title: Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study.
abstract: BACKGROUND
  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 (0.75 months, [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 (0.75 months [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.
authors.affiliation: Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.|Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Moriceau
authors.affiliation: Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.|Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bourmaud
authors.affiliation: Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Tinquaut
authors.affiliation: Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Oriol
authors.affiliation: Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Jacquin
authors.affiliation: Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournel
authors.affiliation: Radiation Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Magné
authors.affiliation: Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.|Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France.|Clinical Investigation Center and Clinical Epidemiology, Jean Monnet University, Saint-Etienne, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Chauvin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000628:therapy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000628:therapy; D005060:Europe; D005260:Female; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D010865:Pilot Projects; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000628:therapy; D012923:Social Class; D012959:Socioeconomic Factors; D061665:Time-to-Treatment / Q000592:standards / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: access to care; cancer; european deprivation index; population based; socio-economic inequalities