Demographic differences between cancer survivors and those who die quickly of their disease.
OBJECTIVE
Some people diagnosed with cancer die extremely quickly of their disease. We investigated whether certain demographic and geographical characteristics were associated with these early deaths.


METHODS
The Ontario Cancer Registry enhanced with census data was used to study early death in patients aged 40-69 years, diagnosed between 1990 and 1997 with colorectal, female breast, head and neck, lung, prostate, stomach, or primary cancer of unknown origin. For each site, cases were either those who constituted the quickest 10% of deaths, or those who died within 30 days, whichever was the larger number (n = 5022). Controls were those still alive at 1 year (n = 59 406). Analyses were stratified by disease site and logistic regression identified independent effects. Characteristics included: age, gender, area-level socioeconomic status, county of residence, urban/rural residence, diagnosis year, and distance to a cancer centre.


RESULTS
Lower socioeconomic status (all sites) and increasing age (all sites except prostate and primary of unknown origin) were most strongly and consistently associated with early death. Male gender was a risk factor for early death from lung cancer. Living in urban areas was a risk factor for breast, lung, and unknown primary cancers.


CONCLUSIONS
People living in poorer and/or urban areas and the young-elderly are more susceptible to a very late cancer diagnosis. Unequal access to cancer care can lead to devastating consequences for vulnerable sectors of society.
Groome
P A
PA
Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada. patti.groome@krcc.on.ca
Schulze
K M
KM
Keller
S
S
Mackillop
W J
WJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D017741:Survivors; D014505:Urban Population