Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study

// Guillaume Moriceau 1,2 , Aurélie Bourmaud 2,3 , Fabien Tinquaut 2 , Mathieu Oriol 2 , Jean-Philippe Jacquin 1 , Pierre Fournel 1 , Nicolas Magné 4 and Franck Chauvin 2,3,5 1 Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France 2 Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France 3 Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France 4 Radiation Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France 5 Clinical Investigation Center and Clinical Epidemiology, Jean Monnet University, Saint-Etienne, France Correspondence to: Aurélie Bourmaud, email: // Keywords : cancer, access to care, socio-economic inequalities, european deprivation Index, population based Received : July 17, 2015 Accepted : September 30, 2015 Published : November 02, 2015 Abstract Context: The European Deprivation Index (EDI), is a new ecological estimate for Socio-Economic Status (SES). This study postulates that Time-To-Treatment could be used as a cancer quality-of -care surrogate in order to identify the association between cancer patient’s SES and quality of care in a French comprehensive cancer center. Methods: retrospective mono-centered cohort study. All consecutive incoming adult patients diagnosed for breast cancer(BC), prostate cancer(PC), colorectal cancer (CRC), lung cancer(LC) or sarcoma(S) were included between January 2013 and December 2013. The association of EDI and Time-To-Diagnosis(TTD), as well as Time-To-Treatment(TTT) was analyzed using a cox regression, and a strata analysis per tumor site was performed. Results: 969 patients were included. Primitive tumor site was 505 BC(52%), 169 PC(17%), 145 LC(15%), 116 CRC(12%), and 34 S(4%). Median TTD was 1.41 months (Q1-Q3 0.5 to 3.5 months). Median TTT was 0.9 months (0.4 - 1.4). In a multivariate analysis, we identified the tumor site as a predictive factor to influence TTD, shorter for BC (0.75months, [0.30- 1.9]) than PC (4.69 months [1.6-29.7]), HR 0.27 95%CI= [0.22-0.34], p < 0.001. TTT was also shorter for BC (0.75months [0.4-1.1]) than PC (2.02 [0.9-3.2]), HR 0.32 95%CI= [0.27-0.39], p < 0.001. EDI quintiles were not found associated with either TTT or TTD. Conclusions: Deprivation estimated by the EDI does not appear to be related to an extension of the Time-to-Diagnosis or Time-to-Treatment in our real-life population. Further research should be done to identify other frailty-sensitive factors that could be responsible for delays in care.