Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Cancer. 2020 Oct 15;126(20):4545-4552. doi: 10.1002/cncr.33107. Epub 2020 Aug 3.
The role of socioeconomic factors as determinants of oncology consultations for advanced cancers in public payer health care systems is unknown. This study examined the association between material deprivation and receipt of cancer care among patients with advanced gastrointestinal (GI) cancer.
This was a population-based, retrospective cohort study of noncuratively treated patients with GI cancer diagnosed from 2007 to 2017. Material deprivation, representing income, quality of housing, education, and family structure, was defined as quintiles on the basis of 2016 census data. The first consultation with a radiation oncologist or medical oncologist and the receipt of 1 or more instances of radiation and/or chemotherapy were measured in the year after diagnosis. Adjusted, cause-specific Cox proportional hazards competing risk analyses were used (competing event = death).
This study included 34,022 noncuratively treated patients with GI cancer. Consultation rates ranged from 67.8% for those in the most materially deprived communities to 73.5% for those in the least materially deprived communities. Among those with a consult, rates of cancer-directed therapy ranged from 58.5% for patients in the most materially deprived communities to 62.3% for patients in the least materially deprived communities. Patients living in the most materially deprived communities were significantly less likely to see a radiation and/or medical oncologist after a diagnosis (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.85-0.92) and significantly less likely to receive radiation and/or chemotherapy (HR, 0.80; 95% CI, 0.76-0.85) than those living in the least materially deprived communities.
This study identified socioeconomic disparities in accessing cancer care. Continued efforts at examining and developing evidence-based policies for interventions that begin before or at the time of oncologist consultation are required to address root causes of inequities.
社会经济因素作为公共支付医疗保健系统中晚期癌症肿瘤学咨询的决定因素尚不清楚。本研究调查了物质匮乏与晚期胃肠道（GI）癌症患者接受癌症治疗之间的关联。
这是一项基于人群的回顾性队列研究，纳入了 2007 年至 2017 年间诊断为 GI 癌症的非姑息治疗患者。物质匮乏代表收入、住房质量、教育和家庭结构，根据 2016 年人口普查数据定义为五分位数。在诊断后一年，用调整后的特定原因 Cox 比例风险竞争风险分析（竞争事件=死亡）来衡量首次与放射肿瘤学家或肿瘤内科医生的咨询和接受 1 次或多次放射和/或化学治疗的情况。
本研究纳入了 34022 名非姑息治疗的 GI 癌症患者。咨询率从最贫困社区的 67.8%到最不贫困社区的 73.5%不等。在有咨询的患者中，癌症靶向治疗率从最贫困社区的 58.5%到最不贫困社区的 62.3%不等。与居住在最贫困社区的患者相比，诊断后接受放射和/或肿瘤内科医生治疗的可能性显著降低（风险比 [HR]，0.88；95%置信区间 [CI]，0.85-0.92），且接受放射和/或化疗的可能性显著降低（HR，0.80；95% CI，0.76-0.85）。
本研究发现了获得癌症治疗机会的社会经济差异。需要继续努力研究并制定基于证据的政策，以干预在肿瘤医生咨询之前或之时开始，以解决不平等的根本原因。
