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      Role of patient characteristics in adherence to first-line treatment guidelines in breast, lung and prostate cancer: insights from the Nordic healthcare system

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          Abstract

          Objectives

          This study investigates the influence of socioeconomic status, health literacy, and numeracy on treatment decisions and the occurrence of adverse events in patients with breast, lung, and prostate cancer within a Nordic healthcare setting.

          Design

          A follow-up to a cross-sectional, mixed-methods, single-centre study.

          Setting

          A Nordic, tertiary cancer clinic.

          Participants

          A total of 244 participants with breast, lung and prostate cancer were initially identified, of which 138 first-line treatment participants were eligible for this study. First-line treatment participants (n=138) surpassed the expected cases (n=108).

          Interventions

          Not applicable as this was an observational study.

          Primary and secondary outcome measures

          The study’s primary endpoint was the rate of guideline adherence. The secondary endpoint involved assessing treatment toxicity in the form of adverse events.

          Results

          Guideline-adherent treatment was observed in 114 (82.6%) cases. First-line treatment selection appeared uninfluenced by participants’ education, occupation, income or self-reported health literacy. A minority (3.6%) experienced difficulties following treatment instructions, primarily with oral cancer medications.

          Conclusions

          The findings indicated lesser cancer health disparities regarding guideline adherence and treatment toxicity within the Nordic healthcare framework. A causal connection may not be established; however, the findings contribute to discourse on equitable cancer health provision.

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          Most cited references42

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          Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review

          While socioeconomic disparities are among the most fundamental causes of health disparities, socioeconomic status (SES) does not impact health directly. One of the potential mediating factors that link SES and health is health literacy (HL). Yet although HL can be considered a modifiable risk factor of socioeconomic disparities in health, the relationship between SES, HL and health disparities is not well understood. This study reviewed the evidence regarding the mediating role of HL in the relationship between socioeconomic and health disparities. Medline, Cinahl, Embase, PsychInfo, Eric, Web of Science, Google, Google Scholar, Mednar, Doaj and Worldcat were used to retrieve studies that specifically addressed socioeconomic and socio-demographic factors related to low HL levels, as well as the mediating role of HL in the relationship between SES and disparities in health outcomes. Selected studies were assessed for methodological quality. Sixteen published studies were retained for inclusion and content analyzed using the constant comparison method. The review indicates that disadvantaged social and socioeconomic conditions contribute to low HL levels, whereby low SES, and particularly educational attainment, is the most important determinant of HL, and that HL mediates the relationship between SES and health status, quality of life, specific health-related outcomes, health behaviors and use of preventive services. HL can be considered as a modifiable risk factor of socioeconomic disparities in health. Enhancing the level of HL in the population or making health services more accessible to people with low HL may be a means to reach a greater equity in health.
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            Recent advances in the management of lung cancer

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              Socioeconomic Status and Access to Healthcare: Interrelated Drivers for Healthy Aging

              The rapid growth of the global aging population has raised attention to the health and healthcare needs of older adults. The purpose of this mini-review is to: (1) elucidate the complex factors affecting the relationship between chronological age, socio-economic status (SES), access to care, and healthy aging using a SES-focused framework; (2) present examples of interventions from across the globe; and (3) offer recommendations for research-guided action to remediate the trend of older age being associated with lower SES, lack of access to care, and poorer health outcomes. Evidence supports a relationship between SES and healthcare access as well as healthcare access and health outcomes for older adults. Because financial resources are proportional to health status, efforts are needed to support older adults and the burdened healthcare system with financial resources. This can be most effective with grassroots approaches and interventions to improve SES among older adults and through data-driven policy and systems change.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2024
                8 April 2024
                : 14
                : 4
                : e084689
                Affiliations
                [1 ] departmentDepartment of Oncology , Ringgold_60656Vaasa Central Hospital , Vaasa, Finland
                [2 ] Ringgold_60656Vaasa Central Hospital , Vaasa, Finland
                [3 ] departmentOncology , Ringgold_60654University of Turku Faculty of Medicine , Turku, Finland
                [4 ] departmentDepartment of Diagnostics and Intervention Oncology , Ringgold_8075Umeå University , Umea, Sweden
                [5 ] departmentRespiratory Medicine , Ringgold_7840Tampere University , Tampere, Finland
                Author notes
                [Correspondence to ] Dr Heidi Andersén; heidi.andersen@ 123456tuni.fi
                Author information
                http://orcid.org/0000-0001-5923-5865
                Article
                bmjopen-2024-084689
                10.1136/bmjopen-2024-084689
                11015323
                38589254
                4c64e0f8-35ab-42d4-bcba-1ceade23217a
                © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 25 January 2024
                : 25 March 2024
                Funding
                Funded by: Heidi Andersén;
                Award ID: 100474
                Categories
                Oncology
                1506
                1717
                Original research
                Custom metadata
                unlocked

                Medicine
                health equity,adverse events,protocols & guidelines,oncology,health literacy
                Medicine
                health equity, adverse events, protocols & guidelines, oncology, health literacy

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