People who are marginalized or lack access to a primary care provider are at greater risk of early death from newly diagnosed metastatic breast cancer, according to research in CMAJ (Canadian Medical Association Journal).
The Ontario study found nearly one-quarter of people with stage four metastasized breast cancer that has already spread to other sites in the body when it is found - also known as de novo breast cancer - died within six months of diagnosis.
The study was led by researchers at Western University's Schulich School of Medicine & Dentistry, including Dr. Priya Thomas, a plastic surgery resident and Dr. Phillip Blanchette, professor of oncology and medical oncologist at London Health Sciences Centre, along with their collaborators.
"The relationship between early death from breast cancer and a person's sociodemographic factors hasn't been previously examined in Canada," Thomas said. "It's important to investigate the role of factors like income and housing because patients with existing barriers can be especially vulnerable to disparities in health equity, including access to care."
One in nine women will receive a diagnosis of breast cancer within their lifetime and 3,000 patients are diagnosed annually in Ontario. The type of breast cancer the team studied, de novo metastatic breast cancer, makes up three to six per cent of all breast cancer diagnoses.
Survival rates are steadily increasing for metastatic breast cancer, with numerous new treatments available, but there are long wait times for specialty care and disparities in accessing it.
The research team looked at ICES data from 4,004 patients with de novo metastatic breast cancer who were treated in Ontario between 2010 and 2019. They used the Ontario Marginalization Index tool to understand if other factors influence the risk of death, including housing stability, income, age and employment status.
An increased risk of early death (within six of their metastatic breast cancer diagnosis) was associated with age, concurrent health illnesses and marginalization and observed in 23 per cent of the study population.
For people who were treated for breast cancer, rural residence was also associated with early death, possibly because of challenges travelling for tests or treatment, which is commonly coordinated in larger urban centres.
People linked to a family physician had 26 per cent lower odds of early death. Of those, 60 per cent had received a mammogram within two years of diagnosis, compared to 42 per cent of people without a primary care provider.
The study underscores the critical role of primary care in Canada.
"Access to a primary care provider is a growing challenge in Canada, with one in four Canadians lacking regular access to primary care," said Thomas. "Without the ability to be seen by a family doctor, people with advanced breast cancer may face delays in getting diagnosed and starting treatment."
That's essential to help Canadians - and a strained health-care system, the researchers said.
"Our study highlights the need for better primary care access. It is pivotal in preventing and diagnosing cancer, as well as managing symptoms and treatment side effects, mental health concerns and palliative care," Blanchette said.
"The demand for cancer care is rising exponentially, and specialist oncologists are unlikely to be able to meet these care needs alone."
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