Abstract
BackgroundEvidences 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.MethodsThis 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).ResultsWe 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.ConclusionsFinally, these results suggest an indirect influence of patients’ socioeconomic position on survival through AML initial presentation.
Highlights
Evidences support social inequalities in cancer survival
Studies concerned solid tumors and very few papers have focused on hematological malignancies studies dealing with the influence of socioeconomic position (SEP) on acute myeloid leukemia (AML) care and outcome are sparser
In bivariate analyses (Additional files 1, 2 and 3: Tables S1 to S3), poorer overall survival was associated with non-intensive therapy, the highest level of social deprivation, advanced age, higher level of comorbidity, poorer performance status, higher level of WBC, secondary or undefinable Acute Myeloid Leukemia (AML) ontogeny, and unfavorable or undefinable cytogenetic prognosis (Additional file 1: Table S1)
Summary
Evidences support social inequalities in cancer survival. Studies on hematological malignancies, and Acute Myeloid Leukemia (AML), are sparser. Studies concerned solid tumors and very few papers have focused on hematological malignancies studies dealing with the influence of SEP on acute myeloid leukemia (AML) care and outcome are sparser. Regarding SEP-related differences in treatment utilization, results differed from those observed in private funding healthcare setting [15], with a lower use of intensive therapy in the lower educational level group but only among older AML patients. This indicates that, in addition to the healthcare system, the influence of patients’ SEP on AML treatment and outcome may involve different mechanisms depending on patients’ age. SEP-related differences in the choice of treatment are assumed to be a potential explanatory mechanism of SEP-related differences in survival
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