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 (p = 0.15), nor the metastatic presentation (p = 0.31) differed. Patients with low SES had a higher mean number of physician visits (20.1 ± 19.9 vs. 18.1 ± 16.5, p = 0.001) and imaging studies (56 ± 50 vs. 52 ± 44, p = 0.009) leading to the NET diagnosis. Rates of primary tumour resection (p = 0.14), hepatectomy (p = 0.45), systemic therapy (p = 0.38), and liver embolization (p = 0.13) did not differ with SES. In the low-SES group, metastatic recurrence was more likely (41.1% vs. 37.6%, p = 0.01) during a median follow-up of 61.7 months, and the 10-year os was inferior (47.1% vs. 52.2%, p < 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.