Socioeconomic differences in prostate cancer treatment: A systematic review and meta-analysis |
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| Affiliation: | 1. Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, NSW, Australia;2. The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia;3. Department of Medical Education, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States;4. Faculty of Medicine and Health Science, Macquarie University, Sydney, Australia;5. Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia;6. School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia;1. Cancer Surveillance and Data Analysis Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil;2. Early Detection and Cancer Care Network Division, National Cancer Institute INCA, Rio de Janeiro, Brazil;3. Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France;1. Faculty of Medicine, University of Iceland, Reykjavik, Iceland;2. Department of Pathology, Landspitali University Hospital of Iceland, Reykjavik, Iceland;3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Landspitali University Hospital of Iceland, Reykjavik, Iceland;1. Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel;2. MSD Israel, Merck Sharp & Dohme (Israel-1996) Company Ltd. 34 Hacharash St. P.O.B 7340, Hod Hasharon 45240, Israel;3. Institute of Oncology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel;4. Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel;5. Sackler Faculty of Medicine, Tel Aviv University, Israel;1. Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, Osaka Prefecture 541-8567, Japan;2. Inequalities in Cancer Outcome Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom;1. Cancer Control Office, King Hussein Cancer Center, Amman 11941, Jordan;2. Section of Pulmonary and Critical Care, Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan;3. Pharmacy Student, University of Jordan, Amman 11972, Jordan;4. Volunteer Research Program at King Hussein Cancer Center, Amman 11941, Jordan;5. Medical Student, University of Jordan, Amman 11972, Jordan |
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| Abstract: | BackgroundSince the 1990s, most nations have had a reduction or stabilisation in prostate cancer mortality. However, socioeconomic differences in disease specific mortality and survival have persisted. This has been partially attributed to differences in treatment choices. The aim of this systematic review and meta-analysis was to describe and quantify socioeconomic differences in use of prostate cancer treatment in the literature.MethodsMEDLINE, CINAHL and Embase were searched from 01 January 2000–01 April 2021 to identify articles that reported use of prostate cancer treatment by socioeconomic status. Random effects meta-analysis was used to analyse socioeconomic differences in treatment where there was more than one study for treatment type. A modified version of the Newcastle-Ottawa Scale was used to assess risk of bias.ResultsOut of 7267 articles identified, eight met the inclusion criteria and six were analysed using meta-analysis. Meta-analysis could only be completed for non-active treatment (watchful waiting/active surveillance). Lower education was associated with non-active treatment (OR=0.90, [95% CI 0.83–0.98], p=0.02, I2=67%), however, level of income was not (OR=0.87, [CI 0.75–1.02], p=0.08, I2=94%). Sensitivity analysis of studies where active surveillance was the outcome (n=3), indicated no associations with level of income (OR=0.91, [95% CI 0.82–1.01], p=0.08, I2=52%) or education (OR=0.88, [95% CI 0.70–1.10], p=0.25, I2=79%). All studies were assessed as high-risk of bias.DiscussionThe relationship between socioeconomic status and prostate cancer treatment depended on the socioeconomic variable being used, the treatment type and how it was defined in research. Considerable methodological limitations were identified. Further research should improve on previous findings and address current gaps. |
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| Keywords: | Prostatic neoplasms Socioeconomic factors Conservative treatment Prostatectomy Radiotherapy |
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