Scientists have linked access to a family doctor with breast cancer survival
Canadian scientists have linked the absence of a permanent family doctor and social disadvantage with a higher probability of death in the first six months after the detection of metastatic breast cancer. The study involved patients who were first diagnosed with the disease at the fourth stage. How the availability of a regular medical appointment is related to the outcomes of severe cancer and why income and place of residence are important — in the Izvestia article.
The first six months after diagnosis
The researchers examined data from 4004 patients from the Canadian province of Ontario for 2010-2019. All had so-called primary metastatic breast cancer: when the disease was first detected, the tumor had already spread to other parts of the body. This corresponds to the fourth stage.
The authors analyzed the information collected by the ICES research organization. They were interested in early death, which in this work was defined as death within six months of diagnosis. During this period, 23% of the participants died — almost every fourth patient in the study group.
The indicator applies specifically to people with distant metastases already at the first diagnosis. It cannot be transferred to all cases of breast cancer, including tumors detected in the early stages.
As explained by the authors, including Priya Thomas, a resident physician at the University of Western Ontario, and Philippe Blanchett, an oncologist at the London Center for Medical Sciences in Canada, the relationship between early death and social circumstances in the country has not been sufficiently studied. Most of the previous research on this topic was conducted in the USA.
"We conducted this work because patients with primary metastatic breast cancer often face inequalities in access to medical care," the researchers noted.
Why the family doctor was important
One of the main observations concerned the connection with primary health care. Patients who were registered with a family doctor had a 26% lower chance of dying in the first six months after diagnosis. They were also more likely to have mammograms.
A family doctor in the Canadian system provides primary care. In the context of cancer, his work may include the identification of alarming changes, referral for examinations and further patient support.
The authors suggest that the absence of such a specialist may complicate the timely diagnosis and initiation of antitumor treatment. At the same time, the study shows a statistical relationship: it does not prove that by itself, being attached to a doctor will reduce mortality by a certain amount.
"Access to a primary care specialist is becoming an increasingly serious problem in Canada: one in four Canadians does not have regular access to primary care. This can negatively affect the timeliness of diagnosis, as well as lead to delays in the start of important antitumor therapy," the authors say.
How are living conditions related to the forecast
A higher probability of early death was also associated with old age, chronic diseases, and pronounced socio-economic disadvantage. Indicators characterizing housing conditions and the availability of material resources were of particular importance in the analysis.
To assess social differences, the researchers used the Ontario Marginalization Index, an index that allows comparing Ontario territories across several groups of demographic and socio—economic indicators.
It includes characteristics of households and housing, material resources, age composition, and labor participation. For example, the prevalence of living alone and unemployment are taken into account. The data describes the conditions in a certain area, so the indicator is not equivalent to information about the personal income of each patient.
This approach helps to identify areas where the need for medical support may be particularly high. In the presented study, less favorable social conditions were associated with worse outcomes even within a group of patients with the same stage of the disease.
Why does the distance to the clinic also matter?
Researchers have found geographical differences in early mortality. Additional vulnerability of rural residents was manifested at the stage of antitumor drug treatment.
The authors suggest that one explanation may be the difficulty of traveling for medical help. Cancer treatment is often organized through large urban centers, which are more difficult for residents of remote settlements to reach.
The researchers propose to study separately how to improve the provision of cancer care in rural areas and what role remote consultations can play in this. The effectiveness of such solutions has yet to be assessed.
What kind of help is needed besides antitumor treatment
According to the authors, the primary link should be involved in helping people at different stages of the disease. After diagnosis, there is still a need for symptom control, management of concomitant diseases, assessment of undesirable effects of therapy, and psychological support.
"Primary care plays a key role in cancer prevention, screening, diagnosis, treatment support and control of adverse effects, symptom relief, as well as in psychosocial and palliative care. The need for oncological care is growing rapidly, and oncologists are unlikely to be able to meet it alone," the authors emphasized.
What they propose to change
Researchers consider it necessary to improve access to primary health care, especially in socially disadvantaged communities. Among the areas they mention are the prevention and accessibility of mammographic screening: in their opinion, this can help reduce the number of cases when the disease is first detected with metastases.
The conclusions are based on the observation of patients identified in 2010-2019. Such work makes it possible to identify groups with unfavorable outcomes and possible barriers to getting help, but by itself it does not determine which specific organizational measure will most significantly change survival. This will have to be verified in further research.
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