The role of socio-economic status in the decision making on diagnosis and treatment of oesophageal cancer in The Netherlands

Abstract

In the United States (USA), a correlation has been demonstrated between socio-economic status (SES) of patients on the one hand, and tumour histology, stage of the disease and treatment modality of various cancer types on the other hand. It is unknown whether such correlations are also involved in patients with oesophageal cancer in The Netherlands. Between 1994 and 2003, 888 oesophageal cancer patients were included in a prospective database with findings on the diagnostic work-up and treatment of oesophageal cancer. Socio-economic status of patients was defined as the average net yearly income. Linear-by-linear association testing revealed that oesophageal adenocarcinoma was more frequently observed in patients with higher SES and squamous cell carcinoma in patients with lower SES (P ¼ 0.02). Multivariable logistic regression analysis showed no correlation between SES and staging procedures and preoperative TNM stage. The adjusted odds ratio (OR) for stent placement was 0.82 (95% CI 0.71 -0.95), indicating that with an increase in SES by 1200 h, the likelihood that a stent was placed declined by 18%. Patients with a higher SES more frequently underwent resection or were treated with chemotherapy (OR: 1.15; 95% CI 1.01 -1.32 and OR: 1.16; 95% CI 1.02 -1.32, respectively). Socio-economic factors are involved in oesophageal cancer in The Netherlands, as patients with a higher SES are more likely to have an adenocarcinoma and patients with a lower SES a squamous cell carcinoma. Moreover, the correlations between SES and different treatment modalities suggest that both patient and doctor determinants contribute to the decision on the most optimal treatment modality in patients with oesophageal cancer.

The Effect of Socioeconomic Status on Staging and Treatment Decisions in Esophageal Cancer

“…7,8 Pancreatic cancer patients with a low SES were found to be less likely to undergo surgical treatment. 7 In patients with EC, it was reported that high-SES patients underwent esophagectomy more frequently, compared with low-SES patients.…”

Quality-of-care indicators for oesophageal cancer surgery: A review

“…In the United States, African-American patients with oesophageal cancer were less likely to undergo surgical resection compared to Caucasian patients [62][63][64] . In the Netherlands, low socio-economic status proved to be associated with a lower chance of resection 65 . These disparities are not fully explained by differences in medical factors 64 .…”

“…These disparities are not fully explained by differences in medical factors 64 . It has been suggested that patients' but possibly also physicians' preferences might differ among different socio-economic groups of patients 65 .…”

“…The role of race and socio-economic status on patient selection has received some attention [62][63][64][65] . In the United States, African-American patients with oesophageal cancer were less likely to undergo surgical resection compared to Caucasian patients [62][63][64] .…”

A Comparison of Cervical Cancer Screening Rates among Women with Traumatic Spinal Cord Injury and the General Population

“…11 Previous work has identified the importance of patient and physician characteristics with respect to treatment and clinical management. 46,47 For example, patients with lower SES have been shown to be perceived as less attractive by physicians, which may influence the inequities observed in consultation times, 48 referral patterns, and overall medical management. 49 Additionally, women who are more marginalized are less likely to be assertive and be strong advocates for their medical management.…”