The Impact of Socioeconomic Status on Prostate Cancer Treatment and Survival in the Southern Netherlands

Abstract

To investigate if socioeconomic status (SES) played a role in the selection of prostate cancer treatment and overall survival. Treatment and survival by SES of all newly diagnosed patients with prostate cancer (1998-2008) from the population-based Eindhoven Cancer Registry (n= 11,086) were studied. Younger patients (<75) with early stage disease, including prostate-specific antigen (PSA)-detected stage cT1c, with low SES underwent prostatectomy and brachytherapy less often (10%-16% lower prostatectomy rates in low SES and 0%-7% lower brachytherapy rates in low SES) compared to those with high SES, but underwent more external beam radiotherapy, hormonal therapy, and watchful waiting policy (6%-9%, 5%-7%, and 3%-7% more in low SES, respectively). This was partially related to the prevalence of comorbidity. The introduction of brachytherapy for localized disease occurred first in high SES patients and these socioeconomic differences were hardly affected by socioeconomic differences in the presence of comorbidities. Overall 10-year survival was superior in high SES patients compared to low SES (localized disease 67% vs 44%, advanced disease 29% vs 20%), and was related to treatment and comorbidity. Multivariable adjusted death rates remained significantly elevated for patients with low SES, especially cT1c, age<60 (hazard ratio [HR]low_vs_high_SES 4.2, 95% confidence interval [CI]1.3-13.7). SES affected treatment selection and overall survival for patients with prostate cancer in the Southern Netherlands, where treatment guidelines exist and health care is fully covered. Presence of comorbidities only partly contributed to these differences. The relation with other SES-associated factors (eg, ability to understand medical information or to cope with health problems) remains to be explored.