Access to care and outcomes for neuroendocrine tumours: does socioeconomic status matter?

Current oncology

J. Hallet¹ 

关键词: Neuroendocrine tumours;    carcinoids;    socioeconomics;    income;    outcomes;   

DOI  :  10.3747/co.25.3930

学科分类：肿瘤学

来源: Multimed, Inc.

【 摘 要 】

IntroductionNeuroendocrine tumours (nets) are a poorly understood malignancy lacking standardized care. Differences in socioeconomic status (ses) might worsen the effect of non-standardized care. We examined the effect of ses on net peri-diagnostic care patterns and outcomes. MethodsIn this population-based cohort study, net cases identified from a provincial cancer registry (1994–2009) were divided into low (1st and 2nd income quintiles) and high (3rd, 4th, and 5th quintiles) ses groups. We compared peri-diagnostic health care utilization (–2 years to +6 months), metastatic recurrence, and overall survival (os) between the groups. ResultsOf 4966 net patients, 38.3% had a low ses. Neither the primary net sites ( p= 0.15), nor the metastatic presentation ( p= 0.31) differed. Patients with low ses had a higher mean number of physician visits (20.1 ± 19.9 vs. 18.1 ± 16.5,p= 0.001) and imaging studies (56 ± 50 vs. 52 ± 44,p= 0.009) leading to the net diagnosis. Rates of primary tumour resection ( p= 0.14), hepatectomy ( p= 0.45), systemic therapy ( p= 0.38), and liver embolization ( p= 0.13) did not differ with ses. In the low-ses group, metastatic recurrence was more likely (41.1% vs. 37.6%,p= 0.01) during a median follow-up of 61.7 months, and the 10-year os was inferior (47.1% vs. 52.2%,p< 0.01). Low ses was associated with worse os (hazard ratio: 1.16; 95% confidence interval: 1.06 to 1.26) after adjustment for age, sex, comorbidity burden, primary net site, and rural living. Conclusions Low ses was associated with more physician visits and imaging before a net diagnosis, but not with more advanced stage at presentation nor with an effect on the pattern of therapy. Long-term outcomes were inferior in the low-ses group. These data can help to inform the design of health care delivery for nets.

【 授权许可】

Unknown