ESTRO 2024 - Abstract Book

S106 ESTRO 2024 Cinat D, van der Wal R, Baanstra M, Soto-Gamez A, Jellema-de Bruin AL, van Goethem M-J, van Vugt MATM, Barazzuol L, Coppes RP. Derepression of transposable elements enhances interferon beta signaling and stem/progenitor cell activity after proton irradiation. bioRxiv 2024.02.14.580306; doi: https://doi.org/10.1101/2024.02.14.580306 Invited Speaker

3501

Social inequality and other socioeconomic factors affecting treatment in head and neck cancer care: Can we actually do something?

Maja Halgren Olsen

Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus, Denmark. Danish Cancer Institute, Cancer Survivorshop, Copenhagen, Denmark

Abstract:

Background : Cross-borders, the persistent socioeconomic differences in cancer outcomes are acknowledged as a crucial health issue. 1-3 Among prevalent cancer sites, the socioeconomic differences in survival are pronounced for patients diagnosed with head and neck cancer, and the survival gap has increased over time. 3-6 We investigated the extent to which this gap was driven by differences in patient- and disease-specific factors at the time of diagnosis. 7-10 Methods : We established a nationwide, population-based cohort of Danish patients diagnosed with head and neck squamous cell carcinoma (HNSCC) between 1992-2019. 10 The cohort was obtained by combining information from the clinical database Danish Head and Neck Cancer Group (DAHANCA) and several administrative registries. This facilitated the investigation of the association between various individual-level socioeconomic factors and patient- and disease-specific outcomes. Results : Despite the ethiology and survival vary greatly across HNSCC subsites, we observed consistent socioeconomic gradients in survival ( Figure 1 ). 9,10 Regardless of subsite and p16-status, patients with low socioeconomic position (SEP) had 10−15 %-points lower five-year standardised overall survival probability than patients with high SEP ( Figure 1 ). 9,10 Contrary to expected, we observed no apparent socioeconomic differences in the interval from patient-reported symptom onset to diagnosis, neither in consultation patterns prior to diagnosis. 8 Still, at the time of diagnosis patients with low compared to high SEP had increased odds of advanced stage disease and for being a current smoker, having comorbidity, and being subjected to palliative or no treatment. 7 10 Combined, differences in these factors were estimated to explain 48-75% of the observed socioeconomic survival gap. 9,10 Conclusion : The socioeconomic survival gap is consistent across all HNSCC subsites and to a large degree driven by determinants prior to symptom onset and diagnosis. Socioeconomic differences in smoking behaviour and general health appear as central targets for interventions. 9 Perspectives : Our results underline the importance of prioritizing structural prevention initiatives targeting inequality in health-related lifestyle behaviour. Nevertheless, it remains a challenge to the organisation of clinical practices, that a large group of patients are systematically worse off at the time of diagnosis. Not at least because these differences likely accumulate throughout the cancer trajectory. Ongoing interventions aim at identifying vulnerable groups and increasing their capability to receive the best possible treatment and rehabilitation. Until the design, effect and feasibility of such interventions are established, it appears pertinent to evaluate whether certain groups of patients are inadequately allocated to treatment regimens and prioritize supportive care for this group.