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Regional inequalities in cancer care persist in Italy and can influence survival

Sant, Milena and Minicozzi, Pamela and Alemanni, Claudia and Cirilli, Claudia and Federico, Massimo and Capocaccia, Riccardo and Budroni, Mario and Candela, Pina and Crocetti, Emanuele and Falcini, Fabio and Ferretti, Stefano and Fusco, Mario and Giacomin, Adriano and La Rosa, Francesco and Mangone, Lucia and Natali, Maurilio and Ponz De Leon, Maurizio and Traina, Adele and Tumino, Rosario and Zambon, Paola (2012) Regional inequalities in cancer care persist in Italy and can influence survival. Cancer Epidemiology, Vol. 36 (6), p. 541-547. eISSN 1877-783X. Article.

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DOI: 10.1016/j.canep.2012.06.006

Abstract

Background
Population-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.
Methods
Random 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).
Results
Stage 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.
Conclusions
Notwithstanding 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.

Item Type:Article
ID Code:8182
Status:Published
Refereed:Yes
Uncontrolled Keywords:Breast cancer, colon cancer, lung cancer, melanoma, standard care, Italy
Subjects:Area 06 - Scienze mediche > MED/08 Anatomia patologica
Divisions:002 Altri enti e centri di ricerca del Nord Sardegna > Azienda ASL1, Sassari
Publisher:Elsevier
eISSN:1877-783X
Deposited On:19 Nov 2012 15:35

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