Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Aug 20;42(24):2908-2917.
doi: 10.1200/JCO.23.02099. Epub 2024 Jun 18.

Magnitude and Temporal Variations of Socioeconomic Inequalities in the Quality of Life After Early Breast Cancer: Results From the Multicentric French CANTO Cohort

José Luis Sandoval  1   2 , Maria Alice Franzoi  3 , Antonio di Meglio  3   4 , Arlindo R Ferreira  5 , Alessandro Viansone  4 , Fabrice André  3   4 , Anne-Laure Martin  6 , Sibille Everhard  6 , Christelle Jouannaud  7 , Marion Fournier  8 , Philippe Rouanet  9 , Laurence Vanlemmens  10 , Asma Dhaini-Merimeche  11 , Baptiste Sauterey  12 , Paul Cottu  13 , Christelle Levy  14 , Silvia Stringhini  1 , Idris Guessous  1 , Ines Vaz-Luis  3   15 , Gwenn Menvielle  3
Affiliations
Multicenter Study

Magnitude and Temporal Variations of Socioeconomic Inequalities in the Quality of Life After Early Breast Cancer: Results From the Multicentric French CANTO Cohort

José Luis Sandoval et al. J Clin Oncol. .

Abstract

Purpose: Socioeconomic status (SES) influences the survival outcomes of patients with early breast cancer (EBC). However, limited research investigates social inequalities in their quality of life (QoL). This study examines the socioeconomic inequalities in QoL after an EBC diagnosis and their time trends.

Patients and methods: We used data from the French prospective multicentric CANTO cohort (ClinicalTrials.gov identifier: NCT01993498), including women with EBC enrolled between 2012 and 2018. QoL was assessed using the European Organisation for Research and Treatment of Cancer QoL Core 30 questionnaire (QLQ-C30). summary score at diagnosis and 1 and 2 years postdiagnosis. We considered three indicators of SES separately: self-reported financial difficulties, household income, and educational level. We first analyzed the trajectories of the QLQ-C30 summary score by SES group. Then, social inequalities in QLQ-C30 summary score and their time trends were quantified using the regression-based slope index of inequality (SII), representing the absolute change in the outcome along socioeconomic gradient extremes. The analyses were adjusted for age at diagnosis, Charlson Comorbidity Index, disease stage, and type of local and systemic treatment.

Results: Among the 5,915 included patients with data on QoL at diagnosis and at the 2-year follow-up, social inequalities in QLQ-C30 summary score at baseline were statistically significant for all SES indicators (SIIfinancial difficulties = -7.6 [-8.9; -6.2], SIIincome = -4.0 [-5.2; -2.8]), SIIeducation = -1.9 [-3.1; -0.7]). These inequalities significantly increased (interaction P < .05) in year 1 and year 2 postdiagnosis, irrespective of prediagnosis health, tumor characteristics, and treatment. Similar results were observed in subgroups defined by menopausal status and type of adjuvant systemic treatment.

Conclusion: The magnitude of preexisting inequalities in QoL increased over time after EBC diagnosis, emphasizing the importance of considering social determinants of health during comprehensive cancer care planning.

PubMed Disclaimer

Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Ines Vaz-Luis

Honoraria: AstraZeneca (Inst), Novartis (Inst), Sandoz

Research Funding: Resilience Care (Inst)

Travel, Accommodations, Expenses: Novartis

No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
(A) QLQ-C30 summary scores according to SES indicator at baseline, Year 1, and Year 2. (B) Changes in QLQ-C30 summary scores relative to baseline and according to SES indicator. (C) Inequalities in QLQ-C30 summary scores for each of the studied time points and SES indicators. Models in (B) and (C) are adjusted for age, comorbidities, breast cancer stage at diagnosis, type of lymph node management, surgery type, type of systemic treatment, and use of radiotherapy. Reported P values are for interaction by time points (P.int). MLS, mean least square differences; QLQ–C30, QoL Core 30 questionnaire; SES, socioeconomic status; SII, slope index of inequality.
FIG 2.
FIG 2.
Inequalities in QLQ-C30 summary scores for menopausal status and treatment subgroups for each studied time point and SES indicator. Models are adjusted for age, comorbidities, breast cancer stage at diagnosis, type of lymph node management, surgery type, type of systemic treatment, and use of radiotherapy. Reported P values are for interaction by time points (P.int). QLQ-Q30, QoL Core 30 questionnaire; SES, socioeconomic status; SII, slope index of inequality.
FIG A1.
FIG A1.
Inequalities in QLQ-C30 summary scores in patients that participated in clinical trials for each studied time point and SES indicator. Models are adjusted for age, comorbidities, breast cancer stage at diagnosis, type of lymph node management, surgery type, type of systemic treatment, and use of radiotherapy. Reported P values are for interaction by time points (P.int). QLQ-C30, QoL Core 30 questionnaire; SES, socioeconomic status; SII, slope index of inequality.
FIG A2.
FIG A2.
Inequalities in QLQ-C30 and QLQ-BR23 symptom scales scores for each studied time point and SES indicator. Models are adjusted for age, comorbidities, breast cancer stage at diagnosis, type of lymph node management, surgery type, type of systemic treatment, and use of radiotherapy. Reported p values are for interaction by time points (P.int). AEs, adverse events; QLQ-C30, QoL Core 30 questionnaire; Rx, treatment; SES, socioeconomic status; SII, slope index of inequality.
See this image and copyright information in PMC

References

    1. Park JH, Anderson WF, Gail MH: Improvements in US breast cancer survival and proportion explained by tumor size and estrogen-receptor status. J Clin Oncol 33:2870-2876, 2015 - PMC - PubMed
    1. Bleyer A, Welch HG: Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med 367:1998-2005, 2012 - PubMed
    1. Giordano SH, Buzdar AU, Smith TL, et al. : Is breast cancer survival improving? Trends in survival for patients with recurrent breast cancer diagnosed from 1974 through 2000. Cancer 100:44-52, 2004 - PubMed
    1. Cardoso F, Kyriakides S, Ohno S, et al. : Early breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 30:1674, 2019 - PubMed
    1. Gradishar WJ, Moran MS, Abraham J, et al. : Breast cancer, version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 20:691-722, 2022 - PubMed

Publication types

Associated data