The role of socioeconomic position in use of systemic anticancer therapy

Background: In recent years new medicines used in systemic anticancer therapy (SACT) have been successful in reducing cancer mortality. There are concerns, however, regarding the potential impact of socioeconomic position on patients' access to these treatments. This study aims to assess the extent of socioeconomic differences in the initiation, type, and intensity of SACT for cancer patients, and to identify differences that could indicate barriers to treatment. Methods: We conducted a cohort study of adult patients diagnosed with solid cancers in the North Denmark Region 2008 to 2020 using the Danish Cancer Registry. Socioeconomic position was categorized using income, highest attained education, cohabitation status, ethnicity, and distance to specialized treatment. Outcomes included initiation of SACT, intravenous treatments, different SACT regimens, cost of SACT, only curative therapy, and use of monoclonal antibodies. Analyses were adjusted for age, year, comorbidity, and stage and were stratified by sex, cancer group, and treatment intent. Results: We identified 42 364 patients of whom 12 792 (30.2%) initiated SACT. Socioeconomic differences were observed with lower SACT initiation among patients with lower educational attainment, low income, or living alone. These patient groups also had decreased accumulated cost, intravenous treatments, and fewer different SACT regimens, particularly for gynecological, lung, and upper gastrointestinal cancers. The observed differences were more pronounced among patients treated with palliative intent. Conclusion: This study indicates socioeconomic disparities in SACT utilization, with lower use among disadvantaged patients primarily within palliative treatment regimens. Some of the observed differences warrant further investigation into the complex socioeconomic mechanisms involved.