Socioeconomic differences in prostate cancer treatment: A systematic review and meta-analysis
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- Title :Socioeconomic differences in prostate cancer treatment: A systematic review and meta-analysis
- Author:Benjamin D.T. Gallagher a,b,*, Emily C. Coughlin c, Visalini Nair-Shalliker b,d,Kirsten McCaffery a, David P. Smith b,e
- Publication: Cancer Epidemiology
- Publisher: Elsevier Inc
- Year: 2022
- Language: English
- Pages: 11
- Format: PDF
- File size: 1,535 KB
- DOI: 10.1016/j.canep.2022.102164
- CBID: CBR195
Abstract
Background
Since the 1990s, most nations have had a reduction or stabilisation in prostate cancer mortality. However, socioeconomic differences in disease specific mortality and survival have persisted. This has been partially attributed to differences in treatment choices. The aim of this systematic review and meta-analysis was to describe and quantify socioeconomic differences in use of prostate cancer treatment in the literature.
Methods
MEDLINE, CINAHL and Embase were searched from 01 January 2000–01 April 2021 to identify articles that reported use of prostate cancer treatment by socioeconomic status. Random effects meta-analysis was used to analyse socioeconomic differences in treatment where there was more than one study for treatment type. A modified version of the Newcastle-Ottawa Scale was used to assess risk of bias.
Results
Out of 7267 articles identified, eight met the inclusion criteria and six were analysed using meta-analysis. Meta-analysis could only be completed for non-active treatment (watchful waiting/active surveillance). Lower education was associated with non-active treatment (OR=0.90, [95% CI 0.83–0.98], p=0.02, I 2 =67%), however, level of income was not (OR=0.87, [CI 0.75–1.02], p=0.08, I 2 =94%). Sensitivity analysis of studies where active surveillance was the outcome ( n =3), indicated no associations with level of income (OR=0.91, [95% CI 0.82–1.01], p=0.08, I 2 =52%) or education (OR=0.88, [95% CI 0.70–1.10], p=0.25, I 2 =79%). All studies were assessed as high-risk of bias.
Discussion
The relationship between socioeconomic status and prostate cancer treatment depended on the socioeconomic variable being used, the treatment type and how it was defined in research. Considerable methodological limitations were identified. Further research should improve on previous findings and address current gaps.
Highlights
- • We conducted a systematic review and meta-analysis on socioeconomic differences in prostate cancer treatment.
- • Eight retrospective cohort studies met the inclusion criteria.
- • An association between level of education and non-active treatment was identified.
- • Sensitivity analysis showed combining watchful waiting and non-active treatment into a single category may bias analyses.
- • Quality assessment indicated all studies to be at high-risk of bias.
1Background
In men, prostate cancer is the second most diagnosed cancer and the fifth leading cause of cancer related death worldwide . Since the late 1990s, most nations have seen either a stabilisation or reduction in the incidence and mortality from prostate cancer . Despite these changes, compared to men of higher socioeconomic status, men of lower socioeconomic status continue to have higher disease specific mortality and lower survival .
Socioeconomic status is the level of social prestige and access to resources one holds in a social group . It is often approximated by income, education, occupation, as well as composite measures, and can be measured at the individual, household, or area level . Socioeconomic status has extensive links to health outcomes across the lifetime. Numerous studies have reported lower socioeconomic status to be associated with higher rates of premature mortality , and higher disease burden, such as stroke and diabetes .
Treatment choice, alongside stage of disease, has been proposed as an important factor that explains socioeconomic differences in survival . A previous systematic review reported residential disadvantage to be associated with lower rates of surgical procedures and radiation therapy, and higher rates of androgen deprivation therapy . However, this narrative synthesis was restricted to measures of socioeconomic disadvantage by area, and included non-representative populations, limiting generalizability.
Understanding socioeconomic patterns of treatment may have important implications in the survivorship experience, as treatments vary in post-treatment sequalae , and can impact both people’s economic circumstances and quality of life . Based on the above, gaps in understanding socioeconomic patterns of care in representative populations remain. Therefore, the aim of this study was to describe and quantify socioeconomic status differences in the use of prostate cancer treatment in the literature.
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