Social Inequality in Utilization of Aftercare Services Among Breast and Prostate Cancer Patients

Abstract

This study examines social inequalities in the utilization of medical rehabilitation, complementary and alternative medicine (CAM) and psychosocial support programs among patients with prostate and breast cancer after surgery. A prospective, multicenter observational study was conducted. Subjects were 483 patients after primary manifestation of prostate and breast cancer (UICC-Stadium 0-IV) aged between 18 and 65 years. Patients were asked to fill out a questionnaire after surgery and 6 months later. Social inequality was measured by education, income and occupational status. In addition, the insurance status (private vs. statutory) was taken into account. Logistic regression models were used separately for each cancer site. The analyses were controlled for age, tumor stage and mental comorbidity. The associations between social inequality and the utilization of aftercare services vary by inequality indicator and the different health care services. Inequalities in utilization of CAM are most pronounced and consistent. Differences between status groups are small in utilization of rehabilitation. Among breast cancer patients, inequalities are more pronounced than among prostate cancer patients. Social inequalities in utilization of aftercare services among breast and prostate cancer patients are inconsistent. Future investigations should clarify to what extent such inequalities are due to access barriers or due to differences in health literacy or preferences.