Moriceau Guillaume, Bourmaud Aurélie, Tinquaut Fabien, Oriol Mathieu, Jacquin Jean-Philippe, Fournel Pierre, Magné Nicolas, Chauvin Franck
Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.
Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.
Oncotarget. 2016 Jan 5;7(1):1055-65. doi: 10.18632/oncotarget.6274.
The European Deprivation Index (EDI), is a new ecological estimate for Socio-Economic Status (SES). This study postulates that Time-To-Treatment could be used as a cancer quality-of -care surrogate in order to identify the association between cancer patient's SES and quality of care in a French comprehensive cancer center.
retrospective mono-centered cohort study. All consecutive incoming adult patients diagnosed for breast cancer (BC), prostate cancer (PC), colorectal cancer (CRC), lung cancer (LC) or sarcoma (S) were included between January 2013 and December 2013. The association of EDI and Time-To-Diagnosis (TTD), as well as Time-To-Treatment (TTT) was analyzed using a cox regression, and a strata analysis per tumor site was performed.
969 patients were included. Primitive tumor site was 505 BC (52%), 169 PC (17%), 145 LC (15%), 116 CRC (12%), and 34 S (4%). Median TTD was 1.41 months (Q1-Q3 0.5 to 3.5 months). Median TTT was 0.9 months (0.4 - 1.4). In a multivariate analysis, we identified the tumor site as a predictive factor to influence TTD, shorter for BC (0.75 months, [0.30- 1.9]) than PC (4.69 months [1.6-29.7]), HR 0.27 95%CI = [0.22-0.34], p < 0.001. TTT was also shorter for BC (0.75 months [0.4-1.1]) than PC (2.02 [0.9-3.2]), HR 0.32 95%CI = [0.27-0.39], p < 0.001. EDI quintiles were not found associated with either TTT or TTD.
Deprivation estimated by the EDI does not appear to be related to an extension of the Time-to-Diagnosis or Time-to-Treatment in our real-life population. Further research should be done to identify other frailty-sensitive factors that could be responsible for delays in care.
欧洲贫困指数（EDI）是一种新的社会经济地位（SES）生态评估指标。本研究假设治疗时间可作为癌症医疗质量的替代指标，以确定法国一家综合癌症中心癌症患者的社会经济地位与医疗质量之间的关联。
回顾性单中心队列研究。纳入2013年1月至2013年12月期间所有连续入院的成年乳腺癌（BC）、前列腺癌（PC）、结直肠癌（CRC）、肺癌（LC）或肉瘤（S）患者。使用cox回归分析EDI与诊断时间（TTD）以及治疗时间（TTT）的关联，并按肿瘤部位进行分层分析。
共纳入969例患者。原发肿瘤部位为505例乳腺癌（52%）、169例前列腺癌（17%）、145例肺癌（15%）、116例结直肠癌（12%）和34例肉瘤（4%）。中位TTD为1.41个月（四分位间距0.5至3.5个月）。中位TTT为0.9个月（0.4 - 1.4）。在多变量分析中，我们确定肿瘤部位是影响TTD的预测因素，乳腺癌的TTD（0.75个月，[0.30 - 1.9]）比前列腺癌（4.69个月[1.6 - 29.7]）短，风险比0.27，95%置信区间=[0.22 - 0.34]，p < 0.001。乳腺癌的TTT（0.75个月[0.4 - 1.1]）也比前列腺癌（2.02 [0.9 - 3.2]）短，风险比0.32，95%置信区间=[0.27 - 0.39]，p < 0.001。未发现EDI五分位数与TTT或TTD相关。
在我们的实际人群中，EDI估计的贫困程度似乎与诊断时间或治疗时间的延长无关。应进一步开展研究，以确定可能导致治疗延迟的其他脆弱性敏感因素。
