Socioeconomic differences in prostate cancer treatment: A systematic review and meta-analysis

Benjamin D T Gallagher; Emily C Coughlin; Visalini Nair-Shalliker; Kirsten McCaffery; David P Smith

doi:10.1016/j.canep.2022.102164

Socioeconomic differences in prostate cancer treatment: A systematic review and meta-analysis

Cancer Epidemiol. 2022 Aug:79:102164. doi: 10.1016/j.canep.2022.102164. Epub 2022 May 6.

Authors

Benjamin D T Gallagher¹, Emily C Coughlin², Visalini Nair-Shalliker³, Kirsten McCaffery⁴, David P Smith⁵

Affiliations

¹ Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, NSW, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia. Electronic address: Benjamin.gallagher@nswcc.org.au.
² Department of Medical Education, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States.
³ The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia; Faculty of Medicine and Health Science, Macquarie University, Sydney, Australia.
⁴ Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, NSW, Australia.
⁵ The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia; Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.

PMID: 35526516
DOI: 10.1016/j.canep.2022.102164

Abstract

Background: Since 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.

Methods: MEDLINE, 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.

Results: Out 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.

Discussion: The 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.

Keywords: Conservative treatment; Prostatectomy; Prostatic neoplasms; Radiotherapy; Socioeconomic factors.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Male
Prostatic Neoplasms* / epidemiology
Prostatic Neoplasms* / therapy
Socioeconomic Factors