A Franco-Swiss team highlights the long-term impact of socio-economic inequalities on the quality of life of women who have had breast cancer. © Photo Angiola Harry on Unsplash
In the field of health, inequalities can appear at all levels among women with breast cancer: prevention, screening, diagnosis, treatment and survival. But what about their quality of life? By following nearly 6,000 patients for 2 years, a Franco-Swiss team from the University of Geneva (UNIGE), the University Hospitals of Geneva (HUG), Inserm and Gustave Roussy shows that their socio-economic status has a major and lasting impact, despite identical medical care. These results which are part of the CANTO study promoted by UNICANCER, to be read in the Journal of Clinical Oncologycall for better consideration of socio-economic determinants in support programs for women with breast cancer.
Social and economic determinants (such as income or education level) impact how people cope with illness and are one of the main causes of health inequalities. In oncology, socio-economic inequalities are present throughout the continuum of care, from prevention to diagnosis, treatment and survival.
“ However, the impact of economic inequalities on the quality of life of people with breast cancer was unknown. », explains José Sandoval, oncologist in the Department of Oncology at HUG and researcher in the departments of medicine and community health and medicine of the Faculty of Medicine of UNIGE, first author of this study. “ This is what we wanted to quantify in these women, at the time of diagnosis, but also in the two years that follow. »
Nearly 6,000 women followed for two years
The 5,900 women who participated in this study, treated in France, had early breast cancer (without metastasis), a common cancer from which more than 80% of women are cured.
“ Many women received extensive treatment in the first year after their diagnosis — such as surgery followed by
chemotherapy — then hormone therapy in the second year. We followed them over two years in order to analyze the evolution of differences in quality of life over the medium term. », Underlines Gwenn Menvielle, research director at Inserm and Gustave Roussy, who led this work.
The research team examined five domains of quality of life – fatigue, general health, mental health, sexual health and side effects, against several socio-economic indicators: educational level, household income taking into account the number of people in the household, and perceived financial situation. The combination of these elements made it possible to determine a score where 0 indicates the absence of inequalities.
Inequalities are increasing rapidly
At diagnosis, the inequalities in quality of life between the two socio-economic extremes are notable, with a score of 6.7. The score increases to 11 during treatment, then remains at 10 two years after diagnosis, i.e. at a higher level than when the diagnosis was announced.
“ If we expected a certain inequality at the start of the disease, the fact that these inequalities increase rapidly and persist so much comes as a surprise. », Analyzes José Sandoval. “ The impact on quality of life is much more pronounced in less advantaged women, regardless of the biological characteristics of their cancer, their age or the treatment received. »
For what ? The answers are to be sought not at the level of treatment, which is similar for all women, but probably in all the elements of support around medical care.
“ Having the time, money, and access to information to take care of oneself and find support resources and better manage the physical and psychological side effects of the disease will likely be easier for women of lower socioeconomic status. higher than for, for example, a single mother with a low income, without support for her children », underlines José Sandoval. “ However, these elements influence the disease and its consequences for the physical and psychological health of patients. »
Better take into account inequalities
Equal access to care is therefore not synonymous with the absence of inequality. The socio-economic context can have a major impact on health status, in the same way as biological characteristics.
“ When we talk about precision oncology, we should take into account the person as a whole, including their social dimension. », add the authors. “ Our data concerns women receiving treatment in France, a country that is nevertheless very egalitarian in terms of access to care. In countries without a universal health system, these inequalities are likely to be even more pronounced. »
These results are part of the CANTO study: study of the chronic toxicities of anticancer treatments in patients with localized cancer. This research is funded by the French government as part of the “Investments for the Future” program managed by the National Research Agency (ANR), grant no. ANR-10-COHO-0004.
