Socioeconomic Determinants of Participation in Cancer Screening in Argentina: A Cross-Sectional Study

A Systematic Review to Evaluate the Barriers to Breast Cancer Screening in Women with Disability

Background: Breast cancer (BC) is one of the leading causes of mortality worldwide. There are observed disparities in patients with disability as compared to those without disability, which leads to poor BC screening attendance, thereby worsening disease management. Aim: The aim of this systematic review is to investigate if there are disparities in screening rates in women with disability as compared to those without disability, as well as the different factors that pose barriers to patients with disability for enrolment in BC screening programs. Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed published articles between 2008 and 2023, which assessed different factors that contributed to poor attendance in BC screening programs held across different countries. Detailed study characteristics were obtained, and methodological quality assessment was performed on the individual studies included in this review. Result: A total of fifty-three articles were identified as eligible studies based on the pre-defined inclusion and exclusion criteria. These included 7,252,913 patients diagnosed with BC (913,902 patients with disability/6,339,011 patients without disability). The results revealed there are demographic, clinical, financial, and service-related barriers that contributed to lower screening rates in disabled patients as compared to non-disabled. Patient age is the most common factor, with the highest effect observed for 80 years (vs. 30-44 years) [odds ratio (OR) = 13.93 (95% confidence interval (CI) = 8.27-23.47), p < 0.0001], followed by race/ethnicity for Hispanic (vs. non-Hispanic white) [OR = 9.5 (95%CI = 1.0-91.9), p < 0.05]. Additionally, patients with multiple disabilities had the highest rate of dropouts [OR = 27.4 (95%CI = 21.5-33.3)]. Other factors like education, income, marital status, and insurance coverage were essential barriers in screening programs. Conclusions: This study presents a holistic view of all barriers to poor BC screening attendance in disabled patients, thereby exacerbating health inequalities. A standardized approach to overcome the identified barriers and the need for a tailored guideline, especially for disability groups, is inevitable.

The Practice and Willingness of Women Towards Opportunistic Screening for Breast and Cervical Cancers in Sichuan Province, China: A Cross-Sectional Study

Purpose

To understand the practices and willingness of Chinese women to undergo opportunistic screening for breast cancer (BC) and cervical cancer (CC).

Patients and Methods

From July to August 2021, a cross-sectional study of 1446 women from six cities in Sichuan Province, China, was conducted. A questionnaire was used to investigate practices, willingness, and barriers to opportunistic screening for BC and CC. Furthermore, potential factors for opportunistic screening willingness were analyzed using the chi-squared test and logistic regression.

Results

During their lifetime, 312 (21.6%) and 388 (26.8%) women had undergone opportunistic screening for BC and CC, respectively. There were 1069 (73.9%) women willing to accept physician-recommended screening during a medical visit, while 835 (57.7%) were willing to have a voluntary screening at a healthcare institution. The main barriers to reluctance to participate in physician-recommended and voluntary screenings were "no symptoms; hence, no need for screening" and "unwillingness or difficulty in paying screening cost". Ethnic minorities, lower education levels, and menopause were inversely associated, whereas awareness of the screening methods and eligibility for screening were positively associated with physician-recommended and voluntary screenings (P < 0.05). Furthermore, awareness of "two-cancers" screening was positively associated with physician-recommended screening (P < 0.05).

Conclusion

BC and CC opportunistic screening rates in Sichuan Province were low. The willingness to undergo physician-recommended screening was high, while that towards individual initiative screening was low. Public health education should be strengthened to increase cancer prevention awareness and knowledge of cancer screening, especially for women with low education, ethnic minorities, and post-menopause, for whom tailored interventions are suggested. In addition, novel ways of sharing screening costs need to be explored.

Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study

Background

Cancer, the leading cause of mortality in China, is a significant burden on patients, their families, the medical system, and society at large. However, there is minimal data on health service utilization and catastrophic health expenditure (CHE) among cancer patients in China. The objective of this study was to identify factors associated with health care utilization and CHE in Chinese cancer patients.

Methods

The 2018 wave of a nationally representative dataset, the China Health and Retirement Longitudinal Study, was used in our study. Of 18,968 respondents recruited for the analysis, 388 were clinically diagnosed with cancer. CHE was defined as household health expenditure that exceeded 40% of non-food household expenses. A binary logistic regression model was used to identify the risks of cancer exposure among all participants, along with the likelihood of CHE in households with cancer patients at the 40% threshold. A negative binomial regression model was used to identify determinants of health service utilization among cancer patients.

Results

Contracting a family physician (incidence rate ratio IRR: 2.38, 1.18-4.77), Urban Employee Basic Medical Insurance (IRR: 4.02, 1.91-8.46, compared to the uninsured), Urban and Rural Resident Basic Medical Insurance (IRR: 3.08, 1.46-6.49, compared to the uninsured), and higher per-capita household consumption were positively associated with inpatient service utilization. Patients with a college education and above reported a greater number of outpatient visits (IRR: 5.78, 2.56-13.02) but fewer inpatient hospital days (IRR: 0.37, 0.20-0.67). Being diagnosed with a non-cancer chronic non-communicable disease was associated with an increased number of outpatient visits (IRR: 1.20, 1.10-1.31). Of the 388 participants, 50.1% of households had CHE, which was negatively correlated with a larger household size (odds ratio OR: 0.52, 0.32-0.86) and lower socioeconomic status [for quintile 5 (lowest group) OR: 0.32, 0.14-0.72].

Conclusions

The socioeconomic characteristics of cancer patients had a considerable impact on their healthcare utilization. Individualized and targeted strategies for cancer management should be implemented to identify high-risk populations and trace the utilization of care among Chinese cancer patients. Strategic purchasing models in cancer care and social health insurance with expanded benefits packages for cancer patients are crucial to tackling the cancer burden in China.

Mortality in patients with cancer and SARS-CoV-2 infection: Results from the Argentinean Network of Hospital-Based Cancer Registries

BACKGROUND

Cancer is an important risk factor in patients with COVID-19. We aimed to describe the clinical and demographic characteristics associated with mortality in patients with cancer who were infected with SARS-CoV-2.

METHODS

We conducted a retrospective longitudinal study of 1206 patients with confirmed SARS-CoV-2 infection and cancer, registered in the Argentinean Network of Hospital-Based Cancer Registries (RITA) from March 31, 2020 to January 31, 2021. Demographic and clinical differences between survivors and non-survivors were summarized using descriptive statistics. The primary endpoint was all-cause mortality within 30 days of COVID-19 diagnosis. Risk factors for mortality were identified using logistic regression models.

RESULTS

1206 patients with cancer and confirmed SARS-CoV-2 infection were included, median age was 54 years (interquartile range: 42-65); 793 (65.8%) were female. 1101 (91.3%) had solid tumors and 105(8.7%) had hematological malignancies. The most frequent solid tumor was breast (278, 23.1%), while lymphoma was the main hematological one (59, 4.9%). Cervical cancer was more frequent in survivors, while lung cancer predominated in non-survivors. 275 (22.8%) patients were diagnosed with cancer within the past year. A total of 129 (10.7%) patients died within 30 days after COVID-19 diagnosis, with a case fatality rate of 15.2% (16/105) for hematologic malignancies and 10.3% (113/1101) for solid tumors. Multivariable regression analysis showed that age 60-79 (odds ratio [OR]: 4.69, 95% confidence interval [CI]: 2.72-9.70), age ≥ 80 (OR: 12.86, 95%CI: 5.08-32.54), time since cancer diagnosis < 1 year (OR: 2.49, 95%CI: 1.57-3.93) and 1-2 years (OR: 2.20, 95%CI: 1.36-3.57), and lung cancer (OR: 4.35, 95%CI: 2.02-9.36) were risk factors for death.

CONCLUSION

Patients with cancer and SARS-CoV-2 infection had a high case-fatality rate. Identified risk factors (older age, recent diagnosis and lung type) could guide prevention strategies aimed at reducing the risk of dying from COVID-19 in cancer patients.