Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
Intellectual and developmental disabilities (IDD) and cancer symptom reporting: a matched retrospective cohort study.
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Giblon Rachel, Mahar Alyson, Hallet Julie, Kelly Christine, Coburn Natalie, Shooshtari Shahin, Sutradhar Rinku
Аннотация
PURPOSE: Symptom assessment is key to managing symptom burden following a cancer diagnosis. Adults with intellectual or developmental disabilities (IDD) experience worse outcomes from cancer; disparities may also exist in routine cancer symptom screening. This study investigated whether differences exist in routine cancer symptom assessment between people with and without IDD in a public healthcare system.
METHODS: We conducted a matched retrospective cohort study of adults in Ontario, Canada, with and without IDD who received a cancer diagnosis between 2010 and 2019 using administrative health data. Among people with cancer, those with IDD were hard-matched 1:5 to those without IDD on age at diagnosis, sex, diagnosis year, cancer type and regional cancer centre registration. Cumulative incidence of first symptom assessment accounting for death as a competing risk was estimated. Sub-distribution and cause-specific hazards models were used. Effect modification by age, sex and cancer stage was investigated.
RESULTS: A total of 1545 people with IDD were matched to 7725 people without IDD. Individuals with IDD experienced a lower incidence of cancer symptom assessment (1-year probability: 0.62 vs. 0.77) and lower rates of symptom assessment (sub-distribution HR: 0.63, 95% CI: 0.59, 0.67; cause-specific HR: 0.69, 95% CI: 0.65, 0.73) relative to those without IDD. Results were most pronounced for those in advanced cancer stages.
CONCLUSION: Among persons with cancer, the incidence of symptom assessment is lower for individuals with IDD compared to those without; the magnitude of these findings varied across cancer stages. These findings may indicate systemic barriers to equitable healthcare access for people with cancer and IDD.
METHODS: We conducted a matched retrospective cohort study of adults in Ontario, Canada, with and without IDD who received a cancer diagnosis between 2010 and 2019 using administrative health data. Among people with cancer, those with IDD were hard-matched 1:5 to those without IDD on age at diagnosis, sex, diagnosis year, cancer type and regional cancer centre registration. Cumulative incidence of first symptom assessment accounting for death as a competing risk was estimated. Sub-distribution and cause-specific hazards models were used. Effect modification by age, sex and cancer stage was investigated.
RESULTS: A total of 1545 people with IDD were matched to 7725 people without IDD. Individuals with IDD experienced a lower incidence of cancer symptom assessment (1-year probability: 0.62 vs. 0.77) and lower rates of symptom assessment (sub-distribution HR: 0.63, 95% CI: 0.59, 0.67; cause-specific HR: 0.69, 95% CI: 0.65, 0.73) relative to those without IDD. Results were most pronounced for those in advanced cancer stages.
CONCLUSION: Among persons with cancer, the incidence of symptom assessment is lower for individuals with IDD compared to those without; the magnitude of these findings varied across cancer stages. These findings may indicate systemic barriers to equitable healthcare access for people with cancer and IDD.