Not just excellent drugs and structures.
The level of education also has an impact on the treatment path of a cancer patient.
In Italy, around a quarter of cancer deaths are in fact attributable to low levels of education.
Almost 30 thousand (29,727) cancer deaths in 2019 in our country, in the population between 30 and 84 years old, are related to poor education (22,271 deaths in men and 7456 in women), as highlighted in a study published in the Journal of Public Health.
The socio-economic determinants capable of influencing mortality from cancer therefore include the level of the cycle of studies, which often also influences the subsequent earning capacity.
Shining a spotlight on this aspect - in view of World Cancer Day which is celebrated on 4 February - is the national conference 'Close the Care Gap', promoted by the Istituto Superiore di Sanità, Aiom (Italian Association of Medical Oncology). and Aiom Foundation, with the intervention of Rocco Bellantone, President of the ISS.
It should also be considered that a cancer diagnosis can cause additional financial difficulties for patients.
It is the so-called financial toxicity, which affects 26% of people with cancer and is linked to various factors, including the costs that patients have to bear to travel to places of treatment.
Suffice it to say that, in 2022, almost 28 thousand cancer patients changed Regions for treatment, in particular for surgery.
In 2023, in Italy, an estimated 395,000 new cancer diagnoses were made.
"People with a high level of education - says Saverio Cinieri, president of the Aiom Foundation - have more tools to understand the importance of prevention. Hence the higher cancer mortality rate in less educated citizens. It is necessary to strengthen actions aimed at spreading a healthy and active lifestyle at all ages".
Sedentary lifestyle, for example, "draws a social gradient to the disadvantage of people with greater economic problems or low education, among whom it reaches 43% compared to 25% of citizens who do not experience this condition. And obesity is equal to 17 % among individuals with social disadvantage compared to 9% of those who do not report it".
And in 2022, concludes Cinieri, "the prevalence of smoking among people with many economic difficulties was equal to 37%, while among those without financial problems the share of smokers fell from 27% to 22% between 2008 and 2022 ".
"Financial toxicity also affects patients of universal healthcare systems like ours - explains Francesco Perrone, President of Aiom -. We have already demonstrated, in a study on 3,760 citizens with cancer in Italy, that at the time of diagnosis 26% face problems of an economic nature and 22.5% worsen this uncomfortable condition during treatment. Furthermore, the latter patients have a 20% higher risk of death in the following months and years".
In light of these data, said Perrone, "we asked ourselves what the causes were. Hence the Proffit questionnaire (Patient Reported Outcome for Fighting Financial Toxicity), composed of 16 statements on which patients are asked to express or not express their consent".
It emerged that some expenses, he explains, "regard the use of private healthcare. Others involve additional drugs or supplements, or useful additional treatments, for example physiotherapy which is difficult to practice in the public system. Then there is the logistics: the distance between the home and the place where care is received and the transport costs to be borne. In short, a series of determinants, on which we want to raise awareness among political decision-makers and administrators, who can implement policies of change".
Proffit is available to the scientific community and has been validated in English for its application also in the United Kingdom, because, he concludes, "it is useful in all contexts with a public health system".
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