Socioeconomic impact on quality of care in pelvic gynecological cancers
Abstract
Introduction
Several European studies have shown health‐related social inequalities in pelvic gynecological cancers, with a social gradient in incidence and mortality, partly explained by more advanced stages at diagnosis in low socioeconomic populations. Disparities in treatment and quality of care in these patients could be another cause of inequality in care.
Objectives
This study evaluates the impact of socioeconomic factors on quality of care for pelvic gynecological cancers (adnexal, uterine corpus, and cervix).
Methods
This retrospective multicentric cohort study included women diagnosed with pelvic gynecological invasive cancer, between January 1 and December 31, 2022, in six university hospitals in North Paris. Two socioeconomic indicators, the FDep index and the Evaluation of Deprivation and Inequalities in Health Examination Centers (EPICES) score, were collected. The quality of care was assessed using a binary quality indicator based on selected European Society of Gynecological Oncology (ESGO) quality indicators for each cancer. We compared the “Non‐adherence to Quality Indicator” (NAQI) group, where one or more of the ESGO quality indicators were not met, to the “Adherence to Quality Indicator” (AQI) group using univariate analysis. An analysis of the time to first treatment, according to FDep and EPICES groups, using a Kaplan–Meier, estimation was completed.
Results
A total of 189 patients were included: 50 with ovarian cancer, 76 with endometrial cancer, and 63 with cervical cancer. Ninety‐nine patients (52.4%) belonged to the NAQI group and 90 patients (46.7%) to the AQI group. Patients were significantly in poorer general condition and presented more advanced Federation International of Gynecology Obstetrics (FIGO) stages in the NAQI than in the AQI group (ASA score 3–4: 20/84 [23.8%] vs. 5/76 (6.6%), P < 0.01 and FIGO III–IV stage: 55/99 [55.6%] vs. 35/90 [38.9%], P = 0.03). There was no significant difference for socioeconomic indicators between the NAQI and the AQI groups (FDep quintiles 3–4‐5 = 41/99 (41.4%) vs. FDep quintiles 1–2 = 39/90 (43.3%), P = 0.91; EPICES score ≤ 30 = 31/63 (49.2%) vs. EPICES score > 30 = 21/51 (41.2%), P = 0.50). According to FDep and EPICES groups, we found no difference in the time to first treatment.
Conclusion
We found no socioeconomic impact on hospital quality of care in pelvic gynecological cancers.