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Socio-economic inequalities in stage at diagnosis, and in time intervals on the lung cancer pathway from first symptom to treatment: systematic review and meta-analysis.

ABSTRACT: Cancer diagnosis at an early stage increases the chance of curative treatment and of survival. It has been suggested that delays on the pathway from first symptom to diagnosis and treatment may be socio-economically patterned, and contribute to socio-economic differences in receipt of treatment and in cancer survival. This review aimed to assess the published evidence for socio-economic inequalities in stage at diagnosis of lung cancer, and in the length of time spent on the lung cancer pathway. MEDLINE, EMBASE and CINAHL databases were searched to locate cohort studies of adults with a primary diagnosis of lung cancer, where the outcome was stage at diagnosis or the length of time spent within an interval on the care pathway, or a suitable proxy measure, analysed according to a measure of socio-economic position. Meta-analysis was undertaken when there were studies available with suitable data. Of the 461 records screened, 39 papers were included in the review (20 from the UK) and seven in a final meta-analysis for stage at diagnosis. There was no evidence of socio-economic inequalities in late stage at diagnosis in the most, compared with the least, deprived group (OR=1.04, 95% CI=0.92 to 1.19). No socio-economic inequalities in the patient interval or in time from diagnosis to treatment were found. Socio-economic inequalities in stage at diagnosis are thought to be an important explanatory factor for survival inequalities in cancer. However, socio-economic inequalities in stage at diagnosis were not found in a meta-analysis for lung cancer. PROSPERO PROTOCOL REGISTRATION NUMBER:CRD42014007145.

SUBMITTER: Forrest LF

PROVIDER: S-EPMC5390856 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Socio-economic inequalities in stage at diagnosis, and in time intervals on the lung cancer pathway from first symptom to treatment: systematic review and meta-analysis.

Forrest Lynne F LF Sowden Sarah S Rubin Greg G White Martin M Adams Jean J

Thorax 20160928 5

Cancer diagnosis at an early stage increases the chance of curative treatment and of survival. It has been suggested that delays on the pathway from first symptom to diagnosis and treatment may be socio-economically patterned, and contribute to socio-economic differences in receipt of treatment and in cancer survival. This review aimed to assess the published evidence for socio-economic inequalities in stage at diagnosis of lung cancer, and in the length of time spent on the lung cancer pathway. ...[more]

PMID: 27682330

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Project description:IntroductionThe socio-economic circumstances and health of people with disabilities has been relatively ignored in public health research, policy and practice in Australia and internationally. This is despite emerging evidence that the socio-economic circumstances that people with disabilities live in contributes to their poorer health. Compared to other developed countries, Australians with disabilities are more likely to live in disadvantaged circumstances, despite being an economically prosperous country; it is therefore likely that the socio-economic disadvantage experienced by Australians with disabilities makes a significant contribution to their health. Despite the importance of this issue Australia does not routinely monitor the socio-economic inequalities for people with disabilities. This paper addresses this gap by describing time trends in socio-economic conditions for Australians with and without disabilities according to the severity of the disability and sex.MethodsCross-sectional analyses of the Australian Bureau of Statistics Survey of Disability, Ageing and Carers were carried out at three time points (1998, 2003 and 2009) to estimate the proportions of women and men (aged between 25 and 64 years) who were living on low incomes, had not completed year 12, were not in paid work, living in private rental and experiencing multiple disadvantage (three or more of the indicators).ResultsPeople with disabilities are less likely to have completed year 12, be in paid work and are more likely to be living on low incomes and experiencing multiple disadvantage. These conditions worsened with increasing severity of disability and increased or persisted over time, with most of the increase between 1998 and 2003. While women with milder disabilities tended to fare worse than men, the proportions were similar for those with moderate and severe/profound disabilities.ConclusionPeople with disabilities experience high levels of socio-economic disadvantage which has increased or persisted over time and these are likely to translate into poorer health outcomes. A large proportion experience multiple forms of disadvantage, reinforcing the need to tackle disadvantage in a coordinated way across sectors.People with disabilities should be a priority population group for public health. Monitoring socio-economic conditions of people with disabilities is critical for informing policy and assessing the impact of disability reforms.

Project description:Objective The aim of this study was to estimate the time intervals from first symptom recognition to pathological diagnosis among patients with oesophageal cancer in Ethiopia. Methods Design A cross-sectional study design was employed. Settings and participants Patients with oesophageal cancer aged ≥18 years were included from Addis Ababa, Ethiopia (n=338) from February 2019 to August 2020. The participants were selected consecutively from six health facilities that provided cancer care nearly for 90% of patients. Main outcomes and measurements The Aarhus statement criteria were applied to classify patient intervals (time from first symptom recognition to presentation) and diagnostic intervals (time from first presentation to diagnosis). Patient and diagnostic intervals >60 and >30 days were considered as delays, respectively. For tumour classification, the American Joint Committee on Cancer was used. Data were analysed using SPSS V.24. Descriptive statistics were applied to describe patients’ characteristics. Poisson regression with robust variance was used to compute prevalence ratios. In all statistical tests, significance was declared at a p value of <0.05. Results The mean (SD) age of the participants was 54.30±12.49 years. Approximately 78% of study participants had never heard of oesophageal cancer and thought they had gastritis. Dysphagia was the commonly mentioned symptom. About 76% of the cases were diagnosed at advanced stages (III and IV). Median patient interval was 108.5 (60.5–215) days and median diagnostic interval was 77.5 (39–133) days. After adjusting confounders, being single and unawareness of oesophageal cancer had association with consultation delay; cost of transportation and medical consultation had association with diagnostic delay; and patient delay of >2 months had association with late-stage diagnosis. Conclusion Patients with oesophageal cancer in Ethiopia had prolonged patient and diagnostic intervals. Increasing awareness of symptoms of oesophageal cancer and shortening time to diagnosis will help to improve the outcome of oesophageal cancer care in Ethiopia.

Project description:OBJECTIVES:This study aimed to estimate the magnitude of patient and diagnostic delays and associated factors among women with breast cancer in Addis Ababa. DESIGN:This is a cross-sectional study. SETTINGS AND PARTICIPANTS:All women newly diagnosed with breast cancer in seven major healthcare facilities in Addis Ababa (n=441) were included in the study. MAIN OUTCOMES AND MEASURES:Patient interval (time from recognition of first symptom to medical consultation) and diagnostic interval (time from first consultation to diagnosis). Patient intervals >90 days and diagnostic intervals >30 days were considered delays, and associated factors were determined using multivariable Poisson regressions with robust variance. RESULTS:Thirty-six percent (95% CI [31.1%, 40.3%]) of the patients had patient intervals of >90 days, and 69% (95% CI [64.6%, 73.3%]) of the patients had diagnostic intervals of >30 days. Diagnostic interval exceeded 1 year for 18% of patients. Ninety-five percent of the patients detected the first symptoms of breast cancer by themselves, with breast lump (78.0%) as the most common first symptom. Only 8.0% were concerned about cancer initially, with most attributing their symptoms to other factors. In the multivariable analysis, using traditional medicine before consultation was significantly associated with increased prevalence of patient delay (adjusted prevalence ratio (PR) = 2.13, 95% CI [1.68, 2.71]). First consultation at health centres (adjusted PR = 1.19, 95% CI [1.02, 1.39]) and visiting ≥4 facilities (adjusted PR = 1.24, 95% CI [1.10, 1.40]) were associated with higher prevalence of diagnostic delay. However, progression of symptoms before consultation (adjusted PR = 0.73, 95% CI [0.60, 0.90]) was associated with decreased prevalence of diagnostic delay. CONCLUSIONS:Patients with breast cancer in Addis Ababa have prolonged patient and diagnostic intervals. These underscore the need for public health programme to increase knowledge about breast cancer symptoms and the importance of early presentation and early diagnosis among the general public and healthcare providers.

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Socio-economic inequalities in stage at diagnosis, and in time intervals on the lung cancer pathway from first symptom to treatment: systematic review and meta-analysis.

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Socio-economic inequalities in stage at diagnosis, and in time intervals on the lung cancer pathway from first symptom to treatment: systematic review and meta-analysis.

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