Regional inequalities in cancer care persist in Italy and can influence survival |
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| Authors: | Milena Sant Pamela Minicozzi Claudia Allemani Claudia Cirilli Massimo Federico Riccardo Capocaccia Mario Budroni Pina Candela Emanuele Crocetti Fabio Falcini Stefano Ferretti Mario Fusco Adriano Giacomin Francesco La Rosa Lucia Mangone Maurilio Natali Maurizio Ponz De Leon Adele Traina Rosario Tumino Paola Zambon |
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| Affiliation: | 1. Descriptive Studies and Health Planning Unit, Department of Preventive and Predictive Medicine, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Venezian 1, Milano, Italy;2. Modena Cancer Registry, Via Del Pozzo 71, Modena, Italy;3. Department of Oncology and Haematology, University of Modena and Reggio Emilia, Via Del Pozzo 71, Modena, Italy;4. National Centre for Epidemiology, Surveillance and Health Promotion, Department of Cancer Epidemiology, Istituto Superiore di Sanità, Viale Regina Elena 299, Roma, Italy;5. Epidemiology Unit, Local Health Unit 1, Via Tempio 5, Sassari, Italy;6. Trapani Cancer Registry, Viale della Provincia, Erice, Trapani, Italy;7. Clinical and Descriptive Epidemiology Unit, ISPO, Via Delle Oblate 2, Firenze, Italy;8. Romagna Cancer Registry, IRST, Via Piero Maroncelli 34/36, Meldola, Forlì, Italy;9. Ferrara Cancer Registry, Department of Experimental and Diagnostic Medicine, Ferrara University, Via Fossato di Mortara 64B, Ferrara, Italy;10. Campania Cancer Registry, Local Health Unit 4, Piazza San Giovanni, Brusciano, Napoli, Italy;11. Piedmont Cancer Registry, Province of Biella, Epidemiology Unit, Via Don Sturzo 20, Biella, Italy;12. Department of Surgical and Medical Specialities and Public Health, University of Perugia, Via Del Giochetto, Perugia, Italy;13. Reggio Emilia Cancer Registry, Santa Maria Nuova Hospital, Via Amendola 2, Reggio Emilia, Italy;14. Latina Cancer Registry, Viale P. Nervi, Centro Latina Fiori, Latina, Italy;15. Department of Internal Medicine, Division of Internal Medicine, University of Modena and Reggio Emilia, Via Del Pozzo 71, Modena, Italy;p. Palermo Breast Cancer Registry, Department of Oncology, ARNAS Civic Hospital, Piazza Leotta 4/A, Palermo, Italy;q. Cancer Registry and Histopathology Unit, “M.P. Arezzo” Civic Hospital, ASP Ragusa, Piazza Igea 1, Ragusa, Italy;r. Venetian Cancer Registry, Department of Oncology and Surgery, IRCCS Istituto Oncologico Veneto, University of Padova, Passaggio Gaudenzio 1, Padova, Italy;2. Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada;3. Department of Medical Oncology, London Health Sciences Centre, London, ON, Canada;4. University of Western Ontario, London, ON, Canada;2. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC;3. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC;4. Department of Oncology Sciences, University of South Florida, Tampa, FL;5. Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL;1. Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL;2. Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL;1. Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Hwy, NE, K-55, Atlanta, GA 30341, USA;2. Agency for Toxic Substances and Disease Registry, Geospatial Research, Analysis, and Services Program, Atlanta, GA, USA;3. Hewlett-Packard Enterprises, Palo Alto, GA, USA;1. Norwich Medical School, University of East Anglia, UK;2. Airedale NHS Foundation Trust, UK;1. Ragusa Cancer Registry, Department of Medical Prevention, Provincial Health Unit, Ragusa, Italy;2. Histopathology Unit, “MP Arezzo” Civic Hospital, Ragusa, Italy;3. Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy;4. Clinical and Descriptive Epidemiology Unit, ISPO, Firenze, Italy;5. Ferrara Cancer Registry, Department of Experimental and Diagnostic Medicine, Ferrara, Italy;6. Piedmont Cancer Registry, Province of Biella (CPO), Epidemiology Unit, Biella, Italy;7. Latina Cancer Registry, Centro Latina Fiori, Latina, Italy;8. Statistical, Quality and Clinical Studies Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy;9. Romagna Cancer Registry, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Forlì, Italy;10. National Centre for Epidemiology, Surveillance and Health Promotion, Department of Cancer Epidemiology, Istituto Superiore di Sanità, Roma, Italy |
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| Abstract: | BackgroundPopulation-based cancer registry studies of care patterns can help elucidate reasons for the marked geographic variation in cancer survival across Italy. The article provides a snapshot of the care delivered to cancer patients in Italy.MethodsRandom samples of adult patients with skin melanoma, breast, colon and non-small cell lung cancers diagnosed in 2003–2005 were selected from 14 Italian cancer registries. Logistic models estimated odds of receiving standard care (conservative surgery plus radiotherapy for early breast cancer; surgery plus chemotherapy for Dukes C colon cancer; surgery for lung cancer; sentinel node biopsy for >1 mm melanoma, vs. other treatment) in each registry compared to the entire sample (reference).ResultsStage at diagnosis for breast, colon and melanoma was earlier in north/central than southern registries. Odds of receiving standard care were lower than reference in Sassari (0.68, 95%CI 0.51–0.90) and Napoli (0.48, 95%CI 0.35–0.67) for breast cancer; did not differ across registries for Dukes C colon cancer; were higher in Romagna (3.77, 95%CI 1.67–8.50) and lower in Biella (0.38, 95%CI 0.18–0.82) for lung cancer; and were higher in Reggio Emilia (2.37, 95%CI 1.12–5.02) and lower in Ragusa (0.27, 95%CI 0.14–0.54) for melanoma.ConclusionsNotwithstanding limitations due to variations in the availability of clinical information and differences in stage distribution between north/central and southern registries, our study shows that important disparities in cancer care persist across Italy. Thus the public health priority of reducing cancer survival disparities will not be achieved in the immediate future. |
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