Excess cancer-related mortality can be up to twice as high among patients from the most underprivileged areas compared to those from privileged neighborhoods.
- An estimated 157,400 deaths from cancer occurred in France in 2018: 89,600 men and 67,800 women.
- Contrary to the incidence, the cancer mortality rate has been constantly decreasing for 25 years.
- These diseases experience strong inequalities in the quality of care according to social category.
According to a new study by Public Health France, the social environment has a strong impact on the survival of cancer patients.
A major issue
Social inequalities in health are a major public health issue. In the field of cancer, the scientific literature has already highlighted social disparities in incidence and mortality. However, no study had yet analyzed social inequalities in survival on a large sample of cancer patients in France.
To overcome this lack of data, approximately 210,000 cases of cancer diagnosed between 2006 and 2009 were included in a new study. The socioeconomic environment was measured by the European aggregate index of social deprivation (European Deprivation Index, EDI). The analysis of net survival (ie survival independent of other possible causes of death) was based on the Pohar-Perme method and flexible modeling of the excess mortality rate.
Results: 5-year net survival was worse among people living in the most disadvantaged areas, with differences of varying magnitude depending on the cancer. Among men, 5-year net survival was reduced among the most disadvantaged by 6.4 points for colorectal cancer, 3 points for prostate cancer and 2.9 points for lung cancer. Among women, 5-year net survival was reduced among the most disadvantaged by 5.5 points for colorectal cancer, 5.1 points for breast cancer and 3.6 for lung cancer. “The results were more nuanced for hematological malignancies”, comment the authors of the study.
All solid tumors are affected
Modeling confirmed a significant effect of social environment on survival for all solid tumors (except sarcomas and thyroid), and for Hodgkin’s lymphoma, four non-Hodgkin’s lymphoma and chronic myeloproliferative syndromes. Excess cancer-related mortality can be up to twice as high in patients from the most underprivileged areas compared to those from the least underprivileged areas (example: melanoma in men, chronic lymphoid leukemia or cancer of the bile ducts in the women).
“This study reveals a unidirectional social gradient in survival for almost all cancers in France, with poorer survival in patients living in the most disadvantaged areas”, conclude the researchers.
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