Socioeconomic Disparities in Quality of Life After Early-Stage Breast Cancer Diagnosis

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As reported in the Journal of Clinical Oncology by Sandoval et al, after a diagnosis of early-stage breast cancer, the magnitude of preexisting socioeconomic status–related inequalities in quality of life increased over time for patients in the multicentric French CANTO cohort. 

“When we talk about precision oncology, we need to consider the whole person, including their social dimension,” the investigators commented in a Université de Genève press release summarizing the findings. “Our data concerns women treated in France, a country with equal health-care access. In countries without a universal health-care system, these inequalities are likely to be even more pronounced.”

Study Details

The CANTO study cohort included 11,400 patients with stage I, II, or III disease from 26 French cancer centers. Of this population, 5,915 (51.9%) patients were enrolled between 2012 and 2018 and had available data for 27 of the 30 questions on the European Organisation for Research and Treatment of Cancer Quality-of-Life Core 30 (EORTC QLQ-C30) assessment at diagnosis and at 2-year follow-up, enabling summary score calculation. A total of 15% of these patients were missing 1-year follow-up data.

The investigators considered three indictors of socioeconomic status separately: self-reported financial difficulties, household income, and education level. Covariates included age at diagnosis, menopausal status, Charlson Comorbidity Index, disease stage, participation in a clinical trial, endocrine therapy, use and type of chemotherapy, surgery type, use of radiotherapy, and type of lymph node management.


  • Preexisting socioeconomic quality-of-life inequalities were found to increase at both 1 and 2 years after the diagnosis of early-stage breast cancer and seemed to be independent of patient age, disease stage, and treatment.
  • The findings point to the importance of considering social determinants of health during comprehensive cancer care planning.

Socioeconomic Status–Related Inequalities in Quality of Life

At baseline, social inequalities in the EORTC QLQ-C30 summary score were found to be statistically significant for all indicators (slope index of inequality, financial difficulties = –7.6; income = –4.0; education = –1.9). These inequalities appeared to significantly increase at both 1 (–11.1, –6.5, and –5.0, respectively) and 2 (–10.7, –6.7, and –4.7) years after diagnosis, irrespective of prediagnosis health conditions, tumor characteristics, and treatment received. Similar results were reported in the subgroups defined by menopausal status and type of adjuvant systemic treatment.

The investigators concluded: “The [social inequalities in quality of life] increased after early-stage breast cancer diagnosis, and this increase was not related to differential disease stages or treatments between groups with different socioeconomic statuses.” 

Gwenn Menvielle, PhD, of Gustave Roussy Institute, University Paris Saclay, Villejuif, France, is the corresponding author of the Journal of Clinical Oncology article.

Disclosure: The study was funded by the French Government under the “Investment for the Future” program, which is managed by the National Research Agency, and Fondation ARC. For full disclosures of the study authors, visit

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