Abstract：
BACKGROUND: Precariousness has been associated with an increase in breast cancer mortality, but the links between precariousness, stage at diagnosis and care pathways are little explored. The objective of the DESSEIN study was to assess the impact of precariousness on disease and care pathways.
METHODS: Prospective observational study in Île-de-France comparing precarious and non-precarious patients consulting for breast cancer and followed for 1 year.
RESULTS: In total, 875 patients were included between 2016 and 2019 in 19 institutions: 543 non-precarious patients and 332 precarious patients. Precarious patients had a more advanced stage at diagnosis (55% T1 vs. 63%, 30% N+ vs 19%, P=0.0006), had a higher risk of not receiving initially planned treatment (4 vs. 1%, P=0.004), and participated less in clinical trials (5 vs. 9%, P=0.03). Non-use of supportive oncology care was 2 times more frequent among patients in precarious situations (P<0.001). During treatment, 33% of deprived patients reported a loss of income, compared with 24% of non-deprived patients (P<0.001). At 12 months from diagnosis, lay-offs were 2 times more frequent in precarious patients (P=0.0001).
CONCLUSIONS: Precariousness affects all stages of the cancer history and care pathway. Particular attention needs to be paid to vulnerable populations, considering issues of accessibility and affordability of care, health literacy and possible implicit bias from the care providers.
METHODS: Prospective observational study in Île-de-France comparing precarious and non-precarious patients consulting for breast cancer and followed for 1 year.
RESULTS: In total, 875 patients were included between 2016 and 2019 in 19 institutions: 543 non-precarious patients and 332 precarious patients. Precarious patients had a more advanced stage at diagnosis (55% T1 vs. 63%, 30% N+ vs 19%, P=0.0006), had a higher risk of not receiving initially planned treatment (4 vs. 1%, P=0.004), and participated less in clinical trials (5 vs. 9%, P=0.03). Non-use of supportive oncology care was 2 times more frequent among patients in precarious situations (P<0.001). During treatment, 33% of deprived patients reported a loss of income, compared with 24% of non-deprived patients (P<0.001). At 12 months from diagnosis, lay-offs were 2 times more frequent in precarious patients (P=0.0001).
CONCLUSIONS: Precariousness affects all stages of the cancer history and care pathway. Particular attention needs to be paid to vulnerable populations, considering issues of accessibility and affordability of care, health literacy and possible implicit bias from the care providers.
摘要：
背景：危险与乳腺癌死亡率的增加有关，但是不稳定之间的联系，在诊断和护理路径阶段很少探索。DESSEIN研究的目的是评估不稳定对疾病和护理途径的影响。
方法：在法兰西岛进行前瞻性观察性研究，比较不稳定和不稳定的乳腺癌患者咨询并随访1年。
结果：总计，2016年至2019年期间，共有19个机构的875名患者：543名不稳定患者和332名不稳定患者。不稳定的患者在诊断时具有更晚期的阶段（55％T1与63%,30%N+对19%，P=0.0006),没有接受最初计划治疗的风险较高(4vs.1%,P=0.004),参加临床试验较少(5vs.9%,P=0.03)。在不稳定的情况下，不使用支持性肿瘤护理的频率是患者的2倍（P<0.001）。治疗期间,33%的贫困患者报告收入损失，与24%的非剥夺患者相比(P<0.001)。诊断后12个月，不稳定患者的裁员频率是后者的2倍(P=0.0001).
结论：易危影响癌症病史和护理途径的所有阶段。需要特别关注弱势群体，考虑到护理的可及性和可负担性问题，健康素养和护理提供者可能存在的隐性偏见。
方法：在法兰西岛进行前瞻性观察性研究，比较不稳定和不稳定的乳腺癌患者咨询并随访1年。
结果：总计，2016年至2019年期间，共有19个机构的875名患者：543名不稳定患者和332名不稳定患者。不稳定的患者在诊断时具有更晚期的阶段（55％T1与63%,30%N+对19%，P=0.0006),没有接受最初计划治疗的风险较高(4vs.1%,P=0.004),参加临床试验较少(5vs.9%,P=0.03)。在不稳定的情况下，不使用支持性肿瘤护理的频率是患者的2倍（P<0.001）。治疗期间,33%的贫困患者报告收入损失，与24%的非剥夺患者相比(P<0.001)。诊断后12个月，不稳定患者的裁员频率是后者的2倍(P=0.0001).
结论：易危影响癌症病史和护理途径的所有阶段。需要特别关注弱势群体，考虑到护理的可及性和可负担性问题，健康素养和护理提供者可能存在的隐性偏见。
