Abstract
Background
Although social disparities in survival for patients with cancer are documented in
an increasing number of papers, knowledge on the underlying mechanisms concerning
screening, diagnosis, treatment or follow-up, is relatively poor. Our study was aimed
at investigating the social determinants of access to reference cancer care centres
for surgery for colorectal cancer in France.
Methods
Retrospective analysis was conducted on population-based data from a specialised cancer
registry (County of Calvados, France). The population consisted of 5156 patients with
surgical treatment for colorectal cancer recorded between January 1st 1981 and December
31st 2000.
Results
The probability of being cared for in a reference care centre was 1.3-fold lower for
people living in a deprived district (mean income < 15000€) and 3-fold lower for people
living in a district where more than 7% of houses were devoid of bath and shower in
comparison with districts where this rate was under 2%. After adjustment for distance
from reference care centre, the probability of being cared for in a reference care
centre was still over one third lower for people living in a district with more than
7% of houses devoid of bath and shower. Social disparities in management of patients
with colorectal cancer have increased in the last decade. The reduction of access
to reference care with distance was stronger in elderly patients.
Conclusions
There is a social and geographical determination of type of treatment centre for care
management of colorectal cancer in France. Special attention needs to be paid to the
high quality of care management in non-specialised care centres in order to avoid
an increased social gradient in cancer mortality in France.
Keywords
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Article info
Publication history
Accepted:
June 8,
2006
Received in revised form:
June 6,
2006
Received:
May 5,
2006
Identification
Copyright
© 2006 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
