Access to care, socioeconomic deprivation and colon cancer survival

Olivier Dejardin · Anne‐Marie Bouvier · Jean Faivre · Sébastien Boutreux · Gérard de Pouvourville · Guy D. Launoy

59 citations0/0 files storedAlimentary Pharmacology & Therapeutics

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Health disparities and outcomes Colorectal Cancer Screening and Detection Global Cancer Incidence and Screening

Abstract

BACKGROUND: The influence of socioeconomic environment on cancer survival has been established in numerous studies in the EU and the US, prognosis being constantly poorer for the most underprivileged patients. AIM: To investigate the influence of distance to care centre and deprivation on colon cancer survival, using a multilevel Cox model and taking into account cancer stage at diagnosis and treatment modalities. METHODS: The study population comprised all cases of colon cancer diagnosed between 1997 and 2000 in two French areas covered by specialized cancer registries (n = 2066). RESULTS: Road distance to the nearest reference care centre was associated with poorer prognosis even after adjustment for stage at diagnosis (P for trend = 0.01). Subgroups analysis showed that this association was maximal for patients with advanced cancer [RR = 1.27 (1.04-1.51); P for trend = 0.015] for whom access to chemotherapy varying according to distance explained the major part of geographic inequalities in survival. CONCLUSIONS: The major effect of distance from reference care centre on survival suggests that current regional health planning does not guarantee equity in cancer management. Improvement in access to adjuvant therapy, especially for patients with advanced cancers, seems crucial for reducing geographic disparities in colon cancer survival.

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2006Use of Health Care Services by Lower-Income and Higher-Income Uninsured Adults 2005Explaining Black–White Differences in Receipt of Recommended Colon Cancer Treatment 2002Impact of deprivation and rural residence on treatment of colorectal and lung cancer

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2011Spatiotemporal association between deprivation and mortality: trends in France during the nineties 2008The effect of socioeconomic status on survival from colorectal cancer in the Melbourne Collaborative Cohort Study 2014Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours 2017No effect of comorbidities on the association between social deprivation and geographical access to the reference care center in the management of colon cancer 2013Deprivation and access to treatment for colorectal cancer in southeast Scotland 2003–2009

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