Impact of socioeconomic status on prostate cancer diagnosis, treatment, and prognosis

Abstract

BACKGROUND: The objective of the current study was to evaluate the impact of socioeconomic disparities on prostate cancer presentation, treatment, and prognosis in Geneva, Switzerland, in which healthcare costs, medical coverage, and life expectancy are considered to be among the highest in the world. METHODS: This population-based study included all patients diagnosed with invasive prostate cancer among the resident population between 1995 and 2005. Patients were divided into 3 socioeconomic groups according to their last known occupation. Compared were patient and tumor characteristics and treatment patterns between socioeconomic groups. Cox multivariate regression analysis was used to assess and explain socioeconomic inequalities in prostate cancer-specific mortality. RESULTS: Compared with patients of high socioeconomic class, those of low socioeconomic class were more often foreigners, were found less frequently to have screen-detected cancer, were found to have a more advanced stage of disease at diagnosis, and less often had information regarding disease characteristics and staging. These patients underwent prostatectomy less frequently and were more often managed with watchful waiting. The risk of dying as a result of prostate cancer (hazards ratio [HR]) in patients of a low versus high socioeconomic status was increased 2-fold (95% confidence interval [95% CI], 1.5-2.6). After adjustment for patient and tumor characteristics and treatment, the mortality risk was no longer found to be significantly increased (HR, 1.2; 95% CI, 0.8-1.6). CONCLUSIONS: In the current study, patients of low socioeconomic class were found to be at increased risk of dying as a result of their prostate cancer. This increased mortality is largely attributable to delayed diagnosis, poor diagnostic workup, and less invasive treatments in these individuals

Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparities

“…This is in line with previous studies performed in developed countries including Sweden, which also has free health care and no organized PCa screening program (Cullati et al, 2009;Drazer et al, 2011Drazer et al, , 2015Finney Rutten et al, 2005;Hiatt et al, 2002;Karlsen et al, 2013;Morgan et al, 2013;Rapiti et al, 2009;Robinson et al, 1996;Ross et al, 2005;Rundle et al, 2013), although it contrasts with studies conducted in Australia (Weber et al, 2013;Weller et al, 1998). The importance of considering SES when interpreting time trends in PCa exam has been previously emphasized (Liu et al, 2001).…”

Primary Treatment Choice Over Time and Relative Survival of Prostate Cancer Patients: Influence of Age, Grade, and Stage

“…Liu et al [29] reported that a high socioeconomic status was associated with higher odds of performing a PSA test. Rapiti et al [30] reported similar results for Geneva, Switzerland.…”

Comparison of the epidemiologic features and patterns of initial care for prostate cancer between public and private institutions: a survey by the Brazilian Society of Urology

“…The debate on the association between a lower socioeconomic status and variables such as stage at diagnosis, use of less aggressive treatment, and mortality, has been ongoing in the United States and other countries for several years (19)(20)(21). Socioeconomic factors are clearly associated with the patterns of care for various tumor types, including prostate cancer (14,19).…”