Blais S, Dejardin O, Boutreux S, Launoy G
Cancers & Populations, ERI3 Inserm, Faculty of Medicine, 14032 Caen cedex, France.
Eur J Cancer. 2006 Nov;42(17):3041-8. doi: 10.1016/j.ejca.2006.06.032. Epub 2006 Oct 9.
Although social disparities in survival for patients with cancer are documented in an increasing number of papers, knowledge on the underlying mechanisms concerning screening, diagnosis, treatment or follow-up, is relatively poor. Our study was aimed at investigating the social determinants of access to reference cancer care centres for surgery for colorectal cancer in France.
Retrospective analysis was conducted on population-based data from a specialised cancer registry (County of Calvados, France). The population consisted of 5156 patients with surgical treatment for colorectal cancer recorded between January 1st 1981 and December 31st 2000.
The probability of being cared for in a reference care centre was 1.3-fold lower for people living in a deprived district (mean income < 15000 euros) and 3-fold lower for people living in a district where more than 7% of houses were devoid of bath and shower in comparison with districts where this rate was under 2%. After adjustment for distance from reference care centre, the probability of being cared for in a reference care centre was still over one third lower for people living in a district with more than 7% of houses devoid of bath and shower. Social disparities in management of patients with colorectal cancer have increased in the last decade. The reduction of access to reference care with distance was stronger in elderly patients.
There is a social and geographical determination of type of treatment centre for care management of colorectal cancer in France. Special attention needs to be paid to the high quality of care management in non-specialised care centres in order to avoid an increased social gradient in cancer mortality in France.
尽管越来越多的论文记录了癌症患者生存方面的社会差异，但对于筛查、诊断、治疗或随访的潜在机制的了解相对较少。我们的研究旨在调查法国结直肠癌手术患者前往参考癌症护理中心就医的社会决定因素。
对来自一个专门癌症登记处（法国卡尔瓦多斯县）的基于人群的数据进行回顾性分析。研究人群包括1981年1月1日至2000年12月31日期间记录的5156例接受结直肠癌手术治疗的患者。
与房屋无浴室和淋浴比例低于2%的地区相比，生活在贫困地区（平均收入<15000欧元）的人在参考护理中心接受治疗的概率低1.3倍，生活在房屋无浴室和淋浴比例超过7%地区的人这一概率低3倍。在调整了与参考护理中心的距离后，生活在房屋无浴室和淋浴比例超过7%地区的人在参考护理中心接受治疗的概率仍低三分之一以上。在过去十年中，结直肠癌患者管理方面的社会差异有所增加。老年患者因距离导致的获得参考护理机会的减少更为明显。
在法国，结直肠癌护理管理的治疗中心类型存在社会和地理决定因素。需要特别关注非专业护理中心的高质量护理管理，以避免法国癌症死亡率的社会梯度增加。
