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Access to care and outcomes for neuroendocrine tumors: does socio-economic status matter?


Introduction — Neuroendocrine tumours (nets) are a poorly understood malignancy lacking standardized care. Differences in socioeconomic status (ses) might worsen the effect of non-standardized care. We examined the effect of ses on net peri-diagnostic care patterns and outcomes.

Methods — In this population-based cohort study, net cases identified from a provincial cancer registry (1994–2009) were divided into low (1st and 2nd income quintiles) and high (3rd, 4th, and 5th quintiles) ses groups. We compared peri-diagnostic healthcare utilization (–2 years to +6 months), metastatic recurrence, and overall survival (os) between the groups.

Results — Of 4966 net patients, 38.3% had a low ses. Neither the primary net sites (p = 0.15), nor the metastatic presentation (p = 0.31) differed. Patients with low ses had a higher mean number of physician visits (20.1 ± 19.9 vs. 18.1 ± 16.5, p = 0.001) and imaging studies (56 ± 50 vs. 52 ± 44, p = 0.009) leading to the net diagnosis. Rates of primary tumour resection (p = 0.14), hepatectomy (p = 0.45), systemic therapy (p = 0.38), and liver embolization (p = 0.13) did not differ with ses. In the low-ses group, metastatic recurrence was more likely (41.1% vs. 37.6%, p = 0.01) during a median follow-up of 61.7 months, and the 10-year os was inferior (47.1% vs. 52.2%, p < 0.01). Low ses was associated with worse os (hazard ratio: 1.16; 95% confidence interval: 1.06 to 1.26) after adjustment for age, sex, comorbidity burden, primary net site, and rural living.

Conclusions — Low ses was associated with more physician visits and imaging before a net diagnosis, but not with more advanced stage at presentation nor with an effect on the pattern of therapy. Long-term outcomes were inferior in the low-ses group. These data can help to inform the design of healthcare delivery for nets.



Hallet J, Coburn NG, Singh S, Beyfuss K, Koujanian S, Liu N, Law CHL. Curr Oncol. 2018; 25(5):e356-64. Epub 2018 Oct 31.

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