Abstract
BackgroundIn France during the last 15 years, precariousness among women has increased. In breast cancer, precariousness has been associated with an increase in mortality, but the links between precariousness, stage at diagnosis and care pathway are little explored. Our study aims to evaluate the impact of precariousness on care pathways, treatment and recovery phase according to a multidisciplinary analysis.Methods and designComparative prospective observational multicenter study of exposed / unexposed category. Patients with breast cancer are recruited in the Ile de France area. Three scores are used to identify precarious patients. Precarious patients are matched to non-precarious patients by age group. Questionnaires are distributed to patients at different times of care. The main objective is to compare the stage of the disease at diagnosis between two groups. The secondary objectives are: comparison of socio-economic and geographical characteristics, direct and indirect costs, personal trajectories of care and health. Analysis include multidisciplinary approaches. A geographical information systems method will evaluate the accessibility to health facilities and the characteristics of the places of residence of the patients. An anthropological analysis will be conducted through observation of consultations and semi-directed interviews with patients. These methods will allow to analyze the diagnostic and therapeutic routes, placing it in a life history and an economic, socio-cultural and health environment. The economic analysis will include a comparison of direct, indirect costs and out-off pocket costs, from the patient’s point of view and from the societal perspective.DiscussionConducted in a clinical setting and coupled with a qualitative study, this study will provide a better understanding of how contextual factors, combined with individual factors, can influence the course of health and thus the stage of the disease at diagnosis. The multidisciplinary approach, involving clinicians, geographers, an anthropologist, an economist and a health epidemiologist, will allow a multidimensional approach to the impact of precariousness on breast cancer.Trial registrationClinicalTrials.gov Identifier: NCT02948478 registered October 28, 2016. ID RCB: 2016-A00589–42. protocol version: 2.1. decembre 13, 2018.
Highlights
In France during the last 15 years, precariousness among women has increased
Until the 70’s, breast cancer was characterized by its higher incidence among women with high educational level of than in women with a low-level educational level
Prognosis is strongly related to stage at diagnosis, with a 5-year overall survival rate decreasing from 98% for stage 1 to 20% for stage 4 [7]
Summary
In France during the last 15 years, precariousness among women has increased. In breast cancer, precariousness has been associated with an increase in mortality, but the links between precariousness, stage at diagnosis and care pathway are little explored. Inequalities in mortality were difficult to assess, since there was a combination of different cancer incidences favoring women with a low socioeconomic status and survival difference favoring women with a high socioeconomic status. Prognosis is strongly related to stage at diagnosis, with a 5-year overall survival rate decreasing from 98% for stage 1 to 20% for stage 4 [7] It has recently been shown in UK that breast cancer is more likely to be diagnosed in advanced stage among precarious patients, resulting in decreased survival in those patients. These inequalities are widening when breast cancer leads to significant decreases in income, additional costs and difficulties to re-entering the work world [8]
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