1. Are social inequalities in acute myeloid leukemia survival explained by differences in treatment utilization? Results from a French longitudinal observational study among older patients
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Eloïse Berger, Cyrille Delpierre, Sébastien Lamy, Sarah Bertoli, Oriane Bombarde, Guy Laurent, Audrey Sarry, Pierre Bories, Emilie Bérard, Christian Recher, Fabien Despas, Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Service de Pharmacologie Clinique [Toulouse], CHU Toulouse [Toulouse], Service d'Hématologie [IUCT Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'épidémiologie [Toulouse], Réseau régional de cancérologie Onco-Occitanie, Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherches en Cancérologie de Toulouse (CRCT), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), This work was supported by the Institut de Recherche en Santé Publique [SSC201504 to C.R.]. In addition, the French national Research Agency supported the early development of this study [ANR-11-PHUC-001 to G.L.]., ANR-11-PHUC-0001,CAPTOR,Cancer et Pharmacologie : Projet de Toulouse-Oncopole et de sa Région(2011), Bodescot, Myriam, Pôle hospitalier Universitaire Cancer (PHUC) - Cancer et Pharmacologie : Projet de Toulouse-Oncopole et de sa Région - - CAPTOR2011 - ANR-11-PHUC-0001 - PHUC - VALID, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Pharmacologie Clinique [CHU Toulouse], Pôle Santé publique et médecine publique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Hématologie - IUCT-Oncopole [CHU Toulouse], Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle IUCT [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Epidémiologie clinique et santé publique [CHU Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), and ANR-11-PHUC-0001/11-PHUC-0001,CAPTOR,Cancer et Pharmacologie : Projet de Toulouse-Oncopole et de sa Région(2011)
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0301 basic medicine ,Male ,Cancer Research ,French European deprivation index ,0302 clinical medicine ,Older patients ,Cancer Survivors ,Surgical oncology ,Observational study ,Antineoplastic Combined Chemotherapy Protocols ,Longitudinal Studies ,Prospective Studies ,Aged, 80 and over ,Age Factors ,Myeloid leukemia ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,3. Good health ,Survival Rate ,Leukemia, Myeloid, Acute ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Female ,France ,Research Article ,medicine.medical_specialty ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,lcsh:RC254-282 ,03 medical and health sciences ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Internal medicine ,Genetics ,medicine ,Overall survival ,Humans ,Social inequality ,Healthcare Disparities ,Aged ,Acute myeloid leukemia ,business.industry ,Patient Acceptance of Health Care ,Elderly patients ,030104 developmental biology ,Treatment utilization ,Multicenter study ,Socioeconomic Factors ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Cancer management and survival ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Follow-Up Studies - Abstract
Background Evidences support social inequalities in cancer survival. Studies on hematological malignancies, and more specifically Acute Myeloid Leukemia (AML), are sparser. Our study assessed: 1/ the influence of patients’ socioeconomic position on survival, 2/ the role of treatment in this relationship, and 3/ the influence of patients’ socioeconomic position on treatment utilization. Methods This prospective multicenter study includes all patients aged 60 and older, newly diagnosed with AML, excluding promyelocytic subtypes, between 1st January 2009 to 31st December 2014 in the South-West of France. Data came from medical files. Patients’ socioeconomic position was measured by an ecological deprivation index, the European Deprivation Index. We studied first, patients’ socioeconomic position influence on overall survival (n = 592), second, on the use of intensive chemotherapy (n = 592), and third, on the use of low intensive treatment versus best supportive care among patients judged unfit for intensive chemotherapy (n = 405). Results We found an influence of patients’ socioeconomic position on survival (highest versus lowest position HRQ5: 1.39 [1.05;1.87] that was downsized to become no more significant after adjustment for AML ontogeny (HRQ5: 1.31[0.97;1.76] and cytogenetic prognosis HRQ5: 1.30[0.97;1.75]). The treatment was strongly associated with survival. A lower proportion of intensive chemotherapy was observed among patients with lowest socioeconomic position (ORQ5: 0.41[0.19;0.90]) which did not persist after adjustment for AML ontogeny (ORQ5: 0.59[0.25;1.40]). No such influence of patients’ socioeconomic position was found on the treatment allocation among patients judged unfit for intensive chemotherapy. Conclusions Finally, these results suggest an indirect influence of patients’ socioeconomic position on survival through AML initial presentation. Electronic supplementary material The online version of this article (10.1186/s12885-019-6093-3) contains supplementary material, which is available to authorized users.
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- 2019