, Hobart, Tasmania, 7005, Australia.
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, 6009, Western Australia.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Kent St, Bentley, 6102, Western Australia
| | - Georgia Halkett
- Midwifery and Paramedicine, Faculty of Health Sciences, School of Nursing, Curtin University, Kent St, Bentley, 6102, Western Australia
| | - Rachael E Moorin
- Health Economics and Data Analytics, Faculty of Health Sciences, School of Public Health, Curtin University, Kent St, Bentley, 6102, Western Australia.,Centre for Health Services Research, Faculty of Medicine, Dentistry and Health Sciences, School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia
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22
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Feletto E, Lew JB, Worthington J, He E, Caruana M, Butler K, Hui H, Taylor N, Banks E, Barclay K, Broun K, Butt A, Carter R, Cuff J, Dessaix A, Ee H, Emery J, Frayling IM, Grogan P, Holden C, Horn C, Jenkins MA, Kench JG, Laaksonen MA, Leggett B, Mitchell G, Morris S, Parkinson B, St John DJ, Taoube L, Tucker K, Wakefield MA, Ward RL, Win AK, Worthley DL, Armstrong BK, Macrae FA, Canfell K. Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia. BMJ Open 2020; 10:e036475. [PMID: 32565470 PMCID: PMC7307542 DOI: 10.1136/bmjopen-2019-036475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION With almost 50% of cases preventable and the Australian National Bowel Cancer Screening Program in place, colorectal cancer (CRC) is a prime candidate for investment to reduce the cancer burden. The challenge is determining effective ways to reduce morbidity and mortality and their implementation through policy and practice. Pathways-Bowel is a multistage programme that aims to identify best-value investment in CRC control by integrating expert and end-user engagement; relevant evidence; modelled interventions to guide future investment; and policy-driven implementation of interventions using evidence-based methods. METHODS AND ANALYSIS: Pathways-Bowel is an iterative work programme incorporating a calibrated and validated CRC natural history model for Australia (Policy1-Bowel) and assessing the health and cost outcomes and resource use of targeted interventions. Experts help identify and prioritise modelled evaluations of changing trends and interventions and critically assess results to advise on their real-world applicability. Where appropriate the results are used to support public policy change and make the case for optimal investment in specific CRC control interventions. Fourteen high-priority evaluations have been modelled or planned, including evaluations of CRC outcomes from the changing prevalence of modifiable exposures, including smoking and body fatness; potential benefits of daily aspirin intake as chemoprevention; increasing CRC incidence in people aged <50 years; increasing screening participation in the general and Aboriginal and Torres Strait Islander populations; alternative screening technologies and modalities; and changes to follow-up surveillance protocols. Pathways-Bowel is a unique, comprehensive approach to evaluating CRC control; no prior body of work has assessed the relative benefits of a variety of interventions across CRC development and progression to produce a list of best-value investments. ETHICS AND DISSEMINATION Ethics approval was not required as human participants were not involved. Findings are reported in a series of papers in peer-reviewed journals and presented at fora to engage the community and policymakers.
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Affiliation(s)
- Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joachim Worthington
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily He
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Caruana
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Butler
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Harriet Hui
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily Banks
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Barclay
- Northern Clinical School, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Broun
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Alison Butt
- Research Strategy Office, University of New South Wales, Sydney, New South Wales, Australia
| | - Rob Carter
- Deakin Institute for Health Research, Deakin University, Melbourne, Victoria, Australia
| | - Jeff Cuff
- Faculty of Science Biotech and Biomolecular Science, University of New South Wales, Sydney, New South Wales, Australia
- Research Advocate, Sydney, New South Wales, Australia
| | - Anita Dessaix
- Cancer Prevention and Advocacy, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Hooi Ee
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jon Emery
- General Practice and Primary Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Ian M Frayling
- Inherited Tumour Syndromes Research Group, Division of Cancer & Genetics, Cardiff University, Cardiff, UK
| | - Paul Grogan
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carol Holden
- No Australians Dying of Bowel Cancer Initiative, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Christopher Horn
- Cancer Institute New South Wales, Eveleigh, New South Wales, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - James G Kench
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology & Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Maarit A Laaksonen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Leggett
- Conjoint Gastroenterology, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
- Gastroenterology & Hepatology Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Gillian Mitchell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Morris
- Research Advocate, Sydney, New South Wales, Australia
- Lynch Syndrome Australia, Brisbane, Queensland, Australia
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - D James St John
- Cancer Council Victoria, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Taoube
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Robyn L Ward
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aung Ko Win
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
- Precision Prevention and Early Detection, University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Daniel L Worthley
- No Australians Dying of Bowel Cancer Initiative, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Bruce K Armstrong
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Finlay A Macrae
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Genetic Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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23
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Trewin CB, Johansson ALV, Hjerkind KV, Strand BH, Kiserud CE, Ursin G. Stage-specific survival has improved for young breast cancer patients since 2000: but not equally. Breast Cancer Res Treat 2020; 182:477-489. [PMID: 32495000 PMCID: PMC7297859 DOI: 10.1007/s10549-020-05698-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/18/2020] [Indexed: 11/24/2022]
Abstract
Purpose The stage-specific survival of young breast cancer patients has improved, likely due to diagnostic and treatment advances. We addressed whether survival improvements have reached all socioeconomic groups in a country with universal health care and national treatment guidelines. Methods Using Norwegian registry data, we assessed stage-specific breast cancer survival by education and income level of 7501 patients (2317 localized, 4457 regional, 233 distant and 494 unknown stage) aged 30–48 years at diagnosis during 2000–2015. Using flexible parametric models and national life tables, we compared excess mortality up to 12 years from diagnosis and 5-year relative survival trends, by education and income as measures of socioeconomic status (SES). Results Throughout 2000–2015, regional and distant stage 5-year relative survival improved steadily for patients with high education and high income (high SES), but not for patients with low education and low income (low SES). Regional stage 5-year relative survival improved from 85 to 94% for high SES patients (9% change; 95% confidence interval: 6, 13%), but remained at 84% for low SES patients (0% change; − 12, 12%). Distant stage 5-year relative survival improved from 22 to 58% for high SES patients (36% change; 24, 49%), but remained at 11% for low SES patients (0% change; − 19, 19%). Conclusions Regional and distant stage breast cancer survival has improved markedly for high SES patients, but there has been little survival gain for low SES patients. Socioeconomic status matters for the stage-specific survival of young breast cancer patients, even with universal health care. Electronic supplementary material The online version of this article (10.1007/s10549-020-05698-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cassia Bree Trewin
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet, P.O. Box 4950, Nydalen, 0424, Oslo, Norway. .,Department of Registration, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway. .,Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316, Oslo, Norway.
| | - Anna Louise Viktoria Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway
| | - Kirsti Vik Hjerkind
- Department of Registration, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway
| | - Bjørn Heine Strand
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway.,Department of Community Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1078, Blindern, 0316, Oslo, Norway.,Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, P.O. Box 2168, 3103, Tønsberg, Norway
| | - Cecilie Essholt Kiserud
- National Resource Center for Late Effects After Cancer Treatment, Oslo University Hospital, Radiumhospitalet, P.O. Box 4953, Nydalen, 0424, Oslo, Norway
| | - Giske Ursin
- Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1078, Blindern, 0316, Oslo, Norway.,Department of Preventative Medicine, University of Southern California, 2001 North Soto Street, Los Angeles, CA, 90033, USA
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24
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Afshar N, English DR, Blakely T, Thursfield V, Farrugia H, Giles GG, Milne RL. Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data. PLoS One 2020; 15:e0228551. [PMID: 31999795 PMCID: PMC6992207 DOI: 10.1371/journal.pone.0228551] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/19/2020] [Indexed: 11/23/2022] Open
Abstract
Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001–2015 were identified using the Victorian Cancer Registry and followed to the end of 2016. Five-year net survival and the excess risk of death due to a cancer diagnosis were estimated. People living in more disadvantaged areas had lower five-year survival than residents of less disadvantaged regions for 21 of 29 cancer types: head and neck, oesophagus, stomach, colorectum, anus/anal canal, liver, gallbladder/biliary tract, pancreas, lung, melanoma, connective/soft tissue, female breast, ovary, prostate, kidney, bladder, brain and central nervous system, unknown primary, non-Hodgkin lymphoma, multiple myeloma and leukemia. The observed lower survival in more deprived regions persisted over time, except head and neck cancer, for which the gap in survival has widened. Socio-economic inequalities in survival decreased with increasing age at diagnosis for cancers of connective/soft tissue, bladder and unknown primary. For colorectal cancer, the observed survival disadvantage in lower socio-economic regions was greater for men than for women, while for brain and central nervous system tumours, it was larger for women. Cancer survival is generally lower for residents of more socio-economically disadvantaged areas. Identifying the underlying reasons for these inequalities is important and may help to identify effective interventions to increase survival for underprivileged cancer patients.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Dallas R. English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Helen Farrugia
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Roger L. Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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25
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Mahumud RA, Alam K, Dunn J, Gow J. Emerging cancer incidence, mortality, hospitalisation and associated burden among Australian cancer patients, 1982 - 2014: an incidence-based approach in terms of trends, determinants and inequality. BMJ Open 2019; 9:e031874. [PMID: 31843834 PMCID: PMC6924826 DOI: 10.1136/bmjopen-2019-031874] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Cancer is a leading killer worldwide, including Australia. Cancer diagnosis leads to a substantial burden on the individual, their family and society. The main aim of this study is to understand the trends, determinants and inequalities associated with cancer incidence, hospitalisation, mortality and its burden over the period 1982 to 2014 in Australia. SETTINGS The study was conducted in Australia. STUDY DESIGN An incidence-based study design was used. METHODS Data came from the publicly accessible Australian Institute of Health and Welfare database. This contained 2 784 148 registered cancer cases over the study period for all types of cancer. Erreygers' concentration index was used to examine the magnitude of socioeconomic inequality with regards to cancer outcomes. Furthermore, a generalised linear model was constructed to identify the influential factors on the overall burden of cancer. RESULTS The results showed that cancer incidence (annual average percentage change, AAPC=1.33%), hospitalisation (AAPC=1.27%), cancer-related mortality (AAPC=0.76%) and burden of cancer (AAPC=0.84%) all increased significantly over the period. The same-day (AAPC=1.35%) and overnight (AAPC=1.19%) hospitalisation rates also showed an increasing trend. Further, the ratio (least-most advantaged economic resources ratio, LMR of mortality (M) and LMR of incidence (I)) was especially high for cervix (M/I=1.802), prostate (M/I=1.514), melanoma (M/I=1.325), non-Hodgkin's lymphoma (M/I=1.325) and breast (M/I=1.318), suggesting that survival inequality was most pronounced for these cancers. Socioeconomically disadvantaged people were more likely to bear an increasing cancer burden in terms of incidence, mortality and death. CONCLUSIONS Significant differences in the burden of cancer persist across socioeconomic strata in Australia. Policymakers should therefore introduce appropriate cancer policies to provide universal cancer care, which could reduce this burden by ensuring curable and preventive cancer care services are made available to all people.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- Health Economics Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Health and Epidemiology Research, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- Prostate Cancer Foundation of Australia, St Leonards, New South Wales, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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26
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Lawrance S, Bui C, Mahindra V, Arcorace M, Cooke-Yarborough C. Assessing a modified-AJCC TNM staging system in the New South Wales Cancer Registry, Australia. BMC Cancer 2019; 19:850. [PMID: 31462255 PMCID: PMC6714314 DOI: 10.1186/s12885-019-6062-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background In 2017, the New South Wales Cancer Registry (NSWCR) participated in a project, supported by Cancer Australia, aiming to provide national stage data for melanoma, prostate, colorectal, breast, and lung cancers diagnosed in 2011. Simplified business rules based on the American Joint Committee for Cancer (AJCC) Tumour-Node-Metastasis (TNM) stage were applied to obtain Registry-Derived (RD) stage, defined as the best estimate of TNM stage at diagnosis using routine notifications available within cancer registries. RD-stage was compared with Degree of Spread (DoS), which has been recorded for all applicable cancers in NSWCR at a population-based level since 1972, and a summary AJCC-TNM stage group, which has been collected variably since 2006. For each of the five high incidence cancers, we compared the level of improvements RD-staging provided in terms of completeness and accuracy (alignment to more clinically relevant AJCC-TNM) over DoS. Methods For each of the five cancers, stage data were extracted from NSWCR pre- and post- RD-staging to compare data completeness across all three staging systems. The alignment between DoS/RD-stage and AJCC-TNM was compared, as were the expected and observed cross-tabulated frequency distributions using a subset of NSWCR data. To determine differences between use of DoS, RD-stage, and AJCC-TNM in an epidemiological analysis, we compared survival models developed from each of the three stage variables. Results We found RD-staging provided greatest stage data completeness and alignment to AJCC-TNM for prostate cancers, followed by breast, then melanoma and lung cancers. For colorectal cancer, summary stage from DoS was confirmed as an equivalent surrogate staging system to both AJCC-TNM and RD-stage. Conclusions This analysis provides an evidence-based approach that can be used to inform decision-making for resource planning and potential implementation of a new stage data field in population-based cancer registries. Electronic supplementary material The online version of this article (10.1186/s12885-019-6062-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheena Lawrance
- Cancer Institute NSW, PO Box 41, Alexandria, Sydney, NSW, 1435, Australia.
| | - Chau Bui
- Cancer Institute NSW, PO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Vidur Mahindra
- Cancer Institute NSW, PO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Maria Arcorace
- Cancer Institute NSW, PO Box 41, Alexandria, Sydney, NSW, 1435, Australia
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27
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Yu XQ, Goldsbury D, Yap S, Yap ML, O'Connell DL. Contributions of prognostic factors to socioeconomic disparities in cancer survival: protocol for analysis of a cohort with linked data. BMJ Open 2019; 9:e030248. [PMID: 31427338 PMCID: PMC6825410 DOI: 10.1136/bmjopen-2019-030248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Socioeconomic disparities in cancer survival have been reported in many developed countries, including Australia. Although some international studies have investigated the determinants of these socioeconomic disparities, most previous Australian studies have been descriptive, as only limited relevant data are generally available. Here, we describe a protocol for a study to use data from a large-scale Australian cohort linked with several other health-related databases to investigate several groups of factors associated with socioeconomic disparities in cancer survival in New South Wales (NSW), Australia, and quantify their contributions to the survival disparities. METHODS AND ANALYSIS The Sax Institute's 45 and Up Study participants completed a baseline questionnaire during 2006-2009. Those who were subsequently diagnosed with cancer of the colon, rectum, lung or female breast will be included. This study sample will be identified by linkage with NSW Cancer Registry data for 2006-2013, and their vital status will be determined by linking with cause of death records up to 31 December 2015. The study cohort will be divided into four groups based on each of the individual education level and an area-based socioeconomic measure. The treatment received will be obtained through linking with hospital records and Medicare and pharmaceutical claims data. Cox proportional hazards models will be fitted sequentially to estimate the percentage contributions to overall socioeconomic survival disparities of patient factors, tumour and diagnosis factors, and treatment variables. ETHICS AND DISSEMINATION This research is covered by ethical approval from the NSW Population and Health Services Research Ethics Committee. Results of the study will be disseminated to different interest groups and organisations through scientific conferences, social media and peer-reviewed articles.
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Affiliation(s)
- Xue Qin Yu
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Sarsha Yap
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Mei Ling Yap
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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28
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Rana RH, Alam K, Gow J, Ralph N. Predictors of health care use in Australian cancer patients. Cancer Manag Res 2019; 11:6941-6957. [PMID: 31440086 PMCID: PMC6664209 DOI: 10.2147/cmar.s193615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/07/2019] [Indexed: 12/24/2022] Open
Abstract
Objective The purpose of this study is to measure health care utilization in Australian cancer patients based on their demographic, geographic and socioeconomic backgrounds. Method A total of 13,609 participants (aged 15 and over) from 7,230 households were interviewed as part of Wave 13 of the national Household, Income and Labour Dynamics in Australia (HILDA) survey. Five hundred and seventeen participants indicated a current cancer diagnosis with 90% of those receiving active treatment at the time of interview. Independent sample t-tests, Pearson Chi-sq tests, Kruskal‒Wallis H test, binary logistic regression and a zero-inflated Poisson regression were used to examine inequality in health care use. Results Demographic and sociocultural factors such as advancing age, gender, low income, low education status, rurality, no private health insurance, increased psychological distress and less access to specialist care are associated with lower health care utilization among cancer patients. However, models of care such as general practitioner-led cancer care is preferable in younger individuals with cancer, while accessing specialist care is associated with lower rates of hospitalization and higher levels of psychological distress increases hospital length of stay. Conclusions The findings of lower health care utilization by those cancer patients with characteristics of disadvantage have implications for policy development and intervention design. Broadly, policies targeting structural social inequities are likely to increase health care utilization among the most affected/disadvantaged populations. Further investigation is needed to identify potential links between health care utilization and cancer outcomes as a step toward targeted interventions for improving outcomes in the adversely affected groups.
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Affiliation(s)
- Rezwanul Hasan Rana
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,Centre for Health, Informatics and Economic Research, University of Southern Queensland, Queensland, Australia
| | - Khorshed Alam
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,Centre for Health, Informatics and Economic Research, University of Southern Queensland, Queensland, Australia
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,School of Accounting, Economics and Finance, University of Kwazulu-Natal, Durban, South Africa
| | - Nicholas Ralph
- Health Systems & Psycho-Oncology, Cancer Council Queensland, Queensland, Australia.,School of Nursing, University of Southern Queensland, Queensland, Australia.,St Vincent's Private Hospital , Queensland, Australia
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Zadeh Fakhar HB, Zali H, Rezaie-Tavirani M, Darkhaneh RF, Babaabasi B. Proteome profiling of low grade serous ovarian cancer. J Ovarian Res 2019; 12:64. [PMID: 31315664 PMCID: PMC6637464 DOI: 10.1186/s13048-019-0535-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Serous carcinoma, the subtype of ovarian cancer has the highest occurrence and mortality in women. Proteomic profiling using mass spectrometry (MS) has been used to detect biomarkers in tissue s obtained from patients with ovarian cancer. Thus, this study aimed at analyzing the interactome (protein-protein interaction (PPI)) and (MS) data to inspect PPI networks in patients with Low grade serous ovarian cancer. Methods For proteome profiling in Low grade serous ovarian cancer, 2DE and mass spectrometry were used. Differentially expressed proteins which had been determined in Low grade serous ovarian cancer and experimental group separately were integrated with PPI data to construct the (QQPPI) networks. Results Six Hub-bottlenecks proteins with significant centrality values, based on centrality parameters of the network (Degree and between), were found including Transgelin (TAGLN), Keratin (KRT14), Single peptide match to actin, cytoplasmic 1(ACTB), apolipoprotein A-I (APOA1), Peroxiredoxin-2 (PRDX2), and Haptoglobin (HP). Discussion This study showed these six proteins were introduced as hub-bottleneck protein. It can be concluded that regulation of gene expression can have a critical role in the pathology of Low-grade serous ovarian cancer.
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Affiliation(s)
| | - Hakimeh Zali
- Proteomics Research Center, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Babak Babaabasi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute, ACECR, Tehran, Iran
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Donkers H, Bekkers R, Massuger L, Galaal K. Systematic review on socioeconomic deprivation and survival in endometrial cancer. Cancer Causes Control 2019; 30:1013-1022. [DOI: 10.1007/s10552-019-01202-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/25/2019] [Indexed: 01/19/2023]
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Dalton SO, Olsen MH, Johansen C, Olsen JH, Andersen KK. Socioeconomic inequality in cancer survival - changes over time. A population-based study, Denmark, 1987-2013. Acta Oncol 2019; 58:737-744. [PMID: 30741062 DOI: 10.1080/0284186x.2019.1566772] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Socioeconomic inequality in survival after cancer have been reported in several countries and also in Denmark. Changes in cancer diagnostics and treatment may have changed the gap in survival between affluent and deprived patients and we investigated if the differences in relative survival by income has changed in Danish cancer patients over the past 25 years. Methods: The 1- and 5-year relative survival by income quintile is computed by comparing survival among cancer patients diagnosed 1987-2009 to the survival of a cancer-free matched sample of the background population. The comparison is done within the 15 most common cancers and all cancers combined. The gap in relative survival due to socioeconomic inequality for the period 1987-1991 is compared the period 2005-2009. Results: The relative 5-year survival increased for all 15 cancer sites investigated in the study period. In general, low-income patients diagnosed in 1987-1991 had between 0% and 11% units lower 5-year relative survival compared with high-income patients; however, only four sites (breast, prostate, bladder and head & neck) were statistically different. In patients diagnosed 2005-2009, the gap in 5-year RS was ranging from 2% to 22% units and statistically significantly different for 9 out of 15 sites. The results for 1-year relative survival were similar to the 5-year survival gap. An estimated 22% of all deaths at five years after diagnosis could be avoided had patients in all income groups had same survival as the high-income group. Conclusion: In this nationwide population-based study, we observed that the large improvements in both short- and long-term cancer survival among patients diagnosed 1987-2009. The improvements have been most pronounced for high-income cancer patients, leading to stable or even increasing survival differences between richest and poorest patients. Improving survival among low-income patients would improve survival rates among Danish cancer patients overall and reduce differences in survival when compared to other Western European countries.
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Affiliation(s)
- Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | - Maja Halgren Olsen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen H. Olsen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
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Tron L, Belot A, Fauvernier M, Remontet L, Bossard N, Launay L, Bryere J, Monnereau A, Dejardin O, Launoy G. Socioeconomic environment and disparities in cancer survival for 19 solid tumor sites: An analysis of the French Network of Cancer Registries (FRANCIM) data. Int J Cancer 2019; 144:1262-1274. [PMID: 30367459 DOI: 10.1002/ijc.31951] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/14/2018] [Accepted: 10/18/2018] [Indexed: 01/02/2023]
Abstract
Social inequalities are concerning along the cancer continuum. In France, social gradient in health is particularly marked but little is known about social gradient in cancer survival. We aimed to investigate the influence of socioeconomic environment on cancer survival, for all cancers reported in the French Network of Cancer Registries. We analyzed 189,657 solid tumors diagnosed between 2006 and 2009, recorded in 18 registries. The European Deprivation Index (EDI), an ecological index measuring relative poverty in small geographic areas, assessed social environment. The EDI was categorized into quintiles of the national distribution. One- and five-year age-standardized net survival (ASNS) were estimated for each solid tumor site and deprivation quintile, among men and among women. We found that 5-year ASNS was lower among patients living in the most deprived areas compared to those living in the least deprived ones for 14/16 cancers among men and 16/18 cancers among women. The extent of cancer survival disparities according to deprivation varied substantially across the cancer sites. The reduction in ASNS between the least and the most deprived quintile reached 34% for liver cancer among men and 59% for bile duct cancer among women. For pancreas, stomach and esophagus cancer (among men), and ovary and stomach cancer (among women), deprivation gaps were larger at 1-year than 5-year survival. In conclusion, survival was worse in the most deprived areas for almost all cancers. Our results from population-based cancer registries data highlight the need for implementing actions to reduce social inequalities in cancer survival in France.
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Affiliation(s)
- Laure Tron
- University Hospital of Caen, Caen cedex, France; 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mathieu Fauvernier
- Service de Biostatistique et de Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Laurent Remontet
- Service de Biostatistique et de Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Nadine Bossard
- Service de Biostatistique et de Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Ludivine Launay
- 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Joséphine Bryere
- 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Alain Monnereau
- Registre des hémopathies malignes de la Gironde, Institut Bergonié, Bordeaux, France
- French Network of Cancer Registries, Toulouse, France
| | - Olivier Dejardin
- University Hospital of Caen, Caen cedex, France; 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Guy Launoy
- University Hospital of Caen, Caen cedex, France; 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
- French Network of Cancer Registries, Toulouse, France
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Finke I, Behrens G, Weisser L, Brenner H, Jansen L. Socioeconomic Differences and Lung Cancer Survival-Systematic Review and Meta-Analysis. Front Oncol 2018; 8:536. [PMID: 30542641 PMCID: PMC6277796 DOI: 10.3389/fonc.2018.00536] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background: The impact of socioeconomic differences on cancer survival has been investigated for several cancer types showing lower cancer survival in patients from lower socioeconomic groups. However, little is known about the relation between the strength of association and the level of adjustment and level of aggregation of the socioeconomic status measure. Here, we conduct the first systematic review and meta-analysis on the association of individual and area-based measures of socioeconomic status with lung cancer survival. Methods: In accordance with PRISMA guidelines, we searched for studies on socioeconomic differences in lung cancer survival in four electronic databases. A study was included if it reported a measure of survival in relation to education, income, occupation, or composite measures (indices). If possible, meta-analyses were conducted for studies reporting on individual and area-based socioeconomic measures. Results: We included 94 studies in the review, of which 23 measured socioeconomic status on an individual level and 71 on an area-based level. Seventeen studies were eligible to be included in the meta-analyses. The meta-analyses revealed a poorer prognosis for patients with low individual income (pooled hazard ratio: 1.13, 95 % confidence interval: 1.08–1.19, reference: high income), but not for individual education. Group comparisons for hazard ratios of area-based studies indicated a poorer prognosis for lower socioeconomic groups, irrespective of the socioeconomic measure. In most studies, reported 1-, 3-, and 5-year survival rates across socioeconomic status groups showed decreasing rates with decreasing socioeconomic status for both individual and area-based measures. We cannot confirm a consistent relationship between level of aggregation and effect size, however, comparability across studies was hampered by heterogeneous reporting of socioeconomic status and survival measures. Only eight studies considered smoking status in the analysis. Conclusions: Our findings suggest a weak positive association between individual income and lung cancer survival. Studies reporting on socioeconomic differences in lung cancer survival should consider including smoking status of the patients in their analysis and to stratify by relevant prognostic factors to further explore the reasons for socioeconomic differences. A common definition for socioeconomic status measures is desirable to further enhance comparisons between nations and across different levels of aggregation.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Weisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Belot A, Remontet L, Rachet B, Dejardin O, Charvat H, Bara S, Guizard AV, Roche L, Launoy G, Bossard N. Describing the association between socioeconomic inequalities and cancer survival: methodological guidelines and illustration with population-based data. Clin Epidemiol 2018; 10:561-573. [PMID: 29844706 PMCID: PMC5961638 DOI: 10.2147/clep.s150848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Describing the relationship between socioeconomic inequalities and cancer survival is important but methodologically challenging. We propose guidelines for addressing these challenges and illustrate their implementation on French population-based data. METHODS We analyzed 17 cancers. Socioeconomic deprivation was measured by an ecological measure, the European Deprivation Index (EDI). The Excess Mortality Hazard (EMH), ie, the mortality hazard among cancer patients after accounting for other causes of death, was modeled using a flexible parametric model, allowing for nonlinear and/or time-dependent association between the EDI and the EMH. The model included a cluster-specific random effect to deal with the hierarchical structure of the data. RESULTS We reported the conventional age-standardized net survival (ASNS) and described the changes of the EMH over the time since diagnosis at different levels of deprivation. We illustrated nonlinear and/or time-dependent associations between the EDI and the EMH by plotting the excess hazard ratio according to EDI values at different times after diagnosis. The median excess hazard ratio quantified the general contextual effect. Lip-oral cavity-pharynx cancer in men showed the widest deprivation gap, with 5-year ASNS at 41% and 29% for deprivation quintiles 1 and 5, respectively, and we found a nonlinear association between the EDI and the EMH. The EDI accounted for a substantial part of the general contextual effect on the EMH. The association between the EDI and the EMH was time dependent in stomach and pancreas cancers in men and in cervix cancer. CONCLUSION The methodological guidelines proved efficient in describing the way socioeconomic inequalities influence cancer survival. Their use would allow comparisons between different health care systems.
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Affiliation(s)
- Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
| | - Laurent Remontet
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Olivier Dejardin
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados Digestive Cancer Registry, Centre Hospitalier Universitaire, Caen, France
| | - Hadrien Charvat
- Prevention Division, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Simona Bara
- Manche General Cancer Registry, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Anne-Valérie Guizard
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados General Cancer Registry, Centre François Baclesse, Caen, France
| | - Laurent Roche
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
| | - Guy Launoy
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados Digestive Cancer Registry, Centre Hospitalier Universitaire, Caen, France
| | - Nadine Bossard
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
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Diaz A, Baade PD, Valery PC, Whop LJ, Moore SP, Cunningham J, Garvey G, Brotherton JML, O’Connell DL, Canfell K, Sarfati D, Roder D, Buckley E, Condon JR. Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012). PLoS One 2018; 13:e0196764. [PMID: 29738533 PMCID: PMC5940188 DOI: 10.1371/journal.pone.0196764] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women's higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women. METHODS Data for cervical cancers diagnosed in 2003-2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women. RESULTS Of 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score ≥1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9-3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality. CONCLUSIONS Survival was lowest for women with comorbidity. However, there wasn't a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted. IMPACT The results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).
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Affiliation(s)
- Abbey Diaz
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Peter D. Baade
- Cancer Council Queensland, Spring Hill, Queensland, Australia
| | - Patricia C. Valery
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Lisa J. Whop
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Suzanne P. Moore
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Julia M. L. Brotherton
- Victorian Cytology Service, Carlton, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dianne L. O’Connell
- Cancer Council NSW, Cancer Research Division, Kings Cross, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karen Canfell
- Cancer Council NSW, Cancer Research Division, Kings Cross, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of NSW, Sydney, New South Wales, Australia
| | | | - David Roder
- Cancer Epidemiology & Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth Buckley
- Cancer Epidemiology & Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - John R. Condon
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
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Nymo LS, Aabakken L, Lassen K. Priority and prejudice: does low socioeconomic status bias waiting time for endoscopy? A blinded, randomized survey. Scand J Gastroenterol 2018; 53:621-625. [PMID: 29141477 DOI: 10.1080/00365521.2017.1402207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION An unwanted socioeconomic health gap is observed in Western countries with easily accessible, government-financed health care systems. Survival rates from several malignancies differ between socioeconomic clusters and the disparities remain after adjusting for major co-morbidities and health related behavior. The possibility of biased conduct among health care workers has been proposed as a contributing factor, but evidence is sparse. METHODS A blinded, randomized online questionnaire survey was conducted among specialists in gastroenterology in Norway. Each respondent was asked to give priority for colonoscopy to three different referrals. By randomized sequence, half the referrals contained a discreet piece of information indicating low socioeconomic status (SES). The SES information given was focused on known low-status clusters in Norway, namely the morbidly obese and receivers of disability pensions. RESULTS There were 107 respondents giving a response rate of 67%. A lower priority was consistently given to the referrals containing information on low SES, but the difference only reached statistical significance (p = .018) for one of the referrals. CONCLUSION Information on low SES may influence how referrals for endoscopy are prioritized.
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Affiliation(s)
- Linn Såve Nymo
- a Department of Gastrointestinal Surgery , University Hospital of Northern Norway , Tromsoe , Norway
| | - Lars Aabakken
- b Division of Surgery, Inflammation medicine and Transplantation, Gastrointestinal endoscopy department , Oslo University Hospital , Rikshospitalet , Norway
| | - Kristoffer Lassen
- c Department of Gastrointestinal and Hepatopancreatobiliary Surgery , Oslo University Hospital , Rikshospitalet , Norway
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Lyle G, Hendrie GA, Hendrie D. Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence. Int J Equity Health 2017; 16:182. [PMID: 29037209 PMCID: PMC5644132 DOI: 10.1186/s12939-017-0676-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/03/2017] [Indexed: 12/31/2022] Open
Abstract
Background Globally, the provision of equitable outcomes for women with breast cancer is a priority for governments. However, there is growing evidence that a socioeconomic status (SES) gradient exists in outcomes across the breast cancer continuum – namely incidence, diagnosis, treatment, survival and mortality. This systematic review describes this evidence and, because of the importance of place in defining SES, findings are limited to the Australian experience. Methods An on-line search of PubMed and the Web of Science identified 44 studies published since 1995 which examined the influence of SES along the continuum. The critique of studies included the study design, the types and scales of SES variable measured, and the results in terms of direction and significance of the relationships found. To aid in the interpretation of results, the findings were discussed in the context of a systems dynamic feedback diagram. Results We found 67 findings which reported 107 relationships between SES within outcomes along the continuum. Results suggest no differences in the participation in screening by SES. Higher incidence was reported in women with higher SES whereas a negative association was reported between SES and diagnosis. Associations with treatment choice were specific to the treatment choice undertaken. Some evidence was found towards greater survival for women with higher SES, however, the evidence for a SES relationship with mortality was less conclusive. Conclusions In a universal health system such as that in Australia, evidence of an SES gradient exists, however, the strength and direction of this relationship varies along the continuum. This is a complex relationship and the heterogeneity in study design, the SES indicator selected and its representative scale further complicates our understanding of its influence. More complex multilevel studies are needed to better understand these relationships, the interactions between predictors and to reduce biases introduced by methodological issues.
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Affiliation(s)
- Greg Lyle
- Centre for Population Health Research, Curtin University, Perth, Australia.
| | | | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Australia
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Tervonen HE, Aranda S, Roder D, You H, Walton R, Morrell S, Baker D, Currow DC. Cancer survival disparities worsening by socio-economic disadvantage over the last 3 decades in new South Wales, Australia. BMC Public Health 2017; 17:691. [PMID: 28903750 PMCID: PMC5598077 DOI: 10.1186/s12889-017-4692-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 08/22/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Public concerns are commonly expressed about widening health gaps. This cohort study examines variations and trends in cancer survival by socio-economic disadvantage, geographical remoteness and country of birth in an Australian population over a 30-year period. METHODS Data for cases diagnosed in New South Wales (NSW) in 1980-2008 (n = 651,245) were extracted from the population-based NSW Cancer Registry. Competing risk regression models, using the Fine & Gray method, were used for comparative analyses to estimate sub-hazard ratios (SHR) with 95% confidence intervals (CI) among people diagnosed with cancer. RESULTS Increased risk of cancer death was associated with living in the most socio-economically disadvantaged areas compared with the least disadvantaged areas (SHR 1.15, 95% CI 1.13-1.17), and in outer regional/remote areas compared with major cities (SHR 1.05, 95% CI 1.03-1.06). People born outside Australia had a similar or lower risk of cancer death than Australian-born (SHR 0.99, 95% CI 0.98-1.01 and SHR 0.91, 95% CI 0.90-0.92 for people born in other English and non-English speaking countries, respectively). An increasing comparative risk of cancer death was observed over time when comparing the most with the least socio-economically disadvantaged areas (SHR 1.07, 95% CI 1.04-1.10 for 1980-1989; SHR 1.14, 95% CI 1.12-1.17 for 1990-1999; and SHR 1.24, 95% CI 1.21-1.27 for 2000-2008; p < 0.001 for interaction between disadvantage quintile and year of diagnosis). CONCLUSIONS There is a widening gap in comparative risk of cancer death by level of socio-economic disadvantage that warrants a policy response and further examination of reasons behind these disparities.
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Affiliation(s)
- Hanna E. Tervonen
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - Sanchia Aranda
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
- Cancer Council Australia, GPO Box 4708, Sydney, NSW 2001 Australia
| | - David Roder
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - Hui You
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - Richard Walton
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - Stephen Morrell
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052 Australia
| | - Deborah Baker
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
| | - David C. Currow
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
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Colorectal cancer metastatic disease progression in Australia: A population-based analysis. Cancer Epidemiol 2017; 49:92-100. [DOI: 10.1016/j.canep.2017.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/11/2017] [Accepted: 05/24/2017] [Indexed: 01/05/2023]
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Does exclusion of cancers registered only from death-certificate information diminish socio-demographic disparities in recorded survival? Cancer Epidemiol 2017; 48:70-77. [PMID: 28419901 DOI: 10.1016/j.canep.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/21/2017] [Accepted: 04/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Death Certificate Only (DCO) cancer cases are commonly excluded from survival analyses due to unknown survival time. This study examines whether socio-demographic factors are associated with DCO diagnosis, and the potential effects of excluding DCO cases on socio-demographic cancer survival disparities in NSW, Australia. METHODS NSW Cancer Registry data for cases diagnosed in 2000-2008 were used in this study. Logistic regression was used to estimate the odds of DCO registration by socio-demographic sub-group (socio-economic disadvantage, residential remoteness, country of birth, age at diagnosis). Cox proportional hazard regression was used to estimate the probability of death from cancer by socio-demographic subgroup when DCO cases were included and excluded from analyses. RESULTS DCO cases consisted of 1.5% (n=4336) of all cases (n=299,651). DCO diagnosis was associated with living in socio-economically disadvantaged areas (most disadvantaged compared with least disadvantaged quintile: odds ratio OR 1.25, 95%CI 1.12-1.40), living in inner regional (OR 1.16, 95%CI 1.08-1.25) or remote areas (OR 1.48, 95%CI 1.01-2.19), having an unknown country of birth (OR 1.63, 95%CI 1.47-1.81) and older age. Including or excluding DCO cases had no significant impact on hazard ratios for cancer death by socio-economic disadvantage quintile or remoteness category, and only a minor impact on hazard ratios by age. CONCLUSION Socio-demographic factors were associated with DCO diagnosis in NSW. However, socio-demographic cancer survival disparities remained unchanged or varied only slightly irrespective of including/excluding DCO cases. Further research could examine the upper limits of DCO proportions that significantly alter estimated cancer survival differentials if DCOs are excluded.
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Singh GK, Jemal A. Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950-2014: Over Six Decades of Changing Patterns and Widening Inequalities. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2017; 2017:2819372. [PMID: 28408935 PMCID: PMC5376950 DOI: 10.1155/2017/2819372] [Citation(s) in RCA: 453] [Impact Index Per Article: 64.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/27/2017] [Indexed: 11/17/2022]
Abstract
We analyzed socioeconomic and racial/ethnic disparities in US mortality, incidence, and survival rates from all-cancers combined and major cancers from 1950 to 2014. Census-based deprivation indices were linked to national mortality and cancer data for area-based socioeconomic patterns in mortality, incidence, and survival. The National Longitudinal Mortality Study was used to analyze individual-level socioeconomic and racial/ethnic patterns in mortality. Rates, risk-ratios, least squares, log-linear, and Cox regression were used to examine trends and differentials. Socioeconomic patterns in all-cancer, lung, and colorectal cancer mortality changed dramatically over time. Individuals in more deprived areas or lower education and income groups had higher mortality and incidence rates than their more affluent counterparts, with excess risk being particularly marked for lung, colorectal, cervical, stomach, and liver cancer. Education and income inequalities in mortality from all-cancers, lung, prostate, and cervical cancer increased during 1979-2011. Socioeconomic inequalities in cancer mortality widened as mortality in lower socioeconomic groups/areas declined more slowly. Mortality was higher among Blacks and lower among Asian/Pacific Islanders and Hispanics than Whites. Cancer patient survival was significantly lower in more deprived neighborhoods and among most ethnic-minority groups. Cancer mortality and incidence disparities may reflect inequalities in smoking, obesity, physical inactivity, diet, alcohol use, screening, and treatment.
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Affiliation(s)
- Gopal K. Singh
- US Department of Health and Human Services, Office of Health Equity, Health Resources and Services Administration, 5600 Fishers Lane, Room 13N42, Rockville, MD 20857, USA
| | - Ahmedin Jemal
- American Cancer Society, Inc., Surveillance & Health Services Research, 250 Williams Street NW, Corporate Center, Atlanta, GA 30303, USA
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Yu XQ, Luo Q, Kahn C, Grogan P, O'Connell DL, Jemal A. Contrasting temporal trends in lung cancer incidence by socioeconomic status among women in New South Wales, Australia, 1985-2009. Lung Cancer 2017. [PMID: 28625648 DOI: 10.1016/j.lungcan.2017.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We examined long-term trends in lung cancer incidence for women by socioeconomic groups in New South Wales (NSW), Australia. METHODS Data on lung cancer incidence for women were extracted from the NSW Cancer Registry database. We divided the study cohort into five quintiles according to an area-based index of education and occupation (IEO) and calculated annual age-standardised incidence rates by IEO quintile for the period 1985-2009. The age-standardised incidence ratio (SIR) was estimated for IEO quintiles and 5-year period of diagnosis using the highest IEO quintile as the reference. RESULTS Overall, lung cancer incidence for women aged 25-69 years increased gradually from 19.8 per 100,000 in 1985 to 25.7 per 100,000 in 2009. The trends by IEO quintile were somewhat comparable from 1985 through to 1995, but from then on rates remained relatively stable for women residing in the highest quintile while increasing for women residing in the remaining four quintiles. Consequently, the SIR for all four of the lower IEO quintiles increased significantly over the 25-year period. For example, the SIR in the lowest IEO quintile increased from 1.16 (95% CI, 0.99-1.37) during 1985-1989 to 1.70 (95% CI, 1.50-1.93) during 2005-2009. The corresponding estimates for women aged 70 years or older showed no clear pattern of socioeconomic gradient. CONCLUSION The increasing gap in lung cancer incidence between women in the highest socioeconomic group and all others suggests that there is a continued need for the broad implementation of tobacco control interventions, so that smoking prevalence is reduced across all segments of the population and the subsequent benefits are shared more equitably across all demographic groups.
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Affiliation(s)
- Xue Qin Yu
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Qingwei Luo
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Clare Kahn
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Paul Grogan
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Cancer Council Australia, Sydney, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
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Callander E, Topp SM, Larkins S, Sabesan S, Bates N. Quantifying Queensland patients with cancer health service usage and costs: study protocol. BMJ Open 2017; 7:e014030. [PMID: 28119391 PMCID: PMC5278294 DOI: 10.1136/bmjopen-2016-014030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/08/2016] [Accepted: 12/20/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The overall mortality rate for cancer has declined in Australia. However, socioeconomic inequalities exist and the out-of-pocket costs incurred by patients in Australia are high compared with some European countries. There is currently no readily available data set to provide a systematic means of measuring the out-of-pocket costs incurred by patients with cancer within Australia. The primary aim of the project is to quantify the direct out-of-pocket healthcare expenditure of individuals in the state of Queensland, who are diagnosed with cancer. METHODS AND ANALYSIS This project will build Australia's first model (called CancerCostMod) of out-of-pocket healthcare expenditure of patients with cancer using administrative data from Queensland Cancer Registry, for all individuals diagnosed with any cancer in Queensland between 1 July 2011 and 30 June 2012, linked to their Admitted Patient Data Collection, Emergency Department Information System, Medicare Benefits Schedule and Pharmaceutical Benefits Scheme records from 1 July 2011 to 30 June 2015. No identifiable information will be provided to the authors. The project will use a combination of linear and logistic regression modelling, Cox proportional hazards modelling and machine learning to identify differences in survival, total health system expenditure, total out-of-pocket expenditure and high out-of-pocket cost patients, adjusting for demographic and clinical confounders, and income group, Indigenous status and geographic location. Results will be analysed separately for different types of cancer. ETHICS AND DISSEMINATION Human Research Ethics approval has been obtained from the Townsville Hospital and Health Service Human Research Ethics Committee (HREC/16/QTHS/110) and James Cook University Human Research Ethics Committee (H6678). Permission to waive consent has been sought from Queensland Health under the Public Health Act 2005.
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Affiliation(s)
- Emily Callander
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, Queensland, Australia
| | - Stephanie M Topp
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, Queensland, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Sarah Larkins
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sabe Sabesan
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Department of Medical Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia
| | - Nicole Bates
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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