Access to care and outcomes for neuroendocrine tumours: does socioeconomic status matter?

Introduction: Neuroendocrine tumours (nets) are a poorly understood malignancy lacking standardized care. Differences in socioeconomic status (ses) might worsen the effect of non-standardized care. We examined the effect of ses on net peri-diagnostic care patterns and outcomes.

Methods: In this population-based cohort study, net cases identified from a provincial cancer registry (1994-2009) were divided into low (1st and 2nd income quintiles) and high (3rd, 4th, and 5th quintiles) ses groups. We compared peri-diagnostic health care utilization (-2 years to +6 months), metastatic recurrence, and overall survival (os) between the groups.

Results: Of 4966 net patients, 38.3% had a low ses. Neither the primary net sites ( = 0.15), nor the metastatic presentation ( = 0.31) differed. Patients with low ses had a higher mean number of physician visits (20.1 ± 19.9 vs. 18.1 ± 16.5, = 0.001) and imaging studies (56 ± 50 vs. 52 ± 44, = 0.009) leading to the net diagnosis. Rates of primary tumour resection ( = 0.14), hepatectomy ( = 0.45), systemic therapy ( = 0.38), and liver embolization ( = 0.13) did not differ with ses. In the low-ses group, metastatic recurrence was more likely (41.1% vs. 37.6%, = 0.01) during a median follow-up of 61.7 months, and the 10-year os was inferior (47.1% vs. 52.2%, < 0.01). Low ses was associated with worse os (hazard ratio: 1.16; 95% confidence interval: 1.06 to 1.26) after adjustment for age, sex, comorbidity burden, primary net site, and rural living.

Conclusions: Low ses was associated with more physician visits and imaging before a net diagnosis, but not with more advanced stage at presentation nor with an effect on the pattern of therapy. Long-term outcomes were inferior in the low-ses group. These data can help to inform the design of health care delivery for nets.