Room
2ème étage - F205
Theme
Patient experiences with cancer
Chair
Vladimir Jolidon
Title
Patient experiences with cancer care in Switzerland: results of the SCAPE-CH survey
Name
Chantal Arditi
Affiliation
Unisanté
Abstract
Introduction:
The Swiss Cancer Patient Experiences (SCAPE) surveys aim to establish the standardized and regular collection of patient-reported experiences of cancer care (PREMs) in Switzerland. These measures are essential for assessing the quality of health services and determining whether health services are meeting patients’ needs (responsive care). They are particularly important to evaluate care for people with chronical diseases such as cancer, as their care pathway is often long-term and complex, involving a multitude of health professionals.
The third iteration of the SCAPE survey (SCAPE-CH) invited patients who received cancer care between January and June 2023 from 21 cancer centers across all language regions in Switzerland to complete a questionnaire (either on paper or online). The questionnaire included questions about experiences of care before the diagnosis, at diagnosis (e.g., diagnostic testing, communication about the cancer diagnosis, decision-making about the cancer treatment), during inpatient and outpatient care at the hospital (including experiences related to cancer surgery, radiotherapy and chemotherapy), as well as experiences with home care and support and survivorship care. It also included questions on socio-demographic and clinical characteristics.
Results:
Of the nearly 17,000 patients invited to take part, over 7,300 have completed the questionnaire so far, representing a participation rate of around 45%. We will provide further insights on the main results of the SCAPE-CH survey.
Conclusion:
The SCAPE surveys have demonstrated the feasibility of collecting data on patient-reported experiences of care (PREMs) within the Swiss oncology sector, in the three main Swiss languages and English. This initiative has laid the foundations for evaluating the current responsiveness of cancer care, delineating the differences across regions and cancer diagnoses, and establishing a framework for monitoring the quality of care according to patients' perspectives.
Title
Impact of the Swiss COVID-19 lockdown on cancer versus non-cancer inpatient stays.
Name
Loïc Brunner
Affiliation
Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne (UNIL), Lausanne, Switzerland
Abstract
BACKGROUND:To reduce the risk of the healthcare system collapsing during the Covid-19 pandemic, the Swiss government and hospital managers had to cancel/postpone some elective procedures. This may have adversely affected the provision of hospital care to vulnerable patients. Reductions in the number of cancer patients undergoing surgery have been described in other countries. However, evidence on the impact of the pandemic and government policies on hospital cancer care in Switzerland is lacking.
OBJECTIVE:
To assess the impact of the pandemic and related policies on the hospital care of adult cancer patients’ hospital admissions, emergency visits and hospital deaths using adult non-cancer patients as a reference group.
METHOD:
We used nationwide hospital discharge data covering January 2017 to December 2021, which we divided into three periods: pre-COVID (38 months prior to lockdown), lockdown (March-May 2020), and post-lockdown (10 months following lockdown). We performed a comparative interrupted time series analysis to examine relative changes in monthly hospital admissions, emergency visits, and deaths between cancer and non-cancer patients across these time periods.
RESULTS:
A total of 6,268,465 hospital admissions were recorded during the study period, with a monthly average of 95,007 admissions for non-cancer patients and 11,319 for cancer patients in the pre-COVID period. During the lockdown period, hospital admissions (resp. emergency visits) decreased significantly, but the decrease was much smaller for cancer patients (10.5%) (resp. 3.5%) than for non-cancer patients (24.4%) (resp. 33.4%).
While there was a significant increase in the number of stays leading to death for non-cancer patients both during (28.9%) and after the lockdown 36.5% compared to the pre-COVID period, there was a decrease in volume for the cancer patient group of -1% during the lockdown and -0.4% after the lockdown. This may be explained by a lower average prevalence of COVID among cancer patients (during lockdown 1.5%, post-lockdown: 3.6%) compared to non-cancer ones (during lockdown: 3.1%, post-lockdown: 5.6%).
DISCUSSION:
The Swiss healthcare system managed to moderate the negative impacts of COVID-19 and related policies on cancer patients, unlike many countries. These results also suggest that protective measures in place and personal health choices may have significantly limited COVID incidence among the cancer patients.
Title
Inequalities in Breast and Cervical Cancer Screening Participation: A Narrative Review of Participation Outcomes
Name
Vladimir Jolidon
Affiliation
Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne (UNIL), Lausanne, Switzerland
Abstract
Cancer screening is a public health strategy for early detection and possibly reducing cancer-specific mortality. Understanding socioeconomic inequalities in cancer screening participation is crucial, yet research shows varying results, depending on which screening participation outcomes are considered (e.g., up-to-date, ever screening) and the potential impact of screening programs on inequalities in screening participation. A narrative review of socioeconomic inequalities studies on the different participation outcomes of cancer screening was conducted. The scope of the review was limited to studies examining socioeconomic inequalities on cervical and breast cancer screening participation carried out in Switzerland and Belgium. In the studies selected for review (n=17), different screening participation outcomes were examined, including up-to-date, ever, never, over, and under-screening. For both cervical and breast cancer screening, the literature revealed socioeconomic inequalities in all screening participation outcomes that persisted over time, except for the over-screening outcome. One study found contrasting patterns in never and under cervical cancer screening, with socioeconomic and demographic inequalities being more pronounced among never-screeners, indicating more structural and enduring inequalities. Organized mammography programs had a limited effect on altering socioeconomic inequalities in up-to-date screening participation, except for occupational inequalities, as screening uptake increased for not employed women more than for full-time workers. On the other hand, mammography programs contributed to decreasing income-based inequalities in ever-screening. In conclusion, the narrative review shows that different outcomes of screening participation, such as ever, up-to-date, and under-screening, reveal various forms of socioeconomic inequalities. It is essential to consider these distinct outcomes and the role of screening programs in shaping screening participation. These findings emphasize the need for comprehensive public health strategies that account for diverse methods of assessing inequalities, aiming to effectively address and tackle inequalities in cancer screening.Title
Socioeconomic Disparities in Cancer Incidence among People Living with HIV in South Africa
Name
Ayeni Peace
Affiliation
Swiss Tropical and Public Health Institute
Abstract
Introduction:Global estimates show socioeconomic disparities in cancer morbidity and mortality, particularly affecting individuals in low socioeconomic position (SEP) areas. These estimates may underrate true disparities, as cancers in low SEP areas might be underdiagnosed and underreported. We assessed the impact of municipal SEP on cancer incidence among people living with HIV (PLHIV) in South Africa.
Methodology:
We included PLHIV aged 15+ years from the South African Cancer Match (SAM) study (doi:10.1136/bmjopen-2021-053460), 2004-2014. The SAM cohort was constructed with routine care HIV-related laboratory records linked probabilistically to the National Cancer Registry. We used the South African Index of Multiple Deprivation to assign SEP to the municipality of the HIV facility providing care. We restricted our analysis to the nine most frequent cancers in our cohort: Cervical, Kaposi Sarcoma, Breast, non-Hodgkin Lymphoma, Eye, SCC of skin, Lung, Prostate, Colorectal. We used multivariable Cox proportional hazard ratios (HR) with 95% confidence intervals (CI) to estimate the association of municipal SEP (low, lower-middle, upper-middle, high) and cancer incidence. We ran separate analyses for cancer symptom signaling (high, moderate, low; doi:10.1016/j.neo.2017.11.005), cancer etiology (infection related versus non-) and preventable versus treatable cancers.
Result:
We included 4.6 million PLHIV. Of these, 52% received HIV care in municipalities of high SEP, 17% in upper-middle, 16% in lower-middle and 15% in municipalities of low SEP. Adjusting for age, urban/rural settlement, calendar period, sex and CD4 cell count where needed, the risk for diagnosing cancer was higher in high compared to low SEP municipalities: HR 1.62 CI 1.51-1.72. The effect was similar in cancers with strong (HR 1.69; CI 1.53-1.86), moderate (HR 1.50; CI 1.36-1.65) and low symptom signaling (HR 2.14; CI 1.64-2.78); infection related (HR 1.60; CI 1.48-1.72) and non-infection related cancers (HR 1.69; CI 1.49-1.91); preventable (HR 1.63, CI 1.52-1.76) and treatable cancers (HR 1.56, CI 1.35-1.80). These findings may be explained by higher accessibility to screening and diagnostic services in high compared to low SEP areas.
Conclusion:
Our results point to a potential imbalance in the allocation of cancer screening and diagnostic services due to the centralization of cancer services in South Africa, urging more efforts to ensure equitable access to cancer care for PLHIV across the country.
Title
Awareness about hearing loss after ototoxic treatments in adult childhood cancer survivors
Name
Philippa Jörger
Affiliation
University of Bern
Abstract
Background:
One in four childhood cancer survivors (CCS) treated with ototoxic therapy, including platinum chemotherapy, cranial radiation ≥30 Gray, and surgery involving the auditory system, develops hearing problems. The International Guideline Harmonization Group (IGHG) recommends that survivors exposed to ototoxic treatments should be aware of the risk of hearing loss to facilitate monitoring and early treatment.
This study aimed to assess awareness about hearing loss and associated socio-demographic and clinical factors among adult CCS at high-risk for hearing loss in Switzerland.
Methods:
We examined data from the HEAR-study, a research project focused on hearing loss in CCS. We invited adult CCS diagnosed with cancer before age 20 since 1976, ≥2 years after diagnosis, at risk for hearing loss per IGHG guidelines, and registered in the Swiss Childhood Cancer Registry (ChCR). Participants completed a questionnaire about their hearing, and information received on hearing loss and recommended screenings. The ChCR provided participants’ clinical data. We used logistic regression to investigate factors associated with awareness.
Results:
In total, 105 of 424 invited CCS completed the questionnaire (25% response rate). Median study age was 32 years (IQR 24-37). Fifty-nine (57%) participants stated they did not receive or do not remember receiving any information or advice regarding hearing loss or recommended screening. More recent year of diagnosis (OR 1.2, 95% CI 1.1-1.3), self-reported hearing loss (14.3, 3.3-61.1), and platinum chemotherapy (14.5, 2.4-86.5), compared to cranial radiation ≥30 Gray were associated with having received information/advice.
Conclusions and outlook:
There is a lack of awareness in CCS exposed to ototoxic treatments about the risk of later hearing loss. Practitioners should inform high-risk CCS about the potential late effects of ototoxic treatments on their hearing, especially those diagnosed with cancer a longer time ago and those exposed to cranial radiation.