How do age and social environment affect the dynamics of death hazard and survival in patients with breast or gynecological cancer in France?

Abstract

Several studies have investigated the association between net survival (NS) and social inequalities in people with cancer, highlighting a varying influence of deprivation depending on the type of cancer studied. However, few of these studies have accounted for the effect of social inequalities over the follow‐up period, and/or according to the age of the patients. Thus, using recent and more relevant statistical models, we investigated the effect of social environment on NS in women with breast or gynecological cancer in France. The data were derived from population‐based cancer registries, and women diagnosed with breast or gynecological cancer between 2006 and 2009 were included. We used the European deprivation index (EDI), an aggregated index, to define the social environment of the women included. Multidimensional penalized splines were used to model excess mortality hazard. We observed a significant effect of the EDI on NS in women with breast cancer throughout the follow‐up period, and especially at 1.5 years of follow‐up in women with cervical cancer. Regarding corpus uteri and ovarian cancer patients, the effect of deprivation on NS was less pronounced. These results highlight the impact of social environment on NS in women with breast or gynecological cancer in France thanks to a relevant statistical approach, and identify the follow‐up periods during which the social environment may have a particular influence. These findings could help investigate targeted actions for each cancer type, particularly in the most deprived areas, at the time of diagnosis and during follow‐up.

Differences in health-related quality of life between native and foreign-born gynaecological cancer patients in Sweden: a five-year cross-sectional study

“…These results are in line with previous research from other countries. In a French study using population-based data, Poiseuil et al showed that socioeconomic factors were associated with net survival among breast and gynaecological cancer patients [ 31 ]. Another study from France showed that a number of barriers to cervical screening attendance were associated with low socioeconomic status [ 32 ].…”

“…Most studies have, however, focused on differences in mortality rates [ 31 , 34 ]. Sassenou et al [ 35 ] concluded that obese women were less likely to undergo cervical cancer screening and at the same time more often lived in areas with low socioeconomic status, thus being particularly vulnerable.…”