Deprivation and access to treatment for colorectal cancer in southeast Scotland 2003–2009

Hugh M. Paterson · B. James Mander · Hamish A. Phillips · Sarah H. Wild

17 citations0/0 files storedColorectal Disease

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Health disparities and outcomes Colorectal Cancer Surgical Treatments Colorectal Cancer Screening and Detection

Abstract

AIM: Socioeconomic deprivation is associated with poorer survival from colorectal cancer. We examined the association of deprivation with access to treatment, disease stage at presentation and choice of treatment for colorectal cancer within a regional managed clinical network. METHOD: We performed a retrospective analysis of data from the Southeast Scotland Cancer Network colorectal database for the period 2003-2009. Socioeconomic status was assigned into five categories using postcode of residence and the Scottish Index of Multiple Deprivation score. Outcomes were access to consultation and treatment, stage of disease at presentation and treatment factors (type of surgery, adjuvant radiotherapy and adjuvant chemotherapy). RESULTS: Of 4960 colorectal cancer patients, 4016 patients (81%) underwent operative treatment. Deprivation was not associated with age, gender, tumour site, disease stage, delay in treatment pathway or permanent stoma rate. Primary tumour resection (P = 0.006) and chemotherapy treatment (P = 0.018) were higher in the least deprived compared with the most deprived quintile. Socioeconomic status was associated with both primary tumour resection [odds ratio for the most affluent compared with the most deprived quintiles (OR) 1.34, 95% confidence interval (CI) 1.05-1.72, P = 0.018] and chemotherapy treatment (OR 1.44, 95% CI 1.15-1.80, P = 0.001). However, when health board of treatment was added to the model, only chemotherapy treatment was independently associated with deprivation (OR 1.46, 95% CI 1.16-1.83, P = 0.001). CONCLUSION: Deprivation is not associated with treatment delay or more advanced disease stage at presentation. An apparent association between deprivation and treatment choice may be explained by other differences between patients treated in different areas.

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2010Socio-economic disparities in access to treatment and their impact on colorectal cancer survival 2002Impact of socioeconomic deprivation on outcome after surgery for colorectal cancer 2010Social variations in access to hospital care for patients with colorectal, breast, and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics 2002Impact of deprivation and rural residence on treatment of colorectal and lung cancer 2008Access to care, socioeconomic deprivation and colon cancer survival 2005Socioeconomic gradients in the prevalence of cardiovascular disease in Scotland: the roles of composition and context 2008No socioeconomic inequalities in colorectal cancer survival within a randomised clinical trial 2004Deprivation, comorbidity and survival in a cohort of patients with colorectal cancer

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